Page:EB1911 - Volume 26.djvu/841

Rh or too little is eliminated, so that it tends to be deposited as urate of soda in the joints and other tissues. Two means of treating it by diet have been proposed. One is to put the patient on an almost complete vegetarian diet, so as to limit both the amount of uric acid introduced into the body as well as its formation in the body. The other plan is to use an exclusively meat diet, combined with the ingestion of a large quantity of hot water, so as to cause free elimination. Where neither method is strictly pursued it is usual to forbid to gouty patients sugar, pastry and pickles, and to forbid heavy wines, especially Burgundy and port. During an attack of acute gout nothing relieves so much as colchicum, but during the intervals potash or lithia salts taken in water are advisable, as tending to prevent the deposits of urate of soda. In true diabetes, which probably originates in the central nervous system, or in disease of the pancreas, as well as in the glycosuria common in gouty patients, sugar in every form should be entirely forbidden, and starchy food restricted to within narrow limits. The remedy most trusted to in this disease is opium and its alkaloids, morphine and codeine. In acute attacks of rheumatism the remedy par excellence is salicylate of soda, which reduces the temperature, relieves the pain, and removes the swellings from the joints. Rest in bed should be insisted upon for a longer time than appears actually required, because acute rheumatism tends to bring on cardiac changes, and is more likely to do this when the heart is excited than when the patient is kept at rest. In chronic rheumatism the chief remedies are salicylate of soda, and its allies iodide of potassium, guaiacum and sulphur, while massage, liniments and baths are beneficial as local applications.

Elimination of waste-products is one of the most important points in regard to health, and when this is interfered with by disease of the kidneys, the life of the patient is rendered more or less uncertain and the health frequently seriously impaired. In some cases of chronic inflammation of the kidneys, where the disease is not extensive, the patient may continue in fair health for a number of years, provided attention be paid to the following rules: - (i) The body must be kept warm, and chills must be scrupulously avoided; (2) the digestion must be attended to carefully, so that no excess of poisonous bodies is formed in the intestine or absorbed from it; (3) eliminating channels such as the skin and bowel must be kept active. It is usual to reduce the quantity of proteid food to a minimum, in order to lessen the amount of nitrogenous waste to be excreted by the kidneys. Sometimes an entirely milk diet is useful, but in others it does not agree, and a more liberal diet is essential. Alcohol should be avoided as much as possible. The small contracted kidney, which is so common in elderly gouty people, is usually associated with a very large secretion of urine containing only a minute trace of albumin. The tension within the blood-vessels is generally high, and the patients run a risk of anginal attacks or of apoplexy. A nearly vegetarian diet and a complete abstinence from alcoholic stimulants is the ideal in such cases, but it must be modified to suit individuals, as sometimes very strict limitations prove injurious. The daily use of potash, and especially nitrate of potash, tends to reduce the tension and increase the patient's safety, but if pushed too far may sometimes render him very weak and depressed.

It has already been mentioned that water is absolutely necessary for the body: by taking it hot it does not lie like a weight on the stomach, and by taking it an hour before meals it washes out the remnants of the previous meal; and being absorbed into the blood, it probably renders the secretion of gastric juice freer and accelerates digestion, instead of diluting it and interfering with the digestive processes. Where the stomach and bowels are irritable, all food likely to cause mechanical irritation should be avoided, such as skins, bones, fibres and seeds. In some cases of diarrhoea an entirely milk diet has to be prescribed, and in the diarrhoea of children it is sometimes necessary to alternate a diet of barley water with one of beef juice or white of egg and water, or to give whey instead of milk. The drinking of large quantities xxvi. 26 of whey is used as a means of cure for dyspepsia in adults, and also in cases of chronic bronchitis. The whey is drunk warm, and for this cure it is usual to go to some Alpine resort where pasturage is abundant and fresh milk can be had at all times of the day. The cure is greatly helped by the fresh air and sunshine of such places, among which are Interlaken, Rigi-Scheideck and Weggis in Switzerland; Ischl and Meran in Austria; Harzburg, Reichenhall and Sanct Blasien in Germany. Another therapeutic method is the so-called "grape cure," in which, along with a regulated diet, five or six pounds of grapes are eaten daily. As the grapes contain a quantity of water and of salts, they tend to lessen the amount of food taken, to increase the action of the bowels, and to stimulate the kidneys. The "grape cure" is used both in chronic disease of the stomach and intestines with or without constipation, and also in cases of gout or ailments depending upon a gouty constitution. The chief places where it is carried on are in the neighbourhood of the Rhine, on the Lake of Geneva and in Tirol. Amongst places in the Rhine and its vicinity may be mentioned Kreuznach, Neustadt, Riidesheim and St Goar; on the Lake of Geneva are Montreux and Vevey; and in Tirol Gries and Meran. The socalled "Salisbury" cure consists of living entirely upon minced beef and hot water. It sometimes answers very well in persons troubled with flatulence, since meat does not give rise to the same amount of gas in the intestines as carbohydrates. During its continuance fat is absorbed from the subcutaneous tissue, and patients become very much thinner, so that it not only lessens flatulence, but reduces obesity. It is, in fact, very much the same system as that proposed a number of years ago by Banting (see Corpulence). It is very important for those who are trying this diet to bear in mind the necessity of abundance of water, because sometimes they may be tempted to lessen the water on account of the inconvenience produced either by frequent micturition or too profuse sweats. If the meat diet be continued with too small a proportion of water, a gouty condition may be brought on. This diet has been recommended in gout, and no doubt the essential part of it is the hot water, but there can be little doubt that in fat gouty people it is often useful. An entirely opposite dietary is that in which butcher's meat is completely excluded and proteids reduced to a minimum, as advocated by Dr Haig. This dietary also is very useful in gout, but it answers better in thin gouty people than in fat ones.

The dietaries already mentioned, the whey cure, the grape cure, the meat cure and the vegetarian cure, are all more or less systems of starvation, one or other article of ordinary diet being either reduced to a minimum or omitted altogether. In three of them at least - the whey cure, the grape cure and the meat cure-a diminution in one or other of the solid constituents of food is associated with the ingestion of an unusually large quantity of water. In visiting the most famous wateringplaces, it is curious to note how one finds, in the various waters, here some chloride, there some sulphate, here some potash, there some magnesium, but in all of them we find water. In watching the troops of patients who go to the wells we notice that most of them do more early rising, take more regular exercise, and drink more water in the course of a month at the well than they would do in the rest of the year at home. The watering-places divide themselves, according to the temperature of the waters, into cold and thermal, and according to the composition of the waters, into purgative saline, indifferent saline, sulphur and iron. Amongst the most celebrated saline waters are those of Carlsbad, which contain sulphate of soda and bicarbonate of soda. These salts crystallize out when the water is partially evaporated and may be used with hot water at home, the best imitation of the Carlsbad water being obtained by mixing with hot water the powdered Carlsbad salts (pulverformig), which contain all the constituents of the natural water. Where it is impossible for the patient to visit Carlsbad, half a teaspoonful or a teaspoonful of salt may be taken in a large tumbler of hot water on rising every morning; but when taken at home the treatment is not so effective as at Carlsbad, because