endency
to the disease is usually inherited. Overeating, together with
insufficient exercise and indulgence in alcohol, are conducive to its
development in susceptible persons. Injuries, violent emotion, and
exposure to cold are also thought to favor attacks.

The heavier beers and ales of England, together with their stronger
wines, as port, Madeira, sherries, and champagne, are more prone to
induce gout than the lighter beers drunk in the United States and
Germany. Distilled liquors, as brandy and whisky, are not so likely to
occasion gout. "Poor man's gout" may arise in individuals who lead the
most temperate lives, if they have a strong inherited tendency to the
disease, or when digestion and assimilative disorders are present, as
well as in the case of the poor who drink much beer and live in bad
surroundings, and have improper and insufficient food. Workers in
lead, as typesetters and house painters, are more liable to gout than
others.

=Symptoms.=--There is often a set of preliminary symptoms varying in
different persons, and giving warning of an approaching attack of
gout, such as neuralgic pains, dyspepsia, irritability, and mental
depression, with restless nights. An acute attack generally begins in
the early morning with sudden, sharp, excruciating pain in the larger
joint of one of the big toes, more often the right, which becomes
rapidly dark red, mottled, swollen, hot, tense, shiny, and exceedingly
sensitive to touch. There is commonly some fever; a temperature of
102 deg. to 103 deg. F. may exist. The pain subsides in most cases to a
considerable degree during the day, only to return for several nights,
the whole period of suffering lasting from four to eight days.
Occasionally the pain may be present without the redness, swelling,
etc., or _vice versa_.

Other joints may be involved, particularly the joint of the big toe of
the other foot. Complete recovery ensues, as a rule, after the first
attack, and the patient may thereafter feel exceptionally well. A
return of the disease is rather to be expected. Several attacks within
the year are not uncommon, or they may appear at much longer
intervals.

Occasionally the gout seems to "strike in." In this case it suddenly
leaves the foot and attacks the heart, causing the patient severe pain
in that region and great distress in breathing; or the abdomen becomes
the seat of violent pain, and vomiting, diarrhea, collapse and death
rarely result. In the lat