. The senile heart: its symptoms, sequelae, and treatment. parts affected, when the hand is at fault, is in-variably associated with a characteristic adductionor inclination of all the fingers towards the ulnarside of the hand.^The knobs are due toimpurity of the blood,the nodosities to dis-ease of the is peculiar toman ; rheumatoid ar-thritis he shares withthe lower animals,notably with thehorse. For nearly 100years the impurity ingouty blood has beenknown to be uricacid, usually present as urate of soda.^ This uric acid is due to defectiveoxidation of the effete material in the blo
. The senile heart: its symptoms, sequelae, and treatment. parts affected, when the hand is at fault, is in-variably associated with a characteristic adductionor inclination of all the fingers towards the ulnarside of the hand.^The knobs are due toimpurity of the blood,the nodosities to dis-ease of the is peculiar toman ; rheumatoid ar-thritis he shares withthe lower animals,notably with thehorse. For nearly 100years the impurity ingouty blood has beenknown to be uricacid, usually present as urate of soda.^ This uric acid is due to defectiveoxidation of the effete material in the blood; 1 Adams, op. ciY., p. 252. 2 In 1797 Tennant and Wollaston established the fact thattophi are composed of urate of soda ; but Charcot rightly says,the period of positive knowledge dates from Garrods re-searches in 1848, Clinical Lectures on Senile and ChronicDiseases, by J. M. Charcot, New Sydenham Societys Trans-lation, 1881, p. 127. Vide also A Treatise on Gout and Bheu-matic Gout, by Alfred Baring Garrod, , London, 1876, 3dedition, p. 49, Fig. 11. — Haygarths nodosities. 182 THE SENILE HEART instead of urea being formed and excreted,the lower compound, uric acid, is formed andretained. At certain parts of the body — aboutthe joints, cartilages, and tendons — the circu-lation, never very active, gets delayed as ageadvances. The blood-plasma, flooding the tissueinterspaces, is reabsorbed but slowly; the urateof soda, never very soluble, crystallizes out onsome slight provocation, and gradually grows togouty pearls on the ear, to Heberdens knobs onthe fingers, and to so-called tophaceous depositselsewhere. The synovial oil lubricating the jointsand tendons is less perfectly elaborated thanformerly; hence the gouty stiffness and pain onmovement, aggravated by a certain amount oftension in the tissue interspaces, which is alwayspresent, and is worse at times. Moreover, theuric acid, or urate of soda, not only forms knobsand pearls in the situations specified,
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