GOUT. This very peculiar modification of inflammatory action has been known since the days of Hippocrates, and is a disease of common occurrence among the higher classes of society, especially with those who indulge habitually in the luxuries of the table, and use little exercise, or who inherit a predisposition to its attacks. This hereditary tendency is often very strongly marked; sometimes indeed so much so as to prevail against every precaution of diet and bodily exercise. Gout is emphatically a disease of adults, and is for the most part confined to the male sex, females seldom being attacked; yet a few rare cases have occasionally occurred in boyhood, and in one well authenticated instance even so early as the eleventh year. That gout is a blood or humoral disease has long been the common opinion, and is the origin of its name, gout or gutta, or morbid matter passed, drop by drop, into the affected part.
An attack of the disease is generally preceded by heartburn and other dyspeptic affections. An acute seizure (and the first few are nearly uniformly acute) usually begins about an hour or so after midnight, when suddenly the patient is awakened by a severe pain in some part of the foot, most commonly in the great toe, though sometimes in the heel, instep, ankle, &c. With the commencement of the attack there is shivering, and very soon the pain becomes of an extremely acute character, and is attended by great general uneasiness. Commonly about the next midnight, the pain ceases, often almost in a moment, and the sufferer falls asleep and is soon in a gentle perspiration. Next morning when he awakes he finds the part that was affected red and swollen, and the skin over it tense and shining. The affected part, however, soon resumes its natural size, and the cuticle falls off—a process usually attended with much itching.
During the paroxysm the urine is almost invariably found to be loaded with urea and lithates. After the paroxysm is over, not only does the patient feel as well as he was before, but usually much better. "The fit," says Cullen, "leaves the person in very perfect health, enjoying greater ease and alacrity in the functions of both body and mind than he had
for a long time before experienced." After a person has suffered from one attack, he may have no return of gout for some years, but it is very liable to revisit him again and again, the intervals between each attack becoming briefer and briefer, but the paroxysm being less painful, although there is more of stomachic disorder. Joints, too, that have been frequently affected seldom completely recover their pliancy, and in many instances are liable to have, what are popularly termed, chalk-stones (deposits of lithate of soda) formed immediately beneath the skin. These sometimes give rise to open sores, and then are very troublesome.
In the great majority of cases gout is an hereditary disease. Sir Charles Scudamore collected information regarding 522 gouty individuals, and found that 332 could trace the disease to their fathers, mothers, grandfathers, or other progenitors. Gout seldom makes its appearance until after the age of 35. Some time after its appearance the affection frequently becomes complicated with severe dyspepsia, including impaired appetite, heartburn, and gastrodynia, with irregular action of the bowels, hypochondriasis, and other disorders.
Sometimes during a paroxysm the gout suddenly disappears from the extremities, and violent pain is felt at the stomach, with great sinking of the pulse; or sudden inflammatory action may supervene, generally in the chest. The former of these affections is called retrocedent, and the latter misplaced gout.
The pathology of gout is now again generally believed to be humoral, and the essence of the disease to consist in a morbid matter or matters, which gradually accumulate in the system, producing general indisposition, until at length it is concentrated and expelled at the foot; after which "the bodily economy, like the atmosphere after a thunder storm, is for a while unusually pure and tranquil." That the poisonous matter should tend to one particular spot, usually the toes, is exactly analogous to what we know regarding other poisons. Thus, white arsenic tends to the stomach, cantharides to the bladder, and so in like manner does the morbid accumulation of lithic acid in the system tend to be deposited in the joints, particularly in those of the lower extremities. During the paroxysm it may be detected, says Berthollet, in the skin of the affected part, and, as before mentioned, in the urine, having doubtless been absorbed by the lymphatics.
