44 PRACTICE OF MEDICINE. 



Gout is generally a disease of advanced life, and seldom occurs 

 till after puberty. It is liable to be brought on by sedentary habits, 

 and indulgence in animal food and wine or malt liquors. 



It presents many resemblances to rheumatism, but differs in the 

 following points: — 1. Rheumatism affects chiefly the young or 

 middle aged ; gout, the elderly. 2. Rheumatism prefers the larger 

 joints ; gout, the smaller, and especially the feet and hands. 3. 

 Gout is attended with more obvious disorder of the digestive organs ; 

 the pain is of a more burning character, and the swelling greater and 

 more vividly red. 



Symptoms. — After suffering some time from premonitory symp-' 

 toms, such as irritability of temper, loss of appetite, and various 

 anomalous aches and pains, there comes on (often suddenly in the 

 night) a very severe burning, aching, wrenching pain in the ball of 

 the great toe, or some other joint of the hand or foot ; at the same time 

 there is shivering, followed by feverish heat, thirst, foul tongue, scanty 

 urine depositing lithic acid, and confined bowels. The pain usually 

 remits towards morning, but occurs again for several days, till the 

 fit is over, and then the cuticle of the inflamed part desquamates, with 

 violent itching. 



After the fit is over, the patient feels better in his health than he 

 had done for some time before. But without great care, another fit 

 comes after some months ; and the disease becomes established in 

 paroxysms, which almost every time recur at a less interval and 

 more severely ; till at last in some cases the disorder becomes 

 chronic and habitual. The joints affected, return to their usual plia- 

 bility after the first few attacks, but gradually become stiff and 

 crippled, and deposits of lithate of soda are formed in the cellular 

 tissue. 



Besides these evils, gouty persons are liable to various anomalous 

 and dangerous affections of internal organs. Sometimes they are 

 seized with pain of a cramp-like character in the stomach, with cold- 

 ness and deadly sickness ; — sometimes with extreme pain of the 

 heart, palpitation and dyspnoea ; — sometimes with furious delirium 

 and headache, or coma ; and as these symptoms are relieved by the 

 appearance of gout in the foot, it is evident that they arise from the 

 gouty poison ,* and such attacks are often called misplaced gout. If 

 such symptoms come, upon the gout leaving the extremities, the 

 case is said to be one of retrocedent gout. 



Gouty people are also liable to inflammations of the eye, lungs, 

 and other parts, which are very stubborn when treated with common 

 remedies, but yield generally to colchicum. 



Treatment during an acute attack, — The indications are to free 

 the system from superabundance of lithic acid, by low diet and in- 

 creasing the secretions ; and to allay pain. 



The first point is to act well on the bowels by calomel, followed 

 by senna draught, and any other warm purgative. The diet should 



