Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Thompson, Henry, Sir, 1820-1904.
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

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    heat. The opacity of the liquid, as Avell as its tint, which may vary from fawn to dull red, are due to the unduly large pro- duction of the mixed urates; that is, urates of soda, potash, lime, &c. But if, without any errors of diet, among which, any but a very small allowance o£ alco- holic drink is only one, a patient habitu- ally passes this kind of urine—if in time there frequently arrives also a deposit of uric acid, manifested by the presence of little crystals, looking like particles of cayenne pepper, at the bottom of the vessel—when this occurs rather early in life, say before forty, we cannot doubt that there is a strong tendency to produce uric acid, either inherited or acquired. For this tendency may to a certain extent be acquired, or a pre-existing habit may be intensified; but, as I have before said, it is mostly inherited. I now show you a specimen of urine quite cloudy with mixed urates, although you must be ilimiliar Avith it in the wards, and also with the fact that on heating the liquid it again becomes clear, and that in a short time, while we are talking, it again be- comes cloudy on cooling. Let me once more remind you that this may happen with the most healthy individual; and it is only the persistence of the symptom, without errors of diet, which should lead you to suspect a constant condition that requires treatment. We have followed the complaint up to the formation of cayenne-pepper crystals. Of this deposit I have some very good specimens here, which have been collected from patients who passed it habitually. These consist mainly of the transparent rhomboidal uric-acid crystals—which you know to be very beautiful objects under the microscope. They may be passed almost daily and habitually by some per- sons, and without any sense of discomfort, or occasion for complaining. Other per- sons may pass this material periodically in large quantity, little or none of the deposit being observed during the interval. At such periods, the patient often ex- ])eriences pain in the back, or over one hip, with uneasiness extending to the groin and testicle, all this perhaps accom- panied by sickness or nausea; and he may then be said to have an attack of sand or gravel. He feels relieved after the occurrence, which, just as a storm is said to clear the air, has freed him from an accumulation in the system. I have satis- fied myself that many patients who have had symptoms commonly denoting the passage of renal calculus, have been merely the subjects of a * uric-acid storm,* if I may use the expression ; and that much calculous matter has been eliminated in a soluble condition, not necessarily always in the concrete form of gravel, although the process has been accom- panied by pains sufficiently severe to arouse the suspicion that a calculus has been passed. These phenomena occur at varying intervals, and usually become more fi:equent or severe, unless the patient does something to prevent their occur- rence. Subsequently, he may pass tiny calculi, rightly termed gravel, which seem to be rounded or irregular aggregations of the same crystals; and these little bodies tend in time to become larger, sometimes as large as small peas, or even beans; and they are still specimens of the same product—that is, of uric acid, associated more or less with some alkaline base, such as those above named. These attacks are usually accompanied by excruciating pain in the regions already mentioned, and by severe vomiting, lasting a few hours; after which relief often occurs somewhat suddenly. The urine is at times scanty, and at times deposits blood in that dark form which is described as resembling ' coifee grounds.' Here, let me recall for one moment what I said as to the relation between gout and uric-acid deposit. I have some- ^ times seen these two complaints alterna- ting, comparing one generation with another ; gout appearing in the one, gravel in the second, and then gout in the third. But the same individual may also have alternating attacks of gout and gravel. I have seen a patient suffering for years from gout, which ceased for several months, when he developed for the first time a uric-acid stone in the bladder. Lastly, the so-called ' chalk-stones,' which you have often seen infesting the knuckles and disfiguring the hands of elderly people in advanced stages of gout, are composed of the same material—that is, of uric acid, usually as urate of soda. The identity of the two things, then, is unquestionable; they constitute two different series of phenomena, but both spring from one and the same root. Now, what is to be done for these cases ? What mode of treatment will help to prevent the arrival of at least the