As the paroxysm of the gout is the effort of nature to rid the system of a poison, many physicians have been unwilling to interfere with the progress of the disease, save by the antiphlogistic regimen, and some very slight antiphlogistic remedies. But it seems to be now quite confirmed by experience, that colchicum (meadow saffron) with antacids may be given during the paroxysm with the result of shortening it, and without producing any bad effects. If pushed too far, however, colchicum causes great sickness, purging, and faintness; and in such cases it is necessary to administer stimulants and opiates. Also by means of antacids and biters administered during the intervals, the tendency to gouty paroxysms may be mitigated. But it is also quite certain, that if the latter be done without a change in the mode of life which produced or excited the gout, various internal diseases of a very serious nature, chiefly in the head and chest, are liable to be induced. The rational plan of treating gout, therefore, consists in relieving the attack, when it is fairly developed, by means of colchicum and antacids; and, in the intervals, to recommend a regimen calculated to diminish the tendency to it, such as food mainly vegetable, a small proportion of fermented drink, habitual exercise, and the general tonic mode of treating disease.
Cases of misplaced and retrocedent gout should be treated as in persons not gouty, and in the usual way; but great care should be taken to watch for and be prepared to treat the severe neuralgic attacks that are liable to supervene. (T. L. K.)
Government. THE members of the human race are not isolated and independent individuals, each acting for himself without reference to his fellows. This is a fact borne out by all history and by all experience. Wherever a number of individuals have assembled on the face of the earth, it is found universally, that they have adopted certain regulations for their mutual guidance, thus proving that the association of men is not an accidental, but an inherent attribute of human nature. But as men, tribes, and nations, are placed in a variety of circumstances, this diversity of circumstances affects the arrangements by which societies are regulated.
Among these different circumstances, it is unnecessary to refer to the disputed question of variety of species; but it must be acknowledged that there are most extensive varieties in the moral, intellectual, and physical conditions of men. We may therefore be prepared to find a corresponding variety of systems of society, and of the institutions regulating them, according as these societies are distinguished by intellectual capacity, acquired knowledge, historic antecedents, and physical position on our globe.
In considering government therefore as a science which has rules, we must bear in mind that it involves two elements, the variable and the invariable, the abstract or ethical, and the economical. There is not only the intellectual perception of what the form of society ought to be, and of the principles on which it ought to be constructed; but there is the consideration of the peculiar circumstances in which the community is placed. The form of government that would suit Great Britain could not possibly be established among the Red Indians; yet those Indians might have their own rules for their own government, and as perfect a system of administration of them as the administration of the laws in Britain.
There is scarcely any truth more indubitably established by history, than that the form of government suitable at one period of a nation's history is not suitable, and could not be realized, at another and subsequent period.
When it is admitted that man is by nature a social being, there can no longer be a question as to whether there ought or ought not to be rules by which he, in a collective capacity, should be governed. There can therefore be no question as to whether there ought or ought not to be a government, but only a determination of the proper nature of government, of its ends, objects, and purposes. We must accept government as a necessity, and inquire, not whether it should exist, but how and under what conditions it can exist profitably and beneficially. And, therefore, the first question is, What is government?
The system of rules regulating a society may be termed in general law, and the fact and form of administering the rules is government. Two countries might have exactly the same body of law, and yet have essentially different governments. On the other hand, two countries might have exactly the same form of government, and yet have laws radically dissimilar. We see this exemplified in several modern states.
Of the term government there are three distinct significations:—1. Government is, in general, the administration of rule, law, and direction. 2. Government is the form of the institutions by which the rules are administered. 3. Government is the body of administrators who rule.
Were we to ask from history what is the end of govern-
ment, we should be compelled to affirm—"the interests and advantages of the governing classes." Reason replies differently, and assures us that there is another and more appropriate end which harmonizes with the higher and better instincts of our nature. From the days of Locke, or more properly speaking, from the days of Milton, this has been termed the "good of the public," the "good of the greatest number," the "good of the whole body of society," the "greatest good of the greatest number," with other equivalent expressions, which mean that the welfare of the whole mass of society is the true end of government. Nothing, of course, can be better than the greatest good; but there has been an obscure and indefinite enunciation of the principle which renders more minute examination desirable.
