Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

The evil potentialities that make for gout reside not in this or that particular wine, but in the individual. This or that wine does not give him gout, but evokes or brings to fruition a morbid tendency already latent in him. In the absence of this inherent proclivity, it would not have elicited those specific local reactions typical of gout. But for those who would interpret this statement as approval on my part of alcohol or an absolving thereof from any part in the genesis of gout I would issue this caveat: Alcohol will not originate gout in a non-gouty subject, but it will almost infallibly in those in whom there exists by heredity an inborn tendency to gout. In short, the “gouty” are hypersensitive to the evils of alcohol; the greater the need then for abstemiousness and self-restraint.

But, to resume the thread, in the absence of any absolute chemical criterion as to the relative suitability of this or that wine for the “gouty,” what shall be our advice to the “gouty” individual on this point? In a word, his “palate” and his “stomach” are the best criteria of the wholesomeness of this or that particular wine in his particular instance. If he is in the habit of taking wine do not forthwith, as is so often done, forbid him wine in all forms and order him whisky. This is done so light-heartedly that I do not wonder that the subject goes away frequently with the idea that whisky is not only innocuous, but desirable.

The whisky-drinker is not immune from gout, and I have no hesitation in affirming that “light” wines when fine, mature, and of a good quality are, subject to individual idiosyncrasy, quite as suitable for the “gouty” as whisky. Of the many wise warnings given us by Sir James Goodhart none is more apt for the present day than the following. Discussing the “treatment of uric acid,” he observes: “I am as much as ever an opponent of the prevalent dictum, ‘You must not touch wine; you must drink whisky,’ which too often means to the patient, ‘A glass of good wine is poison; I may take as much whisky as I like, and it is harmless,’ one of the most mistaken and mischievous beliefs that ever plagued a world.”

Again, if a “gouty” man takes wine, there is always one special variety that agrees with him, and as certainly one other or more that infallibly upset him. Putting aside all preconceived ideas, find out his personal idiosyncrasies in this respect. In this way you elicit and utilise for your ends the individual’s own experience, the only experience that counts.

A man of a certain age, he generally by the time he develops overt gout has arrived at definite conclusions as to what does and what does not suit him. He will frequently tell you he has had to give up malt liquors, perhaps port and champagne, and now finds that whisky, gin, or the lighter wines agree with him better. Or, as like as not, he may upset all your preconceived ideas. He may be of those gouty subjects—and they are not so few—who can drink champagne in moderation, or even a glass or two of port, daily with apparent impunity. On the other hand, a glass of claret or hock plays the mischief with him. He may, like some individuals cited by Burney Yeo, be one of those exceptional gouty subjects in whom even stout is well borne, Yeo thought largely because they habitually took daily large quantities of alkaline salts.

The sum of these erratic findings is that you must respect idiosyncrasy. It is said that the best wine for a “gouty” subject is the one that causes most diuresis. For myself, I am equally positive that the worst wine for a gouty man is that which upsets his stomach, which gives him some hours afterwards “acidity” or a feeling of “liver.” Often, too, it is not the wine, but the stomach into which it is put, that is to blame. Thus the “gouty” subject with atonic dyspepsia finds a glass of sound wine helps digestion. On the other hand, if he suffers from hyperacidity or chronic gastritis, the reverse will probably be the case.

Again, it is not the name, but the quality, of the wine that counts. It makes all the difference whether the wine taken is fine, mature, and of good quality, or some factitious, mixed, or adulterated product, passing muster, say, as claret. Fine mature clarets or red Bordeaux wines are most suitable for the gouty. But, as Burney Yeo rightly says, “a more injurious beverage than bad claret or imperfectly matured claret—and, speaking generally, all but the more expensive or most carefully selected clarets are bad—was never drunk.”

It seems opportune here to lodge a protest against fashions in wines for the “gouty.” At one time it was claret, then light white wines, Moselle, etc., and anon whisky, and even cider had its vogue. Fashions in wines, as in other spheres, postulate uniformity and lack of discrimination. Any one of the foregoing beverages may suit some particular “gouty” individual, but not all “gouty” subjects.

We have said that in some instances the wine, in others the stomach, is at fault. But intrinsically it may lie in neither, but simply in the quantity of the wine drunk. It may not, as judged by ordinary standards, be an excessive amount, but it may be excessive for that particular man. It is here that a medical man may often intervene with advantage. For a man may, quite unbeknown to himself, be really a heavy drinker, one of those unfortunates who are peculiarly tolerant of alcohol. A tactful reminder of the amount he is consuming per diem will frequently come as a shock, often a very beneficial one.

Apart from this, it is, I am sure, wise to fix the daily amount. The daily habit in the “gouty” is all-important. If accustomed to take one or two glasses, and they stick to it, all may be well; but it is on the occasions when the glass grows into a half-bottle that the trouble comes. Metabolically speaking, the “gouty” subject is most unstable, and disturbance of what one may call his daily alcoholic rhythm is always perilous. Unfortunately it works either way, too, both in the matter of “too little” as well as “too much.” Here experience and sound judgment will alone enable the physician to decide how far he may tamper with long-established habits.