436 



JOSEPH H. PRATT 



The Urine in Gout 



For a day or two previous to the onset of an attack of acute gout the 

 amount of uric acid in the urine falls. This drop is followed by a marked 

 rise reaching the maximum on the second or third day of the seizure. 

 The output again lessens as the attack abates, but does not usually reach 

 the low level of excretion that preceded the attack. 



This characteristic curve of the uric acid output has been observed and 

 described by many investigators and occurs when the patient is on an ordi- 

 nary diet as well as on one that is purin free. The variations in excretion 

 are well shown in the accompanying chart taken from Umber and in the 

 chart that Osier gives in his text-book from a case studied by Futcher in 

 his wards. 



Daily Output of purin nitrogen in the urine of a 

 gouty subject on a purin-free diet (Umber), a, d, 

 Stage of depression in excretion following an acute 

 attack of gout; 6, depression stage preceding an 

 attack; c, onset of attack. 



On a mixed diet the output of uric acid in the intervals between attacks 

 is not abnormally low (His(e) ). The endogenous uric acid output in gout 

 is low in the majority of cases. According to Schittenhelm and Schmidt 

 (6) it is below normal in 80 per cent of the cases. From analyses collected 

 from the literature, I found that the average daily excretion of twenty nor- 

 mal persons on a purin-free diet was 0.39 gram, while the average daily 

 excretion of twenty gouty persons was 0.25 gram. In some cases of gout 

 very low figures have been obtained. In Pollak's(a) case the average en- 

 dogenous excretion over a period of five days was 0.06 gram. In a case of 

 gout with a history of lead poisoning reported by Eschenberg the excretion 

 was as low as 0.02 to 0.04 gm. In one of my own cases the output was 

 0.07 gm. for two successive days, but rose to 0.33 gm. three days later. 



