If the underlying constitutional anomaly has been correctly diagnosed as gouty, the colchicum will exert its specific effect, and quickly, and the more speedily the sooner it is exhibited in the early stage. But even when seen later it is well worth trying the following combination:—
| ℞ | Quin. hydrochloratis | ½ drachm. |
| Pot. iodidi | 2 drachms. | |
| Vin. colchici | 1 ounce. | |
| Tinct. aurantii | 2 ounces. | |
| Aquam chloroformi | To 8 ounces. | |
| Sig., 2 teaspoonfuls in a wineglass of water twice a day. | ||
Having regard also to the gouty origin, it is hardly necessary to insist on regular and adequate evacuation of the bowels.
Of all varieties of gouty fibrositis the acute brachial type is the most difficult to treat, owing to the marked tendency to prolongation of the acute stages. The only chance of cutting short such an attack is not to treat lightly its earlier manifestations, but to bear in mind its evil potentialities; but only too often they do not come under observation until the condition is well established.
Gowers, who has written so illuminingly on this particular type of fibrositis, obtained the best results in the early stages from a combination of nitrous ether, citrate of lithium, and colchicum, with in addition, in the more intense forms, small doses of perchloride of mercury. Of the salicylates, salicin and aspirin, he speaks with but faint praise, and I have myself known them afford but little aid.
In reviewing the foregoing acute types of fibrositis, I would, as to relief of pain, insist on internal medication of all sorts being held as purely secondary to the infinitely more important matter of procuring rest and fixation for the inflamed structures. Immobilisation, indeed, supplemented by thermic and anodyne applications, hardly, if ever, fails to alleviate the suffering. If these prove futile, aspirin and phenacetin, either singly or in combination, should be exhibited. Here I would remark also on the value of cimicifuga, which I have found strikingly useful. Lastly, only very exceptionally in my experience is morphia called for.
In chronic or recurring forms of fibrositis we should mark any deviation from health in the shape of gastro-intestinal or hepatic derangement, while noting also any inactivity on the part of the kidneys or skin. As to drugs, chief reliance must be placed on the iodides guaiacum, arsenic, and sulphur. They are most useful, of course, when exhibited during the early stages, before organisation of the inflammatory products ensues. When hard and resistant nodules or infiltrations have formed, their administration is of little value.
It is for this reason that I have elsewhere advocated early resort to local massage, viz., at the close of acute attacks, as only by this means can we hope to dissipate these new formations, the persistence of which determines the inveterate tendency to recurrence. In the space at my disposal it will be impossible to consider in detail all the special modes of therapy—electrical, thermal, hydrotherapeutic, etc.—and for this information I must refer the reader to the next chapter.
Oxaluria.—This condition is sometimes met with in the gouty. The subjects are often nervous, irritable, and languid, complaining at the same time of vague pains, most frequently in the loins and along the distribution of the sciatic nerve. It occurs more commonly in persons of sedentary habit, and correction of this, as well as revision of their diet, is almost the only effectual method of getting rid of the complaint.
All vegetables rich in oxalates, such as rhubarb and spinach, must be eliminated, and likewise tea. At the same time, as Sir Alfred Garrod suggests, we should, to influence the proportions of the bases present in the urine, cut off all foods rich in calcium, i.e., milk and eggs. On the other hand, we should advise the intake of such as are rich in magnesium and yet poor in oxalic acid, viz., peas, beans, and coffee, and oxalate-free foods, such as all kinds of meat.