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J3S 
 
 URICACIMMIA ; 
 
 ITS CAUSES, EFFECTS 
 
 A.ND 
 
 TREATM ENT. 
 
 PERRY DICKIE, M. D. 
 
 Philadelphia : 
 
 BOERICKE & TAFEL,. 
 
 1903. 
 
THE LiBRA 
 
 RYOF 
 
 CONGRESS, 
 
 Two Copies 
 
 Received 
 
 JAN 21 
 
 1903 
 
 \ Copyright 
 
 Entry 
 
 &LASS CU 
 
 <1 6 3 
 XXc. No. 
 
 € & %-( 
 
 S 
 
 COPY 
 
 B. 
 
 COPYRIGHTED 
 
 BOER1CKE & TAFEL. 
 
 1903. 
 
 .:";!.: 
 
 T. B. & H. E. COCHRAN, 
 
 PRINTERS, 
 
 LANCASTER, PA. 
 
DEDICATION. 
 
 TO THK 
 MEMBERS OF THE CLASS OF '80, 
 
 IN WHOSE COMPANY THE AUTHOR PLODDED 
 
 THROUGH THE TORTUOUS BUT PHEASANT 
 
 PATHS OF MEDICAL LORE, THIS 
 
 LITTLE VOLUME IS MOST 
 
 HEARTILY DEDICATED. 
 
PREFACE. 
 
 Knowing full well that the very complete 
 and voluminous work, by Haig, on "Uric 
 Acid," exists, and to which, by the way, the 
 writer is largely indebted for much general 
 information as to his interesting, ingenious, 
 and valuable theories on this subject, in the 
 preparation of this work, however, believ- 
 ing that something smaller and more com- 
 pact might be acceptable to the physician, 
 on this assumption he launches forth this 
 little volume upon the sea of chance, hoping 
 that it will meet with some success as to 
 proving of slight value to the medical pro- 
 fession in elucidating the question as to the 
 importance of uric acid as a disease factor. 
 
URICACID^MIA. 
 
 Introduction. 
 
 That the past history of medicine has 
 been the repository of innumerable fads and 
 fancies is a veritable fact to which we can 
 all readily attest without the slightest feeling 
 of uncertainty ; a large proportion of which 
 being of a purely ephemeral and fleeting 
 nature, often of no value from a scientific 
 standpoint, while others of a kind more 
 stable and lasting, have become, after pass- 
 ing through the ordeal of trial and exper- 
 ience, valuable factors of intrinsic worth. 
 
 In the memory of the modern physician of 
 extended experience and observation will 
 be cognizant of three, what we might term, 
 epochs or periods, in which it would seem 
 that the unanimous mind of the medical pro- 
 fession ran to a certain extent, as far as pos- 
 sible, in one channel, that is, to the certain 
 points in question ; which, by the way, as 
 unanimity on any one subject in the medical 
 profession being not a common occurrence. 
 
8 Uricacidcemia. 
 
 we must therefore consider that when such 
 as this happens it is surely deserving of the 
 dignified title of epoch. 
 
 The principles of these in their beginning, 
 although rather partaking of the nature of 
 fads, and to many almost a subject of ridi- 
 cule, however later did each a great fetich 
 become ; but time and experience demon- 
 strating their full value and worth, the scof- 
 fers and mockers fell into line, as well as the 
 scales falling from the worshippers' eyes, 
 they therefore settled into their proper place 
 in the domain of medicine. 
 
 Of the three subjects to which I have al- 
 luded as constituting epochs, we have, first, 
 the "Bilious," when, in the words of the 
 patent medicine pamphlet, "the liver is 
 (was) king ; " to us of middle age this experi- 
 enced in our boyhood days, in the shape of 
 treats to that delightful tasting stuff — man- 
 drake — in decidedly appreciable quantities* 
 or the volatile mercury, in doses however to 
 us as results, certainly did belie this descrip- 
 tion of its, at least, physical properties. The 
 old physicians of the present day have a 
 practical remembrance of this age, and fully 
 know the worth of the term " bilious" as a 
 diagnostic appellation to satisfy the com- 
 
Uricacidczmia. 9 
 
 munity at large, whether the condition was 
 a case of bile excreted in too profuse quan- 
 tity, or not at all ; as this ever potent term 
 was sufficient to lull the most tumultuous 
 bosom to rest in quiet peace. However, 
 this useful etiological factor served its time 
 well, but as all things have an end, this was 
 not an exception to the rule, and with the 
 passage of time has now sunken almost into 
 oblivion, except in patent medicine circulars, 
 where its value is of tremendous import. 
 
 Then the second of these epochs appeared 
 upon the scene with " Malaria" inscribed 
 upon its banners. Becoming the common 
 watchword and the cry, the why and the 
 wherefore for every pain and ache, the cause 
 of every ill to which mankind was heir, and 
 quinine in massive doses was crammed into 
 the unfortunate individual very much after 
 the fashion of feeding the wretched fowl 
 fattened for market by means of the stuffing- 
 process. 
 
 This period is within the recollections of 
 many of us during our professional experi- 
 ence, and we can appreciate the tremendous 
 support and mainstay that this portentous 
 word has been to us ; how it has helped us 
 out of many quagmires of doubt, when the 
 
io Uricacidcemia. 
 
 admission of indecision or uncertainty would 
 have been utter annihilation to our pride and 
 dignity. 
 
 With the inevitable decline of this period 
 has been the adoption of this term with a 
 signification of an actual existing state, and 
 not of meaningless import as originally used. 
 
 The third and most important etiological 
 factor which has held sway ever since is 
 "Uric Acid," greater than its predecessors, 
 being founded upon genuine facts; in short, a 
 real condition capable of producing much of 
 the mischief laid at its doors, so much so that 
 the use of this term, as a cause of disease, 
 has not seemed to have partaken of the slip- 
 shod character of diagnosis as the two former 
 ever have. True, this agent in the past has 
 been made a veritable pathological scape- 
 goat for all the ills of humanity ; the cause 
 of everything we had or might have had ; a 
 cloak wherewith to cover our ignorance. 
 But this is largely of the past, as uric acid as 
 the cause of disease has been for some time 
 settling into its proper place, as its prede- 
 cessors have done ; but owing to a position 
 more stable and firmer than the others, this 
 decline has not been so great, or its ultimate 
 position as obscure or lowly, but simply to its 
 
Uricacidczmia. 1 1 
 
 rightful sphere in the domain of pathology. 
 That it will ever be relegated to the past, 
 as has been the case with so much in medi- 
 cine, is not at all likely, for as long as we 
 have the present existing state of civilizing 
 influences, together with the inactive life of 
 the so-called better classes, this cannot but 
 be ever present as an important etiological 
 factor in disease. 
 
 Having passed through the various stages 
 which every new theory or discovery in med- 
 icine has undergone ; at first overestimated 
 and overworked, extolled to the skies as 
 potent for all ills ; in fact, claims made for 
 it far in excess of its capabilities ; to be fol- 
 lowed by the inevitable fall from grace, in 
 which its former praise is turned into con- 
 demnation ; exceptionally it has escaped 
 this latter, but has surely come down from 
 its heights of faddism to a mundane level, 
 where it is possible for it to remain immuta- 
 bly fixed and permanently established for the 
 future in the domain of medicine not subject 
 to the change of opinion, a possibility of ex- 
 ceedingly frequent occurrence in the medical 
 profession. 
 
SYNONYMS. 
 
 Uricacidsemia. 
 
 Uricsemia. 
 
 Uric Acid Diathesis. 
 
 Lithaemia. 
 
 Lithiasis. 
 
 Lithuria. 
 
 Lithic Acid Diathesis. 
 
 Latent Gout. 
 
 Arthritic Diathesis. 
 
DEFINITION. 
 
 Uricacidsemia is essentially a derangement 
 of the process of metabolism ; an impair- 
 ment of the eliminative functions of the 
 body; whereby certain excrementary sub- 
 stances are retained in the blood, setting up 
 various disturbances, resulting in this condi- 
 tion. Characterized by manifestations of a 
 decidedly protean character, simulating va- 
 rious other diseases, and acting as a toxic 
 agent of different degrees of power, ac- 
 cording to the amount retained in the sys- 
 tem, and the susceptibility and temperament 
 of the individual ; those of the nervous being 
 most susceptible, undoubtedly owing to its 
 irritant action upon the nervous system. 
 
 True, it has been until recently a veritable 
 medical scapegoat at whose door nearly all 
 of the ills have been laid, when we could not 
 find the true cause ; its symptoms and influ- 
 ences probably in many cases largely exag- 
 gerated ; still it is a bona fide etiological 
 factor, a genuine pathological condition, its 
 action thoroughly accounted for, and in 
 every way worthy of the dignity of being 
 considered a veritable disease. 
 
1 6 Definition. 
 
 It has at times been termed by the fa- 
 cetious or sarcastic the lazy man's disease, 
 though in some ways not inappropriately > 
 because the sedentary are so frequently the 
 recipients of its action ; but even so it does 
 not follow that all others are exempt by any 
 means, although non-activity is certainly 
 not a cure for it. 
 
 A most widely prevalent and commonly 
 existing complaint, being nowise a respecter 
 of persons, attacking the wealthy devotee of 
 fashion, who, by the way, spends two-thirds 
 of the twenty-four hours in counteracting its 
 effects so as to be able to eke pleasure and 
 dissipation out of the remaining one-third ; 
 as well as the sedentary brain-worker and 
 the closely-confined man of business ; all 
 being a victim of its pernicious effects. 
 
 The only class of humanity free from its 
 bad results and escaping the attending con- 
 sequences is the hard working son of toil, in 
 whom the functions of metabolism are in 
 such a complete working order that waste 
 products in such have no chance to accumu- 
 late, but are rapidly and completely elimi- 
 nated as soon as formed, as intended in the 
 normal process of nature. 
 
URICACID^MIA. 
 
 METABOLISM. 
 
 The ultimate normal object and end 
 of all nutritive matter taken into the 
 body is for the purpose of the building 
 up of the tissues and the replenishment, 
 of waste. This following upon the prep- 
 aration of the food for assimilation by 
 means of the digestive processes in the 
 stomach and intestines ; which passing 
 from the latter through the lacteals and 
 blood vessels, is carried to the various 
 tissues to replace the never ceasing 
 losses entailed upon them by the pro- 
 cesses of life, besides in addition to this, 
 in children and young people supply- 
 ing the material for their bodily growth. 
 A constant change going on in the 
 
18 Metabolism. 
 
 body by which the protoplasm of the 
 cells is being destroyed and the new pro- 
 toplasm built up by the assimilation of 
 the food. 
 
 This process of life is resultant of 
 waste material normally carried from 
 the tissues by the blood, and by means 
 of its several excretory functions, urine, 
 perspiration, etc., is discharged from 
 the body. 
 
 Regarded as a whole, these changes 
 taking place in the human economy, 
 from the assimilation of the food to the 
 deliverance of the waste products to the 
 organs of excretion, although complex 
 and purely of a chemical nature, are 
 characterized under the general term of 
 " Metabolism." 
 
 Composed of two factors : Anabol- 
 ism, or assimilation proper, a construct- 
 ive process relating solely to the build- 
 ing up of the tissues ; and Katabolism, 
 a destructive process consisting of the 
 combustion or breaking down of tissue 
 
Metabolism. 19 
 
 into a lower state of oxidation, with 
 the consequent formation of waste 
 products, as carbonic acid, water, and 
 the various nitrogenous substances, 
 urea, uric acid, etc. Those which 
 concern us principally in this connec- 
 tion being confined solely to the nitrog- 
 enous, of which uric acid is the main 
 factor, although it is claimed by some 
 that there are also other bodies with it 
 in exercising its deleterious influences. 
 However, for all practical purposes we 
 may assume this to be the one. 
 
ORIGIN OF URIC ACID. 
 
 Uric Acid like urea is a waste product 
 of the metabolism of nitrogenous prin- 
 ciples , and varies entirely in quantity 
 with the character of tlie food taken. 
 
 . Of the several theories as to its 
 origin, that of the liver being the seat 
 is not well authenticated, as this organ 
 contains but a small amount, and the 
 blood in the hepatic vein containing no 
 more than that which, is conveyed to 
 the liver by the portal vein. As it is 
 found in considerable quantity in the 
 spleen, and as the return blood from 
 this gland must enter the liver, it 
 would serve to explain the amount of 
 uric acid emerging from the latter 
 organ. 
 
 To the kidneys has also been at- 
 tributed the function of the formation 
 of this substance, but there is also a 
 
Origin of Uric Acid. 2 1 
 
 lack of any positive data on this point. 
 Another theory which has had many fol- 
 lowers, is that uric acid, like the other 
 constituents of the urine, is separated 
 from the blood by means of the se- 
 lective power of the epithelial cells 
 lining thetubuli uriniferi of this organ. 
 But the most generally accepted opin- 
 ion, however, the most plausible as 
 borne out by results and facts, seems to 
 be in favor of the view that uric acid 
 is formed within the tissues, and simply 
 eliminated in the urine by the kidneys 
 as a mechanical process, as far as it re- 
 lates to them. 
 
OCCURRENCE OF URIC ACID. 
 
 Uric Acid is a permanent constituent 
 found in the urine in combination with 
 sodium and ammonium, constituting 
 the " acid urates ;" is slightly soluble 
 in water, but readily so in alkaline 
 fluids, as the blood, and when separated 
 from these bases, due to an excessive 
 amount of uric acid, appears in the 
 typical, whetstone, crystalline form re- 
 sembling grains of Cayenne pepper. 
 By some it is claimed to be ever pres- 
 ent in the blood in varying amounts. 
 
 As to the normal proportion of the 
 elimination of uric acid authorities 
 differ, some giving five to eight grains 
 per twenty-four hours on a vegetable 
 diet, proportionately increased accord- 
 ing to the amount of nitrogenous food 
 ingested, about ten to fifteen grains in 
 the same period. 
 
Occurrence of Uric Acid. 23 
 
 While, according to Haig, it varies 
 in proportion to the urea in the ratio of 
 one to thirty-three ; the urea ranging at 
 from three to three and a-half grains per 
 pound of body weight, which in a man 
 of, say, one hundred and fifty pounds, 
 would be somewhat over fifteen grains 
 in the twenty-four hours. Therefore, as 
 to this point, we can readily see that 
 the subject is not as clear as one 
 would wish for. 
 
 The amount of uric acid excreted 
 will materially vary with the diet, but 
 it is not the excretion of this product in 
 its normal amount or excess that gives 
 us any trouble, but its retention in the 
 system that does so. 
 
 The occurrence of uric acid in the 
 body in normal proportions is, of course, 
 as we know, the result of the meta- 
 bolistic functions, an excretory waste 
 product ; but when in excessive quan- 
 tities constituting a pathological condi- 
 tion, is to be attributed to one of two 
 causes. 
 
24 Occurrence of Uric Acid. 
 
 i. A fault in the process of Katabol- 
 ism, whereby the eliminative matter, 
 the ultimate end of which should be 
 urea, being by reason of some patho- 
 logical process, this oxidation is not 
 carried far enough, and as a result we 
 have uric acid instead. Essentially 
 constituting a jpathological condition, 
 or, 
 
 2. Simply an increased formation due 
 to a diet largely consisting of nitroge- 
 nous substances ; the uric acid derived 
 therefrom, which not being properly 
 eliminated on account of its excessive 
 amount, or certain conditions existing 
 which do not favor its excretion, accu- 
 mulates in the body; an increased elim- 
 ination taking place at times of quan- 
 tities stored up in the past, and re- 
 moved by the alkalinity of the blood. 
 Partaking more of a purely physical 
 process. 
 
 Haig and others deny the former of 
 these, and claim that the latter is the 
 
Occurrence of Uric Acid, 2 5 
 
 only cause. The writer is of the opin- 
 ion that it is possible for both to be at 
 times causative factors in this condi- 
 tion. 
 
