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Symptoms of Acute Gout

pain, patient, attack, morning, paroxysm and premonitory

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The onset of an attack occurs in no uniform fashion. Sometimes it comes on suddenly, in the midst of perfect health, and the patient is waked in the middle of the night by a terrific pain in the foot. Sometimes, after the occurrence of various premonitory symptoms, as above described, all pain and uneasiness cease; there is perfect relief from suffering; the spirits rise and become buoyant; an exalta tion of function is evident in every organ of the body. But this is only a deceitful lull in the storm, and after a few hours of comfort, the attack is ushered in as usual with an agonizing nocturnal par oxysm. With certain patients this mode of attack is uniformly ex perienced with every recurrence of the disease. In other instances, however, the premonitory symptoms persist for a long time, and increase in severity until the very moment of. the articular paroxysm.

In many cases the future localization of the disease is predicted by antecedent pains of a rheumatic character that hover around the joints, especially iu the lower extremities. Sometimes they are as sociated with slight articular swelling that suggests the imminence of an attack of rheumatism. Still more emphatic is the appearance of turgescent veins in the leg, premonitory of the swollen veins that are to be found in the neighborhood of an acutely inflamed gouty joint. Among certain patients, the attack is immediately preceded by a feeling of profound prostration and universal exhaustion. This experience is often a consequence of some form of physical or mental over-exertion. Thus, it may follow excessive fatigue after a long walk, a debauch, a venereal extravagance, or an intellectual effort of unusual duration and intensity. The patient seeks his couch in a condition of feverish lassitude very similar to that of influenza, and before morning the great toe is violently inflamed.

But, however advertised and foreshadowed, the acute attack is marked by a paroxysm of painful inflammation that has no parallel in other diseases. It is usually in the middle of the night, between the hours of twelve and two, that the patient is waked by a horrible pain in the arch of his foot, or at the base of the great toe.

moves and twists and turns; he draws up his leg, and then pushes it out again; he tries every possible change of position; but in vain. The pain will not cease. At first, it seems like that of a sprain or a bruise, and the mind calls up all the incidents of the preceding day in search of some accidental cause for such distress. As the hours roll on, the agony increases; it is a biting, tearing, crushing pain, as if the member were being rent by the teeth of a tiger, or were slowly yielding to the compression of a vise. The sufferings are in creased by recurrent spasmodic muscular contractions that shake the limb. The weight of the bed-clothes is intolerable, and every movement of the bed itself is unendurable. Besides pain there are redness, heat, and swelling in the affected part. A universal fever burns the patient; all the classical symptoms of acute inflammation are present.

Fortunately, however, the paroxysm is not interminable. Toward three or four o'clock in the morning a gradual subsidence of the pain begins. Slowly the fever yields; a gentle moisture bedews the fore head ; sleep comes at last, and with it some degree of imperfect re pose. When, at a late hour of the morning, the patient awakes, his foot is lame and tender, and the great-toe joint is swelled and red. Still, the clay may be passed in comparative comfort; but as evening returns the paroxysm is renewed, though usually with a degree of severity that does not quite equal that of the previous night. It reaches its height soon after midnight, and then subsides again at the approach of morning. In this way with gradually decreasing intensity the successive paroxysms follow ea-ch other for several clays —perhaps for an entire week. Little by little the swelling disap pears; fever ceases its manifestations; appetite returns ; and in a few days the patient is restored to his usual health.

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