In the following dietary a liberal variety of foods will be found, some of which may be selected and changed from time to time according to need in the intervals between the exacerbations or in chronic gout. Should an acute attack occur at any time in the course of the disease, the diet must be at once restricted, as described above. The number of dishes allowed at any one meal should be few. In dealing with any case of chronic gout for the first time it is injudicious to make radical changes in the diet too suddenly.

Soups

Soup should be free from all fat, and it is better made of vegetables than meat, and purees of potatoes, celery, etc., may be recommended. If the taste of meat is desired, as suggested by Yeo, it is best imparted to the soup by one of the meat extracts which contain simply the highly flavoured extractive matter without contributing to the bulk of proteid food. A teaspoonful or two of Valentine's meat juice or Liebig's extract of meat in a half pint of vegetable soup accomplishes this result.

Milk

Milk wholly disagrees with some gouty persons, but in those who digest it well, if it be not too rich in fat or if it is taken skimmed or diluted, it forms an excellent food. Many are, however, opposed to its use in any form, even when rendered alkaline by the admixture of alkaline waters or a few grains of bicarbonate of sodium. Yeo gives a small salt-spoonful each of potassium bicarbonate and common salt in a breakfast-cupful of hot milk and water. Others give it with warm water. The attempt has been made to place gouty patients upon an exclusive milk diet. This sometimes, but not often, aids those who are robust and young, but it is injurious to older patients.

Cheese, being a concentrated, proteid food, should not be eaten.

Eggs

Garrod allows eggs and bacon for breakfast, and Ralfe recommends an occasional "savoury omelet." Eggs cooked with milk and custard puddings (unsweetened except with saccharin) may sometimes prove harmless, but Senator is opposed to them on account of the fat and lecithin which they contain.

Shellfish And Crustaceans

The soft part of oysters and clams may be eaten, but crabs, lobsters, and shrimps may not be allowed, least of all in salads.

Fish

Some writers maintain that fish should constitute the chief nitrogenous food, while others prescribe it very moderately, if at all.

Broiled or boiled fish, such as bluefish, whitefish, bass, shad, are permissible occasionally for variety, but fish having firm flesh and those which contain considerable fat are not good. Salmon, mackerel, halibut, codfish, should therefore be avoided, although Garrod allows salmon served with salt and Cayenne, but without sauce. Rich sauces must not be eaten with fish or salads. In lieu of them, a simple dressing of an infusion of aromatic herbs and pepper, or a plain bread sauce, may be employed.

Smoked and pickled fish are forbidden. Fish roe, such as shad roe and caviare, is admissible.

Meats

Meat cannot be prohibited entirely for months at a time in chronic gout, especially for a middle-aged man, although the young may thrive better without it. It should be only eaten once a day in any case, and roasting or broiling is the best form of cooking it. Twice-cooked meats should not be eaten. Beef, lamb, and poultry may be allowed sparingly. Generally speaking, white meat is better than dark meat. Veal, pork, fat bacon and ham, game, and dried, smoked, pickled, or salted meats must all be forbidden. Only one kind of meat should be eaten at a meal.

Fats

Fats should be used sparingly, and all food fried or cooked in grease must be forbidden. Fat meats and fat fish are to be avoided. A little well-cooked bacon may occasionally be eaten, and butter may be taken only in moderation. The objection to the use of fats and oils is that, unless the general nutrition is very poor, they interfere in gouty subjects with complete oxidation of proteid elements.