Symptoms.  Acute Type.—­There is often a period of irritability, restlessness, indigestion, twinges of pain in the hands and feet; the urine is scanty, dark, very acid, with diminished uric acid and deposit when it is cooled.  The attack sets in usually early in the morning with sudden intense pain in a joint of the big toe, generally the right; less often in an ankle, knee, wrist, hand or finger.  The part swells rapidly, and is very tender, the overlying skin being red, glazed and hot.  The patient is usually as cross as a wounded bear.  The fever may be 103.  The pain may subside during the day, and increase again at night.  There is no suppuration (pus forming).  The symptoms usually decrease, gradually, the entire attack may last from five to eight days.  Scaling of the skin over the sore part may follow.  After the attack, the general health may be improved, and the joint may become normal or but slightly stiff.  It recurs at intervals of a few months commonly.

[316 Mothers’ remedies]

Retrocedent Gout.—­This is a term applied to serious symptoms which sometimes go with rapid improvement of the local joint conditions.  There are severe pains in the stomach, nausea, vomiting, diarrhea, pain in the heart, difficult breathing, palpitation, irregular and feeble action of the heart with brain symptoms, probably from uraemia.  These attacks often cause death.

Chronic Gout, Causes, etc.—­Frequent acute attacks; many joints, beginning with the feet, become stiff and deformed, perhaps with no motion.  The overlying skin may ulcerate, especially over the knuckles.  Dyspepsia, arterio-sclerosis, enlargement of the left ventricle of the heart and a great quantity of urine with low specific gravity are common.  The patient is morose and irritable.  Eczema, chronic bronchitis, frequently complicate the case.

Death often occurs from uraemia, meningitis, pleurisy, pericarditis or peritonitis.

Treatment, Preventive.—­Live temperately, abstain from alcohol, eat moderately, have plenty of fresh air and sunshine, plenty of exercise and regular hours.  These do not counteract the inherited tendency.  The skin should be kept active, if the patient is robust, by the morning cold bath with friction after it; but if he is weak and debilitated, the evening warm bath should be substituted.  The patient should dress warmly, avoid rapid alternations in temperature, and be careful not to have thc skin suddenly chilled.

Diet in Gout.—­Most persons over forty eat too much.  Eat reasonably and at regular hours and take plenty of time to eat.  Do not eat too freely of meats and avoid too much starchy and sugary foods.  Fresh vegetables and fruits may be used freely, except cranberries and bananas.

Dr. Osler of England says.—­While all stimulants are injurious to these patients some are more so than others, particularly malted liquors, champagne, port and a very large proportion of all the light wines.  Take large quantities of water on an empty stomach, mineral waters are no better than others, but treatment of chronic and irregular gout at springs gives the advantage of regular hours, diet, etc.