GOUT AND NEPHRITIS 175 



of the disease, we may probably regard as one of the most 

 important advances in our appreciation of the patholo- 

 genesis of this anomaly of metabolism the recognition that 

 conversion of nucleins is slow in the course of gout. 



The fact that the gouty individual after ingestion of 

 purin-containing food shows a delayed excretion of uric acid 

 has been proved by a number of investigations ; 7 he does not, 

 as a normal person, throw off his excess of uric acid in a short 

 time, but ' i spreads out ' ' the excretion over a number of days. 

 This feature is sufficiently characteristic to have come into 

 employment in diagnosis of gouty affections, the uric acid 

 excretion- curve being kept under observation after addition 

 of a given quantity of nucleinic acid to the food. 8 



Gout and Nephritis. This has suggested the thought that 

 the cause of this uric acid stagnation may reside in the kid- 

 neys; the frequent coincidence of nephritis (particularly 

 contracted kidneys) and gout was emphasized, and the point 

 made that both alcoholism and lead poisoning may play an 

 important part in the etiology of both affections. C. v. Noor- 

 den in his valuable monograph upon gout 9 very properly 

 says that it is not right to do violence to the facts by assum- 

 ing in a case which presents no other evidence of nephritis a 

 "latent nephritis " to explain the gouty uric acid stagnation. 

 When one remembers the fact that usually the kidneys of a 

 case of Bright 's disease perform effectually the uric acid 

 excretion required of them, it is clearly evident that in sup- 

 posing that the nephritis causes the gout there has been a 

 confusion of cause and effect; actually the reverse is some- 

 times the truth. 



7 Vogt, Reach, Soetbeer, Kaufmann and Mohr, L. Pollak, Brugsch, Hirsch- 

 stein, Lesser, Bloch, Schittenhelm, Rotky and others. For Literature, consult 

 Umber, 1. c., p. 271; A. Schittenhelm, Handb. d. Biochem., 4', pp. 531, 532, 1910. 



8 H. v. Hosslin and K. Kato (Med. Clinic, Halle), Deutsche Arch. f. klin. 

 Med., 99, 301, 1910. 



C. v. Noorden, Handb. d. Pathol. d. Stoffwechsels, 2d ed., 2, pp. 164, 165, 

 1907. 



