THE METABOLISM IN GOUT 443 



drink. Wollaston over a century ago advocated the exclusion of all flesli 

 food. Sir Alfred Garrod(d) (1859) advised careful restriction as to quan- 

 tity of meat, but stated also that experience has clearly shown that gout 

 cannot be successfully treated by abstinence from meat. Luff, writing in 

 1 007, stated that "animal food, at all events in moderate quantity, was dis- 

 tinctly indicated" in chronic gout. In a few intractable cases of chronic 

 gout it may be found necessary, he said, to reduce the diet to lean meat and 

 water, the so-called "Salisbury diet." Sir Clifford Allbutt(6) said in 

 1921 that "it is popularly asserted in England at the present time that the 

 gouty do well on this diet," Roberts and Rose Bradford, in Allbutt's Sys- 

 tem, stated that gouty persons should be advised to "partake cautiously of 

 butcher's meat, fowl and game." Futcher(6), writing in Osier's System, 

 would allow meat in moderate amounts. "It is often advisable," he adds, 

 "from time to time to limit the meats to one meal a day." Minkowski(i) 

 held a similar view. 



Within the past twelve years there has been greater unanimity of opin- 

 ion and the tendency has been distinctly toward a purm-poor diet. Von 

 ]S T oorden(w), Umber (/), Brugsch and 'Schittenhelm(e) all emphasized 

 the importance not only of a meat-free diet, but one in which the purins 

 are reduced to the lowest possible amount. The two English authors of 

 recent books on gout Lindsay (1913) and Llewellyn (1920)- still adhere 

 to the view that meat in moderation is indicated in chronic gout. It is 

 interesting to compare the views of the writers on gout in the three differ- 

 ent systems of medicine that have just been published in America. Mc- 

 Phedran in Tice's System (1920) holds to a low caloric diet, but would 

 not interdict wholly the use of meat. Pratt (1920) in Nelson's System 

 advocates a purin poor diet free from all meat, and Allbutt (1921) in the 

 Oxford System advises strict moderation "of meat, never more than the 

 content of a neck chop should be taken" and in a mild case this quantity 

 or its equivalent in fish five days a week, in severer cases every other day 

 or twice a week and in obstinate cases "meat may have to be altogether 

 barred, and even fish taken sparingly." 



Minkowski(Z) (1913) in his latest publication favored more strongly a 

 purin poor diet than in his earlier writings. Archibald Garrod (1913) 

 advocated the limitation, but not the exclusion, of purins from the food. 

 His fear that harm might result if the rebuilding of the nucleoproteins 

 was not facilitated by providing some purin substances in the diet seems 

 unwarranted. In the first place it is impossible to give a patient a purin 

 free diet. Vegetables contain not inconsiderable amounts of purin, and 

 Voegtlin and Sherwin (1918) found in cow's milk more than traces of 

 guanin and adenin. Furthermore, there is no doubt that nucleic acid may 

 be formed from protein in adult mammals ( Benedict (?;), 1916). 



Sufficient knowledge of purin metabolism has now been attained by 

 the new methods of blood and urine analysis to guide physicians in their 



