A treatise on gout / by Sir Dyce Duckworth.

  • Duckworth, Dyce, Sir, 1840-1928.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on gout / by Sir Dyce Duckworth. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    AORTA, ARTERIES, CAPILLARIES. VEINS. IO9 that apoplexy does not usually occur until the left ventricular wall has begun to soften and decay. Respecting the relationship between gout and cerebral haemor- rhage, it is shown by Dr. Norman Moore that in thirty-two cases of the latter in males, uratic deposits were present in thirteen instances, or in somewhat less than one-third of the cases. The earliest age in which these were associated was twenty-eight, and the oldest sixty-six years. In ten fatal cases of gout, Pye-Smith found two resulting from cerebral hemorrhage. Murchison noted that arterial atheroma supervening early in life, and diseases of the aortic valves, which are not congenital, and are independent of rheumatism and injury, are met with chiefly in the subjects of the lithic acid dyscrasia or of gout. Sections of small arteries show great thickening of the in- ternal longitudinal and external circular muscular coats, and the outer fibrous coat is also thickened. With respect to this endar- teritis, although it is commonly associated with granular kid- neys of all varieties, it must be affirmed that it is of especial frequence in persons of arthritic habit, and thus occurs very markedly in certain families. Aneurysm is rare in the gouty,1 and so, too, is gangrene from arterial embolism and thrombosis. Deposits of urates have been found in the renal arteries by Dr. Moore. He affirms that urates are present in the joints of a large proportion of those persons over forty years of age who die of cerebral haemorrhage. The changes in the capillaries relate to thickening and brittle- ness, whence hsemorrhages and ecchymoses in various parts, as in the bladder, nasal mucous membrane, and the conjunctivas. Veins.—Morbid anatomy tells little in respect to these. Clini- cal observation tells more. The venous troubles of the gouty, though serious, happily most often end favourably. Phlebitis is well-recognized as a gouty ailment, with thrombosis, and the clots may be dislodged and cause sudden death by impaction in the heart, pulmonary artery, and lungs.2 Schroeder van der Kolk has recorded a case in which the walls and valves of the veins were thickly infiltrated with urate of lime. The veins are apt to be large and full in gouty persons of sanguine type, and varix is not uncommon in them. Large veins may become suddenly and spontaneously blocked, sometimes permanently so, as in the 1 In N. Moore's tables is a ease in which an aneurysm, the size of a walnut, burst into the pericardium. The vessels were generally atheromatous. Man, set. 44. Kidneys granular and cystic. ! Nedcrland Lancet, 1853.