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530 PYORRHEA ALVEOLARIS.

considered most beneficial in its effects in dissolving: and rcniovinti- ini-
tatintj; prodncts.
The most imjwrtant of the hygienic nieasnrcs in the trcatiucnt ol"
all gonty manifestations is that pertaining to the diet. As nric acid is
a nitrogenized compound and therefore presumably one of the imper-
fectly oxidized products of albuminous or nitrogenized food, it is desir-
able that such foods be excluded as far as possible from the daily
diet. The value of this measure is admitted and insisted upon by all
clinicians.
In the milder manifestations of the gouty diathesis such as we
assume exists in pyorrhea, it is not so imperative that all albuminous
food be prohibited ; nevertheless, as many ])atients are consumers of
large quantities of meat, it would be well to insist, if the effort to
cure is to be made, upon the total exclusion of beef, veal, mutton, and
pork, restricting the patient in albuminous diet to white meat of fowl,
oysters, fish, and lobsters. Cheese, beans, and the white of eggs are
considered objectionable, and in many cases of acute gout are strictly
prohibited by the attending physician.
Experience has shown that various alcoholic drinks, such as cham-
pagnes, port, madeira, and sherry, are particularly liable to give rise to
the accumulation of uric acid. The lighter wines, as claret and hock,
are not considered so injurious. The malt liquors, beer, ale, and porter,
are also by many clinicians considered in their influence to be great
offenders.
The medical and constitutional treatment, it is obvious, should be
directed toward the elimination of uric acid and its compounds. For
this purpose remedies which promote the formation of soluble and
easily diffusible products which are readily eliminated by the kidneys
are indicated. From time immemorial the alkalies and alkaline com-
binations have been used with marked success in the management of all
phases of the gouty diathesis.
The treatment of acute gout necessitates, of course, different or more
vigorous remedies than those required for the subacute or chninic forms
with which the dental practitioner will be called upon to deal.
Of the various alkalies, lithium compounds—the citrate and car-
bonate—have been found well adapted to the milder phases of the
disease. The writer has had much satisfaction in using, on the sugges-
tion of Dr. E. C. Kirk, the tartarlithine lithium bitartrate, also alka-
lithia prepared in the same form as the above-named compounds—com-
pressed tablets containing five grains each ; one tablet three or four
times daily will be found sufficient. Should the use of these lithia
tablets not agree with the patient, the potassium carbonate in ten-grain
doses, in some simple bitter — gentian or quassia water—three or four