Lastly, symptoms of cardiac dilatation and failure, which should be suspected when the arterial pressure falls without the previous use of vaso-dilators, will call for the exhibition of cardiac tonics: digitalis, strophanthus, and strychnine; and threatened uræmia may be postponed by a judicious dietary, saline purgation, and diaphoretic measures.
CHAPTER XXXI.
CLIMATO-THERAPY, HYDRO-THERAPY, ETC
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.