The tedious attacks of bronchitis that harass the gouty subject have been fully discussed. In addition to the ordinary expectorant, ano dyne, and antispasmodic treatment of the bronchial affection, the use of potassium iodide, colchicum, and arsenic is indicated. When asthmatic symptoms predominate, the bowels should be kept freely open, and the ethereal tincture of lobelia in doses of fifteen or minims may be added to the ordinary expectorant mixture. Potas sium iodide is also indicated unless there be a bronchorrhcea by which the lungs may be flooded. In such cases terpine hydrate or the com pound tincture of benzoin will be found useful. The fumes of nitre and stramonium leaves are useful on condition of being inhaled in large volumes. The addition of tobacco is often beneficial, and the mixture may be smoked in a pipe or in the form of a cigar. The English praise the following mixture : Ij Pulv. fol. stramonii 3 ss.
Pulv. anisi, Potass. nitrat flit 3 i j.
Pulv. fol. tabacgr. v.
M. et ft. pelvis. Sig. A teaspoonful to be burnt in a saucer, and the fumes to be inhaled.
Chloroform, other, and chloral hydrate often give great relief, hut tolerance is soon established. ,The same thing may be said of morphine. In desperate cases a change of air will often effect an immediate cure even when death had seemed imminent.
The disorders of the heart have been already considered, but cer tain symptoms connected with the circulatory apparatus demand further attention. Gastric disturbances are frequently acccompauied by excessive pulsation in the large arteries of the body. This some times causes intolerable throbbing iu the head, usually in one of the temples. The general treatment of arthritism and of chronic catarrhal dyspepsia is indicated. Elimination and tonic treatment are the first indications. Tincture of aconite has been recommended against the inordinate pulsations, but its effect is inferior to that of sodium or strontium bromide in moderate doses. After the catarrhal symptoms have been somewhat reduced, a course of nitro-hydrochlo ric acid and bitters is useful. Intermittent or irregular pulsation of the heart is usually dependent, when no organic disease can be dis covered, upon chronic intoxication with nitrogenous toxins, audit is best treated by correction of the diet, mineral waters, sulphur or guaiac laxatives, occasional doses of blue-pill and colocy nth, and the mineral acids with bitter tonics. A course of sodium salicylate often effects great benefit. Similar measures are needed in cases of midi after the acute neuralgic pain has been subdued by emptying the cavity of the stomach with a lobelia emetic or with the gastric siphon, followed by the administration, every fifteen minutes, of drachm doses, properly diluted, of equal parts of aromatic spirit of ammonia and spirit of chloroform. Sometimes the severity of the pain re
quires a hypodermic injection of morphine and atropine before any thing else can be done. When the heart is organically diseased, and the coronary arteries are incapable of fully conveying blood to the cardiac walls, genuine angina pectoris may occur, often with a fatal result. Inhalation of amyl nitrite, and the administration of nitro-• glycerin tablets (gr. every ten or fifteen minutes, will be neces sary in addition to the other measures above mentioned.
Hemorrhages from the veins of the rectum and nasal passages are not uncommon events among the gouty. They are frequently bene ficial, and require only the ordinary treatment, with proper regulation of the diet and attention to the excretions. Epistaxis sometimes occurs in elderly persons who have never experienced such a flux in earlier life. It is then usually the consequence of latent arthritic conditions, and is followed by the same relief that is obtained after an articular crisis. Occasionally such patients discharge blood from the faeces or bronchi. The color of the expectoration is dark. Speedy relief is procured by the application of a few leeches around the anus.
Phlebitis occurring in a gouty subject requires the usual local treatment for inflammation of the veins. Warm fomentations narco tized with belladonna or the oleate of morphine may be applied over the affected vessel, and the limb should be kept at rest. Vegetable food and the general treatment of the arthritic diathesis should be prescribed for several months. The action of the heart must be properly sustained with quinine, strychnine, and the mineral acids as acute symptoms subside. Sometimes the affected limb remains more or less persistently oedematous after the cessation of active in flammation. Warm douches, friction with the hand, and an elastic stocking are the best remedies for this condition, but they must not be prescribed until all danger of detachment of fragments from the clot has disappeared.
The sockets of the teeth are sometimes attacked by a chronic in flammation—pyorrhea alveolaris—that results in absorption of the alveoli, followed by the falling out of the teeth. This malady usually occurs among arthritic subjects, and is an indication for the adoption of measures that are appropriate to that predisposition.