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
Injecting uric acid intravenously into _gouty_ subjects, Umber noted
that at times the whole was retained, but on some occasions was excreted
in fractional portions. On the other hand, a _normal_ individual under
similar circumstances eliminates it completely. In explanation thereof,
he proffered the opinion that this failure on the part of gouty persons
to excrete exogenous uric acid was due to a _special affinity of their
tissues for uric acid_.
As to intravenous injection of uric acid, however, modern investigation
has established that, both in normal as well as gouty subjects, its
excretion is spread over several days, and the _whole_ is _not_
recoverable from the urine. Now this incomplete excretion or _retention_
of uric acid was attributed to _defective elimination by the renal
cells_; but, as shown in a previous chapter, this conception fails of
demonstration. Nor, for that matter is there any proof either that the
retention is due to _fixation of the uric acid in the blood serum_.
Accordingly, to our minds, it is permissible then to canvass the further
possibility adumbrated by Umber, viz., that an _increased affinity of
the tissues for uric acid_ may haply account for the diminished purin
excretion, the excess of uric acid in the blood, lymph, and tissues, and
that these same may lead to _uratic deposition_.
This last hypothesis derives colour from the findings of Schmoll, Magnus
Levy, Vogt, Reach and Bloch, who noted that, after giving thymus to
_gouty_ persons, they found far less uric acid in the urine than in
the case of normal subjects. Also, that the ingestion of thymus by the
victims of _chronic_ gout repeatedly resulted in acute outbursts of
the disease. Moreover, as we saw when discussing the _sources_ of uric
acid, there are cogent reasons for avoiding a too restricted conception
which would make the leucocytes, the muscles, or the digestive glands
alone responsible for the _endogenous production of uric acid_; in other
words, that a more catholic attitude on our part is indicated, one which
would envisage it as the outcome of continuous and _general cellular_
wear and tear. That an _increased cellular destruction_, as induced
experimentally, _e.g._, by exposure to Röntgen rays, is capable of
raising the _blood content_ of _uric acid_ in a _gouty_ subject, and of
precipitating a gouty paroxysm, may be inferred from the researches of P.
Linsen.
RETENTION CAPACITY OF TISSUES FOR URIC ACID
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