SEASON - GOUT.
The change of the seasons produces a decided effect upon the manifestations of gout. The disease is most frequently experienced in the spring and autumn of the year. Various causes unite to bring about this result, and it cannot be ascribed to any single fact. It is during the vernal and autumnal months that sudden changes of atmos pheric temperature are liable to interfere with the normal discharge of heat from the body by sudden excitation and as sudden arrest of the cutaneous perspiration. With every change of wind from north to south, and vice versa, in many countries the individual finds himself either reeking with sweat, or compelled to return to winter clothing in order to protect the body from the dry cold air. When the dry and constant heat of the summer has become established, the heat of the body is regularly through the perfect evaporation of the perspiration as rapidly as it is formed. Hence the greater com fort that is experienced in a hot and dry atmosphere than in a humid though relatively cooler air. In like manner, the steady abstraction of heat that takes place iu the cold, clear days of midwinter causes a feeling of vigor and well-being that is not experienced during the warm and chilly seasons before and after the frosty months of the year. The reason of this is to be found in the fact that the oxidation of tissue-protoplasm is promoted by the normal discharge of heat from the body. Within normal bounds increased metabolism causes an increase of energy in the body and removes obstacles to the liberation of force. Uric acid and other forms of refuse are rendered more soluble by transformation into water, carbon dioxide, and urea, so that there is less accumulation of protoplasmic debris in the body. such circumstances, the detention of orates is less likely to occur, and the manifestations of gout do not appear. Some account must be taken, also, of the increased rate of the circulation during the dry heat of summer and the dry cold of midwinter; the heart beats with greater force, and the blood penetrates the tissues with greater effect. The result of increased atmospheric pressure during periods marked by a high barometer is of the same character. With increase of pressure the amount of oxygen that is inspired is increased and metabolism is promoted. But during the changeable weather of spring and autumn there is no constancy in these conditions, and the nervous system that has been rendered over-sensitive by the establishment of the arthritic diathesis reacts violently and tumultuously under unfavor able circumstances for the preservation of health, and disease is manifested. This result is especially liable to occur after a winter of
dissipation, or of tiresome intellectual labor by which the system is overloaded with the products of fatigue. Still more unfavorable are the conditions when, in addition to all these causes, luxurious living has damaged the digestive organs with alcohol and an excess of nitro genous food. It must not be forgotten that every hearty meal, in which meats, soups, and gravies are conspicuous, serves to introduce into the blood a notable quantity of ready-made uric acid which may suffice, with what has been already stored in the tissues, to excite an explosion of gout. Hence the frequency with which, in the spring of the year, a grand chimer or a wine supper is followed by an articu lar crisis in the person of a subject who is predisposed to the disease. Haig tells us that he can thus excite articular pains in his own limbs at any time. Sir A. Gra,rrod has repeatedly witnessed similar phe nomena after a few glasses of champagne or port. Some patients cannot eat a bunch of grapes or a plate of gooseberries without similar consequences. Garrod, indeed, considers the occurrence of articular inflammation after indulgence in fermented drinks as pathognomonic of gout. Thus it is rendered evident that gout is a continual malady, in which the articular crises are only the most conspicuous manifes tations of the condition of disease which, for the sake of convenience, is called the arthritic or gouty diathesis. Once acquired, the predis position remains permanent ; and, when completely established, the patient becomes so slight deviations from the ordinary routine of life and health are sufficient to precipitate au acute attack. In the female sex the occurrence of pregnancy, like venereal indulg ence on the part of the male, is sometimes sufficient to bring on an attack. Slight ailments, as a sore throat or a coryza, may be followed by articular inflammation; though it is very probable that these may be simple prodromes of the attack, just as they frequently are re lated to the kindred malady, rheumatism. Strong emotions of a depressing character and unusual intellectual efforts often act in a similar way as excitants of the disease. The great Sy Benham has recorded the fact that whenever he applied himself with more than ordinary vigor to the work of writing and study, lie provoked an at tack of the disease with which he was personally so familiar. Of other scholars not a few can report a similar experience. Fatigue of every kind must, therefore, be reckoned among the occasional excit ing causes of gout.