Third Investigation. A healthy individual with a large amount of uric acid in the urine.

Daily diet consisted of 102 to 113 grams of albumin; 212 grams of carbohydrate; 137 grams of fat; 38 grams of alcohol. The daily amount of fluid was very high, owing to the warm summer climate, that is, 3000 c. c. On the days on which Rakoczy water was taken, corresponding quantities of ordinary water were omitted.

Fore-period of three days. Uric acid, 1.5, 1.7, 1.1 grams, an average of 1.4 grams.

Period of investigation of five days, with 900 c. c. of Rakoczy a day. Uric acid, 1.0, 0.9, 1.6, 2.2, 2.0 grams, an average of 1.54 grams a day.

It may not be superfluous to mention that the second day of this series was exceptionally hot, so that the patient perspired very freely, and the total quantity of the urine was reduced from 1700-1900 c. c. to 1530.

Period of investigation of three days, with 1200 c. c. of Rakoczy a day. Uric acid, 1.6, 0.7, 1.1, an average of 1.2 grams. Here, too, similar conditions obtained on the second day as on the corresponding day of the above series.

After-period of nine days. Uric acid, 1.2, 1.3, 1.4,

1.4, 1.5, 1.0, 1.4, 1.9, 1.7 grams, an average of 1.4 grams of uric acid a day.

H. Leber resumed these investigations later again under the direction of von Noorden, and arrived at the result that weak saline waters, taken in abundant quantities, as a rule increase the uric acid excretion slightly, but that occasionally they do not exercise any influence upon the uric acid excretion. During the drinking cure he occasionally observed an increase in the uric acid output of as much as 0.2 grams a day.

All these investigations had this disadvantage, that they were not performed on patients suffering from gout. It may be worth while to mention, however, that in the first case reported by us, in which Rakoczy water produced a daily increase of the uric acid excretion of 0.2 grams, typical gout was added to the obesity two years later. In the meantime, von Noorden has reported a number of other investigations in gouty subjects, of which two may be given in this place.

Fourth Investigation. Prince Al. S. About fifty years old; much gout in the family. The patient has suffered for four years two or three attacks of podagra each year. He has a number of small tophi in the ears. The last attack occurred two months before the investigation was begun. During the whole experiment the daily diet consisted of one liter of milk; 400 grams of meat; 6 eggs; 250 grams of bread; 150 grams of butter; 200 grams of potatoes; 1 order of spinach or cauliflower or green beans; half a kilo of grapes; half a bottle of mild Rhine wine, and a bottle of Apollinaris water.

Fore-period of four days. Uric acid, 0.83, 0.77, 0.74, 0.76 grams. In addition, the urine daily contained 0.04 grams of nitrogen in the form of other purin bodies. Total purin nitrogen on an average, 0.298 grams.

Main period of five days, on the same diet. In addition, daily 600 grams of Homburg Elizabeth water.

Corresponding amount, that is, 600 c. c. of Apollinaris water, was omitted on these days. Uric acid, 0.08, 0.98, 0.99, 0.98 grams. In addition, an average daily excretion of 0.06 grams of other nitrogenous purins. Total purin nitrogen on an average, 0.369 grams.

After-period of four days. Diet as in the foreperiod. Uric acid, 0.96, 0.90, 0.78, 0.80 grams. In addition, a daily average excretion of 0.35 grams of other purin nitrogen. Total purin nitrogen on an average, 0.313 grams.

Fifth Investigation. Doctor F. K., aged 55; frequent attacks of gout for fifteen years; chronic gouty changes in different joints; large number of tophi in the ears and on the hands. For about three months the patient has never been quite free from pain and swelling of the joints. During the whole period of investigation he was in bed or lying on the sofa. The subject was fairly obese, showed great muscular weakness, but had no fever.

The daily diet consisted of 400 grams of meat; 4 eggs; 2 to 3 tablespoonfuls of mashed potato; salad at dinner and supper; a plateful of oatmeal or barley; 150 grams of white bread with plenty of butter; 2 oranges; half a bottle of mild Bordeaux wine; one bottle of Apollinaris water.

Fore-period (four days) : Uric acid, 0.534, 0.610, 0.564, 0.555 grams, an average of 0.566 grams.

Main period (five days) : 800 c. c. of Homburg Elizabeth water are substituted in place of an equal amount of Apollinaris water.

Uric acid excretion: 0.571, 0.713, 0.854, 0.886,

0.798 grams, an average of 0.765 grams.

After-period (four days). Diet the same as in the fore-period. Uric acid excretion : 0.788, 0.692, 0.657,

0.642 grams, an average of 0.695 grams.

In both of these investigations the same result was obtained as in the cases previously published; particularly in the last case of irregular gout was the influence of the saline mineral water apparent, inasmuch as the uric acid excretion was favored, and, as we may conclude, the retention of uric acid in the organism was decreased.

These facts, that are corroborated by other clinical investigations, are so convincing that it is well worth while to pay more attention to the use of weak saline mineral waters in the treatment of gout.

A theoretical explanation of the uric-acid-expelling power of weak saline mineral waters can hardly be given. It is a well-known fact that uric acid is salted out of its solutions by strong sodium chloride solutions. Sodium chloride solutions of such concentration, however, never occur in the blood and tissue juices. We are at present engaged in studying this question.

We find only a very short notice in regard to other investigations performed with reliable methods and with a constant diet in the beautiful dissertation on this subject by W. Bain and W. Edgecombe. The administration of Kissingen Rakoczy for four days decreased the uric acid excretion in a healthy individual from an average of 0.459 grams to 0.437 grams a day. In the next few days the excretion of uric acid rose again to 0.539 grams. It is impossible, therefore, to positively predict an increase in the uric acid excretion. It is a remarkable fact, however, and an important one, that particularly in those conditions in which we desire an increase in the uric acid excretion for therapeutic purposes, that is, in gout, this desirable effect is invariably obtained.