GOUT. 



Aive&. debility in the organs of dlgeftion, is well undcrftood 

 by thofc who are acquainted with the laws of flimulants on 

 the animal body. (See DF.niLiTY and Excitability.) 

 This faft, however, although fometimes adduced as an argft- 

 mcnt againfl the advantages of an abftemious regimen, in 

 preventing the gout, affords no fuch legitimate inference. 

 It is too obvious, indeed, to req\iire an elaborate dilcuflion, 

 that all extremes, haftily adopted, are liable to derange the 

 animal economy ; and that habit alone can render extreme 

 moderation invariably beneficial, on the one hand, and 

 enable us to bear excefs with a confiderable degree of im- 

 punity on the other. Anotlier mode of debilitating the 

 fyftem, which fometimes brings the paroxyfm ot gout, is 

 cxceffivc evacuation of any kind ; fr.ch as by ha;morrhage, 

 brillc purging, vomiting, &c,; efpeciaily in aged pcrfons, 

 ivhofe conlHtutions are already much broken down by the 

 tiifeafe. 



Ruddi-n viciffitudes of weather, efpeciaily when connefted 

 with nioilhire, as from mild to cold, or from fevere cold to 

 damp and mild weather, often excite the gout ; hence, 

 Sydenham remarked, that the molf frequent occurrence of 

 the gouty paroxyfm takes place in the latter end of J?.nuary, 

 or the beginning of February. The fit may be produced 

 either by the local application of cold and moillure to the 

 feet, or by a general expofure to it ; for fuch expofure, 

 which in moll people will oecafion rhenmatifm, a catarrh, 

 er a fore throat, will, in a gouty fubjecl:, excite a lit of the 

 pout. In like manner, bruifes or Iprains of the leg or foot, 

 or mere over-exercife ot the mufcles and ligaments of thole 

 parts, as in long walking, will fometinnes bring on a pa- 

 roxyfm. 



There is another alleged caufe of the gout, wliieli it 

 would not now be necelfary to mention, were it not noticed 

 by Botrhaave, Van Swieten, and others, tv'z. conlnglon. 

 Van Swieten confiders the difeafe as analogous to dylentery 

 and other maladies, which, although originating from very- 

 obvious caufes, neverthelefs propagate themfelves afterwards 

 by contagion. But the llories, by which this dottrine is 

 fupported, are fomewhat ridiculous ; fuch as this, that a dog 

 lying at his mailer's feet during a paroxyfm of the gout, 

 fiiddenly ran howling and barking round the room, ex- 

 prefling the pain which he had caught from his mailer, 

 whofe torture at the fame time became greatly alleviated, 

 &c. (Swieten Com. ad (J 1255.) 



Of the D'lagr.ofis. — The attack of the regulur ^ovX is readily 

 diftinguifliable from the only difeafe which refembles it, vii. 

 acute rheumatifm, if all the fymptoms are taken into con- 

 fideration. In the firil place, gout is commonly a difeafe 

 of advanced life ; acute rheumatifm is rr.oll frequent from 

 the age of 18 to 30. Nor does rheumatifm, like the gout, 

 feize the feet in preference to the other joints, or remain for 

 a confiderable time in the fame joint ; but at the firft attack 

 it often attacks every joint of the body in fucceflion, and 

 fometimes continues for feveral months. The colour of the 

 fkin of the part affefted in rheumatifm, if it be changed, is 

 only fiightly red, whereas it becom.es of a deep bright red 

 in the gout. The paiji in th3 rheumatifm is not extremely 

 acute, uhile the part is at reft, but becomes violent when it 

 is moved only ; which is not the cafe in the gout. And the 

 fymptoms of indigeftion and difordered Itomach, which 

 precede the paroxyfm of the gout, together with the marks 

 of diftinftlon juft mentioned, will ferve particularlv to deter- 

 mine the nature of the paroxyfm. It muft be admitted, 

 however, there are inllances of the combination of the fymp- 

 toms of the two difeafes, which renders it difficult to decide 

 to which of them the individual examples belong. (Hcber- 

 Ccii, Comment, de Morb. p. 58.) 



