At other times the amount, though, strictly speaking, not excessive, is so when judged in light of the victim’s habits. He may be an intellectual worker, but sedentary, and he must either lessen his drink or increase his exercise, or he may overeat as well as overdrink—a victim of the prevalent idea that the one evil counteracts the other. Between the Scylla of overeating and the Charybdis of overdrinking there is no safe course save by way of reduction of both.
We see therefore that in the matter of the choice of a wine for a “gouty” subject there are many points to be considered. Of these personal idiosyncrasy stands first. By this criterion, and none other, can the suitability of the wine be decided. Then the state of the digestive functions, if deranged, has to be considered. Is the gastric disorder such as will be benefited or, on the other hand, impaired by wine of any sort? Again, glycosuria, albuminuria, raised blood pressure, or cardiac degeneration may intervene to complicate the issue, and so our policy in regard to alcohol has constantly to be adapted and readapted to the varying requirements of the organism.
It will be seen that I have largely refrained from specifying the wines suitable or unsuitable for the “gouty.” To have done so would have been alien to the general tenor of my remarks, convinced as I am that our trend in the matter of alcohol for the “gouty” should be more in the direction of “individualisation” than of “standardisation.” Subject to the reservations that such an attitude portends, I would proffer the following suggestions:—
As a general rule, wines which are “dry” are much more suitable for the “gouty” than those which are “sweet.” Wines are termed “dry” when nearly all the sugar of the grape is transmuted into alcohol, as in “dry” sherries. They are termed saccharine or “sweet” when the process of fermentation is arrested before all the sugar has been exhausted, as in Malaga. Again, wines which are both “strong” and “sweet,” e.g., Malaga, sweet champagne, Tokay, etc., are more pernicious than those which are “strong” yet “dry,” e.g., port, sherry, Madeira.
Sir James Goodhart, discussing wines suitable for the “gouty,” confesses to a “personal leaning in favour of the wholesomeness of a glass of good old sherry in those cases where a little wine seems a judicious prescription.” With this I fully agree, and would suggest that of sherries the “gouty” should favour the “Manzanilla” rather than the “Amontillado” class. The former, save for the addition of a small quantity of spirit, are mostly shipped in the natural state; also they are light and “dry” as compared with the latter, which are generally “sweet” and full-bodied.
It is interesting to recall, too, that Sydenham regarded sherry as preferable either to Rhenish or French wines. He himself in his own person found “sack” or Canary the most helpful. “I have during the fits of the last years tried many things to lessen the symptoms. Nothing, however, effected my purpose so much as a small draught of Canary wine, taken now and then, when the faintness or sickness were most oppressive.” Here one may note that sherry was the first wine to be known as “sack” in this country, and that the wine shipped in Sydenham’s time was of the “dry” variety. Chemically the “sweet” sherry differs from the natural “dry” light wine through its relatively high content of alcohol and sugar.
Turning to port, Sir Alfred Garrod absolutely tabooed its usage by the gouty. But this appears too sweeping, and nowadays, at any rate, it is well recognised that, especially in asthenic types of gout, a glass or two of old port is well borne. Consequently in such cases we should not, in the absence of any adverse symptoms, forbid its continuance. The bad reputation achieved by port is, I am sure, a relic of the Regency. But “three-bottle” men are no longer with us, and, allowing for personal idiosyncrasy, I very much question if sound port taken in moderation wholly merits the aspersions cast upon it. I do not by that for one moment suggest its general adoption by “gouty” people, but that where an old or elderly gouty subject takes port and can be trusted not to extend his glass to half a bottle his inclination may be respected. The sugar content of port varies according to the vintage, ranging from 7 to 15 per cent., and the “gouty” man should favour the “drier” varieties.
As for champagne—a manufactured article rather than a natural wine—there is no question that, if taken at all, it should be a “dry” brand. Such contains from 9 to 12 per cent. of alcohol and from 1 to 4 per cent. of sugar, whereas the “sweet” brands may hold as much as 16 per cent. All depends on the quality of the champagne, and, as Ewart wisely remarks, “it is wiser for the ‘gouty’ patient not to incur considerable risks by trying brands with which he is not familiar, though he may sometimes with impunity, and occasionally with benefit, enjoy a glass of champagne which he can trust from personal experience.”
If, on the whole, the most unsuitable wines for the “gouty” are the strong sweet spirituous or liqueur wines, on the other hand the red or astringent and white wines are the most esteemed. As to the red wines, there is no doubt that the delicate Gironde (Bordeaux) wines are par excellence the most suitable. They have sufficient body and alcohol without being heavy or fiery, while their acidity and sugar content are very low. But of course the quality of the wines varies considerably with the vintage. Subject to this, sound, well-made clarets taken in moderation and somewhat diluted with water are the most wholesome wines we can prescribe for the “gouty.”
The more full, though still not coarse, wines of the Burgundy district are by some denounced. One authority, I note, states that in elderly gouty subjects he had often found that two or three glasses of claret or Burgundy were in the course of a few hours followed by eczema. While such idiosyncrasies may obtain, it is not true of the “gouty” as a class. I should consider a “gouty” subject in any case unwise to take two or three glasses of Burgundy. But I do not hesitate to order one or perhaps two glasses somewhat diluted with water. Being a stronger and more tonic wine than Bordeaux, it is useful in the more asthenic types of gout. The pity is, of course, that the cheaper Bordeaux and Burgundy wines are so largely adulterated, while the more mature clarets are available only for the rich. As good substitutes for French wines Burney Yeo commends the red Hungarian wines, such as Carlovitz, while we may add that some of the Dalmatian wines are of fair quality and somewhat resemble Burgundy.