GOUT. 



iVom the gouty diiitliL-fis. We rememher to have heard llii5 

 point Ihvmioiilly infilled upon by tlie iible profeffor yf phyiic, 

 in the iiniveriity of Edinburgh, Dr. Gregory. Many of 

 the fvmptoms above enumerated are obvioudy conneifted with 

 the impaired fundions of the ftomach, and occur in dyfpep- 

 iia, or indigellion, in liabits not gouty ; fuch are the various 

 hvpocliondriac fenfations ; tlic palpitations of the heart, otteu 

 arifnig from over-dillenfion of tlie llomach with flatus, by 

 whicli the heart is mechanically prcffed upwards : the cramps 

 in different parts of the body, which are often relieved by a 

 difcharge of wind from the liomach ; the difficulty ol breath- 

 ing, often occalioned by great dilteniion of the ilomaeh, 

 whicli impedes the defeent of the diaphragm ; and the 

 head-ache, giddinefs, &c. which are daily cbfervcd to be 

 connedled with impaired digellion. On the other hand, ui- 

 flammatory diforders of the lungs and other vifcera, con- 

 geftions in the head, inducing head-ache, fomnolency, verti- 

 go, &c., and ultimately various degi-ees of paralytic and 

 apopleftic difcafe, not effentially different, in any refpeft, 

 from the fame afteftions in habits not tainted with gout, have 

 probably been fuffered to go on, and to prove fatal, undcr 

 a notion that tliey were gouty, and the proper remedies 

 have been therefore neglcdled. 



The irre^iili7r gout occurs in a lefs equivocal form, when 

 the inflammatory Hate of the joints has come on in the ufual 

 manner, but when, without arifmg to the ordinary degree, 

 or atleaft without continuirgfor the ufual time, and receding 

 gradually, as is common, the pain and inflammation fudden- 

 ly and entirely ceafe, while fome internal part becomes dif- 

 ordered. This has been called the retrocedent or repelled gout. 

 When the "-out is thus retrocedent, the fame internal parts are 

 attacked, and the fame diforders produced, as in the n-regu- 

 lar or atonic gout, where no previous imperfeft attack upon 

 the joints had fliewn itfelf. The ftomach is for the moll 

 part commonly affetled, whence violent pain, ficknefs, vo- 

 miting, anxiety, &c.: the heart and lungs are alfo occaiion- 

 allv attacked ; and fometimcs the occurrence of apoplexy, 

 paify, or delirium, mark the head as the feat of the retro- 

 cedent difeafe. 



Another variety of irregular gout has been denominated 

 m'ifplaced gout ; namely, when, inllead of the joints of the 

 extremities, the ftomach, brain, lungs, intcftines, kidnies, 

 or bladder, become affedled with fymptoms of inflammation, 

 which give way upon the appearance of the inflammation 

 in the extremities, when that takes place. This inflamma- 

 tion of the internal organs, however, is indicated by the fame 

 fymptoms which accompany inflammation of the iame parts, 

 arifing under other circumttances, and in conllitutinns not 

 o-outy : audit has probably been fometimes fuppoled to be 

 of gouty origin, when it arofe from the ordinary cauies. 

 Dr. Cullen affirms, that he never met with any inilances of 

 mifplaced gout in his practice, and that no cafe has been dif- 

 tinftly made out by medical writers, except that of pulmo- 

 nary inflammation. But he had known two varieties of in- 

 ternal difeafe alternate with external gouty inflammation; 

 1V2. the one an aftedion of the neck of the bladder, pro- 

 ducing pain, ftrangurv, and catarrhus vefica^ ; the other an 

 affection of the reclum, fometimes marked by pam alone in 

 that part, and fometimes bv hemorrhoidal Iwelling?. 



Such are the phenomena, by which the various forms of 

 regular and irregular gout are chiefly characlcrized. The 

 noxtobjctl; of our inquiry will be the 



Ciutfes uf Gout. — Among the pred'ifpofing caufes of gout, 

 an original peculiarity of conftitution, often tranfmitted from 

 the parent to the offspring, appears to be the inoft common ; 

 in other words, the difcafe is faid to be hereditary. This 

 pofition, indeed, has beeu controverted^ efpecially by Dr. 



