TREATMENT 149 



sary to the gouty patient, requires no further explanation. As long as his 

 strength permits this must be kept up. I have already stated that in these 

 cases I prefer muscular exercise to all other methods. If the gouty paroxysms 

 do not occur so suddenly and are not so severe that the patient must go to bed, 

 he should remain as long as possible upon his feet. When, however, the 

 patient cannot walk, and the affected member cannot be moved, " patience and 

 cotton," as many old gouty persons say, are the best remedies; others praise 

 the Laville liqueur, which is probably beneficial on account of the colchicum 

 which it contains. Colchicum is also administered as a tincture, or in combina- 

 tion with opium, purgatives, and potassium iodid. Pure crystalline colchicin 

 has lately been recommended in doses of one milligram. Such powerful reme- 

 dies should naturally only be taken under the advice and supervision of the 

 physician. But only too frequently persons subject to gouty attacks refuse 

 professional aid and attempt to cure themselves. The so-called antirheumat- 

 ics, e. g., the salicylates, are also valuable occasionally for the relief of pain, 

 although in the present status of our knowledge, they cannot be advised as a 

 rational remedy for gout. 



The various symptoms and complications of gout should be treated accord- 

 ing to special indications. Here we will only consider the treatment of the 

 numerous nervous symptoms, especially the therapy of gouty neuralgia with 

 its related conditions, and the functional cardiac disturbances which so fre- 

 quently occur in the gouty. Where there is chronic constipation, the treat- 

 ment previously mentioned for the evacuation of the intestine filled with 

 feces is of paramount importance. Even if chronic constipation is not present 

 a useful auxiliary remedy in intestinal treatment is the employment of arsenic 

 ' and iron, preferably in the form of iron waters containing arsenic. In general 

 it is advisable to begin with the mildest water of the Levico-Vetriolo in the 

 Valsugana (South Tyrol). A residence in this region, which is easily acces- 

 sible, is to be preferred to the use of the arsenicicontaining mineral water at 

 home, for the place is luxuriously furnished with all curative agents that are 

 effective in gout, and is also advisable on account of its climate. There are 

 many cases of so-called " larval " gout, which cannot readily be diagnosticated, 

 yet are particularly benefited by such cures. Cures of this kind are also very 

 suitable, mutatis mutandis, for such gouty patients as are already decrepit 

 and have reached the so-called cachectic stage of gout. The many curative 

 agents which nature and science there furnish, may be adapted in various ways 

 by expert physicians to the individual needs of the patients. In these decrepit 

 gouty patients no kind of so-called specific treatment is to be used, and col- 

 chicum especially is badly borne. Only tonic treatment — adjusted to the con- 

 dition—is advisable. In the surgical treatment of gouty tophi, all the precau- 

 tions of antiseptic surgery are of course to be observed. 



A few words must be devoted to the consideration of primary renal gout, 

 by which we mean the most serious form of gout, in which a generalized uric 

 acid engorgement arises as the result of a severe renal affection and usually 

 consists in a chronic and, particularly, in an interstitial inflammation of the 

 kidneys. In this renal inflammation, the gout itself is an important patho- 

 genetic factor. At all events, in primary renal gout the renal symptoms are 



