314 THE TREATMENT OF DISEASES. 



it an agreeable and slightly sparkling draught. Rather more than half a pint is 

 required to produce an easy motion. The waters both of Vichy and Vals have 

 attained a high position in the treatment both of gout and gravel. By many it is 

 maintained that their action on the liver is slight, and that although patients are 

 often better for a time after a visit to Vichy, they are not permanently benefited. 

 There is no occasion to drink the waters at the spa, for the majority of them are 

 imported, and may be obtained without difficulty. The course should extend over 

 a period of from six to nine weeks. It may be said that this is an expensive mode 

 of treatment ; but it must be remembered that gout and gravel are essentially the 

 heritage of the rich and well-to-do, and not of the poorer classes. The artificial 

 imitations of the natural waters are of comparatively little value. 



In addition to medicinal treatment the diet must be carefully regulated. In the 

 first place, alcohol must be taken very moderately, and the lighter wines are to be 

 preferred. Port, sherry, and champagne are unsuitable, and beer is absolutely for- 

 bidden. Probably the best drink for the sufferer from gravel is a light, sound 

 Bordeaux, or a Rhine wine of similar quality. Sugar is strictly tabooed, and fat, 

 butter, cream, and pastry are to be taken, if at all, very sparingly. Abstinence from 

 those articles of diet will greatly lighten the work of the liver, and lessen the 

 unnatural strain thrown on the kidneys. In some kinds of gravel, rhubarb, from 

 the amount of oxalate of lime it contains, is especially injurious. 



In many cases great benefit is derived from the simple expedient of taking 

 a tumbler of cold water a couple of hours or so before dinner, and another on 

 retiring to rest. It is found, too, as the result of practical experience, that a 

 long interval should not elapse between meals, and that the period devoted to 

 sleep should not be too prolonged. Many people suffering from gravel take a 

 little bicarbonate or citrate of potash in a tumbler of water every night at bed-time 

 and again on rising in the morning. This is simply a temporary expedient, and 

 seldom does any permanent good. The great thing is to pay strict attention to 

 diet. The following case forcibly illustrates the effects of good living on the 

 production of gravel : " A Dutch merchant had an ample fortune, and lived in 

 accordance with Ms means, keeping a good table, and indulging in its pleasures 

 freely. He was at this time tormented with gout and gravel. Unexpectedly he 

 lost all his fortune, through a political crisis, and was obliged to take refuge in 

 England, where he lived more than a year, almost in poverty, amid numerous 

 privations, but his gout completely disappeared. Little by little he succeeded 

 in repairing his affairs; he resumed his old mode of life, and the gravel was 

 not long in reappearing. A second reverse robbed him in a short time of 

 all he had gained; he passed into France almost without resources, and his 

 regimen was consonant to his means ; the gravel disappeared. Once again his 

 industry restored him to a life of plenty and ease, and he abandoned himself again 

 to the indulgences of the table, and with them appeared once more his old enemy, 

 the gravel." 



