Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    842/976 (page 822)
    examinations proving the existence of deposits of urate of soda in these structures, still such may arise, and the proof of their existence or non-existence is a point of much interest and importance. Deposits of this kind can readily escape notice, unless specially sought for; and even those which occur in the joints in early attacks of Gout were not observed till within the last few years. Epilepsy is not uncommon in gouty subjects, and appears to be closely dependent on the diathesis which gives rise to the articular affection; it sometimes distinctly alternates with the joint affection; at others, the two may occur simultaneously. Mania is frequently the result of retrocedent gout. I have seen numerous cases ; Gout often leaves a joint suddenly, from exposure to cold or an intense mental shock, and after a short time distinct mania is developed ; this may last for days or weeks, but generally terminates favourably. Spinal affections, probably from inflammation of the meninges, with startings of limbs, hypersesthesia, and other characteristic symptoms, occasionally result from the sudden suppression of articular gout, or occur along with the joint inflammation. Acute neuralgia of different nerves is at times closely connected with Gout. Sciatica of this character oftens occurs, and facial neuralgia occasionally. These affections probably depend on gouty inflammation affecting the sheath of the nerves. Forms of local para- lysis have also been observed apparently due to the same cause ; and cramp sometimes becomes so excessively developed, and so perma- nent, as to justify its being looked upon and classified as a form of irregular gout. Gout affecting tlu Digestive Organs.—When the stomach is affected by gouty metastasis, which sometimes occurs from the application of cold to the extremities, there is usually sudden intense pain and spasm in the epigastrium, oppression, and vomiting of bilious matter; at times the heart’s action is involved, and a feeling of great anxiety, with palpitation, produced. Many of the cases reported as examples of retrocedent gout will not bear a close investigation; still there is no reason to doubt the possibility of such an occurrence. True retrocedent gout affecting the stomach is probably of an inflammatory nature, though no direct proof has been afforded in support of this statement. Sometimes the upper extremity of the digestive tube, as the pharynx and oesophagus, becomes distinctly affected in Gout, producing diili- culty of swallowing; at other times the rectum is implicated, and the patient is troubled with piles or tenesmus. Constipation is a ery common, but on the other hand diarrhoea may prevail, apparently o a conservative character, and cases now and then are seen in win .articular gout appears to be warded off by the discharge from tie intestinal canal. , ,1 Gout affecting the Circulating Organs.—When articular gout su. denlyr recedes and the heart becomes alfected, the symptoms expen