THE NERVOUS SYSTEM - GOUT The influence of gout upon the nervous system is beyond ques tion, yet there is no department of pathology that presents a greater number of difficult problems than that dealing with the nervous phe nomena associated with gout. So many and so various are the mor bid changes that affect the principal organs of a gouty patient that it is often a matter of extreme delicacy to decide what is due to masked or retrocedent gout, and what must be ascribed to a diseased kidney or other disabled apparatus. Thus, it being not unusual for gouty sub jects to suffer with chronic interstitial nephritis, the intercurrence of cerebral symptoms calls for careful discussion of the possibilities of unrmia as the cause of the nervous disturbance. It is well known that interstitial nephritis may progress insidiously without notable symp toms until a sudden and violent explosion in the midst of ordinary apparent health unmasks the fact of disease. If now the patient has been subject to the prodromes of gout, or to an occasional articular crisis, it is very natural to ascribe to that disease, in either its latent or retrocedent varieties, the apoplectiform seizure, the epileptiform convulsion, the violent headache, the delirium, or the coma by which he is prostrated. But examination of the urine, indicating the pres ence of casts and albumin, or a post-mortem section of the body, will usually refer such accidents to their source in a ruined kidney.
Disease of the cerebral arteries is a frequent cause of death among gouty subjects. Here, again the phenomena of hemorrhage and compression of the brain might be mistaken for retrocedent gout, or for ummic coma. At the bedside, without full knowledge of the history and antecedents of the patient, the problem sometimes as sumes great difficulty.
In like manner, the concurrence of an attack of delirium tremens with an imperfectly developed crisis of gout might easily lead to the belief that the brain was suffering from the incidence of retrocedent articular disease.
But, in spite of the fact that very many of the cerebral accidents that occur among the gouty can be referred to causes other than gout, it still remains true that violent disturbances of the brain may be ex cited by sudden suppression of the articular manifestations during an ordinary attack. Cases have been recorded in which the sufferer
has sought to ease his pain by plunging the feet into cold water, with the result that disappearance of local pain and swelling in the foot has been promptly followed by violent headache, disturbances of vision, vertigo, and somnolence, or even by still more alarming symp toms of apoplexy, hemiplegia, and coma. In such cases active re vulsive treatment, with leeches, mustard applications, and purga tives, has sometimes been rewarded with the renewal of articular swelling and pain, and the complete disappearance of all cerebral phenomena. Similar evidences of retrocession have been sometimes witnessed as a consequence of great fatigue and violent emotion; but it must not be forgotten that under such conditions old people oc casionally become temporarily delirious and prostrate without the existence of arthritic manifestations.
An interesting fact in connection with the cerebral disorders of the gouty is the frequent occurrence of aphasia. This sometimes occurs merely as a consequence of failing nutrition of the brain, but in cer tain cases it clearly alternates with the articular phenomena. Some times it is accompanied by convulsive spasms of the facial muscles and upper extremities, which are generally unilateral in their mani festation. Genuine epilepsy is almost always aggravated by a gouty habit of body, but sometimes it completely disappears after the de velopment of acute articular gout.
These violent disturbances of the brain are, however, the exception rather than the rule. In the majority of instances, only the milder varieties of nervous disorder are encountered. Headache, usually in the form of hemicrania, is a common experience among the gouty. Sometimes it alternates with the joint affections; sometimes it per sists for weeks and months until dissipated by an articular crisis. Vertigo, either with or without headache, is also of frequent occur rence and similar behavior. It is probably dependent in certain cases upon gastric disorder, and in others upon a diseased condition of the cerebral vessels.