TREATMENT OF THE ACUTE ATTACK. —Abortive treatment of an acute attack of gout has repeatedly been tried, but it is not to be recommended, being attended with great risk. The method proposed has been strapping the affected joint with adhesive plaster; the application of snow or ice; the hypodermic injection of morphine; large doses of colchicum, etc. Undoubtedly the attack may be stopped short by these methods, but very danger ous symptoms, such as fainting, disorder of the action of the heart, etc., have been observed as the immediate result of these procedures.
Although medicine has now abandoned the old maxim that during the attack the affected joint was only to be treated "with flannel and patience," the treat ment of the attack ought not to be too active. The patient should remain in a recumbent position, though not neces sarily in bed, for some days; the affected limb should be raised and supported, kept warm, and protected from pressure. The pain is relieved by warm alcoholic lotions, application of opium ointments or liniments; menthol in an alcoholic solution. Ointments of ichthyol are also to be recommended.
In mild attacks of acute gout, abso lute rest, diluent drinks, and the applica tion to the affected joints of an oint ment composed of sodium salicylate, 1 V, drachms, and lanolin, I 'A, ounces. recom mended. W. Moraiu (Bull. General de Th6rap., July 30, '95).
Most of the remedies are useful, mainly through the suggestion of relief they afford to sufferers. Blood-letting and blisters were formerly in use, but are now generally abandoned.
English practitioners often begin the treatment of an attack of gout by the administration of a free purgative: calo mel and jalap or mistura sennw com posita.
Best results obtained from giving fractional doses of calomel at the be ginning of an attack of gout until it freely moves the bowels. F. Grimm (Le Praticien, May, '93).
Of remedies directed toward the gouty process itself colchicum is the most effect ive; its mode of action is obscure, but it seems to relieve the pain better than any drug; colchicum is ordinarily prescribed as wine of colchicum and may well be combined with tincture of aconite; 25 minims of wine of colchicum with 3 to 5 minims of tincture of aconite may be given three or four times daily. The use
of colchicum ought only to be continued from four to six days, as it is liable to produce nausea and diarrhoea, and even paralysis of the nervous centres when taken too long a time. A very active principle of colchicum—the colchicine has also been employed. As soon as the anodyne effect of colchicum has been reached the use of the drug is to be dis continued. Under any circumstances, however, it should no longer be given when nausea or diarrhoea sets in.
Colchicum is par excellence the specific for gout. Lecorehe (La Med. Mod., July 14, '94).
To check the excessive formation of uric acid, liver-metabolism should be promoted, and congestion of the portal system relieved by regulating the diet and regimen. Colchicum and guaiacum, as stimulants of hepatic metabolism, are very useful in many forms of gout. Con stipation and the congestion of the por tal system may be relieved by occasional doses of blue pill followed by an Epsom salt purge.
To promote the elimination of the quadriurates formed in the kidneys and so prevent their absorption into the blood is to strike at the primary evil in the causation of gout. To promote this, diu resis should be increased and the acid ity of the urine diminished. Citrate of potassium is a good diuretic which not only increases the solubility of the quad riurates, but also diminishes the acidity of the urine, and should be pushed until moderate alkalinity of the urine is pro duced.
The removal of uratic deposits and the elimination of quadriurates and biurates from the system may be attained by free diuresis, baths, and suitable exercise, and the careful selection of a mixed diet with a fair amount of vegetable food, since the mineral constituents of certain vegetables—such as Brussels sprouts, cabbage, French beans, spinach, turnips, and turnip-tops—possess to a remarkable degree the double function of inhibiting the conversion of sodium quadriurate into the biurate and increasing the sol ubility of the latter; but the idiosyn crasy of each patient to various articles of diet must be made the subject of careful observation. Lull' (Indian Med ical Record, July 1, '98).