« PreviousContinue »
of a sweating which the feet had been commonly affected with before; an unusual coldness of the feet and legs; a frequent numbness, alternating with a sense of prickling along the whole of the lower extremities; frequent cramps of the muscles of the legs; and an unusual turgescence of the veins.
507. While these symptoms take place in the lower extremities, the whole body is affected with some degree of torpor and languor, and the functions of the stomach in particular are more or less disturbed. The appetite is diminished; and flatulency, or other symptoms of indigestion, are felt. These symptoms, and those of 506, take place for several days, sometimes for a week or two, before a paroxysm comes on: but commonly, upon the day immediately preceding it, the appetite becomes greater than usual.
508. The circumstances of paroxysms are the following They come on most commonly in the spring, and sooner or later, according as the vernal heat succeeds sooner or later to the winter's cold; and perhaps sooner or later also according as the body may happen to be more or less exposed to the vicissitudes of heat and cold. bus dixer
o'clock of the morning. The paroxysm begins with a pain affecting one foot, most commonly in the ball or first joint of the great toe, but some. times in other parts of the foot. With the coming on of this pain, there is commonly more or less of a cold shivering, which, as the pain increases, gradually ceases, and is succeeded by a hot stage of pyrexia, which continues for the same time with the pain itself. From the first attack, the pain becomes by degrees more violent, and continues in this state with great restlessness of the whole body, till next midnight, after which it gradually remits; and after it has continued for twentyfour hours from the commencement of the first attack, it commonly ceases very entirely, and, with the coming on of a gentle sweat, allows the patient to fall asleep. The patient, upon coming out of this sleep in the morning, finds the pained part affected with some redness and swelling, which, after having continued some days, gradually abate.
510. When a paroxysm has thus come on, alı though the violent pain after twenty-four hours be considerably abated, the patient is not entirely ra lieved from it. For some days he has every evening a return of more considerable pain and pye rexia, and which continue with more or less violence till morning. After continuing in this man. ner for several days, the disease sometimes goes entirely off, not to return till after a long interval.
511. When the disease, after having thus remained for some time in a joint, ceases very entirely, it generally leaves the person in very perfect health, enjoying greater ease and alacrity in the -functions of both body and mind, than he had for. a long time before experienced.
512. At the beginning of the disease, the returns of it are sometimes only once in three or four years: but, after some time, the intervals become shorter, and the attacks become annual ; afterwards they come twice each year, and at length recur several times during the whole course of autumn, winter, and spring; and as it happens that, when the fits are frequent, the paroxysms become also longer, so, in the advanced state of the disease, the patient is hardly ever tolerably free from it, except perhaps for two or three months in summer.
513. The progress of the disease is also marked by the parts which it affects. At first, it com. monly affects one foot only; afterwards every paroxysm affects both feet, the one after the other ; and, as the disease continues to recur, it not only affects both feet at once, but after having ceased in the foot which was secondly attacked, returns again into the foot first affected, and perhaps a second time also into the other. Its changes of place are not only from one foot to the other, but also
from the feet into other joints, especially those of the upper and lower extremities; so that there is hardly a joint of the body that is not, on one occasion or other, affected: it sometimes affects two different joints at the same time ; but more commonly it is severe in a single joint only, and passes successively from one joint to another ; so that the patient's affliction is often protracted for a long time.
514. When the disease has often returned, and the paroxysms have become very frequent, the pains are commonly less violent than they were at first; but the patient is more affected with sick. ness, and the other symptoms of the atonic gout, which shall be hereafter mentioned. ...
· 515. After the first paroxysms of the disease, the joints which have been affected are entirely restored to their former suppleness and strength: but after the disease has recurred very often, the joints affected do neither so suddenly nor so entirely recover their former state, but continue weak and stiff; and these effects at length proceed to such a degree, that the joints lose their motion altogether.
516. In many persons, but not in all, after the disease has frequently recurred, concretions of a chalky nature are formed upon the outside of the
joints, and for the most part immediately under the skin. The matter seems to be deposited at first in a fluid form, but afterwards becomes dry and firm. In their dry state, these concretions are a friable earthy substance, very entirely soluble in acids. After they have been formed, they contribute, with other circumstances, to destroy the motion of the joint.
517. In most persons who have laboured under the gout for many years, a nephritic affection comes on, and discovers itself by all the symptoms which usually attend calculous concretions in the kidneys, and which we shall have occasion to describe in another place. All that is necessary to be-observed here is, that the nephritic affection alternates with paroxysms of the gout, and that the two affections, the nephritic and the gouty, are hardly ever present at the same time. This also may be observed, that children of gouty or nephritic parents, commonly inherit one or other of these diseases; but whichever may have been the principal disease of the parent, some of the children have the one, and some the other. In some of them, the nephritic affection occurs alone, without any gout supervening ; and this happens to be frequently the case of the female offspring of gouty
518. In the whole of the history already given,