438 VICTOR C. MYEES 



shortly before death, while in several cases figures as high as 15 mg. were 

 observed, values much higher than any noted in gout. It is perfectly 

 logical to expect that high figures would be found in the last stages of 

 chronic interstitial nephritis, with the consequent accumulation of all the 

 waste products of nitrogenous metabolism. Tnat the retention of uric 

 acid in nephritis results in a fairly even distribution of this substance 

 in the various body tissues has been shown by Fine (a) in tissues obtained 

 at autopsy. The distribution, however, is not quite as uniform as in the 

 case of the urea or even the creatinin, a fact which might be expected from 

 their physical properties. 



In 1916 Myers, Fine and Lough called attention to the fact that very 

 high figures for uric acid may be noted, not only in cases of advanced 

 interstitial nephritis, but also in the very early stages of the disease, be- 

 fore a retention of either the urea or creatinin had taken place. It was 

 suggested that, when symptoms of gout were absent, a high blood uric 

 acid might -be a valuable early diagnostic sign of nephritis, possibly earlier 

 evidence of renal impairment of an interstitial type than the classic tests 

 of proteinuria and cylinduria. This point is well illustrated by the stair- 

 case table on page 439, taken from Chace and Myers. As a result of a 

 recent study of this question Baumann, Hansmann, Davis and Stevens 

 conclude that the uric acid concentration of the blood is a delicate, if not 

 the most delicate, index of renal function at our disposal. 



Owing to the fact that the tophi found in gout have long been recog- 

 nized to contain deposits of sodium urate, it is quite natural that the 

 uric acid content of the blood in this condition should possess a special in- 

 terest. Following the investigations of Folin and Denis a number of 

 different workers took up a study of this question. Among these in par- 

 ticular should be mentioned Pratt, Fine and their coworkers. From the 

 normal variations of from 2 to 3 mg. to 100 c.c. of blood, the uric acid may 

 be increased to as much as from 4 to 9 mg. in gout, but it does not follow 

 that these uric acid accumulations are infallible signs of gout, since, as 

 noted above, similar uric acid figures may be found in nephritis. We may 

 conclude, however, that gout is almost invariably associated with an in- 

 creased uric acid content of the blood and therefore a high uric acid blood 

 may be of considerable diagnostic value in cases of gouty arthritis, in which 

 tophi containing sodium urate are not already present. 



High figures for the blood uric acid may be considerably reduced in 

 many cases, where appreciable urea retention does not exist, by the use 

 of purin free diets. Such diets will not, as a rule, equally influence the 

 blood uric acid in gout, although appreciably lowering the initial figures. 



It is of considerable interest in this connection that salicylic acid, 

 phenylcinchoninic acid (cinchophen) and certain of their derivatives have 

 recently been shown to have a marked influence upon the elimination of 

 uric acid and upon the uric acid content of the blood. In many cases mod- 