When we inquire into the character of the good that government ought to produce, we find two essential principles which have been more or less acknowledged in all societies, and which depend on the very nature of man himself. The first is the administration of justice; the second is the development of social improvement and well-being.
The first is the negative, or restrictive function of government, the second the expansive or positive function; the first lays upon society rules which deter all subjects or citizens from injuring their fellows by force or fraud; the second regulates those modes of action by which a much greater good can be achieved by combination, by distribution of labour, distribution of office, united effort and national action, than if each were to undertake for himself all the multifarious duties of life. On this distinction depends the division of government into its two great departments, judicature, or the judicial exercise of civil and criminal justice; and administration, including all fiscal arrangements, taxation, duties and customs upon home and foreign produce, municipal and electoral powers,—in fact, the whole organization of society, where crimes or civil suits are not involved. But as both of these divisions are presumed to be under the direction of law; and as laws must be made either by acknowledged custom, or by positive enactment, legislation is the department of government which dominates the other two.
But these are not the only ends of government, although the most important. Wherever there is a government, there is a geographical limit of space, or a numerical determination of persons to which the authority of government extends. Government is not merely an abstraction, but a concrete fact, and every government has its boundaries, either of geographical demarcation or of personal citizenship and accountability. The mariner on the high seas, although for the time located on a spot that is not claimed as the possession of any government, is yet amenable to the laws of his country, and is under the rule and sway of a special particular government which claims him as a subject.
This agglomeration of territory, with the sum-total of its people, is termed a state, a realm, kingdom, empire, republic, or some other term which expresses the unity of the whole. Where the persons only are united, and the territory is indefinite, or altogether undetermined, they form only a tribe, or it may be a small nation, which, however, may have a positive unity of its own, although fluctuating in its territorial residence.
This unity of the state involves another distinct end of government, namely, its defence against the aggression of other states. Hence the military establishments of countries. The third great end of government, therefore, is the defence of the national territory, and the defence or protection of every member of the state or nation. Every one who owes allegiance to a state is entitled to its protection;
Government. hence, where there is a monarchy, the subject is sheltered by the whole military power of the monarch; and where there is a republic, the citizen is sheltered by the whole power of the republic.
But government has yet another end distinguished from the foregoing, namely, the distribution of honours. Whatever may be said regarding the futility of titular honours, it is a fact apparent from history, and from the practice of all civilized people, that honours form a very important ingredient in the composition of human society. To some men honours are more desirable than wealth; and if they were accorded only for distinguished services really performed, they would be just and reasonable rewards, marking out not the fallacious vanities which too often have been combined with an utter want of merit, but marking the national esteem and gratitude, which, if fairly earned, ought also to be publicly acknowledged.
To sum up concisely the ends for which government may be supposed to exist, we recapitulate as follows. The ends of government are—
Under these four heads every operation of government may be ranged, with the exception of legislation, which overrides all the rest. Law is the rule, and the four operations are performed under the law and by authority of the law, so that legislation is the most general function of government. It might be said in still fewer words, that the end of government was "to enact good laws and to execute them with certainty and despatch," leaving it to be ascertained and determined what laws were or were not good.
But here it is necessary to point out the fact that history presents only an imperfect fulfilment of the ends of government, yet even in the imperfect fulfilment there is the similitude of the truth. We must regard government therefore as an imperfect art which historically grows and improves like other arts. Growth, development, the gradual perfection of systems, the decay of those systems, the recasting of materials, and the gradual issue of better systems, are the keys which enable us to read history—the history of government not less than the history of other arts. If we neglect this idea of growth we can never arrive at an intelligent understanding of history, nor of the changes which, as time rolls onwards, seem destined to invade the political constructions of mankind. Stability, in fact, seems only to be attainable by providing for perpetual change.