432 JOSEPH H. PRATT 



TABLE III 



Mgs. of Mgs. of 



uric acid ' - - uric acid 



in 100 in 100 



gms. of gms. of 



blood blood 



McC. Chronic polyarthritis. Purin- 24 hours after eating 100 gms. of 



free diet 1.7 thymus 2.2 



R. Multiple recurrent thrombosis: 48 hours after eating 300 gms. of 



streptococcus isolated from thymus 2.3 



blood. Purin-free diet 2.0 



M. Chronic polyarthritis. Ordinary 24 hours after eating 225 gms of 



diet 2.0 thymus 1.8 



H. Chronic polyarthritis. Ordinary 47 hours after eating 190 gms. of 



diet 2.9 thymus 2.5 



Average 2.1 Average 2.2 



On comparing the figures given in the two tables it will be seen that 

 prior to the sweetbread meal the average amount of uric acid present in the 

 blood of the gouty and the non-gouty patients was practically the same. 

 Twenty-four hours to three days after feeding the exogenous purin the 

 average amount of uric acid was 5.1 nags, in the blood of the gouty, while 

 in the blood of those who did not have gout it was only 2.2 mgs. 



Exogenous purins in five gouty patients produced marked hyperuri- 

 cemia twenty-four hours to three days after they were fed, while in indi- 

 viduals who did not have gout the uric acid concentration was practically 

 unchanged twenty-four to forty-eight hours after the purin meal. 



These observations indicate that the uric acid derived from exogenous 

 purin does not accumulate in the blood unless there is a disturbance in 

 the uric acid metabolism. In one patient, however, who had recurrent 

 iritis, but whose history and physical examination revealed no evidence 

 of gout, the uric acid content of the blood was abnormally high two days 

 after a sweetbread meal. His blood on November 1 after having been on 

 a purin-free diet for two days contained 2.2 mgs. of uric acid. On No- 

 vember 7 he ate 150 grams of sweetbread. Two days later there was 4.8 

 mgs. of uric acid in the blood. With the sweetbread meal he took two 

 cocktails. It is possible that the alcohol caused a transitory disturbance 

 of the uric acid metabolism. Pollak has shown that a retarded and di- 

 minished excretion of exogenous purin may occur in chronic alcoholism. 

 No persistent increase of uric acid existed in my patient as the blood 

 examined on March 30 when on a mixed diet contained only 0.8 mg. of 

 of uric acid. This is a lower amount than has been found in any case 

 of gout. 



The increase in the uric acid content of the blood in gout after feeding 

 a purin meal may not appear for twenty-four hours or more, and an initial 

 fall has been observed in two cases of gout in which the blood was examined 

 four to eleven hours after the sweetbread meal. 



