A TOUCH OF THE GOUT.

Hawke's Bay Times, Volume 6, Issue 330, 7 December 1865, Page 1

A TOUCH OF THE GOUT.

(Prom All the Tear Bound.) "When Sydenham, our father of medicine, discoursed of gout, and felt it in his own toe as ha wrote he found one poor comfort in the fact “that gout, unlike any other disease, kills more rich men than poor, more wise than simple.” Great kings emperors, generals, admirals, and philosophers, have all died of gout. Hereby Nature shows herimpartiality, since those whom she favors in one way she afflicts in another. It is always the rich uncle or father in the farce, or the king in the burlesque, or leading statesman in parliament, who limp with a gouty leg ; and, until of late years when gout has become rather common among the poor, there has been a sense that gout was, at any rate, a respectable disease to have. Savages never have it. There can be no doubt that it is the fruits of civilization, and a very early fruit. Gout troubled the old gentlemen who sat in the Areopagus, and they had it in all forms. Their physicians called it a foot seizure (podraga) when it seized the foot, a hand seizure (chinagra) when it took its victim by the hand, or gonagra jf it pinched the knee, or arthritis if it inflamed severaj joints. It was first called gout at the end of the thirteenth century, from the Latin for a drop, because it was supposed to be caused by a humor distilled drop by drop into the joints. Seneca counted it among the signs of Homan degeneration in luxury that even the woman got their equal share of gout; gout being a disease rare in woman, and, when it does occur, occurring in them usually when they are advanced in life. The disease, said a doctor of Galen’s time is one that “ none but the gods can truly understand” its coming and going; and that doctor told the case of a gouty man, who in an interval of his disorder, won a foot-race at the Olympic games. In much later times the appearance of the chalkstones formed in gouty joints, combined with knowledge of one cause of gout to suggest the theory that they were deposits of the tartar of wine. It was crusty port venting its crustines upon its friends.

Suppose that a man who considers himself quite healthy is to have his first attack of gout. He goes to bed happy, and is awakened after a few hours’ sleep, usually between one and four in the morning, with pain in the ball of one great toe, which increases with a sense of burning and throbbing, and he finds next morning that his too is swollen with a deep red shining skin. Moreover, it is so exquisitely tender, that during the height of the attack he cannot bear the weight of the bedclothes or the shaking of the bed by footsteps in the room. There are a series of such attacks. Then the swelling abates. In a few days the skin itches and peels off, and there is in the joint only some little remaining tenderness. That is the term of a brisk first attack in a man otherwise healthy. Gout has a partiality for gn-.wing at a man’s great toe. Of five hundred and sixteen cases of gout observed by Sir C. Scudamore, three hundred and fourteen seized on the great toe of one foot only, twentyseven fastened upon both the great toes, but only two fastened upon the thumb, only fifteen touched in any way the hand or wrist. In not more than five cases in a hundred, in fact, in any joint affected with true gout where the great toe has not been, or is not also a sufferer, and in those cases there has usually been some local injury to causa the gout to appear first in some other than its natural place. As for the pain, “ Screw your joint,” said a Frenchman, “ in a vice until you can no longer bear the pressure, that is rheumatism; then give the vice another twist, that’s gout.” Gout having once seized on its chosen outwork, has a tendency to fight its way upward, first storming the ankles, then making an ugly rush, upon the knee, then taking possession of the hands and elbows. There used to be a superstition that gout lengthens life, and Cullen endorsed the maxim that the only remedy for it was “patience and flannel.” But he would not now be considered a wise man who should resign himself thus to the mercy of an enemy that can deal fatal blows, though it docs usually kill when it has made death welcome by depriving life of its pleasures. A man otherwise healthy, who is careful of diet, may, indeed, live beyond his eightieth year, after suffering from gout for more than half a century ; he may remain In-a from chalkstones, stillness, and deformity, and suffer only few and slight attacks in his old age. But with many the gout remains long enough in a joint to destroy its flexibility, or to deposit chalkstones, which were so called when people supposed them to be so. They are not chalk, and they may contain no particle of iimo, but they contain a large proportion of a salt—urate —of soda. Chalkstones are much more commonly absent than present; or they are not very often present as visible disfigurement. In a slight degree they are often to be found, and if they occur anywhere in any degree, they are found usually on the ear, commonly on the upper edge, as little pearly spots, or a single spot that may be smaller than u pin’s head ; they give out, when pricked, a milky fluid ; or such a spot may be as large as a split pea, and, when bard, is firmly fastened to the gristle of ear. These testily to the altered condition or the blood, the difference being that while it may retain all other natural constituents in just proportion, it has two constituents, always there but properly only in small proportion, combined as urate of soda, and existing in unnatural excess. It is the business of the kidneys to remove all but a very little of the urate of soda formed within the body. When they fail to do that, and it accumulates, its irritation causes goat. 13? Garrod, whose boob on the subject, representing the researches of seventeen years, is the standard professional su*

