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
d