Again, as before stated, one of the results attaching to deficiency of “vitamines” is functional derangement of the organs of digestion and assimilation. Such disturbances are prominent in gout, and that “errors of diet” play an important rôle in the genesis of the disorder can scarcely be denied. At the same time there is no proof as yet that the absence of some mysterious “accessory factor” makes for the development of the disorder.
Nevertheless reflection on these findings is, I think, wholly apposite. It should, at any rate, chasten those who affect extreme dietaries on insufficient grounds. They are not justified of results, for, with Sir Archibald Garrod, I venture to doubt “whether by dieting our ‘gouty’ patients we achieve nearly as much as we think we do.”
Such good, moreover, as we do compass, is, I think, exerted indirectly. Even in the inter-paroxysmal periods of the disorder, despite good or perhaps exuberant health, gout is there. Its morbid tissue potentialities are latent, though functionally inactive. To maintain this state of passivity is the aim of all dietetic measures, viz., to diminish or withdraw the dietetic factors that are provocative of gout.
The diet most void of offence is one the least calculated to excite digestive disturbance—one that makes more surely for gastro-intestinal asepsis. At this juncture it is interesting to note McCarrison’s observation that although the absence of certain “accessory food factors” is the essential etiological agent in the genesis of “deficiency diseases,” yet he holds that infections and parasitic agencies are often important causes in determining the onset of symptoms.
Similarly in the causation of gout, “errors of diet” are not the only agencies at work. They are in truth but contributory factors in that such indiscretions favour the incidence of catarrhal states. These again promote increased toxicity of the intestinal flora with sequential disturbance of general nuclein metabolism and associated specific local reactions in certain tissues.
I make no apology for this somewhat lengthy digression. In the sphere of dietetics, as elsewhere, “a little knowledge is a dangerous thing.” We need to walk more circumspectly in this matter of dieting; and to this end reflection on the disabilities that still beset us cannot fail to be salutary, and will form, I think, a fitting prelude to our suggested mode of procedure.
CHAPTER XXVII
TREATMENT OF GOUT (continued)
Regulation of Diet in the Gouty
The victim of gout is easier led than driven. Show no “bowels of compassion” for his failings, talk to him in the spirit of a dehumanised disciplinarian, and your tenure of his confidence will likely be short. You deal with a man more often wise than foolish, not merely a digestive tube.