In the digestive tract congestion and a catarrhal state are found, as well as ulceration of the mucous membrane; but, as the ulcerations are observed only when the granular atrophy of the kidneys is fairly developed, they are probably caused by the renal disease and cannot be regarded as directly gouty.
The live, is commonly enlarged and in a state of fatty infiltration or of stitial hepatitis; when this is the case, the spleen may also be enlarged.
The kidneys are always more or less pathological. In the large majority of cases they are granular,—atrophic: the kidney is contracted with a rough and granulated surface, small cysts are com monly seen on it, the capsule is adherent in different places, the color of the organ is red, the cortical substance warty and granular, and the walls of the arteries generally thickened; in short, the gouty kidney is identical with the small, granu lar kidney. In some cases deposits of bi urate are found in the tubuli or between them, appearing as whitish points or lines in the red structure of the organ. Uratic deposits may also be found in the pelvis and in the bladder.
In connection with the atheromatous changes which take place in the arteri oles in gout is the gradual progress of the renal disease, the organ being af fected in spots, with intermissions in the degenerative changes which are micro scopical in size, until finally large areas are involved. In those cases the glome run and tubules are attacked in a way at times to cause scarcely an appre ciable symptomatology, whereas the same change coming on suddenly, as in cases of a different etiology, cause strik ing clinical and urinary manifestations. The arterial changes in the nervous sys tem lead to various nervous disturb ances by interference with the nutrition of nerve-eentres. Cerebral manifestation may arise from uremia or from throm bosis of the cerebral arteries. N. S. Davis, Jr. (N. Y. Med. Record, July 10, '97).
A few observers have noticed the pres ence of orate deposits in the meninges of the brain and in the neurilemma of peripheral nerves.
Prognosis.—Acute gout is rarely im mediately fatal; the attacks are very liable to return, but much depends on the mode of living adopted by the patients. Chronic gout decidedly shortens the life of the patients and often results in crip pling them completely. The kidneys are
always diseased in gout, and, when the granular atrophy of the kidneys devel ops to its utmost, there may be serious danger from the retention of the con stituents of the urine, and gouty patients may die from uremia.
Gout diminishes the power of resist ance against acute disease and injuries; many gouty patients, nevertheless, reach an advanced age.
The prognosis of gouty heart is de cidedly •good. T. Mitchell Bruce (Prac titioner, Jan., '95).
Treatment. — Prophylactic treatment of gout is of the greatest importance, not only to prevent the first attack in the case of hereditary disposition, but also after the first attack to prevent or at least delay recurrences. Gouty patients should avoid all aliments containing much nuclein, which, necessarily, tends to increase the percentage of uric acid in the blood; hence are contra-indicated all glands and internal organs composed chiefly of cells, such as brain, kidney, liver, and especially thymus gland; also meat-extracts contain much nuclein and are not to be allowed. Eggs do not con tain nuclein, but paranuclein, which in the body is not decomposed into uric acid, and moderate quantities of eggs, therefore, can be eaten by the patients. As the proteids do not change into uric acid, there is no reason to prohibit meat or fish in moderate quantity; about 200 grammes daily is quite sufficient, and a larger quantity will only tax the digestion and the secretory power of the kidneys.
Every influence which may lead to irri tation or injury of the kidneys must be eliminated, and in particular alcohol and diet that might increase the amount of irritating alloxins must be interdicted. Among the latter are flesh rich in cello . lar constituents, while muscle, particu larly such as has been boiled, is permis sible. The carbohydrates and fats may be allowed. Milk and eggs are entirely unobjectionable, as the nucleins con tained do not form alloxins. Of the veg etables, salads and greens, excepting such as asparagus, are useful. Overexereise should be avoided • on account of the tendency to increase the alloxin produc tions. Kolisch (Wiener klin. Woch., No. 45, '95).