GEOGRAPHICAL DISTRIBUTION OF GOUT.
In his "Handbuch der Histonsch-geographischen Pathologic," Hirsch has shown that gout is chiefly encountered in the cities of the temperate zones, where from time immemorial the highest degrees of civilization and luxury have been attained. In the torrid zone, the disease is unknown, but sporadic cases appear in the borders of the tropics, and they multiply as the centres of population in the most favored northern regions are approached. For purposes of compari son Europe may be divided into three parallel bands extending from east to west. The first comprises the borders of the Mediterranean Sea, including Spain, the south of France, Italy, Sicily, Greece, and Turkey. Throughout this zone the climate is semi-pelagic and toler ably uniform ; the people lead an open-air life, and are poor and temperate. Among them gout is practically unknown excepting oc casional cases among the luxurious denizens of the great commercial cities and aristocratic capitals, such as Lisbon, Madrid, Marseilles, Genoa, Rome, Athens, and Constantinople. Among the Mohammedan inhabitants of Turkey, Syria, Egypt, and the north of Africa, the disease is unheard of by reason of the poverty and sobriety of the Oriental population, to whom alcoholic stimulants are forbidden by their religious teachers.
Throughout the remaining countries of continental Europe, ex cluding Holland, gout is not an uncommon malady, though by no means of frequent occurrence. In France it is in the large cities and among the cider-drinking Bretons and Normans of the west that it is best known. It is more frequently found in the north and northeast than in the rougher and poorer regions of the central territory of the republic. In the rich Champagne country in Lorraine and Burgundy, where good living abounds, gout claims frequent victims. In like manner, the disease flourishes in the rich cities of Germany along the Dutch frontier, and upon the Baltic coast, while it is rarely ex perienced by the impoverished peasants of the interior and in the di rection of the Russian border. In the whiskey-chinking regions of
the north of Europe, in northern Russia, Lapland, and the north of Sweden and Norway, gout is seldom known ; hut in the wealthy cities of southern Scandinavia and Dcninark, it is not infrequent. So, also, it appears among the comfortable residents upon the "black lands" of eastern and southern Russia, where a productive soil per mits a considerable degree of luxury.
The third section of Europe, comprising the kingdom of Holland and the British Islands, forms the true paradise of gout. Under a gloomy sky, where the cold, damp winds of the ocean are perpetually flooding the atmosphere with foam from the sea, an immensely wealthy population is crowded within a narrow compass. Upon no other equal space of the earth's surface can be found such an accu mulation of all the appliances of luxury. Owing to the character of the climate these comforts must, for the greater part, be enjoyed within doors, by the perpetual fireside, remote from the open air. As a consequence the number of gouty patients is much greater than elsewhere. It is impossible to effect a statistical comparison, because the majority of arthritic patients belong to the upper classes, and are not subject to enumeration and classification like the poor who are compelled to seek relief in the public hospitals. But, even when the statistical returns of the hospitals are compared, the great pre-emi nence of England in the matter of gout becomes at once apparent. Ebstein, comparing the returns of the Munich hospitals with those of London, found that among 4,670 Bavarian patients there were only 11 who suffered with gout, while among 4,695 Londoners there were 97 who had the disease. In the Parisian hospitals a case of gout is hardly ever seen. It is, however, a noteworthy fact that all parts of the British Isles do not equally share these morbid privileges. Among the whiskey-drinking Scotch and the potato-eating Irish, despite the atrocity of their climate, gout is rare compared with its prevalence among the beer-drinking English.