The analysis of the strawberry shows it to be particularly rich in sodium salts, and in spite of the high percentage of water this fruit excels all other common fruit in the amount of mineral salts. The chemistry of the strawberry there ' fore would teach that this fruit is likely to be beneficial in gouty states. (Lancet, June 24, '00, from Nature.) It is useful to prescribe rather large quantities of inoffensive beverages, such as pure water and milk, especially skim milk or butter-milk, to favor the free action of the kidneys. The quantity of urine per twenty-four hours ought to be about 1500 to 2000 grammes (3 to 4 pints). Alkaline springs have been much recommended, and when they do not contain too large quantities of soda they may be taken in moderate doses. Their use, however, should not be ex aggerated, as the ingestion of much soda in the blood is liable to accelerate the I deposition of biurate, and thus provoke an attack of gout.
The usefulness of Vichy water in gouty conditions probably depends on the so dium bicarbonate it contains. As long as one quart is taken a day a patient will remain free from migraine, but as soon as this is left off the attacks will return. W. J. Tyson (Lancet, Aug. 12, '09).
The light wines—such as Bordeaux, Mosel, and Rhine wine—may be allowed in small quantity; the stronger wines— such as sherry, port, champagne, etc., as well as ale and porter—are to be strictly prohibited. The pernicious effects of the stronger alcoholic drinks are proved by numerous observations, and are probably due to the power of alcohol to increase the formation of uric acid and to facilitate the deposition of urates.
The deleterious effects of alcoholic liquors in producing gout depends very . much upon the incompleteness of the process of fermentation by which they are produced. The sugar alone is not claimed to be injurious, but only when taken with the alcohol or some other article of diet that induces it to ferment in the digestive organs. Editorial (Nice med.. July, '92).
Attention called to the fact that those accustomed to a saccharin diet have no special tendency to gouty arthritis, and that the urine of herbivorous animals, in whose diet sugar plays an important part, is alkaline in reaction. The re lation of champagne to gout is difficult to determine, as the constituents of vari ous preparations vary greatly. Of its constituents, sugar is, according to the author's view, the least and acetic acid the most harmful. G. Harley (Lancet, Aug. 1, '96).
Apart from individual peculiarities which are common in the gouty, the safest diet for these patients is the simplest diet. One must study indi
vidual dietetic capacities of the patients and adapt the diet to them.
A vegetarian diet may suit some. but it has not fallen to personal lot to meet I such eases. The most troublesome gouty headaches have been seen to dis appear and a condition of greatly im proved health result from an exclusive, or nearly exclusive diet of pounded meat with liberal draughts of hot water. The success of this treatment in such cases is plain. The pounded lean meat is about the simplest that can be offered to the feeble digestive organs, and physiologists state that "proteid food increases the quantity of bile secreted," and the large draughts of hot water flush the excretory ducts both of liver and kidneys. Extremely simple food, limited in amount, meaning as it does digestive ease, means also freedom from gontiness.
There is much also in the quality and cooking of food, often more than in the kind of food. The difference in the wholesomeness and digestibility of dif ferent specimens of bread is remarkable, and so it is with joints of meat, poultry, and fish.
This remark might be extended as to quality to wines also. A dry port, long in the wood, if it is freely diluted with hot water, is one of the best and safest wines for those gouty people who need some stimulant. Gouty women bear all wines badly. Many gouty- patients can drink a small quantity of a well-ma tared, high-quality wine,—even cham pagne and port,—especially if diluted with water, who would be made ill by a single class of common claret. The more diuretic the effect of the wines proves to be, the more suitable it is to the particular case.
There seems to exist a general impres sion that the gouty person is one who does not take an adequate amount of physical exercise and that he must be ordered to take more. That is not per sonal experience. The gouty patients seen have, in the majority of instances, been extremely active and energetic people, and it is often difficult to get them to take sufficient rest. This ex cess of muscular activity constantly leads them to take an excess of food, and then trouble arises because their ex cretory organs can hardly keep pace with the waste produced in the body; this is especially notable after middle age. I. Burney Yeo (Brit. Med. Jour., June 15, 1901).
Open-air exercise is very useful in the treatment of gout, and, when possible, gouty patients ought to spend their holi days in regular active exercise, such as walking, cycling, riding, etc.