Sydenham's treatise on gout is interesting not only as containing the well-considered views of a master in the medical art, but also as the faithful description of the disease by one of the victims of it. His account of the paroxysm of regular gout may be given here with sonic abbreviation. After some weeks of previous indigestion, attended with flatulent swelling and a feeling of weight, rising to a climax in spasms of the thighs, the patient goes to bed free from pain, aud having had rather an unnaturally strong appetite the day before. In the middle of the night, he is awakened by a pain in the great toe, or sometimes in the heel, the ankle, or the calf of the leg. The pain resembles that of a dislocated bone, and is accompanied by a sense as if water not perfectly cold were poured over the affected limb; to this succeeds chilliness, with shivering, and a trace of feverishness,•these last symptoms diminishing as the pain increases. From hour to hour, until the next evening, the patient suffers every variety of torture in every separate joint of the affected limb; the pain being of a tearing, or crushing, or gnawing character, the tenderness such that even the weight of the bed-clothes, or the shaking of the room from a person's walking about in it, is unbearable. The next night is one of tossing and turning, the uneasy limb being constantly moved about to find a better position; till towards morning the victim feels sudden relief, and falls over into a sleep, from which he wakes refreshed, to find the limb swollen; the venous distention usually present in the early stage having been succeeded by a more general form of swelling, often with itching between the toes, and a peeling-off of the cuticle. This individual attack may be repeated many times, in the course of what is termed "a fit of the gout," which commonly extends over a period of weeks, or even months, before the patient is completely relieved; or the attacks may occur in both limbs, or in several other parts of the body in succession, the real termination of the " fit " being at last indicated by an apparently complete restoration of health, and even, in sonic cases, by a period of improved condition and capacity for exertion, as compared witlfthe state of the patient before the attack.
• Such are the principal features of the "regular gout." In this form, it might almost be called a local disease; although the connection of the attacks with deranged diges tion, or with a variety of other minor ailments too complex to be described here. and the obvious relief obtained through the "lit" from the symptoms of constitutional suffering, point to a cause of the disease operating over a larger range of functions than those included in the ordinary local manifestations at this period. Regular gout, accordingly, forms only part of a nosological picture, in which the so-called irregular, atonic, metastatic, or retrocedent forms have to be included before it can be said to be at all complete. These, indeed, form almost all the darker shadows of the picture; for regular gont,though a very painful disorder, can hardly be said to be dangerous to life, or even to the limb affected, at least until after many attacks.
It is the tendency, however, of gout, when recurring often, to fall into irregular forms, and herein lies its danger. One source of local aggravation is, indeed, soon
apparent, and it leads rapidly to other evils. The joints which have been repeatedly the seat of the regular paroxysm, become, more or less permanently, crippled and dis torted. A white, friable. chalk-like material is gradually deposited around the car tilages and ligaments, and sometimes in the cellular tissue and under the skin. .Some times this material is discharged externally by ulceration, and then usually with relief. At other times, it accumulates into irregular masses, or " nodosities," which entirely destroy, or at least greatly impair, the movement of the limb. The patient is laid up more or less permanently in his arm-chair; and exercise, the great natural specific remedy of the gouty, is denied by the very conditions of the diseased state itself.
Then follow aggravations of all the constitutional sufferings; the more so, perhaps, in proportion as the local attacks in the foot become obscurely marked. Indigestion continues, or becomes constant, assuming the form chiefly of acidity after meals; the liver becomes tumid, the abdomen corpulent, the bowels disposed to costiveness; the kidney discharges a vitiated secretion, and not unfreqdently there is a tendency to gravel and calculus (q.v.); the heart is affected with palpitations, or fainting-titioccur, • sometimes with spasmodic attacks of pain; the arteries become the seat of calcareous deposits, and the veins are varicose in the limbs and in the neighborhood of the lower bowel (see PILES); the temper is singularly irritable, and often morose; then, sooner or later, the appetite fails, or is only kept up by very stimulating and unwholesome diet, with an excess of wine or of alcoholic liquors; in the end, the body emaciates, the energy of all the functions becomes enfeebled, and the patient falls a prey to diarrhea, or to some slight attack of incidental disease. Sometimes the end is sudden, as by apoplexy or structural disease of the heart; sometimes, on the other hand, it occurs in the midst of one of those violent spasms which have 'popularly acquired the name of "gout in the stomach ;" the true character of these attacks, however, being by no means well understood.
The sketch here given of the leading external phenomena of gout is very incomplete, as every popular description, to be at all intelligible, must necessarily be. But the reader will not fail to see in 'it the type of a disease occurring under a number of remarkably varied forms, and lurking in the constitution, at times, under the most anomalous disguises, or even under the general aspect of robust or rude health. It been an object, accordingly, with physicians to trace out the gouty predisposition under the name of a habit of body, or aatheffis, cognizable previously to any of the local manifestations. At this point, however, the ideas of authorities usually become hazy, and their descriptions correspondingly ill defined or contradictory. The anomalous forms of the disease itself are also exceedingly difficult to describe accurately, and must on this account be left out of the present summary of the characters of the more usual aspects of gout, as it presents itself to physician and patient. The causes of the disease have been sufficiently .indicated above.