Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

It is well that the potency and complexity of spa treatment be realised, involving as it does not only drinking or internal treatment, but also balneotherapy, electro-therapy, and all the other accessory therapeutic methods now at command. With all these powerful weapons to hand, it is obvious that their use demands a corresponding degree of discrimination, this even in cases otherwise suitable, and here a word as to the types of gout most suitable for the internal exhibition of mineral waters.

In this matter the rules laid down for hydrotherapy, or the external use of waters, are in the main applicable. In other words, acute cases of gout are always ineligible, as likewise those instances in which an attack appears imminent or those in which recovery from an acute paroxysm is barely accomplished. On the other hand, mineral waters are indicated in chronic gout and in the inter-paroxysmal periods that mark the early stages of the disorder. Indeed, I know of no other treatment that is as effectual, and, with Sir William Roberts, “I do not think, therefore, that gouty patients, if they can afford the time and expense, should forego the advantages of the time-honoured practice of a visit to a mineral spring.”

But, to attain the best results of spa treatment, not only should the cases be suitable, but they should be despatched at the right season. Even in spas that are open all the year round we should try to select the most congenial month. Thus, if the subject is intolerant of heat, we should not advise him, say, to go to Bath in July or August, or, for that matter, during the hottest summer months to Aix-les-Bains, Baden-Baden, Wiesbaden, Neuenahr, etc. If he has to take his course at this period of the year, and a thermal spring is indicated, Buxton will be more suitable than Bath, and we have a large choice of other spas in more bracing localities, such as Harrogate, Llandrindod, Strathpeffer. In short, some discrimination must be exercised. Again, if a course be indicated in the winter, we should favour those spas where the hotels are in proximity to the springs, so as to obviate unnecessary exposure, e.g., Bath, Wiesbaden, Helouan, etc.

As to duration of a course, there is, I think, in many spas a too great tendency to be dominated by tradition. Not only is the duration of the cure arbitrarily fixed, but, still worse, the drinking of the waters, the bathing, and even the dietaries are frequently in danger of becoming stereotyped, with, as a consequence, a lack of that eclecticism necessary in the best interests of individual cases. A certain amount of routine is unavoidable, and has this advantage, that persons find it easier to submit to irksome restrictions when they see others conforming thereto. But even so there is ample scope for such modifications as may be required, and upon their adoption the success of spa treatment mainly depends.

If arbitrary rules in respect of drinking, bathing, etc., are to be deprecated, the same applies with unvarying fixity to the duration of a cure for all cases. Generally speaking, three to four weeks is the average stay at spas. But obviously it should be varied to suit the patient’s condition, and in many instances of chronic gout it may with advantage be extended to six or eight weeks.

Again, I think perhaps in this country the advantages of an after-cure are insufficiently realised. In this respect our Continental brethren set us an example, attaching the greatest importance as they do to an after-cure, especially after a course of laxative waters, e.g., Karlsbad, Marienbad, and Kissingen. Certainly to plunge forthwith into work immediately after a cure leads but too often to another breakdown and the undoing of any advantages that may have been reaped. Of late I have noted, especially in business men, a tendency to interrupt even their course by travelling considerable distances on non-bathing days to attend to their affairs. The folly of this is obvious, and the results are almost invariably unsatisfactory. Indeed, in these all too strenuous days one almost despairs of after-cures, for it is difficult enough oftentimes to prevail on people to stay even for their course of three weeks, and frequently one is asked to conduct their treatment after a more intensive fashion, and so abridge it to a fortnight or even a week!

As to the nature and site of the resorts suitable for an after-cure it is impossible to lay down general rules, as individual peculiarities have to be considered. But the physician who prescribes such ought, as Sir Hermann Weber remarks, “to be acquainted with the nature of the locality recommended, if possible by personal visits, and the reports of thoroughly judicious people.” For, as he rightly says, there are numerous places in the British Isles perfectly suitable for an after-cure, to mention but a few in England, Ilkley, Ben Rhydding, Malvern, Haslemere, Church Stretton, Crowborough; in Scotland, Braemar, Ballater, etc.; and in Wales, Llanberis, Llangollen, etc.

Spas from a National Aspect

But brief reflection on the foregoing considerations suffices to make it clear that the various spas and health resorts with which this country, through Nature’s beneficence, has been so bountifully endowed, are but members one of another, in short complementary, not antagonistic, as I fear is sometimes thought. This latter is a view to be discarded in favour of a more rational conception of these various centres from their collective aspect as integral parts of a therapeutic whole.

Now what, in a word, is the outstanding feature of our national life to-day? Co-operation—a veritable furore of national and international effort such as the world has never seen. Spas, too, must fall in line with the national trend, must organise and co-operate, if they would play their full rôle in the drama of reconstruction. Now, from the point of view of the State, the true objective in therapeutics is the achievement and maintenance of national efficiency—the production of healthy citizens, sound economic units. This then is the high purpose with which those responsible for spas must ever be animated—an aim only to be attained by their whole-hearted co-operation one with the other.