448 JOSEPH H. PKATT 



This is due apparently to a diminished formation of uric acid. Bain holds 

 that the calcium content of foods may have an injurious effect in gout. 



Care should be taken to avoid the accumulation of an excessive amount 

 of alkali in the body. Fruits as well as vegetables increase the alkaline 

 store. Alkaline mineral waters should be taken in limited amounts if at 

 all. Sir William Roberts observed fresh attacks of gout apparently brought 

 on by drinking alkaline waters, such as those at Carlsbad. 



The experiments of van Logheim offer a reasonable explanation for 

 the injurious action of alkalies and the favorable effect of acids. He 

 produced tophi by injecting uric acid suspended in water under the skin 

 of rabbits. The introduction of HC1 per os hindered the deposit of urates 

 and the inflammatory reaction, while large doses of alkalies hastened the 

 formation of tophi. His results received confirmation from Silbergleit. 

 Pfeiffer(fr) injected uric acid subcutaneously in men and found that the 

 inflammatory action was lessened when large doses of mineral acid were 

 taken, while the administration of alkalies increased the local inflamma- 

 tion. Falkenstein introduced a hydrochloric acid treatment in gout con- 

 sisting of very large doses of acid. The theory on which he based this has 

 been discredited, but it is well to give 1 to 2 c.c. of dilute HC1 three times 

 daily when the patient is on an alkaline diet. 



Caffein and theobromin are methyl purins. It is doubtful if they are 

 converted into uric acid in the body. The methyl purins of normal urine 

 could be formed by the removal of the methyl group, occupying position 3, 

 from caffein and other methylated purins of food. Kriiger and Schmid 

 held that the methyl groups are decreasingly stable in the order, 7, 1, 3. 



Benedict reported a carefully conducted experiment which indicates 

 that caffein does slightly increase the excretion of uric acid. Mendel 

 and Wardell found that the addition of strong coffee infusion to a purin 

 free diet causes a marked increase in the uric acid output. Kaffee-Hag, 

 a decaffeinated coffee product, had no effect. 



The increase is possibly due to demethylation and oxidation of 

 a small percentage of the ingested caffein. Brugsch thinks the caffein 

 simply mobilizes the uric acid in the body. He holds that normally uric 

 acid is deposited in the liver, and that caffein facilitates its entrance into 

 the blood stream. 



In dogs caffein increased both the uric acid and the allantoin excretion 

 (Schittenhelm). While the evidence at hand does not clearly show that 

 coffee, cocoa and tea are injurious in gout, it is the safer course to interdict 

 their use, at least in the severer cases. 



Atophan Therapy. Nicolaier and Dohrn in 1908 found that phenyl- 

 cinchoninic acid (2-phenyl-quinolin 4 carboxylic acid) increased greatly 

 the output of uric acid. It was introduced into therapeutics under the 

 name of atophan. It is also known in America as cinchophen, which 

 is another trade name for the same substance. The word atophan, like the 



