Although the salicylates are certainly inferior to the colchicum, it is advisable to try them when colchicum is not well borne or when it fails to alleviate the pain. Generally the salicylate of sodium is used; the salicylate of lithium has also been recommended.
Sodium salicylate causes an increased excretion of uric acid, because it causes an increased formation. Bollland (Cen tralb. f. innere Med., vol. xvii, p. 70, '96).
The clearing of the system of uric acid by alkalies or salicylates leaves the prin cipal part of the work undone, which is the use of suitable remedies to correct the faulty metabolism in whatever sys tem the disease first arose. M. A. Boyd (Lancet, Aug. S, '96).
When the pain has subsided and the swelling of the joint is somewhat dimin ished, gentle use of the joint and careful (but not energetic) massage are useful.
In the interval between the attacks the tendency to renewed attacks by the prolonged use of alkalines is of impor tance. Of these the carbonates and the phosphates of sodium and potassium and the carbonate of lithium have been most employed, but their use is now known to be based upon fallacious deductions.
[The administration of alkalincs is based upon the theory that gout is caused by a lessened alkalinity of the blood. The alkaline remedies, by aug menting the alkalinity, would increase the power of the blood to dissolve uric acid and thus prevent the deposit of biurate.
The experiments of Roberts have quite destroyed this fundamental hypothesis by proving that in gout there exists no abnormal acidity of the blood and that addition of carbonates or phosphates of alkalines to blood-serum impregnated with uric acid does not retard the pre cipitation of biurate; the alkalines are consequently without power to prevent the formation of uratic deposits, and salts of soda may even prove directly pernicious when taken in large doses.
Carbonate of lithia was introduced in the therapeutics of gout by Garrod ex pressly on account of its chemical action. A solution of carbonate of lithia has great solvent power on uric acid, and from this fact it was inferred that lithia administered internally might communi cate its power to the urine and the blood, and that in this way as well the formation of uric-acid gravel as the deposition of biurates in gout might be prevented.
Neither of these inferences is justi fied. Mendelsohn (Berliner klin. Woch., '93) has shown by numerous experiments that the urine of persons to whom car bonate of lithia had been freely admin istered did not dissolve more uric acid than normal urine, and he observed, moreover, that the addition of normal urine to a solution of uric acid, effected by the aid of carbonate of lithia, was sufficient to precipitate almost all the uric acid contained in it. When carbon ate of lithia has some value in the treat ment of gravel it is only on account of its action as a powerful diuretic. Roberts demonstrated that the addition of carbonate of lithia to blood-serum or to synovia has not the slightest effect to enhance the solvent power of these media on sodium biurate or in retarding' its precipitation from sermn or synovia im pregnated with uric acid. F. LEVISON.] Various basic organic products piperazin, lycetol, lysidin—have recently been recommended as specifics for uric acid gravel and gout on account of their power to dissolve uric acid. Mendelsohn has tried the effects of all these com pounds, and found that urine saturated with them does not dissolve uric acid any more than normal urine, and they are, of course, still more ineffective when circulating in feeble concentration with the blood.
In an old gouty case, by daily injec tion of 5 minims of hydrochlorate of piperazin, the uric-acid deposit in the urine was very materially lowered. Bar det (Mfineb. med. Woch., June 16, '91).
Piperazin highly recommended in the treatment of both acute and chronic gout. It may be given to the extent of 15 grains per day, largely diluted with water. Schweininger of the Amer. Sled. Assoc., Sept. 24, '92).
Lysidin has proved to be a powerful remedy for gout, the pain ceasing soon after its use is begun, the joints becom ing supple and the tophi diminishing. E. Grawitz (Deutsche med. Woch., No. 41, '94).