INFLAMMATIONS. H3 



which was secondly attacked, returns again into the foot first 

 affected, and perhaps a second time also into the other. Its 

 changes of place are not only from one foot to the other, but 

 also from the feet into other joints, especially those of the upper 

 and lower extremities ; so that there is hardly a joint of the 

 body that is not, on one occasion or other, affected : it some- 

 times affects two different joints at the same time; but more 

 commonly it is severe in a single joint only, and passes succes- 

 sively from one joint to another ; so that the patient's affliction 

 is often protracted for a long time. 



DXIV. When the disease has often returned, and the par- 

 oxysms have become very frequent, the pains are commonly 

 less violent than they were at first ; but the patient is more af- 

 fected with sickness and the other symptoms of the atonic gout, 

 which shall be hereafter mentioned. 



DXV. After the first paroxysms of the disease, the joints which 

 have been affected are entirely restored to their former supple- 

 ness and strength : but after the disease has recurred very often, 

 the joints affected do neither so suddenly nor so entirely recover 

 their former state, but continue weak and stiff; and these effects 

 at length proceed to such a degree, that the joints lose their mo- 

 tion altogether. 



DXVI. In many persons, but not in all, after the disease has 

 frequently recurred, concretions of a chalky nature are formed 

 upon the outside of the joints, and for the most part immediate- 

 ly under the skin. The matter seems to be deposited at first 

 in a fluid form, but afterwards becomes dry and firm. In their 

 dry state, these concretions are a friable earthy substance, very 

 entirely soluble in acids. After they have been formed, they 

 contribute, with other circumstances, to destroy the motion of 

 the joint. 



DXV 1 1. In most persons who have laboured under the gout 

 for many years, a nephritic affection comes on, and discovers it- 

 self by all the symptoms which usually attend calculous concre- 

 tions in the kidneys, and which we shall have occasion to des- 

 cribe in another place. All that is necessary to be observed 

 here, is, that the nephritic affection alternates with paroxysms 

 of the gout, and that the two affections, the nephritic and the 

 gouty, are hardly ever present at the same time. 



VOL. II. H 



