THE METABOLISM IN GOUT 451 



of atophan until the uric acid output dropped to the previous endogenous 

 level. Brugsch(/) states that this may occur in some cases of gout within 

 a few days, but I have not seen any chemical reports that supported this 

 statement. In polyarthritis urica Brugsch gave atophan daily in 1 to 2 

 gram doses for a year. The excretion of uric acid continued to be high 

 during this entire period. There were no signs of renal irritation. In 

 so-called renal gout, that is, gout with marked renal insufficiency, the same 

 writer found that atophan exerted little effect on the uric acid output. 

 Fine and Chace(c) presented evidence that in .ordinary nephritis not 

 associated with gout the atophan exerted little or no effect on uric acid 

 elimination. 



When a patient with gout is allowed a purin meal on one or two days 

 of the week it is well to give two or three grams of atophan on those days. 



Skorczewski observed an increase of neutral sulphur after ihz admin- 

 istration of atophan, and he further claimed that urochrome was increased. 

 It was later shown that this is not true. The positive diazo reaction ob- 

 tained after giving atophan has no significance as it is due simply to de- 

 rivatives of the drug itself (Greinert). 



Atophan, as Folin and Lyman first showed, reduces the amount of 

 uric acid in the blood. Their observations were confirmed by McLester, 

 Bass, E. Frank (d), Steinitz(a), and Fine and Chace(a). McLester gave 

 a patient whose blood contained 2.4 mg. of uric acid 3 grams of atophan 

 at 9 A. M. Three hours later the amount of uric acid was cut in half and 

 at 3 P. M. only 0.7 mg. was present. Steinitz observed a fall in the blood 

 uric acid content from 4.8 mg. to 3.7 mg. after a dose of atophan. Retzlaff 

 and also Gudzent, Masse and Zonder claim that in all the cases they studied 

 atophan increased the blood uric acid. Their results are probably due 

 to the use of faulty methods of chemical analysis. Griesbach and Samson 

 in a recent paper state that at the end of twenty-four hours they found 

 the uric acid in the blood nearly always diminished and never increased. 

 They did find, however, in some cases an initial rise of the blood uric acid 

 above the endogenous level. This increase in persons not on a purin poor 

 diet may extend over several hours. In one of their cases the uric acid 

 rose from 3.7 nig. to 5.7 mg. in half an hour after the administration of 

 three grams of atophan. Their findings are important if true, but need 

 confirmation before they can be accepted. 



It is quite possible that atophan removes uric acid from the plasma and 

 not from the blood corpuscles (Frank and Pietrulla). 



After the discontinuation of atophan the uric acid increases rapidly 

 in the blood. In the experiments of Fine and Chace it returned to 'the 

 original level twenty-four hours after the last dose of atophan. 



Weintraud held that the atophan exerts a selective action on the kid- 

 neys, "an elective increase of a partial function of the tubuli contorti," 

 which causes a freer excretion of uric acid. The renal theory of atophan 





