iquors, especially
fermented, with little or no exercise; too much meat. Unhygienic living
with poor food, and excessive drinking of ale and beer may be followed by
the "poor man's gout." It is common in lead workers.

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.

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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