§ 172. Gout Arthritis.

Gout is supposed to originate in some peculiar dys-crasia, affecting the joints and synovial capsules. An attack of gout is almost always preceded by loss of appetite, flatulence, pressure in the region of the stomach, heaviness and tension in the abdomen, rumbling in the bowels, turbid and slimy urine, slimy coating on the tongue, sluggish alvine evacuations or slimy stools, discharges of mucus from various parts of the body, lungs, bladder, rectum, etc. A sensation of coldness, drawing numbness, stiffness, creeping heaviness and heat is generally experienced in the parts some time previous to the attacks setting in. Malaise, lowness of spirits, hypochondriac symptoms generally co-exist with the other precursory symptoms. These precursory symptoms seldom exist all together, and are frequently designated by the term "atonic gout." It is not always easy to designate the precursory symptoms of gout, inasmuch as similar symptoms may arise from other sources. We are somewhat sure of the arthritic character of those symptoms if the patients are born of arthritic parents, if they are visited now and then by arthritic pains, if the pains are relieved by sweat, if a calcareous sediment is deposited in the urine, if season, weather and temperature of the atmosphere have a great influence on the disease. A characteristic symptom of latent gout is numbness at a certain spot on the skin, or the sensation as if wool or fur were lying on the skin.

Symptoms of fully-developed acute arthritis are: pain now in one, then in another joint of the extremities; it comes on suddenly, is gnawing, boring, cutting, and then changes to a violent tearing and burning, with great sensitiveness of the affected parts, so that they bear neither covering nor contact. This pain exacerbates and remits regularly with the fever, is most violent at night, makes the patient wakeful and uneasy. The joint cannot be bent or moved on account of the pain, which is relieved by warmth, and is disposed to shift to other joints or internal organs, with more or less danger. The affected part does not become red till the pain has lasted several hours; the redness is attended with heat and a tight hard swelling, of the colour and consistence of erysipelas, and readily transformed into arthritic nodosities with calcareous concretions. The accompanying fever has generally an erethic character. It sets in at the same time as the local inflammation, and is generally attended with flatulence, acidity, accumulation of mucus, apepsia, constipation, scanty, turbid, cloudy urine and dry skin.

§ 173. Genuine acute gout is distinguished by regular paroxysms which are accompanied with fever, and terminate critically; they occur generally at the equinoctial periods, and are succeeded by perfect relief, lasting more or less time. These paroxysms have the character and run the course of an inflammatory fever. They last from three to four weeks, with disposition to relapses, each paroxysm being characterized by increase, acme of development, decrease, and terminate with critical sweat which generally smells sour, and a thick, white, calcareous and sometimes reddish sediment in the urine. Gout may affect various parts of the body, and is apt to shift to internal organs. Chronic gout arises most frequently from the frequent recurrence of an acute attack, and results in the formation of arthritic nodes, calcareous concretions, which form around the joints, impeding motion or rendering it impossible, and sometimes in actual exostosis.

Gout affects principally males, with strong, plethoric constitutions, fond of rich food, excesses in venery, spirituous drinks, and leading a sedentary life. This disease is hereditary, and may moreover arise from exposure to a damp, cold atmosphere, damp habitations, suppression of habitual discharges of blood, such as piles and menses, suppressed or mismanaged cutaneous eruptions, particularly from suppression of itch and syphilis.

§ 174. Gout is more easily cured in the precursory stage than when fully developed. When arising from rich living, abuse of coffee, wine and spirits, mental exertions, watching and sedentary mode of life, Nux v. is the best remedy. When caused by venereal excesses, onanism, China, Acid Phosph., Phosphor., Coni-um, Sepia and Staphysagria should be used. In other cases, Bryonia, Pulsat., Ignat., Chamom., Bellad., or some one of the remedies mentioned for gastric affections, will prove useful. (See § 44, etc.)

