The results of a medical treatment of a gouty diathesis are hard to control, because in a given individual the return of the attack of gout is very probable and frequent fluctuations are inevitable; and because the premises on which any method of treatment is based are very uncertain. As yet we know little as to what way and how far we are able to influence the uric acid content of the blood by therapeutic procedures for its transformation. On the other Hand, however, we do know that our influence on the purification of the blood from its superabundance of uric acid by the stimulation of diuresis is very limited. The mineral water cures always seem suitable for the latter object, either carried out at home or, better still, at some designated water cure. From this point of view, first of all a thorough washing out of the organism is to be recommended, and we consider mineral water particularly good for this object in uncomplicated cases. The water should be of a low molecular concentration in order that - if taken warm enough - it may pass quickly from the stomach into the blood and thence into the urine. According to examinations which were conducted by von Kostkewicz at our suggestion several years ago, the waters which were best for our purpose, - that is those which lie in the lower half of the zone of "gastro-isotonicity," - were especially: Assmannshâuser, Wildunger, Neuenahrer, Obersalzbrunner, Fachinger, Emser Kesselbrunnen and Emser Kràhnchen, Tarasp-Schulser Bonifaciusquelle, Sodener Milchbrunnen, Vichy, Homburger Luisenquelle, Offenbacher Kaiser Friedrichsquelle, Karlsbad waters, and others.* Other excellent waters for the treatment of a uric acid diathesis showing a higher molecular concentration are: Tarasper Luciusquelle, Salzschlirfer Bonifaciusquelle, Sodener, Wiesenbrunnen, and the Homburger Elizabethquelle; Weisbadener Kochbrunnen, Kissinger Rakoczy and Pandur and likewise at Marienbad, Ferdinands- and Kreutzbrunnen approach the upper boundary of the "gastro-isotonicity." It is not necessary to give in numerical form the amount of fluid intake, but a gouty patient should excrete daily not less than 1550-1800 cc. urine. Since the gouty subject should avoid as much as possible both soups rich in extractives and alcohol, the need of fluid must be supplied first of all by milk, lemonade, pure water, or such mineral waters as contain a low molecular concentration, especially lithia. A regard for the heart and kidneys demands a frequent administration of small amounts of fluid distributed over the day, and this seems to us advisable rather than the occasional intake of large portions. The fluid enters the blood with much greater ease if taken in small portions than in large ones. The rule given by some authors to drink a fourth of a liter of lukewarm water at night, just before going to bed, serves the purpose admirably, as does also the rule that the evening meal should be frugal and non-irritating, because the acute attacks occur most frequently in the hours of darkness. Since the time has not yet come for the cures resulting from the use of mineral water to be explained on a strictly scientific basis, the advances of physical chem istry may be employed only for the gross questions of the differentiation of Physiology and Pathology, and to amplify our outlook, until now relatively narrow, into the complicated mechanism underlying the continual alteration in the relationship of the fluids. We may seek in these provinces the results of a pure empiricism, which give preference to alkaline, and above all to lithia containing water. We shall not discuss how far this idea may be correct; in practice these waters are believed in for every case. However, those who concur with the opinion of Falkenstein and van Loghem will prescribe carbonic acid waters instead of alkaline waters. There are above all certain conditions which are in part complications, in part sequelae, of gout, such as obesity, diabetes, hepatic infarct, stomach and intestinal disturbances, etc., in which certain springs would appear to be distinctly prohibited, as they would aggravate, not only the gout, but also the other symptoms. However, we will return later to the properties of the springs which may be made use of in certain forms of and at certain stages of gout. The excellence of treatment in a "cure" frequently shows its effects, because at a "cure" many factors for healing are at work at the same time, and also because the physicians are specially trained for a definite class of patients.

* The American springs that are best suited to gouty patients are Hot Springs, Ark., Hot Springs, Va., White Sulphur Springs, W. Va., Bedford, Va. We have obtained best results from Hot Springs, Ark. Of waters for table use, it is our opinion that any pleasant table water is adapted to cases of this disease, but if a special water is desired, Salvatorquelle or Vais may be recommended. [Editor.]