The exalted sensitiveness of the tissues in cases of a predisposition to gout is often so great that the slightest injuries may suffice to disturb the balance of health and to induce an acute attack. Sir Dyce Duckworth has collected a number of illustrative examples. Thus an outbreak has been known to follow the bite of a gnat, or the nulling of a tooth, or the scratch of vaccination, or the letting of blood from a vein. Operations upon the eye and other minor surgi cal operations have thus sufficed to excite the manifestations of the disease. In like manner certain natural morbid disturbances may arouse the latent predisposition. Thus a copious discharge of blood from the nose has been followed by gout; but in such cases there is room for the opinion that the hemorrhagic flux was really one of the prodromal symptoms of the articular inflammation. In one instance, at least, I have seen passive hemorrhage from the lungs precede a gouty attack in a patient who never was tuberculous. Charcot has recorded the case of a hemiplegic woman whose paralyzed limbs were attacked with gout, infiltrating the joints with uratic deposits, while the non-paralyzed side remained healthy throughout life.
The similar effect of intercurrent diseases and injuries iu exciting either gout or rheumatism, according to the predisposition of the in dividual, affords another interesting proof of the close relationship that exists between the two diseases. Courty, of Montpellier, has reported a number of cases in which the operation of lithotrity was followed by rheumatism in certain instances, and by well-marked gout with uratic deposits in others. Such facts serve to illustrate the modifying influence of constitutional conditions under the operation of identical excitants.
It can hardily be affirmed that gout exercises any particularly un favorable influence upon the healing process in open wounds, or in fractures of the bones. Many gouty subjects ordinarily enjoy vigor ous health, and their injuries heal as readily as those of non-arthritic patients. But in old and cachectic cases, when the kidneys, the heart, and the liver have been long diseased, it often happens that wounds heal slowly and imperfectly. Before fide days of antiseptic surgery this fact was probably more conspicuous than it is at present. The
oculists were of the opinion that operations upon the eyes of the gouty were less successful than they were in other cases by reason of a greater proclivity to inflammation among arthritic patients. Sir James Paget has emphasized the opinion that in the majority of chronic periosteal inflammations caused by traumatism, and of persis tent cases of iritis, or of urethritis degenerating into permanent gleet, when the disease lingers interminably, like the obstinate forms of senile bronchitis which tend to become perpetual, gout is to be looked for as the determining cause of such intractability in the majority of cases from which the intervention of tuberculosis has been excluded.
An increased sensibility to pain after injury has been often re marked among the gouty. Thus light contusions excite a degree of pain that is out of proportion with the character of the traumatism. Ordinary neuralgias assume an inordinate intensity, and they some times persist for a long time after the apparent recovery of the in jured tissues. I have seen this illustrated by the occurrence of ex cessive pain after the ordinary operations of surgery. In a gouty patient whose arm had been amputated at the junction of the middle and upper thirds of the humerus, there were recurring attacks of pain in the neck and shoulder, accompanied by spasmodic contrac tions of the pectoral muscles, which always yielded to the eliminative treatment with sodium salicylate and colchicum following a mercu rial cathartic, and non-nitrogenous diet. Severe attacks of trifacial neuralgia occurring in plethoric subjects who were arthritically disposed I have known to yield under similar management. It is probable that in all such cases the local -lesions are comparatively insignificant, but the irritability of the affected nervous tissue is ex aggerated by the peculiar form of malnutrition to which it had been long subjected before the experience of traumatism revealed the heightened susceptibility of the sensory organs. In this way also may be explained the horrible intensity of the pain that characterizes gouty inflammation of the joints—so far exceeding the pain that is experienced in ordinary forms of arthritis.