GOUT is a disease as obstinate as it is painful. If owes its origin usually to high living, although heredity has much to do with its development. Murchison, in his able lectures on functional diseases of the liver, traces Gout to Lithaemia; that is, to imperfect oxidation in the liver with the consequent production of excreta less oxidized than normally-lithic acid and lithates, instead of urea.
Now., Dr. Garrod determined that the gouty joint contained a concretion of lithates of soda. This salt accumulates in the blood by reason of its excessive production, which excess is favoured by over indulgence in rich foods and by a functionally imperfect liver. The surcharged blood seeks to rid itself of the offender through the kidneys, and also by depositing it in various tissues removed from the central organs.
This deposit would seem to be made first in the smaller joints, later in larger joints, and finally it encroaches on several of the viscera. If the kidneys are able to eliminate the lithates, the patient maintains comfortable health; but when these organs fail in their work or are overburdened, or again, if perchance, exposure start an articular inflammation, the joints become involved.
As the disease progresses, the kidneys may become affected with Morbus Brightii, the heart may suffer from inflammation, the stomach becomes deranged, and arthritic headache and Ophthalmia complicate the case, rendering the torture intolerable. The Frenchman’s diagnosis between Rheumatism and Gout is trite and painfully true: ‘Put ze finger in ze vice and screw him tight; zat is ze rheumatism; now give him one under screw-zat is ze gout”
But why is it that all who indulge to excess in the pleasure of the table are not affected with Gout? And, too, why is it that this lithic deposit so frequently selects the great toe for its punctum saliens?
The answer is involved in that great unanswered problem of constitution, the soil in which disease is to grow, and by which disease is so materially modified. Hahnemann and Grauvogl gave us each three constitutions, but there must be many more. The physician who daily cauterizes the Chancre or checks Gonorrhoea with injections, is forming a “constitution” for his patient which will last him through life and seriously impress his offspring.
No disease is ever cured except it be removed to the periphery. When we begin to treat our patients according to their several tendencies to disease, rather than according to the acute symptoms only. we will attain an amount of success never yet even dreamed of. Until then let each physician endeavor to make his prescription as accurately as his Materia Medica will permit. always valuing symptoms from the centre to the circumference; from mind to body; from more to less vital parts; from function to organ.
The treatment of Gout may be divided into that of the acute paroxysm and that of the general symptoms.
In an acute attack the following have been most successfully used:
COLCHICUM: In the evening fretful, cannot tolerate any annoyance; any external impression, noise, odor, touch or bright light makes him irritable. Toe-joint becomes inflamed, dark-red hot and intensely painful; he is besides himself with agony. The foot becomes oedematous. Urine scanty and dark-red. The smell of food makes him sick at the stomach. Greatly prostrated.
LEDUM PALUSTRE : After abuse of alcoholic drinks; pimples on the forehead; face bloated; awakened with a hot, tensive swelling of the toe and foot, with tearing, shooting, grinding pains; cannot bear the least covering or the warmth of the bed; foot becomes oedematous, and yet the urine is copious and frequently passed. Old nodes, the sequalae of former attacks, become excessively painful.
ARNICA: Inflamed joint is shining, red and hard. He dreads the proximity of any one, having a constant fear that they will touch him. Pains unbearable during the night; the bed feels too hard.
SULPHUR: Especially for drunkards or those who indulge in too rich food and take but little exercise; face blotched red; nose red habitually; as soon as he drops into a sleep the affected limb jerks and arouses him with excruciating pains. Pains are erratic and leave a sensation of numbness. Often indicated.
EUPATORIUM PERF. : In some cases, when the big toe is swollen, the foot oedematous, the urine profuse and the body aches all over as if, the “bones were broken”.
SABINA: Probably more for women; great toe hot, swollen, paining at night, worse, from warmth of bed; high fever.
ANTIMONIUM CRUDUM; Especially when the stomach is involved; tongue white, bowels costive; vomiting and retching.
BRYONIA: The patient is irritable, overbearing; leads a sedentary life, and yet eats to excess; habitually costive; face sallow, but often also a flushing of the cheeks; arouses at 3 A.M. with pains in the great toe. Useful for drunkards.
NUX VOMICA.: The patient is irritable, overbearing; leads a sedentary life, and yet eats to excess; habitually costive; face sallow, but often also a flushing of the cheeks; aroused at 3 A.M. with pains in the great toe.
Useful for drunkards.
RHUS TOX.: After exposure to wet; must move, though it intensifies the pains.
