Von Noorden and Schliep6 suggest that gouty patients be tested for their "tolerance" for purin bodies just as diabetics are tested for their tolerance for carbohydrates; 400 grams of meat contain 0.24 gram of purin nitrogen, which is the equivalent of 0.72 gram uric acid. A patient was put on a purin-diet free; was given 400 grams of meat, then put on a purin-free diet again, and afterward was tested with 200 grams of meat. The results were as follows:

The authors conclude that while the increased uric acid output after giving 400 grams of meat is not what it would be normally, yet after giving 200 grams the quantity of additional uric acid is fully eliminated. Hence this patient had a tolerance for the purins in 200 grams of meat.

Dietetic rules for gouty sufferers are intended to combat the fundamental anomalies of the metabolism. The organism must not be overloaded with uric acid. Minkowski's rules1 for treatment of gout may be thus abstracted: Sweetbreads, liver, and kidney are to be strictly excluded from the diet since they contain purin bases in large quantity. Meat is to be taken in moderation only. Wine should be taken sparingly or not at all, and beer rigidly excluded on account of the nuclein in yeast. Cathartics may be given to rid the intestine of purin bodies excreted into the intestinal canal, and water-drinking, which promotes a larger flow of urine and increased uric acid elimination, is strongly to be commended. The diet for a gouty patient should contain each day 100 or 120 grams of protein, 80 or 100 grams of fat, and 250 or 300 grams of carbohydrates (2200 to 2600 calories). This should not include more than from 200 to 250 grams of meat per day. Indigestible cakes, pies, rich foods, and heavy salads should be forbidden. Moderation and self-control are the watchwords for the gouty sufferer.

1 Minkowski: "Deutsche medizinische Wochenschrift," 1905, xxxi, 409.

It is impossible to oxidize uric acid, and no treatment now known increases its solubility. Minkowski hopes that some organic compound may be discovered which will accomplish this purpose.

Bearing the facts of the above discussion in mind, the reader will comprehend that present-day doctrines concerning metabolism in gout may shortly become entirely obsolete through new and far-reaching discoveries.