 Uric acid being soluble in alkaline 
 and insoluble in acid solutions, its pres- 
 ence in the blood would depend upon 
 the reaction of that fluid, which condi- 
 tion is almost entirely influenced by 
 the food taken, bodily exercise and 
 temperature. In regard to which latter, 
 exercise increases and cold diminishes 
 the alkalinity. 
 
 Although uric acid may be ever pres- 
 ent in the blood, still its quantity 
 varies largely in the twenty-four hours, 
 which, according to Haig, is in excess 
 when the acidity of this fluid is low, 
 from four or five in the morning to two 
 in the afternoon. During which period 
 the so-called " alkaline tide " occurs, 
 about nine in the morning to twelve 
 o'clock noon, when it is in an amount 
 three-fold that of the other period. 
 
26 Occurrence of Uric Acid. 
 
 The excess at this time not being 
 due to any increase in formation, how- 
 ever, but simply an elimination of that 
 retained or stored up during the other 
 portions of the day, when the acidity is 
 in excess, or, more properly expressed, 
 the alkalinity is low. 
 
 The other period, from two o'clock 
 in the afternoon to the early morning 
 hours, is termed the " acid period,' ' not 
 that its reaction is at any time acid, 
 but simply less alkaline, when the 
 urates being rendered more insoluble 
 they are in it in a lesser amount. This 
 period is also influenced by diet, cold, 
 etc., as is the other, and the quantity 
 of uric acid also fluctuates, in which 
 we find it from about three to six in the 
 afternoon, to be less acid, and is some- 
 times termed in consequence the second 
 alkaline tide. 
 
 These periods are of considerable im- 
 portance in explaining the various 
 phenomena occurring in cases of 
 
Occurrence of Uric Acid. 27 
 
 uric-acidaemia, as the appearance of 
 symptoms and other manifestations of 
 this condition. 
 
 Exercise and work increase the alka- 
 linity of the blood, bringing into it the 
 uric acid, which if stored up in the 
 tissues in any considerable amount is 
 the cause of fatigue. Those who exer- 
 cise most retain the least uric acid, and 
 in such the storing up is little, if any, 
 consequently their fatigue is but a 
 minimum ; but in the sedentary and in- 
 active this is retained in large quantities 
 and they therefore tire on the slight- 
 est exertion. For instance, gout, in 
 which we have this storing up pro- 
 cess at its maximum, seldom, if ever, 
 attacks the laborer. 
 
 Cold and winter weather by dimin- 
 ishing the perspiration, there is a con- 
 sequent retention of its acids in the 
 system, therefore keeps the alkalinity 
 of the blood low, whereby the uric acid 
 retained in the body is driven into the 
 
28 Occurrence of Uric Acid. 
 
 tissues, or, according to Haig, may also 
 be thrown down in a colloid form in 
 the blood when in too excessive quan- 
 tity to be taken into them. 
 
 With high uric acid there is a low 
 acidity and urea, also a diminished 
 urinary secretion, its excess (uric acid) 
 in the blood obstructing the circulation 
 of the kidneys, thus preventing diuresis, 
 and with which condition we have an 
 accompanying high blood pressure. 
 
 Fevers cause acidity of the blood, 
 with its attendant rapid combustion of 
 the tissues; but in time, as the vitality 
 of the system becomes worn out, this 
 decreases and the blood becomes more 
 alkaline. Resultant on this excess of 
 stored up uric acid being excreted is to 
 be attributed the various sequelae of so 
 common an occurrence. 
 
EXCRETION OF URIC ACID. 
 
 Haig considers the absolute amount 
 of uric acid excreted as of less import- 
 ance than its relation to the urea 
 passed, which, as we have said before, 
 should be in the ratio of one to thirty- 
 three, with the urea at three to three 
 and a half grains per pound of body 
 weight. The amount of uric acid 
 eliminated in the urine is increased or 
 diminished by the greater or lesser 
 alkalinity of the blood, owing to its 
 solubility under these circumstances. 
 
 An increase of this product is usual 
 for a day or so after the administration 
 of alkalies or sodium salicylate, pre- 
 sumed to be the uric acid stored up in 
 the tissues and various organs, during 
 which period it is to be found in in- 
 creased quantity in the blood and the 
 urine. 
 
30 Excretion of Uric Acid. 
 
 A diminution of the alkalinity of 
 the blood for any length of time results 
 in a diminished excretion of uric acid. 
 
 In youth there is always a minus ex- 
 cretion due to a lessened amount of 
 waste products in the process of de- 
 velopment, winch at maturity is in- 
 creased, while at old age the output is 
 larger still. 
 
 In spring, especially, and summer a 
 larger excretion occurs, as heat in- 
 creases the alkalinity of the blood ; de- 
 creasing in autumn and winter, as cold 
 diminishes the alkalinity of this fluid, 
 and, therefore, drives the uric acid into 
 the tissues, except when present in an 
 excessive amount, causing a condition 
 of discomfort and sensitiveness to the 
 cold so common in individuals suffer- 
 ing from this complaint (uricacidsemia) . 
 
 Many persons, when the warm 
 weather of spring comes on, suffer 
 from malaise, fatigue on the least ex- 
 ertion, and a general feeling of wretch- 
 
Excretion of Uric Acid. 3 1 
 
 edness, attributed by certain elderly 
 females versed in medical lore to sundry 
 marvellous pathological causes, as 
 "thickening of the blood," " spring 
 blood humors/' etc.; the true explana- 
 tion being an accumulation of uric acid 
 in the system during the cold months, 
 due to confinement indoors, sedentary 
 life, or a diet of too heavy a nature ; 
 consequently when the heat coming on 
 and the blood becoming more alkaline 
 this stored up product coming into it in 
 increased quantities and being excreted 
 causes a condition of at least discom- 
 fort, if not sometimes symptoms of a 
 more serious nature. 
 
 All substances which increase the 
 solubility of uric acid in the blood aug- 
 ment also its excretion in the urine, 
 while all those which diminish its solu- 
 bility by causing acidity or lowered 
 alkalinity lessen, also its amount in the 
 urine, driving it into the tissues and 
 causing a condition of irritation to 
 those susceptible to its influence. 
 
3 2 Excretion of Uric Acid. 
 
 In the latter class are to be in- 
 cluded mineral acids, wines, beers, etc., 
 which, as we know, cause gout by free- 
 ing the blood from the uric acid con- 
 tained in it and sending it into the 
 tissues and joints. 
 
 Certain drugs form soluble com- 
 pounds with uric acid, or, by making 
 the blood more alkaline, aid in its 
 elimination through the kidneys, as the 
 alkalies, sodium and potassium, also 
 salicylic acid and the salicylates, and, 
 when the alkalinity is low, salicin and 
 salol also acting in this way. 
 
 Besides sodium phosphate, in a 
 highly alkaline media only, as well as 
 piperazine, quinine and belladonna, as 
 also a vegetable diet, by diminishing 
 the acidity. 
 
 In opposition to this we find certain 
 other drugs forming insoluble com- 
 pounds with uric acid, thus not allow- 
 ing of its excretion, as the various acids, 
 especially mineral ; the metals, as iron, 
 
Excretion of Uric Acid. 33 
 
 lead, mercury, silver, copper, zinc, 
 lithia, manganese, calcium; the sul- 
 phates, chlorides, etc., besides acid 
 sodium phosphate ; or else raising the 
 acidity (lowering the alkalinity), there- 
 fore resulting in insoluble compounds, 
 as opium, cocaine, iodides, antipyrin, 
 ammonium, nitrates and various com- 
 pounds of sulphur. These all diminish 
 the excretion of uric acid by clearing it 
 out of the blood and circulation, but 
 bring about its retention in the 
 tissues, joints, spleen, liver and other 
 organs, resulting in a train of symp- 
 toms exactly the reverse of those ex- 
 perienced when it is retained in the 
 blood In fact, a condition of stimula- 
 tion. 
 
 Even lithia as a solvent of uric acid, 
 hitherto so highly extolled as a panacea 
 for all conditions attributed to the re- 
 tention of this product, according to 
 Haig, while it removes the uric acid 
 from the blood, never reaches this 
 3 
 
34 Excretion of Uric Acid. 
 
 substance itself, but by combining with 
 the phosphates in the blood lessens its 
 alkalinity, thus driving it into the sys- 
 tem. 
 
 Likewise cold, fevers and alcoholic 
 beverages cause a condition of acidity, 
 holding back the urates in the tissues. 
 
ETIOLOGY. 
 
 Uricacidsemia is essentially a disease 
 of comparatively modern times, due to 
 a pernicious mode and method of life, 
 inactivity, diet, etc. The consequences 
 and results of an imperfect excretion of 
 the waste products in the act of living, 
 either through an excess of nitroge- 
 nous substances taken into the system 
 there ensues such an accumulation ot 
 these products whereby the oxidizing 
 functions are overwhelmed and unable 
 to dispose of them by excretion, or else 
 a condition in which the metamorphosis 
 in the human economy is not carried to 
 completion through a fault in the 
 chemical processes in the bodjf ; in 
 other words, instead of urea, perfectly 
 soluble and easily eliminated, the ulti- 
 mate excretory and product of the 
 metabolism of nitrogenous substances, 
 
36 Etiology. 
 
 owing to an incomplete oxidation, they 
 consist of nric acid, which, possessing 
 different properties as to solubility, 
 elimination, etc., is retained in the sys- 
 tem, acting as an irritant to the various 
 structures and organs. 
 
 Owing to what is termed an increased 
 acidity of the blood, but in reality 
 simply a diminished alkalinity, being 
 unable to hold the uric acid salts in 
 solution, a deposition of this substance 
 takes place into the tissues, a condition 
 of affairs we find in gout, and, accord- 
 ing to Haig, also in rheumatism, two 
 diseases which he claims to be identi- 
 cally the same as to their etiology, dif- 
 fering, as he considers, simply in the 
 former being more localized and the 
 latter more of a diffused character. 
 
 But the more common forms of 
 uricacidsemia, however, are those de- 
 rived from the presence of uric acid in 
 the blood, its occurrence there due to 
 an excess in the system, in an amount 
 
Etiology. 37 
 
 not possible to permit this fluid to be 
 free from it at any time. 
 
 To this condition Haig attributes an 
 innumerable train of symptoms, also 
 going so far as to make it an etiological 
 factor for various actual diseases, as 
 epilepsy, apoplexy, etc. While the 
 more conservative would not feel will- 
 ing to agree with him in all his reason- 
 ings and theories, still we cannot but 
 admit that his explanations sound very 
 plausible, and we are sometimes almost 
 carried along with him in his surmises ; 
 but we must admit, however, that he 
 supplies us with valuable etiological 
 reasons for some conditions hitherto 
 not accounted for, and while we at the 
 present time do not admit all of his 
 theories, still, however, much of them 
 are to be accepted as of great value, as 
 supplying many missing links in the 
 etiology of disease. 
 
 Of importance as a causative factor 
 in this condition is an inherited 
 
38 Etiology. 
 
 tendency on the part of some, derived 
 especially through gouty parents, the 
 transmission by tlie male side being 
 more common, manifesting itself by 
 means of the various symptoms char- 
 acteristic of this condition. 
 
 In such cases we have most assuredly 
 what has been termed a " uric acid dia- 
 thesis/' denied by some as not existing, 
 among whom Haig being one who dis- 
 putes it. 
 
 Among the causes of this condition 
 we will find anything which tends to 
 promote a sluggishness of the process 
 of assimilation and excretion. 
 
 The most important of which in 
 contributing their share, we may men- 
 tion, a sedentary, inactive life as tend- 
 ing to lower the par of the system, too 
 much confinement indoors, with insuffi- 
 cient fresh air, practically starving the 
 blood of the necessary oxygen for the 
 complete metamorphosis of this product 
 into urea, which, being deprived of it, 
 
Etiology. 39 
 
 thereupon seizes upon what is available 
 in the blood corpuscles. 
 
 Errors in diet and excess of food are 
 also attributed as a cause, possibly due 
 to their natural impairment of the 
 health, rendering the subject suscep- 
 tible to, in fact, any deleterious influ- 
 ences. 
 
 A neurotic temperament and too 
 much worry we would expect to predis- 
 pose an individual to a condition so 
 liable to arise from a cause of such an 
 irritating nature to the nervous system. 
 
 Inasmuch as sufferers from this con- 
 dition are usually worse in cold weather, 
 this has been given as one of the causa- 
 tive factors; but, unless the blood of the 
 subject is pretty well charged with uric 
 acid, I do not think he would be likely 
 to be influenced by low temperature, 
 rather, according to Haig, it would, if 
 but in small quantities, be removed 
 from the blood, but if present in large 
 amounts would be precipitated in it, as 
 he expresses, in " colloid n form. 
 
40 Etiology. 
 
 Another cause that has been ad- 
 vanced is too little water drinking, 
 which it seems hard for us to realize 
 how this could be ; and also the use of 
 alcohol and tobacco is accredited by 
 some as producing this condition. 
 
 As to the action of tobacco in this 
 state, it does not seem to be well under- 
 stood, and as to alcoholic beverages we 
 know that they cause a lessening of the 
 alkalinity of the blood, driving the 
 uric acid into the tissues, especially so 
 in the case of rich wines, as port, 
 sherry, champagne and burgundy, also 
 malt liquors and porter. Spirits having 
 the least prejudicial effect. 
 
 But the principal and most common 
 factor in producing this trouble, is an 
 excess diet of animal food, of which 
 beef is the most pernicious, together 
 with the xanthins, tea, coffee, etc. 
 Yielding as they do a large amount of 
 nitrogenous matter, which, if partaken 
 of in too great a quantity, taxes the 
 
Etiology. 41 
 
 metabolistic functions to an extent not 
 possible to effect a complete conversion 
 of the products into urea, but stopping 
 short at a lower grade of oxidation — 
 uric acid. 
 
SYMPTOMS AND PATHOLOGY. 
 
 We cannot but admit that the evi- 
 dence is pretty strong to lead us to be- 
 lieve that a large number of diseases of 
 the human body owe their causation to 
 the effect of uric acid, which by its con- 
 trolling action upon the circulation, as 
 well as its irritant properties, exercises 
 a deleterious power over the processes 
 of life to a very great extent. That it 
 is a possible cause of many pathological 
 conditions although not the only one. 
 
 Its pathological action being due to 
 two factors, viz.: 
 
 i. The direct irritant effect on the 
 tissues owing to its presence in them in 
 considerable quantity, as we find in 
 gout or rheumatism. 
 
 2. Its presence in the blood, obstruct- 
 ing the capillaries through the vaso- 
 motor system ; affecting the circulation, 
 
Symptoms and Pathology. 43 
 
 nutrition, function, and temperature of 
 all the organs and tissues of the body ; 
 also producing high blood pressure 
 which directly affects the heart and 
 vessel walls, as well as the intracranial, 
 thoracic, and chylopoetic circulations. 
 
 The presence of uric acid in the blood 
 causes an increased arterial pressure, 
 with slowness of the pulse (brachy- 
 cardia) , attributed by Haig to an actual 
 plugging or occluding of the smaller 
 capillaries by this substance in a form 
 termed by him " colloid " uric acid ; but 
 this savors so much of the etiological 
 factors of a century ago, that a more 
 satisfactory theory should be sought for. 
 The writer is of the opinion that its in- 
 fluence on the blood pressure is really 
 due to uric acid in this fluid, irrespect- 
 ive of form, either colloid or crystal, but 
 without doubt at all times in solution 
 when in it, and acting as an irritant to 
 the vaso-motor nerves, causing a spas- 
 modic condition of the muscular coats 
 
44 Symptoms and Pathology. 
 
 of the vessels, thus bringing about the 
 same results in a lessening of their 
 calibre, interfering with the circulation, 
 deranging nutrition and resulting in 
 structural changes, controlling the 
 heart's action by slowing the pulse, 
 and ultimately resulting in cardiac hy- 
 pertrophy ; interfering with the action 
 of the renal and pulmonary circulation, 
 with also headache and depression, and 
 from the impairment of nutrition and 
 metabolism a resulting anaemia and 
 hsemoglobinuria. 
 
