MEDICINE. 
awakened by a very acute pain, most com- 
monly in the first joint of the great toe : 
sometimes, however, it attacks other parts 
of the foot. The pain resembles that of a 
dislocated bone, and is attended with the 
sensation as if all but cold water was poured 
upon the part. There is at tlie same time 
more or le.«s of a cold shivering, which abates 
as the pain increases in violence, and is 
succeeded by a hot fit. The pain, from the 
commencement, gradually becomes more 
violent : it is sometimes so acute, as to be 
compared to a dog gnawing the part, and 
that and the fever continue in the same 
state, accompanied with great restlessness, 
till next midnight, when they gradually re- 
mit, and after a continuance of twenty-four 
hours from the commencement of the pa- 
roxysm, they commonly cease entirely : the 
patient falls asleep, during which a gentle 
peispiration generally comes on, and on 
waking he finds. the part affected somewhat 
red and swelled. For some days the pain 
and fever return in the evening, but with a 
less degree of violence, and a remission 
takes place towards morning; and after 
these symptoms have continued for about 
ten or fourteen days, gradually becoming 
less severe, they generally cease altogether. 
Costiveness, an impaired appetite, chilliness 
of the body towards evening, are also to 
be reckoned among the symptoms of this 
disease. 
The indications of cure are, in the pa- 
roxysms, to moderate their violence and 
shorten their duration as much as can be 
done with safety; and in the intervals to 
prevent the return of the paroxysms, or to 
render them less frequent and more mode- 
rate. The violence of the paroxysm will 
be moderated by blood-letting, which must 
be repeated according to the state of the 
pulse and degree of excitement, where the 
constitution is not worn down by repeated 
attacks; leeches should be applied to the in- 
fliamed parts, and gentle cathartics should 
be administered: these parts should also 
be exposed to cool or cold air, and diluting 
liquids should be taken freely: the anti- 
phlogistic regimen must be strictly adhered 
to : abstinence from wine, spirits, ferment- 
ed liquors, and stimulating food, should be 
carefully enjoined, unless the system is very 
much debilitated ; in which case a more 
nourishing diet, and a small quantity of wine 
or of diluted spirits may he allowed : after 
the excitement has been subdued by pro- 
per evacuations, blisters may be employed 
with advantage ; they are recommended by 
that enlightened physician. Dr. Rush, to be 
applied to the legs and wrists : burning 
with moxa may be advised, or a cabbage- 
leaf applied to the part affected will often 
afford considerable relief ; bootlets made 
of oiled silk, are an useful application to 
gouty joints: when tlie violence of the 
symptoms is abated, opiates may be given 
with advantage, wben the pain only returns 
during the night, and prevents sleep, When 
the constitution is broken down by repeated 
attacks of the disease, evacuations mu.st be 
employed with caution, and it will in gene- 
ral be more advisable and safe to allow 
some animal food, and wine or diluted 
spirits : the parts affected should at the 
same time be wrapped in flannel, fleecy 
hosiery, or new-combed wool, and a gentle 
diaphoresis should be excited. When a 
swelling and stiffness remain in the joints, 
after the paroxysm has ceased, they will be 
removed by the diligent use of the flesh- 
brush, gentle exercise of the parts, and the 
Buxton or Bath waters, taken at the foun- 
tain head ; and where the gout has left a 
number of dyspeptic symptoms, the latter 
may be drank with considerable advantage. 
Purging immediately after a paroxysm will 
be very apt to induce a relapse. In the in- 
tervals we must endeavour to prevent a re- 
turn of the paroxysms, or to render them 
less violent ; 1. By temperance, which 
should be regulated according to the age, 
habits of life, and constitution of the pa- 
tient. It is very probable that a diet, con- 
sisting of milk, vegetables, and water, would 
prevent the recurrence of the disease ; but 
in general fish, eggs, the white meats, and 
weak broths, may be taken in small quan- 
tities once a day, and a little salted meat 
may be eaten occasionally, and weak wine 
and water, or small beer, may be taken at 
meals. As there is a disposition in the gout 
to return in the spring and autumn, a gi eater 
degree of abstinence in eating and drinking 
will be necessary at those seasons than at 
any other period : and if any of the premo- 
nitory symptoms are then present, and the 
vigour of the system remains unimpaired, 
the disease may be often prevented from 
occurring by the loss of a few ounces of 
blood, or perhaps by an emetic or a gentle 
cathartic, and afterwards bathing the feet 
in warm water ; a full dose of the tincture of 
opium might probably be of service. In the 
decline of life, or when the constitution is 
much debilitated, this abstemious mode of 
living must be commenced with caution, 
as it might be the means of inducing more 
