A Post-Graduate Lecture ON THE HUMORAL SYNDROME OF GOUT
Authors: A. Chauffard
Journal: BMJ (1922)

IN addressing you to.dayI wish, in tile first place, to thlank you for the honour you do me in inviting me to take part in this conference.I see in it a promise of excellent relations of friendship and scientific intercourse which will unite our two countries more and more.But you must allow me to say also that it is not without hesitation and apprehension that I have made the choice of the subject with which I propose to deal.Am I not a trifle overbold to come and speak on gout here in England, where Sydenham wrote his immortal description of the acute attack of gout-a description always copied or imitated, but never equalled; where Bright taught us to recognize the gouty kidney; where Scudamore and Gairdner wrote their classical dissertations; where Garrod inaugurated the scientific study of gout in demonstrating the pathogenic role of uric acid; and wlhere so many, eminent clinicians have since proclaimed the results of their investi- ,gations of this disease?My excuse is that in science nothing is final or perfected, and I shall have achieved my object if I awaken your interest in the new researches which for nearly two vears I lhave conducted in my clinic at Saint-Antoine witli my two co-workers, P. Brodin and A. Grigaut.It is necessary in every study of gout to return to Garrod; his book has not passed out of date, and is richl in information, in clinical experience, and in personal ideas.It was Garrod who first defined the humoral state in gout and,recognized and proved its essential character-excess of uric acid in tile serun.I am bound to recall the delicate test of the thread, with its crystalline deposits of uric acid.In spite of tlle fact that this technique seems not to be exact, since we,cannot say that all, the uric acid of the serum becomes deposited, on.tlhe thread, Garrod was able to estimate the quantity found in 65 grams of serum, which in the five cases he quotes, when expressed in terms of 1,000 grams of serum, give the,figures 50 mg., 125 mg., 30 mg., 175 mg., and 110 mg.A little farther on, for the blood of patients suffering from albuminuria or gout, he gives an average quantity of uric acid varying between 44 and 173 mg. per 1,000 grams.He is careful, lhow- ever, to add that in all these analyses the quantity of uric acid obtained is undoubtedly less than the real figure.Thle limit of sensitiveness of the method is fixed at 24 mg.per 1,000 grams of serum.It is very curious to note how Garrod's technique gave hiim results near to the figures whichl we obtain at present witl improved methods.Results of absolutely thle same order are obtained in both cases.Tlhese ingenious researchle of.Garrod's are classical, and all clinicians have made use of tlhe thread test.But this obviously imperfect process did not allow fresh progress, and whilst researches on the uric acid of tlle urine were multi- plying weo.relied on tlhe initial researclies of Garrod for the uric acid of the blood.,A new,technique was necessary, and it came to us from America with the work of Folin and Denis, and the-eimployment of tlhe reagent phosphotuingstic acid, whiclh gives a9 blue colour witlh solutions of uric acid.The estimation, whiclhiwas gravimetric -in Garrod's method, has tllus becQw\le colorimetric; and the researches of Louglh, Fine, and Myers have brought new and interesting deductions.According to the' American tQe,wique the normal content of the serum in uric acid io estimated at 2 to 3 centigranms per 1,000 grams, rather a low figure on account of the solubility in water of the precipitate of urate of silver and magnesium, whiclh diminislhes the real figure of the uric acid of the serum.In the technique modified by A. Grigaut tllis cause of er ror no longer operetes, and we believe ourselves to be able to say that tlhe normal figure of uric acid per litre of the serum varies between 4 and 5 centigrams; byperuricaemia com- mences above this.Grigaut's process estimates the uric acid without including the xantlhin bases, and only alloxan and alloxanthin, derived from the immediate oxidation of uric acid, are included with this substance in the figures of the estimation.Setting out in this way we were able to begin the study of gouty urice aemia, and the researclhes we lhave published.were carried