Lead poisoning in its acute and chronic forms : the Goulstonian lectures, delivered in the Royal College of Physicians, March 1891 / by Thomas Oliver.

Date:: 1891

Credit: Lead poisoning in its acute and chronic forms : the Goulstonian lectures, delivered in the Royal College of Physicians, March 1891 / by Thomas Oliver. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

184/234 page 104

$blood, it will be thrown out by the urine, and the one circum- stance, in particular, which determines the amount of uric acid thrown out is the alkalinity of the blood. Whatever diminishes the alkalinity of the blood and fluids generally, will favour the retention of uric acid in the tissues, for uric acid, being insoluble, generally leaves the body in the form of urate of ammonia and soda. Whenever, therefore, the administration of medicines is followed by increase of uric acid in the urine—by an increase far in excess of the normal—the explanation, in all probability is, that the insoluble uric acid, which had been deposited in the tissues, around the joints, in the liver, and in the spleen, has been rendered soluble and is being thrown out in the urine. On the other hand, lead, by diminishing the alkalinity of the blood, as Ealfe has shown, lessens the solubihty of uric acid, and must therefore diminish its excretion in the urine. Haig, basing his conclusions upon the relationship of uric acid and urea as being 1 to 33, has shown that on the first day after lead has been, taken, the relationship became 1 to 51. The absence of gout amongst lead workers in the Eorth of England is a point of great interest, physiologically as well as pathologically. Are we perfectly sure that lead^e?- se determines gout ? Sir Wm. Eoberts has not only coined the word “uratosis,” to designate the precipitation of crystalline urates in the tissues or fluids of the body, but appears to me to have raised a most important question. “ It is not easy,” he says,^ “ to believe that lead poisoning produces really and truly the same constitutional diathesis as that which exists in true gout. . . . The gouty diathesis and lead poisoning, while differing in all other respects, have one tendency or vice in common, viz., the tendency to uratosis.” He regards uratosis therefore as a gouty tendency which may be reinforced by lead poisoning, and saturnine uratosis as one in which saturnine poisoning is reinforced by a previously existing gouty tendency. ]\Iy observations go strongly to support this conclusion. ^ British Med. Journ. 1890, vol. ii., p. 1164.$