The Good Old Days: The misery of gout

Gout is an unhappy malady that may be generated by errors in diet and regimen, especially by the consumption of large quantities of nitrogenous food, and the use of certain beverages tending to prevent excretion of bodily waste.

Inactive habits are also a contributory factor. Its causes are chiefly a sedentary mode of life, rich food, gluttony and the use of such liquors as port wine, sherry and Madeira. When it occurs in individuals from the lower grades of life, it may be traced to the use of such drinks as old ale, Burton ale or stout. Spirits rarely induce gout.

Between outbursts of the malady, the individual may be well. The patient presents certain characteristics that distinguish him/her from his more fortunate brethren. He/she comes from a gouty stock; among his near ancestors are those who have had gout in its classical form or have suffered from allied disorders.

But when the gouty habit is truly upon a person, they become miserable, and exhibit irregularity of the bowels, palpitations, indisposition to exertion, irritability of temper, headache and flushing of the face. Gout can be acute or chronic, and when chronic commonly attacks the ball of the great toe, giving rise to exquisite pain, tenderness and rubor, but never going on to suppuration.

The agony of gout is great. The intensity of the discomfort is such that it has been described as the devil himself sinking tooth and claw into the inflamed tissues. Deposits of urates can be found, but the true cause probably lies in imperfect changes in certain articles of food, resulting in compounds intermediate between albumen and urea, one of which is uric acid.

Patients who have suffered from repeated attacks of gout become affected with chalk-stones, which impede greatly the usefulness of the hands; the constitution too gives way. In these patients a reduction in diet will be required. Fifteen grains of calcined magnesia, 10 of rhubarb, and 40 drops of sal volatile, in a wine-glassful of water, will form a draught which may be repeated twice a day. It may also be given with advantage to double the quantity of sal volatile, and 20 or 30 drops of laudanum in the event of gout receding to the stomach, as evidenced by pain and other signs of the disorder of the organ, and by the sympathetic faintness, accompanying the attack.

A glass of brandy may be substituted for the above with good effect; these stimulants, however, being given under the caution that no extreme tenderness, indicative of inflammation, exists at the pit of the stomach.

Adapted from Practical Medicine by Alexander Silver MA MD, published in 1874 by Henry Renshaw of London

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