To the confirmed gouty subject the question of what he may drink is sometimes a more important one than that of what he may eat. Alongside of this question there is another bearing on the time - relationship to meals - at which various liquids should or should not be taken. Thus, it is as a general rule advisable to recommend alcoholic stimulants only to be taken with meals; in other cases the consumption of fluids, of a non-alcoholic nature, may be wisely restricted mainly to the intervals between meals. Fluids may act prejudicially in two ways. In the first place, they may act injuriously in a mechanical way, i.e., by clogging the food elements,and at the same time diluting the digestive fluids, favour abnormal decomposition of the proteins and also carbohydrates. And, secondly, they may, in virtue of a specific action, lead to faulty nitrogenous metabolism in the digestive tract, and secondarily, in the tissues.

Like the question of diet, it is impossible to lay down definite rules applicable to the disease. Everything depends on the age of the patient, his constitution, his previous history as to consumption of fluids of different kinds, the nature of the symptoms, and the reaction of the tissues to various fluids. Specially is this so with the use of alcoholic stimulants. While there is no doubt that the subjects of inherited gouty tendencies are better without any form of liquor, this is frequently not so in the case of the patients more or less habituated to the use of stimulants. In judging of the suitability of the various liquors, we must have regard to the usual methods of preparation of the individual beverages, e.g., beer, claret, champagne, etc., and to their common defects as recognised by experts in the trade (see p. 147). With regard to alcoholic beverages, points already referred to are of supreme importance. The decision as to what any given subject can take, may only be arrived at after a careful study of the history, diet, and state of muscular activity in each case. There is no doubt that malt liquors and sweet wines are much more injurious than other liquors.

The sweet wines include champagne, Madeira, port, sherry, Malmsey, and Tokay; also porter, ale, and cider. Burgundy, Bordeaux, Rhine, and Moselle are almost void of sugar, and are therefore more suitable. The greater acidity of Burgundy and the Rhenish wines makes them, on the whole, less suitable than claret and Moselle wine.

German beer, e.g. lager, can frequently be taken with impunity when even one glass of the British beers will induce some acute disturbance.

The free consumption of water can be safely recommended to many, but not to all gouty subjects. In the case of stout adult plethoric subjects it may be advisable to restrict its use to early morning and late evening. The water is, as a rule, best taken on an empty stomach. With regard to tea, coffee, and cocoa, when suitably prepared these beverages may be partaken in moderate amount, but idiosyncrasies in their use are very often encountered. To some, cocoa is specially injurious, to others the daily consumption of coffee is soon followed by digestive and other disturbances, and in these cases special restrictions are called for. The amount of sugar allowed should be small. All sweet beverages should be restricted or cut off, more especially if they be in addition aerated.

The administration of the alkaline and mineral waters is so closely related to the question of food and drink that special attention may be directed to it.

Mineral Waters

The various waters in common use are recommended for one of the following reasons: i. A purely purgative action, ii. A diuretic action, iii. A diuretic and medicinal action.

Of The Purgative Waters

Franz Joseph is one of the most palatable, and its action is mild. Apenta, a bitter and faintly sulphurated water, is also mild, and much favoured. Hunyadi Janos, Aesculap, Friedrichshall, and Carlsbad are all bitter aperients, with a more powerful action, but are all suitable for occasional use. A teaspoonful each of sulphate of magnesia and sodium phosphate in half a tumbler of water may also be commended The action of these waters is hastened by admixture with hot water, and they should be taken the first thing in the morning. The continual daily use of any mineral water or saline purgative is not, however, desirable.

Of The Diuretic Waters

Some are palatable, and are taken as table waters; others are specially suited for a short course of home treatment, and should be taken thrice daily on an empty stomach for a period of two or three weeks. The table-waters, which are aerated, include Apollinaris, Brires-born, Johannis, Seltzer, St Galmier, and Salutaris, which is a distilled water of English manufacture. The other group is represented by Contrexeville, a mild water containing sulphate of lime and magnesia, and Vichy water (bicarbonate of soda the main saline), of which there are several varieties. Celestins is the best known, but the Grand-Grille and Hauterive may also be employed with benefit. Sulis water from the springs at Hath is also useful.

Diuretic And Medicinal Action

Occasionally the presence of anemia, rheumatism, or some pelvic disorder suggests the use of other waters. Thus Levico (arsenic and iron) is useful in anemia So also is Schwalbach (Weissenbrunn preferred) and La Bourbule, the former being especially useful in rheumatic cases. Kissingen, a saline gaseous aperient water, is valuable in various uterine and other pelvic disorders in gouty subjects.

The foregoing only represents a few of the mineral waters available; artificial representations of many of these and other waters are prepared in this country and sold in tabloid form.