| ℞ | Olei origani vel olei terebinthini | Partes æquales. |
| Linimenti ammoniæ. | ||
| To be applied with friction to the affected part. | ||
| ℞ | Ætheris | 1 drachm. |
| Linimenti belladonnæ | ½ ounce. | |
| Tinct. capsici | To 2 ounces. | |
| To be well rubbed into painful parts night and morning. | ||
When a joint is the seat of fixed pain with definite thickening, it may be necessary to resort to blisters; but frequently they are so utilised as to merit the aspersion of “adding additional distress to unrelieved pain.” They are of course unsuitable for cases with acute serous effusion of recent origin; but are often beneficial when applied over joints, bursæ, or tendon sheaths, when the seat of long-standing passive distension.
Garrod held them of most advantage in gout of asthenic character with lingering effusion; but he thought them inadvisable in the later stages of gout with defective kidneys and where the joints were the seat of massive uratic deposits, as in the last event sores difficult of healing may follow.
In the vast majority of instances such drastic counter-irritation is unnecessary, as the pain usually relents to less strenuous measures. For the dissipation of exudates and thickening nothing is superior to iodine and mercurial preparations. Painting with strong iodine may occasion soreness, but not if the glycerinum iodi be used. Better still is it if we use iodine preparations that admit of gentle inunction. The iodide of potassium and soap liniment is of course most reliable, or we may use one of the proprietary preparations, e.g., leukion. The oleate of mercury (10 per cent.) is often useful, and if pain linger on in the joint, may be combined with morphia (½ grain to 1 drachm). Ichthyol lanoline also deserves mention, and is best rubbed in after a fomentation followed by a dry pack. It is extremely probable that the stimulant and absorbent action of these agents is markedly reinforced by the friction which accompanies their usage.
In conclusion, it must be recalled that the swelling, stiffness, and pain are of dual origin, viz., in part due to inflammatory products and in part to uratic deposits, and it is the former that will be the most influenced by the foregoing measures. As to the means available for the reduction or dissipation of tophaceous matter, we shall best postpone their consideration until we come to discuss the treatment of tophi.
Ionisation in Acute Gout.—The introduction of medicinal substances into the interior of the joints by means of an electrical current is now in extensive vogue, both as a means of relieving pain and promoting absorption in periarticular and synovial affections. It is of course in the more accessible or superficial articulations that its beneficial effects are most easily attainable.
The sensitiveness of the parts in acute gout is such that I have never felt justified in invoking ionisation therein. Nevertheless Finzi tried it in two cases of acute gout. Instant relief of pain and diminution of swelling followed the first séance, while in sequence to a second all local tenderness disappeared. Finzi used a combination of lithium and iodine, the former at the positive and the latter at the negative pole. I would only add that in non-gouty forms of arthritis, if relief of pain be desired, salicylic ions, by general consent, would appear to be the most reliable. As far as I know, most authorities confine ionisation to chronic articular gout, and to this I shall refer later.
Massage.—The success that follows the application of stimulant or absorbent preparations in the after-treatment of acute gout largely depends on the skill and persistence with which the rubbing or kneading is performed. Hence it is that treatment by external medication has been largely superseded, and rightly so, by skilled massage, the outstanding advantages of which find increasing appreciation.