How fallacious, it now transpires, were the assumptions based upon the mere uric acid output in the urine, and how little understood even to-day the many conditions that determine its variations.[17] But, fortunately, we can now to some extent control and review our urinary findings in light of the uric acid content of the _blood_. But we anticipate, and meanwhile let us confine our discussion to the variations in uric acid excretion that occur in _gout_, and this as revealed by more modern students of the disease. This will be more conveniently dealt with if we consider first the oscillations in uric acid output in relation to _acute_ attacks of the disorder, and subsequently the same as met with in its more _chronic_ manifestations. URIC ACID VARIATIONS IN ACUTE GOUT Generally speaking, there appears to be a consensus of opinion on the following points:— (1) That in the _intervals_ between _acute_ attacks of gout the elimination of uric acid lies within the normal limits, but that (2) For one or two days _prior_ to an acute attack an appreciable _decline_ in the output of uric acid occurs. This, however, is not so marked as the subsequent (3) _Increased_ output of uric acid _during_ the acute attack. According to Magnus Levy the increase may reach from 0·3-0·5 gram, daily, and more, and may sometimes last for a week or even two. (4) Following attack a tardy decline in uric acid output to former level. To sum up, during an attack of _acute_ gout the uric acid output stands at a relatively low level between the paroxysms. But one or two days before the oncoming attack a _diminution_ in uric acid output ensues. In contrast with the outbreak of the attack, the uric acid excretion _increases_ markedly, this enduring for a week or more, when the output again _declines_. The augmented output _during_ the paroxysm is more constant than the diminished excretion antecedent thereto. Now, while it may be taken that the foregoing variations in _uric acid output_, prior, during, and subsequent to, acute attacks, obtain as a general rule, such behaviour is not invariable; for, unfortunately, as Wells reminds us, instances are met with in which “the uric acid excretion shows no variation from that of normal persons.” URIC ACID VARIATIONS IN CHRONIC GOUT