Exercise
It has been wisely said that “those threatened with gout should imitate as far as practicable and consistent with comfort the habits of agricultural labourers,” for sedentary occupations and idle ways not only favour the invasion of the disorder but hasten its recurrence.
How frequently, indeed, is it the direct outcome of an abrupt change in habits—a hunting man, predisposed to gout, sustains an accident, can no longer ride to hounds and takes to motoring. Unless he forthwith curb his food intake, the disorder overtakes him. Sometimes misfortune proves a blessing in disguise, as in the case related by Van Swieten of an opulent and gouty old priest, who, captured by Barbary corsairs and forced to work as a galley slave, soon lost his gout.
Again, it is notorious that in those in whom the brunt of the disorder falls on the lower limbs, the outlook is more sombre than in those more severely crippled in the hands. In short, capacity for and willingness to take adequate exercise is one of the most potent measures wherewith to fend off the gout. The amount should be in proportion to the age, strength, and previous habits. The exercise should be taken not after a spasmodic but systematic fashion. For erratic, like excessive, exertion often converts the expected benefit into the exciting cause of an attack. The aim should be not exhaustion but wholesome fatigue.
Young and fairly vigorous persons, if previously sedentary or indolent in habit, should take regular exercise, gradually increased. In the middle-aged, especially if obese, it should be graduated according to the capacity of their circulatory organs, and more stress laid on respiratory exercises and dietetic restrictions. For in their instance fatigue or over-exertion is easily induced, often with grave consequences. Also, in long-standing cases, neurasthenic from long-continued pain, it is well to begin more or less tentatively, and in many cases to prescribe a course of massage before proceeding to active exercise. For not seldom such subjects have but a small fund of nerve energy to draw upon.
In the gouty, even the malign influence of bad habits of living is greatly mitigated by active exercise and labour. “The gout very rarely visits the poor man’s cottage.” Nothing can so effectually counteract a predisposition to the disorder, and what Sydenham thought of its value we may guess from his trenchant remarks on horse exercise. “And, indeed, I have often thought if a person was possessed of as effectual a remedy as exercise is, in this and most chronic diseases, and had the art likewise of concealing it, he might easily raise a considerable fortune.”
In conclusion, if healthful exercise of the body is imperative for the gouty, I need scarcely labour the desirability also of congenial and adequate exercise of the mental faculties. Adequate, but not excessive, lest, like Sydenham, it reacts in added sickness. Otherwise absorption in some honourable pursuit will do much to dissipate that tendency to introspection and depression so often born of the consciousness of an ever-constant menace to long-continued health.
“Orandum est, ut sit mens sana in corpore sano.”