Climate and Residence
While, naturally, individuals display wide differences in their capacity of adjustment to variations in climate and season, there is no doubt that the gouty, as a class, are abnormally deficient in their power of adaptation in this respect. Said Hippocrates in one of his aphorisms, “Podagrici affectus vere et autumno plerumque moventur,” and this peculiar influence of season, viz., the aptness of gout to recur in spring and autumn, especially in its early stages, is a very singular feature.
The increased incidence at these particular periods of the year is, I think, a striking proof of their deficiency in the defensive mechanisms that enable normal persons to withstand with comparative impunity sudden transitions from cold to heat, dryness to damp, and so forth. So it is that rapid changes in the surrounding air, in its degree of warmth, or its motion by wind are fertile of attacks. The east and north-easterly winds of spring account for no few examples, as likewise inadequate protection from cold or damp.
In short, a variable climate is the most provocative of gout, that is, most likely to elicit gouty manifestations in one predisposed thereto. Conversely, stability in climate favours freedom from attacks. Thus some obtain exemption from their gout by removing to a hot climate, others when removed to one of cold, dry character. Doubtless these differences in response hark back to individual constitutional peculiarities.
It is the vigorous plethoric persons, who eat too much, that do well in dry, cold climates. The low temperature and dryness of the air stimulate tissue changes, dispose them to active exercise with consequent increased efficiency of digestion, assimilation, and excretion.
On the other hand, many victims of gout are spare feeders, with feeble powers of digestion and metabolism, and for them a mild, moderately warm and not too damp climate is the more suitable, involving, as it does, less strain upon their capacities of adjustment.
If one may be permitted the generalisation, the ideal climatic conditions for the gouty are low relative humidity, abundant sunshine, and a low rainfall. But, alas! too often, permanent residence in such desirable surroundings is unattainable, and the most that can be compassed is a brief sojourn in some more congenial environment.
Still, some discrimination must be shown in the matter of choice, and the physician, while mindful of the gout, must envisage the individual as a whole; for in advocating a change of climate his hope is that he may remove or antagonise certain noxious influences and coincidently restore the physiological machine as near as can be to a state of functional efficiency.
The former purpose will often be fulfilled by mere withdrawal of the subject for a time from his usual calling and environment. How frequently will simple rest and recreation succeed when medicinal and other forms of therapy have wholly failed! And how largely, may we remark, does the Vis Medicatrix Naturæ work through the medium of things psychic, not physical, to achieve its beneficent ends!
Still, not always is it rest that is needed, and some regard must be had to previous habits. Thus, for the sedentary, repair to a bracing climate is indicated, some inland resort of moderate elevation, where oxidation processes are quickened, and where if they eat more they take more exercise, and so adequate elimination is assured.
On the other hand, for the elderly or old, or those enervated by long-continued gout, a sedative climate must be sought, one marked by mildness, dryness, and equability. Bath, with its low diurnal range of temperature, is eminently suitable for this class of gouty patient, who often stand but ill the, for them, too stimulating qualities of more bracing localities, such as Llandrindod, Harrogate, or Buxton, etc.
Frequently, however, our choice is dominated by some associated morbid affection. Our patient may suffer from a so-called gouty eczema; if so, he must avoid cold, damp places, or windy localities, and, for that matter, sea air often, at first at least, aggravates the affection. Or it may be that he suffers with “dyspepsia,” some catarrhal condition of the alimentary canal, or a “sluggish liver.” For him, then, a dry inland health resort of moderate or high altitude is preferable to one of sea level, which will likely find him drowsy, indisposed to exercise, and a prey to what he terms biliousness.
If renal disease be a complication, he should seek a dry, warm climate, and, if he can, winter abroad, say, in Upper Egypt or Algiers, which, though it is warm and dry, is nevertheless somewhat marred by the wide diurnal range of temperature and the not infrequent cold winds. If, therefore, very sensitive to vicissitudes of temperature, the relatively dry, warm marine health resorts of the Riviera are open to him.
