2G9 
PATHOLOGY, 
who from mental exertions, from hereditary predifpofi- 
tion, or from tome other of the numerous caufes of indi- 
geftion, have had the abdominal vifcera difordered. In 
fpeaking of Dyfpepfia, we have before dated, that it was 
capable of producing nervous irritation in many parts of 
the body, and that, if it continued very long, was very 
violent in degree, or if the fanguineous fyltem was debi¬ 
litated, it would produce inflammation. This it feems 
to do in gout. We infer that it does fo, becaufe dyfpep¬ 
fia always precedes gout. It does not indeed appear that 
it is the long continuance or the violence of the nervous 
excitement which is the caufe of the inflammation, fince 
neither the one nor the other is often prefent. We mull 
look, therefore, to the fanguineous fyltem, which w’e 
believe will in all gouty cafes fie unufually full, and its 
contained blood will be unnatural. 
We are quite unable, in the prefent (late of our know¬ 
ledge, to fhow why the inflammation attacks the limbs 
and joints rather than other parts; but we are equally ig- 
norantof thecaufes which determine other inflammations 
to particular parts of the body. We conclude, then, 
that gout is a difeafe of irritation, in which the inflam¬ 
matory a&ion is brought on by diftant diforder. It is 
no argument againft the theory in queftion, that many 
patients are quite free from fymptoms of indigejlion during 
an attack of gout ; becaufe, as we have before Ihown un¬ 
der Dyfpepfia, inflammation being eftabliflied in a diftant 
part, it a&s as a counter-irritant to the original difeafe, 
as when long-continued indigeftion brings on inflamma¬ 
tion of the lungs, and the dyfpepfia goes off. Rheumatifm, 
on the other hand, feems lefs conne&ed with indigeftion. 
Having indulged in thefe few remarks, and being on 
the whole quite difi’atisfied with our progrefs in the 
aetiology of either gout or rheumatifm, we lhall proceed 
to detail their fymptoms and cure. 
i. Arthrofia acuta, acute rheumatifm : pain and in¬ 
flammation, ufually about the larger joints and furround¬ 
ing mufcles, often wandering; urine depofitingalateri- 
tious fediment; fever a cauma. Four varieties. 
a. A. artuum : pain chiefly felt in the joints and muf¬ 
cles of the extremities. 
( 3 . A. lumborum, lumbago: pain chiefly felt in the 
loins ; and (hooting upwards rather than below. 
y. A. coxendicis, fciatica pain chiefly felt in the 
hip-joint; producing emaciation of the nates on the fide 
affeCted, or an elongation of the limb. 
<?. A. thoracis, fpurious pleurify: pain chiefly felt in 
the mufcles of the diaphragm; often producing Pleuritis 
diaphragmatica. 
This divilion into varieties is rather nominal than real; 
and all the diftinclions of rheumatifm required by prac¬ 
tical men is that of acute or chronic, or combined with 
gout. 
Acute rheumatifm begins, like moll other febrile dif- 
eafes, with fits of chillinefs, which are fucceeded by in- 
creafed heat, frequent pulfe, third, lofs of appetite, and 
proftration of ftrength. Not unfrequently, however, the 
peculiar fymptoms appear before any febrile fymptom is 
obferved ; namely, pain and inflammation in the joints. 
