552 DISEASES OF THE ORGANS OF LOCOMOTION. 



ternal gout. But we must remember how rarely we have the oppor- 

 tunity of making autopsies on gouty patients, and how carefully an 

 examination would have to be made to discover deposits of urates in 

 the gastric mucous membrane, lungs, or heart ; also, that it is not at 

 all improbable that these deposits disappear after the attack is over. 

 The organs most frequently attacked by gout appear to be the stom- 

 ach, brain, and heart. 1. Gout in the stomach appears with the 

 symptoms of severe cardialgia, which is occasionally accompanied by 

 violent vomiting, and sometimes with hsematemesis. 2. Gout in tfie 

 brain may sometimes present the appearance of apoplexie foudroyante, 

 while in other cases it manifests itself by severe circumscribed head- 

 ache, dizziness, and vomiting. 3. Gout in the heart induces irregular 

 and enfeebled action of that organ, and, as a consequence of the dis- 

 turbed circulation, dyspnoea, or fainting. Lastly, cases are reported 

 where there was metastasis to the spinal marrow, inducing sudden 

 paraplegia, and to the lungs, causing asthmatic attacks. We must 

 take care not to refer every intercurrent disease, affecting a patient of 

 gouty diathesis, to an attack of anomalous gout. We are only justified 

 in so doing when the disease runs its course with unusual symptoms ; 

 also when the patient is affected with gouty inflammation of the joints 

 at the same time ; when disease, running a peculiar course, occurs 

 suddenly in an internal organ while a gouty affection of the joints is 

 subsiding or developing ; and lastly, when the termination of the dis- 

 ease is accompanied by a copious excretion of urates through the kid- 

 neys. 



The course of the disease is tedious and insidious. The termina- 

 tion in permanent cure is rare, but would be more common if the 

 patient would entirely change his mode of life before the disease be- 

 comes firmly rooted. Death, also, is a rare termination, and results 

 almost exclusively from severe attacks of anomalous internal gout. 

 Most patients die of complications, or of intercurrent diseases. 



TREATMENT. Since, next to hereditary predisposition, the dispro- 

 portion between supply and demand is the most important cause of 

 gout, the causal indications require the removal of this disproportion 

 by limiting the supply and increasing the consumption. During the 

 course of gout, particularly when the disease has become irregular 

 instead of regular, there is a time when the state of the patient does 

 not permit a restriction of the supply, and where the increase of con- 

 sumption must be made very carefully ; but in all recent cases of regu- 

 lar gout, and in all patients whose general health and nutritive condi- 

 tion indicate a continuance of this disproportion, the fulfilment of this 

 indication is the only means from which we can expect a cure. Hence 

 we see that in treating gout we should write few prescriptions, but 



