GOUT is rheumatism's cousin; the parentage of both belong to the brotherhood of the acids.
A very acid state of the blood, or a state favorable to the formation of acid, is supposed to be the cause of the inflammation peculiar to both these disorders. In rheumatism, an acid which exists in sour milk, and in cider, called lactic acid, is thought to be the disturbing element. In gout, lithic or uric acid is known to be uncommonly abundant, and to form a principal ingredient of those concretions found in gouty joints and familiarly called chalk stones.
The larger joints are most often affected by rheumatism; while gout prefers the smaller ones. In rheumatism, the pain is excruciating in gout, it is intolerable. There is truth in the humorous Frenchman's description of the pains of these two complaints, which is, in substance, as follows: Place your joint in a vice; turn the screw till you can bear it no longer; that gives you an idea of rheumatism; now give the instrument one more turn, and you have gout.
Symptoms. A fit of the gout, as it is called, generally makes its attack in the night. Its unsuspecting victim is first awakened, perhaps an hour or two after midnight, by an intensely burning, wrenching pain in the ball of the great toe, or some other small joint. This pain, with its accompanying symptoms of fever, continues with little abatement for twenty four hours. There is then a distinct remission, when the sufferer may get some sleep. He has a similar experience during several succeeding days and nights, when the disease, which has been growing milder, leaves him.
After a considerable interval, there is likely to be another similar visitation. The length of this interval is inversely as the number of attacks, that is, it diminishes in length as the attacks increase in number; in yet plainer and more homely terms, the attacks come thicker and faster ; the space between them gradually shrinking from three or four years to one or two months.
Recovery from the first attack may be complete, the skin peeling off from the red and swollen joint, and leaving it strong and supple as ever. But, after several repetitions of the inflammation, the joint becomes stiff, its motions being obstructed by the deposit of lithic acid concretions, or chalk stones, the limbs are sometimes actually frosted over with crystals of urate of soda (Fig. 149). This form of urate of soda crystals differs very materially from Fig. 124. When these crystals appear upon the surface, and deposits are made in the joints, uric acid is not secreted as usual by the kidneys, but accumulates in the blood.
But gout is a disease by no means entirely local in its character. It vitiates the blood, affects the system generally, and is often betrayed by general symptoms long before the local mischief is indicated by one of the attacks. Irritability of temper, unpleasant sensations in the stomach and head, and various uncomfortable feelings of body and mind, have been considered as premonitory of this disorder. Many other organs also, besides joints, are subject to the gouty inflammation. The stomach, heart, lungs, head, and even the eyes, are known to have been thus affected.
Causes. Luxury and indolence particularly the former are regarded as the principal causes of gout. But poverty and activity will not always keep the disease away. Probably an improper diet has more to do with the creation of gout than all else. Starchy food, sweets, etc., which cause an acid fermentation, are most likely to set up the trouble.
Treatment. Colchicum is the remedy for gout. It removes the disease by exciting the kidneys to action, so that the poison is conveyed away in the urine. Perhaps it acts in some other unexplained way as an antidote to the disease. One teaspoonful of the wine of colchicum may be taken two or three times a day, until relief is experienced. It should then be continued, in ten drop doses, for a few days longer, to prevent a relapse. The colchicum may be taken in the form of prescription (301). Coffee, drunk freely every day, is said to be a sovereign remedy for gout.
The bowels must be kept in order, but not actually purged (34), (40). The diet must be simple and unstimulating.
Let the inflamed joint be bathed often in a saturated solution of bicarbonate of soda in soft, warm water. Cold applications should not be made, as there is danger of provoking a sudden change of the inflammation to some internal organ.
A regulation of the diet and open air exercise are the best methods of fighting the disease.
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