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PROBENECID∥ was introduced in 1949 as an agent that would inhibit the renal tubular secretion of penicillin.1 Other uses were soon found, and probenecid is widely used for its uricosuric effect in chronic gout and gouty arthritis. In 1955 Boger and Strickland2 reviewed the side effects of probenecid as observed in over 2500 patients and reported no fatal reactions. The case described below is reported because it is interpreted as a fatal reaction to probenecid with the major lesion consisting of massive necrosis of the liver. The validity of this assumption will become apparent from a review of the time . . .

THE nephrotic syndrome has been reported to occur in the course of therapy with a number of drugs including trimethadione,1 , 2 paramethadione,3 mercurial diuretics,4 tolbutamide5 and perchlorate,6 as well as in association with sensitivity to poison oak7 and bee sting.8 In the case reported below, the nephrotic syndrome appeared to be the result of a reaction to probenecid.¶ Although proteinuria and renal failure are known to occur in the course of chronic gout, the nephrotic syndrome has not heretofore been reported as a result of gouty nephritis or in association with probenecid therapy. Case Report A 52-year-old man was first seen . . .

RAPID progress has been made in recent years in the management of gout, one of man's oldest diseases. Today the patient with gouty arthritis can be effectively relieved during acute attacks and protected from recurrent bouts, and if tophi exist they can be reduced in size. This optimistic outlook depends, first, upon the physician's knowledge of the therapeutic measures available and, second, upon the patient's willingness to submit to uninterrupted life-time therapy. Few illnesses follow such a set clinical pattern as does classical gout. Hench has described two stages—that characterized by recurrent episodes of acute joint inflammation followed by complete, but temporary, remissions (intercritical periods) and that of chronic gouty arthritis, or tophaceous gout. 1 Because asymptomatic hyperuricemia (larval gout) precedes for some time attacks of acute joint symptoms, it is proposed that this part of the total disease be designated as the first stage of gout. For the purpose

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Benemid zeigte eine auserordentlich gunstige Wirkung bei der Behandlung der chronischen Gicht. Es fuhrte zu einer Ausschwemmung von Uraten und zur Senkung des pathologisch erhohten Harnsaurespiegels im Serum. Durch gleichzeitige Verabreichung von Cortison konnte die sog. urikosurische Wirkung von Benemid wesentlich gesteigert werden. Besonders eindrucksvoll war die Verkleinerung der Tophi und die weitgehende Wiederherstellung der Beweglichkeit vorher fast immobiler Gelenke.

Erythromelalgia was first described by Graves 1 in 1864 and by Mitchell 2 in 1872 and is characterized by shooting, throbbing or burning pains associated with duskiness, congestion or redness of the affected part. The five essential features necessary for establishing a diagnosis are: (1) burning pain in the hands or the feet, (2) aggravation of symptoms by heat or exercise, (3) relief by elevation, rest or cold, (4) increased local heat and (5) refractoriness to treatment. REPORT OF CASE History.— On Nov. 5, 1936, I was called to see J. F., a white man aged 50, a laborer. He had both feet suspended in a basin of cold water in order to obtain relief from local burning and throbbing pain. They were swollen and hot to the touch but did not pit on pressure. The symptoms were aggravated by local pressure, suspension in warm water or application of an

It is generally accepted that less exogenous uric acid is eliminated by persons subject to gout than by normal persons. It is still disputed whether or not this lessened excretion of exogenous uric acid can be used for diagnosis. Vogt, Reach, Soetbeer, Pollak, Mallory, Weinberger and Yavein have found that in gout the excretion of exogenous purins is diminished and delayed. This is not always the case according to Magnus-Levy, Weintraud, Rommel and Pratt. In a recent article, McClure and Pratt 1 present tables showing a summary of all the previous observations on the exogenous uric acid excretions of normal persons, of patients with chronic arthritis, and of gouty patients. They have studied the uric acid excretion in two cases of gout after the feeding of sweetbreads. They believe that the retention of uric acid is a symptom of questionable importance in the diagnosis of gout. METHODS In the present

A number of recent papers on gout refer to it as a forgotten disease, implying thereby that it is frequently overlooked. In a series of 100 patients reported by Hench 1 approximately fifteen years had elapsed from the first attack before a correct diagnosis was made. The average age of onset.of gout is usually about 40. Although the majority of patients are men, women are not infrequently affected, and the disease has also been described in children. 2 It is generally recognized that the essential features of this condition consist of arthritis with or without podagra, hyperuricemia, deposits of sodium urate crystals in the articular, periarticular and subcutaneous tissues and, in a certain number of cases, of manifestations of cardiovascular or renal involvement. The complete reversibility of the arthritic attacks in the early stages and their irreversibility in the later phases, terminating in crippling chronic gouty arthritis with tophaceous deposits