Etiology, Pathogenesis. 969 



Etiology. Without a doubt gout stands in close relation to 

 the diet, since it develops preferably on generous feeding with 

 substances containing much albumin, especially nucleoproteids. 

 Such substances are especially the thymus glands, the liver, 

 kidneys, brain, pancreas, and the flesh of animals in general 

 which, although poor in nuclei, yet contains much hypoxanthin ; 

 young germinating plants also contain much of nucleoproteids 

 (Kionka and Bannes produced typical gout in birds by feed- 

 ing them for weeks and months exclusively on horseflesh). That 

 certain chemical substances have an etiological importance is 

 indicated by the experience that in man the disease may occur 

 in connection with chronic lead poisoning, and v. Kossa pointed 

 out the gout producing action, upon chickens, of chromic acid, 

 oxalic acid, carbolic acid, corrosive sublimate, cane sugar, aloine 

 and acetone. According to earlier observations smut fungi 

 (Ustilago maidis) also are said to be capable of causing gout, 

 in birds. Finally the disease probably develops in birds in 

 certain cases in connection with disease of the kidneys or ure- 

 ters, for Ebstein and others succeeded in producing gout artifi- 

 cially in birds by ligating the ureters, and v. Kossa proved 

 in cases of toxic gout that nephritis must be considered as a' 

 cause for the deposition of urates in the tissues. 



Favoring factors are want of exercise or confinement of 

 the animals. Of birds, especially the more carefully bred and 

 kept large breeds are inclined to the disease (cochin-china, 

 brahma), then adult and especially older animals. Male animals 

 are affected more frequently than females. Lastly it appears 

 that individual peculiarities are of essential importance for the 

 predisposition. 



Pathogenesis. The mode of development of gout is at 

 present not entirely cleared up. This much may be concluded 

 from investigations or animal experiments that have been made 

 that, under the influence of the enumerated causative factors, 

 an increased production of uric acid occurs, and also a toxic 

 nephritis, the latter either under the influence of the eliminated 

 toxins or also in consequence of the excess in uric acid. The 

 increased formation of uric acid, together with the inhibition 

 (owing to the existing nephritis) of the elimination of urates, 

 lead to a storing of urates in the blood (Benion, Kionka, v. 

 Kossa) and under certain conditions to the deposit of urates 

 in the tissues. According to Brugsch & Schittenhelm, the ulti- 

 mate cause of gout may, however, lie in a deficient transforma- 

 tion of the purin bases which are formed from the nucleo- 

 proteids (first of all of the hypoxanthin) into uric acid, and in 

 retarded combustion of the uric acid, owing to the absence of 

 certain ferments. 



According to Ebstein the urates which are eliminated from the blood produee 

 necrotic foci in the tissues, especially in places where the circulation is very slow, 

 and are only later deposited in the necrotic tissue in the form of crystals. Around 



