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