Gout. Podagra. . Arthritis Urica. 565 



The uric acid theory is favored by the constant presence of 

 this acid in considerable amount in the blood of birds, and by 

 ■ Ebstein's experiment in tying the ureters, but it has to face the 

 fact that young and active birds living in the open air, and hunt- 

 ing for their food do not suffer, that it is usually scanty in the 

 blood of man just before an attack, that Oilman Thompson failed 

 to produce any symptoms of gout by injecting into the' blood of 

 animals more uric acid than the amount which they normally 

 excrete in twenty-four hours, that the familiar symptoms of 

 uric acid poisoning are not at all those, of gout, and that the ex- 

 cess of uric acid in leucaemia, anaemia and pneumonia produces 

 no such symptoms. In addition to excess of uric acid some 

 other factor is required. 



Xanthin bases (Xanthin, hypoxanthin, etc.) found in the blood 

 by various observers, are derived from albuminoids, especially 

 nuclein and nuclein bases, including in man caffein and theine, 

 and being closely allied to uric acid are believed to have a nearly 

 similar action. 



• Various forms of abnormal metabolism are invoked as the 

 cause of uric acid and gout, and Haig and Vaughan hazard 

 the theory that the breaking down of the nuclein is an important 

 factor. This and other metabolisms are atrributed to the local 

 action of the uric acid and urates, and again to a fault in innerva- 

 tion. The imperfect action of the liver where the uric acid should 

 be largely resolved into the more soluble urea, and of the kid- 

 neys through which it should be promptly excreted must be at- 

 tributed to a nervous source. Ivevison incriminates the granular, 

 contracted, inactive kidneys. 



Ebstein attaches great importance to impaired nutrition in the 

 affected tissues which undergo necrotic changes that pave the 

 way for the deposition of urates in their substance. This is some- 

 what sustained by the occurence of the local deposits in tissues in 

 which circulation and nutritive changes are slow, and in older 

 animals in which not only are the osseous tissues more calcic and 

 less vascular, but the articular lamella has been formed by 

 cretefaction of the bone and cartilage. Haig suggests that in the 

 old, the joints are less vascular and less alkaline, and more sen- 

 sitive to cold. On the other hand those in the greatest vigor of 

 life are more ravenous, digest more actively and are in this sense 



