GOUT. 221 



the family predisposition is exceedingly strong, does 

 not make its appearance until middle life, or even 

 later. There are instances recorded of gout appearing 

 even before puberty, but such cases are rare, and 

 only occur in families whose members have exhibited 

 the disease for many generations. It is essentially 

 a cumulative disorder, and the limited, or rather 

 natural, feeding, and great muscular activity of 

 infancy and youth in each generation, so to speak 

 reduces the accumulated poison capital, so that it 

 is only in very rare cases that it can proclaim itself, 

 before a personal indulgence in the vicious habits 

 from which it originally sprang gives it the neces- 

 sary strength. Sir Spencer Wells pointed out, some 

 years ago, that the children begotten before any 

 acute attack of gout in the parent, were but slightly 

 predisposed to the disease, as compared with those 

 begotten after the parent had actually suffered an 

 attack. Now, as few fathers develop gout until 

 middle life, it is clear that many of their children, 

 and especially the eldest, must receive the family 

 taint in a mitigated form ; and as such children are 

 generally properly clothed and fed, take good and 

 sufficient outdoor exercise, and are otherwise cared 

 for hygienically, it is also clear that the weak in- 

 herited taint cannot develop much until the vicious 

 habits also inherited become a part of the routine 

 of life* which seldom or never occurs before twenty 

 to thirty years of age. Thus, we see, is the gouty 

 degeneration retarded in its course at every genera- 



