666 URINE. 



water l and of alkalies. 2 Certain medicines, such as quinine and atro- 

 pine, diminish, while others, such as pilocarpine and, as it seems, salicylic 

 acid, 3 increase the elimination of uric acid. 



There is much diversity of opinion regarding the elimination of uric 

 acid in disease, 4 although it is known that it is increased after an 

 abundant destruction of nucleated cells as in pneumonia, after the 

 crisis, and in leucaemia. In leucaemia in most cases not only is the elimina- 

 tion to the urea increased absolutely, but a] so relatively; and the relation 

 between uric acid and urea (total nitrogen calculated as urea) may in 

 lineal leucaemia even be 1:9, while under normal conditions, accord- 

 ing to different investigators, it is 1 :50 to 70 to 100. As to the behavior 

 of uric acid in gout, authorities are by no means agreed. That the 

 blood contains uric acid in gout has been repeatedly shown, and it is 

 also found with a purine-free diet (BRUGSCH and SCHITTENHELM) . Accord- 

 ing to the extensive investigations of BRUGSCH and SCHITTENHELM 5 the 

 endogenous uric acid elimination (see below) is not higher in chronic gout, 

 but rather lower than normally, and gout is more probably characterized 

 by a diminished enzymotic formation of uric acid as well as by a decreased 

 enzymotic destruction of uric acid. This last moment is the cause for 

 the appearance of uric acid in the blood and its accumulation in certain 

 tissues. 



Formation of Uric Acid in the Organism. Since HORBACZEWSKI 

 first showed that uric acid could be produced by oxidation from the 

 nuclein-rich spleen-pulp or nucleins outside of the body, he also showed 

 that nucleins when introduced into the animal body caused an increase 

 in the elimination of uric acid. These observations have been confirmed, 

 and at the same time developed by the work of a great number of investi- 

 gators, and we are sure that uric acid can be produced from purine 

 bases either outside or inside the animal body, and also that food rich 

 in nucleins (especially the thymus gland) increases the elimination of 

 uric acid and purine bases (alloxuric bases 6 ) . The original view of 

 HORBACZEWSKI, that the nucleins do not directly cause an increased 

 elimination of uric acid, but indirectly by causing a leucocytosis with 

 a consequent destruction of leucocytes, has been generally discarded. 



1 See Schondorff, Pfluger's Arch., 46, which contains the pertinent literature. 



2 See Clar, Centralbl. f. d. med. Wissensch., 1888; Haig, Joura. of Physiol., 8; and 

 A. Hermann, Arch. f. klin. Med., 43. 



3 See Bohland, cited from Maly's Jahresber., 26; Schreiber and Zaudy, ibid., 30. 



4 In regard to the extensive literature on the elimination of uric acid in disease 

 we must refer to special works on internal diseases. 



5 Zeitschr. f . exp. Path. u. Therap., 4. 



6 As it is not within the scope of this book to enter into a discussion of the numer- 

 ous researches on this subject, we will refer to Wiener, " Die Harnsaure," Ergebnisse 

 der Physiol., 1, Abt. 1, 1902. 



