Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

From his experiments Bickel came to the conclusion that in conditions of subacidity supervening on chronic gastric catarrh the most suitable are muriated waters, or muriated alkaline waters, or simple gaseous waters.

Gastric Insufficiency, or Atonic Dyspepsia.—Now, as I have before emphasised, this is the functional gastric disorder most commonly met with in the gouty; the hyperacidity is due to excess of organic acids, and this, again, is the outcome of not excess, but deficiency, of HCL. Now in cases of this nature with subacidity of the gastric juice numerous observers—Von Noorden, Dapper, Boas, and others—have reported an increase in the secretion of hydrochloric acid following a course of muriated waters.

My own clinical experience of the muriated waters of Llandrindod abundantly confirms the results obtained by these authorities. The enhanced digestive capacity of the patients is evidenced by relief of epigastric pain and discomfort after meals and the decline of flatulent distension. For, following the increased secretion of hydrochloric acid, their intolerance of carbohydrates, due to subacidity, disappears, and, fermentation no longer taking place, the over-distended walls of the stomach gradually recover tone. It is customary for patients to walk either during or after the consumption of water. But in decidedly atonic conditions of the stomach with dilatation it is better, as Ageron suggests, that such subjects lie down after drinking. Nor must the beneficial effect of muriated waters on the associated constipation be overlooked. The daily thorough evacuation of the intestinal canal minimises or prevents toxic absorption, and at the same time depletes the overloaded portal system.

The sources of blood contamination being removed, the general symptoms of languor, drowsiness, and mental depression give place to a more cheerful tone of mind. At the same time relaxation from business, an outdoor life, and bracing air, with change of scene and society, doubtless contribute to dissipate those feelings of supreme misery which are the bane of the dyspeptic.

As to the foregoing remarks, I have but chosen Llandrindod as a type. Thus some of the Harrogate waters are equally eligible for inclusion in the muriated as in the sulphurous group. Again, to these may be added Builth Wells and Llangammarch Wells, the latter distinguished by its content of chloride of barium, which is said to raise the blood pressure and promote diuresis through its tonic action on the muscular coat of the arteries. Woodhall Spa, too, calls for mention, the presence of iodides and bromides in its muriated waters investing it, according to some, with special alterative properties; lastly, the strong brine waters of Droitwich, which find their special sphere in external application by baths.

As to the Continental springs in this category, the most noteworthy are Homburg, Kissingen, and Kreuznach, the last decidedly radio-active; while of thermal muriated waters Wiesbaden and Baden-Baden are the most representative.

Chronic Gastric Catarrh.—In this condition, not uncommon in the gouty, and which Ewald aptly characterises as “the best fostered and widest spread of this world’s ills,” a deficiency of gastric secretion with impaired motility is constantly present. With this is frequently correlated distension of the small intestine, due to abnormal fermentative and putrefactive changes in the food.

Leaving aside the vexed question as to whether muriated or saline waters can be regarded as direct excitants of gastric secretion, it cannot be doubted that the prolonged and systematic lavage of the stomach, ridding it of viscid mucus and hastening the removal of retained fermenting foodstuffs, must favour restoration of a healthy state of the mucous membrane, and thus indirectly promote its secretory activities. Again, inasmuch as the bulk of saline waters undergoes absorption in the small intestine, the duodenal catarrh usually associated with this condition is also markedly benefited by the removal of toxic accumulations. Indeed, Niemeyer, discussing the therapeutic efficacy of mineral waters in such states, goes so far as to remark that “the results obtained are the most brilliant that have ever been attained in medicine.” To achieve these salutary effects the “waters” must be taken in amounts adequate to produce copious daily evacuation. For, if insufficient to ensure this same, discomfort and distension ensue pending the more tardy removal of the water by the kidneys.

Now, while in these cases the muriated waters above alluded to are suitable, the muriated alkaline are equally eligible. Of these the highest in repute are Royat, Chatel Guyon, and Saint Nectaire, and in Germany Ems, Wildbad, Assmannshausen, and Wildungen.

Here a reservation in regard to Bickel’s researches, viz., it has been found that in some cases of chronic gastric catarrh in robust subjects simple alkaline springs, such as those of Vichy, Vals, and Neuenahr, have, despite his experimental findings, proved actually beneficial. On the other hand, these same waters have this cogent objection, that long courses are apt to cause depression and emaciation, and, moreover, may aggravate the gastric trouble. Worse still, these simple alkaline waters are more likely to produce an attack of acute gout, whereas the muriated alkaline varieties are free from these objections.