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.

    877/976 (page 857)
    of its solid constituents, but of this there will be occasion to speak further on. ... . . a Although colchicum causes purging, still its peculiar influence is quite apart from this effect. Occasionally an almost magical change is produced by a single large dose, without the appearance of the least increase in the secretion from any organ, the effect being manifested in the rapid subsidence of the pain and other symptoms of the joint inflammation ; and simple purging, even though copious, will often fail to produce any notable effect under the same circumstances. I am of opinion that, in articular gout, colchicum may be advanta- geously administered during the time that the inflammatory symptoms are present; and the dose of the wine of colchicum may be from ten to twenty or even twenty-five minims repeated every six hours. Colchicum given in the above manner will of itself be sufficient in most, cases to cut short the gouty attack, and I have often depended on it alone; but, at the same time, in the majority of cases, it is advantageous to combine it with other remedies, which must necessarily vary in different cases. From what has been stated of the condition of the blood and of the urine, it will at once appear that some moderate alkaline plan of treatment is likely to prove advantageous, both for the purpose of increasing the alkaline state of these fluids, and also to keep in solution the salt of uric acid, which is liable to be deposited in the cartilaginous and ligamentous tissues. There can be no doubt of the value of alkaline remedies in the gouty paroxysm, and, in many cases, such salts, given in a freely diluted form, are sufficient of themselves for its removal, and are peculiarly applic- able when there are circumstances rendering the administration of colchicum undesirable. Alkalies may be given either in the free state, or combined with carbonic acid, in the form' of the carbonates or bi- carbonates, or united with some vegetable acid, as the citric, tartaric, or acetic acids. If the stomach is irritated, and an over-secretion of acid be present, then the free alkalies or their carbonates may be administered ; but if, on the other hand, there be no such condition, then the salts with the vegetable acids may be used, which produce an alkaline state of the blood and urine, although they do not act as antacids in the stomach. These alkaline remedies not only tend to keep up and restore the normal reaction of the blood, but likewise augment the excretion of urine, and with it the elimination of those solid matters which are unduly retained in that fluid in gouty states of the system. It is important, likewise, to make a selection of the alkali, and unless there are circumstances which render the use of soda desirable, such as an imperfect action of the liver, or a deficient secretion of bile, this alkali is the least fitted for exhibition ; as it has much less power than the other fixed alkalies of dissolving or holding in solution uric acid,. The salts of potash are, in the majority of cases, more suitable than the salts of soda, as they not only exert a much greater solvent action upon firate of socla, but likewise augment in a greater degree the excretion of the urine. A third fixed