Any fruit which from experience is known to agree with the individual may be taken by gouty subjects. Apples and oranges generally agree best. Uncooked fruit should never be taken at a meat meal, and is best consumed fasting fairly early in the day, as between breakfast and lunch. It should always be thoroughly masticated.
Strawberries are frequently avoided by the gouty owing to their producing in some subjects a certain amount of temporary irritation of the skin, but such irritation generally passes off in a short time. In a few subjects strawberries produce eczema or some other rash, but such cases merely represent idiosyncrasy to the special fruit, and necessarily such individuals, whether gouty or not, should not eat strawberries. I am, however, strongly of opinion that the indiscriminate banishment of strawberries from the dietary of the gouty is unnecessary. Except in those cases in which there is an idiosyncrasy to their use they constitute a good article of diet for the gouty, on account of their delicious flavour, their antiscorbutic properties, and their richness in potassium salts. It is, however, very necessary that they should be ripe and fresh. They are soon prone to decomposition, and in such a state they aid in the development of those intestinal fermentations which are so inimical to the gouty.
It is my custom to question closely each gouty patient that I see, not only as to the nature of the beverages taken, but also as to their amount; and my general experience is that the great majority of people suffering from gout take an insufficient quantity of water to drink. Consequently there is an insufficient flushing of the liver, kidneys, and other organs and tissues, and therefore imperfect removal of waste and toxic products. More especially does one find this insufficient consumption of fluid among female patients, in many cases due to the absurd and erroneous belief that a diminution in the amount of fluid taken tends to keep down the body weight and to prevent the occurrence of obesity. Taking from my casebooks ten consecutive cases of gout occurring in ladies whom I carefully questioned as to the amount of fluid consumed per diem, I find that amongst these ten the amount averaged only 26 fluid ounces; this included all fluid, whether taken as water, tea, coffee, soup, wine, ale, etc. The amount is obviously insufficient for the proper flushing of the system. For the treatment, as well as for the prevention, of the gouty condition the free consumption of water apart from meals is most desirable.
Only a small quantity of fluid should be taken during meals, but during the day from two to three pints of some pure water should be taken. In many cases the ordinary tap water answers perfectly well, but if it should happen to be too hard a water, or of doubtful purity, then some simple water, such as still Salutaris.. Contrexeville, etc., may be taken.
"Imperial drink" constitutes an excellent febrile drink for the gouty, and in cases of chronic gout may advantageously be taken when the urine is high coloured and when it deposits amorphous urates on cooling. It is made by dissolving a tea-spoonful of powdered cream of tartar (potassium bitartrate) in an imperial pint of water or barley-water, and then sweetening to taste with loaf-sugar which has been flavoured by rubbing against the rind of a fresh lemon. In place of the sugar, an ounce and a half of syrup of lemon may be added to the pint of liquid. In cases of obese individuals the drink should be sweetened with saccharin or saxin in place of the sugar. The question of alcohol is fully dealt with later on.