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THE

BROOKLYN MEDICAL JOURNAL

Published Monthly under the supervision of the Medical Society of the County of Kings.

ENTERED AT BROOKLYN, N. Y. POST OFFICE AS SECOND CLASS MATTER.

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No paper published or to be published elsewhere as original will be accepted in this department.

THE RAPID. ESTIMATION OF URIC ACID IN URINE.

BY E. H. BARTLEY, M. D.

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Read before the Medical Society of the County of Kings, February 16, 1897.

For many years it has been recognized that uric acid, when present in excess in the blood and tissues, gives rise to certain disturbances of health, more or less distressing in their nature.

Until recently, these disturbances have been rather indefinitely described, and grouped under the head of a dyscrasia or diathesis. It has been known to be associated with rheumatism, gout, neuralgias, carious teeth, urticaria, and calculous concretions.

More attention seems to be given, in recent years, to this acid as a cause of ill health, and we have been taught something more definite as to its origin in the system, and its relation to pathological conditions. One fact that has stood in the way of more frequent examinations into this subject has been the lack of any reliable clinical method of making quantitative estimations of it.

The object of this paper is to call attention to a method of determining the amount of uric acid in the urine, that approaches to the requirements of a clinical method in rapidity, ease of application, and results sufficiently accurate for the purpose.

While a complete discussion of the origin of uric acid in the body is foreign to the object of this paper, it will be perhaps clearer if I call attention to a few facts in such a discussion. For many years physiologists accepted the theory that uric acid is a result of deficient oxidation of the retrograde decomposition products of tissue metabolism. It was looked upon as unoxidized nitrogen waste. This theory was supported by the fact, that uric acid is associated with conditions in which we have reason to believe that the facilities for oxidation are deficient, as in pneumonia, capillary bronchitis, extensive burns, phthisis pulmonalis, etc.

This theory is not supported by the more recent studies into the chemistry of the tissues. It has been noticed that the largest amounts of uric acid are excreted in leucocythemia, and in all conditions in which the white blood-cells are proportionately increased. The nuclei of all cells are composed largely of the peculiar protein-like substance known as nuclein. When this substance breaks up as a result of the functioning of the cells, it yields two bodies known as adenin and guanin. These two basic bodies are submitted to a process of hydration, by which means they are converted into hypoxanthin and xanthin respectively. This change is believed to take place in the body of the cell, and the oxidation process only takes place after these bodies leave the

Both of these bodies, viz., hypoxanthin and xanthin, yield uric acid by oxidation. All four of these are to be found in the commercial "extracts of beef," and it is believed by many that these extracts owe their principal virtue to these substances. We may summarize these reactions as follows:

1. CH,N+H2O=C,H,N ̧O+NH„.

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5. 2NH,+CO2+0=CO(Urea NH ̧)1⁄2 +2H2O.

From these and other facts, it is now thought that the immediate antecedents of uric acid are these products of the decomposition of the nuclein of the living active cells of the body, and especially of the leucocytes. According to this idea, a deficiency of oxidation will be accompanied by an increased elimination of

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