derived from the treatment; along with these he was in the habit of ordering a draught containing sulphate of magnesia, burnt magnesia, and the acetic extract of colchicum, which had the effect of keeping up the action of the bowels.

In speaking of the value of purgative medicines in the treatment of gout, I purposely exclude the preparations of colchicum, not that colchicum does not act as a powerful cathartic, but because it certainly does not owe its efficacy to this property, and frequently proves of most benefit when its operation is unattended with increased alvine evacuation. My own experience has taught me that in the acute stages of the disease, purgatives possess no peculiar power of lessening the articular inflammation, and can therefore in no way be depended upon for effecting this object. I am induced to make this remark, being aware that some practitioners look upon the curative action of colchicum as due to its cathartic properties, and have an idea that a like amount of purgation excited by other remedies would answer the same purpose. Of the incorrectness of this opinion I am fully convinced from repeated clinical observations, and from the results of trials made to determine this point, which will be related when we are discussing the therapeutic powers of colchicum.

Purgatives given in moderation are undoubtedly of value in many cases of acute gout, more especially, when accompanied with constipated bowels, retention of the bile, and hepatic congestion; but their

efficacy under such circumstances simply depends on their power of restoring, to a healthy state, functions previously deranged, and not on their producing any. specific effect either upon the affection of the joints or the state of the blood. It is very questionable if the secretion from the mucous membrane of the bowels induced by the operation, even of hydragogue purgatives, contains uric acid, and certainly not sufficient to relieve in any sensible degree the overloaded state of the blood in gout we can neither reasonably hope for, nor do we find, from the action of hydragogues, the relief which so frequently follows their administration in cases of albuminuria, or in anasarca dependent on cardiac disease. On the other hand, purgatives if given in doses sufficient to cause much depression are decidedly injurious, for although perhaps some temporary mitigation of suffering may be afforded, yet the disease is rendered more liable to recur and to assume a chronic and asthenic form. The amount of cathartism must be determined by the peculiarities of the individual case, for that which in one would not be followed by appreciable inconvenience, in another may be attended with serious prostration.

The kind of purgatives most suitable to the treatment of gouty inflammation, must also depend on individual peculiarities; if mere constipation exists without sensible derangement of the hepatic function, the simple laxatives or milder cathartics may be em

such as manna, magnesia, rhubarb, senna, or mpounds of these, as Gregory's powder, the