With respect to the treatment of gout the greatest variety of opinion has prevailed and practice been pursued, from the numerous quaint nostrums detailed by Lucian to the “expectant” or do-nothing system recommended by Sydenham. But gout, although, as has been shown, a malady of a most severe and intractable character, may nevertheless be successfully dealt with by appropriate medicinal and hygienic measures. The general plan of treatment can be here only briefly indicated. During the acute attack the affected part should be kept at perfect rest, and have applied to it warm opiate fomentations or poultices, or, what answers quite as well, be enveloped in cotton wool covered in with oil silk. The diet of the patient should be light, without animal food or stimulants. The administration of some simple laxative will be of service, as well as the free use of alkaline diuretics, such as the bicarbonate or acetate of potash. The medicinal agent most relied on for the relief of pain is colchicum, which manifestly exercises a powerful action on the disease. This drug (Colchicum autumnale), which is believed to correspond to the hermodactyl of the ancients, has proved of such efficacy in modifying the attacks that, as observed by Dr Garrod, “we may safely assert that colchicum possesses as specific a control over the gouty inflammation as cinchona barks or their alkaloids over intermittent fever.” It is usually administered in the form of the wine in doses of 10 to 30 drops every four or six hours, or in pill as the acetous extract (gr. ½-gr. i.). The effect of colchicum in subduing the pain of gout is generally so prompt and marked that it is unnecessary to have recourse to opiates; but its action requires to be carefully watched by the physician from its well-known nauseating and depressing consequences, which, should they appear, render the suspension of the drug necessary. Otherwise the remedy may be continued in gradually diminishing doses for some days after the disappearance of the gouty inflammation. Should gout give evidence of its presence in an irregular form by attacking internal organs, besides the medicinal treatment above mentioned, the use of frictions and mustard applications to the joints is indicated with the view of exciting its appearance there. When gout has become chronic, colchicum, although of less service than in acute gout, is yet valuable, particularly when the inflammatory attacks recur. More benefit, however, appears to be derived from potassium iodide, guaiacum, the alkalis potash and lithia, and from the administration of aspirin and sodium salicylate. Salicylate of menthol is an effective local application, painted on and covered with a gutta-percha bandage. Lithia was strongly recommended by Dr Garrod from its solvent action upon the urates. It is usually administered in the form of the carbonate (gr. v., freely diluted).
The treatment and regimen to be employed in the intervals of the gouty attacks are of the highest importance. These bear reference for the most part to the habits and mode of life of the patient. Restriction must be laid upon the amount and quality of the food, and equally, or still more, upon the alcoholic stimulants. “The instances,” says Sir Thomas Watson, “are not few of men of good sense, and masters of themselves, who, being warned by one visitation of the gout, have thenceforward resolutely abstained from rich living and from wine and strong drinks of all kinds, and who have been rewarded for their prudence and self-denial by complete immunity from any return of the disease, or upon whom, at any rate, its future assaults have been few and feeble.” The same eminent authority adds: “I am sure it is worth any young man’s while, who has had the gout, to become a teetotaller.” By those more advanced in life who, from long continued habit, are unable entirely to relinquish the use of stimulants, the strictest possible temperance must be observed. Regular but moderate exercise in the form of walking or riding, in the case of those who lead sedentary lives, is of great advantage, and all over-work, either physical or mental, should be avoided. Fatiguez la bête, et reposez la tête is the maxim of an experienced French doctor (Dr Debout d’Estrées of Contrexéville). Unfortunately the complete carrying out of such directions, even by those who feel their importance, is too often rendered difficult or impossible by circumstances of occupation and otherwise, and at most only an approximation can be made. Certain mineral waters and baths (such as those of Vichy, Royat, Contrexéville, &c.) are of undoubted value in cases of gout and arthritis. The particular place must in each case be determined by the physician, and special caution must be observed in recommending this plan of treatment in persons whose gout is complicated by organic disease of any kind.
Dr Alexander Haig’s “uric acid free diet” has found many adherents. His view as regards the pathology is that in gouty persons the blood is less alkaline than in normal, and therefore less able to hold in solution uric acid or its salts, which are retained in the joints. Assuming gout to be a poisoning by animal food (meat, fish, eggs), and by tea, coffee, cocoa and other vegetable alkaloid-containing substances, he recommends an average daily diet excluding these, and containing 24 oz. of breadstuffs (toast, bread, biscuits and puddings) together with 24 oz. of fruit and vegetables (excluding peas, beans, lentils, mushrooms and asparagus); 8 oz. of the breadstuffs may be replaced by 21 oz. of milk or 2 oz. of cheese, butter and oil being taken as required, so that it is not strictly a vegetarian diet.
