Gout, or Podagra, a disease of the Pouteus-kind, thus defined by Dr. Cullen : It is hereditary, and commences without any a parent external cause, but is in most instances preceded by indigestion, or other affection of the stomach ; its paroxysms are ushered in with fever, pain at the joint, generally, of the great toe, always attacking the joints, and chiefly those of the feet or hands : it returns at intervals, often alternates with indispositions of the stomach, or other internal parts.
Forerunners of the Gout: - Indi-gestion often returning; thick sediment in the urine, sometimes for a whole year previously to the paroxysm, while that fluid emits the flavour of milk; vomiting, hiccough, and frequent pains of the forehead.
Peculiarities of the disease :— Chalky excrescences appear on the joints, which shortly before death also cover the face; the gout infects dogs ticking the sore or tumefied parts of their master, and, according to some authors, it may likewise be communicated by clothes : it occurs most frequently in the spring ; is often connected with the stone or gravel ; and bus sometimes been confounded with acute rheumatism.
Causes : - Acid food, especially sour cherries ; the immoderate use of fish, sugar, wine, cyder, and spirituous liquors ; in short, luxury and debauch of every kind; suppressions of diarrhoeas, dysenteries, or the hemorrhoidal flux ; repud-sion of the itch, scurvy, or other cutaneous eruptions; sleeping on fresh hay, etc.
Prevention and Cure. - Although this obstinate disease has generally been considered as incurable, and thus become too often the boon of the most ignorant pretenders, yet we believe that the want of success in _ the profession, must be ascribed partly to that fashionable superficial treatment which constantly aims at alleviating urgent symptoms, and partly to the difficulty of prevailing on those whimsical patients to pursue a steady and regular course of both medicine and diet, without which no radical cure of the gout can reasonably be expected.
During a paroxysm of the gout, the patient ought to be treated according to the state of his fever (which see); and, as the crisis of the disease generally takes place in three or four weeks, either by transpiration of the pores, or the discharge of urine, those secretions should be promoted by the mildest sudorifics and diuretics. Hence diluent drinks, such as barley-water in which sal ammoniac has been dissolved, in the proportion of one dram to each pint, should be liberally drunk; but, where impurities in the first passages are suspected, gentle emetics may be administered ; and if fulness of blood prevail in the vessels, venesection will perhaps be advisable. - Ma-rino, an Italian physician, prescribed for his gouty patients half a pound of olive oil to be swallowed several times a day, with uncommon success: but we apprehend, that few persons will be inclined, or able, to take such profuse draughts. Meanwhile, the parts affected should be carefully covered with flannel; and though we do not approve of anodynes to be taken internally, because the crisis of this rnalady cannot be accomplished by Nature without painful efforts, yet the following applications have occasionally been found of great service, in abating the most excruciating pain, viz. oil of wormwood; or Peruvian balsam dissolved in alcohol; or a solution of sal ammoniac, in white wine; or a cataplasm made of elder flowers, boiled in cream, and applied as hot as the patient can bear it; or oil of wax dropped on the part affected ; or the skin of an eel; or liniments consisting of vinegar and soap ; or the leaves of the Rough Bindweed; or even fresh horse dung, etc. all have, in particular cases, been employed, and found productive of good effects Nevertheless, we by no means recommend these remedies to be indiscriminately or promiscuously used, as the propriety and safety of their application should be determined by professional advice.
When the gout retreats to more dangerous, internal parts, such as the breast and stomach, it is generally attended with vomiting, which ought to be supported by small doses of ipecacuanha, about half a grain every ten minutes, while the parts affected are rubbed with vitriolic aether. As soon as the stomach is composed, small doses of camphor, or vitriolic aether, internally, will be of essential service to allay the spasmodic action of the viscera. At the same time, sinapisms should be applied to the soles of the feet, and the lower extremities kept warm; a treatment by which the pain, as well as the seat of the disease, easily returns to its former place.
Various expedients and plans of regimen have been devised, in order to prevent, or retard, the fits of the gout. As we cannot enter into the peculiarities of different constitutions, we shall here briefly point out that mode of living which. will, in general, be found the most conducive to the purpose. - Tem-perance, in the strictest sense, total abstinence from acid, fermented and spirituous liquors, and a very moderate use of wine, are the prin-cipal circumstances to be attended to by the gouty ; but, in their food also, they should be extremely careful, and avoid all fat, rancid, salted, or smoked provisions of every description, especially game and fish. Spices, pickles, and stimulating dishes, in general, are the most powerful promoters of this painful disease; while hot suppers, late hours, and long sleeping in feather-beds, are its greatest nursery. Hence, persons liable to attacks of the gout, ought attentively to observe whatever agrees or disagrees with their digestive organs ; for, as long as their stomach duly performs its office, there is reason to hope for a favourable change. Moderate exercise should likewise, on no account, be neglected ; because excessive fatigue and long-continued application to intense study, are equally detrimental. Fear, violent grief, and an irascible temper, ought to be vigilantly controlled by the calm reflections of reason. - Beside all these precautions, however, it will be useful to adopt some particular rules of diet and regimen, in order to counteract the constitutional predisposition to that formidable disease. With this intention, we from experience recommend the constant use of barley-bread, and to bilious individuals, wares milk, or the whey obtained from it after coagulation. Large doses of ginger, from one to four or six drams pulverized, and boiled in cow's milk for breakfast, have lately been found an excellent preventive. Absorbent powders, consisting of two scruples of calcined magnesia, with purified kali and powdered bubarb, from three to live grains of eac have likewise been taken with con-siderable advantage during the intervals of gouty fits ; but this medicine ought to be repeated for several weeks, or even months, at least every other morning, according to the nature of the case.
Lastly, there is sufficient reason to conclude, that the internal use of the marine acid, or spirit of salt diluted with water, if continued for a proper length of time, and aided by bathing the legs daily in water saturated with a small proportion of the same acid, would greatly tend to prevent the return of the disease. Indeed, Dr. Wollaston has discovered, that gouty matter consists of a peculiar (lithic) acid which is supposed to be generated in the human body, and combined with the mineral alkali: consequently, as the marine acid has a greater attraction for this alkali than the lithic acid (or that which contributes to the formation of the stone in the bladder), it appears to be a reasonable inference, that the generation of chalky matter may be counteracted by the copious use of that acid, both internally and externally, which would preferably combine with the mineral alkali, and thus deprive the lithic acid of its nucleus or basis.