Foods containing starch and sugar should be avoided or taken in moderation. As already explained, starch is turned into glucose or sugar by the process of digestion, so that starch and sugar may be considered to have the same effect. Why sugar should have so deleterious an effect on the gouty is ill understood; but it is the common experience of gouty persons that sugar is poison to them. It is supposed that as starch and sugar are more easily and rapidly oxidised in the body than albumen, and as in the gouty the power of oxidation of foods is impaired, if the usual mixed diet of foods containing albumen, starch, and sugar be taken, the body will seize on the more easily oxidisable starch and sugar, while the albumen will remain partly oxidised, thus causing the production of urate of sodium in the blood, which, as I have shown, is the cause of gout. For the same reason fatty foods should be taken in moderation. They rapidly undergo acid fermentation in the stomach, and become, in some measure, the cause of the "acidity" so much complained of by gouty subjects.

The diet should be limited to beef, mutton, chicken, game, fish, eggs, green vegetables, a few ounces of stale bread, and a small quantity of butter (Roose). Fruit may be allowed, if not too sweet, and if found by experience not to disagree. Tea and coffee should be used in moderation. Cocoa made from nibs is recommended. Milk is ill-tolerated by some; but in other cases from one to two pints a day can be taken with advantage. Pastry of all kinds is forbidden. Bread, rice, potatoes, beans, and peas, all of which contain a large amount of starch, should be taken only in small quantities. The gouty person should not therefore be a vegetarian; for the vegetarian, in order to obtain the amount of albumen necessary for tissue change in the body, is obliged to take with it a large amount of starch, as vegetable albumen is contained in beans and peas, which are full of starch. The gouty person should, however, be a total abstainer, for it is indisputable that alcohol in any form is injurious. Excessive beer drinking is often the cause of gout among the poor, while a long course for many generations of "high living" is the fruitful source of gout among the well-to-to. If the enfeebled digestive powers need the stimulus of alcohol, old brandy or whisky well diluted, or good claret or hock, are the most suitable and least injurious drinks. Water is the only article of diet the gouty may take in excess. It is well for him to drink an abundance of water, either hot or cold as he may prefer. Water washes out the tissues, augments secretion, and, by removing waste products, may prevent deposits of uric acid and urate of sodium. The various effervescing alkaline waters may often be substituted with advantage for plain water, and, as lime juice is recommended to those who are unable to take vegetables, a lemonade made of an effervescing alkaline water with lime juice and saccharin will be found a most refreshing and agreeable drink.