Having regard to their radio-active properties, the best results are undoubtedly to be obtained by a combined bath, drink, and inhalation cure. Simple immersion baths, deep or reclining, with or without massive under-current douches, enjoy well-deserved vogue for their general and local effects.
Moreover, as the local douching exerts a sedative as well as a resolvent effect, they prove most useful not only in articular gout, but in the treatment of those frequent concomitants, lumbago and sciatica. Their efficacy is much enhanced by coincident or subsequent massage, and to increase the powers of resistance, such hot baths should be followed by graduated sub-thermal or cold applications.
Sool-Bader, or natural thermal brine waters, exert a similar effect, but such are not available in this country. But cold brine baths—given at temperatures of 98° F. and upwards—are obtainable at Droitwich, Harrogate, and Builth, and are invoked more particularly in long-standing cases with great thickening of the arthritic or related muscular structures.
Again, gouty subjects not seldom suffer with high blood pressure, and our treatment must be modified accordingly. Here we may enlist what are known as Aix massage baths, which tend to lower arterial pressure through the profound influence they exert on metabolism, and the elimination of toxic and waste products. As in warm immersion baths enervating after-effects are apt to ensue unless the tonic-bracing action of a terminal cold application be invoked. On the other hand, in some cases of chronic gout the abdominal musculature is very flabby, with a tendency to visceroptosis and low blood pressure. In their instance, a Vichy bath, inasmuch as it tends to raise the blood pressure, is preferable to Aix massage.
Another powerful method at our disposal for the elimination of waste products is the vapour bath. It is not suitable for the old and feeble, or those with advanced cardiac or renal disease, but it is especially adapted to gouty subjects with harsh, thickened or irritable skin, and those of obese habit.
While the foregoing procedures, generally speaking, are eligible for the more robust type of individual, we must have regard also to those of delicate constitution, whose strength is sapped by long-continued gout, or who show signs of pre-senilism. In such instances, sub-thermal baths (82° to 97° F.) have a great sphere of usefulness. Thus in the presence of high arterial pressure, a course of immersion baths, say, at 93° F., combined with fan douches, and applied according to the Bourbon-Lancy method, are very effectual in reducing arterial tension. Of marked sedative action, such neutral baths are peculiarly eligible also for all types of gout associated with insomnia, irritable skin affections, or showing signs of vasomotor instability.
Moreover, these sub-thermal baths are valuable in articular gout of subacute or lingering character if the douches used are of low pressure, which latter is essential if the joints are sensitive. Their therapeutic action is of course more pronounced in those natural mineral waters which more nearly fulfil the requirements of a neutral bath. Such are possessed in high degree by the waters of Buxton, Ragatz, and Baden-Weiler, the average temperature of which approximates to the point of thermal indifference.
Methods of Local Hydro-therapy
In one form or another, douches have for centuries been used for chronic joint affections. Three factors have to be considered—the volume, pressure, and temperature of the impinging water. The size and form of the stream determine its thermic and mechanical effect, and cæteris paribus, the more massive the volume, the more marked the results produced.
The pressure, again, is a most important factor, as the influence on the circulatory and lymph flow in deep-seated tissues is directly proportional to the force of delivery.