An excellent formula, in which the colchicum is combined with mercury, has already been furnished on a preceding page. Needless to say, it should, like the above pill, be followed in the morning, if necessary, by a mild saline purgative.
Colchicine.—This, the active principle of colchicum, has of recent years been widely and successfully employed in acute gout, as well as in exacerbations of the chronic type. By some subjects, especially the old, it is often better borne than colchicum preparations. The dose ranges from ⅟₁₀₀-⅟₃₂ grain in a pill. By the French Codex the maximum single dose is fixed at ⅟₃₂ grain, and the maximum administered during twenty-four hours should not exceed ⅟₁₆ grain approximately.
The following is a suitable combination in an elderly subject, and it may be noted that the drug has been found of use, too, in cerebral congestion and uræmia:—
| ℞ | Colchicine | gr. ⅟₁₀₀ |
| Ext. belladon. alcoh. | gr. ⅛ | |
| Ext. nucis vomicæ | gr. ¼ | |
| Fiat capsule or cachet, 1 every three or four hours. | ||
In robust subjects the colchicine may be given in larger doses. Luff states that few patients will tolerate ⅟₅₀ grain, because of the diarrhœa and griping pains produced. He found that colchicine (⅟₇₀ grain), in combination with henbane and nux vomica in the form of a pill, rapidly relieved gout when taken every three or four hours.
Or as a substitute we may use the salicylate of colchicine, the dose of which is ⅟₆₀ grain. Colchicine is readily soluble in methyl salicylate, and is conveniently administered in the form of capsules, each containing ⅟₂₅₀ gram (Martindale). In acute gout one capsule may be given every two hours, or two capsules three or four times a day. These doses are well within the limits of safety, and, if necessary, may be combined with nux vomica and belladonna; but with the alkaloids, as with the colchicum itself, it is essential that the bowels should be kept freely opened. Also with the waning of the pain and inflammation the colchicine or its salicylate should be given less frequently, so as to obviate any depression.
Atophan.—This is a yellowish cream-coloured amorphous powder of the composition 2-phenylchinolin 4-carbonic acid. Its use has been much extolled both in acute and subacute gout. The dose ranges from 30-45 grains daily for three to four days, according to some authorities, but others consider that it may be taken for prolonged periods with advantage. It is most conveniently exhibited in the form of tablets containing 4 or 8 grains. Agotan, a drug identical with that formerly sold under the German registered name “atophan,” is supplied in the form of crystalline powder and in 7½-grain tablets, and appears to be equally efficient.
Atophan is incompatible with sodium bicarbonate and other alkalies in vitro, but Martindale and Westcott “did not find it incompatible with potassium iodide.” It has been repeatedly noted that, following the intake of atophan, the uric acid content of the blood falls and the urinary uric-acid output increases. Weintraud in gouty patients on a purin-free diet noted that after atophan the quantity of uric acid excreted in the urine was more than doubled, but subsequently the excretion fell below normal.
Even in healthy individuals when taking atophan the urine becomes turbid from the presence of urates. This excess of uric acid in the urine may in gouty individuals be precipitated in the urinary tract, and so induce an attack of gravel. Consequently Weintraud advises that the drug be taken with alkalies, either sodium bicarbonate or alkaline waters. Drs. Jansen and Plum, of Copenhagen, during their recent visit to the Royal Mineral Water Hospital, Bath, informed me that they had met no instances of gravel, but in several of their cases atophan had induced urticaria.
As to the simultaneous intake of alkalies, while the precaution is probably desirable, I have known gouty patients take atophan without alkalies for several weeks in full doses without any apparent ill effects. Brugsch, indeed, states that in polyarthritis urica the subjects are able to take 15-30 grains of atophan per diem for a year without any affection of the kidneys. Moreover, uric acid excretion was increased throughout the whole period, and when the drug was discontinued, the pains recurred.