454 JOSEPH H. PRATT 



It has long been known that the salicylates cause a significant increase 

 in the output of uric acid (Rockwood, Pietrulla). Fine and Chace(&) 

 held that sodium salicylate acted better than atophan in the removal of uric 

 acid. Twice it caused an almost complete disappearance of uric acid from 

 the blood. In one case of gout eight grams of sodium salicylate reduced 

 the blood content from 4.4 mg. to 3.2 mg. The eight grams of sodium 

 salicylate were given for two more days, and the uric acid fell further 

 to 1.4 mg. Denis (a) gave eight grams of sodium salicylate daily for three 

 days in a case of gout. The uric acid in the blood fell from 4.1 mg. to 

 0.4 mg. Aspirin has a similar action. 



Large doses of salicylates are required to produce this effect and 

 a small dose, that is, one under two grams daily, may even cause a lessened 

 output (Fauvel). Atophan on the other hand in a dose of 0.5 gram may 

 increase the uric acid excretion more than 100 per cent and even 0.25 

 gram has raised the output 13 to 18 per cent (Nicolaier and Dohrn). 

 Denis found that an amount of sodium salicylate as high as 3.3 grams 

 (50 grains) in a day had no effect on the uric acid output. 



Some physicians have claimed good results from the use of salicylates 

 in gout, but on the whole it has not been highly esteemed in this disease. 

 If there is intolerance to phenylcinchoninic acid and its derivatives the 

 salicylates should be employed. One should remember that large doses 

 are necessary, 5 to 8 grams daily, in order to increase the uric acid output. 



In acute attacks rest to the inflamed parts is absolutely necessary. 

 Warm dry applications lessen the pain more than moist compresses. As 

 soon as the acute paroxysm has passed the patient should be enjoined to 

 leave his bed and exercise in increasing measure. During convalescence, 

 massage and gymnastics may be of value. The diseased joints should be 

 protected from injury or excessive exercise. If this is not done the inflam- 

 mation may quickly return. 



Exercise in the intervals between acute attacks and in chronic gout 

 is undoubtedly of great importance. The manner in which it acts so 

 beneficially is unknown. Sometimes exercise seems to increase the uric 

 acid output, but many observations have been made in which there was 

 no increase after exercise (Sherman). 



Gentle exercise in the open air should be taken regularly. An incen- 

 tive should be found to lure the patient out-of-doors. Horseback riding, 

 rowing and golf are forms of exercise well suited to gouty persons. 



Local electric light baths are often useful in chronic gout. In robust 

 patients with strong hearts much benefit may result from sea baths. 



Radium emanations have been highly extolled, especially by His and 

 his pupils. Fine and Chace in careful experiments found that neither 

 the intravenous administration of the bromid nor inhalations for long 

 periods in strengths as high as 100 Mache units per liter influenced the 

 uric acid content of the blood. 



