HEREDITY - GOUT.
Of all the personal influences that favor the incidence of gout, heredity is one of the most important. All the older writers insisted upon this as a most potent factor in the evolution of the disease from generation to generation. It is noticeable, however, that hereditary antecedents are more conspicuous in England and Holland, where gout is frequently encountered, than in France and the south of Europe, where it is comparatively rare. Thus, Gairdner found, among 156 patients, 140 who had descended from gouty families. Bouchard, on the contrary, could discover only 40 per cent. of his cases who were similarly connected. Obviously, this must be true of a disease which is not absolutely transmitted, but is chiefly dependent upon individual behavior. The word heredity must be understood in connection with gout as a convenient designation for certain habits, modes of training, and occupations that tend to become permanent in certain families or lines of descent. In this sense, heredity exercises a powerful influence upon the constitutions of the several members in a given line of descent, so that a tendency to particular maladies be comes ingrained in the structure and functions of the organs that have been thus moulded. In this way is prepared the field for the manifestation not only of gout, but of all other allied diseases of nutrition, such as gravel, biliary lithiasis, asthma, neuralgia, obesity, diabetes, and articular inflammations. Hutchinson, Dyce Duck worth, and others have noted the interesting fact that the age of the father has a decided effect upon the heredity of gout. When the male parent is young and but recently attacked by the disease, the children who are then begotten will often escape the transmitted pre disposition, or will manifest its signs in a minor degree. But the later children will exhibit the tendency with a progressively increas ing severity. This is exactly the reverse of what is often observed iu syphilis, a disease that is usually contracted in early adult life, and manifests its greatest intensity very soon after infection, gradually subsiding and progressing toward latency as life advances. The earlier-born children of a syphilitic parent, consequently, receive the disease in full intensity, while the later offspring either escape altogether, or exhibit only the milder forms of the malady. Syphilis, like all infectious diseases, tends toward recovery as life proceeds; but gout becomes more inveterate and malignant with the lapse of time; and, consequently, the offspring of its victims are successively representative of the downward course of their progenitors. Many examples of this family decadence have been noted from the days of Sydenham to the present time.
Acute gout, followed by uratic deposits in the joints, appears to be more frequently transmitted by the father than by the mother. According to the often-quoted statistics gathered by Scudamore, among 263 cases of hereditary gout 181 were derived from the father, and 58 from the mother, while only 24 were children of parents who were both gouty. But this disproportion seems less remarkable when we take note of the greater frequency of articular gout among men, and the fact that when it does attack-the members of the female sex it usually makes its appearance after the close of the child-bearing period. If, however, we look beyond the sphere of ar
ticular manifestations, we shall find that anaemia, neuralgia, lithiasis, asthma, bronchitis, and the allied diseases that depend upon the arthritic diathesis are perhaps quite as common among women as among men. In gouty families, the males develop articular disorders in addition to the minor forms of arthritism, while the females less frequently reach the most conspicuous manifestations of the diathesis which they also have inherited. It is still an open question whether the transmission of the gouty predisposition is more likely to occur when both of the parents are affected with the disease at the time of maternal conception. Such a result seems highly probable, but its proof is very difficult. The explosion of gout is liable to so many caprices that are dependent upon accidental and variable causes that it is extremely difficult to trace their operation. That the children of a gouty couple should be exposed to greater errors of diet and hygiene through the traditional habits of their ancestors in accordance with which they are educated seems very likely. But, so changeable are the conditions of life in many families, that hereditary influences may be wholly or in part counteracted by the mutations of fortune and the consequent abandonment of faulty habits, or they may be intensified by the attainment of new opportunities for intemperance and self-indulgence.
For similar reasons it is impossible to decide whether gout be comes modified through the course of successive generations. Mis led by a fancied analogy derived from observation of the infectious diseases, some have imagined that gout can become attenuated and die out in the course of descent through time. This, however, is only possible in diseases that depend upon the transmission of an infective agent. The infective germs are gradually attenuated through contact with healthy tissues, and tend to become innocuous. Were it not for fresh infection from sources external to the body, it is probable that all bacterial diseases would in time thus become ex tinct. But gout is not thus derived by the transmission of a conta gium. Only the enfeebled and susceptible constitution is inherited.
The subsequent manifestations depend chiefly upon individual and personal causes that may or may not be called into action. For these reasons the course of gout through a series of generations will ex hibit great variations. Sometimes the disease seems to become masked and to assume visceral forms for successive periods of family life. In other instances, it disappears for a generation, and then reappears with all its pristine severity in the next. Rarely, however, does it become latent without the manifestation of one or more of its congeners, eczema, neuralgia, bronchitis, asthma, lithiasis, etc., among those who have escaped its full force.