In 1901 Vogt showed that in gout the excretion of exogenous purins was not only delayed but diminished. Giving simultaneously to a gouty subject and a healthy individual a diet rich in purins, he found that, in the former, retention and delayed excretion of purins ensued. Vogt’s findings were confirmed by Reach, Soetbeer, Pollak, Mallory, and others.
Brugsch and Schittenhelm also observed that, following the intake of purin-containing substances, the exogenous uric acid excretion was retarded and reduced; in other words, the percentage of exogenous nitrogen excreted as uric acid nitrogen is less than in normal individuals, although the increased elimination extends over a longer period of time.
On the other hand, Walker Hall finds that, though there is retardation, there is no diminution in the output in gouty subjects. Thus he states: “When an adult takes a meal consisting of half a pound of beef and a quarter of a pound of sweetbread, containing about 0·620 gram purins, the moiety which usually occurs in the urine, say 0·300 gram, is not fully excreted until 6-10 hours have elapsed. When a similar meal is taken by a gouty individual the full 0·300 gram is eliminated, but the rate of output is delayed, some 48-72 hours being necessary.”
The same observer states that, given intravenous injection of acid into a normal man, its elimination is spread over several days, and the total amount injected fails to appear in the urine. But if the injection be administered during a course of atophan, then the uric acid excretion is completed within twenty-four hours, and the whole amount injected can be recovered from the urine. Now if in a gouty subject the same method of procedure be adopted, the sequence of events is precisely similar, and like results have been reported, following the administration of sodium salicylate to vegetarians of five or more years’ standing. To sum up, the above findings would appear to indicate that:—
(1) A gouty subject can excrete exogenous purins as adequately as a normal man, but he takes longer to do so.
(2) If the extra purins be taken during a course of atophan, even this departure from normal is obliterated, i.e., the customary delay in excretion is obviated.[18]
But, unfortunately for the diagnostic valency of this symptom in gout, viz., retarded exogenous purin output, it has not been found to be invariable. Thus Magnus Levy has shown that, in some instances of gout, the elimination of exogenous purin is neither reduced nor protracted. Pratt, too, has confirmed this observer’s findings, while, as we shall see later, this authority, also McClure, Mallory, and others, have placed on record the still more disconcerting fact, viz., that a diminished and retarded output of exogenous purin is not peculiar to gout.
The inference then would appear to be that:—
(1) Reduction and retardation of the excretion of exogenous purin, though common in gout, is not invariable.
(2) The same is not peculiar to gout, but occurs in other disorders.