Pharmacology 197 



Gout, which was still called a forgotten disease in 191()/''^ has re- 

 gained nnich medical attention. New methods of treatment and 

 neA\- methods of study have brought this change. Also, the frequency 

 of cases of gout ma\ liaAC increased in some coimtries. The principal 

 and painful lesion that affects the joints of gouty patients results 

 from dcjiosits of uric acid. This chemical was believed to be mainly 

 related to nucleoprotein metabolism. Studies ^\■ith radioactive uric 

 acid, marked with N^^ have helped to understand the origin of the 

 so-called "miscible pool" of uric acid, which is considerably increased 

 in some cases of gout. This has been demonstrated to originate from 

 many pathways of metabolism. All proteins, carbon dioxide, anmionia, 

 glycine, serine, and carbohydrates may be used as building blocks 

 for uric acid. Methods for studying the changes of the "miscible pool" 

 of uric acid have been developed.-''- -■'■ '^- 



This has been mainly the consequence of the discovery that 

 steroid hormones like cortisone,'' and the adrenotropic hormone of 

 the jMtuitary (ACTH) may play an important part in gout and may 

 possibly be used for its treatment.-^, ^s. 29 Now, the nonspecific toxic 

 reactions of colchicine poisonings have been described. These would 

 result in an increased secretion of ACTH and cortisone.'"'-'- ■''^ Could 

 colchicine possibly act in a nonsjjecific way in this disease? 



The considerable amount of work, mainly clinical, which has 

 been published these last years on this subject can only be rapidly 

 reviewed here.-^^- •*-^- ^'•- *'''• ^*' '^^- '"' Current practice of handling gouty 

 patients with colchicine has recently been summarized.-^ 



The doses which elicit in animals the alarm-reaction and ACTH 

 secretion are far larger than those effective in human therapeutics. The 

 Thorn test of adrenal stimulation demostrates effectivel) that in 

 patients with diseases other than gout, therapeutic doses of colchicine 

 do not stimulate the pituitary and the adrenal. The urinary elimi- 

 nation of 17-cetosteroids is not modified either.^''- ^•' A positive 1 horn 

 test is demonstrated by a rapid fall in the numbers of eosinophil 

 leukocytes in the blood. In one case only was this positive, the eosino- 

 phils falling to 53/cmm. and later rising to the normal number of 

 269. This, however, was in a man Avho had taken 24 mg. of colchicine 

 in 24 hours, that is to say more than six times the usual dose. 



On the other hand, while ACTH and cortisone may be effective in 

 the treatment of gout, they have by no means taken the place of col- 

 chicine. This is now used either at the same time or after the injections 

 of hormones, and it is recognized that its action is unrelated to the 

 alarm-reaction, and to ])ut it shortly, "entirch unknown." -•'' 



Some workers believe that the acute crisis of gout, the origin of 

 which is by no means clear, is related to allergy. Colchicine has been 

 found to decrease the intensity of the anaphylactic shock in guinea 

 pigs injected with ovalbuniine.' In j)atients suffering from diverse types 



