INFLAMMATIONS. Ill 



eating liquors ; indigestion, produced either by the quantity or 

 quality of aliments ; much application to study or business ; 

 night-watching ; excessive evacuations ; the ceasing of usual la- 

 bour ; the sudden change from a very full to a very spare diet ; 

 the large use of acids and acescents ; and, lastly, cold applied 

 to the lower extremities. 



DV. The first (Dili.) seem to act by increasing the predis- 

 position. The last (DIV.) are commonly the exciting causes, 

 both of the first attacks and of the repetitions of the disease. 



DVI. It is an inflammatory affection of some of the joints 

 which especially constitutes what we call a paroxysm of the 

 gout. This sometimes comes on suddenly without any warn- 

 ing, but is generally preceded by several symptoms ; such as 

 the ceasing of a sweating which the feet had been commonly 

 affected with before ; an unusual coldness of the feet and legs ; 

 a frequent numbness, alternating with a sense of prickling along 

 the whole of the lower extremities; frequent cramps of the 

 muscles of the legs ; and an unusual turgescence of the veins. 



DVI I. While these symptoms take place in the lower extre- 

 mities, the whole body is affected with some degree of torpor and 

 languor, and the functions of the stomach in particular are more 

 or less disturbed. The appetite is diminished ; and flatulency, 

 or other symptoms of indigestion, are felt. These symptoms, 

 and those of DIV., take place for several days, sometimes for 

 a week or two, before a paroxysm comes on ; but commonly, 

 upon the day immediately preceding it, the appetite becomes 

 greater than usual. 



DVIII. The circumstances of paroxysms are the following : 

 They come on most commonly in the spring, and sooner or 

 later, according as the vernal heat succeeds sooner or later to 

 the winter's cold ; and perhaps sooner or later also according as 

 the body may happen to be more or less exposed to the vicissi- 

 tudes of heat and cold. 



DIX. The attacks are sometimes felt first in the evening, 

 but more commonly about two or three o'clock of the morning. 

 The paroxysm begins with a pain affecting one foot, most com- 

 monly in the ball or first joint of the great toe, but sometimes 

 in other parts of the foot. With the coming on of this pain, 

 there is commonly more or less of a cold shivering, which, as 



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