Alcoholic beverages do not exert any appreciable influence upon the development of the gouty diathesis unless taken in the form of wine or malt liquors. Sir William Roberts has shown that the addi tion of alcohol to the liquid in which sodium bi-urate is held is with out effect upon the solubility of the salt, or influence of any kind in the way of accelerating or retarding its precipitation. It is, more over, a matter of common observation that distilled spirits are con sumed in large quantities by whole races of men who never become gouty.
But the consumption of wine and malt liquors, if conjoined with abundant nitrogenous aliment, does seem to favor the occurrence of arthritic disorders. Now, these beverages differ from spirits chiefly in the fact that they contain various saccharine substances, acids, and a certain amount of ether due to the action of acid the alcohol that they contain. Beer contains acids in a comparatively small quantity, but, when consumed in the enormous draughts that are common among the votaries of Gambrinus, the amount of acid that is introduced into the body may be very considerable. In this way the accumulation of urates and other nitrogenous refuse is aided. The ethers, also, which give odor and flavor to wines are not without influence upon the processes of oxidation in the tissues to which they are carried. According to Bence Jones, the various wines in common use may be ranked in the order of their acidity, beginning with the lowest : Sherry, port, champagne, claret, madeira, burgundy, Rhine wine and Moselle. Haig declares as the result of his analysis that " Champagne is about the most acid of wines, and the cheaper beers are generally more acid than those of better quality. I found acidity equivalent to 18 grs. of oxalic acid in a pint of 4c1. ale, and 25 grs. in a pint of stout. Sherry, 37 grs. in a pint. Port about the same. Claret, 46 grs. to the pint, and champagne, 49 grs. to the pint." Ac cording to Sir A. Garrod: " The least acid Of all alcoholic fluids are Geneva and whiskey." Haig is however quite positive that the ordinary use of alcoholic beverages is innocuous as regards the development of gout, provided that the blood and the tissues be kept clear of nitrogenous refuse through the adoption of a properly regulated diet. In all cases such
drinks should be largely diluted with water. Sydeuham counselled such dilution of the strong ales affected by his countrymen. The French also always practise a similar attenuation of their light wines. The famous Erasmus appears in his letters to have thought differently of the matter, and he died miserably of gout and stone in the bladder.
The non-alcoholic beverages, tea, coffee, and chocolate, are toler ated with difficulty by the arthritic constitution. Many patients suf fer severely with migraine so long as they indulge in the use of these drinks with their meals. This is due in part to the caffeine—a nitrog enous substance—winch they introduce into the tissues, and in part, as Haig has shown. by experiment, to the accumulation under their influence of urates and other nitrogenous matters in the body. Oaf feine is said to retard the processes of metabolism, hence its unfavor able influence in all cases where metabolism needs acceleration.
We are thus brought back to the beverages of childhood—milk and water—as the only liquids that are fitted for the harmless irriga tion of the tissues. Especially true is this when the organization of those tissues is modified or in danger of modification through the influence of hereditary causes or acquired habits of excess in the matter of eating and drinking.
By a careful modification of the diet upon the principles that have been thus indicated, it is possible to reduce very considerably the nitrogenous refuse of the body. Haig ascertained, as a result of repeated observations, that while on ordinary food his daily excretion of urea was from five hundred to six hundred grains per diem, it was reduced to about three hundred and fifty grains after the adoption of a restricted diet. Finding also that under all circumstances the pro duction of uric acid bears to urea the ratio of 1: 33 or 1: 35 there must be a corresponding reduction of the less oxidized compounds of nitrogen. There will therefore be less opportunity for the accumu lation of those substances in the tissues and less chance of the con sequent occurrence of nitrogenous poisoning.