Gout is a markedly hereditary disease, de scending from parents to children in a very remarkable way. Men are more frequently attacked than women ; the age most liable to the disease is between thirty and forty-five. The circumstances that usually determine an attack in those liable by inheritance to the dis ease, or that excite the disease for the first time, are habitual excess in eating, specially in the over-eating of animal food and rich dishes, long-continued excess in drinking, especially strong wines, such as port, sherry, madeira, and malt liquors (beer and porter), and prolonged want of proper exercise. It appears also that persons subject in their occupation to the influ ence of lead are rendered more liable to an attack, if other circumstances favour it. It appears that the disease is due to an excess iu the blood of a substance called uric acid, either because it is formed in the body in too large quantity, or because it is not removed from the blood by the kidneys in the urine as it ought to be. It is a disease specially apt to return frequently, very slight causes being sufficient to determine an attack in those subject to it.. Thus even a slight degree of indigestion, irregu larity of bowels, cold, mental anxiety or worry or excitement may occasion a fit of the gout in gouty persons.
Symptoms.—An acute attack of gout usu . ally comes on suddenly during the night with pain and swelling in a joint, commonly the joint that forms the ball of the great toe. The joint becomes not only much swollen, but also turns red and shiny, the veins on the foot and part of the leg being very marked. The pain is often extremely severe, and is burning or shooting in character. Other joints may also be attacked, the smaller ones specially. The least movement is almost unbearable, and even the weight of the bed-clothes is not endurable. Towards morning the pain lessens, but next evening it returns, and this may continue for a week or ten days, when the severe symptoms pass away, though the joint remains swollen and tender for sonic time longer. However swollen the joint may be, matter does not form. Attending the joint affection there are general symptoms of disturbed health, shiver ings and sweatings, loss of appetite, white tongue, increased heat of skin, quick pulse, confined bowels, and scanty high-coloured urine from which a brick-red deposit separates out on cooling. The sleep is much disturbed ; cramps and startings of the muscles of the leg are common ; and the patient is of very irrit able temper. After the first attack the joint apparently quite recovers. As a rule the dis ease returns sooner or later, generally within a year ; and not only does it tend to return, but the intervals between each "fit" become shorter. With the greater frequency of attack, more joints are liable to suffer—joints of foot, hand, ankle, knee, &c. As the disease becomes chronic the joints become permanently altered. They enlarge, and deformities are produced, due largely to the deposit within the tissues of the joint of masses of orate of soda, called "chalk stones," which not only form prominences and irregularities, but by being deposited around the joint tend to fix it in unusual and awkward positions. Abscesses may form round the chalk stones, from which they may be discharged, leaving ulcers. The general system tends to become affected and the person to grow feeble and weak.
Those who suffer from attacks of gout are often warned of an on-coming "fit" by symp toms not well marked, but which, by experi ence, they know too well the meaning of. Those
symptoms may be connected with the digestive organs—flatulence, heartburn, irregularity of bowels,---or connected with the heart, such as palpitation; or there may be headache, irrit able temper, and various other nervous symp toms.
There are forms of irregular gout that show themselves by severe stomach disturbance, such as acute spasmodic pain or cramp and bilious vomiting, or by disturbance of the heart, evi denced by palpitation, faintness, &c. By similar attacks of irregular gout the breathing may be .much disturbed, and rendered so laborious that suffocation seems to threaten. Nervous and other symptoms may also be due to a similar cause.
Treatment. —Very strict regulation of the habits of life is one of the most important de ments in the treatment of gout. The person must exercise great restraint in eating, and must take no more than is necessary for proper nourishment. A mixed animal and vegetable diet is the best, but the amount of animal food in particular must not be in excess. Of this class of food the best kinds are white fish, game, fowl, and mutton. Fat meat such as pork, salted and spiced meats, and all rich dishes are to be avoided. In regard to vegetables, some believe in the free use of celery. Stewed fruits are allowed, but no pastries, and the fruits should be sparingly sweetened. Extreme mod eration in drink is absolutely necessary, beer, porter, and rich wines, champagne included, being rigidly abstained from. Such wines as hock, moselle, claret, alone are safe ; whether they should be used at all, and, still more, whether any whisky or brandy may be taken, ought to be left to the decision of a medical attendant. Water should be the principal drink. Tea and coffee are not necessarily Harmful. Potash, soda, and lithia water may do much good, a'nd ought to be taken freely, but only between meals.
The gouty person should take regular out door exercise daily, and should go early to bed and rise early. The clothing should be warm. Baths are of great use, and specially a well ordered Turkish bath. Exposure is to be avoided ; and sudden changes of temperature are to be guarded against. For this reason, where a choice can be made, an equable climate is to be preferred. As regards treatment during an acute attack, it should be begun with opening medicine, such as rhubarb (10 grains) and bicarbonate of soda (15 grains), the dose being repeated as found necessary. To relieve the pain the drug most extensively used is meadow-saffron or colchicum. The preparation used is the wine, given in water in 10- to 30-drop doses every four or six hours along with 6-grain doses of citrate or carbonate of lithia or potash. The use of the colchicum may be continued for several days if it agrees with the patient. At the same time the action of the skin and kidneys is to be promoted by the patient being kept warm, and drinking freely of barley-water, soda-water, or cream of-tartar water flavoured with lemons. The food should be light and nourishing—milk and bread, a little beef-tea, &c.—and rather spare in quantity. The affected joint should be kept at rest, supported in a raised position, and surrounded by a piece of flannel dipped in warni water, and covered by cotton-wool.
In chronic cases 3 to 6 grains of carbonate of labia should be taken twice daily in a wine glassful of water, and Carlsbad or Vichy water largely used.