Saline mineral waters belong to that group of waters that is employed in the treatment of the uric acid diathesis, and we believe that great therapeutic advantages may accrue from the use of these waters in this condition. We merely call attention to the old and well-established reputation in this direction that Homburg in particular has acquired, particularly among English physicians. In view of all this, it is peculiar that so little has been written in regard to the influence of these waters on the excretion of uric acid. True, there are some older investigations on record, especially the investigations of Genth, with the waters of Wiesbaden, but none of the older publications on the excretion of uric acid can be utilized nowadays, since we know how inexact the old methods of uric acid determination are. Compare the remarks by von Noorden on this subject in his text-book on "The Pathology of Metabolism," page 52. Neither can we utilize the sporadic publications from the pens of a number of physicians in Wiesbaden, simply because these publications deal with isolated data and not with continued series of investigations.

Isolated data are of very little value, for in inter preting the clinical significance of fluctuations in the uric acid excretion large or medium or small figures for the uric acid of the urine should be utilized only with much conservatism. There is undoubtedly much confusion in regard to this matter in all of the literature on the treatment of the uric acid diathesis. We may find that one author warmly recommends a certain remedy, because it decreases the excretion of uric acid, whereas another author praises another remedy with equal enthusiasm because it increases the excretion of uric acid. Which of the two is right ?

In contradistinction to older teachings, we are justified nowadays in saying that that method of treatment is the best that causes the maximum excretion of uric acid, assuming always that the diet is the same during the periods that are used for comparison. The uric acid appearing in the urine and the other urinary purin bodies probably do not represent the total quantity of these substances that are generated in the organism. They constitute, however, a definite and a very constant proportion of the total uric acid. If this were not the case, such uniform values for the endogenous and exogenous purin bodies of the urine would not be found. We do not agree altogether with the statement made by Burian and Schur, and also, with certain modifications, by O. Loewi, that a certain and definite quantity of purin nitrogen appears in the urine for each definite quantity of purin bodies (nuclein) that is introduced by mouth; for Kaufmann and Mohr have shown in a very thorough investigation, that they carried out under the direction of von Noorden, that certain individual differences may be observed. In the same individual, however, provided the diet remains the same, the excretion of uric acid is fairly constant. We know no factor that is independent of the disease, or of the diet, that is capable of permanently increasing the excretion of uric acid, that, in other words, can increase the metabolism of nucleins, and in this way increase the uric acid. On the other hand, we know of a number of drugs, and we know of many measures, that are capable of increasing the uric acid of the urine for the time being, or of decreasing it. This means that, by employing these remedies or measures we are able to wash out the uric acid or cause its retention. We have every reason to include uric acid retention in the pathology of gout, and to welcome every measure that is capable of removing an excess of uric acid from the blood.

Let us see how the saline waters that we are discussing in this place (Homburg and Kissingen) act in this respect. The best opportunity for studying this question was offered in the course of those investigations that were performed in certain cases for other purposes, and in which the diet was constant and was being carefully controlled. Our first investigations were performed in a case of obesity, in a case of chronic alcoholism with incipient tuberculous phthisis of the lungs and slight febrile movements, and in a healthy individual, who, as was already known, excreted very large quantities of uric acid.

First Investigation. Obesity

The diet during the whole course of the investigation contained daily 127 to 132 grams of albumin; 150 grams of carbohydrate; 112 grams of fat; 30 grams of alcohol. The total amount of fluid ingested each day was 155 c. c. On the days on which Kissingen Bitter water was taken, corresponding quantities of other beverages were omitted.

Fore-period of four days. Uric acid excretion, 1.1, 0.9, 1.0, 1.1 grams, an average of 1.0 gram a day.

Period of water-drinking of five days' duration. On four days 300 c. c., one day 500 c. c. of Kissingen bitter water. Uric acid excretion 1.3, 1.1, 1.3, 1.2, an average of 1.2 grams.

Second Investigation. Chronic alcoholism, with chronic gastric catarrh.

Daily diet, 1 liter of milk; 100 grams of beef; 200 grams of white bread; 120 grams of butter; 60 grams of sesame oil; 1.40 grams of barley flour; 200 grams of potatoes; 600 c. c. of meat broth; 100 grams egg; 120 grams of apple; 60 c. c. of brandy; 700 c. c. of artificial carbonated water.

Fore-period of four days. Uric acid excretion 0.49, 0.54, 0.43, 0.41 grams, an average of 0.47 gram a day.

Period of water drinking of five days. Uric acid excretion while taking 600 c. c. of Rakoczy a day (omission at the same time of a corresponding quantity of the artificial carbonated waters), 0.58, 0.42, 0.52, 0.61, 0.45 grams, an average of 0.52 grams of uric acid a day.