GOUBOFF. 85 tion entitled liecherchcs siir Irs etifants trouvt's, etc. (1839), which contains statistics on illegiti- nuicy in Europe, Asia, and America. GOUKVILLE, gSor'vi'd', Jean H^bault de (1625-1703). A French political agent, born at La Rochefoucauld. He entered the service of the Abbe de la Rochefoucauld, went to Paris with him, and there became secretary to the Prince de Marsillac (1640). From that time he was deep in all the jjolilical intrigues of the day. During the wars of the Fronde he attached himself pnr- ticularh- to Conde. By various means he had enriched himself considerably, so that when con- demned to lose his fortune through confiscation after the fall of Fouquet, he escaped to Eng- land, and finally settled in Brussels. In 1667 he was able to be of service to France at the Congress of Breda, an.d afterwards was employed in political missions until he obtained the ollieial pardon necessary before he could return to Court. The last years of his life were spent in the best of the literary society of the time. He left some Memoires (1724). GOUT (from OF. goute, goutte, It. gotta, drop, gout, from Lat. gutta, drop). A term first used by Radaljihus in the thirteenth century, who taught that gout was caused by a humor that flowed drop by drop into the joints. The very numerous references to the disorder, not only in the medical writings of Hippocrates, Galen, Are- tiEUs, Caelius, Aurelianus, and the later Greek physicians, but in such purely literary works as those of Lucian, Seneca, Ovid, and Pliny, show not only the frequency, but the notoriety of the disease. It is caricatured by Lucian in his bur- lesque of Tragopodagra in language quite ap- plicable to the disease as now observed ; while the connection of it with the advance of luxury in Rome is recognized by Seneca in the remark that in his day even the women had become gouty, thus setting at naught the authority of physi- cians, who had asserted the little liability of women to gout. Pliny likewise remarks upon the increase of gout, even within his own time. Ovid and Lucian represent gout as mostly in- curable by medicine ; from this view of it Pliny dissents. The' list of quack remedies given by Lucian is one of the most curious relies of an- tiquity. Gout is both a local disorder and a gen- eral perversion of nutrition. Con.sequent upon imperfect oxidation, there is found an excessive formation of uric acid, fats, and fatty acids, in- stead of water, carbonic acid, and urea. Some- times there is an excess of unoxidized sugar. The disease is a special manifestation of a tendency called the arthritic diathesis. (See Diathesis.) Baldness, pityriasis, acne, eczema, urticaria, prurigo, asthma, catarrhal inflammations of mu- cous membranes, varicose veins, hemorrhoids, and neuralgia are often resultants of the same per- version of nutrition that in some cases results in gout. Iritis and irido-choroiditis are the most common of the gnuty inflammations of the eye. The external and middle ear, too. sufTer from gout. Biliary lithiasis. visceral calcvili. diabetes, obesity, hemicrania. and arthritis deformans are among the morbid affinities of gout. Gout is hereditary; and in some gouty families functional neiTous diseases are verv common among the descendants (especially the females) of gouty ancestors. But diet and mode of life are far more potent factors than heredity in its causa- GOUT. tion. Some families ascribe to heredity di.seasea that are actually due to living under the same faulty conditions of hygiene and dietetics, where- by a morbid predisposition becomes established. Gout has disappeared from many localities in Europe step by step with the growth of tem- perance and the acquisition of hygienic Icnowl- edge. Acute gout, however, followed by uratic de- posits in the joints, is frequently transmitted in families. It is almost alwa3's a disease of adult age. Of the first attacks of gout in .515 cases (among Scudamore's statistics), one occurred at eight years, 57 between twenty and twenty-five years, 85 betw-een twenty-five and thirty years, 105 between thirty and thirty-five years, 80 be- tween thirty-five and forty years, 64 between foity and forty-five years, 54 between forty-five and fifty years, 2 at sixty-six years. Women are far less liable to acute gout than men. The character of food largely determines the amount of urea and uric acid produced in the body, and nitrogenous food is provocative of gout. Active muscular exercise and avoidance of great intel- lectual exercise, avoidance of grief or anger, or disturbance of p.sychical balance, are valuable preventives of attacks, even in those who inherit the gouty tendency. Change of season favors gouty outbreaks, the spring and autumn fur- nishing a large proportion of cases. Climate is a determining, though not decisive, cause. The free perspiration induced in warm countries is a safeguard against gout. Inhabitants of sub- tropical and temperate regions suff'cr from latent gout and the allied disorders connected with the arthritic diatheMs, independently of their dietetic errors. Tlius, calculous disorders are frequent in Central Asia, and 'uric acid diathesis,' or 'lithae- mia,' is prevalent all through the United States. Pathologically, gout is characterized by the presence of an excessive amount of uric acid in the blood and the deposition of uric-acid salts in the tissues. The most common seat of deposits is the articular cartilage of the first joint of the great toe, but other articular cartilages may also be involved, as may also the cartilages of the eyelids, larynx, and cars, and the ligaments of joints. The deposit incrusts or infiltrates the cartilage, and if ulceration of the overlying skin takes place, may appear on the surface as the so- called 'chalk-stones.' According to Ebstein, the primary changes in the joints are those of a local necrosis due to the excess of urates in the blood. Sclerotic conditions in the arteries and kidneys are quite common, and deposits of urates in the latter may occur. Hypertrophy of the heart is often associated with the arterial changes. As to the cau.se of the accumulation of urates in the system in gout we are uncertain. It may be due to defective elimination of urates or to local conditions which favor their deposition. A typi- cal attack of acute gout presents the following symptoms: After some weeks of previous indiges- tion, attended with flatulent swelling and a feel- ing of weight, rising to a climax in spasms of the thighs, the patient goes to bed free from pain, and having had rather an unnaturally strong appetite the day before. In the middle of the night he is awakened by a pain in the great toe. or sometimes in the heel, the ankle, or the ealf of the leg. The pain resembles that of a dis- located bone, and is accompanied by a sense as if water not perfectly cold were poured over the
