* We know so little concerning the native mineral waters, that it is difficult to speak confidently as to their effects. Many of them, especially those of this Beats (New York), contain a large proportion of lime (sulphate and carbonate), which does not appear to me to be a desirable ingredient in these conditions.

+ This statement is chiefly based upon urea determination*. The quantitative analysis of uric acid being tedious, and often unsatisfactory, has not been so frequently employed.

If the kidneys are perfectly healthy, we may leave the bowels entirely alone and call upon the former to perform most of the depurating work.

This is effected by diuretics, and the ones specially serviceable in this connection are Vinum Colchici, Infus. Digitalis, Balsam of Copaiba, Propylamine, Carbonate of Lithia, Acetate of Potassium, Vichy water, etc.

These remedies, one and all, appear to exert a marked influence upon the urine, notably increasing the amount of solids daily excreted in this fluid. They are, moreover, among our chief reliances in gouty and rheumatic conditions generally. The Carbonate of Lithia and Vichy, besides being diuretic, tend in addition to restore the normal degree of alkalinity to the blood, and by their presence as alkalies to assist oxidation. These different diuretics may be used singly or combined, and for a considerable period. Lithia and Vichy, however, and alkalies generally, if too long employed, tend to impoverish the blood by diminishing the number of red corpuscles. To obviate this, the use of the Benzoate of Lithia, combined with Iron, has been suggested. A better plan, however, if we anticipate a prolonged use of alkalies and other diuretics, is to intermit their employment for one or two weeks out of each month, giving iron if necessary in the intervals*.

Having put in force the measures necessary for the depuration of the blood, and the re-establishment of its normal alkalinity, attention must be directed to the question of oxidation.

If the conditions present be simply due to incomplete oxidation of an excessive amount of albuminoid ingesta, the course is very clear. It is only necessary to diminish the proportion of this kind of diet. In other words, cut off the meat to a greater or less extent, and substitute for it a larger quantity of bread, vegetables, and fats. Some of these patients are exceedingly fond of meat, and eat it in large quantities, and are sometimes inclined to rebel against restriction of their diet. The quantity of meat eaten by many persons is greatly in excess of the real bodily needs; and this excess being of no service is pretty apt to do harm, and soon brings the patient in contact with his physician. In these cases, then, our principal effort should be to induce the patient to modify his diet in the way suggested, and, even if he is a little rebellious at first, it is surprising how soon he becomes reconciled to the changed conditions, and frequently loath to return to his former dietetic habits.

If, on the other hand, but a moderate quantity of nitrogenous food is ingested, and even this is incompletely oxidized, it will be necessary to institute measures specially designed to increase oxidation. The red corpuscles being the vehicles by which the inhaled oxygen is distributed to the different parts of the body, it is, of course, of the first importance that they should be present in normal quantities. Any notable deficiency in this respect is easily ascertained, and may usually be remedied to a great extent by the use of preparations of iron. This being accomplished, we must endeavor to insure a full supply of oxygen by exercise in the open air, good bedroom ventilation, and the like. In addition we may attempt to furnish oxygen directly to the blood by inhalations of the pure gas, or better, perhaps, by inhalations of oxygen, a small portion of which has been rendered more active by ozonation. Further, we may employ certain medicines which contain oxygen largely, and are believed to be capable of giving it up to the blood, as, for instance, the Chlorate of Potassium. The alkalies already mentioned, which by their presence assist oxidation, are appropriate adjuvants.

* It must be remembered that we are dealing with chronic conditions, and treatment, to be effectual, must be continued for a long time.

Finally, if the liver be torpid - that is, functionally inactive - we may have recourse to the occasional, and, in some cases, frequent use of certain drugs which have the reputation of being hepatic stimulants, as Mercury, Podophyllin, Iris versicolor, Leptandra, Euonymus, etc.

The above outline of treatment is certainly the one which the conditions supposed to exist would naturally suggest. I should hesitate, however, to offer it, even with personal experience in its favor, were it not that there is abundant corroborative testimony from other sources in favor of each and every one of the remedies mentioned. The value of cathar-tics, of diuretics, of alkalies, of chalybeates, and of hepatics, as isolated remedies in the affections embraced in this diathesis, is recognized by almost every modern writer, and their employment counselled under various circumstances. Heretofore their use has mainly been empirical, and not founded upon well-considered views as to the special indications which they are expected to fulfil.

Their acknowledged clinical value, however, is strong presumptive evidence of the at least approximate correctness of the theoretical views that have been expressed, and should induce us to seek farther for remedies still better adapted to fulfil the indicated requirements.

It is not of course supposed that in any given case all of the drugs mentioned will be required, but the happiest results are to be expected from their judicious selection, combination, and alternation.

The treatment which I have here advocated for the affections belonging to this group is intended to replace the method which, until recently, has received almost universal adhesion. I allude to the treatment by arsenic.

Arsenic has been and is still by many, perhaps by most, regarded as the sheet-anchor in the management of these affections. Its reputation is based upon the fact that it has the most undoubted control over many of the manifestations of this diathesis; a control evidenced by the prompt removal, in many cases, of the visible lesions and other appreciable symptoms* But does it, in addition to this, exert any influence upon the constitutional conditions which underlie them? Does it in the slightest degree tend to prevent their relapse? I have never been able to perceive that it did. In my earlier experiences I employed arsenic largely, and obtained the effects usually ascribed to it; gradually I used it less frequently, and at present depend upon it but seldom, and have no hesitation in saying that the arsenical treatment of these affections, though often more prompt, is on the whole less satisfactory than the method which I have here detailed.

The foregoing refers simply to the internal treatment of the rheumic affections, or rather of the diathesis on which they depend, but it must not be supposed that dependence is to be placed on it alone. On the contrary, local treatment is of service in almost every case, but can only be considered in connection with the special affections themselves.