BENZOIC ACID; Usually his urine has an offensive odor and deposits a reddish, closed sediment, but now it is nearly clear and he complains of tearing in the joints; old nodes become painful. As these pains abate, palpitation of the heart sets in ceasing only when they increase.
BERBERIS VULGARIS; Tearing, burning, stinging pains; patient subject to the formation of biliary calculi; darting, sharp pains radiate from the kidneys, usually downward and along the ureters; urine cloudy, grayish, depositing a sediment; fistula in ano.
MANGANUM : Toe or other joints dark-red in spots; tendo Achillis shortened; pains shift, seem to be in the periosteum, and are worse at night.
CINCHONA; Painful; oversensitive to pain; great weakness; pains worse at night.
For sub-acute and chronic cases, chose from the following:-
CAUSTICUM: Nodes on the joints; joints stiff, toes or fingers contracted; pains relieved by the warmth of the bed.
GUAIACUM: Similar to the above and follows it well. Limbs drawn up and curved; worse from motion.
COLOCYNTH: Stiffness of the joints, with boring pains.
LYCOPODIUM: Nodes fingers and toes pain more at night; swelling of the dorsa of the feet; numbness; flatulence: rumbling in the splenic flexure; full feeling after a mouthful or two of food; lithic acid deposit in the urine. Must rise often at night to pass water.
CALC. CARB.: Especially when the well-known “lime-constitution” exists. Useful for drunkards, who feel worse at every change of weather. Also when standing or working in water aggravates the disease.
GRAPHITES: Tearing in the toes; awakens at night and springs out of bed suffocating; eating relieves; gastralgia. Fleshy, bloated; nose red; skin rough, herpetic.
RHODODENDRON: Always worse at the approach of a storm, especially of a thunder-storm.
STAPHISAGRIA: Pain from the eyes to the teeth; eyes burn and feel dry despite the profuse lachrymation; patient weak, exhausted by dissipation; face sallow; eyes sunken.
KALI. HYD.: Periosteum affected; distressing pains at night, preventing sleep, limbs contracted; morbus Brightii. Abuse of Mercury.
KALI BICH.: Pain in the fingers alternate with gastric ailments.
NATRUM PHOS. Caused pains about the heart, which ceased when pains returned in the toe.
LITH.CARB. Heart affected; worse stooping; tearing down the limbs; urination relieves the heart. Deposits on the valves of the heart; pain from heart to head; burning in the great toe.
IODIUM: Inveterate nocturnal pains, but not much swelling of the joints.
AMMON.PHOS. To remove deposit in the joints.
AURUM MUR.: Gnawing deep in the joints, which were recently inflamed.
GOUT AFFECTING THE HEAD OR EYES.
BRYONIA: Sharp pains, worse on motion, neck stiff, eyes sore when move, sclerotica red; Glaucoma.
COLOC.: Boring pains in head or eyes, better from firm pressure.
IPECAC.: Pains from head into tongue, with nausea.
NUX VOM.: Headache with persistent retching.
KALI HYD.: Lumps on the cranium; chemosis of the conjunctiva.
COLCH. and SPIGELIA: Severe pains in and around the eyes.
SULPHUR: Persistent headache; eyes inflamed, feel as if sticks or splinters were piercing the eyes.
LYCOPODIUM and RHUS TOX. Tearing about the head Iritis, Glaucoma, piercing, tearing pains through the eye to the occiput, worse at night; lids spasmodically closed, scalding tears.
STAPHISAGRIA: Eyes feel dry, yet there is lachrymation; pains from eye to teeth.
Sepia: Pains shooting upwards, with nausea and sour vomiting.
STOMACH OR ABDOMEN.
ANTIMONIUM CRUDUM: White tongue, vomiting and retching.
BRYONIA: Tongue feels dry, is coated, especially down its centre; deathly sick on sitting up; pains worse from any motion of the body.
Nux Vom., Nux Moschata, Saul., Lycopodium, Arsenic., Coloc.
Benzoic Acid, Lithium carb.Carb., Kalmia Lati., Colchicum, Phos, Arsenic.
KIDNEYS Benzoic Acid, Berberis, Lycopodium, Sarsaparilla, Sul., Kali Hyd. Contracted kidney.
Arsenic, Colch, Phosphorus, PhosphorusZincum met. (can pass water only while bending backwards; the urine deposits yellow sediment).
Terebinth. Urine dark, cloudy, depositing a dirty pink sediment.
Plumbum, Aurum: Contraced Kidney.