GOUT. 



foot, wliich return at intervals, and are connefted with 

 dcraiigfincnt of the digeftive organs. Tlie term, liowever, 

 includes fuch a variety of morbid aJeftions, in its extended 

 fcnfe, that it is not eafy to give a concife definition of it ; 

 and we mull: have recourfe to a more ample defcription of 

 thofc affedtions, in order to convey a jull notion of its figiii-, 

 jication. 



The ancient phyficians included all the varieties of inflam- 

 mation, that are liable to occur in the joints, under the ge- 

 neral term, ArthMs, ( from af 3 jo,-, aynnt, witli the termina- 

 tion tits, denoting inflammation,) for the dillinclions, made 

 by modern phyficians, between the two modifications of im- 

 fiammation in the joints, now denominated ^nul and rheii' 

 miliftn, had not then been attended to. Tlie term /liih- 

 rilis, however, was ufed both as a generic and fpecific term, 

 and fignilied, not only inflammation of the joints generally, 

 but the ordinary form of gout by way of excellence. But 

 the Greeks alfo gave fpecific names to the varieties of ar- 

 thritis, according to tlie particular joints which tlie difeafe 

 occupied : thus, tor the ordinary form of gout in the foot 

 the term troliy^x, podiigra, was employed, whicli alfo be- 

 came a generic title ; for gout in the liand, the word xiifwye^, 

 chiragra ; and for gout in the knee, yo-ziy^ot, gonagra ; and 

 io on. Among the fpecies of arthritis was alfo included the 

 ifchias, fcintica, or htp-gont, which is now deemed a fpecies 

 of rheumatifm. "I'hefe terms the Romans adopted ; and 

 they are llill^retained in medical language. Our vernacular 

 term gout, which came to us probably through the French, 

 lagoiitte, originated in the dark ages among tlie humoral patho- 

 logies, who confidei-ed the difeafe as arifing from the How 

 depofltion of a morbid humour, gutlatim, as it were, upon 

 the joints ;, hence, the name giitta, or drop, was applied to 

 the difeafe. Tiiis term, according to Du Cange, was ufed 

 by Radulfus, a Dominictn of the 13th century, who writes, 

 " cum gulta, quam podagram vel arthreticam vocant, fre- 



, quenter vexaretur." Mufgrave de Arthritide. 



' In confequence of the various forms whicii gout affumes, 

 phyficians have divided it under two heads, ngti/nr and ii-ir- 

 gtilar gout, or, as fome have termed it, tonic and atotiic gout ; 

 the former occurring in the earlier periods of life, while the 

 ftrength or tone of the fyllem remains unbroken ; the 

 latter, after a certain degree of weaknefs, or atony of the 

 conflitution, has been produced by the frequent attacks of 

 the diieafe, advanced age, or other caufes. We (hall firft 

 defcribe the fymptoms by which thefe forms of the difeafe 

 are cliaradleriied, and afterwards flate the caufes and inethod 

 of treatment, together with the fpeculations of pathologills, 

 rtfpefting the nature of the difeafe, beginning with an ac- 

 •count of the paroxyfm of 



Regular Gout — It is an inflammatory affeftion of the 

 joints of the foiit, which conftitutes what is called a fit or 

 paroxyfm of the regular gout. Tiiis fometimes comes on fud- 

 denly witliout any warning of its approach ; but it is gene- 

 rally preceded by feveral fymptoms, efpecially by thofe of 

 indigcltion, as heart-burn, flatulence, and heavinefs after 

 meals, with eruftations of acid or bitter matters, and fome 

 decree of languor and torpor of the body ; but immediately 

 before the fit the appetite is fometimes imufually fliarp. 

 There is all'o often an unufual coldsiefa of the feet and legs 

 for 3 few days preceding the fit, with the eefl"ation of the 

 perfpiration about the former ; a frequent numbnefs, alter- 

 nating with a fenfe of prickling, alon» the whole of the 



, lewer extremities ; occafional cramps of tlie mufcles of the 

 legs J and an unufual turgefcence of the veins, are occa- 

 Aonally ohferved. 

