Recently a preparation by the name of piperazine has been widely advertised as a solvent of uric acid. It is prescribed in doses of fif teen to twenty grains a day. As a diuretic it possesses some virtue, but beyond this quality it does not seem to exhibit any special efficacy that is not equally manifested by the well-known and often tried remedies that have been already enumerated.
The hydropathic treatment of the gouty diathesis has been men tioned upon a preceding page. Similar measures have been advo cated in the local treatment of the acute disease. Hippocrates and his pupils were familiar with the relief from pain that may be pro cured by immersion of the affected limb in cold water. The illus trious Harvey, discoverer of the circulation of the blood, is said to have followed this practice in his own case, and yet to have reached a great age. In later years the allusion of cold water, followed by cold compresses laid upon the inflamed joint, has found advocates. But Sir A. Garrod, whom nothing has escaped, found that this prac tice was by no means uniformly successful in the relief of pain. Such alleviation of suffering as may have been experienced was merely transient, and was followed by a renewal of agony so soon as the cold applications were discontinued. The chief objection to the practice lies in the fact that in many instances the suppression of local inflammation by cold is followed by violent invasion of the internal viscera. The stomach, the heart, and the brain may be thus
attacked by an inflammation that has been driven from the periphery, where it was comparatively harmless, to the central organs of the body where its manifestation must be accompanied by the most se rious risks.
The same objection can be urged against the application of leeches to an inflamed joint. Garrod and his associate, Todd, have noted the interesting fact that after such local depletion joints thus treated remain permanently weakened, and may even become completely ankylosed. Before the days of aseptic surgery there was also no little danger of erysipelas and other infections through the cutaneous wounds that were thus inflicted.
During the period when every one was experimenting with anaes thetics, lotions and sprays of ether and chloroform were sometimes prescribed. To the refrigeration of the affected parts by a rapidly evaporating lotion or spray, the same objection should be raised that is laid against the application of cold water—there is danger of caus ing retrocession to the internal viscera of the body. But to the use of chloroform as a counter-irritant and anodyne in association with the ordinary narcotic liniments, there can be no reasonable opposi tion. During the stage of convalescence a well-fitted bandage is often of service; and sometimes a tardy subsidence of local oedema, may he accelerated by the application of a blister.