628 URIC- ACID METABOLISM AND GOUT 



which suggests tliat uric acid may be less easily excreted by the dis- 

 eased kiduey than the other chief nitrogenous constituents of the 

 urine. 



In normal individuals there seems to be little uric acid present in 

 the tissues. By using Folin's method, Fine ^'"' found that various 

 tissues contain quantities comparable to that in the blood of the same 

 person, whether this is normal or increased in amount. Ordinarily 

 these quantities are not sufficient to permit readily of isolation of the 

 uric acid in a pure state, but in the tissues of a young woman who died 

 after complete suppression of urine for nine days following poisoning 

 with HgCL, I found considerable amounts.^"'' AVhenever much de- 

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

 the elimination of endogenous uric acid becomes abnormally raised, the 

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

 kemia, especially leukemia under .r-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 am'- 

 Ihing 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. According 

 to findzent's studies,^^ in nearly all cases of gout the blood contains 

 as much or more mono-sodium urate than it can liold in solution (8.3 

 mg. per 100 cc), so that it is often actually a supersaturated solution 

 of tlie 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 f) mg. ]ier 100 cc), independent of acute attacks or any marked 



inf.Tour. KuA. (')i.'iii., lt)l,-) (2^), 47.3. 

 i«'i.T(>ur. Biol. Cliom., lOlfi (20), ."^lO. 

 IT Zcit. physiol. Cliem., 1909 (63), 4.55. 



