SYMPTOMATOLOGY 143 



occur in paroxysms. In this group also belongs vertigo, which, however, 

 as experience has taught me, may also be due to disease of the audi- 

 tory apparatus in connection with gout. Here we must also mention migraine 

 so commonly associated with gout, but which apparently develops under vary- 

 ing conditions. Gouty paralyses and neuralgias, among which we find the 

 visceral form, are in many cases due to- neuritis. The gouty affections of the 

 organs of special sense, in which, perhaps, those of the eye fill a prominent place, 

 require description by a specialist. It need only here be remarked that glau- 

 coma, so far as I am able to understand the condition, is usually due to gout. 



That gout plays a prominent role in the etiology of cutaneous affections 

 cannot Be doubted. We have already described the gouty inflammation of the 

 skin in the paroxysms; to these also belong the so-called copper nose which is 

 not always due to gout, but arises so frequently in gouty patients that a causal 

 relation between them may be looked upon as very likely. This appearance of 

 "rhinagra," which usually runs a chronic course in this prominent portion 

 of the human countenance, must be considered analogous to the gouty processes 

 in the ear. However, within the limits of my experience, necrotic processes 

 of the skin rarely occur in the nose, and, therefore, gouty tophi are absent 

 there. In regard to gouty concretions in the skin and in the subcutaneous 

 connective tissue of the various regions of the body, it is unnecessary to speak 

 further. Occasionally lymphangitis is seen as a consequence of gout. This 

 condition does not give rise to difficulties according to the views which I have 

 formed of the pathogenesis of primary arthritic gout. Gouty eczema and 

 gouty psoriasis are frequently mentione'd. It is at once evident that in the 

 development of the former the irritation of the skin in gout, like the gouty 

 inflammation of the mucous membranes, forms a predisposing factor. In 

 psoriasis, of the cause of which we know so little, I have not succeeded in 

 deducing any reliable connection between it and gout; I do not, however, by 

 any means desire to deny the existence of such a connection, particularly as 

 psoriasis and gout so often occur side by side. The same is also true of cer- 

 tain cutaneous affections which may be referred to vasomotor disturbance, 

 among which I desire primarily to call attention to urticaria, which often 

 appears as a chronic affection in gouty women. That these cutaneous affec- 

 tions are invariably due to gout I naturally do not believe. Finally, it may 

 here be mentioned that alopecia is sometimes found associated with gout, 

 although in these cases quite a number of other etiologic factors may bring 

 about the condition. 



At this place only a review of the more frequent symptoms in so-called vis- 

 ceral gout can be given. In the consideration of the diseases which occasion- 

 ally accompany gout, the question will and must occur whether there is actually 

 a causal connection between them. If we reflect that in gout all the organs 

 are subject to a certain tissue irritation, we shall be inclined to regard many 

 diseases as due to gout. The fact is of interest that celebrated French inves- 

 tigators, such as Bazin and Ch. Bouchard, are of the opinion that cancer is 

 the result of gout. The former has even said that gouty patients are par- 

 ticularly apt to succumb to cancer, especially to cancer of the rectum or of 

 the bladder. I shall not enter into this in detail. On the other hand, the 



