E. Fischer has applied the name purin to a nucleus C5N4, and hence all bodies so constructed may be called purins. Fisher reproduced his so-called purin nucleus by synthesis. Hall gives a list of ordinary occurring purin bodies as follows: Hy-poxanthin, xanthin, uric acid, guanin, adenin, caf-fein, and theobromin. The purin bodies exist free or as nucleic acid combined with albumin. As with uric acid, we have two forms of purins, the endogenous, those, formed within the body from the breaking down of its own tissue cells and independent of the food taken, and the exogenous, those coming from without with the food taken. The endogenous are the more numerous, and, unfortunately, cannot be controlled by diet to the same extent as can the exogenous. Here we have the reason why starvation or semi-starvation, more properly, will not cure gout. Abstaining from eating will in a great measure control the exogenous uric acid, leaving the endogenous uric acid from the breaking down of our tissues still in our system to vex and debilitate us.

Now we are in a better position to take up uric acid. Since its discovery, one hundred and thirty years ago, this has been given as the cause of gout. Uric acid itself in the system is not toxic, is not poisonous, yet some of its forerunners may be. If we find an excess of uric acid in the urine we argue oxidation of its forerunners as the cause and excess of uric acid as the effect, and the relief more or less of the gouty attack the result. This is what we want to bring about if we are on the right track. So far as we now know uric acid is formed in the body by the oxidation of the purins, both the endogenous and the exogenous. As we have seen, the nucleic acid produces these.

Uric acid may be an antecedent of urea or may come from urea synthetically. Now, suppose we eat a diet rich with nuclein and its products, we get an excess of uric acid; but even if we eat a highly nitrogenous diet, purin free, we get no excess of uric acid. This is a very important point in diet for gout, yet it does not explain gout, for we may have the blood full of uric acid and no gout. Individuality also has great influence here, as it does in so many cases physicians have to deal with. If uric acid is not toxic, its forerunners, the purins, are probably the cause of the gouty condition. We have endogenous and exogenous uric acid as we do purins. The former is formed in the body substances contained in it, by the breaking down of the tissue cells, and the latter from the food taken. How important if we could control the former as we can the latter. I have no doubt proper diet will in some measure control the former, but not to a very great extent where the individual lacks in oxidizing power, and this unfortunate individual is the gouty individual most frequently. The endogenous uric acid comes from the cell nuclei and with phosphoric acid passes to the urine during their katabolism.

Now, as to the cause of gout, a writer in Ameri-can Medicine has well said, we can go so far and no farther. In the changes going on with the nuclein metabolism, that is, where the purin bodies are being dealt with, there is something radically wrong in these bodies which prevents them becoming, as they should under proper conditions, the soluble forerunners of uric acid, in which soluble form the uric acid could pass on and be gotten rid of by excretion, going off as urea, for instance. Instead of this, it reunites with sodium and forms insoluble sodium urate. Here we have the gouty deposit. The toxaemia comes in here and may be caused by the breaking down of the leucocytes and the fixed cells in their attempt to neutralize the toxaemia.

Now, finally, as to the cause of gout, we must reckon not so much with the uric acid as with the purins and their like, the forerunners of uric acid and which are in the healthy individual soluble, but in the gouty person insoluble and are deposited in the tissues and set up much of the trouble.

Vaughan gives as the origin of uric acid the oxidation of the nuclein of the blood-corpuscles, and in addition to uric acid and its forerunners we must look to the group of leucomaines as a factor in causing gout. Here we again come to the purins.

Garod says uric acid is a result of nitrogenous waste; that it represents a lower degree of oxidation than urea, - that is, instead of passing to urea by oxidation, it stops short as uric acid and is deposited in the tissues and causes gout.

Here are two important points to consider in choosing diet for the gouty. Do not feed too much nitrogen, especially purin nitrogen, and see that the food does not consume too much oxygen in its assimilation as nourishment. This accumulation in the system is an incomplete waste product, a result of suboxidation, and is not urea, as it should be if fully oxidized, but uric acid, and is uric acid because of some defect in the liver interfering with its urea-making powers. The defect here is probably its faulty action on the peptones in digestion.

The action of the liver on the peptones, if normal, causes the proper formation of urea; if abnormal, uric acid and not urea is formed, uric acid being much lower in oxidation than urea. We are probably getting at some truth here.

I myself believe much of the trouble causing gout originates in the liver, and in gouty people there is, so to speak, an hepatic insufficiency, possibly anatomical, possibly physiological, possibly pathological, or all combined. A pathogenic germ may sooner or later be found to be an etiological factor.

Gout is a condition of sulfoxidation, and hence in choosing diet for the gouty we must be sure we are not feeding them too much carbohydrates as well as too much nitrogen and the purin bodies. Too much starchy vegetable food, too much sugar, too much fats may consume too much oxygen in their digestion and assimilation, and thus return to plague the sufferer from gout. Another matter do not forget, - study the individual and his peculiarities. "One man's meat may be another man's poison." If a man should be a great eater, it is of almost as much importance to curb his appetite for starches and fats and sugars as for nitrogenous foods. Moderation in all things must be the rule. It is, as a rule, better to eat a little of nitrogenous food and indulge moderately in non-nitrogenous foods than to eat three or four rations of rice and potatoes and such as exclusive diet. Again I say, moderation in everything as to diet is the rule for the gouty to follow. Generally, the gouty lack power in oxidation as to the foods taken, they are born with the lack of this power, and in eating they must accommodate themselves to their natural condition.