Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

“Make less thy body hence, and more thy grace;

Leave gormandising; know the grave doth gape

For thee thrice wider than for other men.”

There are so many dietetic methods of treating obesity that they cannot all be outlined here. The Banting method, like the Salisbury, is too severe for the average patient, while the Weir-Mitchell method has one cogent objection to general adoption, viz., the expense entailed. Nevertheless as regards the last-named, or skim milk, method, it certainly achieves marvellous results in those cases in which there is a mere accumulation of fat without any other complication.

Generally speaking, however, one has to be content with the following suggestions: All varieties of lean meat may be taken, as well as poultry, game, and fish, subject to idiosyncrasies and digestibility. Meat may be taken twice daily, not exceeding six ounces at one time. All starchy and farinaceous food is to be reduced to a minimum or wholly forbidden. Leaf vegetables may be taken freely, but the roots and tubers, such as potatoes, abstained from. Bread should be largely reduced in quantity and thoroughly torrified. Sugar must be prohibited, and saccharine or saxin substituted. Fresh fruits may be eaten, but milk should be avoided, also cream, or very strictly limited. Where feasible, it is often a good plan if the subject can for one day a week content himself with a diet of skim milk.

Alcohol, as far as possible, should be rigidly excluded, or only a very moderate quantity of good whisky or a light wine, such as hock or Moselle, permitted. As a rule, only a little hot water should be sipped at meals. But I think in these subjects of so-called “uric acid diathesis” it is well not to restrict their fluid too markedly. A pint of hot water may be drunk one and a half hours before each of the three meals, and one pint more half an hour before bedtime. Weak hot tea may be substituted, as many subjects find a difficulty in drinking so much plain hot water at one time. If while on this regime the subject lose weight and pari passu gain strength, all is well. If he lose weight and therewith lose strength, further reduction or its continuance is contra-indicated. It should be recollected that the reducing effects of dieting may be markedly enforced by an open-air life, with riding or other outdoor exercise.

Glycosuria.—This condition conjoined with obesity is not uncommon in middle-aged “gouty” subjects. It is of benign type, and the amount of sugar excreted is usually reduced to a mere trace by extraction of the carbohydrates in the food. Thus, we should forbid, e.g., sugar, pastry, sweet wines, and dishes made with flour, rice, or sugar. In these cases von Noorden considers that it is better after reduction of the amount of sugar by dieting to a mere trace to be content rather than to get rid of it wholly by a rigid elimination of all carbohydrates. To this end the patient may be allowed to eat a limited amount of bread, potatoes, and other vegetables, while he may eat freely of butter, bacon, and other fats.

One should recollect also that these “gouty” glycosurics have periods of enhanced carbohydrate tolerance, this, as Burney Yeo pointed out, quite “independently of any therapeutic interference.” In short, at times they can take quite a considerable amount of carbohydrates without passing sugar in their water.

Needless to say, the regime must be adapted to each individual case. The urine should be examined frequently, and the influence on the sugar content of different articles of food noted; also the weight should be frequently taken. It is certainly unnecessary in gouty glycosurics to wholly banish the carbohydrates. By such a plan we are more likely to do material injury than by exceeding by a little their limits of tolerance. Our remarks of course apply strictly to alimentary glycosuria. But we should also remember that exceptionally a case of gouty glycosuria may emerge into one of true diabetes.

Albuminuria.—In the so-called “gouty” contracted kidney, if the amount of albumen in the urine be very large, or when there are symptoms of nephritis, a milk diet for a few days or a week at a time may be given. More often it is unnecessary, or it is frequently badly borne or rejected. Consequently a modified milk diet has to be adopted, and a gradual return to a mixed diet permitted, provided no increase in the quantity of albumen ensues.