In diabetes mellitus I proposed to divide the diet into two groups, and this plan has been almost universally adopted.

1. Main diet, carbohydrate free

No restrictions in regard to the quantity; that is, the amount taken should correspond to the state of nutrition of the patient.

2. Accessory diet, containing carbohydrates

The quantity is to be adapted by the physician exactly to the individual peculiarities of each case.

In an exactly similar manner the diet in patients suffering from gout or nephrolithiasis may be divided into two groups:

1. Main diet, purin-free

No restrictions in regard to the amount excepting as determined by the general state of nutrition of the patient. Care should be taken above all things that a sufficient amount of albumen is incorporated in the diet.

2. Accessory diet, containing purins

The quantity is to be adapted by the physician to the individual peculiarities of each case.

As has been stated above (Vol. VIII) the following articles must be included under the category of a purin-free "main diet":

1. Milk and all preparations made from milk; (care in the case of cheese that contains many bacteria or fungi).

2. Eggs of all kinds, also caviar.

3. All vegetables that are at all considered in the ordinary bill of fare, and, above all, also all varieties of flour and sugar made from plants. In particularly severe cases, care should be taken in using the seeds of plants, as well as coffee, tea, and cocoa. I should like to call particular attention in this place to caffein-free coffee (trade mark "Hag") that has a very satisfying taste and incorporates only very slight quantities of caffein.

So-called spices that contain irritating materials as mustard, pepper, paprica, curry, leek, garlic, horseradish, radishes, parsley, etc., are especially to be avoided on account of the danger of irritating the kidneys, for one should never forget that in arthritis urica as well as in nephrolithiasis urica there is always a certain predisposition to renal disease. The above-named vegetable products, however, have nothing to do with the formation of uric acid.

Of acids vinegar is, as a rule, forbidden, while lemon juice is permitted. This distinction is, how ever, not justified. The small quantities of vinegar that are necessary to prepare a dish of salad can do no harm, for vinegar stands in no relation to the formation of uric acid and does not irritate the kidneys as such at all, because it is immediately oxydized to carbonic acid and water in the body. Citric acid, however, is oxydized with more difficulty.