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.

    887/976 (page 867)
    forms of Gout, it is of importance that their condition should he carefully attended to; purgatives, stomachics, and alteratives are the remedies resorted to for correcting any morbid state of these organs. Value of Purgatives.—It has been already stated that free purga- tion alone will not rapidly cure gouty inflammation, and that it is impossible to explain the effects of colchicum upon this idea; that, for example, sulphate of magnesia, although it causes a free watery action, will not relieve in the same manner as colchicum, even when the latter drug produces no appreciable action upon the bowels. Purgatives, however, are often of much value, especially when there is portal congestion present, and the occasional use of the compound colocynth extract, or some such preparation, is usually of great ad- vantage. Mercurials should, as a rule, be avoided, as they are pecu- liarly prone to cause ptyalism in gouty subjects, and as their frequent use lowers the powers of the system. Value of Stomachics and Tonics.—If there exists an irritative form of dyspepsia, accompanied with flatulence, acidity, and heartburn, this is generally relieved by the administration of free or carbonated alkalies; if pain or palpitation is present, a few drops of hydro- cyanic acid may be added to each dose, taking care to relieve any sluggish condition of the liver and bowels. These alkalies are often advantageously combined with some bitter stomachic, as the juice or extract of taraxacum; or, if there appears to be great want of tone, the more powerful bitters, as chamomile, gentian, chiretta, quassia, &c. &c. If much flatulence be present, then ginger or capsicum may be likewise added. Ash-leaves in the form of an infusion have also been recommended, and clinical proof afforded of their efficiency in chronic gout. I have frequently made use of them, and with advantage; but the amount of infusion taken each day has always been considerable, and the action of the diluent must not be forgotten. Value of Ferruginous Preparations.—In the majority of instances, iron salts are not indicated, but at times cases are met with in which their administration is attended with striking benefit. They prove most useful when the blood is impoverished from the diminution of the red corpuscles, and the circulation enfeebled from weakness of the walls of the heart, and where the whole nervous system has become exhausted; it is often a good plan to combine these with small doses of the extract of colchicum. The. selection of the ferruginous preparation should be made according to the peculiar requirements of the patient; if only the hmmatinic property is wanted, reduced iron (ferrum reductum) may be prescribed; if the astringent influence is required, the sulphate may be made use of. J Value of Diaphoretics or Sudorifics.—Friction of the skin must not be overlooked in the treatment of chronic gouty cases ; we must remember, that although there is no elimination of uric acid from the healthy surface, still the skin gives off a large amount of some 3 k 2