LACTAM AND LACTIM FORMS OF URATES 179 



the interrelations of blood alkalescence, local changes of 

 tissue alkalescence, and gouty deposits as ' ' swinging loosely 

 in the air/ 7 it will doubtless take a very long time before 

 physicians will stop making their patients believe that their 

 malady is due to too much acid in the blood, and that nothing 

 but continued drinking of this or that alkaline water (n.b., to 

 be taken at the spring) can possibly eradicate this acid. Un- 

 fortunately there are many instances in the chemical physi- 

 ology of metabolism in relation with which material interests 

 directly interfere with the acceptance of scientific facts. The 

 opportunity should not be passed over here to point out too, 

 how irrational it is to try to draw any sort of conclusions 

 from the analysis of a single specimen of urine (whether 

 from its "degree of acidity " or its "content of uric acid") 

 for application in the diagnosis of gout or in the recognition 

 of improvement or regression of this condition. This is pos- 

 sible only, and then with great caution, from a long series of 

 careful quantitative examinations during purin-free diet, or 

 perhaps in the way that C. v. Noorden tests the limits of 

 tolerance of his patients, by increasing dosage of purin and 

 determining how much purin the subject can handle without 

 manifesting a retention in the daily balance-test. When 

 a physician allows a quantitative analysis to be made of any 

 arbitrarily collected specimen of urine of his patient and 

 then makes a diagnosis of presence or absence of a "gouty 

 diathesis ' ' after a glance at the list of data of the analysis, 

 he is really not proving by his actions his possession of diag- 

 nostic acumen as much as he is laying bare his total 

 ignorance of biochemical matters. 



L act am and Lactim Forms of U rates. Among the fac- 

 tors to be considered in reference to the solubility of uric 

 acid in the blood and its removal therefrom, is the important 

 point, first discovered by Gudzent, that uric acid forms two 

 series of primary salts, and that one of these, a readily 

 soluble, instable urate, has the tendency in its solutions to 

 change over into the second, a less soluble (about one-third), 



