CHAP. III.] THE BLOOD IX DISEASE. 157 



/ 



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upon the intercurrent inflammatory lesions which so frequently occur. 

 As yet, however, facts are wanting to shew in what precise manner 

 the composition of blood is affected in scurvy. 



Purpura Hemorrhagica and Haemophilia. 



In these two diseases no constant alteration of the blood has been 

 discovered. 



It was maintained by Becquerel and Eodier that in these diseases 

 as well as in scurvy, the proportion of fibrin was diminished, but such 

 is not actually the case. The colourless cells of the blood too have in 

 some cases been stated to be increased ; in others, on the other hand, 

 to be unaffected. We can scarcely doubt that these are affections 

 in which primarily the blood-vessels are more at fault than the blood. 



Gout. 



There are few diseases in which so notable a change in the com- 

 position of the blood can be observed as in gout. Whatever may be 

 its cause, gout appears to be preeminently a disorder of nutrition, in 

 which there is a great tendency to a peculiar inflammatory process, 

 affecting in the first instance and chiefly (though by no means 

 exclusively) certain joints. In this peculiar, inflammation crystalline 

 deposits of sodium urate are formed in the affected parts. 



It is the great merit of Dr Garrod 1 to have discovered and 

 demonstrated that during the attack of acute gout, as well as in 

 the course of chronic gout, the blood invariably contains an excess of 

 uric acid, so that from a comparatively small quantity of blood serum, 

 a characteristic microscopic crystallization of uric acid can be obtained. 

 This accumulation of uric acid in the blood is probably in some 

 measure due to its non- elimination by the kidneys, seeing that whilst 

 the attack of gout is at its height, though the relative proportion 

 of uric acid in the urine may be high, and an actual spontaneous 

 separation from it often occurs after emission, the actual amount 

 excreted is usually below the normal. 



The non -elimination is doubtless connected with the kidney 

 affection which is an almost invariable concomitant of gout. 



Garrod shewed, moreover, that in gout the blood contains oxalic 

 acid 2 , and it is very probable that it contains an excess of urea ; upon 

 this point, however, further research is greatly needed. 



It appears to be indisputably proved that chronic lead poisoning 

 renders those affected with it specially liable to attacks of gout, 

 also that the ingestion of minimal doses of lead compounds will some- 

 times induce in the gouty an acute attack of the disease. 



1 Garrod, "Observations on certain pathological conditions of the blood and urine 

 in gout, rheumatism and Bright's disease." Medico-Chirurgical Transactions, Vol. xxxi. 

 p. 83, (1848). See also A treatise on Gout and Rheumatic Gout, 1876; and Article 

 "Gout," Eeynolds's System of Medicine, 3rd ed. London, Vol. i. p. 810. 



2 Medico-Chirurgical Transactions, Vol. xxxvn. (1854), p. 54. 



