AND OTHER URINARY DEPOSITS 89 



kidneys. Even so, the percentage in the blood 

 remains too high, and crystals of sodium biurate 

 are deposited in the cartilages. In joints, this is 

 usually a painful process. 



There is evidence, however, that the impermeable 

 kidneys are not the whole secret of gout. Apparently 

 the tissues, and particularly the joints, are more 

 vulnerable to uric acid in this disease than they should 

 be. In leukaemia, in consequence of the formation 

 and death of the many leucocytes, there is probably 

 more uric acid in the blood than ever exists in gout, 

 yet no joint symptoms are produced. As Walker 

 Hall has stated, " Few will doubt that gouty indi- 

 viduals possess some inborn defect or alteration of 

 nuclein metabolism which lowers the resistance of the 

 tissues in certain directions, and so permits a response 

 to irritants which is scarcely appreciated by those 

 whose metabolism does not exhibit this peculiarity." 



We are now in a position to draw some practical 

 and clinical deductions from the work of the physiolo- 

 gists. An explanation is furnished of the appearance 

 of the uric acid or urates deposit in the urine so 

 common in functional or organic affections of the 

 liver ; this organ is evidently less active than usual 

 i n destroying uric acid. We may draw the following 

 conclusions with regard to the prevention of calculus 

 or gravel in those threatened with these complaints. 

 Meat and broths should be restricted, also tea, coffee, 

 and cocoa ; muscular exercise must be mild, and 

 warning given that fever is dangerous. Of course 

 if uric acid crystals tend to form, plenty of fluid must 

 be taken, and alkaline citrates, acetates, or tartrates 



