GOUT. 



43 



from joint to joint, (by metastasis, as it is technically called,) and 

 most especially is it liable to affect the pericardium, and the lining 

 membrane of the heart. 



Treatment. — If the patient is young and robust, and the fever very 

 violent, venesection may be employed ; — if employed it should be 

 done early and decidedly, for a repetition of bleeding is not well 

 borne, although the blood is buffed to the last ; and too much bleed- 

 ing is apt to induce metastasis to the heart. 



The next remedy deserving of notice, is that which is commonly 

 known as Dr. Chambers' plan of treatment, and which consists in 

 producing a large flow of secretions from the liver and intestines. 

 Five or ten grains of calomel are given at bedtime every other night, 

 and followed in the morning with a black draught ; and this is repeated 

 twice or thrice till a copious secretion has been produced from the 

 liver and bowels. 



After this, diuretics and colchicum, alkalies, diaphoretics, and calo- 

 mel and opium may be administered in conjunction, with almost 

 equal claims on our confidence. The grand secret seems to be, to 

 ensure a free discharge of all the secretions, from skin, bowels, and 

 kidneys. The general plan is, to give a dose of calomel and opium 

 at bedtime, and a saline draught of liq. am. acet. with vin. coichici 

 twice or thrice during the day. When the acuteness of the fever 

 has abated, and the urine is clearing, great benefit may be derived 

 from bark combined with ammonia. Pain at night may be allayed 

 by opium. Prof. J. K. Mitchell, who regards this as a disease of 

 spinal origin, has had much success in the acute form by the appli- 

 cation of cups to the spine, in the neighbourhood of the affected part. 



Chro7iic Rheumatism is of two kinds. One has a nearer affinity 

 to the acute ; it is aggravated by heat and stimulants, apd is best 

 treated by clearing out the liver, and securing a free action of the 

 kidneys and skin ; and at the same time taking care that the diet 

 consists of nutritious and digestible substances, not disposed to 

 acidity. 



The iodide of potassium is also extremely serviceable in these cases 

 o^ subacute rheumatism, in doses of three grains ter die, with an*- 

 alkali, and a bitter. It causes a great flow of urine, in which it may 

 be detected by the proper tests. 



The other variety, which is very common in elderly people, is 

 benefited by stimulants, especially by warmth, friction, ammoniated 

 tincture of guaiacum, &c. 



GOUT. 



Gout is a constitutional disease, characterized by a superabundance 

 of lithic acid in the system, which is deposited from the urine, and 

 concretes around the joints in the form of what are called chalk-stones; 

 which really consist of lithate of soda. 



