Gout is more common in mature age than in the earlier years of life, the greatest number of cases in one decennial period being between the ages of thirty and forty, next between twenty and thirty, and thirdly between forty and fifty. It may occasionally affect very young persons; such cases are generally regarded as hereditary, but, so far as diet is concerned, it has to be remembered that their home life has probably been a predisposing cause. After middle life gout rarely appears for the first time. Women are much less the subjects of gout than men, apparently from their less exposure to the influences (excepting, of course, that of heredity) which tend to develop the disease, and doubtless also from the differing circumstances of their physical constitution. It most frequently appears in females after the cessation of the menses. Persons exposed to the influence of lead poisoning, such as plumbers, painters, &c., are apt to suffer from gout; and it would seem that impregnation of the system with this metal markedly interferes with the uric acid excreting function of the kidneys.
Attacks of gout are readily excited in those predisposed to the disease. Exposure to cold, disorders of digestion, fatigue, and irritation or injuries of particular joints will often precipitate the gouty paroxysm.
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).