Salicylates arc often beneficial in short courses by relieving the wearying joint pains, and Guaiacum has long enjoyed a reputation of a similar nature. Even the old-fashioned and despised " Chelsea Pensioner," which contains guaiacum, sulphur, and other drugs, sometimes proves a valuable routine preparation, and it keeps the bowels free. Guaiacum resin may be administered as a 5-gr. tablet three times daily.
Iodide of potassium is upon the whole the most reliable drug in chronic gout. It may he given in 5 to io gr. doses in courses of 6 or 8 weeks' duration, alone or in combination with minute doses of Arsenic a min., Fowler), or 5 min. doses of Colchicum wine. Radium emanations and radium drinking water are always beneficial.
The treatment of the chronic joint inflammations and deformities must be cautiously carried out. Pain may be relieved by the applications which soothe the acute arthritic manifestations—viz., an anodyne liniment containing Belladonna, Aconite and Chloroform—care being exercised that the belladonna constituent be not of such strength as to cause danger from its absorption. A safer application is the green extract rubbed up with glycerin. if friction be employed it must be of the gentlest.
A warm alkaline lotion of r of Bicarbonate of Potash in 4o of water applied under the oiled silk may be tried, but the tendency to gouty dermatitis or eczema may be brought into intense activity by wet applications; a dry heat is always best.
Stiffness and indurations may be often removed by skilful and gentle massage, with passive movements so conducted as not to set up pain or fresh arthritis. Counter-irritation should he avoided, hut mild Iodine preparations may be found useful.
Gout-stones should not be actively dealt with when nut causing pain or great discomfort. Their removal is impossible by drugs administered with the intention of dissolving the deposited urate of soda, since they are already extravascular. Alkaline hot lotions may he applied when the skin has ulcerated, and under very exceptional circumstances, as when stones seriously impede the movements of an essential joint, the skin may be incised and the concretion turned out. The use of electrical currents, X rays, Radium, electrical endosmosis, cataphoresis, &c., generally prove
futile and sometimes mischievous.
Retrocedent gout shows itself when the gouty inflammation flies to some internal organ from the inflamed joint during an acute attack, and the metastasis may prove fatal if not promptly dealt with. Very hot mustard fomentation should be applied to the joint from which the pain, heat, redness and swelling have suddenVdeparted, with the view of re-establish ing the original arthritic disturbances. Colchicum should not he given, and if the patient has been already under its influence the drug should be promptly suspended. A smart purge and a hot mustard pack to power fully stimulate the bowels and skin to eliminate the poison is the only safe resource.
Symptoms must be treated when they arise. When the metastasis is cardiac a hot mustard fomentation should be applied over the heart region, and strychnine given hypodermically. When brain symptoms with delirium or coma are present, the ice-cap is a doubtful agent to resort to. z drops of Croton Oil may be placed upon the tongue, and a warm sinapism applied to the nape of the neck. Gouty patients bear blood letting badly, and leeching would be useless under such circumstances, but when death is threatening a vein must be opened. This should not be done till a warm saline solution is prepared, which should be immediately injected into the opened vein in twice the amount of the blood let out. This need not exceed 15 to 20 oz. The serum may be hypodermically injected in heart cases without blood-letting when the patient has been placed in the hot pack.
When the stomach is affected the best procedure will be to speedily inflame the skin with a very hot mustard fomentation, and give warm water copiously by the mouth, and assist elimination by the hot pack, and hypodermic or rectal injection of warm saline to dilute the poison in the Hold.
The different diseased conditions which complicate gout, as eczema, neuritis, cystitis, renal cirrhosis, asthma, dyspepsia, glycosuria, &c., will require treatment on the lines recognised as suitable in each affection, the underlying gouty condition being always attended to by diet and drugs, as above detailed.