This distinction is of much greater importance than is generally imagined; for if a person firmly believes that the gout, as a disease, is hereditary, what will be his conduct? My father had the gout, says he, therefore I must have it; well, what cannot be avoided, must be endured; let me then enjoy a short life, but a merry one: he therefore abandons himself to a luxurious mode of life, and, if the gout be the consequence, which most probably it will, he accuses his stars, and his ancestors, instead of his own misconduct.
On the contrary, if a person be convinced that he has received from his ancestors a constitution liable to be overpowered by the use of high seasoned food, and fermented liquors, and excited into gouty action, what will be his conduct? Surely, if he reason at all, it must be in this way: my father was dreadfully afflicted with the gout; I have frequently witnessed his sufferings with the deepest concern. But is not my constitution, which resembles his, liable to be affected in the same manner, by similar causes? To avoid his sufferings, therefore, I must be very temperate; more so than those who have not the hereditary propensity; for the exciting powers, which would only keep them in health, would, if applied to me, infallibly bring on the gout. In consequence of this reasoning, he adopts a temperate mode of living, and avoids the disease.
From this you must be convinced, that it is not a matter of small moment to determine, whether the gout is hereditary, and consequently unavoidable, or not. The next part of Dr. Cullen's definition is "oriens sine causa evidente". This too, I can have little hesitation to pronounce erroneous. The cause of gout, namely, the use of highly seasoned food, and the use of fermented liquors, with, in general, a luxurious, and indolent mode of living, are quite evident enough in most gouty cases, and are amply sufficient to produce the disease.
There is another part of the definition, likewise, to which I would object, as it gives a false idea of the nature of the disease, and therefore causes the preventative plan to be pursued with less confidence. I mean that part where he says "per intervalla revertens."
That the gout, when once cured, is apt to return, if the mode of life which brought it on be not abandoned, no one will deny; nay, the fits will increase in violence, because the constitution gets more and more debilitated. This, however, is not peculiar to the gout, but common to most diseases.
In describing a broken leg, it would surely be wrong to say, that it is a disease which returns at intervals, after being cured; yet, it will return as infallibly as the gout, if a person take the same kind of leap, or expose himself to the same accidents as those which brought it on. Let those, therefore, who wish to avoid a return of the gout, totally change their mode of living: otherwise, if the attacks return, let them blame themselves, and not the nature of the complaint.
These observations were thought necessary, with a view to do away some prejudices, which very much retarded our inquiries into the nature and cure of this disease. I shall now proceed to give an account of the symptoms by which it is usually attended.
The gout generally attacks the male sex; but it sometimes, though more rarely, attacks also the female, particularly those of robust and full habits. It does not generally make its appearance, till the period of greatest strength and vigour is past; for instance, about the fortieth year; but, in some cases, where the exciting causes have been powerfully applied, or where the hereditary predisposition is very strong, it attacks much earlier; such cases are, however, comparatively rare, and can, in general, be easily accounted for.
This disease is seldom known to attack persons employed in constant bodily labour, and who live temperately; and is totally unknown to those who use no wine or other fermented liquors.
If then a person of a full strong habit have for several years accustomed himself to full diet of animal food, and a regular use of wine, and malt liquor, though he may for a long time find that he can perform all the functions with vigour, his strength will at last fail: the mind and body become affected with a degree of torpor and languor for which he cannot account, and the functions of the stomach become more or less disturbed. The appetite becomes diminished, and flatulency, and other symptoms of indigestion are felt. These symptoms take place for several days, and sometimes for several weeks before the fit comes on; but often, on the day immediately preceding it, the appetite becomes greater than usual.