554 DISEASES OF THE ORGANS OF LOCOMOTION. 



bad for gouty patients, and that active exercise is important in the 

 treatment. We should not have entered into this discussion of theo- 

 ries, if theory and practice did not fully agree in the treatment. The 

 rules that we might lay down for the treatment of gout, from the 

 known action of certain substances on the transformation of tissue, 

 have long since been proved correct at the bedside of the patient. 

 The treatment by mineral waters forms a kind of connecting link be- 

 tween dietetic and medical treatment ; it is perhaps more highly es- 

 teemed in gout than in any other disease. The springs celebrated as 

 being antiarthritic are those of Vichy, Karlsbad, Marienbad, Kissin- 

 gen, Homburg, etc. The favorable effect of these mineral waters 

 appears to depend on their reducing the plethora, due to a mispropor- 

 tion between supply and demand in the body, whether the plethora 

 depend solely on hypertrophy of the blood, i. e., an increase of its 

 cellular elements and a certain density of the intercellular substance 

 (the serum of the blood), or on an accompanying absolute increase of 

 the amount of blood contained in the body. It is very interesting to 

 note that the beneficial influence of these natural mineral waters on 

 plethora, which has been long known, and which far exceeds that of 

 ordinary water, agrees with the observations of C. Schmidt and Vbgel, 

 according to which the amount of albumen in the serum of the blood 

 is inversely proportional to the amount of salt. I am undecided as to 

 which of the above springs deserves the preference in the treatment 

 of gout, whether the solution of salt, of which the Kissingen and 

 Homburg waters consist, removes the plethora more rapidly and com- 

 pletely than Karlsbad and Marienbad water, or the reverse. Nor 

 shall I attempt to say whether the supply of those solutions of salt 

 act beneficially not only on the plethora but also on that anomaly of 

 the change of tissue which shows itself as the gouty (uric acid) dia- 

 thesis in some plethoric persons. Nor can we, with our present knowl- 

 edge, say whether in any particular case the preference should be 

 given to Kissingen, Karlsbad, Wiesbaden, Homburg, or Vichy, and 

 what would constitute the peculiarity of the case which indicates one 

 rather than the others. It cannot be denied that in recent times the 

 regular therapeutic employment of the so-called BullricJi's salt, a mix- 

 ture of bicarbonate and sulphuret of soda, rivals the world-renowned 

 success of these springs a fact which is at least opposed to the 

 asserted latent peculiarities and advantages of the natural solutions 

 of salt. Advantageous as the above treatment proves in recent cases 

 of regular gout, if carefully and judiciously instituted, there is often 

 great harm done by excessive limitation of the supply of nourishment, 

 by the sudden complete abstraction of spirituous liquors that had 

 been used for years, as well as by all other debilitating courses of 



