

THE METABOLISM IN GOUT 427 



was injected intravenously and again four hours later. In one instance 

 the uric acid was less at the second examination (2.9 mg.) than it had been 

 before the injection (3.5 mg.), and yet the output of uric acid in the 

 urine had not increased. They attributed the disappearance of uric acid 

 from the blood to its entrance into the body tissues. Van Slyke(&) had 

 previously shown that amino-acids introduced into the blood quickly leave 

 the blood and enter the muscles. Urea behaves similarly. Griesbach 

 also found that injected uric acid quickly left the blood. In two examina- 

 tions only 5 per cent of the uric acid was found fifteen minutes after the in- 

 jection. It has recently been discovered that most of the uric acid leaves 

 the blood within five minutes after being injected into the peripheral 

 circulation (Burger). In some instances it entirely disappears from the 

 circulation in that short time (Russell and Pratt). The rapid passage 

 of uric acid from the blood to the tissues is probably due to forces which 

 attempt to establish an equilibrium in the concentrations of uric acid 

 in the blood and tissues. Frey has discovered the existence of a mechan- 

 ism which equalizes the concentration when sodium phosphate, sodium 

 chlorid and other inorganic salts are injected intravenously. 



Recent observations have shown definitely that uric acid injected intra- 

 venously is often in large part retained in health as well as in gout and 

 in other diseases. .McClure and Pratt injected uric acid and piperazin in- 

 travenously in five non-gouty cases and found that the uric acid excreted 

 varied from 22 per cent to 82 per cent in four cases, while the output 

 in the fifth case was 138 per cent. The output in one of Dohrn's cases 

 was 59 per cent, in another 63 per cent. Frank and Bauch reported only, 

 40 per cent in one case, and Bass 67 per cent. These results were strik- 

 ingly different from those obtained by Umber and Retzlaff, who claimed 

 that when uric acid was injected intravenously into non-gouty persons it 

 was practically all excreted. 



Recent studies have confirmed our findings. Biirger in 1920 found 

 that the average excretion of uric acid in forty-eight hours following the 

 injection of uric acid and piperazin was 52 per cent in 12 cases, on the day 

 of injection only 29 per cent. Uric acid in supersaturated solution was 

 excreted in less amount, the average being only 27 per cent of the injected 

 0.5 gram. As piperazin itself increases the output of uric acid (His(e), 

 Abl, Dohrn, Ewald) the amount excreted a-fter the injection of uric acid 

 and piperazin is only in part due to the uric acid. Griesbach also found 

 incomplete elimination of uric acid introduced intravenously. 



The dogma of the quantitative excretion of parenterally introduced 

 uric acid which has been held by all authorities has been definitely over- 

 thrown by the work here recorded. Earlier observations had formed the 

 most important evidence against the destruction of uric .acid in the hu- 

 man organism. The experiments of Soetbeer and Ibrahim -with subcu- 

 taneously injected uric acid, and especially those of Umber and Retlaff 



