G O U T. 



gii off till tlip fiimnn-r advunccs, (beginning, as is mod c1"!it., which Sydenliam compares to crab's cvts ; but fome. 

 cosnnioii, in January, or early in February,) which fcems to times thvy appear about tlic lar^jer joints, as' the elbow and 

 drive it away. knee, Oi ca/ioning a whitifli fwelling aiinoll ai large as an 



When the fit is going oft", a violent itcliing feizcs the egg, which becomes gradually iii'lanied and red. Mr. Wat. 

 foot, efpecially between the toes, ajid the cuticle peels off. fon has rel-itcd an example of a very cxtenfivc depolftion of 

 The appetite and ftrength return fooner or later, accordi'g urate of ioda, in a g-mty man, who was a martvr to the 

 ti> the greater or lefs feverity of the preceding {it, and the difeafe. Chalk-dojie-; not' only enveloped the joint's of hii 

 interval of health between the paro::y!V.is is generally nearly gr^at toes, formed tun-:ours upon liis legs, and, being mixed 

 in the fame ratio ; /. e. longer in proportion to the greater with the fynovia of the large joints, rendered this fluid as 

 violence of the lall fit. At the beginning of the difc.iie, thick as cream ; but " the joints of the ringers were fwclled 

 Dr. Cullen obfer\'es, the returns of it are fometimcs oiily and knotty, every knot being a lump of chalk ; and I was 

 once in three or four years ; but after fome time the inter- told," he adds, <' that when he jjlayed at cards, he ufed frc- 

 vjls become fliorter, and the attacks become annual : after- quently to fcore up the game with his knuckles." (See 



v.-aids they come twice each year, and at length recur iVIedical Cumnii.nications, vol. i. art. ^. See alfo Parkin- 



feveral times during the whole courfe of autumn, winter, fon's Obf. on the Nature and Cure of Gout, p. 5.) 

 and fpring ; and as it happens that, when the fits are Such is the progrefs of gout, as it affects the joints, and 

 frequent, the paroxyfms become alfo lonirer, fo, in the while it may, therefore, be called regular gout. Svden- 

 advanced Hate of the difeafe, the patient is hardly ever ham, indeed, and fome other v. riters, confine the appcliatioa 

 tolerably free from it, except, perhaps, for two or three of reguhir to gout in the I'eet only ; and confider it as irregit- 

 months in fummer. lar, when it attacks the hands or othi-r joints. But Dr. Cul- 



Before the difeafe becomes thus inveterate, however, it len, Warner, and the pli) ficians of the prcfent dav, in "ene- 

 lias gradually affumed other appearances, and attacked ral, agree in calling the difeafe, when it confills only of an 

 other parts of the body. At firli it commonly affecls one inflammatory afler'tioii of the joints, the regular gout : " and," 

 foot only ; but afterwards every paroxyfm affefts both Dr. Cullen obferved, " whatever fymptoms we can per- 

 fect, the one after tlie other, and then both together ; and ceive to be connided with, or to depend upon, the difpo- 

 its changes of place, as it continues to recur, are not only iition which produces that inflammatory aftection, but with- 

 from one foot to th.e other, but alfo from the feet into other out its taking place, or being prefeiit at the fame time, we 

 joints, as the hands, wrills, elbows, knees, &c. ; fo that name the irregular gout." Firfl Lines, 1) ji8. 

 there is fcarcely a joint in the body that is not, on one Irregular gout, anomalous, internal or atonic gout, as it 

 occafion or other, affefted. It fometimes feizes on two has been alfo called, coiilills of various fymptoms of difor- 

 diffcrent joints at the fame time ; but more commonly it is der in the internal organs of the bodv, which do not differ 

 fevere in a fingle joint only, and paffes fuccefhvely from from the fymptoms affecting the fame organs under other 

 one joint to another ; fo that the patient's affliftion is often circumffanees ; it is, therefore, f'iifpe<Eled tliat thefe fvmp- 