If to go abroad is out of the question, one of the mild southwestern seaside resorts at home is eligible, i.e., Bournemouth, Sidmouth, or the more sheltered parts of Torquay, and Falmouth. Again, if he show a tendency to cardiac dilatation, with or without valvular disease, high altitudes will obviously be unsuitable, and dry, inland resorts of moderate or low elevation should be given the preference.
Lastly, before despatching any gouty subject for a so-called change, it is wise to elicit any personal idiosyncrasies that he may be victimised by. In other words, find out his most vulnerable points. Thus some gouty persons are able to brave cold and damp with impunity, but pay dearly for the slightest indiscretion in diet. They must therefore be warned that no climatic change, however suitable, will absolve from the ill-effects of improper or immoderate eating.
Others again—the majority—are extremely sensitive to atmospheric changes, and such good as they might derive from a well-selected climate is nullified through thoughtless omission of simple precautions against “chills.” In short, the victims of gout can only ensure for themselves the beneficial effects of climatic therapy if, at the same time, they vigilantly shield themselves from what experience has shown to be, in their particular instance, the most fertile extrinsic or intrinsic source of relapses or exacerbations of their disorder.
Choice of Residence.—In these days it may savour of irony to talk of a choice of residence where none is. Still, much of the benefit accruing from a change of air will depend not only on the place resorted to, but the situation of the dwelling or hotel, in which the subject takes up his temporary abode. Thus in inland resorts some parts of the town may lie in a hollow, others on adjoining slopes or plateaux at an altitude higher by some hundreds of feet. Sites like the latter are obviously unsuitable for the victims of cardiac dilatation, etc. Again, where the patient’s condition is such that he must perforce spend a large portion of his time indoors, it is a matter of some moment that the situation and aspect of the building and, more pertinently, the subject’s suite or room be ascertained before he takes up residence.
Apart from sanitary and hygienic considerations, the quality of the cuisine, general comfort, class of society, have all to be thought of, if the best results are to be obtained. They are not unimportant details. How often is the benefit of a stay nullified by uncongenial surroundings, by a gloomy outlook, the fret and jar of ill-assorted or discordant elements, that forbid that cheerful intercourse that does much to restore that sense of bien-être so eagerly sought.
In short, attainment of the best results of climato-therapy can only be achieved through the medium of a closer co-operation between those who practise at health resorts or spas and the patient’s usual medical attendant. But, meanwhile, for most of us, our dwelling place doth rest upon our calling, and we may take this for our comfort that climatic vicissitudes may be greatly mitigated by a well-situated and sanitary residence. I allude, of course, here to a permanent abode, and the gouty, if he enjoy any latitude, should live in a house built on a well-drained gravel soil on a slope, sheltered from the north and north-east winds.
Again, with the question of habitation is bound up the equally important matter of clothing. By our forefathers flannel underwear was deemed the most eligible, despite its low or deficient power of absorption. But, without discussing the various arguments adduced in favour of this or that particular fabric, I would myself favour silk as being, perhaps, the ideal underwear; next to this a single woollen or woven linen vesture, and it goes without saying that, prone to excessive sweating as these gouty subjects are, frequent changes are essential. The feet of the gouty are their weak spot, and, apart from the correction of static deformities, flatfoot, etc., it is extremely desirable that they not only be well shod, but be especially careful not to sit about in wet boots or socks.
For the rest, their outer layers of clothing should be light, warm, easy and not tight fitting. Extremely liable as they are to lumbago and sciatica, they should be careful to enlist a thicker fabric than is usual for the back of their waistcoats; while sufferers from sciatica may, with advantage, insert a silk lining to the seat of their trousers.
Lastly, it is most important that the gouty, and of course all persons, should dress according to the prevailing weather and not according to the time of year. For them, more than any other class of person, to doff summer and don winter clothing for no other reason than some arbitrary date is fraught with mischances, freedom from which would be purchased by a little commonsense.