Rheumatism, gout, and some allied disorders / by Morris Longstreth, M.D.

  • Longstreth, Morris, 1846-1914.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Rheumatism, gout, and some allied disorders / by Morris Longstreth, M.D. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

    286/296 (page 274)
    / V 274 RHEUMATISM, GOUT, AND ALLIED DISORDERS. This is especially true in the earlier j^aroxysms, occurring in healthy per- sons, although it is sometimes best to follow the do-nothing policy in the milder paroxysms of chronic gout, and especially in those j)atients in whom we know that there exists visceral degenerations or lesions. In the latter class all our procedures should be of the most guarded character. There is one drug, and it is perhaps the only one, which has at any time maintained the character of a specific for gout. It is colchicum, and it should be given in an acute paroxysm, whenever there are not pretty cer- tain contra-indications to its use, such as known irritability of the digestive organs, fatty or other lesions of the heart, or kidney disease, and perhaps other less common concomitants of gout. In almost every primary at- tack, and many of the earlier ones, its exhibition may be made with freedom in proper doses. Its effects are usually good and pretty prompt, and when otherwise it not only does no good in the paroxysm, but its general and ultimate influence on the patient is harmful. The more chronic the disease and the further advanced the visceral changes, the less useful is colchicum, and the more carefully watched must be its administration. There are three results to be especially guarded against, its purgative and otherwise disturbing effects on the digestive or- gans, the disturbances on the ners'ous system, and its depressing effects on the circulation. Combined with this drug it is often well to administer moderate doses of the alkalies, either as carbonates or in combination with some of the vegetable acids ; these may be given as effervescing draughts, and this form is applicable to the nausea and vomiting often present. These salts can be made to serve at the same time as purgatives, diuretics, or diapho- iietics. The local measures, as has been said, are not essential to recovery, but it is well to try and mitigate the suffering when intense. It is necessary to remember the character of the inflammation with which we have to deal, an inflammation in which the tendency to suppuration never has to be combated, and also one which, if we may speak so, runs a regular rapid course to recoveiy if not disturbed. It is the comfort of the patient and the after-results of the local disturbance which require attention, and hardly at all the violence of the inflammation. If the inflammation does not tend to run its regular course we cannot force it to do so by violence, but only direct or persuade it by the assist- ance of gentle means. Such is its natural history. In order to abate the