 The various manifestations of the 
 presence of this product in the blood 
 are not in all cases continual, but owing 
 to an excess accumulation in this fluid 
 and the system being unable to dispose 
 of it, we have what are termed " uric 
 acid storms ;" the location of the 
 trouble depending, it would seem, 
 largely upon the local susceptibility of 
 the patient; attacking as a rule at the 
 weakest point. These attacks being 
 
Symptoms and Pathology. 45 
 
 followed by the elimination of these 
 offending waste products, with a conse- 
 quent fall of blood pressure, diuresis, 
 and subsidence of the symptoms and a 
 temporary lull, during which time the 
 capillaries thus freed is followed by a 
 quickened metabolism and combustion, 
 a comparative feeling of well being 
 and apparent immunity from disturb- 
 ing symptoms; these periods varying 
 as to length, during which time the 
 uric acid is again accumulating, and 
 when the system is again overloaded 
 with this product to recur again, and 
 so on repeatedly, until effective treat- 
 ment is instituted or the patient gives 
 out. 
 
 On the other hand, in some we find a 
 lesser variation of the condition, with 
 a more or less continual state of ma- 
 laise, depression, wretchedness, etc. 
 
 The non-elimination of such a seem- 
 ingly trivial quantity as six to seven 
 grains — or even fifteen grains, according 
 
46 Symptoms and Pathology. 
 
 to Haig — of this excretory product in 
 twenty-four hours would seem but a 
 small matter, but when this keeps pil- 
 ing upon itself for days and even weeks 
 or months — possibly years — we can 
 readily understand why the system be- 
 comes so thoroughly saturated, and it 
 is, therefore, no matter of surprise to us 
 that it causes all the trouble attributed 
 to it. 
 
 The action of the uric acid on the 
 human economy (in a simile by Bur- 
 nett) is identical with that of the soot 
 in our chimneys (we would suggest also 
 that of clinkers), interfering with the 
 well behavior of our stoves, or in case 
 of those of us who have to endure it, 
 that very essential article to our com- 
 fort, but, at the same time, hygienic 
 bane of civilization, the hot air furnace, 
 the cause of the majority of the catarrhal 
 and neurotic evils with which we are 
 afflicted. 
 
 Without doubt a heavy eater of 
 
Symptoms and Pathology. 47 
 
 nitrogenous food actively engaged in an 
 occupation which keeps his excretory 
 functions in perfect working order ; his 
 urine might show an amount of urea 
 and uric acid far in excss of the normal 
 amount, and yet the individual, at the 
 same time, enjoying perfect health ; but 
 take a person of sedentary habits on 
 even a moderate nitrogenous diet, where 
 the urine shows an amount of urea and 
 uric acid not above the normal, and 
 symptoms of its retention will seldom 
 be absent, due to accumulations of it in 
 the system. If in a patient of a neurotic 
 temperament or a tendency to the much 
 scouted at uric acid diathesis, the con- 
 ditions will be more aggravated still. 
 
 Although this complaint is possible 
 in all, still the individual in whom 
 uricacidaemia most frequently occurs 
 is usually of a neurotic tendency, non- 
 active and sedentary, susceptible to 
 cold, with a deranged digestion and 
 very often badly working kidneys; 
 
48 Symptoms and Pathology. 
 
 with a lowered vitality and deficiency 
 of haemoglobin in the blood. 
 
 In the normal subject the consump- 
 tion of haemoglobin being considerable, 
 the demand for it is, therefore, large ; 
 the uric acid of the waste products by 
 means of this substance being oxidized 
 into urea, as more soluble and of 
 easier elimination; therefore, when this 
 product is in excess, a greater tax is 
 levied on the blood in its oxygenating 
 functions, in which case accounts for 
 the resulting and ever present anaemic 
 condition. 
 
 In fact, a constant destruction of the 
 red blood corpuscles in a varying de- 
 gree of severity. 
 
 The excretory functions, therefore, 
 taxed to their utmost by the increased 
 amount of this product, and usually 
 inadequate to the task, the result of the 
 existing high arterial tension and pres- 
 sure, as well as also the general im- 
 pairment of the health ; its elimination 
 
Symptoms and Pathology. 49 
 
 is thrown upon the liver and kidneys 
 with consequent derangements of these 
 organs, often of a serious nature, as 
 hepatic cirrhosis, biliary or renal calculi, 
 albuminuria, interstitial nephritis, etc. 
 
 As a rule, in all these conditions of 
 uricacidaemia we have present symp- 
 toms of nervous irritation, as various 
 forms of neuralgia, mental depression 
 irritability, and bad temper, insomnia, 
 weak memory, worrying and annoy- 
 ance, also numbness of the extremi- 
 ties, etc. 
 
 This, together with the deficiency of 
 haemoglobin, and the small amount of 
 heat generated and consequently but 
 little radiated, renders the subject sus- 
 ceptible to cold, all huddled up and 
 afraid of the slightest breath of air, 
 from which exposure to, a cold is in- 
 variably the result, and with this con- 
 sequent lack of reserve vitality making 
 him unable to throw it off, therefore 
 hanging on for an indefinite and pro- 
 tracted period. 
 4 
 
50 Symptoms and Pathology. 
 
 Gout is a condition resulting from 
 uric acid, and, according to Haig, rheu- 
 matism also, the two closely allied ; the 
 difference being that in the former 
 occurring in but one joint, of longer 
 duration and severity with a deposition 
 into its tissues of biurates ; while in the 
 latter it occurs in several joints, is of 
 shorter duration, of less severity, and 
 the urates are present in the tissues in 
 solution ; the pain worse at night on 
 account of the acidity (less alkalinity) 
 of the blood, when at that period it is 
 driven into the tissues. Besides in gout, 
 although there is a diminished alka- 
 linity of the blood, there is not a gen- 
 eral clearing out of the uric acid from 
 it, while in rheumatism the uric acid is 
 all driven out of this fluid, the reaction 
 of which is also less alkaline, but is in 
 the tissues a short time only and not in 
 crystalline form. 
 
 Gout seldom attacks those engaged 
 in bodily labor or on a vegetable diet, 
 
Symptoms and Pathology, 51 
 
 but as rheumatism, however, does very 
 frequently occur in the working classes 
 this, therefore, constituting a weak 
 point in his theory. 
 
 As these diseases do not often appear 
 until the individual is advanced in 
 years is accounted for by an accumula- 
 tion of uric acid in the system from a 
 previous diet of meat, tea, coffee, wine, 
 beer, etc., manifesting its presence at 
 this late date. 
 
 Malaise, disinclination to do any- 
 thing, and fatigue on the slightest ex- 
 ertion, caused by the fact that exercise 
 and motion increase the alkalinity of 
 the blood, when the uric acid stored up 
 in the tissues, being soluble in this 
 menstruum, therefore its invasion into 
 it with the production of these symp- 
 toms. 
 
 Exposure to cold when the blood 
 contains uric acid, if in small amount, 
 drives it into the tissues, but in case it 
 is in excess and not possible to remove 
 
52 Symptoms mid Pathology. 
 
 all from it produce various disturb- 
 ances, as lumbago, pharyngitis, bron- 
 chitis, tonsillitis, rhinitis, etc.; in fact, 
 attacking that part of the body which is 
 the least resistant to its influence. 
 
 Therefore in an individual loaded 
 with uric acid a cold climate is most 
 effectual in producing a defective work- 
 ing of the various functions and a faulty 
 metabolism. 
 
 In warm weather the attacks from 
 uricacidsemia will be less frequent 
 owing to the fact that warmth is con- 
 ducive to alkalinity of the blood and 
 an increase in the excretion of the 
 urates. 
 
 For this reason when the first warm 
 weather comes on after winter there is 
 such a general sense of malaise and 
 that " tired feeling," in a more or less 
 degree, as we have stored up uric acid 
 during the cold months from a diet too 
 heavy for our insufficient inactivity ; 
 while those who have not accumulated 
 
Symptoms and Pathology . 53 
 
 this product in the system have little 
 or no depression at this time. 
 
 As to the effects of cold on a system 
 full of uric acid, its precipitating action 
 will cause trouble when large quantities 
 are retained in the blood, exercising a 
 paralyzing effect upon the circulation, 
 nutrition and metabolism, accompanied 
 by mental depression and an exceeding 
 sensitiveness to the cold. When, how- 
 ever, but little uric acid is in the sys- 
 tem cold acts as a stimulant, raising 
 the acidity of the urine, lowering the 
 alkalinity of the blood, and therefore 
 clearing it of these waste products con- 
 tained in it, thus stimulating nutrition 
 and metabolism ; consequently those 
 who live on a diet free from uric acid 
 feel the cold less and require less cloth- 
 ing in winter than those who eat much 
 meat and xanthin compounds. 
 
 Frequently we meet persons who 
 complain, as they express it, of " feel- 
 ing wretched," or else their symptoms 
 
54 Symptoms and Pathology. 
 
 are worse, during the early part of the 
 day, but during the afternoon begin to 
 feel better, and by night time feel per- 
 fectly well, this occurring repeatedly; 
 also in cases of deranged digestion, 
 where the evening meal is best borne, 
 the others causing considerable dis- 
 turbance, especially that at midday, so 
 much so that total abstinence from food 
 at this time is sometimes compulsory. 
 
 This is to be accounted for from the 
 fact that during the morning hours the 
 increased excretion of uric acid takes 
 place, which, if excessive, is the cause 
 of this trouble ; while in the afternoon 
 and evening, due to lowered alkalinity, 
 it is present in the blood in but very 
 small quantities, hence the apparently 
 stimulating effect of mental activity 
 and well being. 
 
 One of the most common and fre- 
 quently complained of symptoms is 
 headache, paroxysmal or periodic ; 
 identical with migraine, bilious or sick 
 
Symptoms and Pathology. 55 
 
 headache, so-called, lasting twelve to 
 forty-eight hours, accompanied by 
 nausea, vomiting, coldness, chilliness, 
 etc., the patient going to sleep and 
 awakening in the morning free from it. 
 Often in females, occurring around or 
 at the menstrual period. These are 
 practically " uric acid storms," due to 
 the overflow of a storing up of this 
 product and its consequent passage 
 through the blood out of the system, 
 which, when all excreted, the headache 
 passes away and does not return until a 
 new supply has accumulated, when an- 
 other storm ensues. These occurring 
 more frequently in individuals with 
 large supply arteries in the brain ; as a 
 rule, the intellectual and brain workers 
 (although the ignorant are not exempt), 
 also those of sedentary occupation ; in 
 fact, those whose cerebral vessels are 
 of greater extent and calibre, with slow 
 high tension pulse, accompanied by 
 coldness of the skin and extremities, 
 
56 Symptoms and Pathology. 
 
 brought on by some extra exertion or 
 muscular effort or after fatigue. 
 
 Also from crowded assemblages, 
 churches, theatres, etc., poorly ventil- 
 ated, due to the heat and deficiency, in- 
 creasing the alkalinity of the blood, 
 when uric acid if present in the system 
 enters into it. 
 
 In regard to the above it would seem 
 that churches are a more prolific causa- 
 tive factor, on account of a tendency to 
 neglect to the important hygienic prin- 
 ciple of ventilation. Theatres are less 
 so on account of the large stage, mak- 
 ing it impossible to exclude air entirely 
 from them, and therefore less liable to 
 be a cause of this trouble. 
 
 Bearing upon this subject, inasmuch 
 as these complaints are quite frequent, 
 the writer has in view a church at 
 which he knows an individual who has 
 attended there frequently, but if morn- 
 ings, in few cases without being laid up 
 the rest of the day with sick headache ; 
 
Symptoms and Pathology, 57 
 
 also, he recalls the case of a lady who 
 has been obliged to stop her attendance 
 there, as invariably on doing so she 
 would faint away during the services. 
 In a conversation with one of the em- 
 ployees, he innocently informed the 
 above party that during the cold season 
 they seldom permitted the fresh air to 
 enter the building ; as when they at- 
 tempted to warm it again, as he ex- 
 pressed it, the hot air all went up to 
 the top and it took too much coal. 
 
 Verily, a modern " Black Hole of Cal- 
 cutta," in a mild way. 
 
 Possibly the question of ventilation 
 in our churches may have something 
 to do with the non-attendance of which 
 we hear so many complaints. 
 
 It is certainly the cause of the drowsi- 
 ness that so many experience. 
 
 This plea of headache on attending 
 church has been sneered at and scouted 
 at by many, but the writer knows there 
 is more truth in it than the doubting" 
 
 c> 
 
 ones would have us believe. 
 
58 Symptoms and Pathology. 
 
 The presence of uric acid in the 
 blood causing, as previously explained, 
 a raising of the arterial pressure, symp- 
 toms of this will of necessity manifest 
 themselves. When the respiratory or- 
 gans are the susceptible parts, asthma 
 is often present ; the attacks when 
 coming on in the early morning hours, 
 as is so frequently the case, due to low 
 blood pressure, free capillaries and 
 quick pulse of the night; with the 
 " acid tide " of the blood ; giving place 
 to the high blood pressure ; obstructed 
 capillaries and slow pulse of early morn- 
 ing ; the " alkaline tide " of this period. 
 
 In fact, the exacerbation of all symp- 
 toms and conditions so frequent at this 
 period in the twenty-four hours, we 
 here find a ready and satisfactory ex- 
 planation, for inasmuch as this has 
 hitherto been unaccounted for in any 
 way to meet the requirements of a 
 mind seeking for the why and where- 
 fore. 
 
Symptoms and Pathology. 59 
 
 Also as a result of the continued high 
 tension, derangements of the circula- 
 tion are apt to occur, as arteriosclerosis, 
 and later, various cardiac lesions, espe- 
 cially hypertrophy. Angina pectoris is 
 also a symptom attributed to this con- 
 dition. 
 
 The increased labor put upon the 
 kidneys in the elimination of the ex- 
 cess waste products, together with the 
 high arterial tension, if allowed to con- 
 tinue, as a result ultimately we will 
 have a diseased condition of these 
 organs, albuminuria, interstitial ne- 
 phritis, etc. 
 
 But the amount of excretion should 
 not influence us in an opinion, as in a 
 healthy kidney with low alkalinity of 
 the blood, the uric acid may be very 
 scanty, leading us to infer that this 
 organ is diseased, which under some 
 conditions, when so, may excrete a con- 
 siderable amount. 
 
 Haig, who, as I said before, attributes 
 
60 Symptoms and Pathology. 
 
 to this condition a very large number 
 of ailments to which humanity is heir, 
 also considers this a causative factor 
 in epilepsy, convulsions, hysteria, and 
 like ailments, due to an interference of 
 the cerebral circulation on account of 
 the high blood pressure. To this he 
 also attributes diabetes, glycosuria, and 
 Raynaud's disease (symmetrical gan- 
 grene), the early stages of which are so 
 characteristic of uricacidaemia with its 
 cold extremities, etc. 
 
 Regarding which it would seem that 
 inasmuch as his arguments are, as a 
 rule, the most plausible of any hitherto 
 advanced for them so far, we would not 
 be making a very great mistake in ac- 
 cepting them, at least for the time until 
 something better turns up. 
 
 In individuals with a weak digestive 
 tract of necessity this will here cause 
 trouble from attacks of indigestion, 
 more or less protracted and of varying 
 degrees of severity. 
 
Symptoms and Pathology. 61 
 
 In some, cutaneous manifestations 
 will occur, as urticaria, eczema, etc. 
 
 Those with weak respiratory mucous 
 membranes will also not be allowed to 
 escape the effects of this agent, and in 
 the nose we will find frequently a neu- 
 rotic rhinitis, and a condition of the 
 turbinals in which on the slightest 
 provocation a congestion will occur, 
 occluding the nostrils and causing the 
 individual an amount of annoyance not 
 appreciated except by those so affected 
 in this manner. 
 