If the local affection should be accompanied with synochal fever, Aconite should be used first. Ferrum proves curative when several parts are affected at once, when the violent stinging and tearing obliges the patient to move the parts constantly, and when the patient has a pale, consumptive complexion. If there should be evening exacerbations, or if the pains should be diminished by uncovering the part and exposing it to a current of cool air, Pulsatilla is the best remedy. It is a specific remedy when the symptoms shift suddenly from one place to another, or when the knee is inflamed, with fleeting drawing, darting pains. Cocculus is sometimes useful in arthritis inflammation of the knee, or in hot swelling of the hands; likewise for a tearing, sticking pain in the shoulder and elbow-joints, as if broken, with sensation of heaviness, aggravation during rest, and diminution when moving the affected parts. Sabina is likewise an excellent remedy for wandering gout, with tearing, sticking pains in the distended joints, with feeling of lameness, general malaise, and disappearance of the pains by exposure of the affected parts to cool air. If the exacerbation should set in in the morning hours, Nux v. is indicated. Bryonia corresponds to attacks of gout which are excited by motion. If the local affection should be accompanied with erysipelatous swelling, Bellad. is frequently the most suitable remedy. Beside these remedies we have Arnica, Rhus t., China, Dulc, Dig., Conium mac, Aurum, Spong., Tinct. arris, Mercur., Antim. cr., Staphys., Stann., Stram., Guajac, Arsen., Sarsap., Rhodod., Chelid., Sulph. Calc. acet. is useful for little relapses, which are apt to set in at every change of weather. Antim. cr. will prove useful when nausea, vomiting, coated tongue, flatulence, diarrhoea, etc., continue in spite of the local affection.

I know from experience that China and Arnica are two of the principal remedies for gout; China for swelling of the knee and foot and aggravation of the pain by contact; and Arnica for inflammatory, or rather erysipelatous swelling of the joints, with sensation of great uneasiness in the parts, obliging one to move them constantly, and sensation as if they were lying too hard: the patient looks pale and livid. Arnica is likewise useful in erratic gout.

In arthritic panaritia and swelling of the joints of the fingers, Mercurius and the south pole of the magnet deserve particular attention. For nodous gout, when another acute paroxysm sets in, Staphysagria is very useful. Bryonia is excellent in arthritic swelling of the foot, with redness and heat of the affected parts. Ledum, Arnica, Sabina and Veratrum are particularly suitable for podagra, when the big toe is affected. Arnica is the best remedy for an arthritic, numb pain in the joint of the big toe, as if sprained, and attended with redness; also for an indescribable pain in the affected foot, as if from internal uneasiness, as if the part were lying too hard, obliging one to move the part to and fro.

Sulphur, second, third, or fourth trituration, is excellent for swelling, redness, heat, pain of the affected part, particularly violent in bed. In podagra, Sulphur sometimes relieves the most acute pain in a few hours. When the pain in the ball of the big toe had been excited by friction or pressure of the boot, Arnica is the best remedy. Some propose to use a very high dilution of Arnica for that kind of pain, and if some rigidity of the knee-joint should remain, to remove it with Colocynth and Graphites.

Rhododendron is frequently useful after the inflammatory symptoms have been removed by Aconite, Arnica, Sulphur, etc.

Causticum has been employed for nodous gout, or gouty concretions, with apparent anchyjosis.

The affected part should be wrapt in flannel, oil-silk, or new wool, to promote perspiration.

§ 175. Gout is sometimes complicated with various symptoms indicating a disturbance of the reproductive functions. Sometimes the arthritic affection shifts to other organs, causing,

(1.) Ophthalmitis arthritica, which is recognised by the fact that it appears simultaneously with or after the sudden disappearance of arthritic pains. Its symptoms are, a dark redness of the opthalmic arteries, stinging, pressure, photophobia, and lachrymation. It generally affects the cornea, which is dim and exquisitely painful. This kind of ophthalmitis is disposed to terminate in internal exudations and suppuration, causing perforations in the cornea, and resulting in staphyloma, leucoma, prolapsus iridis, etc.

The remedies for this disease are various: they are, Acon., Bellad., Nux v., Puls., Antim. cr., Chamom., Dig., Cann., Rhus t., Mercur., Veratr., Euphras., Crocus, Colocynth, Spig., Hep. s., Cale, c, Phosphorus, Silic, Caust., etc. We shall refer to this disease in treating of inflammation of the eye.

(2.) Inflammation of other organs, gastritis, hepatitis, nephritis, encephalitis, etc., which require to be treated in the manner indicated in their respective chapters.

(3.) Metastasis and metaschematismus to other organs, such as obstinate constipation, cardialgia, induration of the stomach, chronic vomiting, to be treated with Nux v., Bryo., Veratr., Slaphys., Coee, Bell., Puls., Tart, emet., Ipec, Ars., Lye, Natr. mur., etc.