Entered according to the Act of Congress in the year 1898, by LEA BROTHERS & CO., In the Office of the Librarian of Congress at Washington. All rights reserved. ROONEY & OTTEN PRINTING CO NEW YORK சைர் ΤΟ VOLUME SEVENTY-THREE. GEORGE DOCK, M.D., of Ann Arbor, Mich. S. W. ABBOTT, M.D., of Boston, Mass. A. L. HALL, M.D., of Fair Haven, N. Y. JOHN L. HEFFRON, M.D., of Syracuse, N. Y. DUDLEY N. CARPENTER, M.D., of the United HENRY B. HEMENWAY, M.D., of Evanston, Ill. WALTER LESTER CARR, M.D., of New York. CHARLES W. HITCHCOCK, M.D., of Detroit, Mich. F. HUBER, M.D., of New York. J. B. HUBER, M.D., of New York. WOODS HUTCHINSON, M.D., of Buffalo, N. Y. Mich. BEVERLEY OLIVER KINNEAR, M.D., of New York. HENRY KOPLIK, M.D., of New York W. SCHEPPEGRELL, M.D., of New Orleans, La. AUGUST JEROME LARTIGAU, M.D., of Albany, CHARLES L. SCUDDER, M.D., of Boston, Mass. LOUIS LICHTSCHEIN, M.D., of New York. GEORGE ROE LOCKWOOD, M.D., of New York. J. H. LOPEZ, M.D., of Philadelphia. J. G. LYNDS, M.D., of Ann Arbor, Mich. L. L. MCARTHUR, M.D., of Chicago JOHN C. McCoy, M.D., of Paterson, N. J. NICHOLAS SENN, M.D., of Chicago. JOHN B. SHOBER, M.D., of Philadelphia. A. ALEXANDER SMITH, M.D., of New York. WILLIS G. MACDONALD, M.D., of Albany, N. Y. GEORGE A. SPENCER, M.D., of Haverhill, Mass. DONALD MACLEAN, M.D., of Detroit, Mich. MORRIS MANGES, M.D., of New York. C. J. MARCH, M.D., of Fordyce, Ark. DILLON J. SPOTSWOOD, M.D., of Mobile, Ala. GEORGE M. STERNBERG, M.D., of Washington, D. C. DAVID TRUMBULL MARSHALL, M.D., of New JOSEPH EARLE STEVENS, A.M., of Boston, Mass. York. J. B. MAXWELL, M.D., of Mount Carmel, Ill. WILLIAM H. PARK, M.D., of New York. D. M. PROVENCE, M.D., of Barwell, S. C. HENRY I. RAYMOND, M.D., of the United States V. M. REICHARD, M.D., of Fairplay, Md. JOHN W. ROBERTSON, M.D., of Livermore, Cal. W. STEVENS, M.D., of New York. GEORGE D. STEWART, M.D., of New York. LEWIS A. STIMSON, M.D., of New York. J. COPLIN STINSON, M.D., of San Francisco, Cal. H. H. STONER, M.D., of Rock Rapids, Ia. GEORGE TULLY VAUGHAN, M.D.. of Washington, H. H. VINKE, M.D., of St. Charles, Mo. WILLIAM H. WATHEN, M.D., of Louisville, Ky. DAVID WEBSTER, M.D., of New York. A WEEKLY JOURNAL OF MEDICAL SCIENCE. VOL. LXXIII. NEW YORK, SATURDAY, JULY 2, 1898. ORIGINAL ARTICLES. THE TREATMENT OF URICACIDEMIA.' BY JOHN L. HEFFRON, M.D., OF SYRACUSE, N. Y.; PROFESSOR OF CLINICAL MEDICINE IN THE COLLEGE OF MEDICINE OF SYRACUSE UNIVERSITY. URICACIDEMIA is a condition the manifestations of which are so multiform that the consideration of the treatment of all its protean aspects is obviously beyond the limits of a short paper. It has already been demonstrated that every one of the acute or mature manifestations of this diathesis is but the expression in an individual of his peculiar reaction to the circulating acid excess or of the vulnerability of some one of his tissues or organs. This vulnerability of organ or tissue may be an inheritance. Whether a man develops arteriosclerosis from this irritant depends on the stuff his arteries are made of, not on chance. Heredity would determine whether the nerves had to bear the brunt of the burden, or the liver, or the kidneys, or the joints, or the muscles. But in all cases there is the underlying common condition, which must be overcome, else there is no such thing as a permanent cure. In this discussion, therefore, the problem which I set myself is the proper management of the daily lives of that large class of individuals who present any of the ills arising from imperfect metabolism and deficient excretion of nitrogenous waste. It must first be pointed out that the individuals making up this class do not belong to a group that can be characterized by common points of resemblance. They may be plethoric, fat, and hearty; they may be anemic, thin, and sour, like the "lean and hungry Cassius," or they may be athletic in figure, strong in body and mind, passionate, and high livers. It is because of this diversity that the treatment of this condition cannot be reduced to rules that are hard and fast, a sort of "cut-and-dried" treatment that once learned is always available. It must be because of this diversity and the tendency in writing to confine one's thoughts to a particular class of cases that we observe such apparent contradictions in the recommendations of the leading authors upon this subject. The underlying condition is an increase of the uric-acid ratio to urates, so that free uric acid is present in excess in the blood or is deposited in the tissues. It is caused by a too abunRead before the Syracuse Academy of Medicine. No. I. dant supply of uric acid in the food taken, or by an excessive formation of uric acid within the body, or by a changed condition of the blood, making impossible the solution of the normal amount of uric acid, and so interfering with its proper excretion. The indications then are to eliminate the excess, and to prevent its formation. As the excess is caused, first, by the too free consumption of foods containing uric acid; secondly, of foodstuffs from which it is made; and, thirdly, of such articles of consumption as by their nature give rise to imperfect digestion and to fermentation and acidity, thus diminishing the normal alkalescence of the blood, and interfering with the perfect elimination through natural channels of the nitrogenous waste material, the regulation of the diet is, therefore, clearly proven to be of the utmost importance. This is agreed to by all. However, if one should take a list of articles commonly used for the diet of man, and strike from it the foods interdicted by eight or a dozen accredited authorities, one would have in the end hardly water enough to keep the blood fluid, and almost nothing to eat. I do not propose to analyze the dietaries of various authorities, but give those which in my experience have proved of most value, easiest inculcated, and easiest adhered to. There are a few general directions given to all, fat or lean, weak or strong, plethoric or anemic. I exclude from the dietary of all lithemics, all soup stocks, broths, and meat extracts, because they contain all the waste in the animal tissues from which they are made, and little else, and can but add embarrassment to eliminating organs already overburdened. I exclude sweetbreads, kidneys, liver, and pâté de foie gras, because they contain excessive amounts of urates, and greatly increase the output of uric acid. I exclude all acids and acid fruits, and include in this exclusion all beers and wines because of their acidity, for the reason that acid ingesta, even though they may combine with alkalies to form salts, do so at the expense of a complete chemical metabolism of nitrogenous waste, and, furthermore, because in the lithemic, they often disagree and disturb digestion. disagree and disturb digestion. If the uricacidemia is pronounced, I exclude tea, coffee, chocolate, and cocoa, because of the close chemical resemblance of caffein and theobromin to uric acid, and because, clinically, I have found patients with marked symptoms do better without them. Another direction |