 Uric acid is considered to be one of 
 the causes, by some the one, of hay 
 fever ; of both the neurotic condition 
 necessary for it, as well as also that of 
 the hyperesthesia of the mucous mem- 
 brane, rendering it susceptible to the 
 local irritant setting up this condition. 
 
 Enlarged tonsils and also lymphoid 
 enlargement of the pharyngeal tonsil 
 are by some attributed to an inherited 
 gouty diathesis. 
 
62 Symptoms and Pathology . 
 
 In regard to the character of the 
 symptoms developing as a manifestion 
 of the presence of nrie acid in the 
 blood, the writer is of the opinion that 
 according to the temperament of the 
 individual so will these be. 
 
 In the so-called sanguine or full 
 blooded we will find derangements of 
 the circulatory system, as congestive 
 headaches, cardiac and kidney lesions, 
 arteriosclerosis, and also gout. 
 
 In the nervous temperament various 
 neuralgias, and especially in these in- 
 dividuals do we find affected with hay 
 fever and the several respirator}^ neu- 
 roses, as asthma, neurotic rhinitis, etc. 
 
 In the bilious temperament lies the 
 susceptibility to sick headaches, also 
 many liver, spleen and gastric troubles. 
 
 The phlegmatic temperament seems 
 to be less susceptible to the influences 
 of uric acid than any of the others, yet 
 why is not clear, as persons with this 
 temperament are, as a rule, prone to 
 
Symptoms and Pathology. 63 
 
 inactivity, even sometimes laziness in 
 the highest degree, and very often large 
 eaters, both of which being potent fact- 
 ors in the production of the uric acid 
 condition ; therefore why this class of 
 individuals should be free from its 
 effects has not yet been explained. 
 Possibly for the reason that their ex- 
 cretory functions are, as a rule, more 
 active, bowels more open, skin perspir- 
 ing more profusely, and kidneys free, 
 thus rapidly eliminating this product 
 as soon as it is formed and not allowing 
 it to accumulate, is the only explana- 
 tion it seems possible to offer at present. 
 
TREATMENT. 
 
 General Remarks. 
 
 In the treatment of uricacidsemia 
 drugs, although useful as far as they 
 go, have but a limited sphere of action 
 in this condition, and while efficient 
 agents when used at the proper time 
 and place, still are of lesser importance 
 compared with the various hygienic 
 factors, which we will soon discuss as 
 to their use in this complaint. 
 
 To cure our patient suffering from 
 this trouble more than a mere prescrip- 
 tion and some general platitudinic ad- 
 vice is necessary as to the regulation 
 of his mode of life ; but to be successful 
 in leading him along the path to bene- 
 ficial results, at least, if not perfect re- 
 covery, the slightest detail of his living 
 must be arranged and regulated for 
 
Treatment. 65 
 
 him, if lie will not follow out and con- 
 form to the advice given him by the 
 physician, in case of failure the fault 
 will then be his only, for in the 
 instructions given him for his cure, if 
 sufficiently explicit, the physician will 
 have then done his duty. More than 
 this would not be possible. 
 
 However, if we neglect this more 
 important part of the treatment we are 
 most certainly derelict in our duty, no 
 matter how much as an offset we ply 
 him with drugs, for with these alone no 
 permanently curative results need be 
 expected. 
 
 Our principles and mode of life 
 should not influence us as to what is 
 hygienic unless we ourselves conform 
 to its regular adopted principles as ac- 
 cording to authorities on this subject. 
 In short, we must prescribe genuine 
 hygienic principles for our patients 
 and not fads of our own concocting. 
 For instance, the healthfulness of 
 
66 Treatment, 
 
 alcohol and tobacco never has been a 
 fact, although some of us use them and 
 live through the effects ; even it may be 
 that we have had an ancestor in days 
 gone by who was addicted to the prac- 
 tice of these agents in large quantities 
 and yet lived to the age of ninety years 
 or thereabouts. Without doubt if this 
 same party had cultivated better habits 
 he would have lived to over a hundred. 
 
 In uricacidaemia we have a condition 
 of toxaemia, a poison in the blood, being 
 continually introduced by means of our 
 diet, with two-fold indications for treat- 
 ment ; firstly, to eliminate the waste 
 products that are present in the sys- 
 tem in excess ; and secondly, to pre- 
 vent the new supply from coming in ; 
 and until this is done the trouble will 
 not cease. 
 
 Cures are not, as a rule, possible, 
 that is, to alter the life processes of the 
 individual so that he can return to his 
 former unhygienic way of living with- 
 out suffering inconvenience again or 
 
Treatment. 67 
 
 the old symptoms returning, but by 
 the change of injurious habits to those 
 of a healthful nature, very few cases, 
 if not all, will experience more or less 
 relief, prevented only according to the 
 amount of structural change that has 
 taken place, and in these cases where 
 this has not occurred we may hope for a 
 complete return to health. 
 
 But that the cure of this condition by 
 drugs alone is possible, is about as 
 reasonable to expect as that a fracture 
 or the removal of a foreign body 
 treated only by internal medication, 
 without any mechanical procedures, can 
 be accomplished successfully. 
 
 Bver remembering the above indica- 
 tions in the treatment of uricacidaemia, 
 elimination of the excessive waste 
 products, and prevention of their re- 
 formation ; when this is accomplished, 
 then by means of drugs treat the symp- 
 toms arising, when we will find our 
 remedies to come into play and with 
 gratifying results. 
 
TREATMENT. 
 
 Hygienic. 
 
 Under this head we will include as 
 essentials in the treatment of uricaci- 
 dsemia, the following factors : Exercise, 
 Baths, Clothing, Air, Climate. 
 
 Exercise. We may not follow out 
 this principle ourselves, or insist upon 
 it in our patients, save in a casual way- 
 suggesting it to them as an optional 
 matter ; but none of us will deny that 
 proper exercise is absolutely necessary 
 to perfect health, and for the proper 
 performance of the functions of life ; 
 quickening the circulation and increas- 
 ing its flow throughout the body, aug- 
 menting the respiratory process by 
 causing an enlarged demand for oxygen 
 and the expulsion of carbon di-oxide, 
 also hastening and aiding the elimina- 
 
Treatment. 69 
 
 tion of the waste products of the body, 
 by means of the various excretions, as 
 the urine, perspiration, etc. 
 
 In health this is necessary to keep 
 well, and even in the invalid, as much 
 as he can take without fatigue, is advis- 
 able ; but when we crowd exercise 
 unlimited, as is advised by the majority 
 of the laity and many physicians, upon 
 an individual full of uric acid and 
 unable to dispose of the already in- 
 creased amount of this waste product 
 in the system, we by means of the 
 formation of more, through this addi- 
 tional exercise, instead of bettering, as 
 is intended, simply aggravate the con- 
 dition. 
 
 Physical exercise creates a demand 
 for haemoglobin which at this time the 
 debilitated system cannot supply, also 
 increasing the quantity of toxic waste 
 products, which, not being rapidly 
 eliminated, the patient consequently 
 suffers from the bad effects, besides 
 
70 Treatment. 
 
 draining his vitality and with a non- 
 resisting recuperative power causing 
 the resulting condition. 
 
 A mild systematic exercise in the 
 open air is not only beneficial but ab- 
 solutely essential, but not to be carried 
 beyond the balance of repair and waste, 
 no further than the stage of slight 
 fatigue, increasing daily if possible 
 nntil a considerable amount can be in- 
 dulged in without tiring the patient, 
 ever making an effort to enlarge his 
 powers of endurance. 
 
 In this, however, we cannot hope for 
 any success until the uric acid is out 
 of the system. This accomplished, and 
 its recurrence prevented, then our ex- 
 ercise is a valuable prophylactic and 
 remedial measure, and not a means of 
 aggravating the evil, as it would be if 
 nsed alone as a mode of treatment as is 
 so commonly advised. 
 
 Baths are necessary to stimulate the 
 skin to its normal functional activit} 7 > 
 
Treatment. 7 1 
 
 also to keep open the excretory ducts. 
 For the first of these cold, always fol- 
 lowed by friction, is considered prefer- 
 able ; but for the second, which is 
 synonymous with cleanliness, warm 
 water is necessary. 
 
 In weak, debilitated subjects the cold 
 bath is not advisable on account of its 
 depressing effects upon the heart, and 
 the non-liability to an early reaction. 
 In patients who are cold, chilly, and 
 feel bad for several hours after, this 
 should be avoided, but in a case where 
 an exhilaration and well being follows 
 immediately after the bath they may be 
 allowed. 
 
 As a rule, however, for the uric acid 
 patient, warm baths will be more often 
 required, as the action of cold on this 
 product acid being to cause its retention, 
 the very things we wish to avoid. 
 
 On account of the liability to take 
 cold afterwards, they are, therefore, pref- 
 erable at night before going to bed. 
 
72 Treatment. 
 
 For those who must have their morn- 
 ing cold bath, either from an exagger- 
 ated sense of cleanliness, or in whom 
 a tonic and exhilarating effect is really 
 produced, I would strongly advise in 
 lieu of this that a sponge bath is all 
 sufficient, invariably followed by a brisk 
 rubbing with a crash towel,which is fol- 
 lowed by a glowing feeling and a sense 
 of warmth, we may safely allow such ; 
 but in the stage of uricacidsemia this 
 mode of bathing is not advisable until 
 in the patient, the stored up products 
 are eliminated and the increased forma- 
 tion has been stopped. 
 
 Remembering that cold checks the 
 elimination of uric acid, which outflow 
 being greatest during the morning 
 hours, the cold morning bath will tend 
 to interfere with this excretion, and 
 even though the patient may feel well 
 after it, should a sense of discomfort, 
 wretchedness and depression occur dur- 
 ing the afternoon hours, due to an 
 
Treatment. 73 
 
 excessive deferred action at this time, 
 we may infer that uric acid is being re- 
 tained in the system as a result of this, 
 and therefore the cold morning bath 
 should be discontinued. This may ac- 
 count for the afternoon nap so obliga- 
 tory to some individuals, although 
 apparently unnecessary from their 
 slight exertions. 
 
 The pernicious practice of the cold 
 plunge bath, introduced by the few and 
 followed in a lamb-like way by the 
 many, simply because it is a fad ; 
 cannot but be condemned for general 
 adoption by the average individual of 
 the present day. 
 
 I verily believe that the increased 
 prevalence of cardiac and renal diseases 
 is due to the wholesale and indiscrimi- 
 nate indulgence in this practice, espe- 
 cially on the part of adults ; although 
 the young and hardy may be able to 
 withstand its entailed strain upon the 
 system. 
 
74 Treatment. 
 
 By its action driving the blood from 
 the surface, thereby congesting the in- 
 ternal organs, this cannot but be in- 
 jurious to them, and with any tendency 
 to weakness on their part, serious de- 
 rangements are liable to result there- 
 from. 
 
 That certain strong and hearty indi- 
 viduals who indulge in them and seem 
 w r ell is not by any means indicative of 
 their healthfulness, but simply that 
 they are hardy enough to endure the 
 continued strain. 
 
 It is a significant fact, however, that 
 as so many of these apparently robust 
 and strong ones pass out of the world 
 so suddenly from kidney and heart dis- 
 eases, generally like the snuffing out of 
 a candle, it has occurred to the writer 
 to ask the question, could not this be a 
 means of possibly contributing towards 
 this result ? 
 
 The baths should be taken as hot as 
 the patient can comfortably bear them, 
 
Treatment. 75 
 
 and quite frequently ; subjects well 
 charged with uric acid are often bene- 
 fited by one every night, but in all cases 
 it should be tried, when if no debilitat- 
 ing results occur it should be kept up 
 until symptoms of excessive retention 
 of uric acid disappear, when they may 
 be gradually lessened. 
 
 Clothing is another point of import- 
 ance to be looked after at all times. 
 Woolen underwear, preferably Jaeger's, 
 should be worn next to the skin all the 
 year round, varying in thickness accord- 
 ing to the season. 
 
 Silk or other material, no matter 
 how much advertised or highly puffed 
 up — even if more expensive — will not 
 take its place. I fully agree with one of 
 our authorities — I forget who — who, in 
 writing on this subject, expressed his 
 opinion as to silk underwear, that its 
 preference by so many he attributed 
 solely to its costliness. 
 
 Air must be fresh, pure, and in 
 
76 Treatment. 
 
 \ abundance at all times, night and day. 
 The patient must sleep in a well ventil- 
 ated room, as cold as he can do so with 
 comfort and no resultant bad feelings 
 in the morning on awaking. 
 
 During the day in the case of weak 
 and debilitated subjects, avoiding any 
 exposure to cold before, say, two o'clock, 
 in cold weather remaining indoors until 
 this time ; this is advisable so as not to 
 interfere with the normal process of 
 the " alkaline tide." 
 
 The apartments through the day 
 should also be provided with good ven- 
 tilation, and in cold weather not heated 
 by steam, or if so, a pan of water should 
 be kept boiling in the room to relieve 
 the excessive dryness resultant on this 
 mode of heating. In some ways I think 
 the hot-air furnace is worse ; not so 
 much on account of the dryness, which 
 is bad enough, as from the fact that 
 it seems about impossible to have one 
 so regulated as to ran even throughout 
 
Treatment, 77 
 
 the day ; it being the usual thing to 
 shiver and shake in the early morning 
 hours, possibly be comfortable during 
 the middle of the day, and at night to 
 swelter from too much heat, just the 
 very time it is not wanted. 
 
 In this I think a large majority of 
 persons will agree with me as to their 
 experience with the hot-air furnace, oc- 
 casionally there being a few exceptions. 
 
 Besides a gas-tight furnace is prac- 
 tically an impossibility ; consequently 
 the air we breathe, when one of these 
 is in operation in our house, contains 
 at all times in a more or less dilute 
 form such delectable bodies as carbon 
 monoxide, and dioxide, together with 
 hydrogen sulphide, all highly poison- 
 ous gases, and our only salvation being 
 that they are usually present in but 
 small quantities ; but even then enough 
 so to be deleterious to our health, mak- 
 ing us feel wretched and disinclined to 
 work. 
 
78 Treatment. 
 
 The ideal method for all who can 
 afford it is by means of hot water, as 
 near perfection as we can ever hope to 
 reach in this world, insnring us at least 
 a complete immunity from poisonous 
 gases from this source, and besides 
 granting us a equable temperature at 
 all times. 
 
 Of course, I refer to these means of 
 heating in our cold climate with our 
 disagreeable winters, as where a wood 
 fire is sufficient it is the most hygienic 
 form of heating, next to it being the 
 grate fire; these being the methods pref- 
 erable to all others. Stoves are but 
 makeshifts, and not to be advised at 
 any time, except when nothing else is 
 available, and being a case of necessity 
 knows no law, the individual who has 
 to endure them is to be most heartily 
 pitied. 
 
 For these class of cases an outdoor 
 life, as much as possible, should be in- 
 dulged in. This cannot always be 
 
Treatment, 79 
 
 carried out to an extent really necessary 
 to our usually severe winter climates ; 
 and even our springs of late have been 
 a travesty on the term as usually under- 
 stood, viz.: sunshine , singing birds, 
 blossoming flowers, etc., etc.; but in the 
 summer months and early fall, even 
 late spring, when possible to do so, the 
 patient should remain out of doors all 
 day, and at night in a room well ven- 
 tilated. 
 
 In a country perfectly healthy, a dry 
 air, free from dampness, camping out 
 is to be advised as most beneficial in 
 every way. 
 
 Individuals not able to exercise 
 should sit or lie in a hammock in the 
 open air, of course not exposed to 
 draughts or wind, but in sheltered and 
 shaded situation. 
 