Again, the fymptoms which the irregular gout prefcnts, are 

 extremely numerous and proteifonii. appearing frequently 

 as dyfpeplia, hyfteria, hypochondriafis, aiUur.a, palpitation, 

 fyncope, vertigo, apoplexy, paralylis, &c. aceording to 

 the original or acquired tendency of the conllitutioii to thole 

 difeafes. Hence the dilcrimiiiation between thele modifica- 

 tions of gout, and the difeafe which it mimics, is occafionally 

 very difficult. 



Of the nature or proximate caiife rf Gout. — This is a part (>f 

 the fubject upon which, if we were to confine ourfeives to 

 the communication of atlual and ufeful knowledge, v.-c 

 (lioiild be altogether filent, or fay but a few words. The 

 obfervation, indeed, will apply to many other dileafes, as 

 w-ell as to gout ; but as gout is an affection almoft er.clu- 

 fively occurring in the higher claffes of iociety, among liie 

 wealtliy and intelligent, it has claimed a more general at- 

 tention, and become the objeft of more general difciiflidn. 

 It is greatly to be lamented, however, that the moll mif- 

 taken notions have prevailed, from the earliell times, in 

 regard to the nature and extent of the infight, which we are 

 capable of obtaining, into the operations of the animal eco- 

 nomy, and to the means by which we can obtain it. InSead 

 of confining themfelves to the obfervation of the phenomena 

 of health and difeafe, faithfully recording tliefe plienomena, 

 and arranging them ai cording to their moll obvious anak.- 

 gies,' phyllcians have been bufy in fearching after their 

 hidden caufes ; and, fancying a refemblance between tiie 

 moft diffimilar things, have fucceflively called to aid the 

 analogies of every human fcience, as it advanced in cultiva- 

 tion, to explain the phenomena ot animal life. The ancient 

 doilrines of numbers and elements, and their qualities, and 

 the modern difcoveries and luppofitions of the chemical, 

 mathematical, and mechanical philofophers, have in turn 

 been afiumcd as affording the moil perfect elucidation of tlie 

 operations of the living body ; and, as they have, of courfe, 

 been in turn exploded, we need not recur to any other argu- 

 ment in proof of their want of foundation. By thtfe remarks 

 we wilh only to ihew the futility of realuning on the fubjecl 

 of proximate caufes of difeafe, which, as we are and mull 

 remain entirely ignorant of the proximate caufe of health 

 and life, mull be equ;;lly infcrutable. " Nam qu;e demum 

 cauf^E,'' as Celfus juiUy obferves, " vel fecundam valetudi- 

 n em prajllent, vi 1 morbos excitent, &c. ne fapienti^ quideiii 

 profellores fcientia comprehendunt, fed conjeclura profe- 

 quuiitur,' (De Med. Prief. lib. i.) Tiie inquiry relpefting^ 

 the proximate caule of difeafes is as futile as the fpeculations 

 of the Cartcfidus to explain the efTcnce of gravitation, and 

 have as little to do with the advancement of true medical 

 fcience, as the hypothelis of an ether affilled Newton in his 

 obfervations and calculations refpcdling the phenomena of 

 that agent. 



If thefe obfervations flinuld not be fufficiently intelligible 

 to the general reader, a brief enumeration of the hypothefes, 

 which have been invented by medical writers, in order to 

 explain the effential nature of gout, will probably be fulti- 

 cient to prove the abfurdity of inch attempts. Moft of t lie 

 Greek and Roman phvficians, with the exception of the 

 methodifts, confidered the prefence of a corrupted humour 

 in the fmall veftels as the effential caufe of gout. Hippo- 

 crates believed this humour to confiil of bile and phlegm, 

 which flowed upon the joints. Galen followed him in lup- 

 poling the defluxion upon the joints to be chiefly pituitous 

 or phlegm, or bile mixed with phlegm. Paiilus iEgineta 

 attributed the di-feafe to a redundancy of blood, black hWp, 

 and phlegm. Trallian and Caflius imagined, that it arofe 

 from the blood itleit being forced into the joints ; and Ori- 

 bafius aiEnned that the blood in gouty people was vilcid, 



refemblinn- 



