Tea, Coffee, Etc

Tea and coffee are admissible among beverages for the gouty, and it will be found that they are less likely to cause dyspepsia if taken quite weak without sugar. A quarter of a grain of saccharin may be added instead. Senator forbids tea and coffee, and prescribes "acorn coffee." Infusion of cocoa nibs is less to be recommended on account of the excessive fat which it holds. Esbach states that he has found oxalic acid in it also, amounting sometimes to 0.4 per cent. Chocolate is forbidden.

Patients who are still able to lead active outdoor lives may drink more alcohol than those of sedentary habits, without aggravating their symptoms. In general the quantity consumed is as important as the quality, and it should be definitely prescribed and kept within bounds.

Alcoholic Drinks

With regard to the use of alcoholic beverages it is their acid and saccharine ingredients rather than the alcohol itself which disagree. Strong liquors, diluted, may not be injurious, but nothing is worse than rich sweet wines and malt liquors.

It is, however, true that alcohol in all forms lessens the elimination of tissue waste, and decreases the volume of urea and uric acid excreted. According to Pfeiffer, both beer and wine may lessen this volume by one half; on the following day it is increased, and subsequently diminished again. The longer wines have been fermented, or the more complete the conversion of the sugar to alcohol, the less hurtful they become to the gouty.

While free perspiration exists in warm weather, and free diuresis as well, alcoholic drinks of all kinds are less harmful. Whatever form of alcohol is taken, it should be drunk to the exclusion of all others, for mixtures are particularly bad. 44

Strong beer, ales, porter, stout, all malt extracts, and sweet cider must be absolutely prohibited. Sir Henry Thompson and Germain See regard cider as beneficial as a solvent of uric acid, but by others it is looked upon as injurious on account of the malate of potassium which it contains, and which it is claimed favours the formation of uric acid (Yeo). Undoubtedly the alcoholic drinks which are best tolerated by the gouty are good French Cognac or old Scotch whisky, well diluted with water, Apollinaris, or soda water. Scotch whisky is by many found to agree better than any other variety. Weak brandy and soda may be substituted, or unsweetened Plymouth gin. It is the part of wisdom to abstain entirely from alcohol. Very many persons are so habituated to its use that they are unwilling to abandon it, and a compromise must be effected. It is easier for them to give up certain foods than drink. There are some wines which should be absolutely prohibited, among them all which are re-enforced by, or which contain, a large proportion of saccharine material.

Strong port, sherry, champagne, Madeira, Canary, claret, and Burgundy are comprised in this list.

Port wine has even acquired the reputation of being a primary factor in producing gout, when a hereditary diathesis does not exist. It is an incompletely fermented wine to which alcohol has been added for preservation, and all wines of this class are the worst forms of alcohol for the gouty. Garrod says that exceptionally a sound sherry, Amontillado or Manzanilla, may be prescribed. There are patients, too, who maintain that they do better with port as a daily beverage than with any other form of wine, but their example would be a very unsafe one to follow, and their experience is due to constitutional idiosyncrasy.

Duckworth says: "Rhenish wines are acid and harmful; those of the Moselle district are, however, less acid, and rather better borne. Australian, Californian, Hungarian, Greek, and other Mediterranean wines are too strong, and after a time generally disagree".

An absolutely dry champagne may sometimes be permitted, or very dilute and weak pure claret. The stronger clarets containing more tannin, and all wines with much free acid, are injurious. Among the light wines, several may be permitted in moderation, but they should be diluted with an alkaline water in order to completely neutralise any acidity.

Such wines should be either long bottled or drunk from the cask, for newly bottled wines are more injurious.

The best Bordeaux and lightest Hungarian wines, light hock and a still Moselle, such as Zeltinger, may be drunk, for these wines are quite thoroughly fermented, and therefore contain no sugar or free acid, though they have salts, such as cream of tartar. These wines should only be allowed in extreme moderation, not over half a pint in a day.

Yeo says: "The more distinguished the diuretic effect of the wine, the better, as a rule, will it agree with the gouty".

Ralfe's practice is to allow no wine of any sort with dinner, but afterwards two claret-glassfuls of some light wine are permitted; and he says that a tablespoonful of brandy in half a tumblerful of water before meals increases the secretion of gastric juice. If the patient is weak, or suffers from insomnia, he gives brandy or whisky at bedtime in some effervescing water.

He states that in his experience patients who have been long habituated to the daily use of port, sherry, or ale, often become worse when a sudden change is made to claret or hock. In such cases he advises changing gradually by substituting at first a drier port or sherry.

Usually such red wines as St. Julien and St. Estephe are preferable to the higher class, such as Lafitte or La Rose.

Different persons show peculiar idiosyncrasies in regard to the gout-producing influence of certain wines. Some will always have gouty inflammation set up within a few hours in a particular joint by one form of liquor or wine and not by others.