Precisely the opposite view as to diet has recently been put forward by Professor A. Robin of the Hôpital Beaujon, who says serious mistakes are made in ordering patients to abstain from red meats and take light food, fish, eggs, &c. The common object in view is the diminished output of uric acid. This output is chiefly obtained from food rich in nucleins and in collagenous matters, i.e. young white meats, eggs, &c. Consequently the gouty subject ought to restrict himself to the consumption of red meat, beef and mutton, and leave out of his dietary all white meat and internal organs. He should take little hydrocarbons and sugars, and be moderate in fats. Vegetarian diet he regards as a mistake, likewise milk diet, as they tend to weaken the patient. To prevent the formation of uric acid Robin prescribes quinic acid combined with formine or urotropine.
GOUTHIÈRE, PIERRE (1740-1806), French metal worker, was born at Troyes and went to Paris at an early age as the pupil of Martin Cour. During his brilliant career he executed a vast quantity of metal work of the utmost variety, the best of which was unsurpassed by any of his rivals in that great art period. It was long believed that he received many commissions for furniture from the court of Louis XVI., and especially from Marie Antoinette, but recent searches suggest that his work for the queen was confined to bronzes. Gouthière can, however, well bear this loss, nor will his reputation suffer should those critics ultimately be justified who believe that many of the furniture mounts attributed to him were from the hand of Thomire. But if he did not work for the court he unquestionably produced many of the most splendid belongings of the duc d’Aumont, the duchesse de Mazarin and Mme du Barry. Indeed the custom of the beautiful mistress of Louis XV. brought about the financial ruin of the great artist, who accomplished more than any other man for the fame of her château of Louveciennes. When the collection of the duc d’Aumont was sold by auction in Paris in 1782 so many objects mounted by Gouthière were bought for Louis XVI. and Marie Antoinette that it is not difficult to perceive the basis of the belief that they were actually made for the court. The duc’s sale catalogue is, however, in existence, with the names of the purchasers and the prices realized. The auction was almost an apotheosis of Gouthière. The precious lacquer cabinets, the chandeliers and candelabra, the tables and cabinets in marquetry, the columns and vases in porphyry, jasper and choice marbles, the porcelains of China and Japan were nearly all mounted in bronze by him. More than fifty of these pieces bore Gouthière’s signature. The duc d’Aumont’s cabinet represented the high-water mark of the chaser’s art, and the great prices which were paid for Gouthière’s work at this sale are the most conclusive criterion of the value set upon his achievement in his own day. Thus Marie Antoinette paid 12,000 livres for a red jasper bowl or brûle-parfums mounted by him, which was then already famous. Curiously enough it commanded only one-tenth of that price at the Fournier sale in 1831; but in 1865, when the marquis of Hertford bought it at the prince de Beauvais’s sale, it fetched 31,900 francs. It is now in the Wallace Collection, which contains the finest and most representative gathering of Gouthière’s undoubted work. The mounts of gilt bronze, cast and elaborately chased, show satyrs’ heads, from which hang festoons of vine leaves, while within the feet a serpent is coiled to spring. A smaller cup is one of the treasures of the Louvre. There too is a bronze clock, signed by “Gouthière, cizileur et doreur du Roy à Paris,” dated 1771, with a river god, a water nymph symbolizing the Rhône and its tributary the Durance, and a female figure typifying the city of Avignon. Not all of Gouthière’s work is of the highest quality, and much of what he executed was from the designs of others. At his best his delicacy, refinement and finish are exceedingly delightful—in his great moments he ranks with the highest alike as artist and as craftsman. The tone of soft dead gold which is found on some of his mounts he is believed to have invented, but indeed the gilding of all his superlative work possesses a remarkable quality. This charm of tone is admirably seen in the bronzes and candelabra which he executed for the chimney-piece of Marie Antoinette’s boudoir at Fontainebleau. He continued to embellish Louveciennes for Madame du Barry until the Revolution, and then the guillotine came for her and absolute ruin for him. When her property was seized she owed him 756,000 livres, of which he never received a sol, despite repeated applications to the administrators. “Réduit à solliciter une place à l’hospice, il mourut dans la misère.” So it was stated in a lawsuit brought by his sons against du Barry’s heirs.
