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
In any case, whatever be the exact nature of the nucleus, the urate of
soda collects thereupon, the acicular crystals tending to assume the
form of radiating needles. But the successive depositions not being of
regular incidence, the surface of the crystals, in the intervals of
quiescence, becomes covered by _mucin_, animal or earthy matter. Hence,
the concretions display not only a _radiating_, but a _concentric_ or
_laminated_ structure.
The mucin acts as the “binding substance,” the crystals lying in its
meshes, and, moreover, remaining as the framework of the concretion even
after the crystals are dissolved out; in other words, the gouty tophus
is made up of a blend of _crystalloids_ and _colloids_, evolved from
solutions of the same character.
The importance of recognising the true nature of this binding substance,
_i.e._, mucin, merits a brief digression, in light of Ebstein’s view that
local tissue _necrosis_ is a necessary antecedent to uratic deposition.
Now, exhaustive studies of the histology of uratic deposits, both those
experimentally induced and of spontaneous gouty origin, have been
conducted by Freudweiler, His, Krause, and Rosenbach.
All their results, according to Gideon Wells, “indicate that uric acid
and urates excite some slight inflammatory reaction, cause a slight
local necrosis, and seem to act as a weak tissue poison.” According
to Rosenbach, however, this sequence is not invariable, inasmuch as
he noted that such deposits may occur without inducing necrosis. More
pertinently to our contention, however, is it that Krause’s experience
seems to indicate that errors of interpretation were possible. Thus, he
suggests that part of the material in the areas of uratic deposits merely
constituted the _framework_ of a crystalline deposit, though such were
currently regarded as _strands_ of _necrotic tissue_.
But, to resume, tophi being blends of _crystalloids_ and _colloids_, we
must recollect that the suspension capacity of _colloidal_ solutions for
crystalloids is much superior to that of simple solutions, by reason of
the fact that at the surface of each colloidal particle there exists a
zone in which the crystalloids are much more closely aggregated than
elsewhere, thus permitting more crystalloids to be dissolved in the
solvent between the colloidal particles. But, be it noted, this same
tendency to concentration of the crystalloids at the surface of the
colloidal elements leads to the colloids acting as determinants of
_precipitation_ when _crystalloids_ are in excess. Accordingly, when the
crystalloids pass out of solution, they form crystals or precipitates
intimately blended with the colloids. Thus, for example, when uric acid
crystallises out of urine it carries with it the colloidal pigments. On
the other hand, if the colloids are precipitated, the solvent capacity
of the solution being consequently depreciated, the crystalloids are
deposited in intimate relation with the colloids.
Public-domain text, read in full here on John Shaqi.
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