142 GOUT 



opinion, there may be a causal relation as well as in the not infrequent occur- 

 rence of gall-stones in gouty patients (see above) with or without simultaneous 

 urolithiasis. ( See my article, " Einige Bemerkungen iiber die Beziehungen 

 zwischen der Gicht und den Steinkrankheiten," Aerztliche Praxis, 1901, Nr. 

 4, where I have discussed these questions at length.) 



I shall now consider the condition of the kidneys in primary ari/iritic gout. 



At the autopsy of those who have suffered from this disease, the kidneys 

 may be found quite sound and normal, even in the cases in which decided 

 gouty changes in the joints had taken place. In other cases, the kidneys are 

 variously altered by the morbid process. We find chronic interstitial changes 

 with especial frequency, usually the picture of genuine contracted kidney. 

 With this, amyloid degeneration of the kidney is often found. Deposits of 

 urates may be entirely absent in the kidney and in such cases we are unable 

 to recognize the etiology from the anatomical changes. In other cases besides 

 a more or less advanced nephritis, urate crystals are found in the uriniferous 

 tubules. Even this condition I do not believe to be characteristic of gout. 

 Finally, we may note in the degenerated kidneys typical foci of necrosis with 

 urate deposits which closely resemble gouty tophi, both consisting of mono- 

 sodium urate (ToUens). Nephritis due to gout, in the main, shows the same 

 symptom-complex as when due to other etiologic factors. So-called gouty 

 gonorrhea has been much discussed; it is certainly a rare affection, in which, 

 in so far as I have been able to form an opinion, we are principally concerned 

 with a catarrh of the excretory ducts of the prostate. 



Inflammation of the mucous membranes of the respiratory organs is by 

 no means rare in gout, and this is not remarkable in view of what has been 

 stated regarding gouty disease of the mucous membranes. No further expla- 

 nation is required concerning the way in which gout produces this complica- 

 tion, nor why in this disease there is a predisposition to nutritive disturbance 

 of the lungs themselves, which favors the development of pulmonary emphy- 

 sema. It is also evident that gout by no means excludes the development of 

 pulmonary tuberculosis and other affections of the lungs. Pulmonary tuber- 

 culosis and gout not infrequently occur in combination. In the larynx specific 

 gouty processes also occasionally take place. 



The symptoms on the part of the nervous system are of special interest. 

 As is well known, many celebrated clinicians have maintained the opinion, to 

 which some still adhere, that gout is essentially a trophoneurosis, or a disturb- 

 ance of the nutritive function. This need not be here discussed. Certainly 

 disturbances in all parts of the nervous system often accompany gout, but 

 many of the usual cerelral affections are due to vascular changes produced in 

 the course of the malady. Diseases of the cerebral vessels have frequently 

 been proven to be the cause of severe diseases of the brain, for example, of 

 cerebral hemorrhage. 



Often, however, in primary arthritic gout, so-called general neuroses are 

 observed, i. e., those affections of the central nervous system for which no 

 constant material substratum can be found. Among these I must first men- 

 tion the severe neurasthenic conditions which sometimes reach the highest 

 degree of hypochondriac depression, and which in some cases may even 



