Lithemia.

Synonyms.—Uricacidemia; Uricemia; American Gout.

Definition.—A condition of the blood in which there is an excess of uric acid, due to a disturbance in cellular metabolism, and characterized clinically by various digestive, circulatory, genito-urinary, and nervous phenomena.

Etiology.—Dr. DaCosta tersely defines lithemia when he terms it a condition "in which the increase of nutriment is in excess of the output of waste." As a result of luxurious living, the consumption of rich foods, and drinking freely of fermented and malt liquors, there is introduced into the system more nitrogenous material than can be oxidized, especially since this class usually lead a sedentary life, and muscular exercise is deficient. As a result, uric acid increases, which for a time may be eliminated by the excretory organs; but sooner or later, the kidneys, lungs, skin, and bowels are unequal to the contest, and disturbances of the stomach, bowels, circulation, and nervous system result.

We may have uric acid in excess, however, in persons of modest living. In such individuals there is feebleness of the digestive apparatus, which gives rise to the same conditions,—imperfect oxidation and disturbed metabolism.

Defective capillary circulation must be considered a cause, the correction of which is so often attended by rapid improvement of the usual phenomena.

Heredity must not be overlooked as a predisposing factor; the patient coming into the world handicapped by enfeeblement of every organ, lithemia naturally results.

Pathology.—Osler has well said that, "In the present imperfect state of knowledge, it is impossible to define with any clearness the pathology of the so-called uric-acid diathesis."

The disturbed metabolism, if continued for a great length of time, finally leads to arterio-sclerosis, renal diseases, and degenerations, usually fibroid, of the various other tissues.

Symptoms.—The symptoms due to uric acid diathesis are legion, many of them quite vague. The principal ones are related to the digestive, nervous, and circulatory systems, although the skin and genito-urinary organs show more or less characteristic symptoms.

Gastro-Intestinal.—Among the most frequent symptoms are those of dyspepsia. The appetite is variable; at times perverted, again voracious. The tongue is usually coated; there is an offensive breath, acrid eructations, sense of weight in the epigastrium, flatulency, nausea, and sometimes vomiting. Constipation is the rule, although diarrhea is not uncommon. Hemorrhages are usually present. A troublesome and unpleasant feature is the frequency with which stomatitis attends the disease, usually of an ulcerative character.

Cardio-Vascular Symptoms.—Palpitation is the first symptom to announce disturbance of the vascular system, and although at first due to flatulency, occurring shortly after a meal, it is not long before it disturbs the patient's rest at night. Arterial tension occurs later, followed by contraction of the arteries—arteriosclerosis.

Nervous Symptoms.—Headache is one of the most frequent symptoms of uric acid diathesis. It may be occipital, general, or affect but one side of the head—hemicrania. Insomnia is common, and the patient is often restless and irritable, finally leading to depression and melancholy, and not infrequently to suicide for relief.

Genito-Urinary Symptoms.—The urine is high-colored and generally of high specific gravity, 1,025 to 1,035, and, on cooling, deposits a brick-dust sediment—uric acid. Urea, oxalate of lime, and the phosphates are often present. Albumin and tube-casts are sometimes found. The acrid urine sometimes gives rise to cystitis and urethritis.

Cutaneous Symptoms.—The skin becomes dry and constricted, to be followed by severe pruritus and various cutaneous eruptions.

Diagnosis.—The frequent and persistent headache, gastric disturbances, high-colored urine depositing a brick-dust sediment, uric acid, and rich in the phosphates, render the diagnosis comparatively easy. The absence of joint symptoms enables us to differentiate lithemia from gout.

Prognosis.—When recognized early, judicious treatment should result in complete recovery. Where arterio-sclerosis has developed, or where degeneration of the kidney and liver has taken place, the prognosis is of course unfavorable.

Treatment.—Dietetic and hygienic measures are a very important, if not the most important, part of the treatment.

