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the hazard of its falling upon a part where it may be more dangerous; and they have sometimes rendered the gout retrocedent.
569. From these reflections (564 et seq.) it will appear that some danger must attend every external application to the parts affected, during a paroxysm; and that therefore the common prace tice of committing the person to patience and flan, nel alone, is established upon the best foundation.
570. Opiates give the most certain relief from pain; but, when given in the beginning of gouty paroxysms, they occasion these to return with greater violence. When, however, the paroxysms shall have abated in their violence, but still continue to return, so as to occasion painful and restless nights, opiates may be then given with safety and advantage, especially in the case of persons advanced in life, and who have been often affected with the disease,
571. When, after paroxysms have ceased, some swelling and stiffness shall remain in the joints, these symptoms are to be discussed by the diligent use of the flesh-brush.
· 572. Purging, immediately after a paroxysm, will be always employed with the hazard of bringing it on again.
573. I have now finished what has occurred to to be said upon the means of preventing and cum ing the regular gout; and shall now consider its management when it has become irregular; of which, as I have observed above, there are three different cases.
574. In the first case, which I have named the Atonic Gout, the cure is to be accomplished by carefully avoiding all debilitating causes; and by employing, at the same time, the means of strength, ening the system in general, and the stomach in particular.
575. For the avoiding debilitating causes, I must refer to the doctrines of the Hygieine, as in 554.
576. For strengthening the system in general, I must recommend frequent exercise on horse back and moderate walking. Cold bathing also may answer the purpose, and be safely employed, if it appear to be powerful in stimulating the sys. tem, and be not applied when the extremities are threatened with any pain.
For supporting the tone of the system in gene. ral, when threatened with atonic gout, some ani. mal food ought to be employed, and the more açescent vegetables ought to be avoided. In the same case, some wine also may be necessary; but it should be in moderate quantity, and of the least acescent kinds; and, if every kind of wine shall be found to increase the acidity of the stomach, ardent spirits and water must be employed.
577. For strengthening the stomach, bitters and the Peruvian bark may be employed; but care must be taken that they be not constantly employed for any great length of time, (Compare 557).
The most effectual method for strengthening the stomach is iron, which may be employed under various preparations; but, to me, the best appears to be the rust in fine powder, which may be given in very large doses. . · For supporting the tone of the stomach, aromatics may be employed; but should be used with caution, as the frequent and large use of them may have an opposite effect; and they should therefore be given only in compliance with former habits, or for palliating present symptoms,
When the stomach happens to be liable to indigestion, gentle vomits may be frequently given; and proper laxatives should be always employed to obviate, or to remove, costiveness.
578. In the atonic gout, or in persons liable to it, to guard against cold is especially necessary; and the most certain means of doing this is, by repairing to a warm climate during the winterseason.
579. In the more violent cases of the atonic gout, blistering the lower extremities may be useful; but that remedy should be avoided when any pain threatens the extremities. In persons liable to the atonic gout, issues may be established in the extremities, as, in some measure, a supplement to the disease.
580. A second case of the irregular gout, is that which I have named the Retrocedent. When this affects the stomach and intestines, relief is to be instantly attempted by the free use of strong wines, joined with aromatics, and given warm; or if these shall not prove powerful enough, ardent spirits must be employed, and are to be given in a large dose. In moderate attacks, ardent spirits impregnated with garlic, or with asafoetida, may be employed; or, even without the ardent spirits, a solution of asafætida with the volatile alkali may answer the purpose. Opiates are often an effectual remedy, and may be joined with aromatics, as in the Electuarium Thebaicum ; or they may be uşefully joined with volatile alkali and cam. phire. Musk has likewise proved useful in this disease.
When the affection of the stomach is accompanied with vomiting, this may be encouraged by taking draughts of warm wine, at first with water, and afterwards without it; having at length ree
course, if necessary, to some of the remedies above mentioned, and particularly the opiates.
In like manner, if the intestines be affected with diarrhoea, this is to be at first encouraged, by tak. ing plentifully of weak broth; and when this shall have been done sufficiently, the tumult is to be quieted by opiates.
581. When the retrocedent gout shall affect the lungs, and produce asthma, this is to be cured by opiates, by antispasmodics, and, perhaps, by blis. tering on the breast or back.
582. When the gout, leaving the extremities, shall affect the head, and produce pain, vertigo, apoplexy, or palsy, our resources are very precarious. The most probable means of relief is, blis. tering the head; and if the gout shall have receded very entirely from the extremities, blisters may be applied to these also. Together with these blisterings, aromatics, and the volatile alkali, may be thrown into the stomach.
583. The third case of the irregular gout is what I have named the Misplaced, that is, when the inflammatory affection of the gout, instead of falling upon the extremities, falls upon some internal part. In this case the disease is to be treated by blood-letting, and by such other remedies as