GOUVION SAINT-CYR, LAURENT, Marquis de (1764-1830), French marshal, was born at Toul on the 13th of April 1764. At the age of eighteen he went to Rome with the view of prosecuting the study of painting, but although he continued his artistic studies after his return to Paris in 1784 he never definitely adopted the profession of a painter. In 1792 he was chosen a captain in a volunteer battalion, and served on the staff of General Custine. Promotion rapidly followed, and in the course of two years he had become a general of division. In 1796 he commanded the centre division of Moreau’s army in the campaign of the Rhine, and by coolness and sagacity greatly aided him in the celebrated retreat from Bavaria to the Rhine. In 1798 he succeeded Masséna in the command of the army of Italy. In the following year he commanded the left wing of Jourdan’s army in Germany; but when Jourdan was succeeded by Masséna, he joined the army of Moreau in Italy, where he distinguished himself in face of the great difficulties that followed the defeat of Novi. When Moreau, in 1800, was appointed to the command of the army of the Rhine, Gouvion St-Cyr was named his principal lieutenant, and on the 9th of May gained a victory over General Kray at Biberach. He was not, however, on good terms with his commander and retired to France after the first operations of the campaign. In 1801 he was sent to Spain to command the army intended for the invasion of Portugal, and was named grand officer of the Legion of Honour. When a treaty of peace was shortly afterwards concluded with Portugal, he succeeded Lucien Bonaparte as ambassador at Madrid. In 1803 he was appointed to the command of an army corps in Italy, in 1805 he served with distinction under Masséna, and in 1806 was engaged in the campaign in southern Italy. He took part in the Prussian and Polish campaigns of 1807, and in 1808, in which year he was made a count, he commanded an army corps in Catalonia; but, not wishing to comply with certain orders he received from Paris (for which see Oman, Peninsular War, vol. iii.), he resigned his command and remained in disgrace till 1811. He was still a general of division, having been excluded from the first list of marshals owing to his action in refusing to influence the troops in favour of the establishment of the Empire. On the opening of the Russian campaign he received command of an army corps, and on the 18th of August 1812 obtained a victory over the Russians at Polotsk, in recognition of which he was created a marshal of France. He received a severe wound in one of the actions during the general retreat. St-Cyr distinguished himself at the battle of Dresden (August 26-27, 1813), and in the defence of that place against the Allies after the battle of Leipzig, capitulating only on the 11th of November, when Napoleon had retreated to the Rhine. On the restoration of the Bourbons he was created a peer of France, and in July 1815 was appointed war minister, but resigned his office in the November following. In June 1817 he was appointed minister of marine, and in September following again resumed the duties of war minister, which he continued to discharge till November 1819. During this time he effected many reforms, particularly in respect of measures tending to make the army a national rather than a dynastic force. He exerted himself also to safeguard the rights of the old soldiers of the Empire, organized the general staff and revised the code of military law and the pension regulations. He was made a marquess in 1817. He died at Hyères (Var) on the 17th of March 1830. Gouvion St-Cyr would doubtless have obtained better opportunities of acquiring distinction had he shown himself more blindly devoted to the interests of Napoleon, but Napoleon paid him the high compliment of referring to his “military genius,” and entrusted him with independent commands in secondary theatres of war. It is doubtful, however, if he possessed energy commensurate with his skill, and in Napoleon’s modern conception of war, as three parts moral to one technical, there was more need for the services of a bold leader of troops whose “doctrine”—to use the modern phrase—predisposed him to self-sacrificing and vigorous action, than for a savant in the art of war of the type of St-Cyr. Contemporary opinion, as reflected by Marbot, did justice to his “commanding talents,” but remarked the indolence which was the outward sign of the vague complexity of a mind that had passed beyond the simplicity of mediocrity without attaining the simplicity of genius.
He was the author of the following works, all of the highest value: Journal des opérations de l’armée de Catalogne en 1808 et 1809 (Paris, 1821); Mémoires sur les campagnes des armées de Rhin et de Rhin-et-Moselle de 1794 à 1797 (Paris, 1829); and Mémoires pour servir à l’histoire militaire sous le Directoire, le Consulat, et l’Empire (1831).
See Gay de Vernon’s Vie de Gouvion Saint-Cyr (1857).