Phenyl-cinchoninic acid, phenyl-quinoline-carboxylic acid, marketed under the proprietary name atophan, is official; dose, 8 grains (0.5 gm.). It is insoluble in water and alcohol and has a biting bitter taste. There is abundant evidence that this substance in both normal and gouty subjects acts on the kidneys to increase the amount of urine and the excretion of all the elements of the urine, but especially the uric acid. Fine and Chace found that it brought the uric acid of the blood to a percentage away below normal. McLester, after the large dose of 45 grains (3 gm.), noted that in three hours the uric acid of the blood was halved and the amount of urine trebled, in the next three hours the blood uric acid was again halved, but the total urine was small, and in the next three hours there was no change in the blood uric acid, both the uric acid in the blood and the excretion of urine having dropped to a low point. He concludes that atophan stimulates the kidneys to a marked degree, and that the excessive activity is followed by a period of fatigue and comparative inactivity. Brugsch, Folin and Denis, and others believe that the drug does not mobilize deposited urates, while Smith and Hawk consider that a rather high and long-continued excretion in cases of gout must be explained by urate mobilization. Daniels found that lithium citrate alone had no influence on the excretion of urine, but that when it was given in doses of 20 to 30 grains (1.3-2 gm.) a day to a person already getting atophan the uric acid elimination was increased 55 per cent. She figured that the lithium salt induced mobilization and brought the uric acid into the blood to be excreted. In any case it is recommended that alkalies and plenty of water be administered during the atophan treatment. Occasional untoward effects are gastric irritation, abdominal pain, diarrhea, purpura, urticaria, a scarlatiniform rash, and collapse.

Cimicifuga, black snakeroot, is a bitter rhizome of the northeastern United States, sometimes employed in gout and rheumatism. The dose of the fluidextract is 15 minims (1 c.c.); of the extract, 4 grains (0.25 gm.).

Piperazine, diethylene-diamine, is hygroscopic and very soluble in water. It is alkaline, forms salts with acids, and is incompatible with alkaloidal salts, metallic salts, tannic acid, acetanilid, and acet-phenetidin. On the finding that its salt with uric acid was readily soluble, this drug was brought forward as a remedy in gout and the uric-acid diathesis; but its value is questionable, for in the urine it is usually found in combination with the mineral acids rather than with uric acid. Starling reports it, however, as promoting the excretion of uric acid by the tubule cells, as shown in kidney experiments. Hanzlik states that equally worthless are piperazine, lycetol, lysidin, piperidine, quinic acid, quinidine, sidonal, urol, and urosin.