thopity, has contrived an ingenious way of discovering whether a man has gouty blood. He puts into a flat glass dish about a teaspoonful of {lie serum or fluid part of the blood to be tested, adds a few drops of acetic acid, and then puts into the mixture one or two fine but rough ultimate fibres from a piece unwashed huckaback or other linrn. After standing undisturbed two or three days—the lime varying with slate of the atmosphere—if there be too much uric acid in the blood, it will hare crystaiised-hke sugar-candy round the Unin fibre, and its crystals will easily be recognised under the mirbscopo. These fads, apparently so simple, represent a marked recent advance in medical knowledge. Apart from the diir'i'rent course of symptoms, the presence of an excess of this acid in the blood, as shown by the tlue.id ted, emi hatically prevents all possible confusion between gout and rheumatism. Where the serum of freshly drawn hood will show it, it it will he shown also by the fluid that a blister draws, if it be not a placed over an inflamed mu-face.

but jf urate of coda in the blood give men the gout whut gives them the urate of soda? Is it all the doing of old crusty p-..n ? Certainly not. In the first place, lucre is a hereditary tendency go strong that Dr Cullen even thought all gout hereditary. In three out oi five, or at any rate in more than half the eases, gout may be traced back to parents or grandparents. It is part of jnany a rich man’s inlierifenee. “A few years since,” says Dr Garrod, “ I was consulted by a gentleman laboring under a severe form of gout, with chalk-stone, and, although not more than fiby years old, lie had suiiercd from the disease for a long period. On inquiry, I ascertained that lor upwards of four centuries the eldest son of the family had invariable been afflicted with gout when he came into possession of the family inheritance.

And so when a man sets up for himself a gout that he has not inherited, he has something at any rate which lie v.iJl probably leave to his children. A first attack of gout is seldom seen in a patient younger than twenty or older than sixty-sis, the gi cater number of such attacks occur between the thirtieth and fortieth year; but inherited gout sometimes appears very early. When a man sets «p gout for himself he gets it by the use of fermented art nks. Had there lesn no fermented- drinks, gout probably would never have existed. JUit different drinks tend in different degrees to produce it, and Iho latest information on that subject is ■wortli having. It is not the alcho] that does it. Brandy or gin or whisky—any distilled spirit taken by iholf—seems to have no power in’ producing gout. It comes of drinking wines, siroim ales, and porter. It is very rare among the wbi-'kv •drinking classes of Scotland, on Ireland. Dr C.n-istison, in thirty years’ experience at the Edinburgh infirmary, met with only two cases of <mut and the patients in each case wcr« fat over-fed English butlers. Russians, Poles, and Danes, who drill): distilled spirit, know hardly anythin'* of gout, Tho Thames ballast heavers' of "whom each man drinks when at work two or three gallons of porter daily, yield, (hough a small body of men, many cases of gout to the Seaman’s Hospital ship. As they are most of them Irish, the nisi asu cannot be inherited. The gout is producedby the large doses vf porter. Ot fermented drinks, those which are most apt to produce pout are port and sherry or stron* varieties of other wine. Free use of port and sherry may produce pout in a few years when there is no hereditary tendency. The lighter wines, us caret, hock, mcssele, mid champagne, may excite an attack m gouty subjects, but when taken in moderation, have little influence in producing gout, and except the finer and stronger qualities—rank, is; ibis respect, with the weaker kinds of beer.

Ut malt liquors, stout and porter tone! most to produce gout; nest to them, slro;i‘ r ale and even ordinary bitter beer. Dr Gnrrou tells of a patient aged only thirty, who was connected with a pale »i 0 brewery, ami bad suffered four years from gout, which was becoming chronic. It'had beer, estabhsl'.ed without any help of his for. fathers, by the ha! it of repeatedly drinking pale ale in sir,all quantities at a time, though the total amount hi the day was considerable. It is curious that while ftrong distilled spirit docs not produce gout, fermented drinks arc liable to do so in proportion to their strength. Acidity is not the cause, nor sugar; lor acid claret is comparatively harmless, while sherry and port, the least Jawid of wines, are the.most powerful lor mischief; so, too, liquors the least sweet may be the most baneful In other respects than as gout-producers, the distilled spirits arc more mischievous than wines ; they bring in tneir train their own diseases when used iu excess— only gout is not one of them.