Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    875/976 (page 855)
    to make much distinction between the acute and chronic forms of the disease : at different offices varying rates are adopted. In the early attacks a patient is likely to inquire of his physician, if it is possible to prevent a return of his ailment—a question tantamount to asking if there is any known method of absolutely eradicating the tendency to Gout from the system. There are records of individuals who have experienced but one attack, though they have lived to a great age. I have known thirty- five years elapse between a regular attack of Gout in the great toe and the patient’s death, which took place after he had attained his seventieth year. Several cases have come under my observation in which the disease, after having recurred periodically for many years, gradually declined in intensity and duration, and at last altogether disappeared. The appearance of Gout can never be looked upon as a good omen ; a statement contrary to a once popular opinion. The greater the age at which Gout first seizes the individual, the more satisfactory the prognosis. If it attacks very young subjects, the future prospects are bad. Hereditary is generally much less tractable than acquired Gout. The appearance of chalk-stones on the surface is always inauspicious, even if confined to the helix of the ears. Gouty patients are more liable to suffer severely from accidents and exposure than the majority of people; the more the kidneys are im- plicated, the less able are they to withstand the effects of shocks upon the system. In concluding the subject of the prognosis of Gout, I will remark, that I consider that a single fit of Gout, however slight, should be looked upon as an intimation that the patient cannot go on with impunity in his then habits of life; it is a warning that either he must change them or expect returns of the disease, which, as time advances, are certain to increase both .in frequency and duration, and both embitter and shorten existence. On the other hand, I am equally persuaded that if proper regiminal and medicinal precautions be taken, the gouty patient may be saved from such an alternative, and the disease, instead of increasing in intensity, may be gradually mitigated, and probably interfere but little with the comforts of life. Treatment.—The subject of the treatment of Gout naturally divides itself into, first, the treatment of the articular inflammation; secondly, the management of the gouty subject during the intervals of the attacks ; and, thirdly, the treatment of the complications and irregular manifestations of the disease. Under the head of Treatment, we shall discuss not only the medicines which it may be necessary to administer, but likewise the dietetic and regiminal management. Treatment of Acute Gout.—Let us first examine if the?’? is any necessity foi giving medicine at all, and whether or not it is prudent