action on the disease. This drug (Colchicum autumnale), which is believed to correspond to the hermodactyl of the ancients, has proved of such efficacy in modifying the attacks that, as observed by Dr Garrod, “we may safely assert that colchicum possesses as specific a control over the gouty inflammation as cinchona barks or their alkaloids over intermittent fever.” It is usually administered in the form of the wine in doses of 10 to 30 drops every four or six hours, or in pill as the acetous extract (gr. 12-gr. i.). The effect of colchicum in subduing the pain of gout is generally so prompt and marked that it is unnecessary to have recourse to opiates; but its action requires to be carefully watched by the physician from its well-known nauseating and depressing consequences, which, should they appear, render the suspension of the drug necessary. Otherwise the remedy may be continued in gradually diminishing doses for some days after the disappearance of the gouty inflammation. Should gout give evidence of its presence in an irregular form by attacking internal organs, besides the medicinal treatment above mentioned, the use of frictions and mustard applications to the joints is indicated with the view of exciting its appearance there. When gout has become chronic, colchicum, although of less service than in acute gout, is yet valuable, particularly when the inflammatory attacks recur. More benefit, however, appears to be derived from potassium iodide, guaiacum, the alkalis potash and lithia, and from the administration of aspirin and sodium salicylate. Salicylate of menthol is an effective local application, painted on and covered with a gutta-percha bandage. Lithia was strongly recommended by Dr Garrod from its solvent action upon the urates. It is usually administered in the form of the carbonate (gr. v., freely diluted).
The treatment and regimen to be employed in the intervals of the gouty attacks are of the highest importance. These bear reference for the most part to the habits and mode of life of the patient. Restriction must be laid upon the amount and quality of the food, and equally, or still more, upon the alcoholic stimulants. “The instances,” says Sir Thomas Watson, “are not few of men of good sense, and masters of themselves, who, being warned by one visitation of the gout, have thenceforward resolutely abstained from rich living and from wine and strong drinks of all kinds, and who have been rewarded for their prudence and self-denial by complete immunity from any return of the disease, or upon whom, at any rate, its future assaults have been few and feeble.” The same eminent authority adds: “I am sure it is worth any young man’s while, who has had the gout, to become a teetotaller.” By those more advanced in life who, from long continued habit, are unable entirely to relinquish the use of stimulants, the strictest possible temperance must be observed. Regular but moderate exercise in the form of walking or riding, in the case of those who lead sedentary lives, is of great advantage, and all over-work, either physical or mental, should be avoided. Fatiguez la bête, et reposez la tête is the maxim of an experienced French doctor (Dr Debout d’Estrées of Contrexéville). Unfortunately the complete carrying out of such directions, even by those who feel their importance, is too often rendered difficult or impossible by circumstances of occupation and otherwise, and at most only an approximation can be made. Certain mineral waters and baths (such as those of Vichy, Royat, Contrexéville, &c.) are of undoubted value in cases of gout and arthritis. The particular place must in each case be determined by the physician, and special caution must be observed in recommending this plan of treatment in persons whose gout is complicated by organic disease of any kind.
Dr Alexander Haig’s “uric acid free diet” has found many adherents. His view as regards the pathology is that in gouty persons the blood is less alkaline than in normal, and therefore less able to hold in solution uric acid or its salts, which are retained in the joints. Assuming gout to be a poisoning by animal food (meat, fish, eggs), and by tea, coffee, cocoa and other vegetable alkaloid-containing substances, he recommends an average daily diet excluding these, and containing 24 oz. of breadstuffs (toast, bread, biscuits and puddings) together with 24 oz. of fruit and vegetables (excluding peas, beans, lentils, mushrooms and asparagus); 8 oz. of the breadstuffs may be replaced by 21 oz. of milk or 2 oz. of cheese, butter and oil being taken as required, so that it is not strictly a vegetarian diet.