Any outdoor exercise that will bring into play the greatest number of muscles, should be indulged in regularly and systematically. Well-regulated exercise increases respiration, and the intake of oxygen helps materially in the burning of nitrogenized tissues. In lithemia, oxidation is defective, hence the need of systematic exercise. When the patient is financially able to carry out the prescription, sea-bathing is one of the best forms of exercise, since every part of the body is brought into play. An ocean voyage is beneficial, if systematic exercise is taken daily while on shipboard. For the stay-at-home people, golf, tennis, dumb bells, Indian clubs, rowing, breathing exercises, etc., should not be neglected.

Diet.—As a rule the diet should consist largely of milk, fruit, and vegetables, although no diet will suit all cases. In general, red meats should be excluded, and pork positively forbidden. Broiled or baked fish may occasionally be indulged in, and the white meat of chicken. Shell-fish can usually be allowed. Eggs, poached or soft boiled, may be served occasionally. Dried beans and peas contain more nitrogenous matter than beefsteak, and should not be used often. Fruits should be freely eaten, unless of a very acid character, like sour cherries, plums, etc. The cereals may be eaten freely, especially rice.

Plenty of pure or alkaline water should be taken. Londonderry lithia water is especially to be recommended. Alcoholic, fermented, and malt liquors are to be prohibited.

The patient should be relieved of work and severe mental worry as far as possible.

The daily bath should be emphasized; the cold bath with brisk friction for the young, active, and robust. The hot bath for the feeble and elderly patient.

Medicinal; Hydrangea.—This agent has long been used in lithemia, and where there is pain in the loins and irritation of the urethra and bladder, with red sandy deposit in the urine, the agent will give good results. Hydrangea one dram, to water four ounces, a teaspoonful every one, two, or three hours should be given. The wrongs of digestion will usually be corrected by a carefully selected diet, although nux vomica, ipecac, rhus tox., hydrastis, and hydrochloric acid may be needed before the normal condition is attained.

Epigea Repens.—Where there is excess of uric acid as shown by the brick-dust deposit, backache with nausea, and marked congestion of the kidneys, epigea will increase the flow of urine, flush out the detritus, and give marked relief. Of the specific tincture, ten to fifteen drops may be given in an ounce of hot water, to be repeated every two or three or four hours. An infusion usually gives better results than does the tincture.

Polymnia.—Where there is enlargement of the spleen, with engorgement of the portal circulation and mesenteric glands, and but little or no pain, the tissues full and doughy, uvedalia one or two drams, to water four ounces, will give good results.

Ceanothus.—Where there is puffiness of the face, doughy and relaxed skin, with pain in the spleen and liver, two to ten drops of ceanothus in a little water every two or three hours will prove beneficial.

Carduus Marianus.—When the patient is despondent bordering on melancholy, feeble capillary circulation, enlarged spleen and liver, carduus is the indicated remedy.

Chionanthus.—Engorgement of the liver with jaundice calls for chionanthus.

Grindelia Squarrosa.—Where there is long-standing dyspepsia with enlargement of the spleen, and the patient sees only the dark side of life, Professor Mundy declares that, for this patient, there is nothing equal to grindelia squarrosa.

Piperazin has been found of marked benefit in some cases.

Lithium Benzoate.—Where the urine is loaded with phosphates, mucus, and pus, with irritation of the bladder and urethra, and where there is tenesmus and burning, benzoate of lithium should be given.

Lithium Salicylate.—If there be rheumatic pains, and the urine is loaded with the brick-dust deposit, the salicylate of lithium will be the better preparation.

Where the capillary circulation is feeble and there is nervous waste, it is well to examine the rectum for hemorrhoids, pockets, papillae, and other wrongs. Also sound the urethra; for when there are wrongs of these parts, but little benefit can be expected from medicine till they are removed.

The alkaline mineral springs will be visited by many with much benefit.. Travel, change of climate, and absence from business and the worry of life, will do much towards a cure. In all cases, the individual case needs especial study, and such remedies as may be needed from time to time must be promptly administered.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.