RHEUMATIC GOUT. 477 



be made from Prs. 1, 2, 3, 4, 5, 6, 7, and 63. When in addition to the 

 bloodlessness there is a relaxed habit of body, the more astringent preparations, 

 as, for example, Prs. 1 and 2, are indicated. 



When the nutrition is imperfect from any cause independent of anaemia, 

 or loss of blood, cod-liver oil will be found of the greatest advantage. It is 

 especially indicated in patients of spare habit, and when the disease has been 

 attended with wasting. When cod-liver oil cannot be taken, pancreatic emulsion 

 may be substituted. When the complaint has apparently arisen from depressing 

 mental causes, such as anxiety, grief, or prolonged attendance on the sick, nux vomica 

 ten drops of the tincture in a wine-glassful of water three times a day quinine 

 (Pr. 9), or ammonia and bark (Pr. 13), may be administered with advantage. 



Iodide of potassium (Pr. 32) is often of service, especially when the pains are 

 distinctly worse at night. Sometimes, when no benefit is experienced from the 

 ordinary five-grain dose, relief may be obtained by increasing it to ten, fifteen, or 

 even twenty grain doses three times a day. It must be remembered that iodide of 

 potassium is somewhat of a lowering remedy, and its effects should therefore be 

 carefully watched. In many cases it proves advantageous to give it dissolved in 

 the bark mixture (Pr. 13). The syrup of iodide of iron (Pr. 4) taken twice a day, 

 and continued for some months, may prove of benefit, and it is said by some to have 

 the power of completely arresting the progress of the disease. 



Arsenic is undoubtedly of considerable value. The indications for its employ- 

 ment are unknown, and its action is apparently somewhat capricious. In some 

 cases it acts like a charm, stiffened joints for a long time considerably enlarged 

 becoming reduced to their natural size, and finally regaining their suppleness. 

 Large doses, as, for example, five drops of the arsenic solution, or its equivalent, five 

 tea-spoonfuls of the arsenic mixture (Pr. 40), three times a day, are necessary to 

 produce this result. This treatment should be resorted to only under the immediate 

 direction of a medical man, as some people are very susceptible to the action of the 

 drug, and it is necessary to know when to stop its administration. It should always 

 be borne in mind that the medicine may have to be taken with but slight inter- 

 missions for weeks or months, and that rf an improvement does not speedily ensue, 

 it is no proof that the medicine will ultimately prove ineffectual. 



Actaea racemosa (ciniicifuga) yields very satisfactory results in many cases of 

 rhumatoid arthritis. It proves most successful when the pains are worse at night, 

 and it is especially indicated when the disease is traceable to some derangement of 

 the womb, a sudden suppression of the periods, an abortion, or a painful and 

 difficult confinement. It is also indicated where the complaint first makes its 

 appearance at the " change of life." The joints may not be enlarged, and the pains 

 may flit from joint to joint instead of lodging steadily in one place. Painful cramps 

 of the leg, aggravated by cold and wet weather, and by certain winds, frequently 

 torment the sufferer, and break his rest at night. Actsea not only frequently gives 

 relief from the pain and cramps, but induces quiet and refreshing sleep. In addition 

 to these cases actsea sometimes proves of service when the disease occurs in men, and 

 even when the pains are worse during the day. The actsea may be given in five- 

 minim closes of the tincture in a little water every two or three hours. 



