Besides the regular forms of the disease, where it occurs in paroxysms, that alternate with, or succeed to complaints of the stomach, and leave the patient in perfect health during the intervals, there are other va rieties of the disease, in some of which the different stages exhibit considerable irregularity, both with re spect to their degree of violence, and the order of their succession ; in one of these, which is called retrocedent, or repelled Gout, after the disease has settled upon the joints of the extremities, it suddenly leaves the part, and attacks some of the internal viscera, the brain, the lungs, the heart, or the stomach ; and, if not relieved by the appropriate remedies, may suddenly prove fa tal, by preventing these organs from performing their ordinary functions. The regular Gout is not a disease which is usually considered as productive of danger to the life of the patient ; but it materially impairs his com forts and utility, for the fits generally increase upon him, both in their violence and their duration, so that at length he is doomed to pass a considerable part of his time under their influence, while the joints, by the iepeated attacks of inflammation, become distorted, or nearly immoveable. The irregular Gout, although pro ductive of less urgent symptoms, and of little or no injury to the joints, has the effect of imbittering the life of the patient, by an almost constant state of in disposition ; and it has a peculiar tendency to induce a distressing lowness of spirits, and a feeling of despond ency, which are more intolerable than acute pain.
The phenomena of Gout were formerly regarded as affording the most direct evidence of the theory of the humoral pathologists, in which a morbific matter exists in the fluids, is capable of being conveyed from one part of the body to another, and manifesting its pre sence in them by its appropriate symptoms. Palpable, However, as this conclusion was conceived to be, the mo dern pathologists have denied the existence of this mor bific matter, of which it has been said that no evidence exists, except what is derived from the symptoms of the disease ; and these, they have asserted, might be better explained upon other principles. The researches of the modern chemists have, however, given some plausibili ty to the doctrine of the humoralists, by discovering that gouty urine contains an unusually large proportion of lithic acid ; and as the same substance has been found exuding from the joints, in combination with so da, it would seem to follow, that the general mass of the circulating fluids are impregnated with it. But although the fact must be interesting, both in a patho logical and a practical point of view, it cannot be con sidered as throwing much light upon the proximate cause of Gout, as we have still to inquire how the pre sence of the lithic acid can produce the peculiar affec tion of the stomach, why it is transferred from the sto mach to the joints, why it particularly attacks the small joints of the extremities, why the general and local symptoms alternate with each other, and, in short, what connexion or relation it bears to the ordinary symptoms of the disease.
The treatment of Gout has varied very much at dif ferent times, according to the prevalence of particular medical theories, or the pathological doctrines that have been entertained respecting the nature of the complaint.
While all diseases were regarded as salutary efforts of nature, the paroxysm of Gout was considered rather as a curative operation, which was to be induced or pro moted by the practitioner, than as a morbid condition of the system which it was his business to remove. Accordingly, all our attempts were more calculated to increase, than to diminish the inflammation of the joints, by the application of warmth, and by the use of stimu lating diet and medicines ; and even during the inter vals of the fits, so great was the apprehension of the mischief that might arise from checking the efforts of the vis medicatrix, that nothing was attempted more than a mere palliative plan, which was generally alto gether inert. Of late, however, we have ventured up on a more active practice, and we have not hesitated to oppose the regular progress of the disease, or even to counteract the natural actions of the system. We administer brisk purgatives to clear the alimentary ca nal, we attempt to moderate the inflammation of the joints, if not by the application of cold, at least by the abstraction of heat ; and we occasionally employ bleed ing, either general or topical, and enjoin the strict an tiphlogistic regimen. To what extent this plan is to be pursued, must be left to the discretion of the practi tioner, as determined by the urgency of the case; while we have ample evidence of its safety, when judiciously employed, we are to bear in mind that the inflamma tion of Gout is of a specific kind, and that the imme diate danger of the disease consists in its being repelled from the extremities to the internal viscera. After we have carried the depleting system as far as is thought proper or necessary, opium, either alone, or in combi nation with ipecacuanha, will be found useful for re moving irritation, and bringing back the functions in to their ordinary state. When the fever and inflamma tion have subsided, we shall probably find a course of bitters and stomachics necessary to strengthen the di gestive organs, and to prevent the recurrence of that state which lays the foundation for future attacks of the disease. But this object, which is even of greater im portance than the cure of the individual paroxysm, is to be attempted more by regulating the habits of the patient, than by the employment of any particular ar ticle of the materia medica; provided the constitution be not too much impaired, and the alteration be not too hastily adopted, we find that, by exchanging a life of gluttony and indulgence for one of temperance and activity, we are generally ahle o accomplish the desir ed effect. Simple however, as this plan may appear, it is but seldom that the practitioner is able to put it into execution ; for so wedded arc the patients to t .eir accustomed indulgencies, that they shut theirs ears to the salutary counsels of their medical attendants, and voluntarily resign themselves to pain and disease, in preference to alth and comfort, when they are to be purchased by the renunciation of their luxurious habits.