TREATMENT 147 



treatment of the so-called acute gout, the typical gouty attack or the gouty 

 paroxysm. In the treatment of the gouty process as a whole, prophylaxis plays 

 a most important part. The latter appears simple enough, provided we are 

 correct in assuming that gout depends for its development and existence upon 

 a manner of life which deviates from the normal. Seneca, the celebrated Stoic 

 philosopher, who lived in the first century, a.d., lamented that, in his age, 

 the women who were living in the same opulent manner as the men showed 

 the same tendency 'to gout as the men, while in the age of Hippocrates women 

 were almost exempt from gout. In general this is true, for Hippocrates says 

 expressly that women do not suffer from gout except when their menses cease. 

 There is, therefore, some truth in the words of Seneca, and since that time 

 moderation has been continuously taught. I will quote the advice of Thomas 

 Sydenham in regard to the treatment of gout. He says (Medical Works, 

 Translated by J. J. Marstaler, Vienna, 1787, ii, p. 312) : "In the first place, 

 then, moderation must be observed in meat and drink, so that the stomach 

 will receive no more food than it can digest, and no fresh fuel be added to the 

 disease. The other extreme, however, as I have found in my own person, is 

 equally injurious. Abstinence weakens the parts by withholding their due 

 proportion of that aliment which is necessary for supporting their strength 

 and vigor." 



In regard to the diet of gouty patients and of those persons who have a 

 family predisposition to gout, the same rules are to be observed as in the nutri- 

 tion of the obese. The view formerly maintained that the use of fat increases 

 the formation of uric acid has been shown to be entirely erroneous by investi- 

 gations carried out in regard to the ingestion of fat. The amount of albumin 

 permitted to gouty patients must not be deficient. Everything that weakens 

 the body and diminishes the activity of the gouty patient influences the gouty 

 process unfavorably. On the other hand, the administration of large quanti- 

 ties of meat, as experience has shown, is decidedly deleterious to the gouty. I 

 believe it, therefore, in the nutrition of gouty patients, to be not only advisable 

 but even necessary to employ vegetable albumin in the manner mentioned by 

 me in the treatment of obesity. I am even willing to maintain that for gouty 

 patients a vegetarian diet with the necessary amount of vegetable albumin 

 forms the most suitable plan of nutrition. Milk and milk products may fur- 

 nish the variety which is grateful to the patient. Eggs also, if taken in mod- 

 eration, may be permitted. White meat is looked upon as better than dark. 

 Alcohol, no matter what its form, is poison for the gouty patient and for all 

 those who are predisposed to the affection. Only when the physician for defi- 

 nite reasons declares it to be necessary, is the amount prescribed by him to 

 be employed. The most suitable drink for gouty patients is ordinary good 

 drinking-water or mild alkaline waters. I frequently order that from the 

 Offenbach Kaiser Friedrich Spring, which in my opinion is preferable to all 

 other alkaline mineral waters on account of its slight amount of alkali. For 

 this reason, drugs containing vegetable acids that are excreted in the urine 

 in the form of carbonates should be used in the treatment of gout. The 

 cherry cure and the strawberry cure are not improperly named. These fruits 

 contain alkalies rich in vegetable acid. On the other hand, much harm is 



