Stated as a general principle, a person who is subject to gout is better without alcohol in any form. There are, however, some who require a little alcohol, either to aid digestion or to enable them to get through their work; and here I am entirely in accord with the advice given by Good-hart, that, if a man requires any stimulant at all, it is a matter he must decide by experiment for himself, for no medical man can tell him. If alcohol is necessary or desirable, the form in which it is to be taken is frequently a matter which the patient can decide better than the medical man; but I would insist upon the importance of definitely limiting the amount to be taken, and of restricting its consumption absolutely to meals. Some patients find that a little whisky or brandy suits them best; others find a light still Moselle preferable; a few, but in my opinion only a very limited number, find a light claret agrees best with them. Champagne is a wine which is seldom suited to the gouty, especially if taken daily. In elderly people, or in the feeble, a moderate amount of pure whisky undoubtedly does good; but the indiscriminate ordering of whisky to gouty subjects is, I am sure, wrong.
It is well known that certain alcoholic drinks injuriously affect the gouty process, whilst others exert a less injurious influence. Alcoholic drinks which have been obtained by fermentation, but which have not been submitted to distillation, such as wines and beers, appear to exercise a more harmful influence than if the same amount of alcohol be consumed in the form of one of the distilled spirits, such as whisky, brandy, etc. Sir Alfred Garrod considers that the reason for the prevalence of gout in the south of England and its rarity in Scotland is chiefly to be found in the difference between the beverages drunk in the two countries.
Distilled spirits contain little or no acid, whilst wines and beers are distinctly acid; and to the acids contained in these drinks many physicians have attributed, and still do attribute, their gout-producing properties. The acids present are tartaric, succinic, malic, acetic, formic, propionic, butyric and cenanthic. The acidity of "wines is mainly due to tartaric, malic, and succinic acids. The amount of free acid in sound wine, reckoned as tartaric acid, varies between 0.3 and 0.7 per cent. I found the acidity of some 1847 port, reckoned as tartaric acid, to be 0.6 per cent. Cider owes its acidity mainly to malic acid. Its total acidity is usually 0.1 per cent. If we arrange the various wines in (a) their order of acidity and (b) the order of their gout-inducing power, we find that the most acid wines are not those which most predispose to gout. The arrangement of wines and beers in the order of acidity, beginning with the most acid, is that given by Bence Jones, while the arrangement in order of their gout-inducing power is that given by Sir Alfred Garrod.
Hock, Moselle and the weaker kinds of ales have comparatively little gout-inducing power.
The acidity of alcoholic liquors cannot have much influence in determining an attack of gout, as port, sherry and malt liquors, which are the most powerful predisposing agents, are amongst the least acid, whilst the more acid wines are comparatively harmless in this respect; moreover, it must be remembered that the organic acids and their salts contained in wines are converted in the body into alkaline compounds, and are excreted in the urine as such.
Wines and Beers arranged in Order of Acidity and Gout-inducing Power.
Other stronger wines.
Stout and porter.
Weaker kinds of ales.