 protracled for a long time. The pains, indeed, are com- toins are of gouty origin, wIk-u they occur in jierfons bcar- 

 raonly lefs violent, in this ftatc of tiie difeafe, than they ing the marks of a gouty diathelis or difpolllion : and cfpe- 

 wcre at firft ; but, in addition to them, lols of appetite, cially wlien, in fuch habits, either a manifell tendency to 

 ficknefs, and other fymptoms of the atonic gout, now the inflammatory affection of the joints has formerly appeared, 

 afHLi!:t him. Bel'ides, in the intervals between the iirfl or when the fymptoms alluded to are intermixed with, and 

 paroxyfms of the diforder, the joints which had been affected art> relieved by, fome degree of the inflammatory affeclion. 

 were entirely reftored to their former fupplencfs and llrength, The morbid fymptoms which appear, in fuch cafes, and an- 

 and were free from pain or uneafineis, and all the functions confidered as figns of alcnic gout, are principally alTeftion?: 

 of life were well performed. But in this protracted con- of the flomach ; Inch as lofs of appetite, indigeftion, and 

 dltion of the difeafe, the joints remain not only weak and fliff, its various concomitants of ficknefs, naufia, vomiting, 

 after the termination of the fit, but they become at length fo flatulency, acid eruiflations, and pains in the region of the 

 contrac'ted and dlfablcd, that although the patient can flomach. Thefe fymptoms are frequently accompanied 

 fland, and perhaps walk a little, yet it is very flowly, and with pains and cramps in the upper CNtremitics of the body, 

 with great lamenefs and difficulty, fo that he is fcarcely able which are relieved by the difcharge of wind from the flo- 

 to move from room to room ; and fometimes the joints mach. 'I'ogether with thefe atlcf tions of the rtemach, 

 lofe their motion altogether. ■ coflivcncfs alfo commonly occurs; but fometimes a loofe- 



In many perfons, though not in all, when the difeafe has nefs with colic pains. Thefe afTeftions of the alimentary 

 frequently recurred, this immobility of the joints is farther canal are ofteu attended with all the fymptems of hypochon- 

 increafed by the formation of concretions, of a chalky ap- driafis ; as dejedioii of mind, a conflant and anxious atten- 

 pearance, upon the outfide of them, and for the mo ft part tion to the flightell feelings, an imaginary aggravation of thefe, 

 immediately under the Ikin. The fecretion or depofition of and an apprehenfion of danger from tlnm. In the fame ato- 

 this matter is characteriftic of the difeafe, being the confe- nic gout, the vifccra of the thorax .^rt alfo fonulimes affed- 



qucnce of gouty inftamir.ation alone. It feems to be depo- 

 Jjted at firlb in a fluid form, but afterwards becomes dry 

 and firm ; in which ilate the concretions have the appear- 

 ance of a friable earthy fubftance, and have been called 

 Cil.\l.Ky/on« (which fee). From the inveftigations of Dr. 

 WoUafton, however, and oilier modern chcniills, it has been 

 afcertained that t!'cy contaii. :;o calcareous or earthy matter. 



cd, and palpitations, faintings, and allhma occur. And the 

 head alfo is often difordercd, with pains, giddinel's, fumno- 

 lency, and even apopleftic and paralytic affections. (Cul- 

 leii. See alio Mulgrave " De .Vrthritide Anomala," w)«ere 

 thefe various modifications of irregular gout are delcribtd at 

 length ; and Warner's " Full and Plain Account of the 

 Gout,' where his obfervations are tranflatcd, pp. 7c — 9c, 



but confift of a neutral ftl' . fivpicd by the combination of fecond edit.) 



tlie lithic or uric acid, wit!, the fixed alkali, foda, — coalUtut- We may here remark, in pafTing, that many errors have 



ing a llthate or urate of foda. Thefe concretions form prin- probably been committed, in conlidering almoli ever)- fpc- 



cipally about the joints of the toes and fingers, in little no- cies of indifpofition, that occurs in gouty habits, as arifmj 



Vol XVI. 3 '^ ^""* 



