Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

(3) In many foreign spas there is the drier and hotter Continental climate.

(4) The stimulating effect to excretion and “tissue change” which the baths, douches, frictions, and manipulations applied at most of them induce.

Now, admitting, as one freely does, the important influence exerted by these factors on what may be termed the pathological groundwork of gout, still it is equally certain that some cases of gout do better than others at certain spas.

This leads me on to the further reflection that the favourable or unfavourable reaction in different cases depends on the varying nature of what I may term the “excitants” of gout. For the deviations from health that evoke the disorder are manifold and diverse, each carrying with it its own therapeutic indications. Something more is needed than what may be termed a blind or unintelligent “washing out” process. In every gouty patient there is some functional flaw or defect, and cæteris paribus, that natural spring will suit him best whose mineral or other content is best calculated to correct or minimise his particular deficiency.

In short, we must get rid of our too common habit of asserting that this or that particular water is “indicated in all cases of gout,” and its use “attended with the most remarkable results.” The question that we should be more anxious to decide is, whether of all natural springs this or that particular mineral water is par excellence the one that will most surely and most swiftly correct or minimise that particular functional derangement which in the subject under review experience has shown to be the most fertile source of gouty outbreaks. But to this we shall refer later when dealing with the individual peculiarities upon which our selection of a spa will depend.

To sum up, in consonance with these views, the general principles of spa treatment, as I take it, are:—

(1) To correct or relieve those functional derangements, gastro-intestinal or other, that appear to be the determining causes or excitants of outbreaks of regular gout.

(2) To reduce the toxicity of the blood plasma and tissues by promoting the elimination of uric acid and toxins through all avenues of excretion.

(3) To restore the organism as far as possible to a state of health or functional efficiency, and therewith to adopt such prophylactic measures as shall diminish the liability to recurrence of the disorder.