Gout, with a section on ocular disease in the gouty

by Llewellyn J. Llewellyn

Taking 1-3 mg. per 100 c.c. as the normal, the uric acid content of the blood, in typical cases of gout, according to MacLeod, rises to nearly 10 mg. Gudzent, from his studies, maintains that the blood, in almost all cases of gout, contains as much or even more mono-sodium urate than it can hold in solution (1-8 mg.), in other words, it is in effect a supersaturated solution of the relatively insoluble lactim urate.

Pratt, working in Folin’s laboratory, investigated a series of cases of gout, selecting only those in which (1) Tophi were found, (2) A history of characteristic attacks of acute gout was obtained, or (3) Typical symptoms developed while under observation.

At the time of examination the average uric acid content, irrespective of the diet or condition, was 3·7 mg. In three patients on ordinary diet, who were seen during attacks, the amounts were 4·5, 4·8 and 5·7 mg. of uric acid. In two other patients, also seen during attacks, and while on a purin-free diet, the uric acid in four estimates ranged from 2·4-5·1 mg., viz., an average of 3·6 mg. None of these patients were taking atophan.

Seven patients, on a mixed diet, and free at the time from symptoms of gout, contained on the average 4·3 mg. of uric acid in their blood.

On the other hand, examination of the blood in six patients on a purin-free diet, at the time manifesting no acute symptoms of gout, revealed an average uric acid content of 3 mg.

From the foregoing considerations it may be deduced that:—

(1) In gout there is a condition not of uricæmia, but of hyper-uricæmia.

(2) That on the average the blood in gouty subjects contains twice as much uric acid as that of non-gouty subjects, as evidenced by comparison of the average uric acid content of the blood in Pratt’s series of gouty cases (4·5 mg.) with Adler and Ragle’s non-gouty examples (1·7 mg.).

(3) In contrast with non-gouty subjects, the uric acid content of the blood in gouty subjects is augmented on a purin-rich diet.

(4) Both in the inter-paroxysmal periods and during attacks the uric acid content of the blood, when on a mixed diet, is higher than when on a purin-free diet.