GOUT. 553 



should regulate the habits of the patient. First, it is necessary to 

 prescribe precisely the form, quantity, and quality of his food. A 

 gouty patient should be carefully taught what and how much he may 

 eat, because, although he breaks the rules often enough, he gives way 

 to excess less readily than he would if he could excuse his errors by 

 the plea of ignorance. How many patients there are who fear the 

 evil results of breaking the rules laid down for them far less than they 

 do the reproaches of their physician ! Gouty patients must be abso- 

 lutely forbidden to go to dinners, etc., even if they promise to be very 

 moderate. It is best for them to eat only vegetables, soups, etc., and 

 to have meat only once a day. The use of beer and wine retards the 

 transformation of tissue, and hence is injurious for gouty patients. 

 Any one may observe on himself that he requires less to eat when he 

 drinks wine or beer with his meals, and also that when using these 

 articles moderately he bears fatigue better than he does without. Per- 

 sons but little inclined to the production of fat, under the regular and 

 free use of wine and beer, become very obese, and from this mode of 

 life most persons have a red face and distended veins, until their diges- 

 tion is impaired or there is some other injurious consequence. This 

 consideration, as well as the fact that in persons who drink neither 

 wine nor beer the occurrence of gout is very exceptional, should in- 

 duce us to forbid these drinks altogether, or else to give directions to 

 have them stopped off gradually. The same is true of the use of tea 

 and coffee. Although there is but little nutritive material in these 

 drinks, and consequently the actual supply of nutriment to the body 

 is but little increased by their use, still there is no doubt that tea and 

 coffee have the same influence on the transformation of tissue that 

 wine and beer have ; they preserve the strength, diminish the need of 

 iiutriment, limit the consumption, and hence are injurious to gouty 

 patients. Drinking large quantities of water has just the opposite 

 effect on the transformation of tissue from what is induced by the use 

 of tea and coffee, or of beer and wine. After drinking freely of water, 

 110 one feels less need of food, fatigue is not better borne, it does not 

 induce corpulence and a red face; on the other hand, it has been 

 shown that, when plenty of water is taken, the amount of water passed 

 is greater than it would be under like circumstances, without this in- 

 creased supply; and as the amount of urea excreted after drinking 

 plenty of water is increased permanently, not temporarily, we are led 

 to the conclusion that much water hastens the transformation of tissue, 

 and hence is as beneficial for the gouty patient as drinking coffee and 

 tea or wine and beer is injurious. Lastly, since muscular action also 

 nastens the transformation of tissue and the consumption of the con- 

 stituents of the body, it may be readily seen that a lazy, easy life is 



