Among arthritic subjects there is often a notable relation between chronic bronchitis and certain obstinate cutaneous eruptions that be long to the arthritic group of diseases. With the disappearance of one, the other is aroused to activity. Thus, it is recorded of the great Napoleon that having been harassed for a long time by an ob stinate cough, he was at last persuaded by Josephine to consult her favorite physician, Corvisart. On investigation it appeared that the bronchial affection was coincident with the suppression of an old erup tion that had existed for many years. Corvisart immediately ordered a course of counter-irritation, which soon revived the cutaneous malady and cured the cough. Chronic gouty bronchitis is sometimes accompanied by sudden paroxysms of spasmodic dyspncea that are out of all proportion with the physical signs that are afforded by auscultation. These attacks are frequently induced by the recumbent position, and are relieved by sitting up, or by the inhalation of the vapor of ether. In elderly subjects, however, the possibility of a ummic cause for such paroxysms should never be forgotten, and they should be the signal for careful supervision of the course of events in the kidneys and heart. Chronic interstitial nephritis and cardiac dilatation will be often discovered as the proximate cause of such respiratory dyspnoea.
The gouty character of these varieties of bronchitis can hardly be questioned when they are associated with the usual articular mani festations; but when bronchitis precedes these changes, the connec tion is more obscure though none the less real. The respiratory malady is in such cases rightly estimated as a masked variety of gout.
Nervous or spasmodic asthma is often associated with the gouty diathesis. In many instances it alternates with or replaces the
habitual articular attacks. Of course there are numerous asthmatics who are never gouty, but there are, besides, many arthritics who ex hibit the phenomena of asthma in such close relation with their dia thetic attacks that it is difficult to doubt their common causation. Such cases are encountered in gouty families where numerous ancestors have transmitted the history of all possible modes of ar thritic disease, and have exhibited all the affiliated disorders without interruption. In such families asthma is of frequent occurrence, either as an antecedent or as an alternative affection. Yet so long as there is no recorded ease of retrocedent gout actually replaced by an asthmatic attack, it may be proper to speak of asthma as the ex pression of a morbid tendency that frequently accompanies gout, though not itself a manifestation of that disease.
The pleuritic effusions that are sometimes witnessed in gouty patients are probably only very indirectly connected with the disease. They occur as a consequence of ordinary exposure to cold, and their character differs in nothing essential from the ordinary varieties of pleuritic inflammation. The same thing may be said of the attacks of pneumonia that sometimes occur in gouty subjects. This might be expected, since pneumonia is not the result of intoxication, but of a specific infection. But the transient attacks of pulmonary hyper remia, that are sometimes accompanied by expectoration of blood, in non-tubercular subjects, are often connected with gouty disorder, and have no more importance for prognosis than the hemorrhoidal fluxes with which they sometimes alternate.