FORMATION OF URIC ACID 171 



covered over with glistening crystals) has given place to 

 more modern methods. Yet the more recent investigators, 

 as Klemperer, Magnus-Levy and Brugsch, have confirmed 

 his original statement that uric acid is usually increased in 

 the blood of the gouty. This holds good in a remarkable 

 manner, according to Brugsch and Schittenhelm, 2 for the 

 gouty even on purin-f ree diet ; from which therefore it may 

 be inferred that the accumulation of the acid in the blood 

 results from an abnormality in the usual course of the 

 endogenous purins originating in tissue destruction, inde- 

 pendently of the dietary purin exchange. 



It was, however, early recognized that the increase of uric 

 acid in the blood could not by any means be held fully ex- 

 planatory of gout as an entity of disease, precisely anal- 

 ogous increments being met in other conditions entirely 

 different from gout. After exhibition of food rich in 

 nucleins (as thymus) an alimentary uriccemia has been ob- 

 served; there is a uriccemia of endogenous source in 

 leukaemia, and, too, in pneumonia, at the time when with the 

 exudate cellular constituents are being massively resorbed. 

 In addition, a retention uriccemia is recognized in conditions 

 of functional renal disturbance, as in chronic affections of 

 the kidneys of all types and their sequel, uraemia. 3 



It is to be presumed, therefore, that the increase of uric 

 acid in the blood of gouty patients is to be ascribed either to 

 an increased entrance or a diminished escape of the material. 



Question of Increase in the Formation of Uric Acid. 

 For a long time the first of these possibilities was the 

 dominating one in discussions of the problem. Many agreed 

 that the fundamental point in the disease is to be looked for 

 in an increase in the destruction of the tissue nucleins. As a 

 matter of fact, however, there was absolutely no basis for 



1 Th. Brugsch and A. Schittenhelm, Zeitschr. f . exper. Ther., 4, 438, 1907 ; 

 B. Bloch (Med. Clinic, Basel), Zeitschr. f. physiol. Chem., 51, 472, 1907; Th. 

 Brugsch (F. Kraus' Clinic), Berlin klin. Wochenschr., 1912, No, 34. 



Literature upon the Various Forms of Uricaemia: A. Schittenhelm, 

 Handb. d. Biochem., 4', 529-540, 1910. 



