148 GOUT 



done by the so-called lemon cure. Patients eat so much of this fruit that 

 frequently troublesome dyspeptic symptoms arise. Neither do the grape cures 

 bring about what was formerly expected of them. Sometimes they are fol- 

 lowed by annoying gastric symptoms and even serious digestive disturbances. 

 Moderation in eating and drinking is the first duty of the patient, but, not- 

 withstanding this, the avoidance of all antifat cures, i. e., all measures liable 

 to produce inanition, should be a guiding principle. In this connection the 

 immoderate use of alkalies which are so frequently advised, chiefly on account 

 of their uric acid solvent properties, is injudicious. 



Mineral spring cures and hath cures are frequently resorted to in gout, and 

 the thermal baths enjoy a great reputation. I usually advise them for patients 

 who cannot take necessary muscular exercise such as gymnastics, mountain 

 tours, etc. The same is true of baths as of the employment of mineral water 

 and bath cures in obesity, which, as we have seen, often accompanies gout. 

 The thermal baths are, in general, to be reserved for (a) such cases of gout as 

 occur in decrepit persons, (&) for old persons for whom energetic muscular 

 activity is no longer possible, (c) for cases of gout in which exudates have 

 formed in the joints and in which resorption is to be brought about, and (d) 

 for cases in which complications make such a treatment necessary. Prom this 

 point of view peat haths and mud baths are in many cases very serviceable. 

 The sulphur mud baths in Pistyan in Upper Hungary as well as the mud baths 

 in Germany are highly recommended. In many such cases of gout it is noted 

 that, when all other remedies fail, sweat baths in the Grotto of Monsum- 

 mano or in the Grotto of Bormio give very excellent results. Carlsbad, Wies- 

 baden, Aix-la-Chapelle, Vichy, Wildbad and many other resorts are visited 

 by gouty patients, but often without success unless they are assisted by suitable 

 dietetic measures. It is of greater importance successfully to combat the 

 morbid processes which in persons predisposed to gout form active auxiliary 

 causes in its development, and decidedly favor its advance. Among these may 

 be mentioned rheumatic affections and especially syphilis. In beginniag a 

 treatment of gout, it should always be determined whether syphilis has pre- 

 ceded it or not. 



There are quite a number of so-called specific remedies for gout. Those 

 which diminish uric acid formation, that is, which render the urates more 

 soluble, play an important role. Of these remedies lithium has been for a 

 long time in the van. It can only be administered as lithium carbonate, not 

 as lithium chlorid. I have been unable to convince myself of the value of 

 this remedy. Vrotropin, introduced into practice by A. Nicolaier (twice daily 

 a dose of 0.5 gram, 7^ grains, each tablet dissolved in a quarter of a liter of a 

 slightly alkaline water), is better. But further investigations concerning its 

 use are necessary. I have heard it praised by a number of old gouty patients 

 who had tried almost everything. Piperazin (about 1 to 2 grams daily in an 

 alkaline water) has proven useful, particularly for the "rheumatic" pains in 

 chronic arthritic gout. The importance of treating the very defective intes- 

 tinal function in the course of gout (constipation) is not to be underestimated. 

 This disturbance of intestinal digestion must be relieved, and, as a rule, I 

 employ large enemata of oil. That plentiful exercise is beneficial and neces- 



