CLIFFORD MITCHELL, M.D.
Lithemia. – This condition is comparatively rare if those urine finding are considered which consist in a tendency to urate sediments associated with a lessened ratio of urea to uric acid. Many cases are called “lithemic” because of clinical features which are not really referable to purinemia but to faulty intestinal digestion. In these latter cases there is no disturbance of the urea – uric acid ratio but indicanuria and increase of glycnronate are in evidence. Genuine lithemia occurs more commonly in men. In women it is very rare, but we have noticed the urinary manifestations of it in several cases of tumor in women, one ovarian, another in the neck. Care must be taken not to rely too confidently upon a diagnosis of lithemia in the case of any patient under observation. The term is not beyond criticism, and in our opinion should be abolished. Purinemia is a term preferable when uric acid and purine bases are relatively in excess of the urea, and when there is a tendency to sediments of urates and uric acid together. A patient is not necessarily lithemic because of a sediment of uric acid alone, for such a sediment occurs in over-acid urine, plenty or not in volume, and is common in diabetic urine.
The Urinology of Hepatio Diseases. – We are indebted to a French journal for certain thoughts and observations upon the urinology of hepatic disease which we shall publish from time to time as space allows. The urinary phenomena of hepatic disease include delayed excretion of urine after meals, slowness of urinary elimination after ingestion of large quantities of water, and scantiness of urine when in the erect posture. Wide daily variations of the urinary output also occur. In the last stages scanty urine is the rule without much daily variation.
The Phenolsulphonephthalein Test for the Renal Function. – This test is now extensively employed in clinics and hospitals owing largely to the exploitation of it in Baltimore where a cheap colorimeter is sold which is of great convenience to the attending physician. Full particulars of this test with technique can be found in Modern Urinology, page 508. It must be borne in mind, however, that a positive finding with the test, i.e., evidence of good functioning, is more trustworthy than a negative one, for in unilaterl kidney disease the healthy kidney may not function well. After removal, of a diseased kidney we have more than once been surprised by the improvement in functional ability of the remaining kidney. The technique of the colorimetric determination by means of the Baltimore instrument is described in literature supplied by the dealers, Messrs. Hynson, Westcott & Co.
Colon Bacillus Infection of the Kidneys. – One hears nowadays much about the treatment, with vaccines, of colon bacillus infection of the kidneys. Commenting upon this Dr. Julius A. Toren, of Chicago, says: To prove that a case is one of colon bacillus infection of the kidney would cost twenty-five dollars approximately. For the things necessary for proof are: (1) Ureteral catheterization, necessitating aseptic technique; (2) bacteriological examination of the withdrawn urine, and (3) cultures on various media to prove the bacterial strain.”
We can not help wondering what would become of certain diagnoses we read about if our worthy doctors were required to prove them in a court of law!
The Saltfree Diet in Renal Diseases. – It is our observation that a diet as saltfree as possible often starts the patient on the road to recovery or ameliorates the condition in renal diseases and also in certain bladder lesions. It is not necessary to remove absolutely all traces of sodium chloride from the dietary. Our rule is to exclude salt from the diet until the total NaCl in the urine (estimated by the Luetke process, Modern Urinology, page 106) drops to two or three grammes per 24 hours.
Edema and blood pressure are favorably affected by the saltfree diet. Illustrating the benefit from the procedure is the following: On December 15, 13, was called to see a case of an elderly man in a late stage of chronic interstitial nephritis. Edema was extending upward from lower extremities, breathing was lagored, and sleep disturbed. The urine was scanty, strongly acid, and contained 0.2 per cent. Of albunim by weight, with many hyaline casts in the sediment. Under the diet, prescribed for three weeks, edema lessened, breathing improved and the urine increased to 2000 c.c. in 24 hours. The salt content was reduced in total to about three grammes. Albumin decreased, and but one cast could be found. This is only one instance of several which the author has seen of beneficial results from a decreases of the sodium chloride in the dietary.
