CONTRIBUTIONS ON THE PHYSIOLOGY & THERAPEUTICS OF FOOD
38 desirable to give first a single dose, no more, say three or four grains, of blue pill at night, and the next morning eight or ten ounces of Friedrichshalle water, so as to ensure good action at first. Then commence with Friedrichshalle combined with hot water, one dose every morning an hour before breakfast, diminishing a little the quantity every day or every few days. One of the characteristics of this water is that the longer it is taken the smaller is the quantity necessary to effect
... essary to effect the purpose. If, for example, seven or eight ounces taken in the morning, say with five ounces of hot water, produce one active movement of the bowels immediately after breakfast, the next morning six or seven ounces will do the same, and the morning after probably five or six ounces; and it is very likely that at the end of three weeks the patient will from four ounces experience the same effect produced originally by seven or eight. But after you have given it thus for one, two, or three weeks, according to the nature of the case and the results, you should combine it with Carlsbad, say three or four ounces of the former and five or six of the latter, with three or four of hot water every morning. When Friedrichshalle is given alone, and also when it is mixed with Carlsbad, 20 or 30 per cent. of hot water should be added, that it may resemble somewhat the original condition at the spring. Friedrichshalle is naturally hot, and is evaporated on the spot to a small extent, being regulated and rendered uniform by stopping the process when the water reaches a certain specific gravity. Carlsbad, which at the spring is too hot to drink until cooled, should, when taken alone and unmixed, be raised in temperature to 90° or 100°, by placing the tumbler containing it in a vessel of hot water for a few minutes. After giving this combination of the two waters for two or three weeks, six, seven, or .eight ounces of Carlsbad may be taken alone for another fortnight perhaps. The quantities given are considerably less than those administered at the spa itself, where a patient's stay is necessarily limited as to time. I am quite satisfied that the smaller quantity here recommended, and employed for six to nine weeks, instead of the usual three weeks of a foreign course, is better for the majority of the patients we have to deal with. The same quantity of water given there in twenty-one days, producing often notable .loss of weight and power, will, if given here in fifty or sixty days, attain the object as certainly and more safely. I by no means dispute that there are other cases which may be benefited by the more heroic plan adopted on the spot. I have largely and systematically employed these agents now for seven or eight years, modifying the quantity and the mode as experience has indicated, and the course thus briefly described is the result of it. The course may be repeated with advantage, if necessary, for most patients after an interval of three or four months. Meantime, as an' occasional aperient and a corrector of digestion for these patients, I know nothing at all equal to Friedrichshalle. It leaves the patient as a rule less constipated after discontinuing it than he was before ; and, as already said, may be taken habitually without lowering the system. I have known patients continuing its daily use for three or four years, but I do not advise this course unless in exceptional cases. Nevertheless I know a gentleman, nearly eighty years old, who has taken it for five years regularly, a wineglass every morning, and the effect has been for him most admirable. Suffering much formerly from an obstinate constipation, he enjoys perfect regularity and excellent health. Let me say here that what is called " Carlsbad salt" is often used for the same purpose, and is taken also in the belief that it represents Carlsbad water. This it does not do, consisting almost entirely of sulphate of soda taken from the water, and has the same and no more virtue than that salt when obtained from any other source. No doubt that the sulphate of soda, known also as " Glauber's salt," is one of the most admirable medicines we possess, and deserves to be more popular than it is. I constantly ' , order it, with or without a small addition of sulphate of ' I magnesia, for the out-patients as the best substitute within ; , my reach for the mineral waters in question. In the few minutes which remain I will advert briefly to the subject of diet, certain restrictions in which are extremely important. It used to be said that when uric acid is largely deposited the nitrogenous elements of the food ' , should be considerably diminished. I do not find in practice that a.strict application of this rule is advantageous. On the contrary, the diminution of the deposit is more certainly attained by a course which is almost the opposite of that. There are three classes of aliments which must be permitted to the patient very sparingly, in order to attain the end in view-viz., alcohol, saccharine, and fatty matters. First, alcohol: any fermented liquor permitted as an article of diet should be selected in its more diluted and in its most pure form. Believing that form in which it is found existing in natural wines to be usually the best, I would advise a light sound Bordeaux or a Rhine wine of similar quality, the former perhaps agreeing better with most persons here. You will forbid champagne, as for the most part imperfectly constituted, and always bad if containing much liqueur. The stronger wines, as sherry and port, are mostly unsuitable, and strong beer is to be absolutely forbidden. Solutions of pure spirit and water are exceptionally desirable for some few persons with weak digestion. Secondly, sugar in all its forms : at every meal and wherever met with, forbid it altogether. Thirdly, let fatty matters, butter, cream, and the fat of meat, whether simply cooked or in combination to form pastry, be taken very sparingly. I cannot enlarge on the theory on which this advice is given. Suffice it to say that abstinence from the substances named probably lightens considerably the work of the liver, and so lessens the vicarious labour of the kidneys in accordance with the views already propounded. Let me just advert, moreover, to the dietetic system at Carlsbad. In recognition of some such principle there, no doubt, the use of sugar and of butter is absolutely forbidden during a Carlsbad course ;,and 'were you patients there, your purveyor would not supply you with the forbidden food, however much you might demand it. I can only say, as the result of observation, that this system, much more than the elimination of meat from the dietary, will reduce the uric-acid deposit. If you will cut off a portion of alcoholic stimulant when necessary, and it often is so, will forbid everything that contains sugar, and diminish considerably all fatty matter-giving nitrogenous food, in fact, and eliminating hydrocarbons-you will generally accomplish more than by the contrary method. In addition to all this, you will of course see that the patient takes daily a fair amount of exercise in the open air, and that he protects his skin and encourages the performance of its functions by habitual ablutions and sufficient clothing. These points I can only name; but they are essential concomitants to the rest. Well, then, it is this system of diet and regimen, and the occasional systematic employment of the mineral waters named, which mainly constitute the treatment I strongly advise for the purpose of checking calculous disease in its early stages, and so to prevent the formation of stone in the bladder in that considerable majority of cases which are due to uric-acid formation and its consequences.