MINERAL SPRINGS. — considerable number of springs to which gouty pa tients commonly resort are strongly im pregnated with the salts of soda; it is not, therefore, surprising that not infre quently the first result of the cure is to provoke an acute attack of gout or to aggravate the symptoms with which the patient was suffering. The physicians practicing at these resorts are accus tomed to consider this aggravation as of good augury. Perhaps they are right, as it does happen that a patient, who for some time has been laboring under the preliminary symptoms of gout, feels better when the attack has passed over and a large quantity of uric acid has been removed from the blood; but it is a rough mode of cure, and many physicians, es pecially the English, now advise the pa tients to avoid strong alkaline springs or to take them very sparingly. Roberts resumes his opinion of the strong alka line springs (Vichy, Carlsbad, etc.) in the treatment of gout in the following words: "It is difficult to believe that they can do any direct good, and easy to believe that they can do direct harm." In cases of gout in which the urine constantly precipitates crystals of uric acid, it is advisable to prescribe some alkaline remedy or alkaline spring-water, to prevent the precipitation and the irri tation of the kidneys caused by it; the doses should, however, be regulated by the degree of acidity of the urine, and not more of the alkaline drug is to be taken than necessary to reduce the acid ity of the urine to the normal level and thus render it limpid and without deposit of crystals.
Some springs are devoid of the dan gers dependent on the use of the strong alkaline waters, as they do not contain the salts of soda or only very small quan tities of them; they are either aerated, contain but little besides the pure, warm water, or they contain some carbonate of lime or sulphate of lime; in many cases the free use of these springs, combined with douches, moor-baths, massage, and hydrotherapeutics in its different appli cations will be useful, especially against the stiffness of the joints remaining after acute attacks.
Hydrotherapy recommended in the treatment of gout, but not during the attack. Rubino (Blatter f. klin. Hydro therapie and verwandte Heihnctboden, June, '93).
Among the most renowned springs of this kind may be mentioned Buxton and Bath, in England; Aix-les-bains and Contrexeville, in France; Wildbad, Gas tein, and Pfeffers, in Germany and Swit zerland; and Sandifjord, in Norway.
Of the drugs which have been recom mended against gout, guaiac merits special mention. It was introduced by
Garrod, and is administered in a dose of 7 to 10 grains of the resin daily, ordi narily combined with iodide of potas sium or quinine. It seems to have a very good effect in many cases, as it is well supported by the patients, even under protracted use. It seems to retard the return of the gouty attacks.
Guaiac does not effect the formation of uric acid, but acts directly upon the kidneys as a stimulant, enabling it to get rid of any accumulation in the tubules, thus preventing absorption from them into the blood. Garrod (Med. Record, July 4, '96).
Edison, and after him Labatut, Lev ison, Chauvet, and Gilles, have advo cated the electric treatment against the stiffness of gouty joints; by this treat ment remedies are introduced through the skin by the aid of a galvanic current. The experiments of Labatut and other scientists have demonstrated that the alkaline substances enter in the body with the positive current, whereas the acids are introduced with the negative. The remedy employed in this way against the gouty affections is lithia, which is liberated by the decomposition of the salts of lithia by the electrolytic effect of the current and enters through the skin in the nascent state, and consequently in a very effective condition. Labatut con ducts the dielectric treatment in the fol lowing way: A 2-per-cent. solution of chloride of lithia is rendered alkaline by addition of some caustic lithia or car bonate of lithia, and the hand or foot which is to be treated is placed in a saucer filled with the solution, into which also the positive conductor is plunged, taking care that the conductor does not touch the skin; the negative conductor (both conductors are made of charcoal) is placed in another saucer filled with a feeble solution of common salt, and some part of the body, hand or foot, is put in contact with this liquid. A current of 15, 20, or 25 milliamperes is used, ac cording to circumstances, and each seance is of 30 minutes' duration. By the continued use of this method, I have in many instances succeeded in restoring to gouty joints the mobility which had been lost for several years. While it is also possible to dissolve tophi, some part of the swelling caused by the deposits will, however, always remain, as the tophi do not consist only of biurate of soda, but contain also new-formed con nective tissue, which cannot be dissolved by the lithia.