446 JOSEPH II. PRATT 



oats contain a relatively large amount of purins and they should be pro- 

 hibited. 



White bread, rice, tapioca, cabbage, cauliflower and lettuce are almost 

 pur in free. 



Animal foods vary greatly in their purin content. The richer an organ 

 or tissue is in cells the greater the amount of nucleic acid and its deriva- 

 tives. Thymus gland which is composed of cells with large nuclei is richer 

 in purins than any other organ. It contains about 1 gram of purin sub- 

 stance to 100 grams of thymus. Kidney and liver contain about one- 

 third gram purin per 100 grams and muscle (beef, lamb) only 1/10 as 

 much as thymus, milk only a thousandth part. Oysters and other shell 

 fish are relatively rich in purins. Caviar and other fish roe are said to 

 to be purin free. I found, however, that the feeding of haddock roe to 

 one of my gouty patients produced a marked increase in the output of 

 uric acid. Fish contains about as much purin as meat and sardines and 

 other small fish more than beef or pork. There is no essential difference 

 in the amount of purin in red and white meat. The old idea that white 

 meat and fish contain less extractives than red meat is an error that is 

 hard to dislodge from medical practice. Boiling removes a large per- 

 centage of the purin substances, and hence boiled meat with the extractives 

 removed is less injurious for the gouty than that broiled or roasted. 



Beef tea is very rich in nucleic acid derivatives, and so are meat stocks 

 which are used in practically all soups served in hotels, except tomato soup. 

 A meat diet is an acid diet as its catabolism in the body leads to the forma- 

 tion of ions (sulphuric and phosphoric acids). Vegetables are rich in ca- 

 tions, and when a patient is on the prescribed purin poor diet there is the 

 possibility of an alkali excess sufficient to exert injury. Hence it is well 

 to give dilute hydrochloric acid (15 to 30 drops thrice daily) regularly 

 to gouty patients who are taking diets largely composed of vegetables. 



Fruits likewise tend to increase the alkalinity of the urine, a fact 

 known to the elder Garrod (1859). 



Many have held that the diet should be low in calories and emphasize 

 the fact that reduction of the quantity of food is as important as the change 

 in quality. Among recent writers McPhedran advises a low caloric diet, 

 while Brugsch thinks the caloric value should be normal. There is no 

 doubt that it should be low in obese, gouty patients. 



Umber believes that the diet should be low in proteins as well as low 

 in purins. Kraus and Brugsch on the other hand insist that it should 

 not be poor in proteins. Brugsch advises that 10 to 15 per cent of the 

 calories of the prescribed diet be made up of protein. This is given chiefly 

 in the form of milk, white bread, eggs and cheese. 



It should be borne in mind that the ingestion of large amounts of 

 purin free protein produces an increase of the uric acid output as Mares, 

 Hirschstein, Host and others have shown. The increase of the endogenous 



