450 JOSEPH H. PRATT 



In gout the increased output of uric acid persists for a long time if 

 the administration of the drug is continued. Study of published analyses 

 shows that the excretion of uric acid has remained above the normal until 

 the atophaii was discontinued or the uric acid determinations were ended. 



In one of Weintraud's patients with chronic gout 3 grams of atophan 

 were given daily for 12 days and the uric acid output continued to be 200 

 or more mg. above the daily endogenous level throughout this period. 

 Bauch in a case of gout gave three grams of atophan daily for thirteen 

 days. The patient excreted three grams of uric acid in excess of the aver- 

 age endogenous output. One of Graham's patients excreted 0.84 gram 

 of extra uric acid during three days that atophan was given. In health 

 Ilaskins found the rise above the endogenous level averaged more than 200 

 mg. during the first twenty-four hours under the influence of atophan. In 

 gout it is often much more than this, amounting to 520 mg. in one of 

 Folin and Lyman's cases. I have seen one case of gout in which atophan 

 caused no increased output of uric acid. It was one of polyarticular ar- 

 thritis and the endogenous level was high at the time atophan was given. 



Trie acid occurs in the tissue fluids as well as in the blood. Injected 

 into the blood it disappears very quickly. Ten minutes after the injection 

 Pratt and Russell found that the uric acid content of the blood was prac- 

 tically the same as before the uric acid had been introduced. It is pos- 

 sible that there are special depots of uric acid in certain organs. Brugsch 

 (e] and Rosenberg(a) hold that the liver stores up uric acid as it does 

 glycogen, fat and protein. Fine (a), however, found but little more uric 

 acid in the liver than in other organs. It is possible that it exists not in a 

 free state, but in a combined form that would have escaped detection by 

 the method of analysis employed by Fine. 



Graham has clearly shown that the extra uric acid excreted in the 

 urine after atophan cannot come solely from the blood as the total amount 

 of uric acid in the blood is much too small. The short duration of the in- 

 creased output in health, 1 to 3 days, seems clearly due to the fact that 

 the stored uric acid is small in amount, while in gout, a disease charac- 

 terized by a tendency to deposit uric acid in the tissues, extra uric acid 

 continues to be excreted under the influence of atophan for weeks or pos- 

 sibly months, because much uric acid is stored in the organs and tissues 

 even when no tophi are present. In the spring of 1918 when the food 

 shortage was acute in Germany Griesbach and Samson gave atophan to 

 subjects without any increased output of uric acid resulting. This ob- 

 servation supports the idea that some uric acid is normally deposited in 

 the tissues, and this store is the chief source of the increased output pro- 

 duced by atophan in healthy persons. 



One would expect the increased output, of uric acid to continue under 

 the influence of atophan until all the excess in the tissues has been removed. 

 For this reason it would seem a good plan to continue the administration 



