-Gout is a constitutional disease (allied to Hahnemann’s “Sycosis” according to Burnett), which manifests itself in various ways, the most characteristic being what is termed “a fit of the gout,” or inflammation of a joint, usually that of the great toe. In gouty persons there is a tendency to accumulation of uric acid in the blood in consequence of some fault in the digestive process. The tendency is a result of wine drinking and high living, and once set up is often transmitted to descendants. Much of the gout of to-day is the result of the excesses of past generations. Gout does not always show itself in joint inflammation (podagra). It often selects the skin, and sometimes internal organs and the throat. The skin and the great toe are the safest places for it to attack.
Diagnosis.-There is not much difficulty about the diagnosis of a fit of the gout. The patient after the first attack knows it very well. The sudden onset of violent pain in a joint, the absence of fever, the irascibility of the patient, distinguish gout from any purely inflammatory affection. In persons who are gouty anything that lowers their normal condition is apt to set up gout; and if they take any ordinary inflammation it is modified by the patient’s constitution. Gout is peculiarly liable to fly from place to place. If a severe inflammation in one part suddenly disappears and reappears in another, a the probabilities are that the disease is gout in one of its multitudinous forms.
General Treatment.-For more than any other persons abstemious living is necessary for the gouty. The only safe rule to make in regard to alcohol is to abstain from it altogether. Port wine and malt liquors are especially bad. Meat should be taken not oftener than once a day. Too much starchy food is not good either. Milk, stale bread, poultry, green vegetables, should form a large part of the dietary. In an attack of gout the diet must be very pain: plenty of cold water to drink (distilled water, such as “Salutaris” or Caley’s aerated distilled water, or filtered rain water or Malvern water, are the best for gouty persons), and the part affected must be kept warm and supported. On no account must cold water be applied to this: it may relieve the pain at the expense of setting up gout internally, with possibly fatal results.
Medicines.-(Every half-hour in the attack. When given constitutionally, three times a day.)
Aconite 3.
-When there is great restlessness, anxiety and anguish.
Nux vomica3.
-In wine and brandy drinks; irascible.
Pulsatilla3.
-Pain flying about from joint to joint; disordered stomach.
Belladonna 3.
-Redness, swelling and great sensitiveness of the part.
Urtica urens 0.
-This is Dr. Burnett’s remedy. He gave 5 drops in a wineglass of hot water every four hours in an attack, and night and morning in the intervals.
Rhus. 3.
-When the patient cannot keep the limb still.
Sulph. 6.
-Whenever the complaint drags. In chronic gout a course of Sulphur will almost always do good.
