The predisposing and occasional causes of acute and chronic rheumatism, idiopathic and symptomatick, are, sudden suppression of perspiration; sudden heats and colds; cold damp night air, beds, houses, habitations, want of sufficient warm cloathing and fuel in rigorous seasons, or during the interchanges of the seasons; wet cloaths; exposure to heats and colds; sudden vicissitudes of heat and cold; change of winds and weather; one part of the body exposed to cold whilst the other part is heated; sleeping on damp ground; plethora; impure blood; repelled eruption; suppressed evacuations; habitual intoxication; intermittent; dregs of fever; arthritic; hereditary; scorbutick; hysterical; venereal; noxious exhalation from lead or mercury; excess of venery; tabes dorsalis; aneurism of the descending aorta near the loins; lifting great weights; internal abscess and scirrhus; abscess, and caries at the upper articulation of the thigh-bone; sprains; luxation and fracture of its neck; diseases of the coverings of the nerves, or of their medullary substance, or of the muscular fibre.
Gout,
arthritis, podagra; acute, chronic, regular, and irregular. Here we have no foundation to accuse the elements, or the invisible demons of disease: this malady either immediately, or by hereditary descent, is too often the natural castigation and penance of voluptuousness and sensuality. In the preceding century it was confounded with sciatica in the London bills. During the present century, there is a considerable increase in arthritic mortality; but, compared to some other of the morbid host, it is a mere buccanier. Arthritic piracy must solely be imputed to the assaults of chronic gout, either gradually breaking down the fabrick, or storming some of the internal organs essential to life. It attacks principally the male sex; sometimes, but rarely, females; and of the latter those of robust full habits, the viragines, luxurious, indolent, corpulent, and generally after the final menstrual cessation: the majority, from the peculiarity in the female constitution, and from superiority in temperance, are exempt. It seldom attacks before middle age; generally in the decline of life: the few exceptions of its earlier occurrence are rare; and in them it is usually by co-operation of hereditary, and of remote exciting causes: in adolescence, and before puberty, it would be numbered amongst the medical miracles. It harasses most those of robust, full, corpulent, large frame and temperament, the voracious, gormandizing, affluent, and pampered; more of the patrician than the plebeian orders; more of the literary and sedentary professions; and, according to Sydenham, those of an acute genius and intellectual eminence. The active and industrious orders of every community; those who are exercised in daily corporeal labour, or who, from necessity, design, custom, or religion, do not indulge to excess in animal food, or in wine and fermented liquors, are seldom arthritick martyrs. Compared to the number afflicted, very few die of gout; it has even been by some considered as an omen of longevity: many, subject to it, have reached the Mosaick goal. It has been alledged, to render men more secure from other diseases; and in some few instances to expurgate and renovate a disordered constitution. These observations, however, must be restricted to regular gout only, and recurring at distant intervals.
That periodical local pain and inflammation called the regular arthritic paroxism sometimes invades suddenly, without any warning; but in general there are presages of its approach, one or two days, or even weeks; by ceasing of usual moisture on the feet; coldness, numbness in the feet and legs, enlargement of their veins, muscular cramps; general torpor and languor; restlessness; headach; depression of spirits; impaired appetite; flatulence, indigestion, cardialgy; costiveness. But frequently one or two days preceding the paroxism, the appetite is keener than usual. The regular and recent paroxism commonly invades by nocturnal surprize in bed, with pain in one foot, usually the ball of the great toe, accompanied with shivering, heat, and shortly after, conspicuous glossy redness, tension, and spreading tumor. The pain becomes often so intense as to be compared to premeditated dislocation, or to a dog tearing the flesh and ligaments: and such is the exquisite tenderness in the inflamed part and foot, as not to be able to tolerate the slightest touch or even weight of the bed-cloaths. In this way there are more or less diurnal remissions and exacerbations of pain; which, after one, two, three, or four weeks, recedes gradually and insensibly, together with the redness and swelling; leaving the patient who had been chained to a bed or couch, in perfect health; and soon after, the foot in the exercise of its former suppleness and strength. Throughout the paroxism the corporeal agony renders the mind more irritable and irascible: the urine is acrid, hot, turbid, and fabulous; in many, the perspiration is fetid; and with both general and local sweats, and desquamation of the inflamed cuticle, the paroxism finally evaporates. In vigorous constitutions the paroxisms are sooner terminated: indications of which are, sudden tumefaction, throbbing pain, and frightful sleep. In recent gout the pain is more severe than in chronic; the paroxisms shorter, with longer intervals; and vice versa. Pustular eruptions on the foot sometimes carry off the arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more regular and distant; at intervals of three or four years, or longer: by degrees the intervals are progressively reduced to two, to one; to two paroxisms annually about the equinoxes and solstices, and during the autumn, winter, and spring; at the same time the paroxisms are protracted to two or three months. At length, in the chronic inveterate stages of the disease the patient enjoys a very short respite; some few of the enervated, perhaps only two or three months during the summer: the pains in the extremities are then indeed less violent; but the stomach is more disordered. In recent gout, one foot only is assaulted; by degrees both feet, one after the other: and in the rooted state of the disease it not only torments both feet in succession, but capriciously deserts and re-attacks various parts; the ancle, knee, elbow, wrist; darting often with electrical velocity and shocks through the nerves and muscular fibres: thus, in a circle of torture and litigious warfare, teazing the arthritick victim.
