Our treatment of gout is based largely upon practical experience, since our knowledge of the disease itself is even more limited than in the case of other dystrophies. It has long been a matter of common knowledge that a sedentary life, combined with high feeding and the free use of alcohol, has a great influence in the production of gout, and we have always advised patients to take vigorous physical exercise, to avoid alcohol, and to live simply.

The reason why gouty patients are often ordered the terrain-cure and other cures is that in addition to gout they suffer from obesity and a weak heart. We allow them to have general massage once or twice a day if they wish, not only because of gout, but also because of rheumatism; for many gouty patients suffer from rheumatism, diabetes, and glycosuria.

* Graham's bread contains about 40 per cent., white bread about 51 per cent. starch. The former is better for constipation than the latter. Hard breads contain too much starchy material.

No more need be said here of the mechano-therapy of gout and the treatment of gouty joints.

Concerning the diet for gout, I must here express my surprise at the frequency with which medical men regulate the diet in a perfectly unscientific manner, according to antiquated, and sometimes even superstitious, ideas. Their partiality for purely white, and fear of red meat for patients rests on no chemical or other rational basis whatever. It is impossible to explain the reason of their fear of cane sugar; disaccharin cane sugar is, like polysaccharin starch, changed in the organism to monosaccharin glucose. The avoidance of all foods that contain nuclein is better grounded, being based on our new knowledge of the important part played by the nucleins in the formation of uric acid and of the somewhat obscure effect of this upon gout. Many doctors still limit all three kinds of nutritive material, since Rubner and others pointed out our definite requirements. It is impossible in the case of a middle-aged patient, accustomed to a generous diet, suddenly to put him on a very frugal diet, or to put him in a permanent condition of under-nutrition. The most important thing in the dietetic treatment of gout is to prevent over-feeding and to decrease the amount of protein taken to a very small portion daily. As far as possible all alcohol should be forbidden, and last, but not least, the amount of water taken daily must be regulated.

For the treatment of arthritic joints I refer the reader to what has been said in preceding chapters.