556 DISEASES OF THE ORGANS OF LOCOMOTION. 



The symptomatic indications require us, first of all, to shorten the 

 attack and to render it as bearable as possible ; for the idea that the 

 trouty attacK must be guarded and cared for, because it has a beneficial 

 depurative effect on the organism, has been very justly abandoned. 

 Experience has shown that, in gouty inflammation, antiphlogistics 

 neither alleviate the pain nor shorten the attack; and it has also 

 shown that the untimely use of antiphlogistics, especially general and 

 local bleeding and active saline purges, favors the passage of regular 

 acute gout into irregular chronic and atonic gout. We should also 

 advise against the application of cold or of warm and narcotic com- 

 presses over the painful joints ; on the other hand, in attacks of acute 

 or chronic gout, the narcotics, and, above all, colchicum, should be 

 freely given. It has not yet been decided to what peculiarity colchi- 

 cum owes its efficacy. Garrod has shown that it is not chiefly due to 

 its diuretic power and the removal of the collected urates from the 

 body. It is customary to give twenty to thirty drops of the tincture, 

 or vinum seminum colchici, four times daily. These doses do as much 

 good as larger ones, which cause pain in the abdomen, and diarrhoea. 

 Besides the colchicum, it is well to give the patient plenty of acid drink 

 during the attack; perhaps the favorable effect of this treatment 

 depends, as I above indicated, on the dilution of the urine and the 

 increased lateral pressure in the kidneys. Our theory would also 

 agree with the treatment of the attack after the method of Cadet de 

 VauXy according to which the patient is to drink six ounces of simple 

 water, as hot as possible, every fifteen minutes. It really seems as if 

 this were of some benefit, although it is not altogether free from dan- 

 ger. During the attack the affected limb should be elevated and cov- 

 ered with cotton or wool, and the patient placed on low diet. If the 

 motions be impaired after the attack, treatment by baths in Wildbad, 

 Teplitz, or Wiesbaden, is indicated. If abscesses form near the joints 

 attacked by gout, we should use cataplasms ; if the abscesses lead to 

 ulcers, the applications should if possible be continued till the ulcers 

 have healed. No general rules can be given for the treatment of 

 attacks of anomalous internal gout. Abstraction of blood readily 

 induces dangerous collapse, and, on account of the threatening paraly 

 sis, stimulant treatment is usually more appropriate. If the disap- 

 pearance of a peripheral affection be followed by an attack upon the 

 brain, stomach, or heart, we may cover the part previously affected 

 with irritating and vesicating plasters, although this rarely does mucb 

 good. 



