Am6SoberP1i9i71'  }       Pharmacologic  Superstitions.  459 
it  into  uric  acid,  and  the  deposit  in  the  joints  is  not  of  the  acid  but 
of  the  monosodium  urate. 
As  regards  the  solvent  properties  of  lithium  toward  uric  acid, 
while  it  may  be  regarded  as  true  that  relatively  concentrated  solutions 
of  lithium  will  dissolve  more  uric  acid  than  water,  yet  in  proportions 
in  which  it  can  occur  in  the  blood  it  exercises  no  such  solvent  effect. 
Krumhoff14  found  that  water  containing  0.012  per  cent,  of  lithium 
chlorid  would  dissolve  less  uric  acid  than  distilled  water.  Roberts15 
says  that  he  has  found  experimentally  that  the  addition  of  lithium 
carbonate  in  the  proportion  of  0.1  per  cent,  or  0.2  per  cent,  to  blood 
serum  had  not  the  slightest  effect  in  enhancing  the  solvent  power 
of  this  medium  for  sodium  urate.  Good16  found  that  the  fatal  dose 
of  lithium  chlorid  for  the  cat  was  less  than  0.4  gm.  per  kilogram 
hypodermically.  Supposing  that  the  lithium  was  equally  distributed 
throughout  the  various  tissues  of  the  body,  this  would  mean  evidently 
a  concentration  of  0.04  per  cent,  in  the  blood.  It  is  manifest,  there- 
fore, that  lithium  if  given  even  in  fatally  toxic  doses  cannot  increase 
the  solvent  power  of  the  blood  for  the  salts  of  uric  acid. 
Some  have  attempted  to  attribute  the  supposititious  beneficial 
action  of  lithium  in  gouty  conditions  to  its  diuretic  powers  or  to  its 
antacid  action.  As  to  the  former,  Good  found  that  lithium  chlorid 
has  no  greater  diuretic  power  than  sodium  chlorid.  As  to  the 
alkalizing  properties,  while  it  is  true  that  by  the  administration  of 
sufficient  doses  of  the  carbonate  or  citrate  of  this  base  one  can 
render  the  urine  alkaline,  the  same  thing  is  true  of  the  corresponding 
salts  of  either  sodium  or  potassium.  Moreover,  there  is,  to  say  the 
least,  grave  doubt  as  to  the  real  benefit  of  alkalies  in  gout.  Roberts 
says,  "  I  have  repeatedly  administered  the  bicarbonate  and  citrate 
of  potash  continuously  for  three  or  four  years  in  sufficient  doses 
to  maintain  the  urine  persistently  alkaline,  yet  I  have  seen  the  ar- 
thritic attacks  recur  with  apparently  unabated  regularity." 
It  is  to  be  noted  that  even  if  we  accept  Garrod's  theories,  the  use 
of  lithium  must  be  limited  to  cases  of  typical  gout  with  paroxysmal 
attacks  of  arthritis.  Even  the  blind  adherence  to  these  improbable 
hypotheses  affords  no  reason  to  believe  in  its  usefulness  in  the 
various  atypical  manifestations  of  disturbed  metabolism  which  we 
14  Krumhoff :  Inaug.  Diss.,  Gottingen,  1884. 
15  Roberts,  William :  On  the  Chemistry  and  Therapeutics  of  Uric  Acid 
Gravel  and  Gout,  Croonian  Lectures  for  1892,  London,  1892,  p.  129. 
16  Good :  Am.  Jour.  Med.  Sc.,  1903,  cxxv,  273. 
