118 PRACTICE OF PHYSIC. 



a greater action of the heart and fever ; but the gout is particu- 

 larly connected with the viscera, viz. the brain in the cranium, 

 the lungs in the thorax, and the abdominal viscera, but in an 

 especial manner with the stomach. Thus, the gout is generally 

 preceded by indigestion, borborygmi, and costiveness ; the ap- 

 petite is sometimes worse, but for the most part keener before 

 the paroxysm ; and, generally, if a gouty patient is desired to 

 reflect, he will remember that some particular affection of his 

 stomach appeared before the fit, though he will not himself 

 mention it, as at other times he is used to it. 



" Thirdly, By the part affected. In both cases the pains 

 accompany especially the joints ; but while the gout seldom af- 

 fects muscular parts separate from the joints, the rheumatism 

 frequently does so ; and while the chief seat in the gouty pains is 

 in the joints, we can perceive that the rheumatism runs along the 

 course of the muscles and communicating membranes. The hip- 

 joint is affected by both diseases ; and there it is most difficult to 

 distinguish them. In rheumatic affections the pains do not re- 

 main fixed there, but extend along the thigh, shooting out more 

 violently in the knee-joint, and from thence descending to the 

 ancle. The sciatic gout much more rarely spreads its pains to 

 the next joints in this manner. 



" The seat of the pain is further distinguished by the particu- 

 lar joints which the one or the other is disposed to occupy. In 

 the rheumatism it is often spread over a considerable part of 

 the body, so that a number of joints are frequently affected to- 

 gether, a circumstance very rare in the gout, in which the 

 pain moves only from one foot to the other, nor is it ever con- 

 siderable in both at the same time. In rheumatism it is more 

 severe in one joint than in another ; but the patient is frequent- 

 ly at a loss to say whih of them is the most violent. The 

 rheumatic pains are more common in the shoulders, elbows, and 

 wrists, and rare in the joints of the thumb and finger ; in the 

 lower extremities they are in the knees and ancles ; but rare in 

 the ball of the great toe. 



" Fourthly, Both diseases may, after being cured, again re- 

 cur ; but we very often find rheumatism occurring only once 

 during life. The gout almost constantly returns at the seasons 

 which are common to it, as well as to rheumatism, spring and 



