A few years ago, when anti-thermal medication was in vogue, large doses of sulphate of quinine were often used as a febrifuge du• ing the feverish stage of the attack. This mode of treatment has now become almost obsolete, and has been superseded in the majority of cases by the exhibition of sodium salicylate. The conditions of success in the employment of this drug are dependent upon the chem ical purity of the remedy and the efficiency of its administration. The impure salt is often very irritating to the stomach, and may produce cerebral symptoms that are indistinguishable from those of delirium tremens. If given in insufficient doses no appreciable result is apparent, and the remedy is accordingly discredited. But when employed as it is in acute rheumatism, in closes of ten grains every two hours, great relief is soon experienced. Under its influence pain and fever are reduced, perspiration increases, and the flow of urine becomes profuse. The discharge of urates is augmented, and the tissues are relieved of this cause of irritation. When this result has been attained, the frequency of administration may be reduced, but it is well to continue the remedy for ten days or two weeks, in doses of ten grains, three or four times a day. When the stomach is intol erant of the powdered salicylate or its solution, it will often endure the medicine in the form of tablets which dissolve slowly and present the drug more gradually to the mucous membrane. In advanced cases of gout, with diseased heart and kidneys, the drug cannot be given as liberally as in the case of a young and vigorous subject.
The remedy that most nearly approaches the rank of a specific for gout is colchicum. This substance is a drastic purgative that acts powerfully upon the nervous system, and tends to produce a state of collapse like that of cholera, if given in considerable doses. In all this there is nothing to suggest its special qualities for the relief of gout. Known to the ancients, it has maintained its reputation for thousands of years. Its effects are most conspicuously manifested in the joints that are the seat of acute inflammation. Under its influence pain and swelling rapidly subside, and in a few hours the affected part resumes its ordinary appearance. The English physicians advise delay in the exhibition of the remedy until the local symptoms are fully manifest in the joint that is the seat of the attack. Then the drug should be given, in the form of either the wine or tincture of the root or of the seeds. The tincture of the seeds is stronger than that of the root, and is the preparation usually employed by American physicians, though the wine of the seeds is with many a favorite preparation. The remedy should be given in diminishing doses—from 30 to 45 minims at night, and half that quantity in the morning. As the severity of the symptoms is reduced, these closes
may be correspondingly lowered, but it is well to give small closes of the medicine for weeks and months together during periods of pro tracted and imperfect convalescence. Sir Dyce Duckworth praises the Raastas culchici. of St. Bartholomew's Hospital Pharmacopoeia : This may be given night and morning as required.
The beneficial effect of colchicum is not due to its purgative energy, and Sir A. Garrod has shown that it does not augment the discharge of urea or the urates. Rutherford has shown that the drug is a most potent cholagogue—probably one of the most energetic in existence. By its action upon the liver it accomplishes an amount of elimination that can be produced in no other way. It probably also exerts a specific influence upon the nervous system by which the processes of inflammation are corrected. For these reasons colchicum, in some form, may be found in the majority of the quack nostrums that are so commonly employed by the public. But in this unquestionable energy lies the danger that accrues from its indiscriminate use. It is advisable to avoid all drastic purgation, hence it is well in cases that present any appearance of debility to begin the treatment with moderate doses. In certain cases there is an unusual susceptibility to the poisonous effects of the drug, and it is not impossible that some of the examples of so-called retrocedent gout with choleriform symp toms have been really instances of colchicum poisoning. The active principle of the plant, colchicine, has been sometimes employed as a substitute for the ordinary officinal preparations ; but the intense energy of this substance renders its extensive use quite inexpedient. The same thing may be said of veratrine—it is exceedingly poison ous, very unreliable, and rarely beneficial.
Against the use of colchicum has been urged the objection that its employment tends to transform acute gout into the chronic variety of the disease. But this is the natural tendency of the malady. As years progress, and the body becomes enfeebled with age, the at tacks of articular inflammation become less violent and are more pro tracted in their duration. Sir A. Garrod has shown that in many instances this degradation of the symptoms is reached at a compara tively early period without medication of any kind. On the other hand, there are patients who all their lives have taken colchicum, in the form of quack remedies or at the hands of intelligent physicians, and yet have never experienced anything but acute crises of gout such as they first knew in early life. It is now generally admitted that, properly used, colchicum is a perfectly harmless remedy. It certainly has never been superseded by any other drug.