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.”
General Massage
In judiciously prescribed and skilfully applied massage we have an agent of pre-eminent value in the treatment of gout. Indeed, Sir William Temple—a martyr to the disease—when speaking of the benefit of “friction,” frankly stated that “No man need have the gout who can keep a slave.” In this there is much truth, for the beneficial results of massage are not confined merely to the affected joints or muscles, but, as a result of the improved circulation, waste products are more readily excreted, the nerve centres regain tone, and a general feeling of bien-être is promoted.
It cannot be doubted that general massage of the trunk and limbs accelerates the elimination of the chemical outcasts of metabolism, and simultaneously, by ensuring a more adequate supply of fresh blood to the tissues, must result in an access of renewed vitality. Many, indeed, have adduced experimental proof that such a quickening of the vital processes does ensue after general massage. We should therefore, in elderly or feeble subjects, or in those of sluggish habits, advocate from time to time a course of general massage for its prophylactic effects.
It is the more especially indicated in those gouty subjects prone to attacks of muscular fibrositis—attacks of which are undoubtedly favoured by the retention of the toxic and waste products of muscular metabolism. Nothing, again, so facilitates the dissipation of exudates, nodules, or thickenings in these structures, for the treatment and prophylaxis of which massage is indispensable.
In enlisting the prophylactic action of general massage, it is not desirable that the séance should exceed forty minutes, and it should in all cases be followed by an hour’s rest; to practise it too soon after a meal is inadvisable, and in those cases in which it favours the advent of sleep it is best undertaken in the late evening.
In conclusion, I would urge the importance of more interest being taken by the physician himself in the technique of massage, as I am assured that, if rationally and perseveringly practised, it constitutes one of the most valuable adjuncts in the prophylaxis of gout.