The connection existing between Gout and convivial excesses is proved by the much less frequent occurrence of the disease, consequent on improved habits in diet. We are less partial to animal food, our meals are shorter, our potations less deep, and as a consequence Gout has gradually declined. Although, however, joint Gout is less often seen than earlier, there remains a vast number of disorders of an ill defined kind, manifesting in digestive and nervous and other symptoms which are just as much gouty as the joint attack. But being less well defined, they are less easy to identify. Very likely further knowledge will sub divide this group of illnesses by identifying the different waste products which in different cases determine them.
Unless the gouty diathesis be very strong, the actual manifestation of the disease may generally be averted. Moderation in food and drink, physical exertion, and temperate and industrious habits of life, will secure exemption.
The influence of lead in the production of Gout Dr. Garrod believes to be considerable; he has observed that a large percentage of the gouty patients that came under his care in hospital practice consisted of painters, plumbers, or other workers in lead. Chronic Gout leads to a condition of chronic inflammation of the kidney, to thickening of the arteries and to high arterial tension. When there is any element of lead poisoning, these conditions are even more likely to arise.
Season and climate have much influence in exciting a paroxysm of Gout. First attacks are most common in spring; as the disease becomes more confirmed, an autumnal seizure is added; after the lapse of a long time, a fit may occur at any season, and at most irregular intervals.
EPITOME OF TREATMENT.
1. dURING AN ATTACK. Colchicum, Aconite, Bryonia, K. Hydriod., Apocynum, Urtica Urens.
2. External applications. Acetic Ac. Formula. Ac. Acet., Sp. gr. I. 056, 3j., Spt. Vini. 3vj., Aq. Dest. 3vj. mix. Dr. Hastings recommends the inflamed part to be bathed with the lotion, and cloths saturated with it kept constantly applied, and covered with dry flannel. Aconite should be administered at thee same time.
Lotions of Aconite (or of any other drug which can be at the same time administered internally), are often employed with good results.
3. Between the paroxysms. Pulsatilla, Nux vomica, Mercurius Iodium, Bryonia, Rhododendron, Rhus, Arnica, Sulphur, Plumb.
LEADING INDICATIONS
Colchicum. This remedy bears a homoeopathic relationship to Gout, and is best administered in comparatively large, and frequently repeated doses as follows Twenty drops of the strong tincture to a tumblerful of water, giving a dessert spoonful every twenty, thirty or sixty minutes, according to the intensity of the pain,, and until it subsides. Colchicum is a drug used both in the new and in the old school of medicine, with this difference, that all the good effects of the remedy are secured by the small doses of the former,, without any of the injury the large doses of the latter entail. The following extracts from an author of each School will be read with interest
There is one drug which has undoubted influence in controlling gouty inflammation, and its action in articular gout appears as marked as that of cinchona Bark in the cure of Ague; this remedy is Colchicum. It signifies not what part of the colchicum plant is taken, whether the corm, the seeds or the flowers, for the same principle pervades the whole plant; neither does it signify what preparations are made use of, whether the wine, the tincture, or the extract, provided equivalent doses be administered, for the effects of all are the same.
Colchicum, as before stated, has a direct controlling power over the joint disease, and I cannot call to mind a single instance in which its influence was not well marked. Garrod.
In adopting Colchicum as the remedy for the gout paroxysms, Homoeopathy may do something towards removing those inconveniences which beset its administration in the old school. Probably all thee effects which result from allopathic doses may be averted by a reduction of the dose. Should the pain recur in the same, or attack other joints, Col chicum should be resumed.
In the interim, any medicine homoeopathic to the general condition may be given, having especial regard to the digestive organs. Pulsatilla, Nux Vom., and Mercurius are most frequently indicated; and sometimes the state of the circulation requires Aconite
When the patient has passed through an acute attack, the morbid diathesis has to be corrected; and there seems no doubt but that in Gout the fault lies in the primary digestion.
This part of the treatment is of paramount importance, and here homoeopathy comes to help us with its array of anti dyspeptic medicines. I cannot enumerate these, or define the place of each; every case must be treated as an individual, and a remedy selected according to the character of the digestive derangement present. In confirmed Gout, Dr. Ackworth states that he has seen much benefit from the administration of Sulphur. Hughes.
