The digestive organs do not so conspicuously exhibit lesions that can be directly attributed to gout, yet their morbid changes contrib ute to the suffering of the patient, and often hasten the fatal termina tion of his disease. The liver most frequently exhibits the appear ance due to chronic congestion. The capsule is thickened, and the peritoneal surface is often adherent to adjacent surfaces. The lobules are surrounded by zones of pigment, and their vessels are dilated. When the heart fails the central vessels are engorged with stagnant blood. When there is a marked tendency to obesity, the organ is pale, soft, and fatty. Sometimes the degenerative changes due to cirrhosis are present, and it is often difficult to decide whether the condition of the hepatic tissue is due to gout or to alcohol which has so long constituted the favorite beverage of the patient. Judging from analogies furnished by the condition of the joints, kidneys, and heart, it seems reasonable to believe that the fibrous tissue of the liver may be, like that of those organs, directly affected by the arthritic disease.
The stomach presents no specific lesions that are peculiar to gout. Its mucous lining is almost always in a state of chronic inflamma tion, but this can be usually explained by the dietetic errors of the patients in the matter of food and drink. Sometimes, when the kid
neys are extensively diseased, the gastric membranes show an unusual vascularity and irritation caused by frequent vomiting and hiematem esis of unemic The intestines seldom exhibit any characteristic lesions, though in rare instances the villi have been found infiltrated with sodium orate. Usually, when any morbid appearances are discovered they are due to urxmic ulceration, or to accidental causes.
The brain is often diseased in fatal cases of gout, but seldom does it display anything that is characteristic. Diseased vessels, hemor rhage, softening, degeneration of the cerebral substance—all these changes may be due to old age, or syphilis, or alcoholism, so that it is difficult to decide how far gout contributes to the actual disorder. Uratic concretions very seldom form in the brain, but they have been occasionally found upon the meninges of the brain and spinal cord, and upon the spinal nerve sheaths. Sometimes the cerebrospinal fluid contains crystals of sodium urate. But it is always the fibrous tissue that participates in the formation of the nervous enve lopes that the deposit is found. Thus, it is in the sclerotic coat of the eye—fibrous envelope of the retina—that uratic concretions are occa sionally discovered, while the other tissues of the organ escape invasion