MINERAL WATERS - GOUT - MEDICINAL TREATMENT.
The employment of mineral waters in the treatment of arthritic states of the body is very extensively practised. But it is often difficult to estimate the exact value of this method because so many elements enter into the result. When the weary man of letters and the tired official find rest and freedom from care in a pleasant moun tain retreat far from the maelstrom of modern civilization, great credit must be given to the change of scene and to the relief from routine and intellectual fatigue. When the over-fed denizen of the damp and gloomy sea-coast inhales the pure, dry air of the continental interior, much of the benefit that he experiences must be ascribed to this wholesome transformation of his environment. After all these factors have been taken into account there remains, however, a certain resi duum of advantage that must fairly be attributed to the effect of cer tain mineral waters that have been pronounced, after long experience, to be particularly remedial in the treatment of arthritic conditions.
During the crises of acute gout the use of mineral waters is in effectual—it may be actually injurious. Large draughts of ordinary water are hurtful iu acute indigestion; and disorder of the stomach is one of the most prominent symptoms in these crises. If mineral waters of any kind are to be prescribed during this stage of the dis ease, they should belong to the alkaline group, of which the Vichy waters form the type. These contain about one drachm of sodium bicarbonate to the quart, and are to be drank while warm at their natu ral temperature. But for the vigorous, though chronic, sufferer from subacute forms of arthritism, for the great eater and drinker with hepatic engorgement, catarrhal gastro-duodenitis, dyspepsia, somno lence, and general plethora, the stronger waters of the Karlsbad type are to be preferred. These contain sodium sulphate, and are quite laxative, hence. their beneficial effects upon the congestive states and catarrhal conditions by which these patients are disabled. When there exists a tendency to diabetes or to gravel, waters that contain very little mineral matter are most useful. Of these the waters of
Contrexeville in France, of the Poland spring in Maine, and of Wau kesha in Wisconsin, are typical. When the joints have become stiffened by repeated inflammation and earthy deposits, hot baths are most useful. Of these the numerous hot springs in different parts of the world are all efficacious when there exist no cardiac nor pul monary complications to contra-indicate their use. But, since the ap plication of moist heat is the principal agent in this mode of treat ment, nearly equal effects can be obtained from daily tub-baths, accompanied by active massage at home. When the cutaneous sur faces are affected by chronic eruptions of arthritic origin, hot sulphur baths are to be recommended. Chalybeatc springs are seldom of ser vice in gout. Iron is one of the agents that cause accumulation of urates in the tissues, hence its action is favorable only after a long course of eliminative treatment.
Having thus briefly outlined the general rules for the employment r•f mineral waters it will be useful to consider at greater length the special indications for their exhibition. It is well known that pure table water is diuretic and to a certain extent laxative. In cases that are characterized by the formation of gravel and by the accumulation of uric-acid sand in the pelvis of the kidney. great benefit is often de rived from a sort of " flushing process" with potable waters that contain very little mineral matter. Of this description are the waters of Wildbad in Germany, Contrexjville, Evian, and Vittel in France, Bath in England, and the Poland and Waukesha springs iu the United States. These waters are especially valuable iu cases of obesity, arthritic diabetes, and dyspepsia with sluggish kidneys and scanty, highly acid urine. They stimulate all the excretory functions, and are easily tolerated by the mucous membranes of the alimentary canal. After a course of Poland spring water, an astonishing quan tity of uric-acid sand is sometimes evacuated, with great and per sistent relief from the lumbar pain that had previously harassed the patient.