Blood-vessels numerous; heart large and powerful; blood-corpuscles numerous; skin over malar bones highly vascular (florid complexion); skin fair, firm, oleaginous, perspirable; eyes blue; hair thick, not falling easily; teeth massive, well-enamelled, regular, even, undecayed in advanced life; malar bones flattened; head symmetrical; nasal bones well-formed, nose aquiline or of mixed form; lower jaw massive; lips symmetrical.
Form.—Figure for the most part tall; thorax broad at the summit; ribs well-curved; abdomen full; muscles firm, large; limbs large, robust; gait erect, well-poised. Nutrition active; digestion vigorous; appetite great for animal food and alcoholic stimuli. Respiration deliberate, deep; circulation vigorous; animal heat abundant; locomotion active; aptitude for exercise and outdoor amusements. Reproductive powers active; innervation abundant, the mental powers vigorous and enduring.
Physiognomy of the Sanguine Gouty Cachexia.—Blood-vessels largely developed over the malar bones and varicose; skin oily, yellow from subcutaneous deposit of fat; hair thick and white; teeth numerous, discoloured, crusted with tartar; lips bluish, nose reddish, hypertrophied; arcus senilis; abdomen pendulous; limbs thick; joints nodose; nodosities on the ends of the fingers, lobes of ears, fascia of muscles, and tendons; respiration hurried, wheezing; pulse intermittent, irregular; stomach flatulent; digestion acid; urine loaded with lithates; temper irritable; mind sometimes enfeebled.
The local diseases of the arthritic cachexia are principally seen in adult males past the age of forty-five. They consist especially in chronic inflammation of the muscular and articular tissues; in calcification of the basilar and coronary arteries, and of the cardiac valves. These changes give rise to hæmorrhagic apoplexy, angina pectoris, cardiac hypertrophy and dilation; and to secondary pulmonary affections, as emphysema, pulmonary apoplexy, and asthma. Irritation of the mucous surfaces may give rise to nephritis, pharyngeal and laryngeal coughs, and diarrhœa.—Med. Observation and Research, 2nd edition, pp. 96-98.
[6] According to Fischer the protein molecule can be split up into amino-acids, di-amino-acids, aromatic-amino-acids, nitrogenous derivatives of the benzene ring, pyrimidine bases, pyrrolidine derivatives, cystin, and ammonia. During proteolysis the amino-acids exist in groups, e.g., glycine and leucine (glycyl-leucine), two leucine radicles (alanyl-leucine), etc.—which combinations Fischer termed polypeptides, and some of which he has been able to produce synthetically. Furthermore, Fischer proved that nitrogen equilibrium can be maintained in animals by feeding them upon these polypeptide products of proteolytic digestion which no longer gives the biuret reaction. The derivation of amino-acids, etc., from peptone is the outcome of the action of a special intestinal ferment—erepsin. This enzyme is found not only in the alimentary tract, but in all tissues of the body, its action being especially developed in the renal tissues.
[7] Glycocoll in solution dissociates more H-ions than OH-ions. In the presence of alkalies this acid character is more marked, so that it tends to throw the uric acid salts out of solution. The inhibitory influence of the urea upon the precipitation of uric acid from solutions is due to its basic nature.
[8] Recent researches by S. R. Benedict show that uric acid, in the blood of most mammals, exists in combination, but not in that of the bird. Fresh ox-blood (Folin method) contains only 0·30005 gram, free uric acid per 100 grams of blood. But after boiling the protein-free blood filtrate with hydrochloric acid the uric acid content was about ten times as high. Moreover, this same augmented uric acid content was found to exist “in whole blood that had been allowed to stand for some time, indicating that the uric acid compound can be split by means of an enzyme.” The compound exists, not in the plasma, but in the corpuscles. MacLeod, to whose work on bio-chemistry we are indebted, remarks that “It is of some significance that after thus setting free the uric acid, there should be about 50 per cent. more of it present in the blood of the ox than in that of the bird, where most exists in a free state in the serum, although the urine of the ox contains only the smallest trace of uric acid, and that of the blood is loaded with it. Investigation of the condition of uric acid in human blood is at present in progress.”
[9] According to Sir William Roberts, there are three compounds of uric acid (H₂U)—the neutral urate, M₂U, in which the metal replaces all the displaceable hydrogen, the biurate, MHU, in which half the displaceable hydrogen is replaced by the metal, and the quadriurate H₂UMHU, in which one-fourth of the displaceable hydrogen of two molecules is replaced by the metal.
Hutchison and Tidy suggest “that if Roberts’ salt be considered as NaHU. MH₂U instead of Na. HU, his hypothesis remains unaltered, whilst much of the criticism urged against it is nullified. The possibility of such a substance is shown by the existence of the compound LiHU₄HU. Roberts’ theory, or such a modification, is not inconsistent with Von Noorden’s views if these intermediate salts be regarded as within the tabernacle of organic combinations from which the kidneys can split off and excrete the uric acid.”
[10] “If further investigations yield facts which sustain such an idea, it may be more easy to comprehend the types of the demands which are made upon the renal functions.... One of the next stages of research will be the determination of the behaviour of renal tissue to the various purin isomers. This may lead on to the identification of the types of nuclein derivations and their precise cellular origin. Perhaps this in turn may reveal whether there are any differences between the nucleotides of normal and gouty tissues. To this end progress in the technics of the cultivation of tissues in vitro may furnish a means for the elucidation of some of these questions.”—Walker Hall.