Excerpt from On the Chemistry and Therapeutics of Uric Acid Gravel and Gout: Being the Lectures for 1892 Delivered Before the Royal College of Physicians of London
Mr. President and Gentlemen, - The morbid phenomena associated with uric acid divide themselves naturally into those which have reference to gravel and calculus, and those which have reference to gout. In the former, uric acid is thrown down in the free state from the urine as concretions in the urinary channels; in the latter, uric acid is thrown down in a state of combination as sodium bi-urate in the interior tissues of the body. In both conditions the precipitated substance necessarily acts as a foreign body, and tends to cause inflammatory incidents and obstructions in the parts implicated. In regard to gravel and calculus, the whole of the morbid sequences are thus accounted for; no suspicion is entertained that uric acid concretions lodged in the kidneys or bladder produce any disturbances above and beyond those which are due to mechanical injury. But in regard to gout, uric acid is supposed to play a double part. It is commonly believed that, besides the irritation consequent on the precipitation of sodium bi-urate in the joints and elsewhere, uric acid floating in solution in the bodily fluids acts as a true poison; and it is assumed that a large part of the symptoms associated with the gouty state are directly due to this poisonous action.
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