This is one of the diseases which are considered hereditary, or descending from father to son; although, if the son lives abstemiously, it may perhaps pass him over altogether and attack a grandson.

Gout chiefly attacks men, and particularly those who have a family predisposition to it; those who live well and lead a sedentary life, those who are addicted to literary pursuits, those who keep late hours, or are in the decline of life; but we meet with it now and then in females of a full and robust habit of body, or whose parents have been severely afflicted with it. Men who are employed in constant bodily labour, or who live much upon vegetable food, as well as those who do not indulge in wine and fermented liquors are seldom afflicted with the Gout. It rarely occurs before the age of puberty.

The attacks of Gout most frequently occur in the spring of the year and the beginning of winter, and from thirty-five to forty are the ages at which it most generally shows itself.

Rheumatism and Gout are sometimes combined, when the complaint is known as Rheumatic Gout.

Among the exciting causes of Gout, may be enumerated intemperance of every kind, late hours, intense application to study, long want of rest, much grief or anxiety of mind, great sensuality, long-continued fatigue, exposure to cold, particularly by getting wet in the feet, too free a use of acid wines, such as claret and champagne, a sudden change from a full to a spare diet, excessive evacuations, acidity in the stomach, violent passions of the mind, etc. A full diet of animal food, with rich sauces, with a free use of fermented liquors and wine, together with indolence and inactivity, are the causes which produce corpulency; hence the frequency of Gout among the rich. A fit of the Gout is sometimes brought on by severe exercise or walking far, and sometimes by a sprain; and that the disease occasionally takes place from a hereditary predisposition is beyond doubt, as youths of a tender age, and females who have been remarked for their abstemiousness, have been attacked with it.

A paroxysm of regular Gout sometimes comes on suddenly, without any warning; at other times it is preceded by an unusual coldness of the feet and legs, a suppression of perspiration in them, and numbness, or by a sense of pricking along the whole of the lower extremities, the appetite is diminished, the stomach is troubled with flatulency and indigestion, a degree of torpor or langour is felt over the whole body, great lassitude and fatigue are experienced after slight exercise, the body is costive, and the urine pale.

On the night of the attack, the patient perhaps goes to bed in tolerable health, and after a few hours is awakened by the severity of the pain, which has affected either the joint of the great toe, the heel, the calf of the leg, or perhaps the whole of the foot, and this becoming at length still more violent, is succeeded by shiverings and other feverish symptoms, together with a severe throbbing and inflammation in the part. Sometimes both feet become swelled and inflamed, so that neither of them can be put to the ground, nor can the patient endure the least motion without suffering excruciating pain.

Towards morning he falls asleep, and a gentle sweat breaks out, and terminates the paroxysm, a number of which constitutes what is called a fit of the Gout, the duration of which will be longer or shorter, according as the person is predisposed to. the disease, the season of the year, and the age and strength of the patient.

When the paroxysm has thus taken place, although there is an alleviation of pain at the expiration of some hours, still the patient is not entirely relieved from it, and for some evenings successively he has a return of both pain and fever, which continue with more or less violence till morning. In time the redness and swelling abate, the paroxysms become milder every day, till at length the disease goes off, either by perspiration, increased flow of urine, or some other evacuation; the parts which have been affected becoming itchy, the skin falling off them in scales, and some slight degree of lameness remaining; the patient, however, enjoying a better appetite than he has had for some time.

At first an attack of Grout occurs perhaps only once in two or three years, it then probably comes on every year, and at length it becomes more frequent, and is more severe and of longer duration each succeeding fit. It does not, like some chronic diseases, wear itself out, but a premature old age comes on, with painful and crippled limbs, and in course of time, the frequent return wears out the patient.

During the progress of the disease various parts of the body are affected, and the Gout shifts from one joint or limb to another, and after frequent attacks, the joints lose their strength and flexibility, and become so stiff as to be deprived of all motion. In some cases little swellings arise in the joints of the fingers,the fluid contained in which gradually hardens, and forms what are known as chalk-stones, from the supposition that they were composed of chalk; but, after being carefully analyzed, they were found to consist of Uric Acid and Soda. This deposit occurs not only during the fits of Gout, but likewise in the intervals, and as the extremities, particularly the hands and feet, are the principal seat of Gout, it is there that the greatest accumulations take place. Sometimes, from the accumulation of these deposits, the skin, stretched to its utmost, gives way, and an opening is formed, though which part of the accumulation escapes.

A case is related of a Gouty gentleman, who was accustomed, when playing at cards, to chalk or score the game upon the table with his gouty knuckles.