 In short, fresh air in abundance at 
 all times is an absolute essential to sup- 
 ply the anaemic blood its oxygen, with 
 as little effort on the part of the system 
 
80 Treatment. 
 
 as possible, and in a pure and unadul- 
 terated form. 
 
 Climate is by no means of minor im- 
 portance, as few of these cases but what 
 a change of air is absolutely necessary 
 for their recovery if their condition is 
 beyond that of medium severity ; in 
 fact, all will be benefited. 
 
 Inasmuch as the uricacidsemic pa- 
 tient, as a rule, is also a neurasthenic, 
 as well as being the possessor of a weak 
 heart, a seashore or a mountainous 
 region for aggravated forms of this 
 complaint are both contraindicated, the 
 former on account of its too stimulat- 
 ing properties, the latter due to its bad 
 effect upon the heart ; but what we 
 would advise in this condition is a 
 healthy hill country, with an altitude 
 sufficient to insure a fresh, bracing 
 quality to the air, but not high enough 
 to tax the heart. 
 
 An altitude of ten to twelve hundred 
 feet above sea level seems to the writer 
 
Treatment. 81 
 
 about right for such, cases as these. 
 Another important point to be taken 
 into consideration is the avoidance of 
 great contrasts between the night and 
 day temperature, the prevalence of sud- 
 den changes and also the liability to 
 cold or hot " snaps. " Of course, these 
 conditions will occur in all portions of 
 the globe to some extent, more or less ; 
 but our endeavor should be to find a 
 place where the lesser changes prevail, 
 and such is more apt to be in a medium 
 altitude than in the extremes. 
 
 No doubt there are innumerable loca- 
 tions to fill these requirements, but the 
 difficulty is to find them when we need 
 them ; in fact, when in a hurry we 
 have not the time to look them up and 
 must take what is recommended to us, 
 sometimes to our exceeding regret and 
 discomfort. 
 
 Having spent many seasons there, 
 the writer has ever been of the 
 opinion that to largely satisfy the 
 6 
 
82 Treatment, 
 
 requirements of an individual suffering 
 from an aggravated form of uricaci- 
 daemia the country around Sharon, 
 Connecticut, is perfectly suitable and 
 conducive to good results for cases of 
 this complaint ; often while invalids, in 
 fact though not apparently so, but who 
 need a quiet country life with city com- 
 forts, minus its bad air, smells, noise 
 and other characteristic features of a 
 disagreeable nature, Sharon is fully 
 adapted for them in every way. Situated 
 in the hills of Northern Connecticut, at 
 the beginning of the Berkshire range, 
 it possesses all the well-known features 
 of this famous region, without quite so 
 much of the " civilizing " influences of 
 the resorts farther north in this section 
 apt to annoy and grate on one with 
 sensitive nerves and easily irritated. 
 It is quite well known as a resort and 
 possesses good accommodation for all 
 desiring to avail themselves of its 
 beauties. Is usually filled to overflow- 
 
Treatment. 83 
 
 ing during the summer months, but 
 owing to the class of people going there 
 one would never be inclined to think 
 this the case, not by any means lonely, 
 but simply that one is not encroached 
 upon in fact or visually by the species 
 of individuals so common in most of 
 our summer resorts. Besides not being 
 a business centre or having any manu- 
 facturing interests, it is possible for it 
 to be what it appears to all w r ho have 
 ever been there, an ideal New England 
 town, remarkably beautiful and exceed- 
 ingly healthy. Its situation being little 
 over two miles back from the railroad 
 station, it is possible for it to maintain 
 its freedom from too much of the 
 " progress" so common to the majority 
 of our towns. 
 
 From this description the writer dis- 
 claims any intention of advertising this 
 place, but simply to make known a de- 
 sirable spot for a summer resting, one 
 where we do not have to pa}' the 
 
84 Treatment. 
 
 penalty of expiating all winter for un- 
 hygienic conditions experienced, and so 
 common to many of us after our sum- 
 mer sojourn in pursuit of health and 
 pleasure. 
 
 For a class of cases who not only can 
 stand but may need the stimulating 
 climate of a higher altitude, besides 
 also a certain amount of social enjoy- 
 ment, I do not know of a location 
 more desirable than Lake Minnewaska, 
 situated at an altitude of about two 
 thousand feet above sea level, where 
 we have a genuine mountain climate 
 amidst beautiful surroundings, both 
 near and far, with many advantages not 
 obtained at other resorts, and entirely 
 free from the turmoil and bustle found 
 at the majority of the summer resorts, 
 especially those but a short distance 
 from the cities. 
 
 For parties but slightly affected and 
 well enough to travel, the White Moun- 
 tain region is a more desirable section 
 
Treatment. 85 
 
 to recuperate in, of which there are 
 many points to settle at, Bethlehem be- 
 ing considered the centre. 
 
 In the case of patients with asthmat- 
 ic complications a high altitude may 
 be necessary, but if in any of the con- 
 ditions insomnia is induced, it is indica- 
 tive that the heart is being affected and 
 that a lower altitude is to be sought at 
 once. 
 
 A certain proportion of these cases do 
 better at the seashore, and for such 
 where a mild salt climate is desired I 
 know of none better than the Connecti- 
 cut shore of Long Island Sound as pos- 
 sessing a balm-like quality, and excep- 
 tionally free from all irritating prop- 
 erties of so frequent occurrence in many 
 of our sea shore climates. 
 
 For a genuine pure and unadulterated 
 seashore with a climate possessing 
 qualities fully equal to an ocean voyage, 
 all this is attributed to the coast of 
 Maine and the islands of Casco Bay. 
 
86 Treatment. 
 
 But the seashore resorts near the city 
 are the very last places for us to send a 
 patient requiring quiet and absence of 
 irritating influences, with their noise 
 and confusion, as staying at home 
 would be of much less injury to them. 
 
 Long Island with its grand expanse 
 of ocean and endless opportunities for 
 the sportsman, besides an object on 
 which much money has been lavished 
 not always wisely, is not a location for 
 us to send our patients to for many hy- 
 gienic reasons. This may savor of 
 heresy to the decrees of fashion, to the 
 devotees of which this section of coun- 
 try is a veritable Mecca. 
 
 The writer does not wish to be under- 
 stood as claiming that the places here 
 enumerated are the only locations in 
 which the debilitated and enfeebled may 
 again become strong and well, but sim- 
 ply in his opinion as advisable to recom- 
 mend to our patients when in need of 
 such. 
 
Treatment. 87 
 
 Bowels. A tendency towards consti- 
 pation should not be allowed. One 
 daily movement of the bowels, at least, 
 should be invariably encouraged, either 
 by habit, diet, enema, or even as a last 
 resort by means of drugs. 
 
 Rest. Early hours for sleep should 
 be enforced; not less than nine hours 
 out of the twenty- four being essential 
 in these cases, and even more in the 
 very debilitated ; but as a rule, prefer- 
 ably at the regular sleeping time, un- 
 less in the very weak, so as to allow of 
 the opportunity to derive as much bene- 
 fit from the sunshine, fresh air, etc., 
 during the day. 
 
 Recreation. A very important point 
 to gain with these patients is to draw 
 their attention away from thinking too 
 much of their ailments, either by means 
 of some agreeable occupation or some 
 easy outdoor work, even to the cultiva- 
 tion of a simple " hobby n to keep them 
 engaged and their minds diverted, to 
 
88 Treatment. 
 
 prevent a brooding over their bad feel- 
 ings and their complaints.^ 
 
 This point gained, mnch will have 
 been accomplished as a means of remedy- 
 ing the evil. 
 
 Water. As to this a water with as 
 little solids as possible is the most desir- 
 able, and that containing lime and iron 
 in too large quantities is apt to cause 
 an aggravation of this trouble and is 
 to be especially avoided. Pure water 
 must be ever considered an absolute 
 essential to the maintenance of perfect 
 health. 
 
TREATMENT. 
 
 Diet. 
 
 This is without doubt the most es- 
 sential factor in the treatment of this 
 condition, as by these means the 
 quantity of waste products in the sys- 
 tem can be either increased or dimin- 
 ished ; its alteration easily effected and 
 in a short time so acting on the excre- 
 tion of the uric acid, a diminution of the 
 nitrogenous or xanthin diet lessening 
 its formation ; but to remove the pres- 
 ent accumulations resulting from the 
 past, if in any considerable quantity, is 
 a matter of months at the very least, if 
 not years. 
 
 The diet of the uricacidaemic patient 
 should consist of no articles containing 
 uric acid or any nitrogenous matter 
 from which this substance can be 
 
90 Treatment. 
 
 formed, as animal food, fish, etc., and 
 in some cases even eggs ; nor should the 
 xanthin bodies, tea, coffee, or cocoa, — 
 substances which in their passage 
 through the human body become con- 
 verted into uric acid — be permitted at 
 all under any circumstances whatever. 
 
 A diet as the above, stimulating as it 
 is, by rendering the blood acid (less al- 
 kaline) , keeps the uric acid out of it ; 
 therefore, although the patient may feel 
 well during the intervals, when the 
 system becomes too overcharged with 
 the waste products, as it surely will, 
 then due to its overflow and increased 
 excretion, we have the so-called " uric 
 acid storms," as headache, bilious at- 
 tacks, etc., a change of diet is absolutely 
 essential. 
 
 Animal food not being absolutely es- 
 sential for perfect nutrition, this end 
 can be attained by means of the vege- 
 table kingdom, although of a neces- 
 sarily bulky nature on account of the 
 
Treatment. 91 
 
 larger amount required^ there being a 
 lower proportion of albuminoids present 
 in them, as also water. 
 
 Milk and cheese have no power in in- 
 creasing the formation of uric acid, and 
 on account of their valuable nutritive 
 properties may be used as a substitute 
 for animal food. 
 
 However, a diet will be necessary to 
 provide enough nitrogen to keep the 
 area at three and a-half grains per 
 pound of body weight during the 
 twenty-four hours — no more or no less 
 — estimating the patient's weight minus 
 fat, t. e., what he weighed before becom- 
 ing fat, if so. The determination of 
 this substance may be made with the 
 Doremus Ureometer as of sufficient ac- 
 curacy; but for uric acid, the process be- 
 ing tedious and complicated, is not 
 adapted for the busy practitioner's use. 
 The determination of the urea, how- 
 ever, will be sufficient, and by this 
 means we may be enabled to keep track 
 
92 Treatment. 
 
 of the patient's condition, and as it is 
 also necessary to maintain the proper 
 body nourishment to prevent the loss 
 of flesh and strength, with the animal 
 foods left off, this must be replaced by 
 other substances containing albu- 
 minates ; as, for instance, milk with a 
 percentage of three to four per cent., 
 cheese thirty-three, peas or beans 
 twenty-two, bread eight, and oat meal 
 twelve ; taking of these an equal 
 quantity of peas, beans or cheese, or of 
 the others in an amount proportionate, 
 any of these will fully replace meat 
 with its average of twenty to twenty- 
 five per cent, of albuminoids, supplying 
 an equivalent as satisfying and efficient. 
 
 By these means we are thus en- 
 abled to maintain the urea in proper 
 quantity, together with the nutrition 
 and strength not at all affected. 
 
 Should the bulkiness of this form of 
 diet produce dyspeptic symptoms or 
 gastric derangements, or, for variety, 
 
Treatment. 93 
 
 the various gluten preparations will be 
 found of inestimable value as foods. 
 
 There may be cases met with, very 
 rarely however, where these articles of 
 diet do not seem to be sufficiently 
 nourishing, where the patient loses 
 strength; in which case we may be com- 
 pelled to allow the use of such articles 
 as fish, chicken (turkey is not advis- 
 able), eggs, etc., but endeavor to have 
 the patient avoid all red meats as much 
 as possible, and only use them under 
 the most urgent circumstances. 
 
 This outlined diet is that recom- 
 mended for the most severe cases ; 
 but in the milder forms, although best 
 without, still meat once a day may be 
 allowed, but tea and coffee should be ab- 
 stained from entirely, until at least the 
 patient is free from all troublesome 
 symptoms and the urine is free from 
 an excess of urea, when coffee once a 
 day, not too strong, may be permitted ; 
 but tea at no time should be taken as a 
 beverage. 
 
94 Treatment. 
 
 As to meat, in these individuals, at 
 no time should they eat it more than 
 once a day, even when apparently well, 
 and in the case of sedentary persons it 
 is advisable that total abstaining from 
 it at all times be the rule. 
 
 In fact, it is the opinion of the writer 
 that none but a hard working laborer 
 should eat meat more than once a day, 
 as in such a case, on account of the 
 usually excellent workings of his meta- 
 holistic functions, a diet of any kind 
 should be digested without the slight- 
 est particle of trouble. But even here 
 I think that meat not eaten at all and 
 the albuminates replaced by oatmeal or 
 wheatena he would be better off in the 
 end. 
 
 It would seem that a suggestion to 
 to the poor man that he dispense with 
 the use of meat is apt to be usually 
 resented as an affront, as to him and 
 his family its use is as essential on the 
 same principle as a carriage and horses 
 
Treatment. 95 
 
 are to the parvenue, a necessary factor 
 to keep tip and maintain a quasi social 
 standing in his " set." 
 
 In all others, especially the sedentary 
 and brain workers, an excess of animal 
 food is liable to generate a condition of 
 uricacidaemia in a more or less aggra- 
 vated form, and at the very least in the 
 latter class of individuals, clouding the 
 intellect so as to incapacitate for good 
 work ; together with, in the cases of all, 
 the ever present liability to generate 
 ptomaines in the body of a toxic nature 
 which in its errand of mischief finishes 
 up what the uric acid leaves undone. 
 
 Especially in children is the ab- 
 stenance of animal food to be en- 
 couraged, as in them it causes a condition 
 of apparent anaemia due to spasm of the 
 vaso motor nerves, relief from which 
 ensuing on the discontinuance of this 
 diet for one of a more hygienic nature. 
 
 The use of eggs as an article of diet 
 may be borne well and resultant of no 
 
96 Treatment. 
 
 bad effects, but although not containing 
 uric acid or any of the xanthin group, 
 yet in some cases brings about a large 
 increase of this product in the urine, 
 and in such should be avoided. 
 
 Haig also includes as producers of 
 uric acid, the various pulses, as peas, 
 beans, etc.; when should we find in a 
 patient, on a diet in which they are al- 
 lowed, a continual large excretion of 
 urea, it would be well to stop them for 
 a time at least to ascertain if they are 
 at fault. 
 
 Experience has demonstrated that 
 one who has been on a uric acid form- 
 ing diet, on giving it up suddenly, will, 
 while the urates are passing out, feel 
 wretched and despondent, as also 
 weak and disinclined for any kind 
 of work ; therefore, in cases where we 
 have large accumulations in the system, 
 it is best to gradually wean the patient 
 from the habit of a meat and xanthin 
 diet, as the sudden change may bring 
 
Treatment. 97 
 
 about a serious condition of high blood 
 pressure and its results, owing to the 
 outpouring of the excess of uric acid 
 from the tissues in the blood ; a condi- 
 tion more liable to occur in the middle 
 aged and old people, the manifestations 
 being from vertigo in a mild case to 
 apoplexy in a severe one. 
 
 Fruit and vegetables should at all 
 times enter largely into the diet, and 
 according to Burnett, in writing upon 
 this subject, he says, " The tissues of 
 those who do not eat fruit and vege- 
 tables show signs of decay and senility 
 at an age much earlier than in those 
 partaking largely of these articles of 
 diet." 
 
 Vegetables contain a large propor- 
 tion of water, but are valuable on ac- 
 count of their mineral constituents, in- 
 creasing the alkalinity of the blood, 
 and consequently solvents of uric acid, 
 especially potatoes and spinach, also 
 Brussel's sprouts, cabbage, cauliflower 
 7 
 
98 Treatment. 
 
 and peas. Of these, cauliflower con- 
 tains 1.53 per cent, albuminates, spin- 
 ach 3.15 per cent., and Brussel's 
 sprouts 4.83 per cent., thus making 
 them of considerable nutritive value 
 also. 
 
