'444: JOSEPH H. PRATT 



treatment of gout. Although uric acid itself is probably not the toxic 

 substance in gout, yet there is an undoubted disturbance of nucleic acid 

 metabolism of which hidden trouble uric acid is the outward sign. In 

 gout there is a constant increase of uric acid in the blood, an increase in 

 the tissue fluids much above the normal which can easily be demonstrated 

 by the administration of phenylcinchoninic acid (atophan, cinchophen), 

 and a deposition of sodium urate in certain locations. In addition there 

 is a diminished excretion of uric acid after foods rich in purin are fed 

 or after the intravenous injection of uric acid. However, this diminished 

 excretion of uric acid, McClure and Pratt have shown, is not pathogno- 

 monic of gout, and their results have been supported by the recent studies 

 of Burger and Griesbach. 



So many problems connected with gout are unsolved that the scien- 

 tific conceptions held to-day regarding treatment should always be viewed 

 critically and be subjected whenever possible to clinical tests. Other- 

 wise we may fall into as serious errors as our predecessors. One illus- 

 tration of what is meant may be permitted. Sweetbreads contain a large 

 percentage of purins. Their administration to gouty patients has been 

 promptly followed by an acute attack of gout in my own experience and 

 that of other physicians. Weintraud(a) in 1895 showed that their admin- 

 istration to a healthy person increased greatly the output of uric acid, 

 and this observation has been repeatedly confirmed. Yet in 1907 Arthur 

 Luff, an English writer, in a book of much value made the following state- 

 ment which has been frequently quoted by other writers with apparent 

 approval excepting Garrod and Llewellyn: "From Walker Hall's ex- 

 periments it would appear reasonable to administer sweetbread to gouty 

 patients, since its nuclein portion is only slightly absorbed, for thymus 

 sweetbread contains principally adenin, which is rapidly excreted, and 

 pancreas sweetbread contains mainly guanin, and aminopurin which is in- 

 capable of increasing the urinary purin output and of exerting any in- 

 jurious effects upon the tissues." 



As has been said, if Luff had fed sweetbreads he would have found that 

 in spite of Walker Hall's conclusions, the amount of uric acid in the urine 

 was greatly increased. It is now known that animal as well as plant 

 nucleic acid contains one guanin mononucleotid and one adenin mono- 

 nucleotid, in other words adenin and guanin in equal amount, and that 

 these both in all probability leave the intestine and enter the circulation 

 while in the combined form either as nucleotids or nucleosids. 



Diet in Acute Gout. In the treatment of this condition there is 

 general agreement. The diet should be light. For the first day and prob- 

 ably for several days the less food the better, but fluids should be given 

 freely. For the first twenty-four hours in a severe case with nephritis 

 I gave only water and lemonade. Milk has been advocated since the days 

 of Sydenham. Diluents and farinaceous food until the attack begins to 



