216 CONJUGATED ACIDS. 



have been applied. Large masses of secreted urate of soda are 

 found in no disease, except in the true granular liver, which ob- 

 viously can never exist without considerable disturbance of the 

 circulation. In fever also, the due relation between respiration 

 and circulation is no longer maintained, and hence there is an 

 augmentation of the uric acid in the urine ; for none but mere 

 chemists could be led to the erroneous idea, that in fever too 

 much oxygen is conveyed to the blood in short that fever is at- 

 tended by too rapid a process of oxidation. Becquerel's extended 

 observations on urine in diseases, may be profitably compared with 

 the above results of my own experience. 



Bird* and many others maintain that in gout there is an in- 

 creased secretion of uric acid ; my own experience, however, per- 

 fectly confirms that of Garrod,f who found that there was a con- 

 stant and well-marked diminution of the uric acid in the urine 

 before the paroxysm in acute gout, and always in chronic gout, 

 (a term which applies only to those cases in which the disease is 

 accompanied by depositions in the joints ;) while, on the other 

 hand, in rheumatism, especially in acute articular rheumatism, the 

 amount of uric acid in the urine is very much increased a point 

 in which all observers coincide. 



It is extremely seldom that free uric acid is found in freshly 

 discharged urine, and its presence there may generally be regarded 

 as a sign of some extremely severe morbid process. 



I have never been able to find separated crystals of uric acid in 

 urine immediately after its emission, although they may often be 

 found when it has stood for an hour or more. In the great majority 

 of cases the uric acid is formed from the urate of soda after the 

 exposure of the urine to the atmosphere, by the process of acid 

 urinary fermentation which has been so carefully studied by 

 J. Scherer.J 



Healthy and febrile urine only differ in this point, that the one 

 contains additional elements by which the formation of lactic acid 

 is excited and promoted. We shall return on a future occasion 

 to this beautiful investigation of Scherer's. I have never seen free 

 uric acid discharged directly from the bladder with the urine except 

 in cases of the calculous diathesis or of pre-existing gravel. 



Even in alkaline urine it is very seldom that urate of ammonia 

 occurs as a sediment ; in these cases it is found in white opaque 



* Urinary Deposits, 3rd. edit., p. 134. 

 t Medico-Chin Trans. Vol. 31, p. 86. 

 $ Untersuch. S. 1-17. 



