DIET - GOUT Although it is evident that many causes contribute to the develop ment of gout, there is none that compares in efficiency with excess in eating and drinking. We have seen that the disease is most prev alent in countries where wealth and luxury abound. It is also ap parent that in those lands where it is common, the incidence of gout is most frequent among the luxurious classes of society—especially among the newly rich, who have recently acquired unlimited means of gratifying their appetites and passions, without having at the same time learned discretion in the enjoyment of good fortune. These people, who have usually risen rapidly from the lower ranks of society by reason of remarkable physical energy, carry into ad vanced life and leisure the excellent appetites that were the delight of their youth. Continuing thus to gorge themselves with belated delicacies long after the close of active existence, they fall victims to arthritic disorder, and the children of their old age yield themselves an easy prey to the influences in the midst of which they were be gotten. For these reasons gout is more often witnessed among the successful middle-class citizens than in the families of an ancient no bility to whom the long experience of wholesome living has become an ancestral heritage. But in any situation, it is impossible to lead a life of indolence and gluttony without being sooner or later called upon to pay the penalty. It was not without a reason in the nature of things that men like the great Napoleon have found themselves continually impelled to break away from consuming intellectual labors, to seek in hard riding over the country a means of relief from the rising tide of arthritism that threatened to overwhelm their tis sues. The physiological chemists have shown that every excess in the use of flesh food causes a corresponding increase in the production of urea and uric acid. If the amount of muscular exercise be reduced to a minimum, the rate of oxidation falls, and the nitrogenous refuse —uric acid—remains in a condition that hinders its elimination through the kidneys. The urates and their congeners accumulate in the system, and finally produce a critical explosion by which they may be for a time wholly or in part ejected from the body. But when exercise stimulates the circulation, causing the transportation of an increased amount of oxygen to the molecular basis of the tis sues, the oxidation of uric acid into soluble forms of nitrogenous refuse proceeds with greater completeness, and the system is cleared of urates, to the great relief of the individual. Hence the instinctive longing for action and muscular effort that characterizes the consumer of animal food during the early portion of his career. Hence the fondness for athletic sports, hunting, and fighting, that characterizes the well-fed eater of flesh. So long as he can keep the field and follow the hounds, all goes well; but when youth has departed, and he can only follow his army in a coach, the end is near, and he must smother in his own excretions.
Besides the accumulation of urates under such circumstances, another most injurious complication arises—the overloaded stomach fails to accomplish its functions, and the nitrogenous elements of the food are but imperfectly digested. Hence a surcharge of undigested substances along the whole course of the alimentary canal, followed by the formation of various toxalbumins and ptomaines that are ab sorbed into the circulation and exert a poisonous influence upon the functions of every organ in the body. From this cause results a further hindrance of the process of oxidation, so that the nitrogenous elements of the tissues are not fully transformed into urea, but tend to accumulate in the form of imperfectly oxidized products, of which uric acid is the most conspicuous example.
The character of the food that is habitually consumed largely de termines the amount of urea and uric acid that is produced in the body. These nitrogenized bodies are derived most abundantly from the nitrogenous aliments ; consequently, the consumption of animal food exercises a direct influence upon their formation. Other things being equal, the more meat one eats the more likely is he to become gouty. In this fact lies one of the causes of the prevalence of gout among the English. From the dawn of history they have been noted for the quantity of flesh that is consumed in their dietary. The beef-eaters of Old England were no figment of poetic fancy—they were, and still are, a most solid and substantial reality. In the lists of viands provided for the daily meals and banquets in the good old times, bread and fruits and vegetables hold a very insignificant place alongside the mighty roasts and joints and chines and jowls and yen icon pies that chiefly occupied the attention of the rubicund trencher men. A surcharge of uric acid was the inevitable result of such a mode of living. It is true that the excessive use of sweets and starches may lead to a somewhat similar end, but in a rather indirect way. Obesity is the primary consequence of a highly carbonaceous diet; but the alimentary tract is in many instances better adapted for the digestion of meat than for the disposition of sugars and starches. These also require for their oxidation so large a proportion of the oxygen that enters the tissues that there may be an insufficient re siduum available for the complete. oxidation of uric acid into urea; and thus a vegetable diet may actually lead indirectly to an accumula tion of urates in the body. The same thing is theoretically true of the fats as an article of diet; yet the blubber-eating Esquimaux never have gout. This is owing to their active exercise in the open air, and to the frigidity of their climate. A low temperature of the air expedites all the processes of oxidation in the tissues, in order to maintain the normal heat of the body ; and thus the excessive forma tion and accumulation of uric acid and fat are prevented.