438 JOSEPH II. PRATT 



a number of cases of gout (Umber and Retzlaff, Biirger and Schweriner, 

 McClure and Pratt). In two of onr four cases no increased excretion re- 

 sulted and in one case in each of the two previous investigations none of the 

 uric acid was . excreted. In one of our patients the increase over the en- 

 dogenous level was 44 per cent. This is more than may occur in healthy 

 subjects. One of our patients with non-gouty arthritis excreted only 22 

 per cent. Injections of uric acid made during an attack of gout are more 

 apt to be retained than when the test is made in the intervals between at- 

 tacks. This is also true when purin substances are fed. 



The diminished excretion of exogenous uric acid in gout is of little 

 value in diagnosis as it occurs in many casefc of chronic arthritis. Out of 

 52 tests on 41 cases of non-gouty arthritis in 17 twenty per cent or less 

 of the purin nitrogen fed was excreted in the urine (McClure and Pratt). 

 A diminished excretion also occurs in some cases of chronic alcoholism 

 (Pollak) and probably in other conditions. 



Brugsch and Schittenhelm(fr) maintained that in gout there was a de- 

 layed as well as a diminished excretion of exogenous uric acid. This view 

 has been widely accepted. In health, however, the excretion often extends 

 over two or three days. Of fifty-two experiments on arthritic patients, the 

 exogenous uric acid output was completed within five days in forty-one, or 

 79 per cent ; and of forty-six experiments on gouty persons the output was 

 ended within five days in forty-one or 90 per cent. Therefore, a prolonga- 

 tion of the excretion of exogenous uric acid is not peculiar to gout (Mc- 

 Clure and Pratt). 



Levene, Kristeller and Manson observed that after the administration 

 of very simple nitrogenous substances such as urea and aspargin in a case 

 of tophaceous deforming gout, the surplus nitrogen was not excreted in 

 the same manner as in a normal individual, or as in a patient with chronic 

 interstitial nephritis who was placed on a low nitrogen intake. In the case 

 of gout the increase in the nitrogen output was comparatively low during 

 the first twenty-four hours and the slightly increased excretion usually 

 continued for several days. Levene and Kristeller (6) later found that the 

 removal of nitrogen taken in the form of nucleic acid derivatives lagged 

 behind the nitrogen output after the administration of urea. The nearest 

 to urea in its action was inosin, then followed nucleic acid and hypoxan- 

 thin. The smallest increase in the nitrogen output followed the ingestioii 

 of uric acid and guanosin, possibly owing to the comparative insolubility 

 of these substances. There was better elimination when the standard diet 

 contained 13 grams of nitrogen than on one containing only 7 grams. 



Action of Phenylcinchoninic Acid (Atophan, Cinchophen) in Gout. 

 In health atophan (cinchophen) produces a marked increase in the output 

 of uric acid in a subject on a purin-free diet. This increase may begin 

 within forty-five minutes. It persists one or two days and is followed 

 by a fall below the original level in spite of the continued administration 



