449 



term adrenalin, is so fixed in the literature that it will be difficult to sup- 

 plant it. 2-phenyl-quinolin 4 carboxylic acid was described by Doebner 

 and Giesecke in 1887. It is insoluble in water and has a bitter taste. 

 Other members of the oxyquinolin carboxylic group increase uric acid 

 excretion. One of these used in medicine has not the unpleasant taste of 

 atophan. It is ethyl 6-methyl 2-phenyl-quinolin 4 carboxylate. This 

 is called novatophan. It is sold also under the name of tolysin. This 

 substitute can be employed in cases in which atophan is poorly borne by 

 the stomach. This has been my experience and that of many physicians. 

 Haskins ( b ) , however, in observations on normal persons found that the in- 

 creased output of uric acid was less after novatophan than after atophan. 



Atophan was first used in gout by Weintraud(&). In this disease as in 

 normal subjects it causes a marked increase of uric acid excretion. The 

 rise is frequently 100 to 200 per cent in twenty-four hours. When uric 

 acid is introduced intravenously in gouty subjects usually only a small per- 

 centage is excreted, and in some severe cases none at all. When atophan 

 is given at the same time the increased output of uric acid may be equal 

 to the entire amount of uric acid injected, and sometimes the extra ex- 

 cretion is much more than 100 per cent. 



Sodium nucleate when given to gouty patients is usually in great part 

 retained. Under the influence of atophan it is excreted quantitatively by 

 these patients (Frank and Bauch). It is also true of all foods containing 

 purin in large amount, that when atophan is given at the same time the 

 uric acid output is increased in amount nearly equal to that of the exog- 

 enous purin fed. 



Deutsch determined the effect of atophan (1 gram three times pro die) 

 on the healthy kidneys, after feeding 300 gm. of thymus. For the first 8 

 hours after the purin meal the uric acid output was maintained at about 

 the same high level, which was 36 to 38 mg. per hour above the normal. 



The increased excretion may begin thirty minutes after atophan is 

 given (Frank and Pietrulla), or the onset of the uric acid "flood" may be 

 delayed for two or three hours. The urine in forty-five minutes from the 

 time the drug is taken may be turbid from urates. These urates are inter- 

 esting from their circular shape, radial striations and double refraction 

 (Frank and Bauch). 



When atophan is given to healthy subjects in doses of from three to 

 five grams a day, the increased elimination of uric acid rarely continues 

 beyond the first day. On the second day the output is usually normal 

 or subnormal (Weintraud, Dohrn). If the administration of atophan is 

 continued the output may be high for two or three days. In exceptional 

 cases, however, Griesbach and Samson observed a slow increase in the 

 uric acid output reaching its maximum on the third day. Haskins noted 

 a period of depressed output after the atophan is discontinued. This has 

 been confirmed by Starkenstein(c). 



