Gout : its pathology and treatment / by Arthur P. Luff.

  • Arthur P. Luff
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Gout : its pathology and treatment / by Arthur P. Luff. Source: Wellcome Collection.

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    of Ebstein's theory is that, not only is there no proof that the neutral sodium urate, upon which he depends for the starting of the gouty changes, ever exists in the human body, but, on the other hand, there is strong evidence to show that it never can exist in the human body. The neutral sodium urate is an extremely caustic and unstable compound, and is decomposed in the presence of carbonates, so that it is impossible for it to exist in the blood. The first factor upon which Ebstein relies for his theory of the causation of gout there- fore disappears. Moreover, the responsibility for the assumed necrotic changes cannot be transferred from the neutral sodium urate to the biurate, since Pfeiffer has shown, by means of subcutaneous injections of a solution of a biurate, that although it can produce pain and irritation, yet it cannot cause necrosis, especially when in so weak a solu- tion as must occur in the human body. The assumption by Ebstein that the process of necrosis generates an acid which is supposed by him to convert the neutral urate into the acid urate is based on an imperfect acquaintance with the chemistry of the urates. Sir William Roberts has shown that uric acid is primarily taken up by the blood and lymph as a quadriurate—not as a neutral urate—and he has also proved that the formation and deposition of the crystalline biurate are not favoured by the intervention of an acid. Moreover, in connection with leucocythsemia severe anaemia, and other diseases, to which reference will bo made later, we know that a considerable