140 GOUT 



soon or late, in consequence of implication of the internal organs in the gouty 

 process, for, in primary arthritic gout, as already explained, the entire organ- 

 ism is more or less damaged in the course of time. These deleterious effects 

 will show themselves earliest in persons whose gouty predisposition is severest 

 and in those who are most exposed to the exciting causes of the disease. The 

 acutest cases, however, are those in which several auxiliary causes become active 

 in combination with a decidedly gouty predisposition. Under such eircum-_ 

 stances it may rapidly become apparent that, as is true also in primary arthritic 

 gout, " Toium corpus est podagra." 



This leads us to the discussion of so-called visceral gout. This indicates 

 nothing else than the implication of various other tissues and organs in the 

 gouty process. In gout there is a decided tendency to catarrhal inflammation 

 of the mucous membrane, and perhaps of the digestive canal, while even with- 

 out this, many gouty patients throw too much labor upon their digestive 

 organs, by immoderate eating and drinking, thus exposing them to inflamma- 

 tory affections of this nature. We may mention, in passing, the frequent 

 catarrhal affections of the mouth and pharynx in gout. The tongue, too, often 

 takes part in this. Among the etiological factors in so-called psoriasis linguce, 

 gout must be included. Worthy of note in the gouty is the loosening of the 

 teeth which is often observed, and terminates in their premature falling out ; 

 an alveolar periostitis is looked upon as the essential cause of this very dis- 

 agreeable symptom. ISTaturally the stomach is early implicated in gout, and 

 it has been quite properly said that the stomach is in gout what the heart is 

 in rheumatism. The gastric dyspepsias of the gouty play a great role in the 

 symptomatology, even in those cases in which special dietetic errors cannot be 

 proven. The causes of these dyspepsias are manifold as has been demonstrated 

 by recent investigations. In the paroxysms of gout a decreased motility of 

 the stomach and a decided diminution of the degree of acidity of the gastric 

 juice has been observed ; a deficiency in HCl is said to be especially common. 

 It is certainly true that in gouty patients dyspeptic symptoms of all kinds, 

 among which anorexia is perhaps in the front rank, are wont to appear. Just 

 as frequent in gout are intestinal dyspepsias. Often in this condition we 

 observe very troublesome and obstinate constipation, by the removal of which, 

 after treatment of the stomach has been quite ineffectual, in many cases the 

 gastric dyspeptic symptoms entirely disappear and even the symptoms of gout 

 in the extremities are decidedly improved. To the symptoms in primary 

 arthritic gout referred to the digestive canal, we may add that in this condition 

 also functional disturbances of the activity of the liver are noted. That inti- 

 mate co-relation exists between gout and the liver can hardly be doubted. 

 Charcot and others have even looked upon gout as the result of a functional 

 disturbance of the liver. However, it is not the purpose of this article to enter 

 upon the discussion of these complicated and theoretic questions. On the 

 other hand, the practical and important point in treatment is to be empha- 

 sized, that primary arthritic gout and cholelithiasis occur simultaneously with 

 comparative frequency. Among other factors, the predisposition in gout of 

 the mucous membrane of the biliary passages to inflammatory processes analo- 

 gous to that of other mucous membranes may represent an important link in 



