GOUT.
Prevention is important, since the tendency to gout is known to be hereditary in a large proportion of cases; but prophylactic measures are often postponed till too late, owing to the association in the lay mind of gout with advanced age, so that no precautions are taken till after the first attack, which in hereditary cases commonly occurs at or before the thirty-fifth year of life.
Free open-air exercises, walking, riding, and games like cricket and golf should be insisted upon in the idle and well-to-do class born of gouty parents. In those who have to work for their living, an occupation should be selected which as far as possible will be incompatible with a sedentary life, and this must be supplemented by open-air games and brisk exercises.
Diet is of great importance, and is identical with the dietetic treatment of the established disease. Over-eating is a potent cause of gout in those whose history shows no hereditary taint, and therefore in those with a family predisposition moderation in diet is an essential. The old view that animal food was the main factor in the production of gout led to the rigid prohibition of red meats of all kinds, and the author, in his " Practice of Medicine," has pointed out that the revolt against the uric acid theory has tempted many physicians who regard the production of uric acid as originating in the increase of the destruction of the nucleins in the leuco evtes to err on the other side. Hence it is not uncommon to see foods recommended which are rich even in nucleins and purin bases such as pancreas, sweetbread, brains, roe, game and red meats. If such are permitted at all, they must be allowed in small quantities. Fish, poultry, fresh vegetables, vegetable soups, cheese, bread and farinaceous foods should constitute the staple dietary. Boiled meats are better than roasts. Sweet fruits like strawberries, apples and oranges, and recooked dishes, pastry, sweet puddings and sugar should be avoided. Cocoa should be the ordinary breakfast beverage.
The amount of the food is often of as much importance as is its chemical constitution, and it is not unusual to find that when animal food is pro hibited the patient takes to enormous quantities of farinaceous compounds to make up the deficiency. Gourmandising must be avoided, no matter
how mild and apparently unobjectionable the quality of the food may be, and many gouty patients are unable to digest farinaceous stuffs. Fats as cream and butter may be freely taken, and salads are beneficial. Mineral Waters (aerated) or hot water flavoured with a slice of lemon should he copiously employed to flush out the kidneys and promote elimination. Strong tea and coffee should be prohibited when an animal dietary is indulged in, though the vegetarian may partake of them.
Alcohol is always injurious, chiefly when indulged in as fermented beverages, like Champagne, Burgundy and Port, though it is now fashion able to prescribe these wines in small amounts as a protest against old fashioned treatment. All wines are injurious, as are also cider, beer and porter. When for any reason alcohol is indicated, the beverage should consist of a little good whiskey or old brandy or gin freely diluted with soda, potash or Seltzer water. The least objectionable wine is a good Hock or Moselle drunk with Seltzer or Apollinaris water.
A holiday at a mineral water spring at which golf or other active open air exercise can be procured is as beneficial to the overworked sedentary inheritor of a gouty tendency as it is to the victim of the established disease. Harrogate, Buxton, Bath, or Strathpeffer at home, Carlsbad, Aix-le-Bains, Contrexeville, and many others abroad are in repute. Roberts advises gouty patients to avoid all spas whose waters are charged with soda salts, and he recommends chloride of potassium instead of table salt, but many patients do well at Vichy. The imported waters of most mineral springs may be freely used at home, but as a rule, when this plan is followed, it is useless, as much more can be swallowed at the resort, where hours of recreation and meals are directed with the view of a free indulgence in the water, of which a gallon per diem is not an unusual quantum.