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Chronic Gout

treatment, patient, joints, doses, waters and tolerance

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The treatment of chronic gout consists, for the greater part, in the general treatment of the arthritic diathesis according to the methods that have been already considered. But the different forms in which the chronic disease is manifested require certain corresponding variations in the treatment. Sometimes the general health remains good despite the fact that the joints become stiffened by gradual infiltration with urate salts. In such cases it is not un usual to experience intermittent attacks of articular inflammation ; but the severity of such exacerbations is ordinarily less than in acute.

gout. In other cases, the local manfestations about the joints are comparatively insignificant, but the force of the disease is ex pended upon the respiratory organs, the circulatory apparatus, or the kidneys. Obviously, these patients require a form of treatment that is adapted to the special disorder of the internal viscera, while for those who belong to the other class a different method will be applicable.

For the class of patients in whom chronic articular manifestations predominate, a long-continued course of intermittent alkaline medi cation yields the best results. The carbonated salts of lithium or of potassium, or the salicylate of sodium, may be given in small doses during one-half of each month. When the last-mentioned salt is administered, it should be given in five-grain tablets before each meal and at bedtime, with fifteen drops of dilute nitro-hydrochloric acid shortly after the meal. These remedies are especially useful when painful sensations are experienced in the abdominal and pelvic viscera, or if neuralgic headache be a prominent symptom. If there be any tendency to the passage of gravel, the patient should be instructed to drink Apollinaris water, or the waters of Vals, Royat, Pougues, Contrex6ville, Bath, Buxton, Clifton, Poland, or Waukesha. For those who cannot afford the natural spring waters, the distilled waters that are now prepared on so large a scale for the manufacture of ice, or even the condensed steam from an ordinary boiler, may be recom mended. During one-half of each month the patient should endeavor

to dispense with the use of drugs, in order to prevent the establish ment of tolerance, or of debility from too long persistence in the em ployment of alkalies. At all times, however, the rules of hygiene and exercise must be observed, together with all the precautions in the way of diet and occupation that have been already inculcated. When the season of the year is favorable, a sojourn at some one of the numerous hot springs, for the purpose of a systematic course of warm baths, will be found advantageous. Warm bathing conjoined with massage at home is always very beneficial.

When the digestive organs are in a fairly good condition, iodide of potassium, in doses of two grains three times a day, often exercises a salutary effect, hindering the formation of deposits about the joints. The administration of the drug should be occasionally suspended for a fortnight at a time, to prevent the establishment of tolerance on the part of the tissues. Colchicum may be in like manner exhibited in small doses for considerable periods of time. In one instance the late Sir Henry Holland administered this remedy for two years with decided benefit to the patient. i'sually, however, it is advisable to reserve its use for the relief of the painful exacerbations that diver sify the course of chronic gout. So great is the comfort that is derived from its exhibition ou such occasions, that the risk of tolerance through constant use should be avoided. Still, there are many experienced physicians who do not fear the continuous ad ministration of colchicum provided the dose be small enough to obviate all danger of gastro-intestinal irritation and cardiac de pression. Thus employed, many of the headaches, backaches, irri tative coughs, and other symptoms of gouty disorder may be kept at bay.

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