Precisely the opposite view as to diet has recently been put forward by Professor A. Robin of the Hôpital Beaujon, who says serious mistakes are made in ordering patients to abstain from red meats and take light food, fish, eggs, &c. The common object in view is the diminished output of uric acid. This output is chiefly obtained from food rich in nucleins and in collagenous matters, i.e. young white meats, eggs, &c. Consequently the gouty subject ought to restrict himself to the consumption of red meat, beef and mutton, and leave out of his dietary all white meat and internal organs. He should take little hydrocarbons and sugars, and be moderate in fats. Vegetarian diet he regards as a mistake, likewise milk diet, as they tend to weaken the patient. To prevent the formation of uric acid Robin prescribes quinic acid combined with formine or urotropine.
GOUTHIÈRE, PIERRE (1740–1806), French metal worker, was born at Troyes and went to Paris at an early age as the
pupil of Martin Cour. During his brilliant career he executed
a vast quantity of metal work of the utmost variety, the best of
which was unsurpassed by any of his rivals in that great art
period. It was long believed that he received many commissions
for furniture from the court of Louis XVI., and especially from
Marie Antoinette, but recent searches suggest that his work for
the queen was confined to bronzes. Gouthière can, however, well
bear this loss, nor will his reputation suffer should those critics
ultimately be justified who believe that many of the furniture
mounts attributed to him were from the hand of Thomire. But
if he did not work for the court he unquestionably produced
many of the most splendid belongings of the duc d’Aumont,
the duchesse de Mazarin and Mme du Barry. Indeed the
custom of the beautiful mistress of Louis XV. brought about
the financial ruin of the great artist, who accomplished more
than any other man for the fame of her château of Louveciennes.
When the collection of the duc d’Aumont was sold by auction
in Paris in 1782 so many objects mounted by Gouthière were bought for Louis XVI. and Marie Antoinette that it is not difficult to perceive the basis of the belief that they were actually made for the court. The duc’s sale catalogue is, however, in existence, with the names of the purchasers and the prices realized. The auction was almost an apotheosis of Gouthière. The precious lacquer cabinets, the chandeliers and candelabra, the tables and cabinets in marquetry, the columns and vases in porphyry, jasper and choice marbles, the porcelains of China and Japan were nearly all mounted in bronze by him. More than fifty of these pieces bore Gouthière’s signature. The duc d’Aumont’s cabinet represented the high-water mark of the chaser’s art, and the great prices which were paid for Gouthière’s work at this sale are the most conclusive criterion of the value set upon his achievement in his own day. Thus Marie Antoinette paid 12,000 livres for a red jasper bowl or brûle-parfums mounted by him, which was then already famous. Curiously enough it commanded only one-tenth of that price at the Fournier sale in 1831; but in 1865, when the marquis of Hertford bought it at the prince de Beauvais’s sale, it fetched 31,900 francs. It is now in the Wallace Collection, which contains the finest and most representative gathering of Gouthière’s undoubted work. The mounts of gilt bronze, cast and elaborately chased, show satyrs’ heads, from which hang festoons of vine leaves, while within the feet a serpent is coiled to spring. A smaller cup is one of the treasures of the Louvre. There too is a bronze clock, signed by “Gouthière, cizileur et doreur du Roy à Paris,” dated 1771, with a river god, a water nymph symbolizing the Rhône and its tributary the Durance, and a female figure typifying the city of Avignon. Not all of Gouthière’s work is of the highest quality, and much of what he executed was from the designs of others. At his best his delicacy, refinement and finish are exceedingly delightful—in his great moments he ranks with the highest alike as artist and as craftsman. The tone of soft dead gold which is found on some of his mounts he is believed to have invented, but indeed the gilding of all his superlative work possesses a remarkable quality. This charm of tone is admirably seen in the bronzes and candelabra which he executed for the chimneypiece of Marie Antoinette’s boudoir at Fontainebleau. He continued to embellish Louveciennes for Madame du Barry until the Revolution, and then the guillotine came for her and absolute ruin for him. When her property was seized
