Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

(1) It be a “light” beer, in which the “bitter” principles predominate, and the extractives are small in amount[61];

(2) It be “sound” and not “turned” beer, and of course free from any possibility of lead impregnation;

(3) It be taken in moderation, not exceeding one to two pints per diem;

(4) The “gouty” subjects by whom it is taken be physically active;

(5) Due respect be paid to personal idiosyncrasy, reserving its use for those in whom its effects are definitely stomachic and tonic, while discountenancing its use when followed by heaviness, drowsiness, and biliousness.

As to cider, there is no doubt that the partially fermented or sweet variety is more harmful than “dry” or “rough” cider. Still there is no room for dogmatism even here, for a “gouty” man, if he be unaccustomed to cider, may find that, whether “dry” or not, it may provoke an attack. Sir Archibald Garrod tells us that he has known not a few gouty patients who alleged that cider suited them admirably, but he adds: “An experience of some months has usually modified their opinion on this point.”

Wines.—When we come to consider wines, we are on very uncertain ground, this especially if we base our opinion too much on the chemical analysis of this or that variety. The current belief is that the most unsuitable wines are those that contain large amounts of alcohol, sugar, or free acid. Then we discover it is not the amount of alcohol in the fluid that determines the incidence of gout and, in witness to our perspicuity, call to note the rarity of gout in Scotland, where whisky is the favourite beverage; ergo whisky par excellence is the drink for the “gouty,” and so we find ourselves in this impasse: we fulminate against alcohol as the cause of gout, and in the same breath advise our “gouty” patients to drink precisely those fluids containing the highest percentage thereof.

True, when we turn to wines we find that it is precisely those that are richest in alcohol that most potently predispose to gout, e.g., port. But seeing that whisky contains infinitely more alcohol than port, and yet is little gout-provoking, we search round for some other constituent in wine on which to lay the blame. So we decline on the varying degrees of acidity in different wines. But this again on reflection, it is decided, is of little moment. For, on the one hand, port and sherry are among the least acid wines, and yet, like the even less acid malt liquors, most productive of gout, while, on the other hand, the more acid clarets and hocks are deemed relatively harmless. Then the varying quantities of sugar in the different wines come under the ban. But here again no definite line can be drawn. For some wines most provocative of gout have a high sugar content, while others equally potent in this direction contain but small amounts.

Now the most salient deduction from the foregoing considerations is our inability at present on chemical grounds to determine why certain wines are productive, and others are relatively nonproductive, of gout. We can impeach neither the alcohol content, the acidity, nor the sweetness. For on all these points startling exceptions preclude dogmatism. Does not the clue to these varying reactions quâ gout reside in the individual, not in the character of the wine? We are far too prone to say that this or that wine is “gouty,” to say that this wine gives you gout, and that not.