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Manifestations of the Gouty Diathesis Treatment of the Obscure

patient, mercurial, require, gout, salicylate, usually and nerve

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We have seen that the gouty diathesis, or, in other words, attenu ated gout, is usually manifested by a considerable number of disor ders involving the different organs of the body, sometimes long before the occurrence of articular crises. These disorders, when dependent upon the diathetic condition of the patient, require certain modifica tions of treatment, just as the diseases that occur in malarious subjects are modified by the action of malaria, and require special treatment with reference to the underlying complication.

The nervous system, always suffers from the toxic influences of gout. In the latent form of the disease the patient is often greatly depressed in spirits, moody, fretful, or surly. The melancholic varieties of insanity may be experienced, and they often persist until cured by a sudden outbreak of articular gout. In all such cases, efficient elimination is needed. The diet must be regulated so as to contain a minimum of meat, and active exercise must be maintained. If the heart is not seriously affected, a mercurial purge, followed by a course of alkalies, sodium salicylate, or even colchicum may be administered. In cases of insomnia, the same general treatment must be employed. A foot-bath, and a full dose of potassium citrate or of lithium citrate in a glass of hot lemonade at bedtime, are to be preferred to narcotics of all kinds.

Epilepsy is often accompanied by symptoms that are due to the accumulation of nitrogenous toxins. A diet of vegetables, milk, and fish may be allowed. The digestive organs require careful supervision. Alcoholic stimulants and venereal excesses must be forbidden. An occasional mercurial cathartic is beneficial, and the specific treatment with bromides should be supplemented with other alkaline salts, alternately with sodium salicylate.

Ordinary gouty headaches require the general treatment that is ap propriate to the diathetic condition. Hem iciania is usually treated with mercurial carthartics, antipyrin, caffeine, and alkalies. A glass of wine and a good dinner sometimes give prompt relief, a fact that Haig explains by their action in driving uric acid and its con geners out of the blood into the tissues. But the suppression of

pain that is thus effected has to be paid for by subsequent misery when the accumulated refuse re-enters the current of the circulation. The treatment that is at the same time palliative and curative consists in the administration of five or ten grains of sodium salicylate before each meal, with a close of fifteen or twenty minims of dilute nitro hydrochloric acid after the repast. General treatment for the im provement of the health is also desirable.

Xeurias of gouty origin, though not very common, is exceedingly persistent. It is often dependent in part upon alcoholism induced by the habits of the patient. It requires a long course of potassium iodide and quinine—three grains of the former with one grain of the latter, three times a day. If the bowels are constipated, a few drops of tincture of colchicum seeds may be added. Counter-irri tation over the affected nerve should be maintained with canthar ides, or tincture of iodine, or a mixture of equal parts of chloral hydrate, camphor gum, and menthol. The galvanic current along the course of the nerve for five minutes every day or two is a valu able adjuvant to the general treatment, as it is also in neuralgia, an affection that requires essentially the same treatment that is requisite for neuritis. It is best to avoid as far as possible the use of hypodermic injections of morphine, but sometimes they must be employed, in order to secure rest from the wearing pain. In such cases, especially when the sciatic nerve is involved, the propriety of surgical intervention by nerve-stretching or nerve-section should be considered.

Vertigo is not infrequently experienced by the gouty patient. It is often temporarily cured by an attack of articular gout. An occa sional mercurial cathartic, and relaxation of the bowels with rhubarb and magnesia at bedtime, together with a dose of compound tincture of gentian and potassium acetate before each meal, will usually effect a cure. If these remedies fail, colchicum may be given in moderate doses for a number of weeks or months. A similar course is indi cated when muscular cramps in the calves of the legs, or elsewhere, become annoying.

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