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.

    847/976 (page 827)
    action; in fact, the fibrin follows the same laws as in other forms of inflammation ; hence, in acute gout, if blood is abstracted, the sur ace of the clot exhibits a buffed and often a cupped appearance. Condition of the Blood in the intervals between the Attacks of Bout. It is a matter of some importance to ascertain the state of the blood in o'outy subjects, when no inflammatory action is present; that is, durino' the complete intervals of the attacks. Although a somewhat difficult task, from the unwillingness of patients to be bled when not suffering from pain or fever, I have been enabled, in a few instances, to collect some facts of importance on this point. 1. In the intervals between the early attacks of Gout no appreciable amount of uric acid was found in the blood. 2. A very marked decrease of uric acid was observed in the blood of patients partially recovered from an acute attack. 3. In chronic gout the blood, even in the intervals between the exacerbations, was always rich in uric acid. 4. In some cases when symptoms of irregular gout were mani- fested, without any accompanying joint disease, uric acid was present in the blood. State of the Urine in different forms of Gout.—Much error prevails in regard to the alterations which the urine of gouty subjects exhibits during the progress of the disease, and such misunderstandings have partly arisen from the prevalent idea, that the appearance and non- appearance of certain principles in the urine necessarily indicate their presence or absence in the blood; and partly from a want of accurate knowledge of the reaction of healthy urine. It must be remembered that healthy urine exhibits a strongly- marked acid reaction, and that this is, in all probability, due, not to the presence of a free acid, but to the existence of an acid phosphate, probably the phosphate of soda (2 HO, HaO, P05), a salt containing two eqruvalents of water and one of soda to each equivalent of tribasic phosphoric acid. The acidity of urine varies much at different times of the day, and is in close relation to the state of the digestive functions. The fact of the acidity of healthy urine has been specially insisted upon, because the application of litmus papers is not infre- quently made both by medical men and patients, and very wrong deductions drawn from the indications thus obtained. It must be remembered that a strong acid reaction is no proof of the presence of any abnormal state of the urine; and that urate of soda is one of • its constituents, a salt which can exist in a solution of the acid phosphate without decomposition, and hence the possibility of the co-existence of the urate of soda with an acid condition of the urine. The amount of uric acid passed by a healthy subject during twenty- four hours is from eight to ten grains—a quantity capable of existing in solution when the urine is in a healthy state. Having premised thus much, we are better prepared to speak of certain changes which are observed in the urinary secretions in Gout,