Gout, with a section on ocular disease in the goutyLlewellyn, Llewellyn J. (Llewellyn Jones)
Science
Gout, with a section on ocular disease in the gouty
Llewellyn, Llewellyn J. (Llewellyn Jones)
Eye -- Diseases; Gout
Brugsch and Schittenhelm noted that, in gouty victims, uric acid was
still present in the blood even when they had been on purin-free diet for
weeks or months. They held endogenous uricæmia to be a constant symptom
in gout. Even as late as 1913 the former investigator contended that, in
a healthy person on a purin-free diet, the presence of uric acid in the
blood cannot be satisfactorily demonstrated. But it must be recollected
that the _precipitation_ (ammonical silver and cupric bisulphite) method
was beset with disadvantages. An approximate estimate only of the blood
content of uric acid was with difficulty to be achieved even when large
quantities were available.
Fortunately, however, our powers of analysis in this direction became
greatly enlarged with the introduction in 1913 of the colorimetric method
of Folin and Denis.
FOLIN AND DENIS’S METHOD
This colour reaction is so sensitive that one part of uric acid in a
million parts of water can be detected. Moreover, unlike the older
methods which required from 75-100 c.c. of blood or more, determinations
can be made with 20 c.c., and if the blood be rich in uric acid only 10
c.c. Walker Hall observes that the procedure “has many advantages and
does not take up much more time than some of the qualitative methods
when once the technical difficulties are overcome.” He described it as
follows:—
Twenty cubic centimetres of blood are withdrawn into a wide-mouthed,
tared bottle containing 0·1 gramme of finely-powdered potassium oxalate.
The flask and contents are then weighed. Five times the weight of
_n_/100 acetic acid is heated to boiling. The oxalated blood is poured
into the boiling acetic acid solution, and the heating continued until
the solution has begun again to boil. The mixture is filtered hot.
The clear filtrate and wash waters are acidified (0·5 c.c. of 50 per
cent. acetic acid) and evaporated to 3 c.c. Five drops of a 3 per cent.
silver lactate solution, two drops of magnesia mixture, and ten to
fifteen drops of strong ammonia hydrate are next added. The mixture
is centrifugalised. The supernatant fluid is removed. To the residue
five drops of freshly-saturated hydrogen sulphide water and one drop of
strong hydrochloric acid are added. The tube is placed in a beaker of
boiling water for ten minutes in order to remove the hydrogen sulphide.
The supernatant fluid is added to 2 c.c. of a solution containing 100
grams of sodium tungstate and 80 c.c. of 85 per cent. phosphoric acid in
1,000 c.c. of water and 10 c.c. of a saturated sodium carbonate solution.
The resultant blue solution is then compared with a standard uric acid
solution, and the result obtained by the following formula:—
(20_V_)/(_RW_) mg. of uric acid per 100 grams blood,[20]
where 20 represents depth in millimetres of standard solution,
_R_, the depth of unknown solution,
_V_, the volume to which the unknown solution is diluted,
_W_, the weight of blood taken for the determination.
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