310 THE TREATMENT OF DISEASES. 



The only real remedy, abstemiousness, is in the patient's own hands, and if he refuses 

 to use it, it is his own look-out. 



What should be clone in an attack of acute gout 1 In the first place, the patient 

 must be kept in a warm room, as quiet as possible, and should on no account be 

 allowed to make any attempt to get about. The diet must be of the simplest 

 possible description, but milk, arrowroot, tapioca, sago, biscuits, toast, toast-and- 

 water, and other similar articles may be taken without restriction. The affected 

 member should be wrapped in flannel, and should be kept strictly in the horizontal 

 position, never being allowed to hang down or support its own weight. 



When the pain is very severe, contractile collodion, which may be advantageously 

 nixed with a little tincture of iodine, painted over the inflamed joint, will speedily 

 give relief, although at first the pain may be temporarily increased. Care must be 

 taken not to apply too many coats of the collodion, or the contraction produced may 

 be too great, and it may do more harm than good. 



Colchicum is undoubtedly the best internal remedy both for acute and chronic 

 gout. A drachm of colchicum wine given in a little water will often remove the 

 severest pain in the course of an hour or two. By some the administration of a 

 drop of colchicum wine every twenty, thirty, or sixty minutes is preferred, but 

 these smaller doses take much longer before they produce the desired effect. When 

 there is much acidity of the stomach, the colchicum may be advantageously given 

 with a little carbonate of potash or other simple alkali. In all cases in which the 

 bowels are confined a free evacuation should be obtained. A compound colocyiith 

 pill (Pr. 60), or a seidlitz powder, or the white mixture (Pr. 25), will usually answer 

 admirably. Mercury and its compounds should be given with considerable caution 

 to gouty people, as in them it often produces very unpleasant effects. The hot 

 air or vapour bath may prove useful in promoting the action of the skin, ' 



In chronic as in acute gout, the remedy on which we place the greatest reliance 

 is colchicum. The action of this drug in curing gout is as marked as that of 

 quinine in curing ague. Some people appear to have an unfounded prejudice 

 against the use of colchicum ; if judiciously administered it can never by any 

 chance do harm. It must always be borne in mind, however, that colchicum is 

 merely palliative, relieving for a time the patient's sufferings, but in no way 

 protecting him from a recurrence of his attacks. Some people say that col- 

 chiciun whilst it cures one attack hastens the return of another, but we believe 

 that there is no truth in this statement. In chronic cases twenty drops of 

 colchicum wine may be given in water every four hours until relief is obtained. 



In old-standing cases where colchicum has not succeeded so well as might be 

 wished, a tea-spoonful of the ammoniated tincture of guaiacum given three times a 

 clay in a little milk may prove useful. 



When the pain is distinctly worse at night, or is experienced only at that time, 

 .the colchicum wine may be administered in combination with the iodide of potassium 

 mixture (Pr. 32). Iodine liniment painted over and around a joint swollen from 

 gouty inflammation will often do good. 



In China, oil of peppermint is used as a local application, and the relief ia said 

 to be almost instantaneous. 



