The Lumleian Lectures on Uric Acid: Its Physiology and its Relation to Renal Calculi and Gravel
Authors: A. B. Garrod
Journal: BMJ (1883)

ON being requested to deliver the Lumleian Lectures for the presenlt year, at oar College, I naturally felt much gratified by the honour but, none the less, I should have hesitated to accept the responsibility of addressing you in my present capacity, had it not so happened that I was at the time engaged in completing some investigations which I had begun many years before.As these had relation to the production of uric acid in the animal economy, and to its morbid manifestation s-sbjects of deep interest to the physician I thought that the results of these researches might not be altogether without attractiveness to my profcssional brethren, if they were made the subject-matter of the present course of lectures.Having, therefore, a subject to brinig before you whichl conitains some little novelty, anid, as it were, breaks new ground, I put this fact forward as my excuse for appearing to-day in the capacity of your Lumleian Lecturer.I shall not hesitate to dwell somewhat on the physiology of uric acid in my lectures, as T feel sure that any advance in its pathology which the future may show, must largely (lepend on our having the firm foundation of a correct physiology to build upon-a thing much needed at the present time, if wve may draw such a conclusion from the diversity of opinions, asto the production of uric acid, which are in vog?ue, while we have many holding that the spleen, others that the llver or the lymphatic glands, are the organs devoted to its elaboration.Nor shall I hesitate to dwell upon the condition and composition of the urinary excretion in different classes of animals;for I have long felt that, if in the study of the physiology of uric acid we confine our attention to the human subject, we place our- selves in a position of great disadvantage towards the inquiry, see- ing that uric acid and its derivatives pervade the whole animal kingdoin.Furthermore, when I considered that, in some animals, the nitrogenised excretion consists almost entirely of uric acid, while in others its amount is extr emely small, it occurred to me that, in the study of this prinlciple in various classes of animals we should be most likely to discover the true solution of its formation and the rile which it plays in the animal economy.For these reasons, I shall lay great stress on the comparative physiology of uric acid in my lectures.Let us imagine a partition separating the blood from the urinary excretion, such as, in nature, is found in the walls of the renal vessels; then uric acid, free or in combination, may exist either on the one or on the other side of this membranous partition; if on the one side,-that is, in the blood-it originates symptoms which are refer- able to various organs; it may be deposited in the articular tissues, and produce the typical form of joint-gout, with chalk-stones; or it may affect the skin in the shape of eczema, or cause cramps, neuralgic pains, dyspepsia, etc., according to the part particularly selected.On these, I shall not touch in this course of lectures, baving had full opportunities of setting out my views and researches elsewhere.But uric acid is also to be found on the other side of our imaginary partitioni, that is, in the urinary excretion, and, under certain circumstances, it forms morbid deposits, such as go by the names of gravel and calculi; and it is to these that I shall con- fine my attention, with special reference to their pathology and treAtment.The metabolism of the various tissues of which the animal body is composed, which occurs during life, is accompanied by the forma- Uon of certain products whicb require to be eliminated.Leaving ut of consideration the inorganic salts, such as the phosphates and lWorides, we have certain elements, chief among which are carbon, hydrogen, omygea, and nitrogen (some of which four elements enter into all organic compounds), to be got rid of.Of these, a large por-