Dr. Burnett (Gout and its Cure) recommends Urtica Urens tita, ten drops in a wineglass of water, every two hours, in an attack of acute Gout.
ACCESSORY MEASURES. During an attack of Gout, the affected limb should be raised, so as to favour the free return of blood to the heart; the application of flannels wrung out of hot water, hot bread and water poultices, after immersion in hot water often do good; or the Acetic Acid lotion, before recommended, may be used. In acute attacks, the patient should be restricted to farinaceous diet arrowroot, tapioca, sago, bread, etc. and milk; water, or toast and water, ad libitum. As the febrile symptoms decline, a more generous diet may be gradually allowed; at the same time the patient should resume daily moderate out of door exercise as early as he is able.
PREVENTIVE TREATMENT. ( The preventive measures recommended in the Section on Calculus should also be consulted ).
1st. A well chosen diet. This should include both animal and vegetable food, be adapted in quality and quantity to the ability of the stomach to digest, and at the same time furnish sufficient nourishment out of which pure blood can be formed. Soles, whiting, and codfish; mutton, tender beef, fowl, and game may be eaten. Salmon, veal, pork, cheese, and highly seasoned dishes are unsuitable. The consumption of animal food should be strictly moderate, and pastry, greasy or twice cooked meat, highly seasoned food, should be avoided, and anything likely to lead the patient to eat more than is strictly moderate. Since Dr. Haig’s writings, there has been a tendency to eliminate all meat from the dietary and even other food ( such as peas) which contain the so called purines. Unquestionably the very strict Haig diet relieves and cures a number of people. But it is not universally suitable, and each case needs individual consideration. Vegetarians should always realize that a sufficient supply of nitrogen is essential, and while meat-eaters may take too much they themselves may take too little. A liberal amount of nuts is essential in a real vegetarian diet. See Chronic Intestinal Infections. The wines most likely to injure are port, sherry, and madeira. If wine be taken at all, good claret, free from sugar and acidity, is best. When Gout attacks a patient early, entire absence from all alcoholic beverages is one of the most likely measures to check its future development; but aged persons, and others whose health has been much enfeebled, may be allowed a small quantity of stimulants, such as the particular circumstances of cash case seem to justify. For although a plan can be sketched out which may apply to the majority of cases of Gout, still each case not only exhibits its own peculiarities, and becomes as separate study, but likewise demands, in certain respects, a separate treatment (Garrod).
2nd. Healthy action of the skin. This should be promoted by bathing, warm clothing, Baden towels, bath brushes. Friction over the whole surface of the body is extremely useful when exercise cannot be taken. The patient should be well rubbed with a flesh brush, or with the hands, twice a day.
3rd. Good habits. A life of indolence should be exchanged for one of activity and usefulness. Exercise, not severe or exhausting, should be taken regularly. Miller’s exercises are particularly valuable. Walking, so as to secure an abundance of fresh air, must ever be considered that best exercise, but it may be conjoined with riding. Without sufficient exercise, probably every other measure will be unavailing. Early and regular hours should be adopted, and severe or prolonged mental application avoided. In some cases, removal to a warm and dry climate during winter and spring may ward off subsequent attacks.
57. Chronic Gout.
DEFINITION. A persistent constitutional affection, characterised by stiffness and swelling of various joints with deposits of urate of soda.
SYMPTOMS. The deposits in the joints constitute the distinguishing feature; chronic stiffness and swelling of various joints, with pain, are considered as cases of Chronic Rheumatism. The original condition of the Chalk stone Deposits is that of a liquid, rendered more or less opalescent from the presence of acicular crystals; as the fluid part is absorbed, the consequently becomes creamy, and at last a solid concretion is produced. When the effusion is confined to the cartilages, unless very excessive, the injury to the mobility of the joint is comparatively slight; but when the ligaments are infiltrated, they are rigid, and the play of the parts is consequently interfered with. If a bursa has been infiltrated the resulting chalk stone is free and of uniform composition, but the distortion is considerable. The visible occurrence of chalkstones is not constant, but when external deposits do occur in any patient, no possible doubt can exist as to the nature of the case, for as the deposition of urate of soda in the tissues occurs only in Gout, its presence constitutes a pathognomonic sign (Garrod).
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."