Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    836/976 (page 816)
    This often happens in the first seizure, and may even occur for several years in succession; but sooner or later, if the disease continues to make progress, not only are other joints implicated, but several are affected either at the same time or in the course of the same attack • and it is not uncommon to find many joints, both large and small’ of the upper and lower extremities, simultaneously in a state of acute suffering. When such is the case, as the accompanying fever is in proportion to the joint affection, the patient’s malady may easily be mistaken for one of acute rheumatism, and unless the history is carefully inquired into, the diagnosis is somewhat difficult. Premonitory Symptoms of Gout.—Some of these are referable to an altered condition of the digestive organs; a form of dyspepsia is induced, and the patient experiences flatulence, often to a very rmcomfortable degree, accompanied with heartburn and acidity. Many gouty subjects, from the unusual prevalence of these symptoms, can predict the advent of an acute seizure. In some the function of the lower bowel becomes altered, and either constipation or diarrhcea ensues. The character of the alvine evacuations may also be changed. A crampy state of the muscles is another very common fore- runner of a gouty paroxysm, usually in the lower extremities, and more especially in the calves of the legs. Palpitation of the heart is experienced by some patients on the eve of a gouty seizure, and this may or may not be accompanied with dyspeptic symptoms. In some individuals the respiratory function is implicated under like circumstances, and a species of asthma produced. At times the urinary secretion undergoes a very visible change in character; from being copious and clear, it may become scanty and turbid. On the other hand, the urine sometimes becomes unusually abundant and limpid a few hours before the establishment of the articular in- flammation. In other persons, derangements of some portions of the nervous system are produced, the temper becomes very irritable, unusual drowsiness, or head-ache, grinding of the teeth during sleep, startings of limbs, and various other phenomena may be experienced. Lastly, it now and then happens that a feeling of unusual good health, with apparent increase both of mental and bodily power, is a prelude to a gouty attack. All these phenomena are probably dependent on the altered state of blood which always exists previously to the development of articular Gout, and the cause of the diversity of the symptoms, in different persons must be sought for rather in individual peculiarities, and the proneness of certain functions to be disturbed, than in any variation in the proximate cause of such symptoms. When any organ or function is implicated in a very marked degree, a. iorm of irregular Gout is established, which we will afterwards describe. Phenomena of Articular Gout when it assumes a Chronic fonn. In Gout, as in other inflammatory diseases, it is difficult to draw an