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GOUTY PEBICEMEJ^TITIS. 529

This apparent interference with the nntrition of the pericemental
membrane before the deposit of uric acid salts takes place is in accord-
ance with what is believed to hold true for other manifestations of the
gouty diathesis. As a prophylactic measure, therefore, it is suggested
that whenever there is the slightest tendency to pyorrhea, or any other
evidence of the gouty diathesis, great care should be exercised in all
dental operations, so as not to impair the nutrition of the pericementum
and thus establish the necessary condition for the uric acid deposit ; also
correction of all cases of malocclusion—surgical rest as* far as possible.
The constitutional treatment which has been indicated as efficient in
the elimination of already established uric acid conditions and the
restoration of a faulty nutrition to its normal state may with great
propriety be subdivided into hygienic and medicinal.
The hygienic treatment embraces systematic outdoor exercise, stimu-
lation of the functional activity of the excretory organs, the skin, bowels,
and kidneys, and regulation of the diet, which must be insisted upon in
all well-marked cases, and especially with those who, for various reasons,
lead sedentary and inactive lives. Increased muscular activity quickens
circulation, induces deeper and fuller respiratory movements, leads to
greater vigor in the general nutritive processes waste products are
;
removed more rapidly and the combustion of the food increased by the
absorption of a large amount of oxygen. The promotion of the func-
tional activity of the eliminating organs is well recognized as an import-
ant hygienic measure.
The perspiratory and sebaceous glands and the surface capillary circu-
lation should all be stimulated by sponging of the skin with cold water,
vigorous friction, and an occasional Turkish bath, where such treatment
is not contraindicated by pulmonary or cardiac aifections. Where the
liver and intestinal glands are deficient in secretion with prevailing
constipation, they should be stimulated into activity by the use of
saline waters ; most excellent for this purpose being the Hunyadi Janos
and Friedrichshalle. These are especially to be commended because
they contain a large percentage of sodium and magnesium sulfates,
both of which are useful as eliminating agents.
The kidneys should be assisted in the excretion of waste products
by the free use of negative waters, or waters in which the saline con-
stituents are present in minimum quantity.
Hot or distilled water in sufficient (piantity will flush the alimentarv
canal, increase the volume of blood, and stimulate the kidneys to
increased activity. It is not only a common observation, but rather
a remarkable fact, that gouty patients are inclined to drink but a com-
paratively small quantity of water. One quart of hot water taken
daily, in four doses, before breakfast, between meals, and at bedtime, is
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