136 DECLINE OF LIFE IN DISEASE. the abundant use of animal food, and also of stimulating drinks, is to accelerate the circulation and induce plethora, which should equally be avoided. Gout more frequently attacks men than women; indeed, it is almost a disease of the male sex. Dr. Gregory says that gout attacks fifty men in England for one woman, and that in Scotland the proportions are a hundred to one; and he attributes this entirely to the grosser feeding and more intemperate habits of the men. But the same distinguished physician gave, in his own person and example, the most valuable lesson as to the best means of avoiding attacks of gout, and combating the disposition to that disease. Born of a gouty family, and having been attacked by the disease early in life, he nevertheless, by a careful attention to diet and regimen, remained free from any subsequent attacks, and yet preserved his health, strength, and general appearance. There seems good reason to believe that the immoderate use of wine and beer tends to the production of gout in a greater degree than the use of spirituous liquors; and this probably arises from the directly stimulant effects of the latter on the kidneys, causing them to carry off a larger portion of lithic acid: certainly gout is not common amongst the intemperate rabble of large towns; Dr. Budd states that many labourers on the Thames are annually admitted into the Dread nought hospital ship affected with the disease; and it is well known that those men drink very largely (often two or three gallons daily) of malt liquor. That it chiefly affects the wine-drinking classes has always been remarked; Dr. Watson well observes that the servants of wealthy families are often so affected, especially butlers, coachmen, porters, &c., yet they are rather a beer-drinking than a wine-drinking class, although they frequently feed as luxuriously and often live as lazily as their masters. Perhaps here, as on a former occasion, I may point to the marked distinction between the effects of those liquids which are the products of fermentation, and of such as are educed from them by the further process of distillation. Fermented liquors, properly so-called, that is, beers and wines, moderately and judiciously used, may sustain the strength and contribute to health; over-indulgence in them may induce indigestion, plethora, and all the evils in their train, gout amongst the rest; but ardent spirits, used habitually as drinks, are at all times hurtful, and if taken frequently in excess induce diseases of a much more serious character; not functional derangements, but changes of structure and often the total disorganisation of parts. is often the really exciting cause of the disease. The usual monthly discharge of blood having ceased to appear, the ordinary safety-valve having ceased to act, yet the woman being strong and healthy, local plethoras are likely to occur; and when they attack organs which have fallen into desuetude, effusion and consequently induration of parts result, and these indurations, although often unimportant, quickly become malignant when any faulty constitutional predisposi tion exists. The individual may do much to prevent the accession of this dreadful disease. It may be caused by a general plethoric condition; it is directly induced by a too great local fulness: let her therefore carefully keep watch for these causes, and prevent or remove them. Let her, by diet, by regimen, by evacuants, avoid great plethora—it is the parent of a thousand evils, and especially to women at the critical period of life. Even so, as to local fulnesses; if they occur let there be no delay-no neglect of remedial measures; but let means be taken at once to remove the superabundant quantity of blood and to diminish the increased impetus, before any evil effect is induced before any effusion of lymph shall have taken place; afterwards it may be too late, it may be impossible to remove induration, it may be impossible 140 DECLINE OF LIFE IN DISEASE. to prevent the accession of disease. When parts have become thickened and hardened, it may be a very grave question, if any attempt should be made to soften them, if it be a case of simple induration; or to remove them if it be malignant. A simply indurated condition of a part, especially if that part be not called on to perform any function, is a trifling evil, and experience has shown that such induration may continue for many years unchanged and harmless, and any attempt to remove it may excite a diseased action, which we may not have the power to allay; on the other hand, if the hardness be really malignant, it may also be progressive and pass by the absorbent vessels from one part to another, and thus contaminate the whole body, and the favorable moment may be lost, when, by removing the local evil, we might have prevented the general disease. This is often a question of the greatest difficulty, and can only be decided by the most careful investigation and most accurate judgment, guided by an enlarged experience. Cancer may attack any organ or structure. In the female it most frequently occurs in the uterus and mammæ; but in both sexes it commonly occurs in the tongue, stomach, and rectum. In the first situation it often results from the pressure of a tooth, the early removal of which or the filing of it down might have prevented |