Saline Waters

Alkaline and saline mineral waters have a well-deserved reputation for benefiting gout. Many persons, especially obese gouty subjects, are helped by taking one or two "courses " of treatment a year for two or three successive years at Carlsbad, in Bohemia, or elsewhere. Carlsbad water may be drunk at home, four or five ounces being taken on rising in the morning, or an equivalent of the evaporated salts - chiefly sodium sulphate.

The water of the Kreuzbrunnen at Marienbad has essentially the same composition with that of Carlsbad, and contains even more sodium sulphate. Elderly persons may be injured by a too vigorous use of these salines, and they should take only milder alkaline waters containing less sodium.

The German Fachingen water has proved very serviceable. It contains 3.5 per cent of bicarbonate of sodium and 6 per cent of bicarbonate of lime.

Vichy is good for strong patients, but not for the feeble or anaemic. It also contains considerable sodium bicarbonate, and the Vals water has more sodium carbonate than many alkaline waters. These waters favour the elimination of uric acid as a salt rather than in the free state.

Saratoga alkaline water is among the best in this country for gouty patients. It contains carbon dioxide, sodium and alkaline carbonates, and chlorides. The waters of the St. Clair Spring in Michigan, and St. Catherine Spring in Ontario, are good alkaline salines for gout. Many lithia waters are also recommended, but they contain little lithium. Apollinaris and Johannis water are good. All beverages drunk by the gouty should be well diluted, and mildly alkaline mineral waters are especially valuable for this purpose.

Aids To Dietetic Treatment

The individual peculiarities of digestion should be carefully studied in each case by the physician, and the patient must be very thoroughly examined in regard to the minutiae of all his hygienic and dietetic habits. Meals should be taken at stipulated hours - the breakfast on rising, dinner not later than three o'clock, when practicable, and late suppers should be avoided. Between the acute attacks it is absolutely necessary to maintain digestion in a normal condition. The bowels must be kept open, and the condition of the skin should be actively maintained by cold bathing and friction. Exercise should be taken in the open air. The urine should be frequently examined, with especial reference to the hour of the day at which it is passed and the relation which its composition bears to the food eaten.