Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

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.

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.