Reverting to white wines, these, as compared with the red wines of the Gironde, contain less tannin and more free acid. According to Burney Yeo, they exert, too, a more diuretic effect, and to remove their excessive acidity he advises their dilution with some alkaline table water. Most of the white wines come from the Rhine or Moselle districts. The Rhenish are relatively full-bodied and of marked vinosity, while the Moselle wines are mostly light and of a somewhat delicate nature. Light hocks and still Moselles are quite permissible, also the white wines of France, such as vin de Grave, all varieties of the latter being fairly “dry” and light in character. On the other hand, the white wines of Sauterne, like some of the Hungarian wines—i.e., Ruster—are rich in saccharine constituents. In this respect they contrast with the Rhenish and Moselle wines. Of these last Johannisberg contains only 0·42 per cent. of sugar, Rudisheimer 0·39, Zeltinger 0·13, and Stein-Reisling 0·01, while Ruster contains no less than 21·74 per cent. of sugar.
In conclusion, I would re-emphasise the fact that, if wine be taken, the patient’s own experience is the best test as to which particular wine is the most suitable in his case. This elicited, the subject should be counselled to adhere to it, taking it only at meal-times, and establishing a rigid rule as to quantity. The least excess is harmful, and breaking of the ordinary routine in the matter of the amount drunk is a fertile source of “gouty” outbreaks. In any case the quality of the wine should be above suspicion, and if the expense is prohibitive, he had best eschew wine altogether in favour of mature spirits.
Spirits.—Brandy, whisky, and gin are the spirits most in vogue in Great Britain, and it has become an axiom with some that, if alcohol in any form be requisite for the “gouty,” the least harmful is one or other of these beverages when adequately diluted. Of the three whisky undoubtedly has found most favour, and the pernicious and far too prevalent idea is that whisky not only does not beget gout, but is actually beneficial for gout. The consequence is that many “gouty” people take far more whisky than is desirable, seemingly oblivious of the fact that, if whisky in moderation be suitable for the “gouty,” whisky in excess is as deleterious for them as for the non-gouty. In short, like any other form of alcohol, if taken immoderately, it will bring to fruition a latent gout, this, as suggested by Ford Robertson, not by the direct action of the alcohol, but by the “indigestion toxæmia” it sets up.
In advising therefore a “gouty” subject to take whisky we should insist that (1) it should be taken only at meal-times and (2) only in moderation. The habit of occasional “nips” at all times of the day should be unreservedly condemned. As to what constitutes a moderate quantity is often a difficult question to decide.
When feasible, I endeavour to limit the daily allowance to a wine-glassful, distributed over lunch and dinner. But it is quite impossible to lay down hard and fast rules in a matter in which personal idiosyncrasy plays such a strong rôle. Frequently, in addition to the above amount, one has to relent to the extent of a “nightcap,” or but too commonly one has to be content if one can compass reduction to an amount which for the particular individual under review seems apparently compatible with no appreciable damage to health.
Sometimes one of the frequent accompaniments of gout comes to our assistance. It may be raised blood pressure, glycosuria, albuminuria, obesity, etc. In such cases a word in season may reduce an otherwise recalcitrant subject to reason.
Needless to say, in regard to “ardent spirits,” as to wines or malt liquors, we must, when determining the quantity to be taken per diem, review the same in light of the person’s habits, whether active or sedentary, whether associated with overeating or not. For manifestly all these bear on the point at issue.
Lastly, as to whether the subject should take brandy or gin in preference to whisky is a matter for himself to decide. Whichever suits him best is the best for him. Albeit, I confess to a leaning in favour of “dry Plymouth” gin, this being more diuretic than other spirits by reason of the juniper contained therein. But, in whatever form “ardent spirits” be taken, it is most essential that it be sound. Brandy should be of the finest quality, the whisky mature, and inferior kinds of both wholly eschewed.