THE METABOLISM IN GOUT 437 



Futcher has observed a case in which the excretion was nil for twenty-four 

 hours. His analyses were made a good many years ago, and probably 

 with present-day methods some uric acid would have been found. Low 

 values occur most often when gout is associated with plumbism (Mallory). 



Soetbeer studied the hourly excretion of uric acid in gout and found 

 that it deviated from the normal, both in chronic and acute cases. His 

 curves show extreme irregularity of form. Sometimes the early morning- 

 rise in uric acid excretion which is a constant feature in health was missing. 

 This is not diagnostic, however, as I have seen it absent in -non-gouty 

 cases. 



The following table gives the hourly output in a case of tophaceous 

 gout toward the end of an attack. The output on that day, 0.03 gram 

 it will be noted, was very low, in fact one of the lowest ever recorded. 



Amount Uric Mg. per 



of Urine Acid Hour 



Feb. 2-3 



7 P.M. 7 A.M. 400 0.010 g. 0.8 



9 A.M. 37 .0028 g. 1.4 



11 A.M. 50 .0065 g. 3.25 



1 P.M. 50 .0026 g. 1.3 



3 P.M. 65 Trace 



5 P.M. 50 " 



7 P.M. 55 .005 g. 2.5 



9 P.M. 47 .005 g. 2.5 



Feb. 3-4 



9 P.M. 7 A.M. 600 .015 g. 1.5 



In some cases of gout the endogenous uric acid level is a high normal. 

 Brugsch states that this most commonly occurs in chronic polyarticular 

 gout, and my experience supports this view. 



In gout exogenous purin is excreted less well than in health. McClure 

 and Pratt collected 50 observations from the literature. In 32 of these 

 20 per cent or less of the purin nitrogen of the food was excreted as uric 

 acid nitrogen. In 19 tests the excretion of exogenous uric acid was 10 

 per cent or less. These results are strikingly different from those obtained 

 in health. Among 40 observations on healthy subjects in only 3 was 

 the percentage of exogenous uric acid 20 per cent or less. In these 

 studies the form in which the nucleic acid precursors were fed made little 

 difference. 



Hypoxanthin, which by simple oxidation produces uric acid, causes no 

 greater percentage output of uric acid than nucleoprotein^ although the 

 latter requires the action of a series of ferments before its conversion 

 into uric acid. 



The intravenous injection of 0.5 gram of uric acid has been made in 



