Popular Lectures on Zoonomia / Or The Laws of Animal Life, in Health and Disease

by Thomas Garnett

In this state, if the person have fatigued himself by violent exercise, or if he have exposed the extremities to cold, or if his mind have been particularly affected by any anxiety, or distressing event; or in short, if any directly debilitating cause have been applied, the fit will often follow. It sometimes comes on in the evening, but more commonly, about two or three o'clock in the morning; the pain is felt in one foot, most commonly in the ball or first joint of the great toe; but sometimes in the instep, or other parts of the foot. With the coming on of this pain there is generally more or less of a cold shivering, which as the pain increases, gradually ceases, and is succeeded by heat, which often continues as long as the pain; 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 the disease has continued for twenty four hours from the commencement of the first attack, it often ceases, and with the coming on of a gentle perspiration allows the patient to fall asleep. The patient on coming out of this sleep in the morning finds the part affected with some degree of redness and swelling, which, after having continued for some days, gradually abate.

Still however, after a fit has come on in this manner, although the violence of the pain after twenty four hours, by the excitement that it produces, cures itself, and is considerably abated, the patient is seldom entirely relieved from it. For several days he has every evening a return of considerable pain and fever, which continue with more or less violence till morning. This return is owing to the exhaustion of the excitability by the stimuli of the day, and its remission is caused by the accumulation of the excitability, by sleep.

After having continued in this manner for several days, the disease often goes off, and generally leaves the person in much better health, and enjoying greater alacrity in the functions of both body and mind, than he had for some time experienced. This is owing to the general excitement produced by the pain, which removes the great torpor and debility which preceded the fit; and from the inability to take exercise or food, the excitability accumulates again. This is the true explanation: it does not depend on any morbid matter, which the gout hunts from its lurking places, drives to a joint, and thence out of the body, as has been imagined by many.

At first the attacks of the disease are confined to one foot only: afterwards both feet become affected, though seldom at the same time; but when the inflammation appears in one, it generally disappears in the other, and as the disease continues to recur, it not only affects both feet at once, but is felt in the other joints, especially those in the upper and lower extremities, so that there is scarcely a joint in the body that is not on one occasion or other affected. After frequent attacks, the pains are commonly less violent than they were at first, the joints lose their strength and flexibility, and often become so stiff as to be deprived of all motion.

Concretions of a chalky or calcarious nature are likewise formed upon the outside of the joints. This arises from an inability of the capillary vessels, which ought to secrete the calcarious matter, and deposite it in the bones, to perform their office, from debility: hence by sympathy other vessels ta ke up the matter and deposite it in the wrong place. These concretions, though at first fluid, become at last dry, and firm: they effervesce with acids, and are totally, or in a great measure, soluble in them.

After this short description of the gout, when it occurs in its regular form, as it is called, I shall now proceed to inquire how the exciting causes produce this disease, and what is the state of the body under which it occurs.

The gout seldom occurs but in those who have for several years lived upon a full diet of animal food, often highly seasoned, and at the same time been in the habit of taking daily, or at least very constantly, a greater or less quantity of fermented liquors, either in the form of wine, or malt liquor, or both. The affection of the limb has all the appearance of an active inflammation: the part becomes swelled, hot, red, and intolerably painful. It is this circumstance which has misled practitioners, who have supposed it a case of sthenic, or active inflammation: not only the appearance, but the causes which produced it, induced them to think so; hence they were naturally led to employ the debilitating plan: a little time and observation would, however, be sufficient to convince them of its inefficacy. They would find that the application of leeches to the part, and of the lancet to the arm, instead of subduing the inflammation, would increase it: or if it did not, that the pain often attacked some internal part, which was ascribed to a translation of the morbific matter from one part to another, but which is merely owing to an increased debility: a little attentive observation would convince practitioners, however mysterious it might seem to them, that this violent inflammation was not to be cured by debilitating: on the contrary, they would see cases, in which the patient, though contrarily to the strict orders of his physicians, could not forego his old habits; but would take his wine as usual, or in greater quantity, after a few days abstinence; and this abstinence having in some degree accumulated the excitability, he would find himself much relieved by wine, and would exultingly tell them, that they were mistaken. Circumstances of this kind seem to have staggered their faith a little, but still the idea of active inflammation which they believed was visible, and almost palpable, dwelt so upon their minds, that they were but half convinced. The favourite idea of increased action of the vessels of the part had so interwoven itself with every other, that we find it never lost sight of, in the indications of cure. Hence, though bleeding is not now generally practised with the lancet, yet leeches are often applied; but the most usual plan is to consign the patient to patience and flannel; strictly forbidding wine, or fermented liquors. As an exception to this general mode, it is however observed, by some practitioners, that when the stomach is weak, and when the patient has been much accustomed to the use of strong liquors, a little animal food, and even wine, may be allowable, and even necessary.

Thus has an erroneous view of the disease been the cause of an inert practice, which wavers between the suggestions of a favourite hypothesis, and the conviction of facts.

On inquiry, however, we shall find none of the increased vigour in the system, which has been suspected, nor increased action in the part more particularly affected; on the contrary, the whole body is in a state of indirect debility, or exhausted excitability, and the part more particularly affected, in a state of asthenic inflammation.

If the gout were of a sthenic or inflammatory nature, might we not ask, why the causes which produce it, do not produce it in the meridian of life, when they produce their greatest effect, and when real sthenic diseases are most apt to occur? or, why the symptoms of the inflammation, like all other real sthenic inflammations, are not relieved by the debilitating plan? The contrary, however, points out to us clearly the nature of the disease: the gout is not a sthenic disease, or a disease of strength: it does not depend upon increased vigour of the constitution, and plethora, but is manifestly asthenic, like all the rest of the asthenic diseases. The mode of living is such as brings on indirect debility, or exhaustion of the excitability, such as the use of rich and highly seasoned food, and a daily use of fermented liquors. These at first certainly produce vigour, or strength, and will be the cause of sthenic diseases; but they are generally taken in such a manner, that, though they produce a degree of excitement above the point of health, still they only approach the line of sthenic disease, without in general falling into it. They continue, however, to exhaust the excitability, and by the time that the vigour of the body begins naturally to decline, the system of a person who has lived in this manner is unusually torpid; all the blood vessels, which have hitherto been distended with rich blood, begin to lose their tone, from their excitability having been exhausted by the use of these powerful stimulants; but this torpor is particularly and first experienced in those parts which have been more immediately subject to the action of the exciting causes; viz. the stomach and bowels: symptoms of indigestion occur, and the excitability of these organs having been almost entirely exhausted by the violent action of the stimulants applied, cannot now be roused to any healthy action; the food is not properly digested, but runs into a kind of fermentation, which causes an extrication of gas: this distends the stomach and bowels, and produces pains, uneasy eructations, and all the distressing symptoms of indigestion. Nor is this in the least surprising, when we consider that many people who have brought on complaints of this kind, have been in the habit of eating heartily of rich and highly seasoned animal food, and of drinking from a pint to a bottle of wine, and perhaps a quantity of malt liquor, almost every day of their lives for years. This mode is sufficient to wear out the powers of the stomach, were it three times as capacious as it is, and of the constitution, were it ten times as strong.