Simplicity Of Meals

The diet of gouty patients should be simple, that is, the meals should not be made up of too many articles. Simplicity of food means facility of digestion. Moderation in both eating and drinking is perhaps one of the most essential points to insist on in the dietary of the gouty. Certainly meat, even red meat, should not be excluded from the diet. No class of food-stuff is so productive of energy as animal food; and as most cases of chronic gout are suffering from lowered vitality and want of tone, animal food, at all events in moderate quantity, is distinctly indicated. My experience supports the truth of this view, as I advise, in the great majority of cases of chronic gout, the taking of one meat-meal a day. The exclusion of any article of diet or of any class of food, without taking into account the surroundings of the case and the peculiarities of the individual, is unscientific. Those articles of diet that are known in the individual to favour intestinal fermentation and putrefaction should certainly be avoided, and, speaking generally, a sense of discomfort after a meal indicates that some article or articles of food have been taken which are not beneficial to the individual in his present condition.

If the gouty symptoms are due to over-production of toxic-material from faulty intestinal and hepatic metabolism, and if at the same time the kidneys are sound, then a diet which mainly consists of animal food is indicated, and in extreme cases of this class even the so-called " Salisbury diet " may be useful. If, on the other hand, the symptoms are due to defective elimination on account of diseased kidneys, then a diet which is more vegetarian will be best. The value of the so-called "Salisbury diet " consists in the small amount of energy necessary for the digestion of so simple a diet, and in the fact that it contains little which can set up intestinal fermentation or putrefaction. On the other hand, a strictly vegetarian diet requires more digestive energy than a purely animal one, and a much larger quantity of vegetable food must be taken to produce an equal nutritive effect.

In connexion with the question of the amount of food necessary for the maintenance of the most perfect health, it is very important to bear in mind the necessity of the adoption of the habit of thorough mastication and insalivation of food. This applies not only to the gouty, but to every one. The thorough mastication and insalivation of food has a very striking effect upon the appetite, leading to the choice of a more simple dietary and enabling it to be satisfied with a diet which is considerably less in amount than the ordinary habit of incomplete mastication demands.

If, during the treatment of gout, an attack of gouty dyspepsia should at any time intervene, then a milk diet should be employed until the dyspeptic symptoms have abated.

The "Salisbury Diet"

As previously stated, as little complexity as is possible in the meals is the main desideratum in the dietary of the gouty, and in a few intractable cases of chronic gout it may even become necessary to reduce the dietary for a time to the simplest possible condition, namely, to two articles of food - lean meat and water. There are a few cases of chronic gout which undoubtedly improve, and even recover, on an exclusive diet of red meat and hot water. These are generally cases of chronic gouty arthritis which have failed to yield to the ordinary methods of treatment, and which are accompanied by dyspepsia, flatulence, acid eructations, pyrosis, and offensive stools. I have successfully treated a few such carefully-selected cases of chronic gout by the employment of this, the so-called " Salisbury " treatment. It is essential, before placing a patient on such diet, that the urine should be carefully examined, as any advanced condition of kidney disease contra-indicates the employment of such a dietary. If the evidence of kidney derangement is only slight, the adoption of the dietary is not contra-indicated; but the urine must be carefully examined every two or three days, as any considerable increase in the albuminuria would at once be an indication for the discontinuance of this special diet. Gouty patients suffering from organic heart-disease with any failure of compensation should never be placed on this dietary. The dietary consists in the patient drinking from three to five pints of hot water daily, the water being taken from one to one hour and a half before each meal, and half an hour before retiring to rest, and eating from two to four pounds of beefsteak daily. The meat should be freed from fat, gristle, and connective tissue, thoroughly minced, mixed with a little water, and then warmed through with gentle heat until it becomes brown in colour. A little salt and pepper may be added, and the meat eaten in this form or made up into cakes and cooked on the grill. Later on in the treatment, part of the steak may be taken grilled, or a grilled lean mutton chop may be substituted for one of the daily meals. The course of treatment should last for from four to twelve weeks, after which a gradual return to ordinary diet should be made.

Articles Of Diet To Be Avoided By The Gouty

Rich Meat-Soups

Ox-tail, turtle, mock turtle, kidney, mulligatawny, hare, giblet.

Salmon, mackerel, eels, lobster, crab, mussel, salted fish, smoked fish, preserved fish, tinned fish.

Duck, goose, pigeon, high game.

Meats Cooked A Second Time

Hare, venison, pork, lean ham, liver, kidney, salted, corned or cured meats, pickled meats, preserved and potted meats, sausages : all articles of food pickled in vinegar; all highly-seasoned dishes and rich sauces.

Tomatoes, beetroot, cucumber, rhubarb, mushrooms, truffles.

Rich pastry, rich sweets, new bread, cakes, nuts, dried fruits, ices, ice-cream.