**ifr

gout.

283

in those who are subject to it, as intense study, too free ause of acid liquors, night-watching, grief or uneasiness ofmind, an obstruction or defect of any of the customary dis-charges, as the menses, sweating of the feet, perspiration, &c.

Symptoms. — A fit of the gout is generally preceded by indi-gestion, drowsiness, wind, a slight headache, sickness, andsometimes vomiting. The patient complains of wearinessand dejection of spirits, and has often a pain in the limbs, witha sensation as if wind or cold water were passing down thethigh. The appetite is often remarkably keen a day or twobefore the fit, and there is a slight pain in passing urine, andsometimes an involuntary shedding of tears. Sometimesthese symptoms are much more violent, especially upon thenear approach of the fit ; and some observe, that as the feverwhich ushers in the gout is, so will the fit be ; if the fever beshort and sharp, the fit will be so likewise ; if it be feeble,long, and lingering, the fit will be such also. But this obser-vation can only hold with respect to very regular fits of thegout.

The regular gout generally makes its attack in the springor beginning of winter, in the following manner. About twoor three in the morning, the patient is seized with a pain inhis great toe, sometimes in the heel, and at other times in theankle or calf of the leg. This pain is accompanied with asensation as if cold water were poured upon the part, whichis succeeded by a shivering, with some degree of fever. Af-terwards the pain increases, and fixing among the small bonesof the foot, the patient feels all the different kinds of torture,as if the part were stretched, burnt, squeezed, gnawed, or tornin pieces, &c. The part at length becomes so exquisitely sen-sitive that the patient cannot bear to have it touched, or evensuffer any person to walk across the room.

The patient is generally in exquisite torture for twenty-fourhours, from the time of the coming on of the fit ; he then be-comes easier, the part begins to swell, appears red, and iscovered with a little moisture. Towards morning he dropsasleep, and generally falls into a gentle breathing sweat.This terminates the first paroxysm, a number of which con-stitutes a fit of the gout ; which is longer or shorter, accordingto the patient's age, strength, the season of the year, and thedisposition of the body to this disease.

The patient is always worse towards night and easier inthe morning. The paroxysms however generally grow milder