Gout

Gout (derived from the Latin gutta, a drop) is a disease in which the substance called urate of soda becomes deposited in the cartilages of joints and in certain other situations. The name for this disease among the ancients was podagra (from two Greek words signifying an attack of pain in the foot). In the Middle Ages it was supposed that some morbific principle escaped from the blood into the joints, and hence arose the name gout. It is now known that the characteristic seizures of gout are always associated wdth deposits of urate of soda in the joints, that of the big toe being involved with especial frequency. Other changes in the tissues have been shown of recent years to be commonly associated with gout. Of these the granular or gouty kidney, and hypertrophy of the heart may be especially alluded to. Gout is most common in men of middle age, and there can be no doubt that heredity plays an important part in its production, and over-eating, over-indulgence in alcohol, and want of exercise are, apatt from the inherited disposition, the three main factors concerned in the causation of gout. The first attack of the disease affects, as a rule, the right great toe joint. The pain usually commences, in the first instance, at night-time, and may continue (with intervals of comparative relief) for several days. Later attacks may extend to other joints, and, when the malady becomes chronic, these joints become swollen and deformed, and nodules may appear in the surrounding tissues, consisting of uratic deposits. Thus the toes and fingers may be ultimately covered with what are called "chalk stones." Similar deposits affecting the lobe of the ear are termed tophi. Dr. Garrod has shown that the blood at the time of an attack of acute gout contains urate of soda in abundance. Gouty patients are usually liable to dyspepsia, and many other troubles occur in connection with the disease. The chief of these are headache, various neuralgic pains, palpitation, bronchitis, and emphysema, kidney mischief, bladder troubles, and various skin affections. Apoplexy is especially common in gouty subjects, and a peculiar, ill-understood, and serious group of symptoms sometimes supervenes immediately on the subsidence of an attack of gouty inflammation. To these the term "retrocedent gout" is applied. The treatment of the disease comprises first that of the acute inflammation, and secondly the general regimen to be adopted between the attacks. The most valuable drug for the relief of the pain and distress of acute gout is colchicum. As regards regimen the most important point is the limitation in the amount of alcohol taken by the patient, best of all its complete exclusion from the dietary. Excess in eating is also to be avoided, in particular all kinds of flesh should be taken in limited quantities, and all rich and highly-spiced foods should be eschewed. Hot baths, Turkish baths, tonics, and regular exercise are valuable adjuncts in the treatment of chronic forms of the disease.