for his master or the king. He received diplomatic missions in Germany, in Holland, and especially in Spain, though it was only in 1694, that he was freed from the condemnation pronounced against him by the chamber of justice. From 1696 he fell ill and withdrew to his estate, where he dictated to his secretary, in four months and a half, his Mémoires, an important source for the history of his time. In spite of several errors, introduced purposely, they give a clear idea of the life and morals of a financier of the age of Fouquet, and throw light on certain points of the diplomatic history. They were first published in 1724.
There is a modern edition, with notes, an introduction and appendix, by Lecestre (Paris, 1894–1895, 2 vols.).
GOUT, the name rather vaguely given, in medicine, to a
constitutional disorder which manifests itself by inflammation
of the joints, with sometimes deposition of urates of soda, and
also by morbid changes in various important organs. The
term gout, which was first used about the end of the 13th
century, is derived through the Fr. goutte from the Lat. gutta,
a drop, in allusion to the old pathological doctrine of the dropping
of a morbid material from the blood within the joints. The
disease was known and described by the ancient Greek physicians
under various terms, which, however, appear to have been
applied by them alike to rheumatism and gout. The general
term arthritis (ἄρθρον, a joint) was employed when many joints
were the seat of inflammation; while in those instances where
the disease was limited to one part the terms used bore reference
to such locality; hence podagra (ποδάγρα, from πούς, the foot,
and ἄγρα, a seizure), chiragra (χείρ, the hand), gonagra (γόνυ,
the knee), &c.
Hippocrates in his Aphorisms speaks of gout as occurring most commonly in spring and autumn, and mentions the fact that women are less liable to it than men. He also gives directions as to treatment. Celsus gives a similar account of the disease. Galen regarded gout as an unnatural accumulation of humours in a part, and the chalk-stones as the concretions of these, and he attributed the disease to over-indulgence and luxury. Gout is alluded to in the works of Ovid and Pliny, and Seneca, in his 95th epistle, mentions the prevalence of gout among the Roman ladies of his day as one of the results of their high living and debauchery. Lucian, in his Tragopodagra, gives an amusing account of the remedies employed for the cure of gout.
In all times this disease has engaged a large share of the attention of physicians, from its wide prevalence and from the amount of suffering which it entails. Sydenham, the famous English physician of the 17th century, wrote an important treatise on the subject, and his description of the gouty paroxysm, all the more vivid from his having himself been afflicted with the disease for thirty-four years, is still quoted by writers as the most graphic and exhaustive account of the symptomatology of gout. Subsequently Cullen, recognizing gout as capable of manifesting itself in various ways, divided the disease into regular gout, which affects the joints only, and irregular gout, where the gouty disposition exhibits itself in other forms; and the latter variety he subdivided into atonlc gout, where the most prominent symptoms are throughout referable to the stomach and alimentary canal; retrocedent gout, where the inflammatory attack suddenly disappears from an affected joint and serious disturbance takes place in some internal organ, generally the stomach or heart; and misplaced gout, where from the first the disease does not appear externally, but reveals itself by an inflammatory attack of some internal part. Dr Garrod, one of the most eminent authorities on gout, adopted a division somewhat similar to, though simpler than that of Cullen, namely, regular gout, which affects the joints alone, and is either acute or chronic, and irregular gout, affecting non-articular tissues, or disturbing the functions of various organs. .
It is often stated that the attack of gout comes on without any previous warning; but, while this is true in many instances, the reverse is probably as frequently the case, and the premonitory symptoms, especially in those who have previously suffered from the disease, may be sufficiently precise to indicate the impending seizure. Among the more common of these may be mentioned marked disorders of the digestive organs, with a feeble and capricious appetite, flatulence and pain after eating, and uneasiness in the right side in the region of the liver. A remarkable tendency to gnashing of the teeth is sometimes observed. This symptom was first noticed by Dr Graves, who connected it with irritation in the urinary organs, which also is present as one of the premonitory indications of the gouty attack. Various forms of nervous disturbance also present themselves in the form of general discomfort, extreme irritability of temper, and various perverted sensations, such as that of numbness and coldness in the limbs. These symptoms may persist for many days and then undergo amelioration immediately before the impending paroxysm. On the night of the attack the patient retires to rest apparently well, but about two or three o'clock in the morning awakes with a painful feeling in the foot, most commonly in the ball of the great toe, but it may be in the instep or heel, or in the thumb. With the pain there often occurs a distinct shivering followed by feverishness. The pain soon becomes of the most agonizing character: in the words of Sydenham, "now it is a violent stretching and tearing of the ligaments, now it is a gnawing pain, and now a pressure and tightening; so exquisite and lively meanwhile is the part affected that it cannot bear the weight of the bedclothes, nor the jar of a person walking in the room."
When the affected part is examined it is found to be swollen and of a deep red hue. The superjacent skin is tense and glistening, and the surrounding veins are more or less distended. After a few hours there is a remission of the pain, slight perspiration takes place, and the patient may fall asleep. The pain may continue moderate during the day but returns as night advances, and the patient goes through a similar experience of suffering to that of the previous night, followed with a like abatement towards morning. These nocturnal exacerbations occur with greater or less severity during the continuance of the attack, which generally lasts for a week or ten days. As the symptoms decline the swelling and tenderness of the affected joint abate, but the skin over it pits on pressure for a time, and with this there is often associated slight desquamation of the cuticle. During the attacks there is much constitutional disturbance. The patient is restless and extremely irritable, and suffers from cramp in the limbs and from dyspepsia, thirst and constipation. The urine is scanty and high-coloured, with a copious deposit, consisting chiefly of urates. During the continuance of the symptoms the inflammation may leave the one foot and affect the other, or both may suffer at the same time. After the attack is over the patient feels quite well and fancies himself better than he had been for a long time before; hence the once popular notion that a fit of the gout was capable of removing all other ailments. Any such idea, however, is sadly belied in the experience of most sufferers from this disease. It is rare that the first is the only attack of gout, and another is apt to occur within a year, although by care and treatment it may be warded off. The disease, however, undoubtedly tends to take a firmer hold on the constitution and to return. In the earlier recurrences the same joints as were formerly the seat of the gouty inflammation suffer again, but in course of time others become implicated, until in advanced cases scarcely any articulation escapes, and the disease thus becomes chronic. It is to be noticed that when gout assumes this form the frequently recurring attacks are usually attended with less pain than the earlier ones, but their disastrous effects are evidenced alike by the disturbance of various important organs, especially the stomach, liver, kidneys and heart, and by the remarkable changes which take -place in the joints from the formation of the so-called chalk stones or tophi. These deposits, which are highly characteristic of gout, appear at first to take place in the form of a semifluid material, consisting for the most part of urate of soda, which gradually becomes more dense, and ultimately quite hard. When any quantity of this is deposited in the structures of a joint the effect is to produce stiffening, and, as deposits appear to take place to a greater or less amount in connexion with every
