GOUT 511 



for any pathological conditions whatever, except uric-acid calculi, 

 " uric-acid infarcts " in the kidneys, and certain manifestations 

 of gout. Uric acid is possessed of but a very slight degree 

 of toxicity, and the body is able to destroy it in such large 

 measure that an actual intoxication with uric acid probably 

 never occurs. 



The amount present in the urine may be very considerably 

 increased by eating food rich in purins, of which sweet-breads, 

 liver, and kidney are the best examples ; and also coffee with its 

 caffein (trimethyl purin l ). Large quantities of meat will also 

 increase the uric acid, because of the free purius contained in 

 muscle. However, the amount of uric acid in the blood is not 

 correspondingly raised, this being regulated by the destructive 

 and binding function of the tissues, arid by excretion through the 

 kidneys. Whenever much destruction of the nucleoproteids of 

 the tissues is occurring in the body, the elimination of endogenous 

 uric acid becomes abnormally raised, the best examples being 

 the resolution of pneumonic exudates, and leukemia, especially 

 leukemia under #-ray treatment (q. v.). In neither of these 

 conditions, however, can any symptoms or tissue changes be 

 referred to the excessive uric acid. It is quite possible that 

 the power of the body to oxidize uric acid may be decreased 

 under certain conditions ; thus, alcohol is found to cause a 

 decided increase in uric-acid elimination, particularly after 

 purin-rich foods have been taken (Chittenden), and this effect 

 is ascribed to lessened uric-acid destruction. However, we 

 have no evidence that, except possibly in gout, this decreased 

 destruction of uric acid under the influence of alcohol causes 

 harm. It has been shown that severe organic lesions involv- 

 ing the liver (phosphorus poisoning) do not cause a marked 

 decrease in the power of oxidizing uric acid. 



GOUT 



After adjusting the many contradictory statements of earlier 

 investigators, the present status of our conception of uric-acid 

 metabolism in gout may be briefly summarized as follows : The 

 excretion of uric acid in patients with chronic gout, when kept 

 upon a definite diet, does not differ from the excretion of normal 

 individuals on the same diet, except in cachectic arthritics, with 

 whom the elimination of uric acid is small. Normally the 

 elimination of uric acid varies within rather wide limits, even on 



1 Concerning the effect of diet upon purin excretion see Taylor, Amer. 

 Jour. Med. Sci., 1899 (118), 141. 



