THE METABOLISM IN" GOUT 431 



Case 1 of my series A. B..was taking 1 a small amount of meat or fish 

 daily on Oct. 15, 1912, when the uric acid was found to be 5.5 mg. per 100 

 grams of blood. Ho was then placed on a purin-free diet. The blood on 

 Nov. 3, 1912, contained 3.4 mg. a drop of 2.1 mg. Sometimes the uric 

 acid may increase in spite of a purin-free diet. The blood of T., a patient 

 with gout, contained 5 mg. of uric acid on Aug. 6, 1915. On Sept. 16, 

 1915, although he had been on a purin-free diet a month, the uric acid 

 had risen to 5.8 mg. The purin-free diet was continued and on Dec. 9, 

 1915, the uric acid had fallen to 4.2 mg. 



Great fluctuation in the amount of uric acid in the blood independent 

 of diet is sometimes observed in other diseases and was strikingly shown 

 in a case of chronic non-gouty polyarthritis, as follows: 



Mgs. of uric acid per 



^ f n 100 gm. of blood. 



JMcC. aged twenty-two years. 



October Ordinary diet 2.7 



December Purin-free diet 5.0 



May Purin-free diet 1.6 



In another case of chronic non-gouty arthritis the blood when first 

 examined contained 7.6 mg. of uric acid. A few months later, when on a 

 diet rich in purins, only 0.8 mg. was found. 



There is sometimes a marked increase of the uric acid content of the 

 blood in gout 1 to 3 days after feeding a single meal rich in nucleic acid, 

 as shown in the following table. 



TABLE II 



Mgs. of Mgs. of 



uric acid uric acid 



in 100 in 100 



gms. of gms. of 



blood blood 



D. N. Gout. Purin-free diet 3.1 52 hours after eating 280 gms. had- 

 dock roe 5.8 



3 days after eating 300 gms. roast 



beef 6.2 



K. Gout. Purin-free diet 2.4 24 hours after eating 270 gms. roast 



beef 3.0 



H. Gout. Purin-free diet 1.7 3 days after eating 150 gms. thy- 



mus 3.6 



P. Gout. Purin-free diet 2.1 3 days after eating 160 gms. thy- 



mus 3.4 



J. X. Gout. Purin-free diet 2.2 48 hours after eating 190 gms. thy- 



mus 8.7 



Average 2.2 Average 5.1 



In four non-gouty persons the amount of uric acid in the blood was de- 

 termined twenty to forty-eight hours after feeding a sweetbread meal. 

 The results are given on the next page. 



