The purging should be stopped and the colchicum diminished or suspended as the attack passes off, and the patient gradually returns to a white fish and chicken and farinaceous diet.
Between the attacks the treatment by diet, exercise in the open air, an occasional natural purgative water, &c., is to be maintained. A host of drugs are recommended at this stage. Alkalies have been employed as a routine by most physicians on the theory that they form soluble salts with uric acid, which is thereby easily eliminated by the kidney; but they no longer hold their own, and Roberts maintained that they were worthless. Lithium, the most prized of the group, has fallen into comparative disuse, and all authorities are agreed that soda salts should be avoided, some going so far as to insist upon a salt-free diet. There cannot, however, be a doubt about the value of such alkaline waters as Carlsbad and Con trexeville when drunk at the spas. They probably act by their large volume, possibly independently of their mineral constituents, and a sojourn at any of the places previously mentioned is a good routine after one or more acute attacks.
Radium drinking water and emanations have their advocates. Salicy lates are prescribed by many in the intervals between the attacks, though their best effects are to be witnessed during the seizure or immediately afterwards. Haig claims special virtues for pure Phosphate of Soda, and others employ the Phosphate or Chloride of Ammonia.
Urotropin, Piperazin, Lysidine, Atophan, Chinotropin. Uricedin, Urosin, Benzoates and Diuretin compounds are but a few' of the innumer able gout remedies which have been extolled and, like Lithium. for the most part found valueless. The latest member of this group of so-call( d specifics is Thyminic Acid, which is Nucleotin-phosphoric Acid with the trade name of " Solurol." It is undoubtedly a good laboratory solvent of uric acid, and being a product of the metabolism of the food nucleins, it is believed to have a strong affinity for uric acid, whose precipitation is thereby prevented. The drug is given in tablets of 4 grs. each, two being taken thrice daily after meals.
Chroilic gout must be treated upon the lines suitable for acute and subacute attacks. The dietary will require continual changing or modification, especially as most of the patients are well on in years and often seriously debilitated by the wearing pains of chronic joint deform ities and asthmatic, renal or cardiac complications. As a rule a more liberal supply of animal food must he given when it is craved for or when farinaceous stuffs cannot be digested. In addition to white fish and poultry plain boiled mutton and eggs with ordinary clear or thick soup may be allowed in moderate amount if not fortified by beef extracts, but the foods rich in purins as sweetbreads, brain, liver, pancreas, roe, &c., must be rigidly excluded. Game may, however, be permitted in the form of roast pheasant, and oysters occasionally.
Alcohol will be more frequently indicated than for younger patients, and distilled liquors in small amount and well diluted arc always to be preferred to fermented beverages; Still Hock or Moselle with Apollinaris water or a little dry Sherry may, however, be allowed when spirits arc objected to.
Exercise is a great difficulty, as locomotion is often seriously impeded, and its place must be taken by general massage, hydropathy, warm douching, and the hot-air or radiant heat (electric) bath, all of which remedial agents are nuw procurable at every alkaline spa, where the waters may be freely indulged in for a couple of months in each year with great advantage.
The bowels must be more than merely kept free from constipation. A smart saline should. be administered at least twice a week, and an occasional Blue Pill is always beneficial.
Colchicum is only to be administered when an acute or subacute exacer bation of the arthritic troubles supervenes. It is a well-recognised fact that aged patients bear this drug badly, and the dose of the wine should not as a rule exceed 15 or at most 20 mins. thrice daily. Salicylate of Colchicine is often better borne in doses of gr., or two capsules which each contain !„ gr. of this salt dissolved in methyl salicylate may be given three or four times a day.