A Lithemic Case.

Editor Ellingwood's Therapeutist:

I have under treatment a man from 45 to 50 years of age. The only symptom of disease he said he noticed was just a little backache, occasionally. He said he felt well, slept and ate fine, but from this backache, which was present only occasionally, he wondered if there was anything wrong.

I had him measure the amount of urine passed in twenty-four hours, and upon examination I found that he passed three pints of urine with a specific gravity of 1035, it was slightly acid in reaction. When passed the color was normal, but when cold, it looked like coffee with considerable milk in it. On warming it, this would quickly clear up, and assume a normal color. There was no albumen, but I obtained a slight reaction for sugar.

Now after having had the patient under treatment for some time, this reaction is gradually becoming less, but the specific gravity varies from 1028 to 1030, although the urine now remains clear, when it is cold. The odor is normal. Everything now seems to be about normal, except the specific gravity. Is this an incipient case of diabetes mellitus, or what is it?

The tongue is very broad, but of normal color, though perhaps at times a little pallid; somewhat toothmarked. The skin is somewhat sallow, appetite is good, patient sleeps well. The bowels are regular. I gave the following prescription, and so far it has seemed to be a good one:

Nux vomica, drops 15
Hydrastis, dr. 1/2
Pulsatilla, dr. 1/2
Kava kava, drs. 4
Phytolacca, dr. 1
Glycerin, oz. 1/2
Water, q. s. ad ozs. 4

Give a teaspoonful before each meal and at bedtime, in one-third of a glass of water.

The condition of the tongue seemed to indicate the Nux and Hydrastis. I gave the Pulsatilla for its influence on the sugar. The other two remedies were given for their diuretic influence, and for their influence upon the glandular structure. The only change I have made in the diet was to cut out all sweets. F. A. H.

COMMENT: Replying to the above query, this is probably one of those cases in which an extreme lithemic condition will induce a reaction similar to that of sugar, although it is not impossible that there was a little sugar temporarily present, how ever, it is certainly not an incipient case of diabetes. The backache is common to lithemic patients, where a large quantity of solids to a small quantity of water are passing through the kidney structures. The color of seasoned coffee is characteristic of urine in which the urates, especially sodium urate, with an excess of uric acid are precipitated on cooling. These remain in solution in urine at the body temperature. If there was diabetes there would be an increased quantity of water.

In the treatment of these cases it is necessary to discontinue all nitrogenous food, for a short period, usually tea and coffee, and always alcohol and tobacco. A vegetable diet, and the very free ingestion of water at the time when digestion has been completed, will soon give evidences of improvement. If medicine is then necessary, Macrotys and Gelsemium in proper doses and one grain of the acetate of potassium four or five times a day will bring about good results in a short time if no sugar is present. In my cases the reaction for sugar has disappeared with the excess of urates. The doctor's prescription, although but mildly indicated, should, if prescribed, be divided. The first two remedies given after meals, and the remainder, if given at all, before meals

Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.