312 THE TREATMENT OF DISEASES. 



lire port, sherry, and madeira. Sherry, however dry and pure, is by no means tlie 

 innocent beverage, as far as the production of gout is concerned, that some people 

 set -in to imagine. The best wine to take is a good sound claret, free from sugar and 

 without acidity. 



Probably the best drink for a gouty patient is brandy, taken in strictly limited 

 quantities, and freely diluted with water. Whisky, hollands, or gin, may in some 

 cases be substituted, but the change should be made with a certain amount of 

 caution. The spirit-and-water should be taken solely at meal-times. The quantity 

 consumed in the course of the day will vary in different cases from one to three 

 fluid ounces, the exact amount being dependent to some extent upon the previous 

 habits of the patient. 



Exercise should be regularly and habitually taken, and walking may be advan- 

 tageously combined with riding. Excessive fatigue always does far more harm than 

 good, and should be guarded against. 



Early and regular hours are of much importance, as is the avoidance of all severe 

 mental application. The importance of plenty of fresh air in maintaining health 

 and warding off attacks cannot be over-estimated. Removal to a warm, dry climate 

 during the colder months of the year will in many cases enable the patient to escape 

 his autumn and winter attacks. 



It is extremely difficult to lay down any general rules for the treatment of the 

 irregular forms of gout, such for instance as gout in the stomach. The personal 

 attendance of a medical man will, in most of those cases, be found necessary. The 

 administration of colchicum wine is usually advisable in the irregular as in the more 

 orthodox forms of gout. 



GRAVEL. 



A patient is said to suffer from gravel when he passes solid matter with his 

 urine, whether in the form of powder, grit, or sand. The term is not applied to 

 those cases in which the water is clear when recently voided and still warm, but 

 throws down a powdery sediment as it cools, which sediment redissolves on warming 

 the urine before the fire or in any other way that may be convenient. There are 

 several different kinds of gravel, but in the large majority of cases the deposit con- 

 sists of uric acid, which is thrown down in the form of red or yellow sand. If 

 carefully examined this deposit will be found to consist of little crystals, resembling 

 in shape, size, and colour Cayenne pepper. The urine is, at the same time, bright 

 and of a dark golden or coppery colour, like brown sherry. Sometimes it feels hot 

 and almost scalding as it is being passed. It is more acid than perfectly natural 

 urine, and turns blue litmus paper a bright red colour. Often enough the quantity 

 passed is below the average, and the specific gravity or density will be found to be 

 higher than natural. This deposit must not be confounded with the pale pink 

 sediment so often seen at the bottom of the utensil on a cold winter's morning. 

 That is never deposited until the urine has had time to cool, and is immediately 

 redissolved when the urine is warmed up to about the temperature of the body. 

 True gravel cannot be made to disappear in this way. Moreover, the latter does 

 not render the whole of the urine turbid when shaken, but rolls over at the bottom 



