Professor Carl von Noorden says of gout, “with regard to treatment we are all agreed that food containing an excess of purin bodies should be avoided, and those words embody almost all there is to be said as to dietetics.  Alcohol is very injurious in gout.  Salicylic acid is a dangerous remedy.  Alkalies in every form are utterly useless.”  Dr. J. Woods-Hutchinson says, “the one element which has been found to be of the most overwhelming importance and value in the treatment of gout and lith3/4mia, water, would act most admirably upon a toxic condition from any source; first, by sweeping out both the alimentary canal primarily, and the liver, kidneys and skin secondarily; and secondly, by supplying to the body cells that abundant salt-water bath in which alone they can live and discharge their functions.”  Dr. Woods-Hutchinson proceeds to state, that the one active agent in all the much vaunted mineral waters is nothing more or less than the water.  “Their alleged solvent effects are now known to be pure moonshine.”  The value consists in “plain water, plus suggestion—­not to say humbug—­aided, of course, by the pure air of the springs and the excellent hygienic rules.”

It is a common experience amongst rheumatic patients, that they cannot take lentils, haricots and some other foods; sometimes, even eggs and milk are inadmissible.  This is not for the alleged reason that they contain purins, or as some misname it, uric acid; but because the digestive organs are unequal to the task.  It will be seen, that although Dr. Haig’s hypothesis of uric acid as a cause of gout and some other diseases is disputed by many eminent physicians, his treatment by excluding flesh and other foods which contain purins, and also pulse, which is difficult of digestion by the weakly, is a wise one.  It has proved of the greatest value in very many cases.

Digestion and nutrition is a complex process, and it may be faulty at various stages and in several ways; there may be either deficient or excessive secretions or inaction.  Thus there are exceptions, where gouty symptoms, including an excessive quantity of urates in the urine, have only been relieved by the giving up of milk foods or starch foods (see Lancet, 1900, I., p. 1, and 1903, I., p. 1059).

Those particularly interested in the subject of the purins and gout are referred to the lecture on “The meaning of uric acid and the urates,” by Dr. Woods-Hutchinson, in the Lancet, 1903, I., p. 288, and the discussion on “The Chemical Pathology of Gout” before the British Medical Association at Oxford (see British Medical Journal, 1904, II., p. 740).