The question is - To what constituent or constituents of wines and beers are their gout-inducing properties due? They are not due to the alcohol alone, for in countries such as Scotland, Norway, Sweden, and Poland, where distilled spirits are, or were, freely consumed, gout is almost unknown. Moreover, several experiments that I have made indicate that alcohol, in such quantities as are ever likely to be present in the blood, has no effect either upon the conversion of sodium quadriurate into biurate or on the solubility of the latter. The gout-inducing properties are most probably not due to the acids of the wines and beers, for the reasons which have already been given. It is also very doubtful whether the sugar present in wines is per se harmful; but as a rule the sweet wines are fortified wines, while the natural wines are generally dry. It is very probable that the sweet fortified wines are prone to produce fermentative and catarrhal changes in the gastro-intestinal tract, and are on that account harmful to the gouty.
The gout-inducing properties are certainly not directly due to the cenanthic ether and other ethereal salts of wines exerting any effect either on the rate of decomposition of the sodium quadriurate or on the solubility of the biurate. To demonstrate these points, I have extracted from old port wines the ethereal salts to which the bouquet of the wines is due, and have experimented with these ethereal compounds on the quadriurates and biurates. Using quantities far in excess of those likely to be present in the blood after the moderate, or even immoderate, consumption of such wine, I find that none of these volatile constituents exercise the slightest effect either in hastening the decomposition of the sodium quadriurate or in diminishing the solubility or hastening the precipitation of sodium biurate. As to the modus operandi of certain wines, such as port, etc., in hastening an attack of gout, I incline to the opinion that the influence of wines on the development of gout is in great part due to the effect they exercise in producing fermentative and catarrhal changes in the gastro-intestinal tract, and in also injuriously affecting hepatic metabolism. At the same time, it must be remembered that those accustomed to drink wine are also able to indulge in other luxuries of the table which greatly favour the development of gout.
As Woods Hutchinson has pointed out, the experiments of Boix appear to have shown that, in the case of alcohol, it is not the direct toxic effect of the drug, so much as the catarrhal and other irritative changes set up by it in the intestines which produce the poisonous products that are carried to the liver and cause irritation and degeneration of that organ. In other words, unless alcohol is taken in sufficient amounts to disturb gastric and intestinal digestion, it will not produce the hob-nail liver.
It must also be borne in mind that the rapidly fermentable fruit and malt sugars, the esters, and the higher alcohols, which are present in wines and beers, are more closely concerned with fermentative changes in the stomach and intestines than is the alcohol itself.
Port is a wine which is especially unsuited to the majority of gouty subjects. The gout-inducing properties of the wine are, I believe, mainly dependent upon the ethereal compounds which give the aroma or bouquet to the wine, although these bodies do not act directly on either the quadriurate or biurate of sodium. If this view is correct it would explain the well-known fact that old and matured ports are much more provocative of gout than comparatively new ports taken direct from the wood. The development of the ethereal compounds in the wine extends over many years, and especially progresses after the wine is laid by in bottles. In a few cases of asthenic gout, especially in old people, a moderate amount of comparatively new port taken direct from the wood undoubtedly does good.
In my opinion the wines which are least injurious as a rule to gouty subjects to whom it is found necessary to order a small amount of wine are the light still white wines, such as Moselle, certain French wines, certain Austrian wines, hock, and a few of the lighter Australian and Californian wines. These last, owing to their greater alcoholic strength should be taken diluted with water or some mineral water.
Gouty subjects suffering from glycosuria or diabetes should entirely abstain from alcoholic drinks, unless marked debility and loss of appetite necessitates the restricted administration of them. Gouty persons subject to attacks of eczema are also much better without alcohol in any form, and certainly entire abstention from alcohol is most desirable during the treatment and persistence of the eczema. It is best that any form of alcohol should be abstained from, but the prohibition applies more especially, in my experience, to the red wines. I have met with several cases occurring among gouty individuals past the middle age of life in whom two or three glasses of claret or Burgundy • will in the course of a few hours cause the development of an eczema.
"Rough" cider, that is the completely fermented apple-juice, taken in moderation, agrees well with most gouty subjects. It contains but a small percentage of alcohol, is free from sugar, and its acidity is chiefly due to malic acid, which passes into the circulation in the form of alkaline malates, which in their turn are converted in the kidneys into alkaline carbonates and excreted as such, thereby increasing the elimination of urates. The bottled or " champagne " cider, which is imperfectly fermented, should never be used by gouty individuals, owing to its undoubted liability to set up gastro-intestinal fermentations. Dry or "rough" cider mixed with an equal quantity of an aerated water is an excellent beverage for the gouty. Dry perry is also a suitable drink for the subjects of gout.