636 URIC-ACID METABOLISM AND GOUT 



struction of the nucleoproteins of the tissues is occurring in the body, 

 the ehmination of endogenous uric acid becomes abnormally raised, the 

 best examples being the resolution of pneumonic exudates, and leu- 

 kemia, especially leukemia under x-ray treatment (q. v.) . In neither 

 of these conditions, however, do any symptoms or tissue changes arise 

 that can be referred to the excessive uric acid. 



GOUT 



Introducing this subject, one cannot do better than to quote v. 

 Noorden's statement that "It is not to-day very alluring to write any 

 thing regarding the theory of gout, especially in a book which is essen- 

 tially devoted to the presentation of facts. All the theories advanced 

 up to the present time have fared badly. The positive material is 

 much too insufficient and much too ambiguous." After adjusting 

 the many contradictory statements of earlier investigators, the pres- 

 ent status of our conception of uric-acid metabolism in gout may be 

 briefly summarized as follows: The excretion of uric acid in patients 

 with chronic gout, when kept upon a definite diet, does not differ 

 greatly from the excretion of normal individuals on the same diet. 

 Normally the elimination of uric acid varies within rather wide limits, 

 even on a constant diet, but the excretion in chronic gout tends to 

 fall at or slightly below the lower normal limits. As a rule, gouty 

 patients on a purine-free diet excrete less endogenous uric acid than 

 normal persons, and when given purines in the food the rate of ex- 

 cretion of these exogenous purines is slower than normal. ^^ There 

 seems to be no particular relation between the amount of uric acid in 

 the blood and the occurrence or severity of attacks. ^"^ This uric acid 

 is, according to the best evidence, in a free state, and not combined, 

 as was at one time urged by several students of gout. 



Analyses of the blood in 120 cases of gout by Gettler and St. 

 George^^ gave the following figures, in mg. per 100 c.c. of blood: 



Normal Gout 



Nonprotein nitrogen 25 to 40 30 to 55 



Urea nitrogen 10 to 18 15 to 35 



Creatinine 0.1 to 0.8 1 to 2.8 



Uric acid 0.5 to 3.0 1.5 to 8.5 



Sugar 00 to 110 85 to 140 



Alkali reserve — percentage 53 to SO 50 to 80 



^^ According to Gudzent's studies (Zcit. physiol. Chem., 1909 (03), 455) in 

 nearly all cases of gout the blood contains as nuich or more inono-sodiuni urate 

 than it can hold in solution (8.3 ing. per 100 c.c), so that it is often actually a 

 .supersaturated solution of the relatively insoluble lactim form of urate. Even on 

 a purine-free diet the blood of the gouty usually contains an excess of uric acid (4 

 to 9 ing. per 100 c.c). These figures, however, are much higher than those ob- 

 tained by more modern methods. 



=" Pratt, Amcr. Jour. Med. Sci., 1910 (151), 92; Bass and Herzberg, Deut. 

 Arch. klin. Med., 1910 (119), 482. 



" Jour. Anier. Med. Assoc, 1918 (71), 2033. 



