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520 PYORRIII'Li . 1 L VI'JOLA JUS.
The gouti/ diafhcsis, in the troneral a('('ej)tati()ii of the term, is a con-
stitutional malady which manifests itself under a great variety of forms
in different individuals. It is characterized by an excess of uric acid
and its congeners in the blood, due either to increased production,
through im]iaired or im])erfect assimilation of nitrogenous food, or to
imperfect elimination of the normal amount of urates by the kidneys.
In either event tluM'c is a disturbance of the normal relations between
uric acid production and the general nutritional j)rocess. The protean
forms under which the diathesis manifests itself will vary in accord-
ance with i\w type of constitution and with the peculiarities of organi-
zation and the degree of vitality of individual organs and tissues. The
lesions or j)athological states observed arc believed to be caused by the
deposition into the tissues, from the l)lood, of urate of sodium. This
diathesis is undeniably hereditary, as its presence is detectable in one
form or another in fully 75 per cent, of all cases in two and even three
generations. The diathesis can also be acquired by individuals who are
subjected to the causes which rendered the diathesis hereditary. The
age at which the local expressions manifest themselves lies between the
thirty-fifth and fiftieth years, at a time when growth has ceased and the
food supply is required only for tissue repair and heat production. It
is most common among those who lead sedentary lives, who indulge in
an excess of nitrogenous food beyond the capacity of the individual to
perfectly oxidize, and those wdio consume excessive amounts of fer-
mented and malted beverages and the heavier wines.
The immediate cause of all gouty expressions appears to be the pres-
ence of urates in the blood. The amount normally present is so slight
that it is almost non-detectable by ordinary chemical methods. It was
shown by Dr. Garrod that in gouty conditions the amount was increased
to as much as 0.175 per 1000 parts, and that this apparently small
quantity was quite sufficient to act as the irritating cause of gout—
fact corroborated by other observers.
The various theories which have been advocated from time to time
in explanation of this uric acid increase in the blood plasma are unsatis-
factory and contradictory ; whether it is the result of imperfect elimina-
tion or of increased production through excess of nitrogenous foods it
is difficult to state positively in the present state of pathology. It is
quite probable that the diathesis is a neurosis which affects simultane-
ously the assimilative as well as the excretory functions of the body.
Whatever the explanation may be as to the accumulation of urates,
their presence in the blood is generally admitted to be the immediate
cause of any gouty manifestation. Dr. Dyce Duckworth states that " No
conception of this malady is possible which should exclude from its
purview the part played in it by uric acid ; " " The most unequivocal
520 PYORRIII'Li . 1 L VI'JOLA JUS.
The gouti/ diafhcsis, in the troneral a('('ej)tati()ii of the term, is a con-
stitutional malady which manifests itself under a great variety of forms
in different individuals. It is characterized by an excess of uric acid
and its congeners in the blood, due either to increased production,
through im]iaired or im])erfect assimilation of nitrogenous food, or to
imperfect elimination of the normal amount of urates by the kidneys.
In either event tluM'c is a disturbance of the normal relations between
uric acid production and the general nutritional j)rocess. The protean
forms under which the diathesis manifests itself will vary in accord-
ance with i\w type of constitution and with the peculiarities of organi-
zation and the degree of vitality of individual organs and tissues. The
lesions or j)athological states observed arc believed to be caused by the
deposition into the tissues, from the l)lood, of urate of sodium. This
diathesis is undeniably hereditary, as its presence is detectable in one
form or another in fully 75 per cent, of all cases in two and even three
generations. The diathesis can also be acquired by individuals who are
subjected to the causes which rendered the diathesis hereditary. The
age at which the local expressions manifest themselves lies between the
thirty-fifth and fiftieth years, at a time when growth has ceased and the
food supply is required only for tissue repair and heat production. It
is most common among those who lead sedentary lives, who indulge in
an excess of nitrogenous food beyond the capacity of the individual to
perfectly oxidize, and those wdio consume excessive amounts of fer-
mented and malted beverages and the heavier wines.
The immediate cause of all gouty expressions appears to be the pres-
ence of urates in the blood. The amount normally present is so slight
that it is almost non-detectable by ordinary chemical methods. It was
shown by Dr. Garrod that in gouty conditions the amount was increased
to as much as 0.175 per 1000 parts, and that this apparently small
quantity was quite sufficient to act as the irritating cause of gout—
fact corroborated by other observers.
The various theories which have been advocated from time to time
in explanation of this uric acid increase in the blood plasma are unsatis-
factory and contradictory ; whether it is the result of imperfect elimina-
tion or of increased production through excess of nitrogenous foods it
is difficult to state positively in the present state of pathology. It is
quite probable that the diathesis is a neurosis which affects simultane-
ously the assimilative as well as the excretory functions of the body.
Whatever the explanation may be as to the accumulation of urates,
their presence in the blood is generally admitted to be the immediate
cause of any gouty manifestation. Dr. Dyce Duckworth states that " No
conception of this malady is possible which should exclude from its
purview the part played in it by uric acid ; " " The most unequivocal
