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.