As to treatment of these cases by mineral waters, a preference must be given to alkaline, sulphated alkaline, or muriated waters, according to the special indications of individual cases. Thus suppose the subject is stout and plethoric, and given perhaps to hæmorrhoids or pruritis ani, then spas with sulphated alkaline waters (Marienbad, Karlsbad, etc.) may be recommended. But equally good results will follow a course at home of muriated waters, or muriated sulphur waters, such as Harrogate, Llanwyrtid, and Strathpeffer, etc.
Bearing in mind that functional hepatic disorders are in large part secondary to gastro-intestinal derangements, it is probable that the beneficial effect of the above types of waters on the liver is exerted indirectly, though we must recollect that the salts of soda have a direct stimulant action on the hepatic function.[66]
Given in adequate doses, they act as mild, unirritating laxatives, the daily evacuations thus produced relieving hepatic congestion and coincidently any tendency to portal engorgement. Through their dual action of flushing the digestive canal and stimulating hepatic and gastro-intestinal secretory activities, we find the explanation of the decided benefit that follows their use in gastric catarrhs, especially of alcoholic origin, also in catarrhal jaundice, incipient cirrhosis of the liver, and so-called abdominal venosity.
As we know, Sir Lauder Brunton long since pointed out that the ingestion of saline mineral waters tends to counteract any tendency to catarrh of the biliary passages, the biliary secretion tending to become less viscid; consequently the passage of gall-sand is promoted. Some, like Hans Kehr, of Holberstadt, advise a course of saline waters after operations for the removal of gall-stones; others advocate their employment before surgical intervention. It is obvious, however, that their range of usefulness in this affection must be limited and is largely to be attributed to their power of mitigating inflammatory or catarrhal changes in the gall bladder and its related ducts.
Intestinal Derangements.—Constipation is, as is well known, the bête noire of the gouty, and, while the basal indications of its therapy have to be carefully ascertained in every individual, still much may be done by a properly chosen and adequately supervised course of spa treatment. This, of course, entails revision of the diet and habits, notably in regard to exercise; in some of sedentary habit a mere change of air to a more bracing climate, with its associated increase of exercise, may suffice; in others of stout plethoric type a visit to one of the sulphated alkaline spas will be of benefit; while in weaker subjects of the lean kind muriated waters will be more suitable.
In many the habitual constipation is due to a catarrhal condition of the intestine. Trautner, as we know, considers that gout originates in a mucous colitis. In France the gaseous muriated waters of Chatel Guyon are in great vogue for chronic catarrhal conditions of the intestines, especially those associated with abdominal plethora and constipation. Indeed, because of its success in these cases, it is sometimes called the French Kissingen.
On the other hand, the Plombières Spa is the one that par excellence devotes itself to the treatment of mucous colitis by a combination of (1) intestinal douches, (2) sedative warm baths, and (3) “under-water” douches directed against the abdomen. Treatment by the Plombières method is now available at most English spas, and, while I can speak highly of its benefits, I think perhaps there is sometimes a tendency to resort to it after a routine fashion irrespective of the presence of any special indications for its usage. The after-results in some cases are not enviable, and recently a distinguished surgeon informed me that he had met with instances in which ill-advised and prolonged usage of such irrigation resulted in an atonic condition of the colon.
Associated Morbid Conditions
Glycosuria.—The more chronic and benign forms met with in gout frequently derive benefit from a course of mineral waters, though, of course, revision of the diet and regimen in general are essential concomitants thereof. Indeed, the high reputation achieved by certain Continental spas—Karlsbad, Vichy, Neuenahr, etc.—in this disorder is in large part due to the care and attention bestowed on these the basal indications.