HEPATIC CHANGES - GOUT The effect of gout upon the liver is unquestionable, but the nature of the connection is not placed beyond dispute. Murchison and his followers have gone so far as to place the original cause of gout in the liver, while others, on the contrary, seem disposed to exculpate that organ from everything but a slight tendency to hyperemia and disordered function during the paroxysms of the disease. Between these extremes lies the truth. It may be safely asserted that the liver of an individual who has either inherited or acquired the arthritic diathesis is never perfectly healthy. The important part that is taken by the organ in the elaboration of urea and its congener, uric acid, renders it certain that the conditions which exaggerate or derange the processes by which nitrogenous refuse is evacuated from the body cannot fail to implicate the liver as well as the kidneys. This will be more fully discussed in the section on the pathology of gout.
A tendency to hyperemia of the liver accompanies acute attacks of gout. The organ is distinctly enlarged and projects below the short ribs. It is often. quite sensitive to pressure on such occasions, but during the interval between attacks it loses in great measure its sensitiveness, and returns to its normal volume. In fatal cases of acute uncomplicated gout, the liver presents nothing remarkable, nor does it contain orates, even though the joints may be loaded with them.
But in many instances during life there is abundant evidence of chronic inflammation or of cirrhosis of the liver. The liver of a gouty person is not less liable to ordinary hepatic diseases than that of another individual. The mode of life and the habits of the patient have been usually of a character to induce chronic or even acute hepatic disease. Consequently, it is to be expected that upon the
autopsy-table the liver will frequently exhibit evidences of disease that are due to. intemperance in eating and drinking rather than directly to the action of gout. As a matter of fact the gout and the diseased condition of the liver are both of them results of the dietetic and hygienic errors of the patient himself or of his ancestors. They own a common cause, and they may exaggerate each other.
The strong tendency to catarrhal inflammation of the mucous sur faces of the body exhibits itself in the biliary canals as it does in the respiratory passages. In many cases jaundice from catarrhal ob struction is a pronounced feature. This may exist through the ex tension of inflammation from the duodenal surfaces, or it may be the consequence of biliary lithiasis, condition that frequently occurs among arthritic subjects.
As a result of the hepatic disorders that afflict the gouty, intes tinal dyspepsia is of frequent occurrence. Slight errors in diet, ex posure to cold, and unusual fatigue very commonly excite in the over-sensitive organism the phenomena of hepatic indigestion. There is loss of appetite, a bad taste in the mouth, a yellow tongue, and a feeling of uneasiness that begins about an hour after eating, and is accompanied by intestinal flatulence, rumbling, and discomfort. Usually these symptoms persist until relieved by a spontaneous diarrhoea of short duration, or by the action of a cathartic, or by voluntary fasting followed by a change of diet on the part of the patient.