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fit is often preceded by certain prodromi which those GEN. XII.

Spec. III. who have suffered from it before very sufficiently under a A. Pod stand, and uniformly take as a warning; such as a cold- agra reguness or numbness of the lower limbs, alternating with a Regular fit sense of pricking or formication along their entire length; of the gout.

Sometimes frequent cramps of the muscles of the legs ; a crassament preceded by in the urine *; slight shiverings over the surface ; lan- particular

signs. guor and flatulency of the stomach ; and sometimes a pain over the eye-lids or in some other organt.

The paroxysm is said by Dr. Sydenham, who has drawn its picture to the life, to shew itself most commonly in January or February; but I have known it occur Generally so often towards the close of the summer, and in the au- appears in

the spring, tumn, and have attended so many patients who have but not never had it except in the latter seasons, that the rule always. does not seem to be in any way very well established.

The first attack is usually in one of the feet, most com- Description. monly about the ball or first joint of the great toe; it commences at night or during the night, and there is sometimes, though not always, a slight horror, succeeded by a hot stage. The local pain and swelling increase in violence, the joint assumes a fiery redness, and the whole body is in a state of great restlessness. The symptoms remit sometimes towards the next morning, yet occasionally not till the morning after; but they still return during the night, though in a more tolerable degree, for three or four days, or even a week; when the inflammation subsides as by resolution; the foot almost instantly recovers its vigour, as though nothing had been the matter with it; and if the patient have been antecedently indisposed, he enjoys, as on recovering from an ague, an alacrity of body and mind beyond what he has experienced for a long time before; the constitutional indisposition disappearing with the paroxysm. At the commencement of the disease, the return of it Return of

the paroxmay be annual, or not oftener than once in three or four

ce of our ysm at first

annual or

less free • Butler, Nadere out dekkinge der menschelyke Waters. Harlem. 1897. quent: † Eph. Nat, Cur, Dec. 1. Ann. 11. Obs. 252.

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the inflam


,Gen. XII. years ; but it is perpetually encroaching on the consti

· tution, so that the intervals gradually become shorter, agra regu- and the attacks more frequent and of longer continuance: laris.

whence, as Dr. Cullen has justly observed, “ in an adof the gout. vanced state of the disease, the patient is hardly ever toafterwards lerably free from it, except perhaps for two or three the intervals much cevano months in the summer.” shorter. Nothing can be more specific, more true to itself, or Character of

- more distinct from every other kind of inflammation mation spe- than that of the disease before us, when thus exhibited

in a regular fit; the inflammation of erythema does not differ more from that of phlegmon than both these, and indeed every other from that of gout: it never suppurates, never ulcerates when simple and genuine, however violent may be the attack, and though to the eye of inexperience the skin may seem to be on the point of bursting; while, in the midst of the severest pain, there is a sense of numbness, weight, and want of energy; insomuch, that if the pain could for a moment be forgotten, the limb would feel paralytic; and though the muscles which move the limb be not affected, they raise it or drag it along like a dead load. If the inflammation run through its course where it first fixes, it subsides by a resolution that leaves no external discolouration or internal weakness or disability; and if it make a transfer from one extremity to another, it passes with inconceivable rapidity; the limb now affected being loaded with all the vehemence of the inflammatory action; and that lately the seat of pain being all of a sudden restored to perfect soundness.

· It is rarely, however, that any metastasis takes place not common in sound on its first appearance in a healthy constitution ; nor health: indeed till after various organs or the entire habit has but the system weaken- been weakened by repeated assaults. We have already ed by fresh observed that it is the nature of the disease to weaken paroxysms: andat length the habit in this manner till the system is completely broken

broken down, as well in mind as in body, and becomes down.

a prey to its tyrannic control. In this case the paroxysms, though much longer and more frequent, are less violent



and painful than at first; but there is no joint exempt Gen. XII.

Spec. III. from its incursion, nor perhaps an internal organ that "A. Poda does not suffer from induced weakness : so that, in the agra regulanguage of Sydenham, “the patient exists only to be Regular fit wretched and miserable, and not at all to taste of the of the gout. happiness of life.”

It is a remarkable fact, hitherto indeed little dwelt upon and altogether unaccounted for, that as the system advances in years and debility, and every other secretion progressively fails, that of calcareous earth seems ,

habits the to increase. Hence the bones of aged persons are more secretion of fragile and apt to break upon slight concussions; and calcareous

earth often the arteries and various other parts become ossified or augmented. loaded with nodules of lime-stone; and where a powerful sympathy exists between the kidneys and the stomach, and either of these is in an infirm state, we have a larger deposit of the same material in the kidneys or the bladder. A similar increase of calcareous earth takes place And hence in the weakness of chronic gout; every affected joint produced becomes loaded with its secretion, which collects and by gout. hardens into nodules in its cavities, or in the adjoining cellular membrane, or bursæ mucosæ, and renders motion uneasy or destroys it altogether. The lime-stone, moreover, as it hardens, acts as a foreign irritant to the distended integuments, and produces, what simple inflammation of the gout never does, ulcerations and an offensive discharge. For the same reason nephritic cal- Hence often culi are often a sequel of gout when it has assumed a ne

a calculi. chronic form; and the children of gouty parents are said to be hereditarily disposed to both complaints, some of them exhibiting a podagric and others a nephritic affection.

