IRREGULAR GOUT.—Besides the symp toms directly dependent on or associated with the deposition of mates in the artic ulations and in other structures, many morbid symptoms have been observed in the course of gout and have more or less correctly been named symptoms of irreg ular gout; these symptoms may alternate with the regular attacks, and their grav ity is frequently in inverse proportion to the violence of the true gouty attacks. Symptoms of irregular gout may occur, —an imperfect development of the at tack, or suppressed gout,—or when in flammation of the joint from some cause or other (improper treatment) unduly subsides,—retrocedent gout.
Almost all internal organs may become the seat of disorders which have been ascribed to gout.
Case of obstinate gout in which, dur ing the attack (the disease involved the penis), continuous priapism resulted, which lasted for twenty-one days. Pathology of the attack believed to be thrombosis in the corpora cavernosa. D. Duckworth (Brit. Med. Jour., Jan. 16, 92).
The absence of excessive heat in joints affected with gout and the fact that some observers have found such joints lower in temperature than surrounding parts, together with the early turgescence of the veins, the redness, and the pain, indicate that the cause of the attack is thrombosis of the vessels about the joints. Balfour (Edinburgh Med. Jour., June, 'OS).
The gouty kidney presents the same signs as the ordinary granular-atrophic kidney, and cannot be distinguished from it, neither by the symptoms nor by the anatomical examination. It will be shown later on that a certain degree of granular atrophy of the kidney is found in all cases of gout; when the renal changes are fully developed, the urine becomes clear and watery, contains urea and uric acid and in deficient quantity, and the patients may die from renal in sufficiency. Gouty persons often suffer from gravel and calculosis; oxaluria is frequently met with; chronic cystitis and urethritis may be observed, especially in old persons suffering from gout.
In the direction of the nervous system many symptoms of morbid derangement may be observed, such as headache, hemi crania, vertigo, fainting, sudden delir ium, mental depression, epileptic fits, and apoplectic attacks. All kinds of neu
ralgia, especially gouty sciatica and costal neuralgia, have been described, and symptoms of disorders of the spinal cord and the meninges and paresis or panes thesia at the peripheral nerves have also been noted.
The vascular disorders are generally caused by atheromatous changes of the large vessels and followed by hyper trophy and fatty degeneration of the heart. Severe palpitations, intermittent and irregular cardiac action, and weak, very slow or rapid pulse are frequent symptoms in gout. There may be dysp ncea and a feeling of constriction, and true attacks of angina pectoris are not uncommon. Phlebitis, especially of a recurrent form, has been observed among the symptoms of gout by competent ob servers.
Although the digestive system is very commonly deranged, the stomach and the bowels are not liable to specific gouty changes; fatty liver and a tendency to cholelithiasis is frequently observed; severe pain in the stomach or in the bowels may occur, but these seem to be of neuritic origin.
The skin is frequently affected.
Among the diseases of the skin allied to gout may be named erythema, eczema, urticaria, psoriasis, prurigo, and acne.
A patch of eczema, of spontaneous de velopment, signifies the existence, in the person possessing it, of a gouty diathesis. As it happens, the floor of the external auditory canal is apt to be the first spot on the surface of the body where an eczematous inflammation develops. This condition constitutes a valuable guide post, pointing, as it does, at a very early stage to the existence of a gouty diath esis. A. IL Buck (Amer. Jour. Med. Sci., Mar., 'OS).
Bronchitis and asthma are often met with in gouty patients; there seems to be a certain antagonism between gout and tuberculosis; at least, it has been asserted by many authors that tuberculous changes develop very slowly in gouty patients.