Note 40 — Chapter XX · CLINICAL DIAGNOSIS (continued)

Max Strunsky, of New York, discussing the frequency with which by the older physicians gouty forms of arthritis were confused with gonorrhœal, syphilitic, and other undifferentiated forms of infective arthritis, makes the following observation: “Also flatfeet must have added herds of cases, for this pathological entity was as yet unknown. The rich man in pursuit of his pleasure and the poor man from prolonged standing at his labour strained their arches then as they do now, and women by their ultra-fashionable shoes, which fashion decreed upon them in certain periods of history, produced painful feet which were undoubtedly mistaken for gout. That patients with local foot trouble were treated for gout the writer can speak from experience. A typical case is of a woman who came to his office two years ago. She had broken-down anterior arches. Hallux valgus, hammer-toes, and bunions were present, and the heels were small and undeveloped. Her feet were one mass of pain, and they looked infantile, reminding one of a Chinese woman. All her adult life she wore high-heeled, narrow, pointed, tight shoes. She said that for twenty years she had been treated for gout.”