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The Hereditary Consequences of Gout

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THE HEREDITARY CONSEQUENCES OF GOUT.

Very little accurate knowledge has been acquired regarding the remote consequences of gout that are manifested along the family line of descent. We have seen that the disease itself often reappears in one generation after another ; and its immediately related diseases exhibit the same tendency. But the questions continually arise, — Are there other diseases which are more likely to attack the descend ants of a gouty ancestry than to be manifested among those who are not thus weighted in the struggle for existence? Is there any an tagonism between gout and other maladies? It has been long believed that gout favors the development of car cinoma, and that cancer might be regarded almost as the terminal .

stage of arthritism. But those who suffer from genuine gout seldom die of cancer. If in any way directly connected, it must be either though the affiliated diseases, or by descent. In neither of these direc tions has it been possible to arrive at anything like probability. The two diseases are not apparently related, nor are they antagonistic.

Tuberculosis is rare among the gouty—its parasite cannot easily find lodgment in the tissues of the well-fed arthritic. Possibly the excess of acid in the fluids of the gouty subject is sufficient to antago nize the growth of the bacillus. But among the descendants of gouty parents tubercular disease is not an uncommon event. It is difficult to prove this assertion by statistics, for they have not yet reached this aspect of the subject. But among the great clinical observers there prevails a very decided belief in the fact that tuberculosis often appears among the children and descendants of arthritic parents. Some have estimated that one-quarter of their consumptive patients belong to such families. The explanation of these facts is to be sought in the different conditions of life to which successive genera tions are subjected by the occurrence of disease. Gouty parents exhaust their vitality and their substance in good living and inactive occupations. Their children and their children's children may be thus both physically and financially placed in the decadent class. It is upon such people that the tubercular parasite is liable to fix itself; and in this way the enfeebled offspring of men who have filled a conspicuous place in society, finding themselves unable to continue in the enjoyments and comforts of life that fell to the lot of their progenitors, fall an easy prey to the diseases of degeneration. As prodigality begets poverty, so does gout bring forth tuberculosis.

As some slight compensation for this result it is interesting to learn that the course of tuberculosis in these subjects is less rapid and virulent than in ordinary cases. The disease progresses by fits and starts, in a sort of paroxysmal fashion, with considerable inter vals between the successive attacks. In this way is developed the long-continued form of pulmonary consumption that persists for years without seriously undermining the health and strength of the individual. In these cases the tendency to cicatrizatiou and to cal cification of the pulmonary deposits is highly characteristic. The effort toward natural recovery is continually apparent, and it is aided by the very measures that favor the evolution of the gouty pre disposition. In many instances the appearance of arthritic phenom ena is followed by an at least temporary subsidence of tubercular manifestations.

Functional nervous diseases are of exceedingly common occur rence among the descendants of gouty families—especially among the female members of such families. It is not alone the enfeeble

ment of the constitution consequent upon arthritism that produces such irritable weakness of the nervous system, for the offspring of a tuberculous stock, though debilitated and amemic, rarely ex hibit any special proclivity to the neuroses. The researches of Haig have made clear the irritant effects of uric-acid compounds when present in the circulating fluids. They excite the vasomotor nerves, thus interfering with the regular movement of the blood through the arterioles, and they disturb the sensory organs to a pain ful degree. As a consequence of these disorders, the nutrition of the tissues is retarded, and the nervous apparatus becomes weakened and over-sensitive. Hence the frequent incidence of every variety of neuralgia among the gouty and their descendants. Including rheumatism and the other allied diseases under the arthritic class, we find that a large proportion of the neuroses have their origin in the arthritic predisposition. Grasset has long since called attention to the fact that such neuroses as cannot be referred to syphilitic or malarial causes are usually dependent upon gout or rheumatism. Charcot and his pupils have repeatedly verified this observation. Among elderly people who suffer with chronic nitrogenous poisoning a functional form of amnesic aphasia is very common. It is charac terized by a defect of memory relating chiefly to the names of per sons and things, and is not accompanied by motor paralysis. The patient loses confidence in himself, and often feels oppressed with the feeling that he has forgotten something, or has failed iu the per formance of some duty. All these symptoms yield rapidly to treat ment by elimination with colchicum and sodium salicylate—especially if at the same time a meat diet be excluded.

Mania and melancholia are not infrequent consequences of cerebral degradation among gouty descendants ; but it is difficult to assign its true value to simple arthritism in such cases, for their causes are so frequently complicated with the effects of alcoholism, syphilis, tuber culosis, and poverty, that it is impossible to traverse the tangled web with any satisfactory success. Intense depression of spirits is a common incident in deficient elimination of urates. The connec tion between gout and epilepsy among the descendants is hardly doubtful in many cases. It is also a well-known fact that epilepsy of an incurable type may be greatly benefited by treatment that is calculated to prevent the accumulation of urates in the system. It is highly probable that the advantages attendant upon long courses of potassium iodide associated with the bromides is largely due to the good effect of that salt in cases of chronic arthritism.

Exophthalmic goitre is another of the neurotic affections that seem to be often dependent upon gouty antecedents of an hereditary character. In like manner the milder forms of hysteria, nervousness, spinal irritation, and neurasthenia with its protean manifestations, are frequently encountered among the descendants of gouty families. Such patients are often delicately constituted, and live the most ex emplary lives, so that a prolonged investigation may be necessary before it can be determined that their neurotic constitution and ner vous temperament are the results of ancestral gout. Yet this discov ery will often reward a carefully conducted inquiry.