Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    845/976 (page 825)
    quantities. Some patients suffer in early life from calculus, in after periods from Gout; in other subjects calculus and Gout alternate, and occasionally the two affections are present at the same time. Oxalic acid, which is so readily produced from uric acid, not infrequently occurs in the urine of gouty subjects, and may lead to the formation of calculi. . . The existence of a gouty diathesis has been regarded as antagonistic to the development of phthisis; I have, however, seen instances in which phthisis and Gout have run a simultaneous course. Gout and diabetes occasionally occur in the same individual, but the development of the latter is usually followed by the cessation of the former disease. Condition of the Blood in Acute and Chronic Gout.—The blood undergoes important alterations in Gout, changes which are almost in themselves pathognomonic, and which require to be carefully studied and clearly understood. In the writings of the ancients, nothing definite is found on this subject; and even until the past few years our knowledge of the state of this fluid in Gout may be said to have been of little value. The blood corpuscles, as far as yet known, undergo no necessary change either in number or quality ; they become lessened in chronic forms of this disease, when the general nutrition of the body is im- paired, but not more so than in other maladies. Many of the poorer subjects of chronic gout, it is true, are pale and anaemic, and among painters and other gouty patients who work in lead, this is often due more to the influence of the metal which has been imbibed than to any other cause. It is in the serum of the blood that the chief deviation from the healthy standard is discovered; and in this portion it is not so much that the normal constituents are affected, as that excretary substances which should have been eliminated are retained—an effect due to the imperfect action of certain of the excreting organs, more especially the kidneys. In healthy blood, it is impossible by ordinary tests to discover the presence of uric acid, the quantity being so extremely small—in fact, almost inappreciable ; but in Gout one can easily not only show its presence but even obtain it in a crystalline form. It was first proved to be present by the author in 1847.* The following process can be adopted for its detection :—The serum of the blood is first dried over a water-bath, then reduced to coarse powder, and treated with hot alcohol; the spirit being removed, the residue is afterwards to be_ digested for some minutes in distilled water, and raised to the boiling point; the watery solution is then filtered and evaporated to a thin syrupy consistence. A drop or two of the solution, when heated on a piece of porcelain, with nitric acid and ammonia afterwards added, exhibits at once the murexide test. A small portion of the same solution, if acidulated strongly with acetic acid, * Mcdico-Chirui'gical Transactions, 1848.