272 PATHOLOGY, 
From the inveftigations of Dr. Wollafton, however, and 
other modern chemifts, it has been afcertained that they 
contain no calcareous or earthy matter, but confilt of a 
neutral fait, formed by the combination of the lithic 
or uric acid, with the fixed alkali, foda ; conftituting a 
lithate or urate of foda. Thefe concretions form princi¬ 
pally about the joints of the toes and fingers, in little 
nodules; but fometimes they appear about the larger 
joints, as the elbow and knee, occafioning a whitifh 
fwelling almoft as large as an egg, which becomes gra¬ 
dually inflamed and red. 
The attack of the regular gout is readily diftinguifhable 
from the only difeafe which refembles it, viz. acute rheu- 
matifm, if all the fymptoms are taken into confideration. 
In the firfl place, gout is commonly a difeafe of advanced 
life ; acute rheumatifm is moft frequent from the age of 
eighteen to thirty. 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 firfl 
attack it often feizes every joint of the body in fucceflion, 
and fometimes continues for feveral months. The colour 
of the fkin of the part affeCted in rheumatifm, if it. be 
changed, is only flightly red, whereas it becomes of a 
deep bright red in the gout. The pain in the rheuma¬ 
tifm is not extremely acute while 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 ftomach, which precede the paroxyfm of 
the gout, together with the marks of diftinCtion juft men¬ 
tioned, will ferve particularly to determine the nature of 
the paroxyfm. It mull be admitted, however, there are 
inftances of the combination of the fymptoms of the two 
difeafes, which renders it difficult to decide to which of 
them the individual examples belong. 
When the gout is cured in the limbs, inflammation of 
other organs of the body is often obferved ; and many 
practitioners have concluded that the tranfiated difeafe 
differed from common inflammation. There appears no 
juft reafon for fuppofing this. The fymptoms of thefe 
inflammations are fimilar, and the cure precifely the fame. 
Our knowledge of the previous condition of the patient 
might induce us to rely more fully on counter-irritation, 
feeing that this procefs had a curative effeCt on the ori¬ 
ginal malady; but further no difference fhould be made 
between the treatment of gout and that of inflammation, 
\vhen vital organs are attacked. Simple irritations alfo 
alternate with gout, and require the ufual treatment: 
fevere fpafms of the belly by hot and ftimulating medi¬ 
cines ; and fo on. 
The cure of gout is no eafy talk. It is one, however, 
which well repays the praCtitioner for his labour, whether 
he confiders the alleviation of human fuffering, or the 
pecuniary emoluments he derives from his profeffion; for 
no difeafe is productive of more pain, or more exclulive- 
ly attaches itfelf to the higher orders of fociety. 
The connexion between gout and indigeftion having 
been pointed out, it remains merely to apply the know¬ 
ledge of this connexion to the cure of the difeafe. In 
the firfl place, we have ftated fulnefs of veffels to be one 
of the conditions of gout: this therefore nnift be removed. 
In fome cafes, a very large bleeding may be neCeflary; in 
others, a very ftnall one will fufficiently diminilh the 
plethora. The treatment of the local plethora is com- 
prifed in cold lotions, leeching, or cupping; but thefe 
fhould not be ventured on till general plethora has been 
removed by bleeding, and the derangements of the di- 
geftive organs, which firfl give rife to the fymptoms in 
the extremities, fet to rights. For the latter purpofe, 
temperance and aClivity are the chief meafures in which 
we can place confidence. By temperance, however, we 
do not mean a fudden relinquifhment of the nutritious 
food and ftimulating liquors in which the patient has 
indulged; neither, in recommending exercife, is it our 
intention to caufe exceffive exertions to fuperfede a life 
of flothful eafe. The diet mull retain many of the pro¬ 
perties to which the gouty fubjedl has long been aecuf- 
tomed; and the change which we make fbduld be gra¬ 
dually brought about. 
