A text-book of medicine : for students and practitioners.

  • Adolph Strümpell
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.

    1016/1108 page 988
    gradually developing secondary hypertrophy of the left ventricle is the pivot on which turns the whole future course of the disease. So long as the heart remains capable of pei’forming its functions, the condition of the iDatient will probably remain endurable if not actually comfortable. Finally, however, comiiensation is sm’e to become impaired ; and then appear oedema, dyspnoea, debility, and emaciation—in short, all the familiar symptoms of cardiac failure. A speedy end may be brought about by m-semia, or cerebral embolism, or hemorrhage ; but in other cases the patient suffers for years, both from the heart disease and from fresh arthritic attacks. The cardiac hypertrophy just mentioned is the result of the contracted kidney. Other disturbances of the circulatory system appear to be referable directly to the gout itself. Among these are chronic endocarditis or myocarditis, and ijerhaps certain “ functional ” symptoms, such as palpitation and angina. An important symptom is chi’onic endarteritis or arterio-sclerosis. This is often seen in gouty subjects, and in many instances seems to be immediately connected with the gout. Sometimes, also, there are gouty lesions of the veins, such as varicosities or throm- bosis. Of coui’se, these changes in the blood-vessels may, in their turn, give rise to various disorders. In a few very rare instances gout seems to attack the brain aiad spinal cord. Usually, however, tbe nervous disturbances seen in gout are, as already stated, symptoms of uraemia, or of circulatory disturbance, and the like. The patient may also have certain fimctional nervous troubles, like neuralgia or migraine. The direct cause of these is seldom evident. The joints, despite frequent attacks, may yet maintain an almost normal appear- ance, inasmuch as the acute inflammatory changes completely vanish after each separate attack. They may, however, undergo permanent enlargement and de- formity from gouty concretions {tophi arthritici). In many instances similar masses can be felt bere and there in the muscles and tendons, the skin (for instance, of the eyelids), and quite often in the external ear. They consist essen- tially of accumulations of urates (pide infra). Occasionally these concretions break externally, discharging a thick pus mingled with urates, and forming indo- lent ulcers, slow to heal. Sometimes atmosphex’ic gei’ms thus find ingress into the system, and give rise to phlegmon. It should be stated, in conclusion, that gout may be complicated with other dis- eases. Thus, it may be associated witb renal calculi, and sometimes with diabetes mellitus {vide supra). Anatomical and Chemical Changes in Gout. Theory of its Nature.—The essen- tial anatomical lesion m gout consists of an abundant deposit of crystalline urates in tbe tissues. This is most evident in the affected joints, the cartilaginous sur- faces of which are often completely covered with white, chalk-hke material. In severe cases the same appearance may also be presented by the articular hgaments, tendons, and bursm,. while thei'e are at the same tune numerous concretions of urates hei*e and there beneath the skin. These deposits are mainly composed of acid sodic ui’ate, Avith traces of calcic ux’ate, calcic xxhosphate, and sodic chloride. Ebstein has lately explained bow these collections are formed. Ho found that the deposition of uric acid is inAmriably preceded by a necrosis of the tissues. The uric acid while still in solution acts as a chemical irritant upon the cartilage here and there, and thus produces necrosis, whereupon the urates are crystalhzed out and deposited. Then a secondary inflammation develops around these foci of necrosis. By ligaturing the m-eters in fowls, Ebstehi succeeded in artificially pro- ducing similar changes. The nephritis of gout corresponds in its pathological appearances to that of the time contracted kidney, with one exception; the organs usually present deposits of
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