Almost always in these cases more or less constipation prevails, which must be corrected. To this end, of course, the magnesia contained in one of the above cachets may be all that is necessary; but often it is not so, especially if the subject be taking bismuth. Moreover, inasmuch as we have to take cognisance of the constitutional taint in these individuals, we may with advantage give an occasional aloetic pill containing colchicum or a nightly dose of guaiacum and sulphur. Again, if the urine be scanty, we may substitute a morning draught of phosphate of soda (¼-½ ounce), which not only stimulates the liver, but exercises also an antacid and diuretic effect.
| ℞ | Ext. colchici | gr. ¼ |
| Aloin | gr. ¼ | |
| Menthol | gr. ½ | |
| Ext. rhei | gr. 1 | |
| Fiat pil., 1 alternis noctibus sumenda. | ||
As soon as the symptoms of fermentation and organic acidity relent to the above or similar measures we should, if possible, dispense with drugs and rely wholly on diet and general hygienic regulations; but unfortunately a case of atonic “dyspepsia,” if of prolonged duration, gradually merges into one of chronic gastritis. Especially in those given to alcoholic indulgence do we meet with a condition of mucous catarrh, with its associated deficiency of hydrochloric acid. Indeed, apart from alcoholic excess, such is the frequency in “gouty” subjects of this form of “dyspepsia,” i.e., fermentation with excess of organic acids, that I am inclined to think that the subacidity which permits of such developing is, if I may say so, the inherent digestive disability in “gouty” subjects. Unquestionably hyperacidity—i.e., excess of organic acids due to hypochlorhydria—is in their instance infinitely more common than hyperchlorhydria, or excess of HCL, that is, much more frequent than the latter as differentiated from organic acidity by the only possible means, viz., an examination of the stomach contents.
Again, accepting the view that infections are the chief excitants of gouty paroxysms, the desirability of reinforcing the antiseptic action of the gastric juice is obvious. In other words, the defensive powers of the stomach against intruding microbes must be raised by prescribing hydrochloric acid. For this purpose it is well to use strong or fuming hydrochloric acid in doses of from 5-10 minims, freshly mixed at the time of administration with 6-8 ounces of water, and the same taken at every meal. The hydrochloric acid may with convenience be placed in a drop bottle, and beginning with 5 minims, an extra minim may be added every few days until 10 or 15 minims are taken at each meal.
Some years ago Armstrong, of Buxton, spoke highly of its value in alimentary toxæmia, which is precisely the condition we are confronted with in gout. Falkenstein, again, highly eulogises it in the latter disorder. He gives from 40-60 drops of pure hydrochloric acid in a large quantity of effervescing water each day. It is taken during meals, and the dilution with water is arranged so that the patient is struck by the acid taste. The diet taken was an ordinary one, and yet Falkenstein noted that the dyspeptic symptoms disappeared and the attacks of gout grew more rare and much less severe. As an alternative to water, either still or effervescing, the hydrochloric acid in from 5-15 drops may be given in mucilage, or, if preferred, we may give the dilute hydrochloric acid in some such form as the following:—
| ℞ | Acid. hydrochlor. dil. | ♏︎ 10-15 |
| Glycerin pepsinæ | dr. 1 | |
| Liq. strych. hyd. | ♏︎ 3 | |
| Tinct. capsici | ♏︎ 1 | |
| Inf. aurantii co. ad unciam, ter die sumenda statim post cibos. | ||
Sometimes it so happens that while taking the above acid mixture the subjects an hour or more after meals complain of acidity. If so, it is due to fermentation, and at the time of its occurrence must be met by an adequate dose of an alkali with or without some antiseptic preparation. It goes without saying that if such can be referred to dietetic errors—food-bolting, etc.—these also must be corrected.
In these cases, too, the liver is frequently inactive, though often their attacks of “biliousness” signify nothing but constipation; but when there are definite signs of hepatic torpor we may substitute for the hydrochloric acid in the above mixture the dilute nitro-muriatic acid. Simultaneously we may occasionally at night give a pill containing calomel, iridin, or podophyllin combined with aloes and belladonna, or we may instead invoke colchicum as a cholagogue, following it up in either case the morning after by a saline purge. As a substitute we may in suitable cases order every morning for some days a full dose of Rubinat, Hunyadi Janos, or other bitter water.
So much for the more common derangements of the inter-paroxysmal period and the measures wherewith to combat them. Collectively their aim is the restoration to functional efficiency of the alimentary canal and its accessory glands, this to the end that, as far as possible, a condition of intestinal asepsis may be attained, with its correlated diminution of the excitants most fertile of outbreaks.