The Croonian lectures on some points in the pathology of rheumatism, gout and diabetes : delivered at the Royal College of Physicians, London, March 30, April 1, 6, 1886 / by P. W. Latham, M.A., M.D., F.R.C.P.
- Peter Wallwork Latham
- Date:
- 1887
Licence: Public Domain Mark
Credit: The Croonian lectures on some points in the pathology of rheumatism, gout and diabetes : delivered at the Royal College of Physicians, London, March 30, April 1, 6, 1886 / by P. W. Latham, M.A., M.D., F.R.C.P. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
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![tion of the vessels caused by impulses affecting the blood-supply, there are impulses affecting directly the activity of the protoplasm. The constructive metabolism about the joints is stimulated, whilst the blood supply and destructive metabolism are lessened, and so there is increased development or growth about the part. Fur- ther, the blood which goes to the part, contains sodium urate; consequently, this is deposited along with the other substances, in the metabolism or inflammatory changes which take place in the tissues around the affected part. But, whilst the vaso-motor centres may be directly stimulated by the irritant, they may be also stimulated by irritation of the effei-ent or sensory nerves. Stimulation of the centripetal end of a divided efferent nerve causes increased blood-pressure. Have we not here, then, an explanation of the phenomena of a gouty paroxysm] The uric acid stimulating both the sensoiy nerve, and, through it or independently, the more active portion of the vaso-motor centre, causes pain in the joint and contraction of the vessels; the pain increases with the continued stimulation, but, after a time the nerve is exhausted or paralysed (as we know to be the case from continued stimulation of other nerves, as, for instance, in tetanizing a muscle). The vessels now dilate, destructive me- tabolism is stimulated; there is relief from pain, and with, the relief, another indication of paralysis of the sympathetic shows itself, namely, more or less perspiration. A similar explanation may, I think, be given of the mode in which arthritic symptoms result sometimes from nerve wounds. The wound may be such, that the sensory or efferent fibres in the nerve are injured, whilst the vaso-motor and other fibres are in- tact. From the irritation set up, either by the cicatrix or other- wise, the sensory fibres are stimulated, and, through it, the vaso- motor centres in the manner I have just described as occurring in gout; but as uric acid is not the irritant, and is not circulating in excess in the blood, there is no deposit of this substance in the metabolic changes taking place in the joint. And further, if irritative, inflammatory, or degenerative changes](https://iiif.wellcomecollection.org/image/b21445278_0083.jp2/full/800%2C/0/default.jpg)