 Regarding the cereals, wheat con- 
 tains 14.15 per cent, proteids, while 
 oats, somewhat less, yield 11. 12 per 
 cent, of the same. 
 
 Fruits as an article of diet, although 
 possessing a low nutritive value, con- 
 sisting largely of water, and of their 
 solids only a small proportion of nitro- 
 genous matter ; their chief food value 
 is in the sugar they contain, which is in 
 considerable amount ; its advantages 
 consisting of its ready solubility, need- 
 ing no previous digesting, although 
 when used with other articles of diet is 
 apt to give rise to acidity and flatulence 
 in dyspeptics and in individuals with a 
 weak digestive apparatus, due to an 
 acid fermentation in the alimentary 
 
Treatment. 99 
 
 canal ; still, when partaken of alone as 
 is advised in these cases, this possibility 
 is avoided; but in all cases, however, 
 their use should be begun sparingly 
 and with care. 
 
 Another important class of ingre- 
 dients are their salts composed of the al- 
 kalis in combination with the vegetable 
 acids, malic, citric, and tartaric, to- 
 gether with some free acid as well, 
 which, all being converted in the sys- 
 tem into carbonates, these acids (unlike 
 the inorganic) exert no restraining in- 
 fluence on the uric acid excretion, 
 while the alkali lessening the acidity of 
 the urine and increasing the alkalinity 
 of the blood thus constitute conditions 
 more favorable for the excretion of the 
 uric acid ; especially at this particular 
 period (breakfast), when the excretion 
 of this product is at its maximum (9--12 
 A. m.), a diet of this description aiding 
 rather than hindering, as some do, the 
 outflow, is peculiarly of advantage, as 
 
 LofC. 
 
ioo Treatment. 
 
 the average diet tends rather to drive 
 the uric acid into the tissues than aid 
 in its elimination. 
 
 Under no circumstances, however, 
 should sour acid fruits be partaken of 
 by these individuals, as the system be- 
 ing weak and the acid in excess, due 
 to this tax upon the system, their con- 
 version into carbonates as in the nor- 
 mal condition may not be possible 
 under these circumstances, together 
 with a lessening of the alkalinity of the 
 blood driving the uric acid into the tis- 
 sues and a diminishing of its excretion, 
 which at this time should be at its 
 maximum ; later on in the day it will 
 again enter the blood at a time when it 
 should be at its minimum, therefore 
 causing various disturbances and symp- 
 toms indicative of its presence in large 
 amounts. 
 
 In the normal state, although fruit 
 acids may lessen the alkalinity of the 
 blood, it is of but short duration when 
 
Treatment. 101 
 
 the acids are broken up into carbonates, 
 the alkalis then coming into action 
 and reversing the effects. 
 
 When fruit has not been partaken of 
 previously b}^ the individual to any ex- 
 tent, it may set up an uric acid storm, 
 with symptoms of headache, bilious at- 
 tacks, etc., this condition being due to 
 a stirring up process of the retained 
 waste products in the system, the 
 blood becoming more alkaline and the 
 uric acid in the tissues therefore pass- 
 ing into it. 
 
 In cases of this kind it is best to be- 
 gin cautiously and increase the amount 
 of fruit eating gradually, when it will 
 not only be tolerated, but a beneficial 
 action will in a short time be experi- 
 enced in the prevention of the forma- 
 tion of an excessive quantity of uric 
 acid. 
 
 As to the kinds of fruit to be eaten, 
 preferably are advised apples, grapes, 
 oranges or peaches ; eating as much as 
 
102 Treatment. 
 
 the patient desires, but of course not 
 carrying the amount to excess. 
 
 In many cases much benefit is de- 
 rived from a breakfast of nothing but 
 fruit, and no other article of diet eaten 
 before twelve o'clock, noon, except 
 plenty of water during the intervals be- 
 tween meals. 
 
 Preserved, cooked, or dried fruits will 
 not answer the purpose at all, and no 
 sugar should be used with them, as 
 fruit sour enough to require sugar to 
 make it palatable is deleterious to these 
 cases. 
 
 Two or three months of this diet will 
 be necessary, when the patient may re- 
 turn to a proper mixed diet, when, 
 should the symptoms indicate a return 
 of the process of deranged nutrition, the 
 fruit breakfast may be again taken up 
 and persisted in until a cure is effected 
 or lasting relief is obtained. 
 
 In the case of individuals with whom 
 this form of diet does not agree even 
 
Treatment. 103 
 
 after repeated trials, to such we would 
 advise, if it be possible for them to do 
 so, to dispense entirely with their 
 breakfast, taking only a glass of hot 
 water or carbonated water. This latter 
 might seem impracticable to those oc- 
 cupied in some vocation, but as the 
 class of individuals, in the large ma- 
 jority of cases, afflicted with this com- 
 plaint, are not, as a rule, of this class, 
 but ones who have no occupation and 
 can lay around and take things easy, 
 therefore we need not feel any hesitancy 
 in advising this mode of treatment for 
 them on account of any possible incon- 
 venience. 
 
 In regard to cheese with its exceed- 
 ingly high proportion of proteids (30- 
 33 per cent.), in a large number of 
 cases disagrees with the digestion when 
 eaten alone, and even sometimes in 
 combination is tasted for sometime 
 after meals. It is best, when to be 
 taken in large quantities, to mix with 
 
104 Treatment. 
 
 some other article of diet, as macaroni, 
 etc., to prevent a possible disagreement, 
 and also in the cooking the addition of 
 a little potassium carbonate makes it 
 more easily digested. Or, it may be 
 taken in the form of the so-called " cot- 
 tage cheese, " which in many cases is well 
 borne when the ordinary cheese is not, 
 and is as fully if not more nutritious and 
 certainly contains less possible adultera- 
 tion. 
 
 As to coffee, many persons are so ac- 
 customed to their cup of it in the morn- 
 ing for breakfast, that without it their 
 meal is to them u incomplete, " as they 
 express it. For such a coffee substitute 
 would be allowable, as there are now 
 several varieties of this made that as 
 taste goes are so little inferior to the 
 average home-made coffee that a large 
 majority of individuals drinking it 
 would fail to detect the difference in 
 them, also being non-stimulating, and 
 by the manufacturers claimed to be 
 
Treatment, 105 
 
 very nutritious, are to be recommended 
 as of especial use in these cases. 
 
 As it is believed that in some of 
 these varieties genuine coffee is added 
 to impart a flavor, we must avoid such 
 ones if we wish for good results with 
 our patients who use these preparations. 
 They are also a very satisfactory means 
 of flavoring milk for those to whom the 
 taste of it is not palatable. 
 
 Milk being a very essential article 
 of diet for these classes of cases, as it 
 does not generate uric acid in the sys- 
 tem, acts as a mild diuretic, and at the 
 same time a most nutritious form of food, 
 should be partaken of freely and in 
 large quantities. Some individuals 
 seem to be under the impression that it 
 does not agree with them, makes them 
 a bilious, " as they express it ; but in- 
 variably we may attribute this fault to 
 something other than the milk. In 
 cases of dyspepsia following its use, a 
 teaspoonful of lime water to the glass 
 
106 Treatment. 
 
 will usually correct this, when, if in 
 case it still persists, by drinking it 
 slightly warm about an hour before 
 meals and with no other food, as a rule 
 all trouble from this will be ended. 
 
 It would seem to one that this would 
 destroy the appetite for the meal com- 
 ing so soon after, but instead of doing 
 so, strange to say, those who have tried 
 this claim that it rather gives them an 
 appetite for the following meal. 
 
 Another very important factor in the 
 treatment of uricacidsemia is the 
 drinking of plenty of pure water, free 
 from lime or iron, not less than six 
 pints a day at the very least, and more, 
 if possible, without any inconvenience 
 ensuing. Most of this should be taken 
 between meals, before retiring at night, 
 and on arising in the morning, when, if 
 the use of it at meals causes dyspeptic 
 symptoms, as is often the case, none 
 should be taken at this time. Under 
 no circumstances whatever should we 
 
Treatment. 107 
 
 drink ice water, nor even cold enough 
 to chill the stomach. 
 
 In the commencement of this diet it 
 is frequent for the bread and starchy 
 foods to disagree, causing flatulence 
 and a sense of oppression in the stom- 
 ach. This is due in part to the in- 
 creased quantity taken to compensate 
 for the lack of animal food, which, on 
 account of its concentration, seldom 
 causes this ; and another reason, that 
 in meat eating, bolting, usually prac- 
 ticed, by the way, is possible as the 
 main factor of this digestion is in the 
 stomach, but in the case of the above 
 as an admixture of saliva is absolutely 
 indispensable, and which not being al- 
 lowed, owing to this rapid eating, as a 
 result digestion is slow and fermenta- 
 tion ensues. 
 
 The use of cane sugar, when it causes 
 fermentation, gives rise also to acid 
 products, and when such a condition 
 arises should be prohibited. 
 
108 Treatment. 
 
 The action of salt tending to cause 
 a deposition of sodium biurates in the 
 joints and tissues, it therefore should 
 be used sparingly and all salt foods 
 be abstained from. In severe cases 
 potassium chloride as a substitute for 
 salt is advisable, on account of its less 
 prejudicial effects and also its moder- 
 ately diuretic action 
 
 All acids and acid foods should be 
 prohibited from the patient's diet. 
 
 Over-eating must not be indulged in, 
 as not only in these cases but is always 
 predjudicial to the well being of the di- 
 gestive organs. 
 
 We hear complaints from many as to 
 a feeling of " good for nothingness " to 
 coin a term to fit the case, so often ex- 
 perienced Mondays after a hearty eat- 
 ing on Sunday, or the day following a 
 holiday on which we have feasted too 
 lavishly ; as in these cases meat is in- 
 variably an important item in the bill 
 of fare, from which we may attribute 
 
Treatment. 109 
 
 the bad effects to an excess of uric acid 
 formed, as the disturbing element aided 
 also by the usual lessened amount of 
 activity on these occasions. 
 
 Just here a point mentioned by Bur- 
 nett in his work on " Gout " might not 
 come amiss. He suggests that in this 
 complaint in those of hereditary ten- 
 dencies and high livers a spare diet is 
 not so beneficial as in those who live 
 plain but from occasional high living 
 are subject to its attacks. 
 
 During one of the so-called uric acid 
 storms the diet should be of the plain- 
 est, and often in many cases during the 
 severity of the attack nothing at all 
 should be eaten, save possibly some 
 warm water drunk at intervals to supply 
 liquid for the system to assist the kid- 
 neys in carrying off the excess waste 
 products. 
 
 In regard to the use of alcohol in 
 this class of cases, it should not be 
 used at all as a beverage. If stimu- 
 
no Treatment, 
 
 lants are really needed at any time a 
 little Scotch whiskey may be allowed 
 as preferable on account of its little or 
 no acidity, but port, sherry, burgundy 
 and champagne, together with malt 
 liquors and porter, should be prohibited 
 on account of their acidity, and to 
 which champagne is attributed the 
 most pernicious, as the most acid. 
 
 These are more liable to give trouble 
 in the case of meat eaters than in 
 those not given to this form of diet ; 
 and to these contained acids is to be at- 
 tributed the mischief making, as the 
 action of alcohol pure is that of an 
 alkali in diminishing the acidity of the 
 urine and for a time increasing the ex- 
 cretion of the uric acid. 
 
 A few points as to the uric acid form- 
 ing properties of some articles of diet 
 might be of service to bear in mind. 
 
 Young meat, as lamb and veal, con- 
 tains more uric acid, 3.5 grains to the 
 pound, than old meat, as beef or mut- 
 ton, containing 1. grain to the pound. 
 
Treatment. in 
 
 Kidneys contain 3.5 grains and liver 
 6.5 grains to the ponnd. 
 
 Fish has only 1. grain, but beef tea 
 contains 7. grains to the pound. 
 
 Of the xanthin compounds, which, 
 as we know, while not uric acid, still in 
 their passage through the body be- 
 come such ; of these cocoa contains 59 
 grains, coffee 70 grains, and tea, the 
 largest of all, 175 grains to the pound. 
 
 From this we can readily understand 
 why the latter plays such havoc with 
 the nervous system. 
 
 As to articles suggested for diet the 
 following quantities are to be recom- 
 mended : 
 
 Milk containing 3-4 per cent, albuminoids, 3-4 pints 
 
 per day. 
 Cheese containing 33 per cent, albuminoids, 2 ounces 
 
 per day. 
 Bread containing 8 per cent, albuminoids, 12 ounces 
 
 per day. 
 Oatmeal containing 12 per cent, albuminoids to equal 
 
 2 ounces dry per day. 
 Wheatena containing 16 per cent, albuminoids to 
 
 equal two ounces dry per day. 
 
 Besides plenty of fruit, vegetables 
 and water. 
 
ii2 Treatment. 
 
 In concluding this subject, as to a 
 diet suitable for this condition, while to 
 some it might appear but a step above 
 starvation, I can assure the hesitating 
 ones that their nutrition will in no wise 
 suffer, and besides after giving it a fair 
 trial will derive so much benefit from it, 
 and feel so much better than when on a 
 uric acid forming diet, that they will 
 not care to return to their old habits^ 
 in fact some even acquiring a distaste 
 for these articles of food, although 
 favorites in the past. 
 
 Of course the difficulty will be to in- 
 duce these patients to try this form of 
 diet, as they cannot realize the possi- 
 bility of dispensing with what they have 
 considered so essential to their nutri- 
 tion. But we should strenuously advise 
 it and do all in our power to w T ean 
 them of their bad habits, when if they 
 will not take our advice the loss is 
 theirs, we will have done our duty and 
 on this point at least can go our way 
 with a clean conscience. 
 
TREATMENT. 
 
 Drugs. 
 
 In a condition of this kind dealing 
 with a substance in the system acting 
 largely as a foreign body, we can readily 
 understand that the first indication in 
 our treatment is its removal, the excess 
 waste products eliminated from the sys- 
 tem ; then by diet and other measures 
 its further increase and retention pre- 
 vented, when by means of our remedies 
 as indicated endeavor to set right what- 
 ever bad results that remain. 
 
 In many cases, however, of long 
 standing and where serious organic le- 
 sions have not occurred ; with old habits 
 corrected, reformed diet, with an elimi- 
 native treatment, proceedings that are 
 absolutely essential in all cases, these 
 will be all that are necessary to effect a 
 8 
 
H4 Treatment. 
 
 cure ; but in an individual where this 
 condition has been of long duration, a 
 matter of years, there is usually a cer- 
 tain amount of deep-seated damage set 
 up, possibly organic, which will some- 
 times require long and persistent treat- 
 ment to rectify, and in some cases not 
 to be cured. Such as these will tax our 
 knowledge of the materia medica, as 
 they are to be treated purely according 
 to the organ or structures involved. 
 
 No doubt in some of these cases of 
 simple excess formation and storage in 
 the system, after a change in living 
 and a diet stopping this increased prod- 
 uct, but requiring a considerable time 
 to do so, nature would gradually elimi- 
 nate the superabundance of uric acid in 
 the tissues and blood, but during which 
 time, however, the patient would be liv- 
 ing a life of utter wretchedness, de- 
 pression, malaise, etc., therefore it is 
 always advisable to adopt an elimina- 
 tive form of treatment to get rid of this 
 
Treatment. 115 
 
 as soon as possible, to start the patient 
 on the right way to recovery. 
 
 To accomplish this we have many 
 agents ; in fact, the manufacturing 
 pharmacist has here been particularly 
 generous, as it would seem that he 
 had made it a veritable target for his 
 creative genius, so numerous have 
 they been ; the last better than all the 
 others combined and the only perfect 
 one; and, as a rule, the majority of 
 them after being weighed in the bal- 
 ance are found decidedly wanting in 
 respect to the qualities claimed for 
 them. But aside from these there are 
 several reliable and efficient agents 
 capable of accomplishing these results 
 in a most satisfactory manner, the 
 properties of which we will now discuss. 
 
