THE RESPIRATORY ORGANS.
The influence of gout upon the respiratory apparatus is not always clear. The laryngeal cartilages and ligaments are occasionally in vaded by a deposit of orates, but it is very seldom that any of the spasmodic or suffocative phenomena of ordinary laryngitis or of the glottis are experienced in such cases. A certain degree of hoarseness and weakness of articulation may be remarked, however, as a consequence of obstruction of the movement of the cartilages through chronic thickening of the laryngeal membrane, and infiltra tion of the cartilaginous structures themselves.
The respiratory passages are liable to inflammation of obstinately persistent character, and to attacks of asthma that either coincide with attacks of gout, or appear to alternate with them. The tenacity with which bronchitis clings to the gouty has been long recognized. It is characterized by a tedious, dry cough, with comparatively little expectoration, but accompanied by considerable feeling of pulmonary oppression. In many instances this chronic inflammation finally terminates life by invasion of the terminal bronchi, and the develop ment of the phenomena of capillary bronchitis. Sometimes the last stage of the malady is complicated by effusion into the pleural cavity, or by the evolution of acute pulmonary cedema. There has been considerable debate regarding the nature of bronchitis among the gouty. Some have insisted upon a specific character by which it can be differentiated from all other varieties of bronchial catarrh, while others are equally positive in the statement that bronchitis is merely bronchitis whether it occur among the gouty or among those without arthritic predisposition. Aged people are liable to a chronic cough, with trifling expectoration, that persists for many years, so long, in fact, as life may endure. It has been claimed with good reason that this is often the result of exposure and neglect of ordinary precau tions against catarrhal inflammation; still, in a large proportion of cases, careful analysis will bring to light a decided diathetic substra tum for such a cough. Sometimes an acute attack of gout is preceded
or accompanied by an acute bronchial catarrh that soon disappears after the establishment of the articular crisis. Such cases are always open to the objection that they were simply accidental coincidences; but in chronic gout the connection between the primary disease and the respiratory malady is Mr more intimate and conspicuous. It is among the advanced cases in which the kidneys and the liver are be coming sclerosed that the emphysematous lungs are farther embar rassed by the establishment of chronic bronchitis. These patients, with or without articular incrustatious, gradually evolve the well known signs of emphysema and bronchitis. The chest becomes bar rel-shaped and resonant; respiration is rendered hurried and labori ous by the slightest exertion ; perspiration trickles from the surface after the least effort, and is followed by chilliness, if there be any exposure to even the most moderate current of air. The changeable weather of spring and autumn is fraught with danger for these sensi tive subjects. They take cold with the first sudden change at the end of summer, and their coughs usually persist until the close of the next spring. Even during the intervals between the periodical at tacks, it is usual to find bronchial rides audible over the posterior and inferior portion of the chest.
So far as the physical signs and the expectoration are concerned, there is nothing pathognomonic about the bronchitis with which the gouty are afflicted. It is its association with other evidences of arthritism, its persistence, and its occasional alternation with articu lar manifestations that give it distinction. It is aggravated by many of the causes that operate unfavorably upon the gouty condition. Sometimes it is worse during the heat of summer, when the arthritic constitution exhibits that tendency to exhaustion that is so often manifest during the sultry days in the earlier and later portion of the hot season. Sometimes it is relieved by a humid state of the at mosphere. It is often made worse by anxiety and fatigue of mind or body.