The free employment of water in the treatment of gout dates from ancient times. At the Temples of Asklepios at Epidaurus and Athens, water was used extensively both internally and externally, and active gymnastic exercise, riding, friction of the skin, massage, and counter-irritation were prescribed.

Spa treatment is a complex treatment made up of several factors, and on the correct apportionment of these different factors depends much of the successful issue of the treatment. These several factors are : (1) Hydrotherapy, which includes the taking of, and the bathing in, the water; (2) diet; (3) exercise; and (4) accessory forms of treatment, such as electric light baths, electrical treatment, massage, etc. With regard to the drinking of a water at a spa there is a tendency with some medical men to consider that the efficacy of a natural mineral water is due solely to its watery constituent - in other words, that its one therapeutic use is that of a flushing agent. Even so astute a physician as the late Sir William Roberts appears to have held this view. In his Croonian lectures, referring to the employment of the waters of certain spas in the treatment of gout, he said : - "Now there can be no reasonable doubt that the efficacy of these springs has nothing to do with their scanty mineral ingredients but depends on their watery constituent .... Their action would be to temporarily dilute the blood and lower its percentage of urates and sodium salts. This effect would tend to retard or prevent uratic precipitation, and thus give the defective kidneys additional time to overtake their arrears in the task of eliminating uric acid".