Notwithstanding the frequency with which one encounters allusions to gout in English literature, it is unquestionably a rare disease in the United States. In the Massachusetts General Hospital there were, among 28,000 patients admitted in the last ten years, but four cases of gout. This is not an altogether fair criterion, as patients with gout are not generally of the class who seek hospitals, nor is the disease one of those which would be most likely to lead one into a hospital. Still, the experience of physicians in private practice substantiates the view of the rarity of gout in this country.

We are still ignorant of the exact changes in the bodily condition which lead to gout, but may say in a general way that in this disease certain products, derived from our food and from the wear and tear of tissues, are not properly used up or eliminated, and are retained in the body. One of these products is known as sodium biurate, and is deposited in the joints, giving rise to the inflammation and changes to be described. Gout occurs chiefly in men past forty. The tendency to the disease is usually inherited. Overeating, together with insufficient exercise and indulgence in alcohol, are conducive to its development in susceptible persons. Injuries, violent emotion, and exposure to cold are also thought to favor attacks.

The heavier beers and ales of England, together with their stronger wines, as port, Madeira, sherries, and champagne, are more prone to induce gout than the lighter beers drunk in the United States and Germany. Distilled liquors, as brandy and whisky, are not so likely to occasion gout. “Poor man’s gout” may arise in individuals who lead the most temperate lives, if they have a strong inherited tendency to the disease, or when digestion and assimilative disorders are present, as well as in the case of the poor who drink much beer and live in bad surroundings, and have improper and insufficient food. Workers in lead, as typesetters and house painters, are more liable to gout than others.

Symptoms. There is often a set of preliminary symptoms varying in different persons, and giving warning of an approaching attack of gout, such as neuralgic pains, dyspepsia, irritability, and mental depression, with restless nights. An acute attack generally begins in the early morning with sudden, sharp, excruciating pain in the larger joint of one of the big toes, more often the right, which becomes rapidly dark red, mottled, swollen, hot, tense, shiny, and exceedingly sensitive to touch. There is commonly some fever; a temperature of 102° to 103° F. may exist. The pain subsides in most cases to a considerable degree during the day, only to return for several nights, the whole period of suffering lasting from four to eight days. Occasionally the pain may be present without the redness, swelling, etc., or vice versa .

Other joints may be involved, particularly the joint of the big toe of the other foot. Complete recovery ensues, as a rule, after the first attack, and the patient may thereafter feel exceptionally well. A return of the disease is rather to be expected. Several attacks within the year are not uncommon, or they may appear at much longer intervals.

Occasionally the gout seems to “strike in.” In this case it suddenly leaves the foot and attacks the heart, causing the patient severe pain in that region and great distress in breathing; or the abdomen becomes the seat of violent pain, and vomiting, diarrhea, collapse and death rarely result. In the later history of such patients, the acute attacks may cease and various joints become chronically diseased, so that the case assumes the appearance of a chronic form of rheumatism. The early history of attacks of sharp pain in the great toe and the appearance of hard deposits (chalk stones) in the knuckles and the ears are characteristic of gout.

The greatest variety of other disorders are common in those who have suffered from gout, or in those who have inherited the tendency. “Goutiness” is sometimes used to describe such a condition. In this there may never be any attacks of pain or inflammation affecting the joints, but eczema and other skin diseases; tonsilitis, neuralgia, indigestion and biliousness, lumbago and other muscular pains, sick headache, bronchitis, disease of heart and kidneys, with a tendency to apoplexy, dark colored urine, stone in the bladder, and a hot, itching sensation in the palms of the hands and soles of the feet, all give evidence of the gouty constitution.

Treatment. One of the most popular remedies is colchicum a powerful drug and one which should only be taken under the direction of a physician. A cathartic at the beginning is useful; for instance, two compound cathartic pills or five grains of calomel. It is well to give five grains of lithium citrate dissolved in a glass of hot water every three hours.

Laville’s antigout liquid, imported by Fougera of New York, taken according to directions, may suffice during the absence of a physician. The inflamed toe should be raised on a chair or pillow, and hot cloths may be applied to it. The general treatment, between the attacks, consists in the avoidance of all forms of alcohol, the use of a diet rich in vegetables, except peas, beans, and oatmeal, with meats sparingly and but once daily. Sweets must be reduced to the minimum, but cereals and breadstuffs are generally allowable, except hot bread. All fried articles of food, all smoked or salted meats, smoked or salted fish, pastry, griddle cakes, gravies, spices and seasoning, except red pepper and salt, and all indigestibles are strictly forbidden, including Welsh rarebit, etc. Fruit may be generally eaten, but not strawberries nor bananas. Large quantities of pure water should be taken between meals at least three pints daily. Mineral waters offer no particular advantage.