A year's experience with the Sprague hot-air therapeutic apparatus has dem onstrated that it has not often been dis appointing in its action in the usual types of gout or rheumatism. Even where tophi have formed, the solidifica tions are frequently softened and car ried off through the excretory organs.
The skin and kidneys are stimulated by the hot blood, and circulation is re stored to the affected part.
All cases, as far as heard from, have kept what they gained, excepting in so far as they have returned to errors of diet and lack of exercise. As a matter of course, the originating causes may induce a return of the trouble.
The failure of an apparatus to run to a very high temperature must certainly curtail its usefulness. This mode of treatment becomes a most useful adjunct to medical and surgical treatment. A. Graham Reed (Phila. Polyclinic, Aug. 6, '9S).
To sum up, the principles of the treatment of gout are these: In all cases the diet is to be regulated with a view to sustain the forces of the patient with out allowing any excess of food; the patient is to be advised to limit the use of alcoholic stimulants and to avoid equally excess of work and of enjoy ments, whereas bodily exercise and open air life are useful. The patient ought to drink pure water of some aerated spring in sufficient quantity to keep the daily excretion of urine from 3 to 4 pints; if the urine be strongly acid and liable to precipitation of uric-acid crystals, the administration of small doses of some alkaline drug or spring should be re sorted to to diminish the acidity and render the urine limpid.
The gouty attacks are treated by rest, somewhat reduced regime, anodynes, if necessary, and colchicum; in the free intervals the resin of guaiac will be of use. The stiffness of the gouty joints and the tophi are treated by the dielec tric introduction of lithia, by the hot-air bath, and by massage.
A visit to some spring where the appli cation of hot baths, douches, and mass age are combined with the use of some aerated spring and good vivifying air will be of use to restore the forces and the spirits of the patient. Also a sojourn in some dry and hot climate is advisable as well for the specific gouty symptoms as for the disease of the kidneys, which is the constant companion of gout.
The obscure symptoms of the so-called visceral gout require very different treat ment after their nature, but in all cases it must be remembered that gout is only to be treated successfully when great care is given to the dietetic and hygienic treatment of the whole system. This
cannot be regulated by one common rule, but it must be carefully adapted not only to each patient, but to the different stages and periods of the malady.
GRINDELIA.—Grindelia is the leaves and flowering tops of Grindelia robusta and Grindelia squarrosa, which are her baceous perennial plants indigenous to Mexico and the Pacific coast of the United States. They contain a resin, a volatile oil, and an alkaloid (grindeline).
Preparations and Doses. — Grindelia (leaves and tops), to 1 drachm.
Extract of grindelia, fluid, to 1 drachm.
Physiolozical Action.—Grindelia has an acrid, bitter taste. When chewed it excites the secretion of saliva. It is an antispasmodic, motor depressant, and has light expectorant and diuretic ac tion. It slows the heart and increases the blood-pressure. It stimulates the bronchial membrane and the kidneys, and is eliminated by them. When given in large doses, it induces paralysis of the peripheral sensory nerves, the sensory centres in the spinal cord, and later the motor centres and nerve-trunks; the pupils become dilated and renal irrita tion is produced.
In warm-blooded animals the phe nomena which grindelia robusta produces may be ascribed to an exciting action upon the bulbar centre of the pneumo gastric, which, when a large dose is in troduced at one time into the circula tion, appears to be paralyzant. The ef fects upon blood-pressure are that with small doses there is a slight rise, which is more evident with medium closes; but as the amount is increased the pressure gradually and continually falls during the same time that the oscillations are shorter. When its effects on the pneu mogastric are considered and also its power of contracting bronchial muscles and its action on the heart, it is likely, in proper doses, to be of value as a remedy for the symptom of asthma. The drug contains an active principle, likely terpene, which benefits the elated catarrh. The drug apparently possesses a paralyzing action on the thermogenic centre. The secretions are changed as follows: The urine is in creased by small and diminished by large doses, partly from changeS in blood pressure and partly from direct action on the renal epithelium. The saliva and bile arc increased. Both urine and saliva are of greenish tinge. Luigi d'Amore (Giornale della Associazione Napoletana di :Medici e Naturalista, Puntata 5a e 6a, p. 331, '96).