If gout is primarily due to the absorption of toxins from the intestinal canal dependent upon a catarrh of the intestinal mucosa, many of the natural mineral waters must be efficacious in altering the catarrhal condition and in improving the digestive processes; also the secondary effect of increasing the flow of bile and of thoroughly washing out all the tissues, so as to get rid of toxic accumulation, is important.

The value of a given mineral water in the treatment of gout depends greatly on the main object with which it is taken. For instance, it may be taken to remove gouty deposits, or to stimulate the action of a sluggish liver and to relieve portal congestion, or for the treatment of gouty dyspepsia, or to relieve the bowels in cases of torpor and gastro-intestinal catarrh, or to act on the kidneys, or to relieve gouty affections of the skin. Now it is manifest that any one mineral water is not likely to produce all these effects and it is also obviously conceivable that a mineral water which might be most useful to effect one of these purposes might prove injurious if employed to effect another. No doubt considerable error has arisen from indiscriminately sending gouty patients to a particular spa, without giving due consideration to the question as to whether the water of that spa is suitable for the treatment of the specific gouty disorder from which the patient is suffering. It is well to bear in mind that a patient should not be sent to a spa during the acute stage of gout, nor if suffering from marked organic disease of the heart or kidneys.

It is especially in cases of chronic gout, of gastro-intestinal catarrh and torpor, of gouty dyspepsia, sluggish action of the liver, gouty eczema, gouty glycosuria, and of other forms of irregular gout, that mineral waters prove so valuable, whilst the various baths, combined with massage, are so useful in producing softening and absorption of the deposits in the joints and other tissues.

The explanations given as to the modus operandi of a particular mineral water must sometimes be received with a certain amount of caution. For instance, the advocates of one mineral water will extol its efficacy in the treatment of gout on account of the lime salts contained in it and its freedom from sodium salts, whilst, on the other hand, the advocates of another mineral water will insist that the large quantities of sodium salts present in it and the absence of lime salts are the potent factors in its usefulness in the treatment of gout.

All gouty individuals should avoid localities in which there are hard chalky waters, or, if they have to reside in such localities, should avoid drinking the water of the district. In such cases they should drink distilled water, plain or aerated, or some of the simple natural mineral waters.