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the tissues produces local irritation, and that urates in solution give rise to even more irritation than when in the solid form. In the condition generally known as the uric-acid diathesis, it is generic viagra 2012 usually considered that the excess of uric acid is due to some morbid process and that it is not the primary cause of the disturbance; but it is generic viagra 2012 also recognized that the generic viagra 2012 uric acid itself is capable of exciting irritation and doing harm to the tissues, and that it should be removed from the body and its production restricted. That the treatment at Glenwood is most appropriate viagra prescription med to such cases seems to viagra prescription med be borne out in my own case. For six viagra prescription med or eight weeks before my arrival at Glenwood, though my previous health had been good, I had been the victim of the various symptoms that go to make up an attack of uricacida;mia, i.e., frequent headaches, acid eructa- tions, coated tongue, constipation, an insurmountable sleepiness after meals, mental depression, and irrita- bility. The treatment consisted of a visit to the vapor cave every other day, the drinking of a glass of the water every morning before breakfast, and frequent swimming in the pool. The daily quantity of urea and uric acid was estimated for twenty days, using the hypobromite test for the former and Salkowski's method for the latter. The food before and during the treatment was about the same, consisting of a simple mixed diet. According to these analyses, the ratio of uric acid to urea at the beginning was 1 to 32. This, must be considered an excessive amount of uric acid. To be sure, Haig puts the normal ratio at 1 to 33, but the consensus of opinion appears to be that his methods are at fault. The ratio after irregular fluctu- ations became 1 to 56 on the twentieth day, this really being about the normal relation of the two nitroge- nous compounds. The improvement in my condition after the first week seemed to keep pace with the changes in the ratio, so that by the fourth week I felt as well as usual. It has been affirmed that some mineral waters have a solvent action upon uric-acid calculi. This I can- not believe, unless the uric acid is in the form of very minute particles. It is quite probable, however, that they interfere with the formation of fresh gravel. When the existence of the stones has been recognized, 842 MEDICAL RECORD. [June 13, 1896 the simplest way of dealing with them is to adopt sur- gical measures for their removal, and after the opera- tion the patient may resort to mineral springs to pre- vent a repetition of the disorder. Gout. The indications to be viagra prescription med met in the treatment of this disease are the correction and prevention of the necrotic processes by the establishment of a more complete metabolism and by the elimination of uric acid, as well as the absorption of deposits about the joints. According to Roberts, Garrod, Duckworth, and others, the deposition of crystalline urates is not merely a concomitant to, but is the actual cause of the joint troubles. There are others, however, who dis- pute this theory and believe that uric acid is the re- sult and not the cause of the morbid processes. Nevertheless, both recommend the time-honored meas- ures to hasten the elimination of uric acid. The treatment of this disorder by means of mineral waters is most suitable and effective, for at the bathing-resort the habits are regulated, the patient willingly submits to irksome treatment, lives in a pure viagra prescription med and invigorating atmosphere, and enjoys abundant exercise. There is a remarkable unanimity generic viagra 2012 of opinion in the literature of the subject as to the good results obtained at a suitable resort, and especially at hot sulphur springs. Senator believes that sulphurous waters containing sodium chloride and alkaline and earthy sulphates tend to re- move the various disorders which stand in a more or less close degree of causal relationship to gout, either as precedents or concomitants, such as irregularities of digestion, gastric and intestinal catarrh, tendency to acidity, constipation, portal congestion, disorders in the urinary secretions, etc. generic viagra 2012 He is generic viagra 2012 also of the opin- ion that such waters exert a more immediate influence upon the gouty diathesis and uric-acid dyscrasia, and that permanent benefit is derived from their influence on the exciting disturbances. E. Pfeiffer, of Wies- baden, having subjected some healthy persons to a se- ries of twenty hot mineral baths, found no essential difference in the amount of uric acid eliminated. Af- ter treating gouty patients with the same course of generic viagra 2012 twenty mineral baths, he generic viagra 2012 found that the quantity of uric acid excreted by them was usually diminished fifty per cent, or more. He concluded that thermal waters have a very marked action in the prevention of gouty manifestations, and thinks that the saline constituents in them exercise an important influence distinct from tlie effect of heat itself, as ordinary hot baths have not the same influence. The mineral waters which exert the most powerful stimulant effect on the secretions and most vigorously promote the absorption of mor- bid products will render the best aid in attacking generic viagra 2012 the deposits in and around the joints, the inflammatory thickening of the tissues, and consequent articular stiffness, dislocations, and contractions of tendons. following is a fairly illustrative case: 1,. K. , aged thirty-eight, generic viagra 2012 of Telluride, Col. Two years ago the large toe of the right foot was swol- len, painful, tender, and red. The condition disap- peared in about two months under medical treatment. viagra prescription med A year later the same symptoms came in the great toe of the left foot, then invaded the other toes, and finally the entire foot. The patient was worse in spite of treatment. June 14, 1895. he came to Glenwood with the condition unchanged; he was barely able to viagra prescription med walk with the assistance of crutches. I reatment, tub baths daily at a temperature of 105 F. : all medicine stopped.