Hyperchlorhydria.—Bickel’s experiments led him to this further conclusion, that in organic gastric disorders accompanied by excess of HCL the simple alkaline and sulphated alkaline group are to be preferred to the muriated waters.
Now, inasmuch as some authorities hold hyperchlorhydria as due to a chronic glandular gastritis, it would seem that these should be given a trial. Personally, I have no practical experience that I can draw upon for substantiation or refutation as to the correctness of Bickel’s assumption. Nor have I on this question been able to find any reference in the literature or clinical findings emanating from these spas.
Much controversy, again, obtains in regard of the usage of muriated waters in these cases. Formerly their employment was unreservedly condemned, but more extended experience has modified this too dogmatic attitude. Albeit, that the results obtained in hyperacidity (excess of HCL) are uncertain is undeniable, and unfortunately it is impossible to foretell whether or no any given case will derive benefit. The pronounced nerve element in these cases, with probably other unknown factors, has doubtless much to say to the conflicting clinical results.
But the experience of most of us will accord with that of Dapper and Von Noorden, that muriated waters, such as those of Homburg, Kissingen, etc., often prove beneficial in cases of neurasthenia with hyperacidity. On the other hand, it is equally true that some examples of apparently the same nature derive no benefit, indeed are aggravated. But, according to Von Noorden, such are in the minority.
Fortunately this secretion of an abnormally acid gastric juice is relatively rare in the gouty. Being of the nature of a secretory neurosis, it occurs most frequently in those of neurotic or neurasthenic type. Now, holding the view that many cases of neurasthenia are due primarily to toxic absorption, secondarily to alimentary derangements, the beneficial effects observed are, I presume, probably attributable in large part to the removal of toxic accumulations through flushing. These deleterious substances not being absorbed in such amounts as before, improvement in the general nerve tone ensues, in which doubtless the secretory mechanisms of the digestive system participate.
But, as we have seen, these same muriated waters prove most salutary in precisely the opposite condition—hypochlorhydria, or deficiency of HCL. That such a beneficial effect should ensue in diametrically opposed states, viz., hyper- and hypo-acidity, gives point, I think, to the contention that the action of muriated waters on the digestive organs must in great part be exerted not locally, but indirectly, that is, secondarily to improvement of the general health and toning up of the nervous system.
Indeed, the pronounced nerve element in these cases is probably the explanation why, especially in instances palpably due to mental fatigue, insomnia, etc., a course of baths or hydrotherapy at some simple thermal spa, preferably those at certain altitudes, such as Buxton, Wielbad, Gastein, Plombière, Ragatz, etc., often suffices without any internal treatment.
Functional Hepatic Disorders.—Fothergill held that some persons were born with “congenitally incompetent livers,” an unwelcome legacy unduly incident among those of gouty heritage. Now the intimate interdependence of hepatic and gastro-intestinal disorders has long been recognised; indeed, the swiftness with which retribution, in the shape of so-called “biliousness,” overtakes those who fare not wisely, but too well, is proverbial even among the laity.
Thus chronic hyperæmia of the liver, due to stasis in the portal area, commonly ensues in those gouty subjects who eat and drink too much, especially alcohol. The same Nemesis awaits those who lead too sedentary a life, and in the train of chronic constipation develop such hepatic congestion, with in some instances attacks of catarrhal jaundice.