I am no foe of alcohol, and I consider the use of moderate quantities of alcoholic beverages not only permitted, but often even useful. In patients, however, that have a tendency to uric acid retention (gout) and to an increased production of uric acid alcohol in any form or quantity is an evil. It can be demonstrated in most cases that alcohol retards the elimination of uric acid. If the individual is placed upon a perfectly constant diet, so that the values for the uric acid excretion reach a definite and constant level, then it will be found that the use of alcohol invariably produces a reduction in the uric acid excretion. This has been tried with 25 g. of alcohol a day, certainly not an ex cessive quantity. In a healthy individual this preliminary retention of uric acid is followed by a compensatory increase in the uric acid excretion, and occasionally even a higher level of the urinary uric acid excretion is reached and maintained for a considerable time, indicating that the production of uric acid has been increased.

This increase, however, amounts to only a few centigrammes a day, a minimal amount as compared to the increase in the uric acid production that 100 g. of meat added to the diet can produce. A healthy individual, in other words, need not fear an increase of this kind, for the organism can without difficulty get rid of much greater quantities of uric acid. A gouty individual, however, is seriously affected even by this minimal increase, particularly when it is combined with retention of uric acid induced by the same cause. The same applies to nephrolithiasis, a disease in which we should also carefully avoid everything that can increase the production of uric acid. It remains undetermined whether the kind of alcoholic liquor that is taken makes much difference, careful investigations in regard to this point still being lacking. Clinical experience seems to show that the use of strong spirituous liquors or of heavy wines (Port, Sherry, etc.) and of beer are most detrimental. Light white wines (Mosel and light Rhine wines, on the other hand, that recently have unjustly been much neglected), on the other hand, seem to be much less harmful. Comparative studies in this field are urgently needed.

In this place it is important to mention that according to the investigations of Bloch and Poliak, that have been corroborated in my clinic, chronic drinkers occasionally develop a retardation of the exogenous uric acid elimination similar to that seen in patients with genuine arthritis urica. It is true that here the same degree of retardation is not found, also that this phenomenon is limited to individuals who are excessive users of alcohol. This point must always be considered in utilizing the purin tolerance for diagnostic purposes (see above). The abuse of alcohol no doubt plays a most important rôle in the etiology of gout, although frequently it is more the alcoholism of preceding generations than of the patient himself that is to blame. It is undecided whether or not in such alcoholics, who show a retardation of the uric acid elimination, there is not present as a complica tion the specific perversion of the metabolism that is always found in gout, even though visible manifestations of gout had not yet become apparent (masked gout). Compare above.

Patients with gout and nephrolithiasis should be urgently advised to use alcohol-free fruit juices as a table beverage in place of wine; the former can be made from grapes, or from apples, raspberries, currants, etc. This recalls the well-known and ever highly prized grape cure for gout. These beverages grant the patient a drink that is very nourishing and completely purin-free.