When examination of the viscera is made after the death of the patient, the parallel between the effects of gout and of lead is still remarkable. Both produce identical changes in the kidneys and arteries. It is impossible to distinguish between the contracted kid neys of gout and those of lead-poisoning. In both are apparent the same chronic inflammation of the interstitial connective tissue, and the same progressive atrophy of the parenchyma of the organ. Hence the remarkable similarity in the composition of the urine in both classes. In a memoir on this subject Lancereaux (Archives Generales de Medecine, Dec., 1881) states that in twenty-four fatal cases of plumbism gouty arthritis was recognized in seven, five of which were verified at the autopsy. In these cases the relationship between the arthritic infiltrations and lead-poisoning seemed quite conclusive.
But Garrod and, more recently, Haig have subjected the question to the test of actual experiment. Giving pills of lead acetate to their patients, they witnessed a diminution of the urinary orates below the quantity that was habitually discharged before the experiment. This result corresponded exactly with their observations in cases of ordi nary gout —retention of uric acid leading to the production of uricacid temia and the symptoms of arthritic dyscrasia. In the vast majority of cases lead-poisoning is not followed by the articular symptoms of gout; but sometimes it does seem to produce a sufficient predisposi tion, so that slight occasional or accidental causes are found ade quate to excite an acute attack, just as such causes operate in ordinary examples of the arthritic diathesis. It is through the agency of lead in modifying the production of nitrogenous waste, and retarding its excretion, that in certain sensitive subjects the establishment of what is equivalent to the diathesis is effected. In this sense lead
may be said to originate gout. The general course of the disease when this excited is identical with that of the typical articular in flammation. It follows the same law of seasonal periodicity ; it affects the great toe by preference, whence it extends slowly to the other joints; and it finally degenerates into the chronic, subacute form that is characteristic of gout in old age. Certain points of difference, how ever, between saturnine gout and the ordinary variety may be noted. It never breaks out in an individual who is in the enjoyment of good health; it attacks those who have been previously suffering with lead-poisoning, usually in the form of colic, anemia, and lead palsy. Its onset is rarely ushered in by any other premonitory symptoms, but when once established it occupies a number of joints, very much like rheumatic polyarthritis. The urine, also, which in ordinary gout seldom contains albumin, almost always contains at least a trace in the saturnine variety of the disease. This profound disorder of the kidneys is one of the most characteristic facts in these cases. Instead. of continuing for many years to enjoy reasonably good health dur ing the intervals between the attacks, the patient soon degenerates into a condition of chronic cachexia, with articular lesions and renal disorders that only appear at a very late period in ordinary gout. Death usually results from ummic accidents, such as suppression of the urine, dropsy, convulsions, and coma.