Gouty Phlebitis.—To obviate the risk of embolism, absolute immobilisation of the affected limb is imperative, and it should be slightly elevated and protected by a cradle. In many cases it will suffice if the limb be enveloped in cotton wool and a broad, many-tailed bandage lightly and evenly applied. If the pain be severe, equal parts of glycerine and the green extract of belladonna should be smeared along the course of the inflamed vein and hot fomentations applied. Internally saline aperients should be given to secure daily evacuation of the bowels, and a mixture containing iodide of potassium and ammonium carbonate taken three or four times a day, to promote solution of the clot.
Gouty Eczema.—In these cases the primary indication is to revise thoroughly the diet, to the end of correcting a frequently associated gastro-intestinal derangement, notably any tendency to constipation. If these the basal indications are not fulfilled, all local forms of medication will be futile. As to these last, the primary desideratum is to protect the parts from all accidental irritants, and the chief source of offence is scratching by the victim himself. Otherwise we should take every care to prevent irritation by clothing, hard collars, etc.
While cleanliness is essential, the soaps used should be of the neutral kinds, or bran or barley-water substituted. Ointments and lotions are best avoided. In the milder cases protection of the parts is the essential. In the limbs this may be attained by glyco-gelatine zinc; but on the neck, the groin, the inside of the thighs or lower parts of the abdomen, the tragacanth pastes or similar preparations are more suitable. Both the gelatine and the pastes and varnishes may be readily medicated with drugs of anti-pruritic properties, such as oil of cade, carbolic acid, resorcin, or salicylic acid.
Gouty Nephritis.—This must be treated on the lines recognised as suitable for chronic Bright’s disease, the underlying gouty condition being always borne in mind, as also any contamination with lead. As general measures any excess in eating or drinking must be avoided, the skin kept active, and the bowels open; and where possible favourable climatic conditions should be attained.
Frequently the treatment resolves itself into that of the associated arterio-sclerosis with high blood pressure. This we should endeavour to control by regulation of the subject’s habits in the matter of diet, work, exercise, etc., rather than by flying forthwith to the use of vaso-dilators, premature resort to which has often proved the beginning of the end.
Moreover, I would, like many others, strongly deprecate the far too prevalent practice of dilating to these subjects on the evil potentialities of raised blood pressure. Not a few thenceforth literally walk in the valley of the shadow, and the fear of sudden death is ever before them. It is not only cruel, but frequently unnecessary. Often the increase of tension is no more than their age would account for, and equally often no symptoms indicative of raised blood pressure are complained of. Why then make the subject miserable?
By all means, take the blood pressure, but say as little as possible about it. These people, in my experience, need more often to be reassured than frightened. Only now and again does one meet with individuals who must for their own sake be gravely warned of the dangers incidental to their condition, men who, despite the warnings afforded by giddiness, epistaxis, etc., will not alter their ways of living.
As to medicinal measures, all agree that an occasional blue pill or a dose of calomel, ½-1 grain, for three or four nights in succession, and followed in the morning by a saline purge, is one of the most satisfactory procedures to adopt. Hand in hand with this, a course of iodides, gr. 10-15 three times a day, for some weeks, is also most beneficial. After six or eight weeks of the above we may substitute a course of nitrites, e.g., nitro-glycerine, sodium nitrite, or erythrol tetranitrate. Nothing is better in the milder cases than Sir Lauder Brunton’s formula, the efficacy of which I have often proved:—
| ℞ | Sodium nitrite | gr. ½-2 |
| Potassium nitrate | gr. 10-20 | |
| Potassium bicarb. | gr. 10-30 | |
| Fiat pulvis, to be taken in a tumblerful of water every morning. | ||
Needless to say, vaso-dilators should not be exhibited if signs of waning cardiac power are evident. Also when there is much albumen the use of mercurial purges calls for great discretion, and saline aperients should be given the preference. Insomnia, a frequent trouble in these cases, is best met by bromides, and I agree with Luff that in gouty subjects sleeplessness is better combated by measures which reduce arterial tension than by resort to hypnotic drugs.