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therefore seem to require some remedies different from those above mentioned. But in all such cases, it is to be suspected, that the effects of cold, or of other such causes are owing to a diathesis produced by an acrid matter applied to the nerve of a tooth, and continuing in some measure to act there; and we have accordingly often found, that the action of those external causes was to be ob. viated only by the extraction of the tooth from which the diathesis had arisen.
OF THE GOUT.
492. The Gout, not only as it occurs in different persons, but even as it occurs in the same person at different times, is a disease of such various appearance, that it is difficult to render the history of it complete and exact, or to give a character of it that will universally apply. However, I shall endeavour to describe the disease as it most commonly appears, and to mark the varieties of it as well as I can. From such a history, I expect that a general character may be given ; and such I think is the following, as given in the last edition of our fuology
Podagra. Morbus hæreditarius, oriens sine causa externa evidente, sed præeunte plerumque ventriculi affectione insolità; pyrexia ; dolor ad articulum, et plerumque pedis pollici, certe pedum et manuum juncturis, potissimum infestus; per intervalla re-' vertens, et sæpe cum ventriculi et aliarum internarum partium affectionibus alternans.
493. The gout is generally a hereditary disease: but some persons, without hereditary disposition, seem to acquire it; and, in some, a hereditary disposition may be counteracted by various causes. These circumstances may seem to give exceptions to our general position ; but the facts directly supporting it are very numerous.
494. This disease attacks especially the male sex; but it sometimes, though more rarely, ata tacks also the female. The females liable to it are those of the more robust and full habits; and it very often happens to such long before the menstrual evacuation has ceased. I have found it occurring in several females, whose menstrual eva. cuations were more abundant than usual.
495. This disease seldom attacks eunuchs; and,
, when it does, they seem to be those who happen to be of a robust habit, to lead an indolent life, and to live very full.
496. The gout attacks especially men of robust and large bodies, men of large heads, of full and corpulent habits, and men whose skins are covered with a thicker rete mucosum, which gives a coarser surface.
497. If, with the ancients, we might ascertain, by certain terms, the temperaments of men, I would say, that the gout attacks especially men of a cholerico-sanguine temperament, and that it very seldom attacks the purely sanguine or melancholic. It is, however, very difficult to treat this matter with due precision.
498. The gout seldom attacks persons employ. ed in constant bodily labour, or persons who live much upon vegetable aliment. It is also said to be less frequent among those people who make no use of wine or other fermented liquors.
499. The gout does not commonly attack men, till after the age of five and thirty; and generally not till a still later period. There are indeed in stances of the gout occurring more early; but these are few in comparison of the numbers which agree with what we have given as the general rule. When the disease does appear early in life, it seems to be in those in whom the hereditary disposition is very strong, and to whom the remote causes, to be hereafter mentioned, have been applied in a considerable degree.
500. As the gout is a hereditary disease, and affects especially men of a particular habit, its remote causes may be considered as predisponent and occasional.
501. The predisponent cause, so far as expressed by external appearances, or by the general temperament, we have already marked ; and physicians have been very confident in assigning the occasional causes; but, in a disease depending so much upon a predisposition, the assigning occasional causes must be uncertain; as, in the predisposed, the occasional causes may not always appear, and in persons not predisposed, they may appear without effect. This uncertainty must particularly affect the case of the gout; but I shall offer what appears to me most probable on the subject.
502. The occasional causes of the gout seem to be of two kinds. First, those which induce a plethoric state of the body. Secondly, those which, in plethoric habits, induce a state of de
503. Of the first kind are a sedentary and indolent manner of life, a full diet of animal food, and the large use of wine or of other fermented liquors. These circumstances commonly precede the disease; and if there should be any doubt of their power of producing it, the fact, however, will be rendered sufficiently probable by what has been observed in 498.
504. Of the second kind of occasional causes which induce debility are, excess in venery; intemperance in the use of intoxicating liquors; indigestion, produced either by the quantity or quality of aliments; much application to study or business; night-watching ; excessive evacuations; the ceasing of usual labour; the sudden change from a very full to a very spare diet; the large use of acids and acescents; and, lastly, cold applied to the lower extremities.
505. The first (503) seem to act by increasing the predisposition. The last (504) are commonly the exciting causes, both of the first attacks, and of the repetitions of the disease.
506. It is an inflammatory affection of some of the joints which especially constitutes what we call a paroxysm of the gout. This sometimes comes on suddenly without any warning, but is generally preceded by several symptoms; such as the ceasing