445 



abate was Garrod's practice and one generally commended. The list of 

 foods after the first day or two would include bread, arrowroot, sago, 

 tapioca, milk, thin gruel, barley or toast and water. After the local 

 inflammation has subsided a larger quantity of food may be allowed, but 

 even then Sydenham's view that everything beyond what is absolutely 

 required for the nourishment of the body only feeds the disease is probably 

 correct. 



Diet in Chronic Gout. In the light of present knowledge, the proper 

 course is to give the patient a purin poor diet. Allbutt puts it well when 

 he says that the "guiding scientific principle of the permanent diet of the 

 gouty is to reduce the intake of the purin substances and to estimate the 

 metabolism by examination of the urine and blood." I believe one should 

 strive to reduce the purin substances in the diet to the minimum and to 

 urge the patient, if the case is at all severe, to follow the diet 

 rigidly for months and years. It cannot be made purin-free strive as we 

 will. Much depends on the severity of the disease. In mild cases 

 definite amounts of purin food possibly may be allowed one or two days in 

 the week, and in six months or a year if no symptoms return the diet may 

 be made more liberal. It is safer in this serious disturbance of metabolism, 

 even when its symptoms are mild, to adhere for years to the purin poor 

 diet but care should be taken that it is not too low in protein or in calories. 

 Few patients are willing to deny themselves the pleasures of the table 

 for many months after symptoms have disappeared. I have had one pa- 

 tient who followed a strict purin poor diet for six years and remained in 

 rugged health until symptoms of heart failure developed. 



If attacks recur in spite of the purin-poor diet, and in some cases they 

 certainly do, it is a mistake to abandon it. Perseverance in this course of 

 treatment may show benefit only after many months (Minkowski(Z), Kraus 

 (e) ). It is to be understood that the diet must be one that appeals to the 

 patient. With care menus can be arranged to satisfy the individual de- 

 sires of different patients. The nutrition should not be too greatly reduced 

 and this will not occur if pains are taken to give appetizing food. 



We can speak with greater certainty of the uniform benefit of a long 

 continued purin-poor diet in gout from the effect of the purin-poor diet 

 which the German people were forced to adopt during the war. This was 

 virtually an experiment on a gigantic scale applied to all gouty patients in 

 Germany. Before the war gout was rapidly increasing in that country. 

 Apparently from published statistics Umber and the staff of Kraus's clinic 

 saw more cases of gout in one year than are to be found in all the hospital 

 clinics combined in the United States and Canada. During the war 

 gout patients remained free from attacks (Kraus (e), Brugsch(^r), Gries- 

 bach and Samson). 



It should be remembered that a meatless diet is not necessarily a diet 

 very poor in purins. Beans, peas, mushrooms, asparagus, onions and 