 Haig advises and his apparently 
 favorite method of elimination of the 
 urates from the system is by means of 
 the salicylates. 
 
 By their action increasing the solu- 
 
n6 Treatment. 
 
 bility of the uric acid by forming with 
 it salicyluric acid, at the same time in- 
 creasing the urinary secretion and thus 
 carrying it out of the body. This sub- 
 stance being soluble in slightly acid 
 solutions and insoluble in alkaline, acts 
 therefore best when the alkalinity of 
 the blood is low. 
 
 Warmth also hinders its action due 
 to this raising the alkaline reaction of 
 the blood, therefore its administration 
 in warm weather is not as resultant of 
 good as some other agents. 
 
 It is always contraindicated when 
 gastric disturbances are present, an 
 existing debility or physical depression^ 
 and should not be administered when 
 dyspnoea or cyanosis exist or any form 
 of heart disease, as it may cause heart 
 failure by the increased blood pressure 
 from the outpouring of the stored up 
 uric acid in the blood. In certain nerv- 
 ous individuals salicylates in large 
 doses develop neurotic symptoms, even 
 
Treatment. 117 
 
 going on to delirium ; and, as it acts as 
 an irritant to the kidneys, should be 
 but sparingly and cautiously given when 
 they are deranged. As large doses also 
 cause dyspnoea, therefore should be ad- 
 ministered with care. 
 
 When necessary, Haig advises a con- 
 tinuance of this treatment for a long 
 time, months or even years (1-3), as he 
 claims that this may in some severe 
 cases be required to eliminate the 
 urates from the system stored up from 
 past excessive accumulations. 
 
 He further advises that the diet be 
 not changed too soon, until the sali- 
 cylates have had time to act in their 
 eliminating sphere, preferring to accom- 
 plish the clearing out first before stop- 
 ping the excess formation. 
 
 To insure the acidit}^ necessary to 
 free the blood of uric acid, and for the 
 proper action of the salicylates, he recom- 
 mends its alternate use with acids, as 
 nitro muriatic acid, 2-3 gtts. in half 
 
n8 Treatment. 
 
 glass of water, taken before meals (a 
 free dilution of it is necessary, as it 
 may otherwise cause a fall in acidity 
 instead of a rise in it) , and salicylate 
 of sodium, x-xv grains, after meals and 
 at night (four times a day) , in water or 
 milk. Sometimes it is well to give at 
 the same time aromatic spirits of am- 
 monia, x-xv gtts., as ammonia al- 
 though an alkali, still, as Haig informs 
 us, in this connection raises the acidity 
 of the urine and aids the excretion of 
 uric acid; also assisting the action of 
 the salicylates. No doubt a satisfactory 
 result is obtained by the administration 
 of this agent, but the reason of its ac- 
 tion does not seem quite as much so. 
 
 Under such circumstances it would 
 seem well to try salicylate of am- 
 monium. 
 
 This acid (nitro muriatic) recom- 
 mended simply removes the uric acid 
 from the blood and drives it into the 
 tissues, when the use of salicylates is 
 
Treatment. 119 
 
 necessary to eliminate it from the sys- 
 tem; otherwise, when the drug is left 
 off, the urates return again into the 
 blood, and the same old train of symp- 
 toms again occurs. During this stage, 
 when the blood is free, an actual state 
 of stimulation exists with a lowered 
 blood pressure, quickened circulation 
 and pulse, with also a brightening up 
 of the intellect, allowing an increased 
 combustion and metabolism throughout 
 the body. In subjects susceptible to 
 it also producing gout. 
 
 Another form of treatment recom- 
 mended by Haig for the removal of the 
 urates from the blood is by means of 
 calomel in ]/^ grain tablets, 2-3 doses 
 at ]/ 2 hour intervals ; or else mercuric 
 iodide yi grain, 2 doses as above, fol- 
 lowed immediately by the same sali- 
 cylate treatment. This, as a rule, is 
 necessary to be repeated for several 
 days (4-5) to clear the blood com- 
 pletely and effectually of these retained 
 waste products. 
 
1 20 Treatment. 
 
 When for any reason an agent is re- 
 quired to drive the urates at once out 
 of the blood for relief of present exist- 
 ing symptoms, a nitrite, as glonoin 
 1-100 minim, or sodium nitrite 2 grains, 
 or else morphia 1-6 grain will suffice. 
 
 In cases where mercury is contrain- 
 dicated for any reason, nitro muriatic 
 acid, as hitherto been suggested, is pref- 
 erable. 
 
 It may seem to some that I have 
 dwelt at too much length on these 
 methods of Haig, as they may not be 
 acceptable to all of us, but as he being 
 acknowledged the foremost authority 
 on this subject (uric acid), it has 
 seemed to me that we should have a 
 clear idea of his views on the treatment 
 of this condition; even although we 
 have no occasion for its present use, 
 there might come a time when all other 
 means failing we would be very glad to 
 avail ourselves of these measures. 
 
 Another nitro muriatic acid method 
 
Treatment, 121 
 
 recommended is the following : 3-5 
 grains of this agent after meals and at 
 night in a ^ glass of water ; always 
 after taking rinsing the month with 
 water and drinking another glassful. 
 To be followed by sodium phosphate 
 and alkali or else piperazine to remove 
 the urates from the system. This 
 treatment should be always begun a 
 week or so before expected attacks if 
 possible, as sick headache, etc. 
 
 In warm weather when salicylates 
 are not indicated, sodium bicarb. 30 
 grains t. i. d. between meals raises the 
 blood pressure and retains the urates 
 in the blood so as to admit of their 
 elimination, but diminishes the excre- 
 tion of the urine. Potassium bicarb. 30 
 grains t. i. d. has the same action as 
 the above, but is more of a diuretic. 
 
 In very many cases irrespective of 
 season these agents are often preferable 
 to salicylates and fully as effective ; in 
 fact, in debilitated individuals they are 
 much safer at all times. 
 
122 Treatment. 
 
 Lithium, regarded by the laity and a 
 majority of the profession as the grand 
 cure-all for this— the uric acid diathe- 
 sis — has been laid in the dust by Haig, 
 who claims that it exercises no in- 
 fluence whatever upon the excretion of 
 the urates, but, as I have said before, 
 combines with the phosphates of the 
 blood, raising its acidity, and drives the 
 uric acid into the tissues ; a condition 
 of relief of but short duration, as it 
 does not eliminate it from the system 
 as we have hitherto been led to sup- 
 pose. 
 
 Previous to becoming aware of this 
 fact, the writer had often wondered at 
 the entire absence of results obtained 
 by him from this drug, it never seem- 
 ing to afford the slightest relief in his 
 experience. 
 
 Lithium salicylate has yielded better 
 results, probably due to the action of 
 the salicylic acid in this combination. 
 However, in the opinion of the writer, 
 
Treatment, 123 
 
 that, as there are many eliminatives so 
 far superior to lithium, we should avail 
 ourselves of them, and only when 
 nothing else is obtainable resort to this 
 agent, and then only when a salicylate. 
 
 Phosphate of sodium for the elimina- 
 tion of urates from the system, in doses 
 of 30-60 grains, 2-3 times a day, not 
 allowing the bowels to become too free, 
 is the most effective and thoroughly to 
 be relied upon for this purpose of all 
 the eliminatives. To obtain the full 
 benefit from it an alkaline media is 
 necessary for its action ; therefore it is 
 best given with sodium bicarb., as in an 
 acid solution it becomes an acid phos- 
 phate, an insoluble compound in the 
 blood, thereby being rendered useless 
 for this its desired purpose. 
 
 Piperazine is a valuable agent for this 
 condition, its directions for use being: 
 15 grains in a quart of water to be 
 taken in one-half glass doses through- 
 out the day. 
 
124 Treatment. 
 
 Gicht wasser of Wiesbaden is also 
 recommended as of benefit. 
 
 Of late a certain nnmber of organic 
 compounds have been introduced with 
 great claims as to their efficacy in form- 
 ing soluble bodies with uric acid in the 
 system, and thereby facilitating its easy 
 elimination, such as : lysidine, pipera- 
 zine (already mentioned), formine, ly- 
 cetol, sidonal, etc. 
 
 The value of these, with the excep- 
 tion of piperazine, is as yet problemat- 
 ical, although most enthusiastic reports 
 are heard from some quarters regarding 
 their value in these complaints, as a 
 rule, however a large majority of the 
 results having been obtained from ex- 
 periments outside the body. But owing 
 to the fact that our results in the labor- 
 atory are not by any means borne out 
 in the human body accounts for the fact 
 that physiological chemistry is not yet 
 an absolute science, and also that we 
 cannot place an implicit reliance upon 
 
Treatment. 125 
 
 these compounds, or others of a similar 
 character, for this purpose as yet, until 
 clinical experience has demonstrated 
 that they are what they are claimed to 
 be. Time and trial will demonstrate 
 the value of these, when the good will 
 rise to the top and the worthless will 
 sink to the bottom. That is, it should 
 be this way, as it sometimes is not. 
 
 The following treatment has also 
 been recommended for this condition : 
 
 fy. Theobromine, 3 iv. 
 
 Lithium Carbonate, ^iiss. 
 Sodium Benzoate, £j gr. xv. 
 M. S. — Divide into sixty tablets. One to be taken 
 each morning. 
 
 Administer for twenty days during 
 each month, for about six months. 
 
 An interval of two months may then 
 be allowed to elapse, and the treatment 
 be resumed for another six months. 
 
 For the feeling of coldness or cold 
 extremities, a common symptom occur- 
 ring in these patients, nitro muriatic 
 acid dilute, 10 minims in l / 2 glass of 
 
126 Treatment, 
 
 water before meals, followed by the 
 salicylate or soda treatment after meals. 
 Recommended by Haig. 
 
 For gout he also advises salicylate of 
 methyl x-xv gtts. painted externally 
 on the affected part, protected with an 
 impervious covering 
 
 Having laid before the reader a 
 very wide selection of " old school" 
 remedies and forms of treatment, I will 
 now take up what methods are adopted 
 by the homoeopathic school; its point of 
 advantage being its ability to cope with 
 the after conditions which frequently 
 occur as a sequelae in these patients, be- 
 sides by no means devoid of methods of 
 its own to effect the elimination of the 
 offending products when in excess. 
 
 Ever bearing in mind the old saying 
 about " two strings to one's bow," and 
 the advantages of this dual capacity, 
 notwithstanding which there comes a 
 time when the destroying processes of 
 nature are not to be vanquished by 
 
Treatment. 127 
 
 either, verily it would seem that lie 
 who would scorn the methods of any 
 school of medicine is but half armed for 
 the fray. 
 
 Urtica urens. This remedy was in- 
 troduced to the medical profession for 
 the purpose of eliminating the excess 
 urates from the system by the late J. 
 Compton Burnett, who modestly in his 
 little book on " Gout " informs us that 
 it will not in all cases fulfill this func- 
 tion. Such a marked contrast to the 
 extravagent claims made for some of 
 the exploited cure-alls, regarding which 
 it would be perfectly proper to rather 
 state as an antithesis that in all cases 
 they will not fail, although our experi- 
 ence might have led us to so infer. 
 Nevertheless it is an agent of great 
 worth in this class of cases, and usually 
 giving satisfaction when used accord- 
 ing to his directions, viz., in acute at- 
 tacks 5 drops of the tincture every 2-3 
 hours in a wineglass full of warm water, 
 
128 Treatment. 
 
 while in the more chronic conditions, 
 he advises 10 drops morning and night 
 or t. i. d. in the same menstnmm. 
 
 He does not give marked indications 
 for its use, but rather suggests it on 
 general principles ; still it is a remedy 
 we should ever have in our mind when 
 treating uric acid patients, and often 
 then to administer it with the one indi- 
 cated. Its results are as a rule quick 
 and lasting, being not only an elimi- 
 nant, but also when in conjunction with 
 hygienic measures and diet a curative 
 agent that is also prophylactic to the 
 after effects of uricacidaemia. 
 
 To those of our school to whom the 
 dosage given above would seem as he- 
 retical, a "backsliding" process, so to 
 speak, the writer would say that in 
 mild cases with symptoms of uric acid 
 retention he has obtained very satisfac- 
 tory results from doses of ]/ 2 to i drop. 
 
 Aurum muriaticum 3X v. gtts. in 
 water every three hours is a most excel- 
 
Treatment. 129 
 
 lent remedy given on general principles 
 for the various sequelse of uricacid- 
 semia, for the conditions remaining 
 over after the stored up products have 
 been excreted and a new diet instituted; 
 its characteristic symptoms being great 
 mental depression, and in old and worn 
 out subjects. 
 
 The various conditions in which it 
 will be found useful are the following : 
 Cardiac hypertrophy, powerful action, 
 with rush of blood to head and chest ; 
 palpitation of the heart ; high blood 
 pressure. Arterio sclerosis. 
 
 Different varieties of neuritis, as also 
 neurasthenia. 
 
 Interstitial nephritis ; early and late 
 stages. 
 
 Hepatic cirrhosis ; sclerotic stage. 
 
 Spiritus glandium quercus x. gtts. of 
 the tincture in water t. 1. d., also recom- 
 mended by Burnett, is another valuable 
 remedy in the case of old alcoholics and 
 high livers. He claims that it will di- 
 9 
 
130 Treatment. 
 
 minish if not remove the craving for 
 spirits. Disease of the spleen is one of 
 its chief characteristics, with pain in 
 that region. 
 
 The following is a classification of 
 the various conditions developing from 
 uric acid as a causative factor, together 
 with their appropriate remedies as in- 
 dicated for them : 
 
 1. Nervous system: Arsenic alb., 
 aurum muriat., kali iod., spigelia. 
 
 2. Heart and Circulation : Arsenic 
 alb., aurum muriat., cactus, berberis, 
 chelidonium, china, iris versic, mercur. 
 dulc, nux vom., podophyllum. 
 
 4. Respiratory Tract : Arsenic alb., 
 arsenic iodide, grindelia, kali iodide, 
 sulphur. 
 
 5. Urinary Tract and Kidneys : Ar- 
 senic alb., aurum muriat., berberis, can- 
 tharis, coccus cacti, ferrum phos., kali 
 chlor., lycopodium. 
 
 6. Gout : Colchicin 3. 
 Arsenicum album $x. Asthmatic at- 
 
Treatment. 131 
 
 tacks ; especially during the intervals, 
 with co-existing heart disease, restless- 
 ness and wheezing. 
 
 Prostration after all attacks ; cardiac 
 palpitation, precordial pain, dyspnoea, 
 weak heart, rapid irregular pulse. Ar- 
 terio sclerosis. 
 
 Angina pectoris, in the intervals only. 
 
 Interstitial nephritis, both acute and 
 chronic forms. 
 
 Neuralgia, worse from cold, inter- 
 mittent, periodic. 
 
 Neuritis, burning pains. Neuras- 
 thenia. 
 
 Gastritis, vomits everything taken 
 into stomach, excessive prostration. 
 
 Arsenic iodide jx. Hay fever, rhinit- 
 is, sneezing, acrid discharge from nose, 
 mucous or watery prostration. 
 
 Berberis tinct. Gall stone colic, 
 pains, burning and boring. 
 
 Lancinating or throbbing pain in 
 the kidneys, worse sitting or lying and 
 on rising from stooping ; better stand- 
 ing. Urine turbid, bloody or scanty. 
 
132 Treatment. 
 
 Cactus ix. Cardiac hypertrophy, 
 palpitation, and congestion ; feeling of 
 constriction. 
 
 Cantharis ix. Bnrning pain in the 
 kidneys ; constant nrging to nrinate, 
 only a few drops passing, with burning 
 pains ; scanty burning urine. 
 
