THE INFLUENCE OF GOUT UPON THE GENITO - URINARY ORGANS.
The gouty kidney has been already described, but it is impossible to insist too frequently upon the insidious manner in which an inter stitial nephritis may be established under the influence of an exces sive circulation of urates through the kidney. Not infrequently does this occur in cases of latent arthritism where no articular deposit or inflammation has ever happened. The only unusual symptom may be an increase in the urinary excretion, especially when, as during pregnancy, there is. some hypertrophy of the heart. But the op posite condition may also obtain, with an enfeebled heart and scanty urine. Whenever there is complaint of headache that is unusually severe and persistent, or when there is debility and vague bodily dis tress without apparent cause, the condition of the kidneys should be carefully investigated. Under such circumstances the urine will often be found acid, depositing crystals of uric acid, and exhibiting a trace of albumin when treated with heat or nitric acid. So long as. no unusual trial or effort disturbs the bodily functions, all these symptoms pass unnoticed, but any little disorder of digestion, a severe cold, the recurrent menstrual flux, or the occurrence of parturi tion, may arouse symptoms of intoxication that vary in severity from the ordinary forms of headache to convulsions and urmmic incidents of the most fatal character. It is in this insidious manner that many of the accidents of pregnancy and parturition are prepared among females who belong to gouty families, and who, perhaps, exhibit few other indications of an inherited predisposition.
The occurrence of renal congestion bears a certain distinct relation to articular gout. It is characterized by lancinating pain deep in the loins, and is sometimes accompanied by lilematuria and a fugitive trace of albumin in the urine occurring alternately or coincidently with articular disease. These symptoms suggest the existence and passage of renal calculi, but they are often experienced when no dis charge of gravel or calculus 'takes place. But since the discharge of such obstructive masses does not invariably occur at the time of the attack of renal colic, it is not always safe to conclude that every case of pain in the loins accompanied by hcematuria without gravel or cal culi is a case of renal gout. The close relation between gout and gravel that unquestionably exists will be more fully discussed on a subsequent page.
The bladder is often affected during the course of gouty disorder. The symptoms of visceral irritation are more frequent among arthritic patients than among others. Irritation at the neck of the bladder, causing painful desire to urinate and accompanied with, or followed by, burning sensations along the whole length of the urethra, are the signs of this functional disturbance. The urine is of rather high specific gravity, clear, and acid. When the irritation advances to the stage of inflammation the urine is charged with mucus, leucocytes, and urates, forming a considerable milky-looking sediment as the liquid cools. Occasionally, there is hemorrhage from the lining of the bladder which cannot be ascribed to the presence of stone, or to villosities, malignant growths, or the other usual causes of bleeding in this locality. When coincident with neuralgic pains elsewhere that alternate with articular gout, such discharges are usually due to the diathetic disease, and are comparable to the attacks of nose-bleed with which so many youthful arthritics are familiar.
The prostate gland often suffers, and it is more liable to enlarge ment among the gouty than among other elderly people. The fact that such patients are prone to habitual constipation, hemorrhoids, gravel, and stone in the bladder, acids greatly to their chances for prostatic disease.
Gouty urethritis is not uncommon as a symptom that may appear toward the close of an arthritic attack. Among youthful arthritics it is sometimes excited by copulation independently of gonorrhoeal infection; and it may occur spontaneously without sexual intercourse. In all such cases, however, the character of the urethral discharge should be determined by the aid of the microscope before deciding upon the absence of infective cocci. In certain cases thrombosis of the veins in the cavernous structures of the penis takes place, and the fibrous septa and sheath of the organ may become infiltrated at different points, causing chronic fibroid thickening that interferes with the free passage of the blood, and excites cliordee and painful erections that are sometimes very persistent. Enlargement and in duration of the testis may also exist. This gouty variety of orchids is seldom as firm and dense as the other forms of testicular inflam mation.