This variety of pain differs from that of colic or ordinary neuralgia, and is probably seated in the sympathetic visceral plexuses. So general does the disturbance become, that distant organs may be in volved in the paroxysm of distress. The association of headache with gastralgia, nausea, and vomiting has been already noted. The heart also shares in the disorder—exhibiting disturbances of the rhythm and force of its beat. Violent palpitation, irregular and intermittent pulsation, with temporary dilatation of its cavities, and feeble circu lation of the blood in the extremities and organs of the body, are common consequences of the irritable weakness that is thus rendered apparent. Sometimes an attack of vertigo adds to the confusion and distress of the sufferer, though this complication is unusual before the latter half of life is reached.
In many instances dyspepsia seems to be of gastric origin, but in many others the liver appears to be the principal seat of disorder. There is a bitter taste in the mouth, especially on rising in the morn ing. A yellow fur befouls the tongue; the mouth is sticky, and the breath may become offensive; the bowels are sluggish; the urine is high-colored and loaded with pigment; the skin becomes slightly jaundiced. This array of symptoms may persist for a long period of time, and may disappear by gradual resolution. But it may become aggravated, and be finally accompanied by evident enlargement and tenderness of the liver. A sensation of weight and dragging pain may be experienced in the right hypocliondrium. At last the diffi culty culminates in a "bilious attack" characterized by headache, bilious vomiting, and sometimes by brief diarrhoea, after which the patient feels greatly relieved. In certain cases, however, the phenom ena of intestinal dyspepsia become quite confirmed. The stomach may not be involved, and in such case there is no dyspeptic disorder until an hour or two after eating. Then the abdomen feels tense and uneasy; there is great flatulence, and gas escapes in considerable quantity from the anus or lingers in the coils of the intestines, where it intensifies the discomfort of the sufferer. The faeces are usually clay-colored, often scanty and constipated, or passing off after the fash ion of a mild diarrhoea. But in many instances the disorder is only terminated when its symptoms are merged in a full-blown attack of articular gout. Sometimes it is possible for an experienced patient thus to be forewarned of an approaching attack by the clay-colored stools and the general disturbance of intestinal digestion, indicative of retention of biliary excreta. as well as of delay in the discharge of
unites through the kidneys. After the crisis of an attack there is usually an excess of all these substances in the faces and in the urine, indicating a close connection between their retention and the phe uomena of the disease. Thus it appears that the dyspepsia with which these patients suffer, though usually involving the stomach and all below it at the same time, may sometimes attack the stomach alone or the liver and its dependencies alone. The victims of hepatic dyspepsia lose their appetite, and instinctively crave acids, spices, bitters, coffee, and alcoholic stimulants, to aid in its recovery, though such artificial provocatives usually do more harm than good. They also tolerate animal food that is deprived of fat; but they cannot easily digest sugars, starches, or farinaceous articles of diet.
Among the other premonitory symptoms of gout have been noticed a tendency to subconjunctival congestion affecting the sclerotic and the conjunctiva in the neighborhood of the insertion of the ocular muscles. It is usually a transient phenomenon, and is sometimes noted among rheumatic subjects. Scintillant scotomata and hemi anopsia are also sometimes experienced in the form of brief paroxysms of the disorder. Grinding of the teeth during sleep_ occasionally happens at any age, but it is more frequent among patients in later life. Sometimes their molars are worn nearly to the gums by this mode of attrition.
The depression of spirits that has been already noted sometimes, especially among elderly patients, reaches the level of hypochondria, or even of melancholia. The whole character is temporarily altered ; the busy leader of men becomes incapable of restraining his own temper, or of caring for anything but the incidents of his own wretched health. He is irascible, unreasonable, and sometimes violent in his behavior. Witness the lives of Frederick the Great and his father. Of the hypochondriacal condition, the famous Lord Chatham exhib ited during his later years a most illustrious example, graphically narrated by the historian Lecky (" History of England during the Eighteenth Century," Vol. III., pp. 133-156). In certain cases, probably predisposed to mental derangement, such periods of wretchedness always precede an attack of gout, and are as invariably dissipated by the outbreak of inflammatory symptoms.