THE METABOLISM IN GOUT 435 



At the autopsy the knee joint from which I had removed the fluid was 

 found to have its lining membrane and the cartilage below coated with 

 u rates. 



Uric Acid in the Tissues in Gout 



Uric acid quickly leaves the blood when injected into a vein and 

 enters into the tissues both in healthy persons and in gouty sub- 

 jects. Whether it is deposited in especial situations, for example 

 the liver, is not known. In two cases of uremia studied by Fine 

 the distribution was fairly uniform. There was only slightly more 

 in the liver than in other organs, and in one case more was found in pleural 

 fluid than in the liver or blood. It is possible of course that the distribution 

 might be different in gout, but no similar analyses in that disease have 

 yet been made. 



The drug atophan causes an increased excretion of uric acid by the 

 kidneys, which usually exceeds in amount all the uric acid contained in 

 the blood. Assuming that the blood volume is 1/13 of the body weight 

 (Keith, Rowntree and Geraghty), a man weighing 65 kilos will have 

 5,000 gm. of blood. If the blood contains 2 mg. uric acid per 100 grams 

 of blood, which is an average amount in health, there would be a total of 

 100 mg. in all the blood. In a gouty person of this weight a concentration 

 of 5 mg. uric acid per. 100 grams of blood would equal 250 mg. in the whole 

 blood. In the first twenty-four hours after the administration of atophan 

 is begun gouty patients frequently excrete an amount of uric acid above 

 the endogenous level in excess of 250 mg. In a case studied by Graham 

 the extra uric acid excreted during three days was 840 mg. During this 

 time the loss of uric acid in the blood was only 64 mg. The extra uric acid 

 excreted was more than ten times that lost by the blood and this extra 

 amount must have come from the tissues. The water of the body con- 

 stitutes 90 per cent of its weight and if this holds the same percentage 

 amount of uric acid in solution as the blood, as is indicated by Fine's 

 analyses, there is a considerable amount of uric acid in the body. On 

 this assumption Graham calculated that the uric acid in the body fluids 

 of his patient, weight 51.5 kilos, was 2.11 grams before and 1.36 grams 

 after the atophan. That is a diminution of 0.75 gram, which corresponds 

 fairly well to the extra excretion in the urine during the three days, which 

 was 0.84 gram. 



In cases of gout under the influence of atophan the increase of uric 

 acid above the previous level persists usually much longer than in health. 

 Bauch gave a patient with gout 3 grams of atophan daily for thirteen days. 

 During this time he excreted 3 grams of uric acid above the endogenous 

 value. In the normal individual the increased output ceases usually in a 

 day or two in spite of continued administration of the drug. 



