+---------------+-------+---------+------+---------+---------+----------+
| | | | |Ratio of |Uric Acid| |
| Name. |Body- |Total | Uric |Uric Acid| per kilo|Phosphoric|
| |weight.|Nitrogen.| Acid.| to |of Body- |Acid |
| | | | |Nitrogen.| weight. |P₂O₅. |
+---------------+-------+---------+------+---------+---------+----------+
| | kilos | grams | gram | | grams | grams |
|Oakman | 62 | 7.42 | 0.405| 1:18 | 0.0065 | 1.39 |
|Morris | 59 | 7.03 | 0.450| 1:15 | 0.0076 | 1.25 |
|Broyles | 60 | 7.26 | 0.398| 1:18 | 0.0066 | 1.41 |
|Coffman | 58 | 8.17 | 0.379| 1:21 | 0.0065 | 1.23 |
|Sliney | 60 | 8.39 | 0.647| 1:13 | 0.0107 | 1.32 |
|Steltz | 53 | 7.13 | 0.416| 1:17 | 0.0078 | 1.24 |
|Henderson | 71 | 8.91 | 0.488| 1:18 | 0.0068 | 1.42 |
|Fritz | 72 | 7.84 | 0.642| 1:12 | 0.0089 | 1.58 |
|Cohn | 62 | 8.05 | 0.512| 1:15 | 0.0082 | 1.28 |
|Loewenthal | 59 | 7.38 | 0.372| 1:19 | 0.0063 | 1.28 |
|Zooman | 55 | 8.25 | 0.457| 1:18 | 0.0083 | 1.19 |
|Bates | 65 | 8.08 | 0.387| 1:20 | 0.0059 | 1.23 |
|Davis | 57 | 8.61 | 0.414| 1:20 | 0.0072 | 1.42 |
+---------------+-------+---------+------+---------+---------+----------+
These figures are interesting in many ways. First, they make clear that
on the diet prescribed, these men were manufacturing or excreting about
the same amount of uric acid per kilo of body-weight as the men of the
two preceding groups, living more or less with free choice of food. In
other words, all these men, with one and possibly two exceptions, were
practically throwing out only uric acid of endogenous origin, _i. e._,
that which came from the breaking down of the man’s own tissue cells.
Second, it is to be noted that the ratio of uric acid to nitrogen in the
men of this group varies only within narrow limits.
It is very evident from these figures, reinforced by those of the
previous groups, that we can diminish greatly the output of uric acid by
simply restricting the extent of proteid katabolism, through reduction
in the amount of proteid food. Further, we now know that this general
lowering of proteid metabolism can be accomplished not only without
danger to the body, but with a distinct betterment of the physical
condition.
Just here I should like to emphasize one point that appears to me of
primary importance in any consideration of the influence of diet in
gouty affections, and in so doing I merely echo a statement made by
Sir Dyce Duckworth[53], viz., “that the subject of gout, either by
inheritance or acquirement, is so far peculiar in his constitution
that he reacts differently to various agencies, such as climate, food,
etc., from persons not so disposed.” In this connection, let me refer
again to the foregoing table of results obtained with the soldier
detachment, remembering that these thirteen men were living under exactly
the same conditions and consuming the same kind of food each day, and
in essentially the same amounts. Yet notice the striking variation
in the output of uric acid by one of these men (Sliney),—a variation
which shows itself especially when the uric acid is calculated per
kilo of body-weight. How can this variation be accounted for except
on the assumption that there may be personal idiosyncrasies, personal
coefficients of nutrition, natural or acquired, that modify to some
extent the production of uric acid, the oxidation of uric acid, or the
elimination of uric acid from the body?
Lastly, in advocating the possible systemic value of a lowered proteid
metabolism as of value in the prevention of gout, and of other disorders
which have their origin in perverted nutrition, I am inclined to
emphasize the desirability of using common-sense in the application
of dietetic rules, remembering that man is an omnivorous animal, and
that Nature evidently never intended him to subsist solely on a “cereal
diet,” or on any specific form of food to the exclusion of all others. On
matters of diet every man should be a law unto himself, using judgment
and knowledge to the best of his ability, reinforced by his own personal
experiences. Vegetarianism may have its virtues, as too great indulgence
in flesh foods may have its serious side, but there would seem to be no
sound physiological reason for the complete exclusion of any one class
of food stuffs, under ordinary conditions of life. Far more rational
is temperance in place of prohibition, and I am inclined to emphasize
the systemic value of a daily diet so reduced in quantity that the
metabolic processes may be largely decreased, in closer harmony with true
physiological needs, especially those which involve the breaking down of
proteid matter; and in making this suggestion I can add the assurance,
based upon these observations on many individuals, that there is not only
perfect safety but gain to the body, in diminishing proteid metabolism to
a level somewhere near the actual requirements of the individual.