This achieved, the sulphate of magnesia may be omitted, and the mixture taken every six instead of every three hours; but it is a good plan to keep the original mixture at hand, giving a dose every morning while the acute stage lasts. Then during the day the colchicum should be persisted with either in the form of the wine or the tincture.
Moreover, there are often special indications to be met. Thus the skin in acute gout is often hot and dry, and the urine unusually scanty and high-coloured. In this event the colchicum may with advantage be given with the citrate, bicarbonate or nitrate of potash, so as to produce a diaphoretic and diuretic effect. In other instances acidity is a prominent symptom, and here the combination of colchicum with the citrate of potash and magnesia will be found useful.
As the intensity of the inflammation wanes and the local pain and tension subside the dose of the colchicum should be gradually diminished; but even after convalescence is established it may advantageously be continued for a few days in small doses, say, 5 minims of the vinum colchici three times a day. The condition of the tongue will usually furnish a safe index, as rarely will it clean up prior to abatement of the gouty fit.
In subsequent paroxysms and alike in the acute exacerbations that chequer the course of chronic gout we may, in the absence of idiosyncrasy or other contra-indication, proceed more boldly. Thus, if the bowels have not previously been briskly purged, we may at once prescribe the following formula:—
| ℞ | Vini colchici | ♏︎ 15-20 |
| Magnesii carbonatis | gr. 15 | |
| Magnesii sulphatis | gr. 60 | |
| Aquæ cinnamomi ad ℥j. | ||
| Fiat mistura, ℥ij. statim sumenda et ℥j. quartis horis p.p.a. | ||
The primary dose, as will be noted, will contain either 30 or 40 minims of the wine, and, though Sir Alfred Garrod prescribed up to a drachm, it will scarcely, if ever, be necessary to exceed 30-40 minims. The subsequent dose of from 15-20 minims may after a day or two be reduced, and instead the mixture given in ½-ounce doses three or four times a day. Or, if preferred, the mixture in its reduced dosage may be renounced in favour of a pill containing either the extract of colchicum or, what many consider even better, the acetic extract thereof. Thus the following pill may be taken every night for a few days, and then on alternate nights:—
| ℞ | Ext. colchici | gr. ¼ |
| Aloin | gr. ⅛ | |
| Ext. bellad. alcoh. | gr. ⅛ | |
| Capsicin | gr. ⅟₂₀ | |
| Ext. rhei | gr. 1 | |
| Fiat pil., 1. | ||
The acetic extract may be given in larger doses, and was in great favour as the chief constituent of many so-called “gout pills” in combination with ipecacuanha and mercury:—
| ℞ | Ext. colchici acet. | gr. 1½ |
| Pulv. ipecac. co. | gr. 1½ | |
| Ext. colocynth co. | gr. 1½ | |
| Fiat pil., 1 nocte sumenda. | ||