GENERAL DISEASES. 365 



GOUT. 



The characteristic lesion of gout is the presence of an abnormal 

 amount 6T uric~aci(t~iErthe bloocTaiicrthe deposit of unite of sodium in 

 the articular cartilages, the ligaments of the joints, the ears, and the 

 eyelids. Inflammatory changes may be associated with the deposits in 

 the joints. 



The most frequent situation of the gouty deposit is the metatarso- 

 phalangeal joint of the great toe. The cartilage may be infiltrated or 

 encrusted with the deposit. These masses of urates, of ten called "chalk- 

 stones," may appear upon the surface by the ulceration of the skin. 



A very important feature of gout is that patients with the gouty di- 

 athesis are especially liable to derangements of digestion and to certain 

 chronic inflammations, such as chronic inflammation of the arteries, the 

 bronchi, and the kidneys. Cardiac hypertrophy may be associated with 

 the arterio-sclerosis. The interstitial tissue, especially in the pyramids 

 of the kidney, may be infiltrated with the urates. 



It is not yet clear whether the accumulations of uric acid in the body 

 in gout is due to faulty elimination or to local alterations w r hich favor its 

 deposition. Nor is the relationship plain of local inflammatory processes 

 to the gouty deposits. 



SUNSTROKE. (Insolation; Heat Exhaustion.) 



Persons exposed while at work or when exhausted to the sun or to 

 high temperatures are liable, especially if of intemperate habits, to sud- 

 den prostration, often associated with cardiac failure, asphyxia, convul- 

 sions, and coma. Death in many cases soon ensues. 



After death, decomposition sets in early and progresses rapidly. The 

 blood usually remains fluid. 



The brain and its membranes are in some cases congested, in others 

 not. There may be an increased amount of serum beneath the pia mater, 

 or small and thin extravasations of blood beneath the pia mater and be- 

 tween the pia and dura mater. Chromatolysis of the ganglion cells has 

 been described by Van Gieson 1 and others. The thoracic and abdominal 

 viscera may be congested ; albuminous degeneration may be evident iu 

 the liver and kidneys. 



In the cases in which cerebral symptoms are protracted for a number 

 of days the lesions of meningitis have been found after death. 



According to Cramer, 3 persons surviving for some time the first severe 

 effects of the heat may suffer important alterations in certain nerve fibres 

 of the brain 



They may be associated with lesions of the nervous system or induced by the action of 

 certain poisons, phloridziu-diabetes for example, or may occur under other conditions. 



1 Van Gieson, "Toxic Basis of Neural Diseases," N. Y. State Hospitals Bulletin, 

 vol. i., p. 407, 1896; also Lambert, Medical News, July 24th, 1897. 



* Cramer, Centralblatt fur allg. Path., etc., Bd. i., p. 185, 1890. 



