GOUT ALKALIES - MEDICINAL TREATMENT.
From the remotest antiquity the alkaline salts and their bases have enjoyed the highest reputation iu the treatment of gout. Long before the birth of chemistry the ancient Greek physicians in Alexandria, Athens, and Rome were in the habit of giving to their arthritic patients a weak lye prepared from vegetable ashes. These ashes contained a notable quantity of the carbonates of potassium and sodium. The German physicians during the Middle Ages, and later, prepared a similar decoction of ashes diluted with Rhine wine. Nitre also had its advocates. Cullen and his followers noted the fact that all of the mineral alkalies were effectual to postpone the attacks of gout, and to prevent the appearance of urates in the urine. The great advances of practical chemistry have placed before the modern physician a large number of alkaline salts, of which all are useful, though many of them differ in their immediate effects.
The action of these various alkalies does not simply consist in their power of neutralizing acids. While it is true that the carbo nates and bicarbonates do serve to antagonize over-acid conditions of the stomach and duodenum, and to cause the disappearance of acidity from the urine, it is highly probable that they stimulate the secretion of the gastrointestinal glands, together with the pancreas and the liver. Claude Bernard's often-repeated experiment upon the mucous membrane of the stomach of a dog illustrates the great in crease of secretion that follows the introduction of a little water into the stomach. A similar effect of alkaline waters upon the discharge of bile through a canula introduced into the common bile duct has been repeatedly observed. The administration of alkalies must, therefore, be followed by an increase in the amount and activ ity of the digestive fluids, and by improvement in the functions of absorption, assimilation, and excretion. Under such circumstances the general nutrition cannot fail to be improved. Accordingly, after a prolonged course of medication the highly acid urine that is char acteristic of the arthritic diathesis becomes neutral or only feebly acid ; and it often remains in this condition for a considerable time after the treatment has been discontinued.
The action of alkalies in the blood is still very imperfectly under stood. As a result of his laboratory experiments Sir William Roberts declares that the addition of alkaline salts to a solvent medium at the temperature of the blood does not materially affect the solubility of sodium bi-urates. He says (loc. cit., p. 82) : "The influence of a salt
depends exclusively on the nature of the base, and has no reference to the acidulous radicle with which the base is combined. Salts with an alkaline reaction, such as carbonates and phosphates, do not differ in the least from neutral-reacting salts, such as chlorides and sulphates. The salts of sodium exercise a strong deterrent in fluence (upon solution), and the deterrent influence increases with the increasing percentage of the salts in solution. Salts of calcium, nesium, and ammonium have also a deterrent effect but slighter than that of salts of sodium. Salts of potassium have no effect either way." These laboratory experiments, however, are of slight value in comparison with the results of observation at the bedside. Haig and many others have shown that the ingestion of alkalies causes an increased discharge of urates with the urine. As he can find no evidence that the ratio of formation between urea and uric acid is ever disturbed, it follows that the increase of tuinary mates is due to the greater capacity of the blood for soluble urates, which by the aid of alkalies are washed out of the tissues where they had been previously deposited. How this process is effected is not yet ex plained, for the experiments of Sir William Roberts have made it clear that the mere addition of alkaline salts to a solvent medium does not increase its power to dissolve the bi-urate of sodium—the combination in which uric acid exists in the body. Doubtless, the chemical processes by virtue of which the 'bi-urates are transformed into quadri-urates, and the solidified salts are again rendered soluble, and vice versa, are far more complicated than anything that we have yet seen in the test-tubes of the chemist. It has been suggested that di-sodium phosphate (Na,11P0,) is the agent that acts as a solvent of uric acid in the blood, and that its efficiency is maintained by the presence of alkalies which prevent its degradation to the acid so dium phosphate a substance that is powerless as a uric acid solvent. Could this inference from laboratory experiment be verified upon the living subject, it would be a great gain to science. The relation of all these alkaline substances to excretion, especially with reference to the elimination of the poisonous compounds of the xanthin group, needs additional investigation.