For alike in simple thermal, sulphurous, alkaline, sulphated alkaline, or muriated waters, the presence of radio-activity has been established. But if, e.g., in the simple thermal, their therapeutic potency is referable to their higher degree of radio-activity and not to their mineral content, in others their relative deficiency in radio-activity is compensated for by their mineral constituents—these present in sufficient quantity to exert a specific action, alterative, aperient, tonic, etc.
In this matter of mineral content we are reminded of the grievous controversy that has long obtained with regard to the use of natural waters, the chief constituents of which are sodium salts. Sir William Roberts, as we know, from his experiments, ascertained that sodium salts promoted the conversion of the quadriate into the biurate, thus augmenting the precipitation of the latter.
This behaviour on the part of the carbonates, bicarbonates, and phosphates of sodium led him to the sweeping generalisation that all sodium salts, including the chloride, were, as far as practicable, to be avoided by gouty subjects. Naturally, in conformity with this view, such patients were warned to flee those spas whose waters contained these peccant salts.
Carried to its logical end, this dictum would have cut the gouty off from, e.g., the carbonate of soda waters of Vichy, the chloride of sodium springs of Homburg, the sulphate of soda waters of Karlsbad, not to mention the muriated (sodium chloride-containing) sulphur waters of Harrogate, Llandrindod, etc., despite the overwhelming clinical evidence as to their efficacy in certain cases of gout.
Fortunately, as Burney Yeo observed, “in spite of all the theoretical denunciations of the use of sodium salts in gout, the gouty, from all quarters of the globe, have resorted, and continue to resort, in steadily increasing numbers, to those Continental springs in which the salts of sodium are overwhelmingly predominant.”
In short, Sir William Roberts’s experiments, while they dissipated the fallacious view of the action of alkalies as solvents in the blood of sodium biurate, have not for one moment imperilled the clinical and practical estimate, deep-rooted in experience, of their general utility in gout.
For myself, I incline to the view of the French authors, who would refer the value of alkalies and alkaline mineral waters in gout rather to their general influence on metabolism than to the now no longer tenable conception of their solvent action on uric acid.
Reflecting on the varied constituents of mineral springs and the claim that each and all of them are of value in gout, one naturally looks for certain conditions common to them all. These are, as Burney Yeo rightly says,—
(1) The quantity of water, more or less pure, taken into the body under regulated conditions daily.
(2) The altered mode of life, the regular exercise in the open air, the modified diet, the early hours, the absence of business cares.