INFLAMMATIONS. 117 



pain, strangury, and a catarrhus vesicae : the other is an affec- 

 tion of the rectum, sometimes by pain alone in that part, and 

 sometimes by haemorrhoidal swellings there. In gouty persons 

 I have known such affections alternate with inflammatory af- 

 fections of the joints ; but whether to refer these affections to 

 the retrocedent or to the misplaced gout, I wiU not presume to 

 determine. 



DXXVI. From the history which I have now delivered of 

 the gout, I think it may be discerned under all its various ap- 

 pearances. It is, however, commonly supposed, that there are 

 cases in which it may be difficult to distinguish gout from rheu- 

 matism, and it is possible there may be such cases : but, for 

 the most part, the two diseases may be distinguished with great 

 certainty by observing the predisposition, the antecedents, the 

 parts affected, the recurrences of the disease, and its connexion 

 with the other parts of the system ; which circumstances, for the 

 most part, appear very differently in the two diseases. 



" Rheumatism and Gout are distinguished, First, By their 

 remote causes : Rheumatism may be known by its cause, the evi- 

 dent application of cold. I will not deny that gout has been 

 brought on by the same circumstances, by cold affecting the 

 body, and in a patient labouring under a catarrh ; but this is 

 very rarely the case in the first attack. One cause they have 

 in common, viz. sprains ; for, if desired to recollect, most pa- 

 tients attribute to this the first fit of the gout, as well as the 

 rheumatism. Often hereditary communication may be consi- 

 dered as the cause of the gout, never of rheumatism ; for though 

 the latter may appear in those whose parents have been subject 

 to it, yet we always find, that it has, even in them, arisen from 

 external causes. 



" Secondly, The gout is more frequently preceded by some 

 change in the state of the stomach, some symptoms of indiges- 

 tion, with this peculiarity, that after they have subsisted for 

 many days, or even for weeks, the day immediately before the 

 attack of the gout the appetite is uncommonly sharp and vigor- 

 ous. I have observed that the rheumatism is a disease of the . 

 joints, and that it only affects the other parts by the inflamma- 

 tion it excites, and the increase of the action of the vascular sys- 

 tem, or fever. Indeed, this is also true of gout, that it excites 



