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We thus see that the series of nitro-carbonaceous compounds in the body begin with albumen and end with urea. Albumen being the form in which nitrogen is combined with the largest amount of carbon, affords the greatest amount of pabulum for the inhaled oxygen, and in proportion as that process of oxidation is carried on in perfection, we have albuminous substances undergoing reduction into the lower compounds. From inosinic acid downwards, these compounds have no longer an organized form, but are crystallizable.
Cold and moisture check oxidation of tissue, and thus generate uric
acid-Reasons for supposing rheumatism a blood diseaseReasons for supposing the urate of sọda the materies morbiEnfeebled condition of fibrous tissues essential for the development of the disease-Cold and moisture much more favourable to the induction of rheumatism than cold alone—All debilitating circumstances predispose-Effects of cold most severely felt while in a state of exhaustion-Although the symptoms vary in intensity in every case, they are sufficiently uniform to show their dependence on the existence of same causes—Dr. Taylor's observations, showing the relative frequency of fatal pericarditis in Bright's disease and acute rheumatism.
In rheumatism, owing to the influence which cold and moisture exercise in checking oxidation in the systemic capillaries, uric acid is not oxidized as it otherwise should be into urea. The formation of uric acid from cold and moisture is not necessarily followed by rheumatism. Where the application of cold is only slight, but a moderate amount of uric acid is formed, which unites with the ammonia of the phosphate of soda and ammonia of the blood, and forms the urate of ammonia, which is seen as the red brickdust deposit of the urine of persons suffering from a common cold. When the checked action of the skin is more severe and more prolonged, uric acid is formed in larger quantities, and the soda of the tribasic phosphate of soda then yields to the uric acid, and the urate of soda is formed. The presence of this powerful animal irritant in the blood gives rise to great constitutional excitement, under which the oxidation of tissue takes place with greater rapidity than perfection; in other words, under this highly excited vascular action a portion of the products of oxidation are carried into the circulation before the process is completed, and fresh urate of soda formed; thus the morbid matter is, under this increased vascular excitement and oxidation, constantly being renewed. In gout, imperfect oxidation of the blood is the result of repletion; that imperfect oxidation also leads to the formation of uric acid, and subsequently of the urate of soda in excess; but a life of inertia and indulgence, while engendering this repletion, has also induced an impure condition of the blood, on which this powerful animal irritant is incapable of producing the same stimulating influence that it does in rheumatism, where the blood was previously in a state of vital purity.
The indications of treatment are in both diseases the same as far as relates to the object to be attained-perfection of oxidation. In rheu.
matism, at all events acute rheumatism, this perfection is to be attained by checking the rapidity with which it is carried on. on the other hand, our whole treatment is directed to the attainment of more perfect oxidation, by promoting its rapidity.
Many circumstances concur to induce us to believe that the peculiar symptoms of rheumatism are attributable to the presence in the blood of an unnatural and morbific matter, and that that morbific matter is the urate of soda. In the first place, it is evident, from the constitutional symptoms preceding the local ones, that they are not due to the local affections; secondly, the local symptoms are not fixed and permanent, but shift from joint to joint, and from one fibrous structure to another, as evinced by the phenomena of metastasis; thirdly, the symmetrical tendency which is so remarkably evinced in this disease, which was first pointed out by Dr. Budd, is strongly corroborative of the dependence of
many of the symptoms of this disease on the existence of a poisoned condition of the blood; fourthly, the copious formation and deposition of urates in the urine contemporaneously with the disease, and their absence on the cessation of the symptoms, together with the, in some respects, striking resemblance of the symptoms to those
of gout, which depends on the existence of the same morbific matter, generated under different circumstances, and in an opposite state of the blood. To which may be added the fact, that the two diseases sometimes assimilate each other so closely, as we see in rheumatic gout; the symptoms of either disease preponderating according to the degree and extent to which the vital purity of the blood has been impaired by mal-assimilated food, retained bile, or any of those causes which produce that impure condition of the blood peculiar to the gouty.
That the urate of soda is the probable morbific matter may be gathered from the following facts :-First, that the disease is to a great extent hereditary, occurring in families in whom the lithic acid diathesis is very strongly marked; secondly, the occurrence of an attack is not unfrequently preceded by circumstances which have led to a more rapid metamorphosis of tissue than ordinary, and the application of the exciting cause, cold and moisture, at this time, by checking cutaneous action, impedes that perfect conversion of the effete albuminous elements into urea; they are thus only partially oxidized into uric acid, which is generated in large quantities; thirdly, the simultaneous cessation of excessive deposits of urates, and the approach of