430 



JOSEPH H. PRATT 



self and others in undoubted tophaceous gout, but they may have been 

 due to errors in the original Folin method. In one of my patients 1.7 

 mg. of uric acid was found (purin-free diet). Nearly two years later at 

 a second examination the still lower value of 1.3 mg. was obtained. The 

 fact that the two lowest analyses were obtained in the same case with a 

 long interval between the tests makes a technical error an improbable ex- 

 planation of the low value. In another case on a mixed diet there was 

 but 1.9 mg. Daniels and McCrudden also reported two cases of sup- 

 posedly chronic gout with low normal values of uric acid in the blood. In 

 their paper conclusive evidence of gout was not presented. The patients 

 had not had typical podagra and tophi were not found. 



A low normal amount has not been observed in gout since the new 

 method has been employed, but as in relatively few cases have blood 

 examinations been made with this method the question is still unsettled. 



McLester (using Folin's original method) found uric acid in the blood 

 of fifteen normal subjects who had been on a purin-free diet at least three 

 days, in amounts ranging from 0.5 to 2.9 mg. per 100 gm. of blood 

 with an average amount of 1.9 mg. In 156 non-gouty patients on a mixe 

 diet the average value was found by Adler and Ragle to be 1.7 mg. Ii 

 16 cases of gout irrespective of diet I found the average amount to 

 3.7 mg. In patients examined when on a purin-free diet the uric aci( 

 ranged from 1.6 to 7.2 mg. The largest amount I have observed was 8.' 

 mg. This was in the blood from a case of chronic gout with multiple tophi, 

 two days after a sweetbread meal. Higher values than this have rarelj 

 been obtained, but Fine in one case of gout found 9.5 mg. 



The blood during an acute attack usually contains more uric acic 

 than at other times, but the increase is small, being rarely more than 1 mg. 

 Bass and Herzberg have observed cases in which the uric acid did not 

 increase during attacks. 



In gout the uric acid in the blood is usually reduced somewhat by a 

 purin-free diet, but the amount generally remains above the normal level. 

 It may, however, fall to normal as shown in the following case in which the 

 purin-poor diet had been taken for more than two years when the normal 

 value was obtained. 



Acute gout many typical attacks. No tophi. 



April 5, 1915. Mixed diet 



" 14, Purin-poor diet for 9 days 



Jan. 26, 1916. One week after onset of attack of 



gout which lasted three days 

 June 27, 1917. Purin-poor diet for 2 years and 2 



months 

 April 21, 1921. Purin-poor diet for 6 years 



4.8 mg. 

 3.5 " 



4.0 " 



2.0 " 

 2.4 " 



