Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

But at the same time it must be realised that no rigid rule can be laid down for “gouty” albuminurics. As a guide to the suitability of a diet it is better to rely on the general condition than on variations in the amount of albumen. For, as Professor H. Andrew Smith, of New York, long since said, “if on changing from a non-nitrogenous diet to a nitrogenous one we find a general improvement in the patient’s condition, it is an evidence that the change is beneficial, no matter if the albumen fills a larger portion of the test tube. On the other hand, if we cut off a large proportion of animal food from the diet, and our patient grows more dyspeptic, weaker, more anæmic, more dropsical, it is nothing to the point that only one half or one-third of the former quantity of albumen is found in the urine; the change has done harm, and the sooner we change back again the better. We should, above all things, seek that diet for the patient which he can best digest and assimilate, for we may rest assured that the products of faulty digestion and assimilation will irritate the kidneys more than any amount of normal material they may be called upon to eliminate, while, at the same time, the general system will suffer from lack of support.”

Lastly, up to this juncture all our suggested dietetic modifications have been in the direction of reduction or abstinence. But we must recollect that in practice we find that not a few gouty persons are most careful and prudent in diet. They commit no indiscretions, but nevertheless their gout is still with them. They are of the asthenic type, thin, pale, sallow, and given to neuralgic forms of fibrositis. They do not want “lowering”; to curtail their food is harmful. In their instance, with due respect to digestive idiosyncrasies, a more or less generous diet should be prescribed. Let them forsake dietetic schedules and follow their instincts. Let your advice be that of Sir William Temple: “Simple diet, limited by every man’s experience to his own easy digestion, and thereby proportioning as near as can be the daily repairs to the daily decays of our wasting system.”

Beverages in Gout

It cannot be gainsaid that the beneficial effects of so-called “water cures” are in great measure referable to the increased amount of water ingested during their progress. Absorbed in the main in the small intestine, it passes into the general blood stream, whence it is excreted viâ the skin, kidneys, lungs, and fæces. Its elimination through these various channels sufficiently accounts for its value as a means of flushing the bodily tissues and hastening the excretion of retrograde and toxic products. Indeed, its efficiency as a depurative agent cannot be over-estimated, and nothing is more beneficial for the subjects of a “gouty” diathesis than regular consumption of an adequate quantity of this admirable solvent.

By general consent, the water ingested should be preferably hot. Water of a higher temperature than that of the blood stimulates the hepatic cells, and promotes biliary excretion. It has been shown, moreover, by Glax that while draughts of cold water raise vascular tension and diminish pulse frequency, on the other hand hot water diminishes arterial tension and accelerates the pulse rate.

It is also claimed that the increased elimination of water viâ the kidneys is correlated with an augmented output of the solid constituents of the urine; that the phosphates, sulphates, sodium chloride, and likewise urea are for the time excreted in greater amounts.

The point at issue, however, is whether or no this increase in the amount of urea excreted can be held to indicate enhanced tissue change in the nitrogenous elements in the body fabric.

Winternitz claims that it does, in contrast to Von Noorden, who holds that nitrogenous tissue change and the formation of urea and uric acid are uninfluenced by the amount of water imbibed. In further contradistinction some contend that following the ingestion of water the excretion of uric acid is diminished.

Fortunately for “gouty” subjects, the beneficial effects of water flushing of their systems occur independently of any coincident increase in their uric acid output. This is true even of mineral waters. Thus Bain and Edgecombe noted that following the ingestion of the old sulphur water of Harrogate the excretion of uric acid was diminished. Nevertheless cases of “gout, especially of the asthenic type, derived the most marked benefit from its use.” “This fact is mentioned,” they say, “because some writers attach the greatest importance to an augmented excretion of uric acid in the urine as a necessary concomitant of successful treatment. This we firmly believe to be an erroneous view.”

Indeed, ignorant as we are of the exact etiology of gout, we must at any rate provisionally attribute the proved efficacy of water-drinking in gout to its flushing action on the tissues, its furtherance of the excretion of waste products. Nor can we doubt that the ingestion of hot water, involving as it does equalisation of its temperature with that of the body, must exert a profound and intimate effect upon processes of cell nutrition. Moreover, through its solvent and penetrative quality, its mineral or chemical constituents are enabled to penetrate freely the interstices of the tissues throughout the economy.