The gout, (from a joint, because it is commonly confined to the joint).
Dr. Cullen, in his Nosology, gives it the name of podagra, (from pes, the foot,) because he considers the foot as the seat of the idiopathic gout. The disease is placed in his twenty-fourth genus of diseases of the class of febrile complaints, in the order of phlegmati*, and he divides it into four species.
1. Podagra regularis, regular gout, when the inflammation appears in the joints to a due degree, and, after continuing a while, gradually disappears, and the patient recovers his usual, or a more improved health.
2. Podagra atonica, atonic gout, when there is manifestly the gouty diathesis; but from some cause it does not produce the inflammatory affections of the joints, but digestion is disturbed, and the general health variously affected.
3. Podagra retrograda, retrograde or recedent gout, when inflammation hath as usual attacked the joints, but not either in its usual degree, or with the usual pain, and then suddenly abates, with an equally sudden affection of an internal part.
4. Podagra aderrans, misplaced gout, when the gouty diathesis produces inflammation in some internal part, instead of the joints of the extremities. It is generally and concisely defined 'an hereditary disease,.
arising without any external evident cause, but preceded for the most part by an unusual affection of the stomach; febrile symptoms; pain in the joints,particularly of the great toe, but certainly in those of the feet and hands; returning at intervals, and often alternating with affections of the stomach, and internal parts.' The gout is called nodosa, knotted, when it forms small tumours at the joints.
The ancients called all kinds of pain, when seated in the joints or the external parts, by the common name of arthritis. The word rheumatism was not known amongst them; but, in the sixteenth and seventeenth centuries, some celebrated French physicians have called the pains which afflict the intermediate spaces between the joints and muscles of the neck, or of either arm, or of the anterior or posterior part of the thorax, the shoulders, scapulae, thighs, and hands, by the name of rheumatism. Those they style arthritic which affect the joints: it was called podagra in the feet, chiragra in the hands, onagra and pechyagra in the elbow, ge-nagra in the knee, dentagra in the teeth, cleisagra in the articulations of the clavicles with the sternum, omagra in the articulation of the humerus with the scapula, rachisagra in the spine of the back; if it seizes the larger tendon., tenontagra. Coel. Aurelianus, lib. v. cap. 2. But the difference betwixt the gout and the rheumatism is considered as very great, both in their cause, seat, symptoms, and cure.
The gout is divided into regular and irregular. The first chiefly affects the membranes and ligaments of the joints, particularly the small joints of the feet. The last afflicts the patient variously, and seizes the internal parts, chiefly the viscera, the lungs, and the head.
The first approaches of the gout are generally sudden, and happen very early in the spring or in the beginning of winter. The regular fit is usually preceded by indigestion, flatulency, drowsiness, headach and sickness; a weariness; dejection of spirits; pain and coldness in the limb, with a sensation as if wind or cold water were passing down the thigh; swelled veins, and frequent cramps. The appetite is sometimes very keen a little before the fit approaches, and the other symptoms sometimes disappear; a slight pain is however felt in passing the urine. Soon after midnight, or rather about two or three in the morning, a pain attacks the great toe, or some other part of the foot or ancle, though now and then it is fixed in the calf of the leg; this pain is accompanied with a sensation as if cold water was poured on the part, and soon followed by a shivering, with some degree of feve: after this the pain increases, and fixing in the small bones of the foot, the patient feels a torturing pain for about twelve or twenty-four hours, which then abates, the part becomes inflamed and swelled; towards the morning the patient falls asleep, a perspiration comes on, which terminates the fit. But what is commonly called a fit of the gout consists of several similar attacks; the pain frequently shifting from one foot to another, or from the feet to the hands; and though a recovery should follow the first remission, some uneasiness returns every night, and goes off the following morning. The first fit may continue two or three weeks; but a tenderness, where the pain was seated, remains much longer. The patient may remain free from any return during the succeeding, or a second year; but the succeeding fits are then often still more painful; and soon after this the returns grow more and more frequent, increasing until the strength fails, and sensation is diminished. Though the patient is then seldom free, he is not violently afflicted. At this period chalky concretions occur, which, accumulating, destroy the motion of the joint: when large they burst through the skin, forming painful and troublesome ulcers. After this event the constitution has often remained free from gout many years; and we have often seen, about the period of seventy or seventy-five, a very violent and in a great measure an irregular fit of gout, which has left the patient for the remainder of his life free from any further attack, in tolerable health.
Much has been said by different authors concerning the cause of the gout. Boerhaave considers it to be a vitiated disposition of the very minute vessels and nerves in the body, from their too great straitness and rigidity; and, also, of the liquid which nourishes the nerves, from its acrimony, and greater tenacity. Hoffman says it is a saline tartarous substance, while some consider it a corrosive bilious salt, others as an. acid, an earth, an alkali, or an austere styptic principle. In general, it is thought that the gout depends upon a certain morbific matter always present in the body; and that this matter, by certain causes, thrown upon the joints and other parts, produces the several phenomena of the disease. Dr. Kirkland thinks the predisposing cause a largeness of the lacteals and straitness of the small vessels, particularly those of perspiration; and the immediate, the acrimony of earthy particles undissolved.