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Retrocedent Gout

treatment, patient and heart

RETROCEDENT GOUT.

Betrocedent gout requires prompt and energetic treatment. The transfer of symptoms is to either the head, the heart, or the gastro int-stinal tract. The indications for treatment are twofold—to obviate the danger of collapse, and to recall the disease to the distal articulations of the limbs. When the brain is the seat of retrocedent phenomena, the symptoms of coma are rapidly developed. Under such circumstances, if the patient be plethoric, blood should be taken. from the arm to the amount of ten or fifteen ounces. Some of these cases are really due to urfemia, and bleeding is in such as useful as it is in puerperal eclampsia. Blood-letting should be followed by a drastic purge with calomel and jalap, or with croton oil if there be difficulty of deglutition. Mustard poultices should be applied to the extremities, in order to provoke the return of inflammatory action about the deserted joints.

When metastasis to the heart or stomach has occurred, the promi nent symptoms are those of collapse. Hypodermic injections of ether (ten drops every few minutes) are very efficient for the stimu lation of the heart. Whiskey and hot water may be given by the mouth, or by injection into the rectum if the patient cannot swallow or retain the potion. Small and stimulant doses of laudanum—one

or two drops every ten minutes—are also beneficial, especially if given with the aromatic spirit of ammonia. Sinapisms, or even a blister, should be applied over the stomach and to the extremities, and the patient should be thoroughly warmed with bottles and rubber bags filled with hot water, and wrapped with flannel, to prevent vesi cation of the skin. The flatulence that is so often present may be re lieved by camphor, or the oil of cajeput, or hot peppermint water with compound tincture of cardamom seeds. In mild cases of gastric disturbance occurring in chronic gout this form of gastric stimulant may be often sufficient, but in the grave cases of metastasis the most energetic treatment is required. If these efforts are successful and the articular manifestations reappear, the patient will for sev eral days need a light diet and the treatment that is appropriate for inflammatory conditions of the stomach and bowels. Colchicum may then be administered in small doses for a considerable period of time.