 Chelidonium tinct. Chronic conges- 
 tion of the liver, pain under inner angle 
 of right shoulder ; sallow skin ; yellow 
 coated tongue ; dull headache ; consti- 
 pation ; fullness in region of liver ; 
 sharp stitching pains ; radiating to 
 right shoulder ; gall stone colic ; bilious 
 headache ; migraine, with nausea and 
 vomiting of bile. 
 
 China 6x. Claimed to prevent the 
 tendency to formation of gall stones. 
 
 Hepatitis. Periodicity. 
 
 Coccus cacti tinct. Renal colic. Uric 
 acid stone. 
 
 Colchicine $x. Acute attacks of gout. 
 
 Ferrum redactum 2x. Anaemia, 
 chlorosis ; pale skin ; sudden flush- 
 
Treatment. 133 
 
 ings ; chilliness ; headache ; hemo- 
 globinuria ; amenorrhoea or excessive 
 menses. 
 
 Ferrum pkos. jx. Interstitial ne- 
 phritis ; hemoglobinuria ; urine brown 
 or blackish red. 
 
 Grindelia tinct. Asthmatic attacks. 
 
 Iris versicolor tinct. Sick headache, 
 beginning with blur before the eyes, 
 followed by nausea and vomiting of 
 mucus and bile. Pain over liver ; grip- 
 ing pains. 
 
 Kali chlor., jx. Hemoglobinuria ; 
 urine brown or blackish red. 
 
 Kali iodide, one grain doses. Asthma, 
 wheezing, tightness of chest. 
 
 Promotes the absorption of effusions. 
 Nasal discharge watery. 
 
 Lycopodiiim jc. Pain in back. Uric 
 acid sediment. Uricacidaemia in men. 
 
 This drug for this condition is as 
 largely overrated in our school as is 
 lithia by the " old school." However, 
 some good results have been obtained 
 
134 Treatment, 
 
 from the use of tlie tincture in these 
 conditions. 
 
 Mercurius dulcis 2x. Liver enlarged 
 and sensitive ; tongue coated thick yel- 
 low ; bad breath ; j aundice ; clay colored 
 stools ; tongue retaining imprints of 
 teeth ; gums sore ; salivation. 
 
 Naja $x. Palpitation in cardiac 
 hypertrophy ; oppression. 
 
 Natrum muriat. 12c. Neuralgia ; 
 neurasthenia. 
 
 Nux vomica tznct. Cirrhosis of the 
 liver ; gastric symptoms in high livers ; 
 fullness and pressure in stomach ; 
 vertigo ; pain in back of head. 
 
 Podophyllum ix. Congestion of 
 liver ; fullness and pain on right side ; 
 jaundice ; bilious headache, with blur 
 before the eyes ; vertigo ; vomiting of 
 bile. 
 
 Phosphorus $x. Hepatic cirrhosis 
 and fatty liver. 
 
 Interstitial nephritis ; nervous de- 
 bility ; albuminous and bloody urine ; 
 neurasthenia. 
 
Treatment. 135 
 
 Sepia $x. Chronic liver disorders 
 especially in females ; dark haired ; 
 sallow complexion. Uricacidsemia in 
 women. 
 
 Spigelia tinct. Heart ; violent pain ; 
 irregular action ; palpitation ; irregular 
 pulse ; syncope. Neuralgic affections. 
 
 Sulphur 6x. Asthma of gouty or 
 uric acid subjects ; chronic conditions. 
 
 To promote the reabsorption of in- 
 flammatory products. 
 
 Thlaspi bursa pastoris tinct., v-xxx 
 gtts. Hematuria. 
 
136 Treatment. 
 
 A typical case in the writer's experi- 
 ence will better demonstrate these prin- 
 ciples. 
 
 X , 45 years of age, possessing 
 
 an inherited gouty diathesis ; (paternal) 
 from a child had always been an exten- 
 sive meat eater and drinker of tea, car- 
 ing little for vegetables and not drink- 
 ing much water. 
 
 Occasionally throughout childhood 
 had been subject to sick headaches, but 
 after the age of 21 they became more 
 severe and frequent, occurring from the 
 slightest provocation, as a trivial error 
 in diet, a little too much exercise, at- 
 tending a crowded assemblage, espe- 
 cially when the air was not pure (more 
 likely in the morning) , and as for a rail- 
 road trip, that seemed to have an espe- 
 cial action in laying him up completely, 
 so that traveling became a veritable ob- 
 ject of dread. 
 
Treatment, 137 
 
 These headaches usually coming on 
 at midday, reaching their severity by 
 night, with nausea and vomiting of 
 bitter liquid and food last eaten. 
 
 When on sleeping through the night 
 would awaken in the morning usually 
 free from the headache, and remaining 
 well for the time until the next attack, 
 this coming on, acting and lasting about 
 the same as the last. 
 
 As to periodicity, would occur about 
 once a week, sometimes more often, oc- 
 casionally less frequently, the inter- 
 vals between these attacks being shorter 
 in the cold weather than in summer, 
 when they were very rare. 
 
 At all times the patient was very sus- 
 ceptible to the cold, it sometimes amount- 
 ing to almost actual suffering ; besides 
 possessing a tendency to take cold on 
 the slightest exposure to the air. 
 
 These headaches coming on fre- 
 quently from ordinary fatigue, and es- 
 pecially so from exercising in the cold 
 out of doors. 
 
138 Treatment. 
 
 But by following out the ideas pro- 
 mulgated in this book, the patient has 
 for the last three years been almost en- 
 tirely free from these headaches, only 
 on certain rare occasions appearing to 
 remind him of the past. 
 
 Railroading still is not possible with- 
 out sometimes causing trouble, but this 
 is not as bad as it was once. In sum- 
 mer, when the doors and windows of the 
 cars can be kept open, experiencing 
 little inconvenience, but when in cold 
 weather with the usual bad ventilation, 
 the old complaint is very likely to show 
 itself, but even then in a milder degree 
 of severity. 
 
 Also the suffering from the cold lias 
 become considerably diminished, so that 
 even the exceedingly raw climate of 
 Brooklyn has become tolerable without 
 causing the usual amount of suffering 
 as hitherto. 
 
 The patient previous to this treat- 
 ment on consulting physicians invari- 
 
Treatment. 139 
 
 ably received the same advice from all, 
 " take exercise," the result of which, if 
 not sparingly indulged in, to again 
 bring on the old trouble, but this sug- 
 gestion, if made by him to anyone, to 
 be received with incredulity as some- 
 thing ridiculous or impossible. 
 
 Applying the principles enumerated 
 in this book to this condition, it is easy 
 to understand the reason of the above 
 occurrences ; knowing that an unusual 
 exertion calls into play an excess met- 
 abolism and its consequent process of 
 combustion in the system, an enlarged 
 amount of waste products, and a body 
 already charged with them unable to 
 throw off the amount now present, any 
 increase is sure to be felt and conse- 
 quently cause trouble. 
 
 Such was the case here in one suffer- 
 ing from uricacidsemia. 
 
 Remembering at all times in this 
 condition, the indications are : Get rid 
 of the increased waste products in the 
 
140 Treatment. 
 
 system, prevent an excessive reforma- 
 tion, when exercise will be rather a 
 source of pleasure than a cause of dis- 
 comfort, even suffering. 
 
CONCLUSION. 
 
 Thus ends my work for the present 
 time, although this by no means ex- 
 hausts the subject or is entitled to be 
 considered as complete, which, owing 
 to its complexity, will be long before it 
 is perfectly understood, if ever. 
 
 However, the dawning light has al- 
 ready burst forth and we now have 
 some dim perceptions regarding uric 
 acid from which it is possible to gather 
 a somewhat intelligent idea. 
 
 The uric acid diathesis is still by 
 some considered a myth, as non- exist- 
 ing ; but to all of this opinion we feel 
 very much like saying with " Romeo," 
 in the work of the immortal Shakes- 
 peare, " He jests at scars who never 
 felt a wound." In short, because the 
 scoffers and doubters have never met 
 
142 Conclusion. 
 
 with a case of this kind, therefore it 
 cannot exist. 
 
 We, of the medical profession, some- 
 times change onr views, therefore this 
 course is still always open to the 
 doubters. 
 
INDEX. 
 
 PAGE 
 
 Acids, no 
 
 Acid tide or period, 26, 58 
 
 Acidity caused by beers, wines, etc., 32 
 
 Acidity of the blood, 36 
 
 Acidity caused by fevers, . . . . 34 
 
 Acidity caused by alcohol, 34 
 
 Acid urates, 22 
 
 Action of cold, 39 
 
 Air, 75 
 
 Alkaline tide, 25, 58 
 
 Alkalinity decreased by cold, 25, 30, 34, 52 
 
 Alkalinity increased by exercise, 25 
 
 Alkalinity increased by warmth, 30, 52 
 
 Alcohol, no 
 
 Alcohol as a cause, 40 
 
 Alcohol, use of, 66 
 
 Anabolism, . 18 
 
 Anaemia, cause of, 44, 48 
 
 Angina pectoris, 59 
 
 Animal food diet, a cause of, 40 
 
 Arterial pressure raised, 58 
 
 Arterio sclerosis, . , . . 59 
 
 Asthma, 58 
 
 Aurum muriaticum, 12S 
 
 Bathing, 70 
 
 Baths, cold not advisable, 71 
 
144 Index. 
 
 Baths, cold checks the elimination of uric acid, . . 71 
 Baths, cold cause of cardiac and renal lesions, . . 73 
 
 Baths, hot preferable, . 71 
 
 Bethlehem, N. H., as a resort, 85 
 
 Bilious epoch, 8 
 
 Bowels, 87 
 
 Breakfast, abstaining from, 102 
 
 Breakfast, fruit, 99, 102 
 
 Burnett, J. Compton, 97, 109, 127, 129 
 
 Calomel, 119 
 
 Camping out, 79 
 
 Cardiac lesions, 59 
 
 Casco Bay, 85 
 
 Cereals, 98 
 
 Cheese, 91, 93 
 
 Cheese, cottage, 85 
 
 Children should not eat meat, .95 
 
 Circulation, action of uric acid on, 42, 43, 58 
 
 Classification of remedies, 130 
 
 Climate, 80 
 
 Clinical case, typical, 136 
 
 Clothing, 75 
 
 Coffee, ..40 
 
 Coffee substitutes, 104 
 
 Cold, effects of, 53, 72 
 
 Cold extremities, . 125 
 
 Coldness and chilliness, 49, 125 
 
 Colloid uric acid, ...... 28, 39, 43 
 
 Conclusion, 140 
 
 Connecticut shore of Iyong Island Sound as a resort, 85 
 Cures not possible by drugs alone, 67 
 
 Definition, 15 
 
Index, 145 
 
 Depression, 49 
 
 Diathesis, uric acid, 38 
 
 Diet, 89, 92, no, in 
 
 Diseases attributed to uric acid, . . . 37, 42, 51, 52, 60 
 
 Diseases following uric acid storms, 45 
 
 Diseases of old age due to uric acid, 51 
 
 Drugs, 113 
 
 Drugs making blood acid, 33 
 
 Drugs making blood alkaline, 32 
 
 Eggs as an article of diet, 95 
 
 Kliminants of uric acid, 114, 124, 128 
 
 Elimination of uric acid, 22, 23 
 
 Elimination of waste products, ........ 66 
 
 Etiology of uricacidsemia, 35 
 
 Exercise, 68 
 
 Exercise influences the amount of uric acid in the 
 
 blood, . . . . 25 
 
 Exercise, excessive, aggravates condition, .... 69 
 
 Fatigue, 51 
 
 Fatigue due to excessive quantity in the blood, . . 27 
 
 Fevers cause acidity, 2S 
 
 Flatulence and dyspepsia from diet, ....... 107 
 
 Food influences amount of uric acid in the blood, 
 
 99, 102 
 
 Fruit, 97, 98, 100 
 
 Fruit, alkaline salts in, 99 
 
 Fruit, avoid sour, 100 
 
 Fruit, breakfast, 99, 102 
 
 Gicht wasser 124 
 
 Gout, 50, 109, 126, 127 
 
 Gout and rheumatism identical, ^6, 50 
 
146 Index. 
 
 Haemoglobin, consumption of, 49 
 
 Haemoglobin, deficiency of, 49 
 
 Haemoglobinuria, cause of, 44 
 
 Haig, 115, 117, 118, 119, 120, 122, 126 
 
 Hay fever, 61 
 
 Headache, 54 
 
 Hobby, cultivated, ,67 
 
 Homoeopathic treatment, 126, 131-135 
 
 Hot water the ideal heating system, ...... 78 
 
 Hygienic principles, 65 
 
 Hygienic treatment, 68 
 
 Indications for treatment, 66 
 
 Insomnia, 49 
 
 Introduction, 7 
 
 Irritability, . 49 
 
 Katabolism, 18 
 
 Kidneys, derangement of, 49, 59 
 
 List of remedies, 131-135 
 
 Lithia, action of, 33 
 
 Lithium, 122 
 
 Lithium salicylate, !, 122 
 
 Liver, derangements of, 49 
 
 Maine, coast of, as a resort, 85 
 
 Malaise, 51 
 
 Malarial epoch, . 9 
 
 Meat eating, 94 
 
 Medium altitude preferable for these cases, .... 80 
 
 Mercuric iodide, 119 
 
 Metabolism, 17, 18 
 
 Milk, 91, 105 
 
 Minnewaska, Lake, as a resort, 84 
 
Index. 147 
 
 Neurotics most frequent subjects, 47 
 
 Neurotic rhinitis, 61 
 
 Nitro-muriatic acid, 118, 120 
 
 Occurrence of uric acid, 22-23 
 
 " Old school " treatment, . . 1 15-126 
 
 Origin of uric acid, 20 
 
 Out-of-door life essential, 76 
 
 Pathology, 42 
 
 Piperazin, 121, 123, 124 
 
 Potass, bicarb, 121 
 
 Prevent accumulation of uric acid, 66 
 
 Recreation, 87 
 
 Relation of uric acid to urea, importance of , . . . 29 
 
 Rest, 87 
 
 Rheumatism, 50 
 
 Salicylic acid, 115 
 
 Salt and salt foods, 108 
 
 Seashore or mountains not as advisable as medium 
 
 altitude for resort, 80 
 
 Sharon, Conn., a most desirable resort, 82 
 
 Sodium bicarb., 121 
 
 Sodium phosphate, 121, 123 
 
 Solubility of uric acid, 25 
 
 Spiritus glandium quercus, 129 
 
 Steam heat undesirable 76 
 
 Sugar, cane, 107 
 
 Symptoms, 42 
 
 Synonyms, [3 
 
 Tea, 40 
 
JAN 21 1903 
 
 148 Index. 
 
 Temperaments, effect of uric acid upon, 62 
 
 Temperature influences amount of uric acid in the 
 
 blood, 25 
 
 Tired feeling in spring, 30, 31, 52 
 
 Tobacco as a cause, . 40 
 
 Treatment, 64, 87 
 
 Treatment, general remarks on, 64 
 
 Urea, determination of, 91 
 
 Uric acid, amount of, eliminated, 22-23 
 
 Uric acid epoch, 10 
 
 Uric acid, occurrence of , . . . . . 22-23 
 
 Uric acid, origin of, 20 
 
 Uric acid, solubility of, .... 25 
 
 Uric acid storms, 44, 59, 89, 109 
 
 Uric acid, quantity of, in the blood varies, ... 25 
 Urine, increase of, with uric acid in the blood, . . 31 
 Urtica urens, 127 
 
 Ventilation bad in churches, 56 
 
 Ventilation in crowded assemblages, 56 
 
 Water drinking, 88, 106 
 
 Water drinking, too little a cause, 40 
 
 Whiskey, Scotch, no 
 
 White Mountains, - 84 
 
 Wines, no 
 
 Wood fires most desirable, 78 
 
 Woolen underwear, 75 
 
 Xanthin bodies, in 
 
 Xanthin diet, . 40 
 
 
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