The recognition of what is termed irregular gout is less easy than that form above described, where the disease gives abundant external evidence of its presence; but that other parts than joints suffer from gouty attacks is beyond question. The diagnosis may often be made in cases where in an attack of ordinary gout the disease suddenly leaves the affected joints and some new series of symptoms arises. It has been often observed when cold has been applied to an inflamed joint that the pain and inflammation in the part ceased, but that some sudden and alarming seizure referable to the stomach, brain, heart or lungs supervened. Such attacks, which correspond to what is termed by Cullen retrocedent gout, often terminate favourably, more especially if the disease again returns to the joints. Further, the gouty nature of some long-continued internal or cutaneous disorder may be rendered apparent by its disappearance on the outbreak of the paroxysm in the joints. Gout, when of long standing, is often found associated with degenerative changes in the heart and large arteries, the liver, and especially the kidneys, which are apt to assume the contracted granular condition characteristic of one of the forms of Bright's disease. A variety of urinary calculus--the uric acid--formed by concretions of this substance in the kidneys is a not unfrequent occurrence in connexion with gout; hence the well-known association of this disease and gravel.
The pathology of gout is discussed in the article on METABOLIC DISEASES. Many points, however, still remain unexplained. As remarked by Trousseau, "the production in excess of uric acid and urates is a pathological phenomenon inherent like all others in the disease; and like all the others it is dominated by a specific cause, which we know only by its effects, and which we term the gouty diathesis." This subject of diathesis (habit, or organic predisposition of individuals), which is regarded as an essential element in the pathology of gout, naturally suggests the question as to whether, besides being inherited, such a peculiarity may also be acquired, and this leads to a consideration of the causes which are recognized as influential in favouring the occurrence of this disease.