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January 5, 1918


JAMA. 1918;70(1):28. doi:10.1001/jama.1918.02600010026011

At the conclusion of a comprehensive review of the subject, Lusk1 has written that "present-day doctrines concerning metabolism in gout may shortly become entirely obsolete through new and far-reaching discoveries." Until recently, gout has been discussed primarily as a phenomenon of faulty metabolism. "Faulty metabolism of purins and their precursors" has been the offhand explanation of the mystery of gout with its manifestations of unusual retention of uric acid in the blood, its occasional deposits of urates in the tissues, leading sometimes to the formation of specific gouty nodules, and its acute inflammatory disturbances in the neighborhood of these tophi. Trauma, toxicity and infection are familiar detrimental agencies that have been called on at times to explain the gouty manifestations. Affinity of the tissues for uric acid (whatever that may mean precisely), increased formation of uric acid (which is now regarded as unlikely), and abnormal chemical union of uric