The treatment of gout varies somewhat, according to the acuteness or otherwise of the attack. During acute gout, lithia is often useful as an adjuvant or an alternative to alkalies, colchicum, etc., but it is during the intervals, when the urine is loaded and the joints obscurely painful, that the habitual use of small quantities is most advantageous. According to Dr. Garrod it lessens the frequency of the attacks, diminishes uric acid deposits, sometimes causes the absorption of concretions, and even wholly removes the gouty dys-crasia. Reasoning from the power of lithia in warm solution to dissolve uric compounds out of gouty bone external to the body, he presumes that it can exert an analogous effect within the system, and favor the elimination of the materies morbi in the form of urate of lithia. Wagner found, after ample experience, that treatment by lithia shortened the duration of acute attacks, and prolonged the intervals of freedom: it relieved pain and promoted elimination by diuresis. He gave from 1/2 to 5-gr. doses of the carbonate in an aromatic bitter, continuing them during the interval between the attacks for many weeks (Schmidt's Jahrb., i., 1875, p. 232). Stricker reports a case in which gouty concretions on the finger-joints disappeared in a few weeks under a course of lithia (quoted by Garrod). Ditterich, while estimating the remedy highly, would restrict its use to chronic forms of gout or chronic illness of any kind, if dependent upon excess of uric acid. He found that doses of 5 to 10 gr. were liable to induce dyspepsia, and recommended not more than 1 1/2 gr. for a single dose, or 15 gr. in twenty-four hours: he generally observed relief in seven to fourteen days without drawback (Schmidt's Jahrb., October, 1870). When acidity of stomach is present, the carbonate should be given, because it is a more direct antacid than the other salts; if, however, there is no marked gastric derangement, the neutral citrate is to be preferred. It is decomposed within the system, and eliminated as carbonate in the urine. The ferruginous benzoate of lithia is much recommended by Dalkiewicz in his essay ("Sur la Goutte," 1873), by Malley, and other French physicians (Medical Record, November, 1874).

The Baden-Baden waters, though very useful in gout and in gouty headache, concretions, etc., are said to increase the joint pains during their early use (Althaus). There is only one spring, the Murquelle at Baden-Baden, which is distinguished for a considerable quantity of lithia, viz., 0.4 gr. of the chloride of lithium in 16 oz. Next to the Murquelle is the Fettquelle, in the same place, with 0.23 gr. of chloride of lithium, and a spring in Elster, with 0.76 of carbonate of lithia (Braun, p. 479).

With the exception of Dr. Garrod's writings, there are but few English observations on the treatment of gout by lithia, though the remedy must be largely used. It does not always give the satisfactory results that have been claimed for it, and some practitioners are still sceptical as to its real value.