It likewise sometimes happens that, after the joint has become inflamed, instead of its continuing the usual time, and going off gradually, the inflammation ceases suddenly, and is conveyed to some internal part. When it falls on the stomach, it occasions nausea, vomiting, or great pain, with a sensation of coldness at the pit of the stomach; when it attacks the heart, it brings on fainting; when the lungs, it produces an affection resembling Asthma; and when it is transferred to the head, it is apt to give rise to Apoplexy or Palsy; when it attacks the stomach, the symptoms are sometimes so violent that patients have died in a few minutes after the attack.

Gouty persons are very subject to attacks of gravel and stone; where the parents have had the one disease the children are apt to have the other, and it frequently happens that the female offspring of gouty parents will be troubled with gravel and stone.

Gout will sometimes produce inflammation of the urinary passage, with a scalding and a discharge resembling gonorrhoea; it will also attack the eye, and sometimes the testicle.

In a regular fit of the Gout there is seldom any great danger, but only when the attack is transferred from the part first affected to the stomach, heart, lungs or head. When the internal organs are not much disturbed; when the tongue becomes moist and clean, and there is a return to the natural appetite, when the faeces regain a healthy appearance, and the urine ceases to deposit sediment; when the nervous system becomes tranquil, and the inflammation of the joints gradually subsides, a favourable termination of the attack may be looked for.

In youth the disease generally yields more readily to medical treatment than at an advanced period of life, and it is easier treated when acquired, than when it proceeds from an hereditary predisposition; but a majority of gouty subjects are able to trace back the disease to some of their forefathers. Of 522 gouty persons of whom Sir Charles Scudamore collected information, 332 could trace their disease to the father, mother, grandfather, grandmother, uncle or aunt. And in 515 cases in which the first attack was noticed, 142 commenced between the ages of 20 and 30; 194 between 30 and 40; and 118 between 40 and 50.

Treatment

During a fit of the Gout, if the attack is severe, the patient had better be kept in bed and moderately warm; he should at the same time be kept quiet, and as free from anything likely to irritate him as possible; and, as gouty people are generally impatient and touchy, from the severity of the pain which they suffer, they should be soothed and not provoked. If the patient is young and plethoric, he should abstain from all kinds of animal food, aromatics, and fermented liquors; living on water-gruel, sago, corn-starch, and similar things. His drink should be thin gruel, barley water, toast and water, and tea.

Colchicum, (meadow saffron), has long been in use as a remedy for Gout. It appears to have more influence over the disease than any-other known remedy. It is usually taken in doses of 25 or 30 drops of the Wine of Colchicum every four hours, till it produces vomiting or purging, Sir Thomas Watson, however, recommends a dose of 40 or 60 drops (minims), to be given in an effervescing draught at bedtime; and 30 drops more in a black draught, the next morning. And the dose to be repeated if the gout continues. After the attack is over, he recommends the continuance of the Colchicum in doses of 5 minims of the Wine three times a day, for some time; with gentle purgatives occasionally if the Colchicum does not keep the bowels open.

There is another medicine which of late years has been found of great service in Gout, which is Lithia. It combines readily with Uric Acid, which is always in excess in gouty subjects, and has a strong tendency to free the blood from any excess of Uric Acid which it may contain, and so to prevent or restrict the amount of Urate of Soda, the presence of which is the principal cause of the attack of Gout. It may be taken in doses of from 3 to 6 grains of the Carbonate of Lithia two or three times a day. It is recommended to be taken in soda water.

When Gout strikes inwardly and attacks the stomach, it often proves rapidly fatal. The attack, which consists of violent pain, and a sense of weight, with sickness, vomiting and faintness, is often relieved by stimulants. In a true gouty seizure, Magnesia with Rhubarb will frequently remove the pain, and sometimes, when these and opiates fail, a glass of brandy will completely relieve the pain. Stimulants, however, are not proper if there is inflammation. Sir Thomas Watson recommends, where symptoms like these occur, that we should inquire whether any indigestible food has been lately taken; for he says that Gout (so called) in the stomach has sometimes turned out, under the test of an emetic, to have been nothing more than pork in the stomach.

A mustard poultice may be applied to the pit of the stomach, and also to the foot which is attacked.

After the patient has recovered from the fit, if he wishes to escape for the future, he must be very careful as to his mode of living. If he is young and plethoric he must live sparingly, and take plenty of exercise. If he is old, however, and has been accustomed to live well, and his health is broken by repeated attacks of the disease, he must not live so as to debilitate himself, nor must he over fatigue himself with exercise, or he may in this way bring on. another attack. He should keep regular and early hours for retiring to rest, and should clothe warmly.