Cadogan (fee his DifT. on ^the Gout, and all Chronic Dif- 

 cafes, p. 7.) ; but the difcufhon has iurned upon a mere dif- 

 putc about words. For it it> admitted, on all hands, that 

 the predifpqfitloii of the conftitution to be affefted by gout is 

 traniiuittcd from father to fon, hke other pecidiarities of 

 habit; hke the family-likencfs, forinftauce, in features, in 

 voii^o, complexion, S:c. It is true, indeed, as Dr. Cadogan 

 contends, that fome perfons acquire this gouty difpofition, who 

 have it not by hereditary traulmilTiou ; and, on the other haudv 

 tliat the hereditary predifpofition may be countcratted by 

 various caufes, but particularly by certain modes of life, fo 

 that the difeafe itfelf fliall never appear. Yet it is equally 

 true, that the fame occafional cauies, which will excite the 

 difeafe in thole who are hereditarily predifptjfed to it, will 

 not produce it in others, although applied in greater force ; 

 and, therefore, the exiftence of an origina'l conftitutional 

 predifpofition muft neceffarily b'' inferred. The middle and 

 advanced periods of life are alfo more difpofcd to gout, 

 than the early periods : thus it does not commonly attack 

 men until after the age of thirty-five, and generally not till 

 a ftill later period. When the gout does appear, in more 

 early hfe, of which there are inftances, it feems to be iix 

 thofe in whom the hereditary difpofition is very ftrong, and 

 to whom the exciting caufes have been applied in a con- 

 liderable degree. Hippocrates remarks, that eunuchs are 

 not liable to be affecled by gout, nor boys previous to vene- 

 ry : but the intimation included in the remai-k is probably 

 unfounded ; fince, with reipect to the latter, the dileafe, as 

 we have already ftated, is almoft peculiar to an advanced 

 period of life ; and the eunuchs, who, in the time of Hip- 

 pocrates, were chiefly Perfian flaves, v.ere doubtlels confined 

 to the ftrift difcipline and the frugal and temperate life, 

 which the rigorous laws enjoined to all, and therefore not 

 expofed to the moft active caufes of gout. For Galen, in 

 his commentary upon this obfervation of Hippocrates, ob- 

 ferves that, in his time, the remark was no longer true, 

 " owing to too much indulgence on their part in an indolent, 

 as well as intemperate mode of life :" and the remark is 

 confirmed by modern experience. (Van Swieten. loc. cit.) 

 It has been fully afcertained, indeed, that the principal 

 fiiurce of the gouty habit confitts of high feeding and indo- 

 lence conjoined. Sydenham (who, upon the fubjeft of gout, 

 ftauds unrivalled in accuracy of obfervation, and the model 

 of all fuccecding writers, many of whom have done little- 

 more than copy his hillory- of it) begins his account of the 

 difeafe with thele remarks. " The gout generally attacks 

 thofe elderly perfons who have fpejit the greater part of 

 their lives m eafe and iiidulsience, both in tlie ufe of hiah 

 feeding and of wine, or other fpirituous and fermented 

 liquors ; and who, in confequence of the lluggiflinefs of ad- 

 vanced life, have ceafed from all thofe exercifes to w'hich 

 they were accuftomed in their youth. The gout, however,'' 

 he adds, " does not always wait till an advanced age ; it 

 fometimes attacks thofe who are in the prime of life. But 

 thc.Q; perfons have unfortunately received the feeds of the 

 difeafe from their parents ; or, if not, they have indulged in 

 premature and exceiiive venery, or left off entirely thofe ex- 

 ercifes which they had previoufly ufed with great adlivity, 

 and have been belides moll indulgent to the appetite, and 

 drank to excefs of vinous and fpirituous liquors, afterwards 

 fuddenly turning to thole that are thin and cold." (Syden- 

 ham, TraClatus de Podagra.) Thefe fafts have been long 

 known. There is a Greek epigram literally figuifying, 

 " of limb-relaxing Bacchus and limb-relaxing Venus is born, 

 a daughter, the limb-relaxing Gout." And a fimilar ob- 

 fervation is contained in the adage, " Bacclius pater, Venus 

 mater, et Ira obftctrix Arthritidis." While this faft is 



«on£rmcd^ 



