GOUT. 



555 



treatment which are employed carelessly or hastily. The patient is 

 often freed from attacks of acute gout by this too zealous or too hasty 

 treatment, but becomes affected instead with irregular, chronic, or 

 atonic gout, an exchange by which he certainly gains notliing. As 

 soon as gouty patients begin to show the signs of general cachexia, 

 their disease is rendered worse by a continuation of this debilitating 

 treatment ; we should then prescribe nutritive diet for them, and even 

 allow them to drink wine. But we must warn against excess even in 

 the strengthening treatment then indicated. Although in this stage 

 of the disease it is not admissible to limit the supply of nutriment, we 

 should nevertheless carefully try to increase the change of tissue. 

 Under no circumstances should we allow the patient to give himself up 

 to sluggish ease, but should see that he exercises as much as his 

 strength permits ; we should not allow more wine than is sufficient 

 for a slightly tonic and refreshing effect, and it is always better to let 

 the patient use the ferruginous, alkaline-saline and alkaline-muriatic 

 mineral waters, such as Eger, Kissingen, or Homburg, than to pre- 

 scribe simple chalybeate waters or preparations of iron. If there be 

 at the time no indication for prescribing solutions of salts, we should 

 at least see that the patient drinks plenty of water. In order that this 

 prescription may be regularly obeyed, we should direct how much 

 water is to be drunk daily. The probability that a retention of urates 

 from obstruction of the uriniferous tubules induces the attack of gout, 

 makes it appear practical to maintain the secretory pressure in the 

 kidneys at a certain height, and to dilute the urine, as the urates re- 

 quire a great deal of water for their dilution. In the later stages of 

 the disease the akratothermal springs, Wildbad, Gastein, Pfaffers, etc., 

 are very serviceable. We may have the patient drink of these waters 

 and bathe in them ; perhaps the infarctions obstructing the tubules 

 may be carried away by the former, and the kidneys washed out, as it 

 were, while the latter has the most beneficial effect on the inflamma- 

 tion of the joints. 



We cannot give any rules for fulfilling the indicatio morbi, as the 

 gout is a peculiar and obscure disease, which we can neither cure by 

 so-called rational treatment, nor have we any specific for it. It is true 

 some physicians consider colchicum as a specific in gout ; but its action 

 appears to be only palliative. The practice of giving colchicum for a 

 long time is being gradually discontinued, and it is administered only 

 iuring the acute attacks. Most physicians of the last century, who 

 generally had a high opinion of the efficacy of medicines, considered 

 gout as a noli me tangere, and even at present we cannot sufficiently 

 warn against the uncalled-for and injurious administration of medica- 

 ments in this disease. 



