GOUT TREATMENT HYGIENIC AND PROPHYLACTIC .
Since gout is a constitutional disorder of nutrition that is either inherited or acquired, and since it exists as a diathesis in which are manifested intermittent paroxysmal attacks that may finally be come merged in the phenomena of chronic gout, it follows that the treatment must be preventive when there is danger that the constitu tion may be undermined; it must be constitutional and general when dealing with the diathesis ; and special and local during acute at tacks. Chronic gout requires a combination of general and topical medication, together with careful observation of hygienic regulations. The range of therapy in this disease is, therefore, exceedingly wide and comprehensive. There is no room for doubt regarding the ad vantages to be derived from properly directed treatment, even though it be admitted that, once acquired, the gouty diathesis is permanent. Many incurable disorders are among those that offer the greatest op portunity for the exhibition of therapeutical skill in the relief of suffering and the prolongation of life. It is also all important to guide the heirs of an arthritic inheritance in a way that shall mini mize the consequences of ancestral misfortune. If their constitutional predispositions are thoroughly comprehended, the transient maladies which they may experience can be more safely and speedily conducted to a successful conclusion than if they are subjected to a treatment without reference to their diathetic peculiarities. And when the frightful suffering of an articular crisis is experienced, even the most obdurate sceptic must admit the necessity for anodyne measures, because no patient under such circumstances can be persuaded to find comfort in scientific explanations of the self-limited and curative nature of the spontaneous evacuations that constitute the principal phenomena of the attack. By judicious aid afforded during the paroxysms much subsequent disorder may be averted, and the return of these paroxysms may be prevented or at least may be longer post polled, especially if medical treatment be reinforced by efficient hy gienic measures during the intervals of apparent health. Of the highest importance is a clue recognition of the fact that gout is not an occasionally recurring malady that consists merely of certain articular manifestations of an inflammatory character. This is the narrow view of the uninstructed laity, and it is one of the principal obstacles to prophylactic and hygienic treatment. Hence the importance of instruction as well as medication; for these people must be made to understand that the disease is not seated in their joints only, but that it is an affection of the entire organism, and that it will inevitably lead to serious, if not fatal, disorder of the vital organs of the body unless restrained by wholesome living and a wisely directed therapy. By such far-seeing providence it will be often possible to rescue men who would be otherwise totally wrecked before their time.
In order to carry into effect a rational system of prophylaxis it is necessary to recognize the existence of the arthritic diathesis, and to comprehend the fact that by reason of its establishment through in heritance or acquisition, the processes of nutrition are modified in a way that leads to intoxication and encumberment of the organism with imperfectly oxidized nitrogenous compounds that are chiefly derived from the food. Since in the majority of cases the diathesis is inherited, it is important to begin at the earliest age with the children of arthritic families, and to enforce through life such hygi enic rules as are calculated to obviate the tendencies that grow out of the working of a defective constitution. From earliest infancy the child should be accustomed to the open air, and should be reared in a dry and sunny yet cool and bracing climate. The vast interior of the continental masses of land in the northern hemisphere, and the highlands of South America and northern Africa, afford the nearest approximation to these conditions. For the inhabitants of damp and chilly sea-coasts, a removal, at least during the unfavorable seasons of the year, to a more favored region should be advised. In addition to the ordinary athletic sports in the open air, horseback exercise should be practised by the growing child as soon as he can hold himself upon the saddle. The functions of the skin must be promoted by daily baths, and by the use of friction with coarse towels, brushes, hair-mittens, and the like. The diet must be regu lated so as to avoid excess of all kinds. Sweets and lean meat are to be used with great moderation. Every child should be taught to like milk, and to drink it in considerable quantity, since no other article of food exerts so great an inhibitory influence over the forma tion of intestinal toxins. Tea and coffee, tobacco and alcohol must never he allowed to the growing child or youth, since they all serve to retard the processes of metabolism and oxidation in the upon which the healthy liberation of bodily force is dependent. It may seem superfluous to advise a very moderate course of study in the intellectual training of such children, but it is among that class, precisely, that restraint rather than stimulation is needed, for it is in the foremost families, and within the circle of the bright and active members of society, that these precautions are most needed. A broad and comprehensive education, including a knowledge of the laws of health, and the cultivation of a habit of self-restraint, should be pre ferred to the miserable system of cramming for examinations that is now generally practised in our public schools and universities as the ideal method of preparation for the labor and responsibility of public life.