AFFINITY OF TISSUES FOR URIC ACID 177 



acid is the real reason for the diminished urinary excre- 

 tion of purins, for the retention of uric acid in the blood, 

 lymph and tissues (which may lead to gross uratic deposits 

 in the body), and for the gouty exacerbation after a purin- 

 containing diet. "To attempt to refer the entire complex 

 of gout completely to faults in the catabolism of nucleinic 

 acid due to insufficiency in the enzymes concerned," says 

 Umber, 15 ' ' as Schittenhelm and Brugsch recently declared, is 

 not satisfactory, entirely apart from the fact that Wiechow- 

 ski, in the course of his studies as to the possibility of uric 

 acid decomposition in the human body, was never able to 

 detect any uricolysis worth mentioning. If we were to refuse 

 the idea of retention in the tissues, it would be a particularly 

 difficult thing to understand why gouty patients do not sim- 

 ply expel by a compensatory hyperexcretion the uric acid 

 which is accumulated from a supposed failure of uricolysis ; 

 precisely as in leukaemia the patient compensates simply by 

 an exaggerated excretion of the excessive uric acid which is 

 mobilized in the body from the excessive purin decomposi- 

 tion. In the gouty individual there must exist some cause 

 which makes a compensatory uric acid excretion impossible; 

 and that is plainly a retention-affinity of the tissues, because 

 of which the uric acid is actually held in the tissues." 



The impression grows on one that this hitherto little con- 

 sidered factor, of an increased affinity of the tissues for uric 

 acid in the gouty subject, 16 is very much closer to the real 

 kernel of the gout problem than, for example, the question 

 of the fixation of uric acid in the blood, about which there 

 has been so much contention and with which of necessity we 

 are compelled at least to some little extent to concern 

 ourselves. 



15 F. Umber, Lehrbuch der Ernahrung und der Stoffwechselkrankheiten, 

 p. 273, 1909. 



" Cf. F. Umber and K. Retzlaff, 1. c. 

 12 



