The gouty diathesis is also one of the causes of glaucoma. Robert Sattler (Med. News, Jan. 22, 'OS).
When uratic deposits occur in the mas toid cells or in the cucum tympani they may cause deafness.
Gout is a cause of ear disease, espe cially producing earache at night and tinnitus au•ium without deafness. A Baum (Phila. Polyclinic, July 24, '97).
Ithinitis and parotitis erica have been mentioned, and also xerostomia, i.e., extreme dryness of tongue and mouth lasting for months. Angina and cesoph acrismus have likewise been noted.
Attention directed to the frequent con nection between gout and irritation of the mucous membrane, more especially as seen in hay fever and chronic nasal and pharyngeal inflammations. William Davis (Omaha Clinic, Apr., '92).
The symptoms of gouty affections of the throat are very similar to rheumatic affections, though the pain may be more intense. Small tophi have been seen on the vocal cords and at the cricoarytenoid joint, though this condition is exceed ingly rare. Gouty deposits in the laryn geal mucous membrane have been diag nosed as cancer. Watson Williams (Laryngoscope, Apr., '95).
The urine of gouty patients is of vary ing aspect and nature; in persons dis posed to gout the urine is ordinarily con centrated, loaded with urates, and a sedi ment of urates and uric acid is deposited; during the gouty attack the urine pre sents commonly the same character. In other cases the urine is pale and watery; there is diminution of its principal com ponents, and traces of albumin may be found. In "poor gout" and in chronic cases which have weakened the constitu tion of the patient the watery, pale urine is frequently observed.
From the investigations of Vogel, Schrnoll, Laquer, and Magnus-Levy it appears that before the attack and in the free intervals between them nitrogen is constantly retained in the body, whereas during the attack this is reversed, urea and also uric acid (His, Pfeiffer) being excreted at this period in quantities even exceeding the normal.
Persons suffering with gout, acute or chronic, have almost an immediate pre cipitation in the urine after passing it. If this precipitate is examined chemic ally, it will be found to differ from uric acid in its ultimate composition. This acid is only found in the urine during an attack of goitt, and always in a free or uncombined state, while the uric acid remains in the urine as a urate and in solution. To this acid, and not to uric acid, the attack of gout is due. C. J. Rademacher (Amer. Pract. and News, June 21, '90).
It is only the great proneness of the urine of persons subject to gout to part with its uric acid which is characteristic of that disorder, and not the mere ab straction itself. While from ounces
of the urine of healthy persons 30 to 45 grains of uric acid are obtained, from the urine of gouty persons the same quantity of urine only produces 3 to 7 grains. Emil Pfeiffer (Lancet, Jan. 3, '91).
Excretion of the alloxnric bodies (uric acid and xanthin bases) in gouty pa tients does not exceed that for the nor mal person unless possibly at the onset of an acute attack. Rommel (Zeitschrift f. Med., B. 30, It I and 2).
Although there is some increase of the alloxuric substances in the urine during acute attacks of gout, this increase does not overstep the physiological limits. D[alfatti (Wiener Min. Woeh., vol. ix, p. 723, '90).
In gout no increase of the alloxuric substances at all found, and the re lation between the excretion of uric acid and xanthin bases was normal. E. &hitt° (Zeits. f. klin. Med., xxix, p. 510, '90).
Inability to confirm the statement that in gout the amount of the xanthin bases and uric acid together is increased, or that there is any constant relative ex cess of the xanthin bases as compared to the uric acid. Laquer (Verhandlungen des Cong. f. innere Med., vol. xiv, p. 333, '96).
The deposit of uric acid in the joints is only a symptom, as is also the increase of uric acid in the blood. It occurs sec ondarily to a necrosis of retained sub stances, alloxu• compounds, particularly adenin. circulating in the blood. Before the outbreak of an attack of gout there is a retention of nitrogen in the system. This is to be credited to the presence of nitrogenous extractives of the alloxur or uric-acid group. The adenin is the most harmful, producing necrosis of the tissue-cells. O. Eager (Milnehener med. Woch., Aug. 7, 1900).
As already mentioned, a slight albu minuria may be occasionally found; but, even if that be not the case, symptoms of a disease of the kidneys are never failing in gout. I have examined many samples of urine from gouty patients and found that by the use of a centrifugal appara tus and a microscope I was always able to detect hyaline and granular casts in it, and am of the opinion that this indica tion of a morbid state of the kidneys is a constant symptom of all stages of gout.
Diagnosis.—The diagnosis of a typical attack of gout is easy not only as regards the localization of the morbid process, but also as to the development of the affection. Chronic gout may be con founded with other chronic affections of the joints of gonorrhoeal, tuberculous, or neuropathic origin. Generally the diag nosis is facilitated by the clinical history of the complaint and by the examination of the affected articulation.