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Poisons - Gout

lead, acid, uric, blood, substances, lead-poisoning, gouty, symptoms and disease

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The interesting observations of Haig have made more prominent than formerly certain facts regarding the influence of a considerable number of chemical agents in the production of arthritic symptoms through their hindrance of the excretion of uric acid. Chief among these substances are " acids, iron, lead, lithia, manganese, calcium chloride, acid phosphate of sodium, some sulphates, chlorides, eta., and many substances which directly or indirectly raise the acidity or otherwise form insoluble compounds with uric acid, as opium, cocaine, mercury, the iodides, antipyrin, ammonium, the nitrites, some hyposulphites, strychnine, and many other less well-known substances" (" Uric Acid in Causation of Disease," second edition, pp. 23, 24). These agents have the common property of repelling uric acid from its solution in the blood, and driving it into the tissues where it is retained and is held in a state of inertia. In this way they give temporary relief from the symptoms that are excited by the circula tion of urates dissolved in the blood. But this relief is only provi sional; after a time the accumulation about the joints becomes suffi cient to excite local disorder; or an increase of the alkalinity of the blood causes it to take up an excess of urates which produce general pain and distress as they are transported through the body on their Nay to the kidneys. Probably the uric-acid compounds are not the only offending substances, but also other nitrogenous compounds and the products of faulty metabolism in the liver must be taken into ac count. Uric acid may be conveniently employed as a general term including all the forms of peccant matter that originate in the body, and contribute to the development of gout.

Conspicuous among the chemical agents above mentioned is lead. Sir A. Garrod noted the fact that rather more than one-quarter of his gouty patients in the hospital had suffered with symptoms of lead poisoning, usually contracted in the course of their work as house painters. The precision with which this distinguished author deter mined the relationship existing between the two diseases gave occasion for extensive investigation of the subject. It was then discovered that older observers had recorded the same fact—notably Barlow (1822), Parry (1825), and Todd (1843). But these observations had pro duced no abiding impression; and the whole matter remained in the shade until the appearance of Garrod's paper in the Medico-Chirurgi cal Transactions, Vol. XXXVI., 1854. Since then the relation of lead poisoning to gout has been carefully studied by numerous observers. Opinions, however, have been for a long time divided, since it is not everywhere that conditions exist for the coincident development of the two diseases. In Scotland and Germany gout and lead-poisoning are too infrequent to admit of an extended comparison. In France,

where lead-poisoning is sufficiently common, gout is a rare disease. It was in England, before the introduction of the great hygienic im provements that have done so much for the health of the population, that the whole subject could be most profitably studied. The ques tion that was presented for solution raised the inquiry as to the possibility of producing gout by the direct toxic influence of lead. This has been denied by the majority of observers, while a consider able number have confessed their inability to render a decision. A few have thought that it was possible in certain cases to recognize a directly causative influence in the action of lead. It must be admitted that coincidence of lead-poisoning and gout will satisfactorily account for a portion of the cases. When an hereditary predisposition exists, the occurrence of saturnism may indirectly excite gouty phenomena, just as any intercurrent disease may suffice to arouse the latent dia thetic tendencies. The habits of the victims of lead-poisoning are often of a nature that is calculated to create the arthritic diathesis, if it be not already inherited. Thus lead-poisoning has been noted among beer drinkers whose mugs are filled from a leaden pipe and faucet. This has been especially true of those ardent devotees whose thirst has urged them in the morning to imbibe the first tap of ale or beer which had lain all night in contact with the leaden pipe through which it was drawn. Such individuals may easily become both plumbic and gouty. Still, it must be admitted that occasionally the well-marked symptoms of gout are manifested by patients who have led an active and temperate life, who have inherited no predisposition to arthritic diseases, but are sufferers from poisoning with lead. Sir A. Garrod has shown that the urine of the victims of plumbism closely resembles that which is voided by the gouty. In both cases the urine is scanty, and the quantity of urea and of uric acid is below the nor mal standard, while the blood and the tissues contain these nitrogenous substances in considerable amount. This, however, is true in certain stages only of the disease. At other periods the quantity of urea and of mates is normal, or iu excess of the usual amount. These fluctua tions have been noted both in gout and in plumbism. In certain cases, also, chemical analysis of the blood fails to detect the presence of uric acid in that fluid. Here, again, gout and plumbism are alike. The variations in the composition of the urine and of the circulating fluids of the body are exceedingly numerous, and they succeed each other with a rapidity that is surprising to every one who is not famil iar with the results of analysis. These facts seem to indicate great similarity between the action of lead and the cause of gout.

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