Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

We have in previous sections emphasised the importance of treating local foci of infection, in view of their possible causal relationship to gout. For, uncertain as we are of the etiology of the disorder, we cannot afford to neglect treatment of any possible source of toxic absorption.

Now a significant number of independent workers contend that in the presence of radium emanation the growth of organisms is retarded, if not actually inhibited. The same bactericidal power has been claimed for radio-active waters even of low grade. Should recent contentions as to the efficacy of the same in states of oral sepsis be confirmed, it will constitute an important weapon wherewith to combat not only the local, but the remote malign, effects of sepsis in the mouth or its accessory cavities.

Again, it is recognised that pharyngeal and nasal affections when present derive benefit from the inhalation of radio-active waters atomised by steam or air. In this connection it may be noted that, by an ingenious apparatus installed at Bath, the natural “niton” gas is now extensively used for inhalation or douching of the mouth and neighbouring cavities.

Alimentary Disorders.—Accepting the fact that gastro-intestinal derangements are the most common excitants of gouty outbreaks, it seems to me highly probable that the good effects of radio-active waters are partly attributable to their mysterious power of activating the body ferments. Thus, through their stimulating action on the digestive enzymes, they may inhibit the formation of abnormal substances, or, through their quickening of the autolytic ferments, may hasten the disruption and excretion of such when formed.

How frequently in these cases do we find that some functional hepatic or gastro-intestinal derangement is the prelude to a gouty outbreak. Again, as pointed out, how often do these subjects suffer with fermentative dyspepsia and “organic acidity,” with associated lowered tolerance for carbohydrates. In such cases, if given in copious quantity and frequently, the radio-active waters prove most beneficial. This is in part attributable to the mechanical flushing of the alimentary canal and tissues, and in part perhaps to their activating influence on the digestive enzymes.

In contrast to the foregoing, such abundant ingestion of the waters is inadvisable in atonic types of dyspepsia marked by dilatation and diminished secretion. But here again, if given in small amounts, radio-active waters undoubtedly exercise a beneficial effect. Also in those gouty subjects who suffer from neurasthenia and nervous dyspepsia a similar favourable reaction is frequently observed. This I apprehend to be due to the fact that radium emanation exerts a sedative effect on the nervous system. Thus it has been noted that guinea-pigs when exposed to radium emanation drop into a state of somnolence and torpor. May not this account for the undoubted fact that highly strung individuals when subjected to a combined bath, drinking, and inhalation cure become less irritable and lose their distressing tendency to insomnia?

Again, intestinal irrigation with these radio-active waters after the Plombières technique is justly esteemed in those cases of gout attributable to intestinal catarrhs and mucous colitis. The constipation these subjects so frequently suffer from is counteracted, and the regular removal of waste and toxic material achieved.

As to the morbid affections associated with gout, notably fibrositis, it is well recognised that muscular and nerve types of this disorder prove very amenable to a course of these waters. Here I would lay stress, too, on the swiftness with which the glycosuria of gouty subjects vanishes under the same conditions. The pruriginous and eczematous eruptions met with are also favourably influenced by a combination of internal and external treatment. I may note, too, that this mode of therapy is not contra-indicated in increased arterial blood pressure. For it has been shown by Deutelmoser, Saubermann, and others that under the influence of radium emanations the blood pressure is reduced.

As regards the administration of radio-active waters, it cannot be doubted that the combined bath, drinking, and inhalation cure is the most advantageous. The subcutaneous injection of radio-active waters does not seem to possess any outstanding advantages, while the danger of sepsis has always to be considered.

As to the relative merits of artificial as opposed to natural radio-active waters, it does not appear to me that the therapeutic action of the former is swifter or more infallible than the products that issue from nature’s laboratory. The limitations and capacities of the latter have been fixed by centuries of experience, and, as far as present researches go, the newly born commercial imitation, at any rate as regards the treatment of gout, has yet to prove itself endowed with a greater range of therapeutic efficacy.