The pain fometimes affefts the joints alone ; but often it 
afteCts alfo the mufcular parts, fhooting along the courfe 
of the mufcles from one joint to another; and it is al¬ 
ways increafed by the aCtion of the mufcles, that is, by 
any attempt to move the joints that are difeafed. Its ufual 
feat is in the larger joints, fuch as the hips, knees, (hould- 
ers,and elbows: the ankles and wrifts are alfo frequently 
attacked ; but the fmaller joints, fuch as thofe of the toe-s 
and fingers, fuffer confiderably lefs. Two, three, or more, 
of thefe joints, are commonly affe&ed at the fame time ; 
but the pain is conftantly fliifting its place, leaving fome 
joint and going to another, and frequently returning 
again to each of them feveral times during the courfe of 
the difeafe; and in this manner the difeafe is often pro- 
traded for a confiderable length of time. Soon after, 
and fometimes at the fame moment with the commence¬ 
ment of the pain, the joint feized becomes fwelled and 
foinewhat red, and is extremely painful to the touch. The 
pain is fometimes relieved by the occurrence of fwelling, 
but not always ; neither is the joint thus rendered more 
fecure from a return of the attack. The patient, thus 
unable to move the joints affeded, which are irritated 
and acutely pained by external contad, fometimes even 
by the weight of the bed-clothes, and in a ftate of fe- 
vere internal pain, unable to find any pofition of eafe, 
lies fleeplefs and reftlefs for feveral days and nights toge¬ 
ther. The fever accompanying the difeafe is molt confider¬ 
able during the night, at which time the pains alfo are moll 
violent. The pulfe is commonly from ninety to a hun¬ 
dred in a minute, and occafionally more frequent; often 
full, and fometimes hard and (harp, but molt frequently 
foft. The heat of the fkin is confiderable, and the dif¬ 
eafe is commonly attended with fweating, even from an 
early period, which is often profufe and con Hunt, but 
never either relieves the pains permanently or proves a 
crifis to the fever. The urine, in acute rheumatifm, is 
remarkably high-coloured from the beginning, and after¬ 
wards depofits moft copioufly a brownifh-red fediment, 
like brick-duft. This fediment, however, is probably 
the refult rather of the profufe fweating than of any pe¬ 
culiarity belonging to the difeafe ; fince it is commonly 
feen after a dole of fudorific medicine, or any other va¬ 
riety of perfpiration. Like the fweating, it does not oc- 
cafion or betoken any favourable change in the fever. 
The blood exhibits, in a high degree, the buffy coat. 
With the fymptoms above detailed, the rheumatic fe¬ 
ver often continues for feveral weeks: it feldom, howe¬ 
ver, proves fatal, and perhaps never while the joints 
alone are the feat of the difeafe ; the fever, indeed, 
ufually becomes lefs violent after two or three weeks, 
and the pains lefs fevere, and lefs difpofed to change 
their place. But occafionally the inflammation of the 
joints has difappeared, and fome vital organ, as the brain, 
lungs, or ftomach, has been feized with inflammation, 
by which the patient has been carried off; or thefe organs 
have become fimultaneoufly affe&ed, and the fame fatal 
event has enfued. 
It has been remarked by Dr. Cullen, as indicative of 
the peculiar nature of rheumatic inflammation, that the 
acute rheumatifm, though it has fo much of the nature 
of the other phlegmafiae, differs from all thofe hitherto 
mentioned in this, that it is not apt to terminate in fuppu- 
ration. Indeed this hardly ever happens in rheumatifm : 
but the difeafe fometimes produces effufions of a tranf- 
parent gelatinous fluid into the (heaths of the tendons. 
He fays, “ if we may be allowed to fuppofe that fuch ef¬ 
fufions are frequent, it muftalfo happen that the effufed 
fluid is commonly re-abforbed ; for it has feldom hap¬ 
pened, and never indeed to my obfervation, that confi¬ 
derable or permanent tumours have been produced, or 
fuch as required to be opened, and to have the contained 
fluid evacuated. Such tumours, however, have occurred 
to others, and the opening made in them has produced 
ulcers difficult to heal. (Firft Lines, par. 448.) The non¬ 
occurence of fuppuration in thefe violent rheumatic in¬ 
flammations is of itfelf a ftriking charaCteriftic of the dif¬ 
eafe ; and the circumftance, that it is not productive, on 
the other hand, of what are called chulk-Jlones, or of 
that cretaceous-like fecretion which is the refult of the 
inflammation of gout,' diftinguifhes it from the latter 
malady. In addition to this circumftance, however, 
there are other points of diftindtion between the gouty 
and rheumatic inflammation ; namely, that the latter 
ufually attacks the large joints; that it is not preceded 
by fymptoms of indigeftion ; that it does not recur in 
regular paroxyfms ; and that it attacks younger people, 
and thofe not liable to gout from their modes of life ; 
and that is ufually the effeCt of a fpecific caufe, cold. 
The predifpofing caufes of rheumatifm, are plethora 
and 
