GOUT. 311 



A cold wet linen compress, constantly applied and frequently renewed, will do 

 much to relieve a painful joint. 



The Turkish bath is particularly valuable in chronic gout, but, as might be 

 rxjiccted, it is not always equally serviceable. In long-standing cases, where the 

 attacks have occurred so frequently as to distort the joints by deposits, and the patient 

 is, perhaps, liable to repeated relapses, and is scarcely ever free from pain, the 

 efficacy of the bath, though striking, is less apparent than in milder and more 

 tractable forms. 



Of late years lithia has been extensively used for the removal of the chalky 

 deposits, particularly when the skin is broken. The urate of soda, of which they 

 are composed, is readily dissolved by carbonate of lithia, and if a solution of this 

 salt of the strength of five grains to the ounce of water be employed, they may in 

 time be removed. The affected joints must be constantly enveloped in lint or rag 

 kept moist with the solution. In many cases this method of treatment has proved 

 very successful, and not only have considerable enlargements been removed, but 

 suppleness and even free movement have been restored to previously stiff and 

 useless joints. The treatment is necessarily somewhat tedious, and many weeks, or 

 even months, may be required to remove large deposits. The local application may 

 be supplemented by the internal administration three tim^s a day of eight grains 

 of carbonate of lithia dissolved in any aerated water, or the citrate of lithia may 

 be given in the same or larger doses. 



We must now consider the treatment which should be adopted by gouty patients 

 in the intervals between their attacks. A few general rules will be given, and they 

 will be found more especially applicable to those who suffer from chronic gout. 



A good plain solid diet should be adopted, but care should be taken to avoid 

 excessive indulgence in animal food. It is hardly necessary to say that the patient 

 should never eat anything which he knows disagrees with him, or causes unpleasant 

 symptoms of any kind. As a rule, what are called " made dishes," and all rich 

 and highly-spiced food, should be tabooed. Pork and veal, and all salted or 

 potted meats are more or less indigestible, and must be regarded with suspicion. 

 Beef and mutton, white fish, fowl, and game are nearly always admissible, so that 

 the patient is in no danger of starvation. 



There should be a due admixture of animal and vegetable food ; and potatoes, 

 greens, peas, beans, and the like, may be taken with advantage. The softer kinds of 

 fruit, such as strawberries, grapes, oranges, and baked or stewed apples and pears, 

 will, if taken in moderation, do no harm, but plums and other stone-fruit should, 

 when uncooked, be avoided. 



Sugar and sweets of all kinds lead to the production of acidity, and favour the 

 development of gout. 



As to beverages, tea, coffee, and cocoa are in most cases admissible. Young 

 people can usually get along very well without stimulants of any kind, and we 

 should strongly advise any person in whom gout makes its appearance at an early 

 age to become a total abstainer. In the case of old people with health broken by 

 disease and long suffering, a certain amount of alcohol is necessary. All malt 

 liquors are to be eschewed. The wines to be most carefully avoided by the gouty 