 The attack is fometimes felt in the evening, but more 



commonly about two or threi^ o'clock in the morning [ ■ 

 when the patient is awakened from a quiet deep by a pain- 

 affefting one foot, generally tlie ball or firll joint of the 

 great toe, but fometimes the other parts of the foot, or the 

 ankle. Tiiis pain is accompanied with more or lef? of 

 cliiUinefs and (liivering, which, as the pani increafes, gradually 

 ceale, and are fucceeded by a hot (lage ot pyrexia, or fymp- 

 tomatic fever, v.'hich continues during the iame time as the 

 pain. The pain becomes by degrees more and more violent ; 

 at tirll it is attended with a fenfation, as if warm water were 

 poured upon tlie membranes afi'eCted, and is laid to refemblc 

 the pain of a diilocated joint ; as it becomes fevcre it is 

 fometimes defcribed as refembling the pain of a tenfion, or 

 laceration of the ligaments, fometimes as like that from the 

 gnawing of a dog, and fometimes as a feeling of weight and 

 conllridtion of the membranes of the part, whicli becomes 

 io exquifitcly tender, as not to endure the weight of the bed- 

 clothes, nor even the (liaking of the room from a perfon 

 walking brilkly in it. Hence, great reillefsnefs of the 

 whole body, and efpecially of the part aiTected, always 

 accompanies the fit ; the patient conftantly changing hii 

 pofture, with a view to eafe the pain, which, neverthelefs, 

 continues fevere all the following day, until mid-night, 

 after which it gradually remits ; and about two or three in 

 the morning, that is, after twenty-four hours from the firft 

 attack, it commonly ceafes almoll entirely ; and this freedom, 

 with the breaking out of a free perfpiration, allows the 

 patient to fall afleep. On waking, he finds the pain flight, 

 and the part affefted with fome rednefs anl fwelling. 



When a paroxyfm has thus come on, although the violent 

 pain, after the period of twenty-four hours, be confiderably 

 diminilhed, yet the patient is not entirely without pain. 

 For fome days he has a return every evening of pain and 

 fever, which continue, with more or lefs violence, till 

 morning. After continuing in this manner for feveral days, 

 the diieafe fometimes goes off entirely, not to return till 

 after a long interval ; and in fuch cales it generally leaves 

 the perfon in very perfeft health, enjoying greater eafe and 

 alacrity in the functions both of body and' mind, than he 

 had for a long time before experienced. 



It often happens, however, that the difeafe does not thus 

 fpeedily quit the patient, efpecially when lie has previoufly 

 fi.flTered confiderably from its attacks. For, inllead of 

 ceafing altogether after a few days, it feizes the other 

 foot in the iame manner as it did the former, both in refpeft 

 to the vehemence and duration of the pain. Moll com- 

 monly the foot firfl. affetted becomes quite eafy, in fuch a 

 cafe, and even as llrong and healthy as if it had not been dif- 

 eafed ; but fometimes both feet are affeAed together, and 

 with equal violence. When this happens, the fucceeding 

 exacerbations, as Sydenham remarks, are lefs regular both 

 as to the time of coming on, and as to their continuance ; 

 but the pain always increafes in the evening and remits 

 in the morning; and what is called a fit of the gout, 

 which goes oflf fooner or later, according to the age and 

 conllitution of the patient, is made up of a number 

 of thefe little fits. For when this difeafe lails two or 

 three months, it is not to be elleemed one continued fit, 

 but rather a feries or alfemblage of fmall fits, the laft of 

 which proves milder and fhorter, until the whole is termi- 

 nated. In ilrong conilitutions, and fuch as have the gout 

 feldom, the attack is commonly finifhed in fourteen days ; 

 but iji thofe of advanced life, or who have frequent returns 

 of the difeafe, thefe feries of fits will continue for two 

 months ; and in fuch perfons as are more debilitated, either 

 by age or the long continuance of the diforder, it will not 



