GOUT DIET - TREATMENT HYGIENIC AND PROPHYLACTIC .
A similar course should be prescribed in all cases where there is danger that a healthy individual may become arthritic. Unfortu nately, however, the physician is seldom consulted until the diathesis has been acquired. It then becomes necessary to regulate the diet of the patient, in order to obviate, so far as possible, the minor ac cidents that precede the occurrence of articular inflammation, and to prevent the deposit of urates in the joints or elsewhere. If the patient be tractable, much can be done to postpone, if not actually to abort, the crises that otherwise would be precipitated by an injudi cious regimen.
Since a large part of the injury that is effected during the course of gout is due to an excess of urates in the system, and since the etiology of the disease is closely connected with the formation and circulation of imperfectly oxidized nitrogenous compounds, it is ex pedient to limit the ingestion of alimentary substances that are rich in nitrogen. In order to facilitate this arrangement, Sir 'W. Roberts has constructed the following table that shows at a glance the average percentage of albuminous substances contained in different articles of food : In making use of such a table it is necessary to take into account the relative quantities of these articles as they are usually eaten. Thus cheese, which contains 30 per cent. of nitrogenous matter, may be very harmless when taken in small quantity as a relish, though quite as injurious as butcher's meat if consumed ill corresponding amount. In the same way it may be perfectly safe to use a little meat, though wholly unwise to take it in any considerable quantity. Haig has shown in his own person the great advantage of leaving off the use of butcher's meat in cases of hemicrania. In the work which has been referred to above lie says : " Having been all my life a sufferer from migraine it was in the autumn of 1882 that in despair of obtain ing any complete relief from drugs, and not without some fear that I was really suffering from organic disease, I gave up all butcher's meat and replaced it by milk and fish.
" I had previously tried a great variety of alterations in diet, in cluding an increased allowance of meat and various alterations in quantity and quality of less important constituents, such as sugar, tea, coffee, and tobacco, without any noticeable result. But ou the non-meat diet a change was at once apparent; my headaches dimin ished both in frequency and severity, and from an average of one a week they fell steadily as the diet was persevered iu, down to one in a month, one in three, six, eight, or twelve months, and eventually eighteen months elapsed without an attack of notable severity."
As a control-experiment the author found that a few meals of meat and wine would at any time reproduce his headaches in all their pristine severity.
Now we know that migraine is one of those disorders that are usually symptomatic of the arthritic diathesis; hence the great value of this experience—which, by the way, is not uncommon—as indica tive of the proper method of prophylaxis whenever the predisposition to gouty disorders exists.
It is claimed by many authors that abstinence from meat is not expedient in all cases, and some have gone so far as to advise the contrary regimen, forbidding the consumption of sugar and starch, and enjoining the use of animal food almost altogether. It is urged by these teachers that many persons are unable to live without meat, and that a vegetable diet causes severe dyspepsia, accompanied by flatulence, acid eructations, and various other disorders that are ob viated by an almost exclusively animal diet. Among the laity it is common to encounter a prejudice against the use of milk as an article of food, because, as they say, " it makes we bilious." Now, there is for all these opinions a certain foundation of fact. It is true that for the majority of people a mixed diet is desirable. But, when called upon to deal with an individual who is predisposed to arthritic diseases, we are brought in contact with a morbid constitution, and frequently with a depraved appetite and retarded nutrition. Haig has shown that under such circumstances animal food gives present relief at the expense of future suffering. We find such patients eager for "strong food," and soon suffering if they do not have it, but also tormented at intervals by " sick headaches," bilious attacks, etc., until an articular crisis clears their pathological atmosphere. Those same patients, however, if gradually accustomed to a milk, cereal, and vegetable diet, will lose their craving for animal food, and will find themselves relieved of their voracious appetites and also of their dyspepsia and other disorders. There are very few patients who cannot learn to take milk to their great advantage, if they will con sent to begin with small quantities—a spoonful with each meal, or every hour or two, as the case may require—followed by a daily in crease of the amount until it can be taken with perfect freedom.