The meals of the gouty subject should be small in bulk and low in nourishment. The stimulation of his appetite should be avoided in every way, and he should not use highly flavored sauces, or potted meats and sausages, because these either predispose the intestine to injury by means of irritating materials, such as pepper, paprika, mustard, onions, or because they contain substances harmful to the kidneys, as, for example, cloves, caraway, gar lic, leeks etc. We repeat only the admonitions of the numerous authors who have written on gout, and we wish to emphasize the importance of sparing the heart, kidneys and digestive tract; this principle remaining the same whether the physician believes in the retention theory, or whether his object is to strengthen the kidneys for the purpose of effecting an improvement in their uricolytic power. A condition of undernourishment is above all to be desired when we have to treat a combination of gout and obesity, or when the condition of the heart demands it.* Otherwise the quantitative measure of the diet should be so regulated that the caloric intake will be held just below the normal limit. To gouty subjects who are cachectic abundant nourishment must naturally be given; on the other hand strong, full-blooded individuals, especially those with a tendency to obesity, should be placed on a diet of relatively low caloric value. In the opinion of William Temple, the most suitable diet is one which is simple, which is adapted to the digestive peculiarities of the patient, and which supplies so far as possible his daily needs. The views of Sydenham were that the amount of food should be no greater than the stomach can easily digest, and it should be so proportioned that it will be sufficient to maintain the strength of the body but not enough to cause still further weakness by too great abundance.

* In cases of obesity where there are signs of embarrassed heart function a restricted milk diet as originally devised by Karell is of the greatest importance. The method prescribed is to give the patient 200 cc. of milk at 8 a. m., 12 M., 4 and 8 p. m. for six days. No other food or fluid is allowed. For the next two to six days in addition to the milk, an egg is given in the morning, and in the evening a little zwieback. Then two eggs are added and the amount of food is gradually increased until by the fifteenth or sixteenth day a full diet is resumed Under this regimen, which is equivalent to partial starvation, there is a gradual and constant loss of weight and the fluids of the body are reduced as in the case of "dry diets." The usefulness of this diet is limited neither to gout nor obesity. [Editor.]