514 URIC-ACID METABOLISM AND GOUT 



rate of deposition and the lack of dissolved urates account for 

 the absence of symptoms with the tophi. 1 



That urates may cause necrosis of the tissues has been 

 definitely established, and this may lead to connective-tissue 

 formation and contraction. 2 But the actual increase of uric 

 acid in the blood and tissues in gout is so slight that we are not 

 warranted in saying that the usual tendency to sclerosis in all 

 the organs in gout is due to the action of uric acid, rather 

 than to some other unknown agent or agents. Excess of uric 

 acid in the blood is by no means pathognomonic of gout, for it 

 has been observed also in nephritis, in diseases with corpuscle 

 destruction, and after taking purin-rich food. Furthermore, 

 it is quite possible that the precursors of uric acid, the purin 

 bases, are responsible for more harm than the uric acid itself. 

 Thus, administration of adenin to dogs and rabbits will produce 

 degenerative changes in the kidneys, associated with the depo- 

 sition of substances resembling uric acid and urates in the renal 

 tissue ; and Mandel 3 states that purin bases may cause fever, 

 independent of infection. In this connection it may be men- 

 tioned that many have looked upon renal alterations, leading to 

 failure of excretion of uric acid, as the primary cause of gout ; 

 but the evidence in favor of this is faulty, because frequently 

 renal changes are slight or entirely absent in gout, whereas 

 marked nephritis of all forms may exist without the coexist- 

 ence of gout. 



URIC-ACID INFARCTS 



Uric-acid infarcts, as the deposits of urates and uric acid ob- 

 served in the kidneys of at least half of all children dying 

 within the first two weeks of life are called, give evidence of 

 the slightness of the toxic effects of these substances upon the 

 tissues. Usually little or no change occurs in the renal tubules 

 as a result of these depositions, except such as can be attributed 

 to their mechanical effect. 4 The reason for the formation of these 



1 Almagia (Hofmeister's Beitr., 1905 (7), 466) has found that joint carti- 

 lage placed in urate solutions becomes filled with crystals, which infiltration 

 does not occur with cartilage of any other origin, or with tendons. 



2 Because the gouty tophi do not suppurate, even when ulcerated through 

 the skin, it has been suggested that the urates have antiseptic properties. 

 Bendix (Zeit. klin. Med., 1902 (44), 165), however, could not demonstrate 

 such antiseptic properties experimentally. 



3 Amer. Jour. Physiol., 1904 (10), 452. 



4 I have recently observed a case of fatal hematuria neonatorum, associated 

 with most extensive hemorrhagic infarction of both kidneys. In the bloody 

 urine B. coli was found in large numbers. From the anatomical findings and 

 history it seemed quite possible that the injury of the kidneys by uric-acid 

 infarcts might have determined the localization of the bacteria in these organs, 

 with resulting hemorrhages. 



