heartburn, various skin diseases, nervous and other manifestations, protean in their variety.
Treatment.—Moderation in quantity of food. Less meat should be eaten, and that chiefly white meat. Sugar, sweets and pastry should be avoided, also all root vegetables. All stimulants are best given up: if any be taken, the least harmful are Hock, Moselle and Chablis. Of spirits, brandy is to be taken in preference to others. Sedentary habits should be altered, regular healthy exercise being taken instead.
Medicines.—In acute gout, 10 to 20 drops of tincture or wine of colchicum may be given every 4 hours, combined with 10 to 15 grains of citrate of potash or lithia. Saline Aperients : Half a wineglassful of Hunyadi, Apenta or Friedrichshall, or a teaspoonful of Carlsbad Salts before breakfast are all useful. For the local pain: Fomentations with laudanum or poppyheads constantly applied are very soothing; and the affected parts should be kept wrapped up in flannel.
In Chronic Gout, sensible dieting, and a course of the waters at Bath, Baden-Baden or Aix-les-Bains will do much good.
Hæmorrhoids, or Piles.—These are swellings situated sometimes within and sometimes outside the lower bowel opening. They are liable to irritation and inflammation, in consequence of which they give rise to a good deal of suffering. External piles consist in a collection of rounded hard tumours and of prominent ridges of skin situated on the outer edge of the opening. When these become irritated and inflamed they occasion very acute pain, with throbbing and a sense of great heat, and a constant desire to relieve the bowels. This affection originates in the distension of the local veins, caused by the circulation being obstructed. Piles are generally met with in persons who follow sedentary employments, and those who, in consequence of highly-seasoned foods and indulgence in alcoholic drinks, suffer from congestion of the liver. The presence within the opening of large, rounded, and soft tumours, covered by red mucous membrane (internal piles) is attended with more serious symptoms. These are very apt to weaken by giving rise to frequent bleedings. Persons subject to piles should carefully avoid sitting on rocks or stones, or on wet grass or omnibus seats.
Treatment.—The diet should be carefully regulated, and all highly seasoned dishes, alcoholic liquors and pastry avoided. Walking exercise is highly beneficial. Bathe the affected region every morning with cold water, and carefully dry and push the obtrusions in. Hazeline is a useful application in bleeding piles. Gall and opium ointment or pure vaseline smeared over the parts often give relief. A quarter-grain morphia suppository (or plug) may answer when these remedies fail. The bowels should be kept open, either by the confection of sulphur, the confection of senna, or compound liquorice powder.