Particularly useful is milk in all cases of intestinal fermentation, for it has been shown that a milk diet causes great reduction of the hydrogen-ethereal sulphates that are formed in the intestine and are discharged with the urine. The same thing is true of the toxic com pounds of the xanthin class. Consequently it is important to form the habit of depending largely on milk as an article of diet in these cases. The patient should be instructed that his "biliousness" is the result of disease, and not a consequence of drinking milk. He should also be encouraged by the information that the constipation which first follows such diet will in the course of a few weeks be cured by the milk itself. In this way all but a very few can be taught and benefited. Occasionally, same remarkable idiosyncrasies relative to milk will be encountered, in the form of urticarious rashes, and their like, whenever it is tasted, even in the smallest quantity. An exclu sively milk diet must not be prescribed for patients who are leading an active life of muscular exertion. For them a variety of food is needful, and a certain amount of meat is essential to the accomplish ment of really hard work. Fortunately, however, gout is rare among this class of laborers, unless, like the London 'longshoremen, they consume excessivee quantitis of porter, thus overloading their tissu2s with unnecessary nutriment. Herein lies the kernel of the whole matter : avoid all excess in eating and drinking. When a patient gorges himself every day of his life upon appetizing viands selected from a vast and varied diet-list, any kind of restriction will prove bene ficial. Such people, for the reasons specified by Haig, usually find it easier to give up vegetables rather than savory meats. Both to gether have been too much, but upon meat alone they begin to feel an improvement. for many this is only a temporary relief, and after a time the old nitrogenous encumberment reappears. Far safer is the position of one who can surrender flesh food, nourishing him self upon milk and vegetables. He may experience more discomfort at first, but soon his morbid craving for nitrogenous substances will subside, his acid dyspepsia will gradually disappear, cardiac inter mission and irregularity will be arrested, neuralgia and headache will cease or be greatly relieved, despondency will give way to cheerful ness, and the intellectual functions will acquire a degree of lucidity to which the patient has been long a stranger. Such people have been over-fed; the reduction of the quantity they consume is the thing of prime importance, and at first it matters little whether they abandon flesh or the saccharine and starchy elements of their over abundant diet. Iu the long run, however, they will be the better for a non-nitrogenous regimen. The learning and skill of the physician will find ample opportunity for display in the guidance of these patients to the adoption of a.cliet that is suited to their condition and necessities. In the vast majority of cases it will be found that after a few weeks dyspeptic subjects, who, on a full diet, were continually complaining of their inability to tolerate fruits and vegetables, will now have no difficulty in digesting such substances, to their great advantage in the matter of constipation, hemorrhoidal attacks, and other kindred complications. Sir A. Garrod has shown the utility of a vegetable diet as a source of hippuric and benzoic acids which act as solvents of uric-acid compounds. By varying the food of a patient it will be found that upon a flesh diet the urine becomes charged with orates, and it deposits free uric acid when cooled. If he is fed with vegetables and cold water, the uric acid compounds quickly disappear, and are replaced by hippuric acid. Led by considerations of this sort, and confirmed by his own fortunate experience, Haig has prepared the following diet-table which will be found generally useful in cases of predisposition to arthritic disorders. It is also of great value for the guidance of elderly people who, though not act ually gouty, are subject to hemicrania, neuralgia, and other kindred affections.
"Breed «st.—A large soup-plate half-full of porridge, eaten with milk, and salted.
"A few mouthfuls of eggs, prepared in various ways ; or some mushrooms, tomatoes, or other vegetables, and occasionally fish.
" One or two rounds of bread, or its equivalent in toast or scones, with plenty of butter.
"A cup of milk (previously boiled) flavored with tea, coffee, or cocoa.
"Finish with a small quantity of any fruit that is in season.
"Loch.—Potato and one other vegetable, cooked in various ways (a plain boiled potato, the summit of ordinary English vegetable cookery, I never have on my table; my cook has been educated to better things than that), eaten with butter, fat, or various sauces.
" Pudding, tart, or stewed fruit.
"Biscuit and butter, with cheese. (Biscuit, bread and breadstuffs are taken in considerable quantity, not a mere mouthful or two, as is often the case with meat-eaters ; and those who attempt to reduce their meat without increasing their breadstuffs are likely to get into difficulties.) "A little fruit as at breakfast.
" For think, a little milk, which in winter is often warm; or water, often taken, in summer, with a little fruit syrup, such as Stower's Lime-Juice Cordial.
"Afternoon Tea.—Bread and butter and cake of various kinds. A little milk and water flavored with tea.
"Dinner.—Soup made without meat stock. (See recipes in Maigre Cookery,' by Sidney Lear; London, Rivingtons.) " Fish or an egg, or a small bit of meat is occasionally substituted for these.
" Two vegetables, with sauces, butter, or fat.
"Any ordinary pudding, tart, or stewed fruit.
"Biscuit and butter, and perhaps cheese, if the quantity of fish or egg has been small.
"A good supply of various fruits for dessert.
"For drink, water with fruit syrup, aerated waters, or a little milk, which I often take warm in winter.
"A tumbler of water, aerated water, or in winter hot water at bedtime.
"It is not necessary to interfere with established habits as to wine, beer, or spirits, unless they are obviously doing harm, for once the introduction and formation of orates (and nitrogenous toxins) has been reduced, the effects of these beverages in preventing elimination may almost be neglected." During early life the subject of the arthritic diathesis can usually enjoy great latitude in the use of fruits, but, as the years advance, and the tendency to gouty disorder becomes more pronounced, many patients grow intolerant of the vegetable acids. For such people it ir; unsafe to eat currants, gooseberries, grapes, tomatoes, and other fruits or vegetables that are rich in acid. When the tissues are charged with nitrogenous poisons, a slight indulgence in acid fruits or drinks may he sufficient to cause pain in certain joints, headache, dyspepsia, and other premonitory symptoms of a gouty attack. Still, it is a noteworthy fact that individual idiosyncrasies are so variable that many persons can with impunity tolerate what would be almost poisonous to others.
The use of sugar has been greatly decried, but here again there is no evidence that it is directly injurious. Only when it is taken as part of an excessive diet is it harmful by furnishing fermentable matter to the contents of the stomach and intestines. Especially when associated with alcohol in wines and malt liquors it is likely to add to the acidity and flatulence that render the patient so uncom fortable. It is thus that cider and similar drinks may be harmful. Vinegar, pickles, salads, and similar articles in which acids, starches, and sometimes sugars are combined, are generally productive of injury and discomfort.
The question of beverages is one of the most important matters for consideration in this connection. It is one of the oldest observa tions that water-drinkers seldom suffer with gout. The passage of water through the tissues promotes interstitial oxidation, and assists in the removal of refuse matters that are delayed ou their way to the kidneys. A number of experimenters have noted an increase in the quantity of urea iu the urine after copious draughts of pure water. When gravel is associated with gout, the effect of waters which are almost chemically pure, like that of the Poland Spring in Maine, is sometimes quite remarkable. Patients who drink freely of such water are often rewarded by an abundant discharge of sand and gravel with the urine, followed by complete relief from preceding uneasiness in the region of the kidneys. When such spring waters cannot be obtained, an excellent substitute may be found in the dis tilled water from which artificial ice is made, or even in the condensed steam from an engine boiler. The temperature of the water that is drunk should be determined by the object in view. When simple diuresis is desired, the beverage should be cold ; but if it be desirable to quicken the action of the skin, and to stimulate a feeble circulation, hot drinks are to be preferred. In winter especially, and when the digestive functions are debilitated, the effect of warmth is desirable in order to avoid the temporary arrest of gastric secretion that follows a cold draught.