In 1909 Gudzent, working in His’s clinic at Berlin, affirmed that in gouty subjects uric acid vanishes from the blood in the presence of radium emanation; moreover, that under the same conditions tophi had been observed to melt away. The explanation proffered by Gudzent was, that the emanation inhibited the transmutation of the unstable and more soluble lactam into relatively insoluble and stable lactim urate, this latter being the salt found in the blood of the gouty.
W. His also claims that the gouty individual benefits by this method of treatment, which, he maintains, not only reduces the uric acid content of the blood, but dissipates uratic deposits in the tissues. On the other hand, at the last Congress of Internists at Wiesbaden (1912) Gudzent and His’s views, though stoutly supported by some, were unacceptable to others, who, although they admitted the favourable influence of radium emanation upon the symptoms of gout, yet contended that its effects could with difficulty be interpreted either in the sense of increasing the solubility of the monourate of sodium or its decomposition into CO₂ and ammonia.
Thus E. V. Knaffl-Lenz and Wiechowski, working in the Vienna Pharmacological Institute, were unable to confirm Gudzent and His’s claim that treatment by radium emanations resulted in destruction or increase in solubility of the mono-sodium urate. On the other hand, in view of the admittedly favourable effect of the emanation on gout, they suggest that it might be due to what they term activation of an uric acid oxidase existing in the human tissues. Yet another view is that in some obscure way radium emanation facilitates the elimination of uric acid through the kidneys.
In regard to the claim that radium emanation has the power of keeping uric acid compounds in their more easily soluble forms, it is interesting to recall the conclusion arrived at by the Lancet’s special commission for investigation of the Bath waters: “The thermal waters of Bath exert a distinct solvent action on uric acid; in our experiments, e.g., it was shown that Bath waters dissolved over five times the amount of uric acid that distilled water would similarly take up at blood heat—i.e., just under 100° F. Since the waters are drunk hot and used hot for bathing purposes, this fact may have an important relation to the therapeutics of Bath waters in the treatment of chronic gouty affections and rheumatism.”
Increased Excretion of Uric Acid.—Delayed excretion of exogenous purin is held to be one of the most characteristic signs of gout. Now, following emanation treatment, Lowenthal and others have noted that this disability on the part of the gouty was apparently removed. For when, at the close of the course, the capacity for dealing with exogenous purins was tested by the intake of large amounts of purin bodies, excretion of the same ensued after a normal fashion. It would seem then that there is not only increased uric acid excretion actually during the progress of a séance of emanation, but also that this enhanced power of coping with purins is maintained subsequently.
Subjective Phenomena of Gout in Relation to Blood Content and Excretion of Uric Acid.—Now, as we have seen, it is claimed that uric acid disappears from the blood in the presence of emanation. But, while in the majority of instances amelioration of symptoms follows reduction of the uric acid blood content, in others improvement ensues even though the amount of uric acid in the blood remains unaltered.
Thus in one of His’s patients under radium emanation striking amendment followed notwithstanding that the blood contained uric acid. In another, the subject of multiple tophi, no uric acid was found in the blood throughout the treatment, and yet the victim had repeated attacks of gout during this period.
Turning to the excretion of uric acid in the urine, similar discrepancies emerge. Thus Mandel out of seven gouty patients under treatment by radium emanation found that an increased uric acid excretion ensued in two subjects. Of the remainder, in two no alteration in average excretion took place, in two a slight diminution, and in one a marked increase, to the extent of 50 per cent.
Now in four of the seven cases an undoubted clinical and subjective improvement was observed, although the uric acid curve showed diminution rather than increase. It seems, therefore, clear that the beneficial effect of radio-active waters in gout involves something more than the dissipation of the uric acid in the blood and its increased elimination in the urine.