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.

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    gradually penetrates deeper into the tissues, but, even in extreme cases, scarcely extends beyond a third of its thickness, and is always at a considerable distance from the bloodvessels of the bone. It is probably owing to this freedom from deposition which vascular tissues enjoy, or to the rapid destruction of the urate of soda when placed under circumstances which bring it into contact with blood- vessels, that acute gouty inflammation does not affect the covering or lining membranes of the heart as is the case with rheumatic inflam- mation. The morbid changes which are often found in the valves of the heart, or the lining membrane of the aorta, form no exception to this statement, for they are not due to the presence of urate of soda, but to an alteration of an entirely different character. “ The kidneys are often, if not always, implicated in Gout, and the affection, possibly only functional at first, soon becomes structural. The urinary secretion is likewise altered.” Under the “ Morbid Anatomy” of the disease it has been affirmed that, in all cases where Gout has existed for any length of time, some alteration is found in the kidneys ; deposition within or external to the tubuli uriniferi is discovered, and the normal structure of the secret- ing apparatus is injured. In chronic cases the peculiar shrivelled or gouty kidney is frequently met with. As yet I have never seen this latter form of kidney disease without finding the white deposition, and I cannot help thinking it probable that the presence of the urate may be the exciting cause of the subsequent changes which ensue in the structure of the kidney. The kidney affection, whether functional or organic, readily explains the altered state of the urinary secretion :—The functional dis- turbance may cause the defect and irregularity of the secretion of uric acid; the organic alteration accounts for the further diminution in the excretory power of the organ, and the frequent presence of a small amount of albumen in the urine. The impure state of the blood, due to the presence of urate of soda, is probably the cause of the disturbance which often precedes the gouty paroxysm ; that is, of the so-called premonitory symptoms, as well as most of the anomalous affections (irregular gout) to whicn such patients are liable.” That suppression of the whole urinary secretion, such as occurs in intense renal congestion and advanced forms of albuminuria, gives rise to many and alarming symptoms, is a well-known and, acknow- ledged fact, and hence it is reasonable to suppose that a suppressed excretion of one of its constituents should manifest itself by symptoms of a less intense and fatal character. Possibly some of the symptoms may be due to the reaction, consequent upon an attempt at deposition of urate of soda in certain unusual situations. Dyspepsia, for examp e, is very common in albuminuria; it is also frequent in persons of a gouty diathesis. “ The causes which predispose to Gout, independent of those con- nected with individual peculiarity, are either such as produce an