Sometimes this calcareous secretion is thrown off by Or calcarethe surface of the skin. I have seen, says Swediaur, an inveterate case in which the patient labouring under a skin. paroxysm of several months duration, had the entire surface of the body covered every morning with a white powder, as though he had been dusted with flour *.


* Nov. Nosol. Meth. Syst. I. p. 218.

ous secre

BA. Pod

rious cha.

Gk. XII. Thus far, we have followed up the progress of a reSpec. III.

- gular attack of gout in a constitution otherwise healthy agra larvata, and vigorous. But the same diathesis exists in systems Disguised, of delicate and infirm health, and where there is a want or atonic gout: de of sufficient energy to work up a fit of inflammation, scription of. and throw it off at its appropriate outlets. And in such Found in case, as soon as it becomes roused into action by any of delicate constitutions, the causes of excitement already enumerated, it constiand why. tutes the SECOND VARIETY, assumes the guise of various Under va- other diseases, as dyspepsy, hysteria, hypochondrias,

palpitations of the heart, vertigo, hemicrania, with seracters; but chiefly veral modifications of palsy or apoplexy. The stomach affects the and bowels, however, form the chief seat of affection ; digestive organs.

the appetite is fastidious or destroyed; a spasmodic

stricture or painful oppression is felt in the epigastric Fugitive

region, or the stomach is distended almost to bursting paroxysms.

with flatulence; nausea, eructations, vomiting, and all the symptoms of indigestion follow, and are alternated with severe colic or costiveness. In the mean while the disease shows itself at times, in one or more of the joints in slight and fugitive pains, as though making an ineffectual effort to kindle up a paroxysm of proper inflammation, but which there is not energy enough in the system to accomplish; whence the articular pains cease almost as soon as they appear; and the visceral derangement is renewed; sometimes slowly subsiding after a continuance of several weeks; and sometimes wearing out the entire frame, and terminating in abdominal or

cellular dropsy. y A. Pod

It sometimes happens, however, that while the general agra complicata. constitution of a podagric patient is tolerably sound, one Recedent; misplaced

or more of the internal organs form an exception to the gout. general rule, and are less healthy than the rest. And as duced.

upon an excitement of gouty inflammation in a gouty habit, the inflammation seizes ordinarily upon the weakest part of the body, it makes its assault upon such organ rather than upon the hands or the feet; or, if it commence in the latter, is readily transferred to it; constituting the THIRD OF THE VARIETIES before us, and which

How pro



has usually been called RETROGRADE OR MISPLACED GOUT. Gen. XII.

Spec. III. And if the general system should, at the same time, be

be y A. Pod below the ordinary tone of health when the paroxysm is agra com-thus excited by the force of some occasional cause, the Reced organ affected may evince great langour and painful in- misplaced ertness, as in the second variety, rather than acute inflammation, as in the first. The sensation in the stomach, Sym

explained. instead of being that of a fiery coal, is that of a cold lump of lead; in the head it changes from maddening pain to Sensations

when in the oppressive horror, in which the patient suddenly starts stomach: from sleep almost as soon as he has began to doze, from in the head, the hideousness of the ideas that rush across the mind and form the distracting dream The fit is sometimes transferred to the bladder; in Sometimes

in the bladwhich case there is acute pain at the neck of the organ, der or recstrangury, and a discharge of thin acrid mucus from the tum. urethra. The rectum has also beeu occasionally the seat of metastasis, and has evinced various species of affection, as simple vehement pain, spastic constriction, or hemorrhoidal tumours. When thrown upon the lungs it mimics the symptoms of a peripneumony. • In applying the art of medicine to the cure or allevia. Indications

of cure to tion of gout, our attention must be directed to the state apply to the of the patient during the paroxysms, and during their paroxysms

and to the intervals : and particularly to the state of his constitution intervals. or previous habits, which, according to their character, may demand a different and even an opposite mode of management. · Let us commence with the PAROXYSMAL TREATMENT: Treatment and, first of all, with that of the inflammatory attack, as

paroxysms. it shows itself in a regular fit of the disease.

It was formerly the belief, as we have already seen, During the that a gouty paroxysm was an effect of nature to throw paroxysmo?

a regular fit. off from the constitution, and thereby restore it to a state of perfect health, some peccant matter forming the proximate cause of the distemper; and it was hence, also, conceived, in addition, to adopt the language of Sydenham, that the more vehement the fit the sooner it will be over, and the longer and more perfect the intermis

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