Treatment during an Acute Attack.—Rest in bed is imperative, and rest of mind and freedom from business worry is essential. The diet should consist of weak diluent drinks, as a thin vegetable soup, milk and Kali water, or barley water, toast and water, with a few plain arrowroot biscuits. Beef extracts are often given, hut they should be avoided. Debilitated subjects may be permitted to take freely of weak chicken soup thickened with barley or other farinaceous material. Alcohol is seldom indicated, and when very specially demanded a little whiskey with Kali water may be permitted.
The affected joint should be placed in a position of absolute rest, surrounded with a thick layer of dry absorbent wool covered up by thin mackintosh or oiled silk, evenly but lightly bandaged and elevated. When the patient is restless he may be allowed to sit in an armchair with his foot supported upon a chair, which is better than the fashionable gout stool. The wool dressing should be changed every 12 or 24 hours, and a layer of warm wool reapplied.
When the pain is unbearable local sedatives must be applied. Leeching and blistering or other form of counter-irritation are always contra indicated, and poulticing is objectionable. A hot stupe, fomentation or foot-bath often gives relief, but cold applications or lotions should never be employed. One of the best methods is to wring a flannel cloth out of a very hot decoction of poppy-heads or chamomile flowers, and apply it to the inflamed joint, or the flannel may be wrung out of hot water and lightly sprinkled with the Liniment of Chloroform, Aconite or Belladonna. For most cases it is best to sprinkle the woollen dressing with a little of any of these liniments, and then envelop the part with more wool and an imper vious dressing, care being taken that the dressing be not saturated with chloroform liniment, which might blister. A mixture of two or three embrocations may be safely employed, but it should not cover the entire foot, or a large joint like the knee.
Hot alkaline lotions are recommended by Yeo and others. They possess no advantage over spirituous liniments, and are, moreover, liable to cool and so expose the part to variations of temperature, which is always to be avoided. Duckworth's application consists of zo grs. Morphia Hydrochloride dissolved in 6 oz. Belladonna Liniment, but it is
very doubtful if the morphia has any action when used in this way. If dissolved in chloroform liniment absorption would be liable to occur, and morphia is a most undesirable drug to be circulating in the blood during an attack of acute gout, hence relief of the local pain by morphia hypo dermically is to be avoided when possible.
Colchicum is the one drug for administration when pain is severe. It relieves pain without increasing the secretion of the kidney, bowel or skin; therefore, its action cannot be said to be eliminatory. Its effects are, however, increased by combining its administration with purgatives; hence, if a full dose of a saline cathartic has not been already prescribed, the best procedure will be to administer the following ancient formula: It. Colchici 3iv.
Magnesii Sulphatis 3iss.
Mag. Carb. Pond. 3ij.
Aqua Mentha pip. ad 3xij. Misce.
mist. Cpt. stating and 3j. quarlis horis, p.p4.
It will be observed that the first dose of the wine of colchicum in the above mixture will be _to mins.—a dose which never should be exceeded or repeated, but which is quite safe when given with a brisk cathartic. It is an excellent plan to direct the gouty patient to take a 5-gr. Blue Pill as soon as he feels the first approach of an attack 8 hours before commencing the colchicum treatment. The above mixture after 24 or 36 hours should be given in doses three or four times a day.
Salicylate of Sodium, or Potassium, is the next best routine when from cardiac weakness or idiosyncrasy the colchicum cannot be given. It also has some depressant action upon the heart, but less so than colchicum. 3o grs. may be given at once, and half this amount every 3 or 4 hours. The salicylate of potassium may be given in effervescence with Lemon juice and Bicarbonate of Potassium with advantage, as this increases its diuretic action. Luff advises drinks of Cream of Tartar (2o grs.) dissolved in to oz. hot water frequently throughout the day. The fever is reduced and all the excretory organs—bowels, skin and kidneys--are kept in an active state by these agents.
Insomnia is best met by liyoscine, 'Friona' or Paraldehyde. The latter is the writer's routine hypnotic in gout, and he never prescribes Morphia or Opium.