_ We cannot give any very precife rules as to the fort of 
diet which it fhould be our ultimate aim to eftablifh. It 
may be fufficient to remark, that in plethoric patients 
this fhould gradually be deprived of thofe fubftances 
which are rich and eafy of affimilation, while the quan¬ 
tity is at the fame time diminifhed. In patients who are 
not plethoric, but in whom nervous irritations, whether 
mental or otherwife, have deranged the digeftive organs, 
this plan mull be modified ; and the diet of a nutritious 
though eafily-digellible quality, as jellies, foups, &c. muft 
fuperfede the more abftinent diet. 
As to the medical treatment of the gouty, this will 
in fome meafure vary according to the nature of the at¬ 
tending dyfpepfia. The acid fecretions of the ftomach 
require carbonate of foda, a medicine which alfo aCts on 
the kidneys. Derangement in the hepatic fecretion re¬ 
quires calomel; and the inaction of the bowels, purga¬ 
tives, &c. But, upon the whole, it feems generally un- 
derftood, that little medicine is required in the dyfpepfia 
of gouty patients. The derangement in the fecretion 
of the kidneys in gout has made many phyficians turn 
their attention to a probable connexion between thefe 
two afteCtions. In fpeaking of Dyfpepfia, we have al¬ 
ready ftated the opinion of a diftinguifhed pathologift, 
that in that complaint an acid is actually affimulated 
into the blood, and that it gives rife to gravel; and, as 
is well known, an acid humour in the blood was once 
confidered the proximate caufe of gout. We have alrea¬ 
dy mentioned objections to Dr. Phillip’s views on t.he 
fubjeCt of calculi. It is certain, notwithftanding, that 
promoting the fecretion of the kidneys is attended with 
falutary effects in the complaint under confideration. 
The aCtion of the fkin and of the capillary fyllem in 
general ftiould be excited, in gout, by bathing, and 
by exercifing the found limbs. The fame treatment, which 
cures the gout once eftablifhed, prevents alfo its recur¬ 
rence ; and indeed, if temperance and exercife were ftritdly 
ufed during convalefcence, it is probable that few would ff- 
fer from repeated attacks of gout. 
Having then gone through the treatment of gout on 
principles of pathology, it remains to mention a powerful 
remedy, of the falutary efteCl of which moft medical men 
can bear teftimony, though they know nothing of its 
modus operandi. This is the Colchicum, or meadow- 
faffron. It has long been ufed in quack-medicines as a 
fpecific for the gout; and was preferibed by the ancients; 
and lately it has become extremely popular. It is faid to 
ail on the fkin, the kidneys, and the bowels; but it 
fometimes does much good without producing any vi- 
fible efteCl of this kind. It is not, however, a fpecific for 
gout: it is a highly dangerous remedy to tamper with ; 
and it labours under the opprobrium, that patients cured 
by it are very apt to fuffer attacks of gout at a (horter 
period than when cured by the ordinary plan of treat¬ 
ment. It may be ufed in conjunction with other medi¬ 
cines with great advantage. A variety of formula are 
advocated by different practitioners; but it does not 
feem that any one of them is preferable to another. We 
have generally ufed the wine. It is worthy of remark, 
that if the fediment be feparated from the preparation of 
Colchicum, its effeCls are lefs likely to be injurious than 
if this portion is taken into the body. We repeat, that 
few patients who are cured by Colchicum, or by any 
other medicine, will fuffer a relapfe if they ftriClly ob- 
ferve temperance and exercife. 
4. Arthrofis hydarthrus, white fwelling : tenfe, per¬ 
manent, colourlefs fwelling, chiefly of the larger joints ; 
inflammation flow, and deep-feated ; pain fevere and 
fixed ; imperfeftly fuppurative ; fever a heftic. Two va¬ 
rieties are noted. 
u. Plethoricus, rheumatic white fwelling: pain dif- 
fufed; fwelling confiderable from the firft 5 originating 
z and 
