CHAPTEE VIII 

 PATHOLOGY OF PURIN METABOLISM 



HAVING attempted in the previous lecture to orient our- 

 selves in relation to the present status of the theory of nor- 

 mal purin metabolism, we may at once proceed to picture to 

 ourselves the nature of gout as it is viewed to-day. Quite 

 naturally the author prefers to limit the present discussion 

 to the basic physiological chemical problems, and would 

 therefore refer to the recent monographs on the subject for 

 the various details, particularly those involving the clinical 

 symptoms, the pathological anatomy and questions as to the 

 therapy concerned in this affection. 1 



Increase of Uric Acid in the Blood of the Gouty. 

 The views held as to the nature of this puzzling anomaly 

 of metabolism are so changing that it is by no means easy for 

 the biological chemist to find a fixed point in the flood of 

 phenomena. Perhaps such a point of inception may be rec- 

 ognized in the increase of uric acid in the blood in gouty 

 subjects. It is true that even at the present day there are 

 earnest persons who doubt whether uric acid, the local 

 depositions of which characterize the morphological picture 

 of the disease, is to be looked upon as the actual materia 

 peccans of gout, and whether it does not play merely a col- 

 lateral and secondary part. But, for at least a half century, 

 the fact pointed out by Garrod in 1848 that the blood of gouty 

 individuals is at times richer in uric acid than that of normal 

 persons has maintained its position. Garrod 's primitive 

 experiment (he demonstrated by his "thread test" that 

 threads laid in blood serum to which an acid was added 

 would, from the crystallization of uric acid, after a time be 



1 H. Wiener, Ergebn. d. Physiol., 2, 377-432, 1903 ; O. Minkowski, Die Gicht, 

 Vienna, 1903 (in Nothnagel's Handb. d. spez. Pathol.) ; W. Ebstein, Die Natur 

 u. Behandl. d. Gicht, 2d ed., 1906; C. v. Noorden, Handb. d. Pathol. d. Stoff- 

 wechsel, 2d ed., 2, 138-188, 1907; F. Umber, Lehr. d. Ernahr. u. d. Stoffwech- 

 selkr., pp. 262-340, 1909; A. Schittenhelm, Handb. d. Biochem., 4' 529-535, 

 1910. 



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