It is preferable that no food be taken for the first twenty-four hours of an acute attack of gout, but water should be drunk freely. During the acute attack the patient should be restricted to a milk diet, which may consist of milk, bread and milk, and tea made with boiling milk instead of with water. Weak tea with cold toast thinly buttered may also be taken. The free drinking of hot or cold water, of salutaris water, or of some simple mineral water, should be encouraged. The milk diet should be continued until the acute inflammation is subsiding, which stage is indicated by the lessening of the pain, and by the pitting on pressure of the affected parts. No alcohol in any form should be given during this stage, unless there are strong reasons for its administration, such as a weak action of the heart and a feeble, irregular pulse, when a little well-matured whisky diluted with salutaris water will prove the best form of alcohol. Beef-tea and any of the meat extracts or essences should be avoided at all times by gouty patients, owing to the tendency they have to irritate the kidneys, and to the fact that they are loaded with waste nitrogenous products. With the subsidence of the acute attack the patient may return to a more liberal diet, but care should be taken to avoid anything indigestible.
The following plan gives an indication of the diet to be recommended to gouty subjects : -
Half a pint to a pint of hot water, flavoured with a slice of lemon-peel, should be slowly sipped immediately on rising.
A selection may be made from the following articles of diet, according to the taste of the patient : Porridge and milk, whiting, sole or plaice, fat bacon, eggs cooked in various ways, dry toast or " Zwieback bread " thinly buttered, and tea infused for three minutes and then strained from the leaves. Fat bacon is digestible when grilled, but less so when boiled. Eggs should not be taken hard-boiled.
Soups suitable for the gouty are vegetable purees, and soups made by boiling beef and mutton bones with vegetables, and subsequently removing the fat which separates on cooling. These soups should not be thickened* with farinaceous substances.
The varieties of fish most suitable to the gouty are whiting, sole, turbot, plaice, smelt, flounder, grey mullet, and fresh haddock. The birds that are admissible as articles of diet are chicken, pheasant, turkey, and game (not high).
Butcher's meat, mutton, lamb, and beef should be taken at only one meal in the day, and then in moderate quantity. Two vegetables may be taken at both lunch and dinner. Any of the ordinary vegetables may be taken, except those previously mentioned as best avoided; but those that I consider most likely to prove beneficial to gouty subjects are spinach, Brussels sprouts, French beans, winter cabbage, Savoy cabbage, turnip tops, turnips, and celery. Potatoes may also be taken in moderate quantities. Stewed fruits, or baked apples or pears, may be taken every day at one meal.
Green vegetables as salads may be taken, provided oily dressings are avoided. A simple savoury may, if desired, be taken at the end of dinner, or a small quantity of cheese, if well masticated, and if free from the penicillium fungus or mould.
Half a pint to a pint of hot water, flavoured with a slice of lemon-peel, should be slowly sipped before retiring to bed.
With regard to persons who are disposed to gout, but are not actually suffering from it, the usual mixed diet may be taken, but they should limit the starchy articles of food, and should avoid all rich sweets, rice, tapioca, and sago. Thin and ill-nourished subjects require modifications in their diet as compared with people who are stout, while those who take plenty of exercise can take food forbidden to the indolent.
Individuals who especially benefit by a reduction of diet, both as regards quantity and quality, are those overfed people who are past middle life.
Careful dietetic treatment should be resorted to, without, however, restricting the diet too much. An excessively nitrogenous diet is to be avoided as tending to accentuate the gouty condition, but no hard and fast rules as to the amount of diet can be laid down. Each case must be treated by ascertaining what amount of proteins, fats, and carbo-hydrates is best borne by the individual. Toasted bread, milk, and milk puddings made with rice, sago, and tapioca are generally permissible in this form of glycosuria. The best test of the suitability of the diet is the fact that the weight of the patient is not diminishing, while, at the same time, the excretion of sugar is becoming less. The patient should, therefore, be weighed once a week, and the whole of the urine for twenty-four hours should be collected once a week, measured, and the quantity of sugar determined in a sample of the mixed urines, so that the total output of sugar for the twenty-four hours may be known.