When either the inflammation of the joints has commenced in the usual manner, but without an adequate degree of pain and inflammation, or at least without continuing the usual time, and precipitately recedes, some internal organ is exposed in its retreat and rebound. Or when the arthritick fuel is occluded, and not ejected to the feet, it will, according to the various parts and organs affected, excite corresponding vibrations and symptoms in the natural, vital, and animal functions; as inappetency, indigestion, nausea, vomiting, flatulence, ventricular eructation, colick, diarrhœa, nephritis, and urinary obstructions; difficult respiration, asthma, palpitation, fainting, general debility, low spirits, hypochondriasm, cramps and spasms in the muscles, apoplexy, palsy. In dubious cases from what source to derive such irregular alarms and minatory explosion; if they happen about the usual arthritic periods, and in such temperaments, their origin may be suspected: and it is of the highest moment to know that they are rarely of an inflammatory nature. After the disease has continued many years with frequent reiterated paroxisms the joints do not soon recover, but continue weak and stiff. In many cases, chalky and calculous concretions are formed in the joints of the extremities, and in the kidneys and urinary passages. Racked by those combined tortures, the patient requires the auxiliary aid of stuffed chairs, flannel, and crutches.
The predisposing and occasional causes are hereditary; inactive sedentary life, with luxurious living and gormandizing, especially on animal food; intemperance in wine, spirituous or fermented liquors; early or intemperate libations to Bacchus and Venus; unremitting application to study or business; sedentary life; nocturnal lucubrations; disturbed sleep, cares, misfortunes, vexation, depressing passions; ceasing of usual exercise or labour; sudden transition from an active to a sedentary life; coaches, dissipation, luxury, effeminacy; sudden violent changes in diet; plethora; suppressed evacuations; profuse evacuations; various causes of debility; indigestion from quantity or quality of aliment.
Of internal suppuration
in the lungs, liver, stomach, intestines, kidneys. Pulmonick suppuration, empyema, or vomica, may be predicted from preceding inflammation, without considerable remissions, the neglect of effectual remedies, and no signs of resolution by the efforts of nature or art, and by remission of acute pain; the difficulty of respiration and also cough continuing; with frequent horrors and shivering, heat and hectic, weight and throbbing in the side, laying on the diseased side painful; dyspnœa aggravated by a recumbent posture; disagreeable taste in the tongue; thirst; fetid breath; emaciation. It may burst in all the intervals between fourteen and sixty days, and either relieves or suffocates, or is gradually expectorated: and sometimes, after absorption, may be evacuated by diarrhœa or urine: the purulent contents may also be discharged upon the diaphragm, or between the pleura and intercostal muscles. Sometimes there are several small abscesses; and too frequently the final termination is ulceration and phthisis. Suppuration in the Liver is a frequent consequence of previous inflammation, and is not altogether so fatal as some other internal abscesses. Its symptoms are those in common with internal formation of pus, horror and chilliness, hectic heat, thirst, weight and load in that region, jaundice-colour of the eyes. Sometimes the purulence erodes the external integuments; sometimes the diaphragm, lungs, or stomach; sometimes is discharged by the biliary ducts into the intestines, or absorbed and washed away with the urine. Suppuration in the stomach and intestines is rare. In the kidneys, the general symptoms, with purulent fetid urine: it may also burst externally; or by slow ulceration and hectic, undermine the constitution.