APPENDIX. Influence of Cider on the production of Gout. At page 257 it is stated that Cider and similar beverages act to some extent as predisposing causes of gout, although probably a much larger quantity of them is required than of the stronger kinds of malt liquors. I have been recently favoured by Mr. Alfred Haviland, a gentleman practising at Bridgewater, with an account of his experience on this subject, and Dr. Wood, of Philadelphia, has also kindly given me his opinion upon the same. Mr. Haviland acknowledges that there are doubtless many cases of gout in the cider districts, although he has been unable, during a long experience, to establish the fact of a single case having been really due to the drinking of cider; he states that, on looking over the books of the Bridgewater Dispensary, he did not find an entry of a single gouty patient during a period of 30 years, and that a personal experience of four years at the same institution has given the same negative result; and again, during 15 years at another dispensary, where the average number of patients is about 250-nearly all agricultural labourers, with their wives and children-there were only three cases of pure gout, and these occurred in beer drinkers. In fact, he says, if the gouty subjects in his neighbourhood, as a rule, are beer drinkers, they at least take mixtures of different liquors :— Formerly there was scarcely a publican in the town but who had suffered from gout. Mr. Haviland believes cider to be a diuretic, but that beer is not so. The odour of genuine cider is soon apparent in the urine. Mr. H. has found the urine less acid after cider than after beer or water. He has not met with any cases of colic from drinking cider, nor has he discovered the presence of any lead in it. He divides cider into labour and luxury cider. The latter may or may not be true cider; if true, much of the saccharine matter is in an unfermented state. Mr. Haviland thinks that sweet cider may produce gout, but he asserts that real cider drinkers never drink sweet cider, as it is very apt to derange the digestive organs. Calculus and gravel are rare in the cider districts and almost unknown in the infirmary. Good sound cider is of low specific gravity, and contains scarcely a trace of sugar. Sweet or imperfectly formed cider has sometimes a sp. gr. 1013, but when cider is well matured its sp. gr. is as low as 998, water being represented by 1000. The following letter, referring to the influence of cider and other alcoholic beverages on gout, I have received from Dr. Wood, of Philadelphia : MY DEAR DR. Garrod, Aug. 11th, 1862. In compliance with your request, that I would furnish you with the result of my observations on the effect of the different kinds of alcoholic drink in producing gout, I have great pleasure in stating the little that I know on the subject. The stronger wines, such as sherry, Madeira, and port, have appeared to me to be the most prolific source of the disease. Since the lighter wines have come into more general use among us, there has, I think, been a decided diminution of gout, at least in its acute and more inflammatory form; but as there have been other agencies, which have contributed to the same result, I am unprepared to say how far it is attributable to this substitution, though I think it has not been without effect. I am quite certain that I have seen the disease result from the excessive use of malt liquor, and quite as certain that I have never known it to be caused by cider, though I am familiar with a considerable population who have long been in the habitual use of this beverage. In the United States, the different forms of ardent spirits have been largely consumed by the poorer classes, especially whiskey and rum. As a result of this, I have constantly seen in hospital practice much visceral disease of various kinds, and not a few cases of delirium tremens, but to the best of my recollection, gout in not a single instance. In making the above statement I have, as you perceive, confined myself to simple facts, without any attempt at explanation. Sincerely your friend, GEO. B. WOOD. Dr. A. B. Garrod. Influence of Lead on the production of Gout. Since the publication of the first edition of this work, Dr. R. W. Falconer, of Bath, has kindly reminded me, that his grandfather, the late Dr. William Falconer, in 1772, and previously to that time Drs. Musgrave and Huxham had noticed that some relation existed between lead poisoning and gout. Dr. W. Falconer, in his Essay on the Bath Waters, published in 1772, makes the following remarks :"The Bath waters are likewise of the utmost service in the gouty complaints that sometimes follow the colic of Poictiers, which have been observed and described by Dr. Musgrave, ୧୧ : and since his time by Dr. Huxham." Dr. Falconer has also pointed out other passages in works which bear strongly on this subject for example, in the unpublished writings of Dr. Caleb H. Parry, published in 1825, the following passage, dated 1807, occurs :- "Gout from Lead.-I observe that, after the palsy from lead, patients of a middle age, otherwise previously healthy, are very subject to fits of gout in the limbs. Mr. C., among others, had gout in his foot, and was somewhat relieved by it. These facts prove that lead has the power of producing undue arterial plethora, &c." In Dr. Edward Barlow's Essay on the Bath Waters, published in 1822, three cases are mentioned of gout following 66 palsy of hands from poison of lead." Dr. R. W. Falconer has himself, in the British Medical Journal, Nov. 2, 1861, related a case of saturnine poisoning, followed by gout, and in his letter makes the following remark :-"We have at times a large number of cases of lead poisoning at the Mineral Water Hospital, and some of them have been known, after their recovery, to suffer from gout, but, as far as I can ascertain, they quit the hospital so thoroughly relieved, that unless they are again exposed to the poison, they remain free from any sequela of it." TABLE OF ANALYSES OF THE DIFFERENT SPRINGS AT VICHY AND THE NEIGHBOURHOOD. Contents of a litre of water from each source, the weights expressed in grammes. (Referred to in Chapter XIII.) VICHY. Puits de Grande Puits Lucas. Hôpital. Celestins. des Celestins. Puits du Parc. Puits 2.183 1.908 |