Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.
1019/1108 page 991
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.
![Dreiudicial, to drink too large an amount of any fluid {vide infra). T-arge quan- Eof alcohol are sure to injure the patient. If they can not be absolutely pro- scribed yet at least their amount should be reduced to a minimum. TMany gouty persons, especially those .suffering from the irregular form of the disease and acid dyspepsia, are more comfortable and seem to do better on a e which is laro-ely nitrogenous, the stai’ches and sugars being greatly limited in amount The diet in fact, should be similar to that laid down for diabetes melli- tus though not so strictly carried out. In chronic and irregular cases it is often desirable to prescribe a stimulant, for a time at least; brandy, whisky, or gin, weU diluted with Avater, is perhaps the best form.] _ By thus limiting the amount of food taken, we shall promote metamorphosis and ayoid any excessiye formation of uric acid. A more direct means of hasten- ino- the conyersion of the albuminoids is muscular exercise. If a corpulent patient is still vigorous and is not threatened by any serious internal disease, he should be urged to take a large amoimt of exercise in moimtain-climbing, gym- nastics, gardening, or similar pursuits. The motto of such a patient should be “little sleep and great activity.” This same indication of accelerating tissue-meta- morphosis is fulfilled also by bathing. In early stages cool baths and sponging are useful, as are also baths containing common salt, or perhaps even sea-bathing cautiously employed. In more advanced cases, particularly if the joints present permanent lesions, the warmer baths are more desirable, such as are found in Teplitz, Wildbad, Wiesbaden, Baden-Baden, Carlsbad, Ems, and Aix. The internal administration of alkalies is an efficient adjuvant to the dietetic and hygienic prescrqitions above enumerated. For a long period the use of alka- line mineral-waters has been found to be most beneficial. Experience confirms the confidence which theoretical considerations would lead us to have in their value in checking the deposit of uric acid, so far as it is occasioned by excessive acidity of the circulatory fluids {vide supra). The sodic chloride contained in these waters stimulates the conversion of the albuminoids. The watei-s also in- crease the activity of the kidneys, benefit gastric catarrh, and overcome constipa- tion, and in all these ways combine to produce a favorable effect upon the patient’s health. Still another factor is the judicious diet and mode of life at such health resorts. The waters of Carlsbad and Vichy have gained the greatest repute in gout, although the Avaters of Ems and Neuenahr have an analogous composition^ and doubtless would produce similar effects. Of the waters which contain sodic chloride, the most adAusable are Wiesbaden, Baden-Baden, Kissingen, and Hom- burg. The salts of lithium especially promote the solution of uric acid, and of late the Avaters Avhich contain lithium have been strongly recommended. The natural springs of this sort, such as the Crown Spring in Obersalzbrunn, and those of Assmannshausen and Salzschlirf, contain comparatively insignificant amounts of lithium; and it might be a better way to use the artificial lithium waters, such as are made by Struve or EAvich. Another way is to prescribe carbonate of lith- ium, in powders containing two or three grains each (grm. 0'10-0‘20), one powder two or three times a day, in a glass of Seltzer or Biliner water. Other remedies formerly in vogue were said to correct the “ goiity diathesis,” but their efficacy is extremely dubious, and they need not be especially mentioned. As to the treatment of the acute attack, it has ceased to be customary to employ any potent remedies. The patient must, of course, keep his bed. The affected joint should be wrapped up in cotton wool, the whole leg elevated, and a proper diet strictly enjoined. Free movement of the bowels should be maintained by means of an enema. If there is considerable gastric disturbance, bicarbonate of sodium, magnesia, or some bitter may be prescribed. The most certain remedy for severe pain is a subcutaneous injection of morphine. Less efficient are nai'-](https://iiif.wellcomecollection.org/image/b28135970_1019.jp2/full/800%2C/0/default.jpg)
