In the gouty obese, with a tendency to piles and abdominal plethora, the sulphated alkaline and simple alkaline waters, such as Karlsbad, Vichy, Neuenahr, Brides-les-Bains, etc., are suitable, and in this country the muriated sulphurous waters of Harrogate and Llandrindod.
In some of the gouty obese their bouts of glycosuria sometimes alternate with attacks of uric acid gravel, and not infrequently there is also present a slight degree of albuminuria. In these cases the earthy or calcareous waters enjoy a considerable reputation, notably Contrexéville, and not a few with uric acid gravel and slight albuminuria resort to Wildungen.
I have before alluded to the beneficial effects in glycosuria of Bath waters, which, like Contrexéville and Wildungen, have an earthy or calcareous content. For the less robust and lean type of glycosuric Sir Hermann Weber recommends “simple thermal baths, such as can be obtained at many resorts of moderate elevation (Gastein, Wildbad, Buxton, Schlangenbad, and Ragatz).” As an alternative, he states that “the internal use of muriated alkaline or simple alkaline waters (Vichy, Neuenahr, Obersalzbrunn, Royat, La Bourboule), in association with thermal baths or alone, may often be recommended.”
Oxaluria.—This condition, like glycosuria, is often met with in the gouty. It is of course often due to faulty diet, but in many instances there is a strong nerve element in the case. In the former instance dietetic restrictions are the basal indication. In these cases, if there be constipation, a visit to the muriated springs in this country or to Kissingen, Homburg, etc., is advisable. Otherwise, alkaline springs, i.e., Vichy, or alkaline earthy springs, such as Vittel, Contrexéville, or Martigny-les-Bains, may be given the preference. For those instances in which the nerve element is predominant the character of the mineral waters is quite subsidiary compared with the all-important point of procuring the subject freedom from worry.
Gouty Phlebitis.—It is believed that gaseous muriated waters, both internally and in the form of baths, are useful in counteracting any tendency to phlebitis. Obviously, if there be any symptom or sign of existing phlebitis, any such procedure would be fraught with risk. Still patients who have had phlebitis frequently resort to such spas, notably Bagnoles-de-l’Orme, where the resident physicians have made a special study of the constitutional tendencies to chronic phlebitis. The waters are but weakly mineralised, and may be classed in the simple thermal group (81°-84° F.).
Respiratory Disorders.—While, as I have said, I deprecate any notion of specific gouty types of bronchitis, asthma, etc., there is no doubt that gouty subjects, like many others, are prone to bronchial affections, and for such mineral water treatment at a favourable season of the year, is equally beneficial. In gouty bronchitics of plethoric type, courses of sulphated alkaline waters will often do much to relieve the symptoms. Again, many sulphur, muriated alkaline, and muriated spas, have achieved a great reputation in the same sphere, e.g., Ems, Royat, Eaux-Bonnes, Baden-Baden, and Soden. Nor need we go outside our own country, for many of our mountain health resorts are in the summer months equally eligible for treatment of these disorders of the respiratory system.
Fibrositis.—Adequately to describe all the methods, internal and external, in vogue at spas for the treatment of, e.g., chronic lumbago and sciatica, would be quite futile in the space at my command. I have the less compunction in being unusually brief inasmuch as Bassett Jones and I have dealt exhaustively with the subject in our work on fibrositis.
The groundwork of successful treatment will rest on the application of the general principles in force for the treatment of the underlying gout. They will, of course, include internal and external treatment by simple thermal waters, the thermal muriated and thermal sulphurous waters, etc. Frequently, too, cold muriated and other waters artificially heated are invoked for this dual purpose.
The benefits of external treatment by douches of varying character will depend on the measure of discrimination exercised in adapting their application to suit the individual necessities of the case. But I would here lodge a plea against the far too great frequency with which such cases are sent to spas during the acute phases, whereas it is only the subacute or chronic forms that are eligible for treatment by hydrotherapy.
Gouty Eczema.—The climatic suitability of the spa is of primary importance, and while, as a rule, cold, damp and windy localities are to be avoided, still personal idiosyncrasy plays a large part in the decision, some cases of eczema being aggravated by cold, others by heat and sunlight.