CLINICAL FEATURES AND SYMPTOMS OF PHOSPHATURIA.
These vary greatly, depending probably upon the grade of the loss and the length of time during which it has existed. Most writers have a sharply stamped clinical picture of the type of patient who is thus suffering. Thus Dickinson says : "I have learnt to rec ognize the manner of a man who is suffering from phosphaturia. He is nervous and mobile, of hypochondriacal temperament, having perhaps half latent gouty characteristics." The symptoms include the phenomena of nervous irritability, of functional derangement of the digestive organs, and of widespread and obstinate neuralgias, especially those of the pelvic viscera. Thus patients may be emotional, excitable, extremely wakeful, they are tortured by presentiments and profoundly depressed and melan cholic. Vertigo is sometimes complained of, the gait is unsteady, the hands tremulous. The tongue is pale and flabby, deeply in dented by the teeth or coated with a white and moist fur. Anorexia and constipation are usually complained of. Abnormal sensations, such as numbness of the legs or vague backaches or limb weariness, are generally present. The urine is usually increased in amount, frequency of micturition being observed in consequence, and there is also the vesical irritability (urethral burning) which is the direct outcome of phosphatic irritation. The whole urinary tract sym pathizes, but the chief section to bear the discomfort is the vesical neck. As the case progresses it is said to become similar in some respects to diabetes insipidus. In fact Tessier has proposed to give the name of phosphatic diabetes to this complaint.
Ralfe, to whom we owe a valuable addition to our knowledge of the subject, records a number of well-marked cases, from which the following two examples are taken : Increased Elimination of Phosphoric Acid; Moderate Polyuria, Hypochondriasis, Rheumatic Pains in the Loins; Emaciation. —A small but well-built man, aged 25, attributes his illness to overwork. No, history of syphilis. Temperate habits; has a pale, anxious, hag Bard expression. States that he has been ailing for some months, has lost flesh, and complains of a feeling of extreme nervousness and exhaustion, with frequent fits of trembling. Constant tear ing pains in the loins, often shooting round the pelvic region with cramp-like spasms in the lower parts of the abdomen.
No lightning pains, patellar reflex unimpaired. Vision perfectly distinct. No apparent disease of the abdominal or thoracic viscera. Digestion fairly good, bowels constipated. Urine pale, whey-like, of medium specific quantity, alkaline reaction, no sugar, no albumin. Patient states that he passes more urine than he should and is fre quently disturbed at night to void it. He was instructed how to collect and measure it, and was told to bring a sample of the mixed twenty-four hours' urine at the next visit. He did not comply with all the con
ditions necessary for accurate measurement, and it was not until October 21st that satisfactory evidence was given that the instruc tions had been carefully carried out. By that time he had been five weeks under treatment with mineral acids and nux vomica, and had improved to some extent.
Analysis of Urine Passed in Twenty-four Hours.—October 21st: Quantity 2,300 c.c., sp. gr. 1.015, reaction alkaline. Phosphoric acid 5.8 gm. or nearly treble what it should be for a man of his weight. Ordered codeine pill, one-third of a grain, and a mixture of bro mide of potassium and mix vomica.
November 18th : Very much improved, is gaining weight, feels stronger, has nearly lost the pains; the discharge of urine is still more abundant than it should be. The patient is to collect and measure as before and to bring a sample at his next visit. To continue the mix tures but to leave off the codeine.
November 25th: Analysis of urine : Quantity 2,300 c.c., sp. gr. 1.015, reaction alkaline, phosphoric acid 5.8 gm.
Excessive Elimination of Phosphoric Acid, No Polyuria, Hypochon driasis, Enormous Quantities of Calcium Oxalate in the Urine.—A gen tleman's servant, aged 27. First came under observation September 28th, 1880. He is a thin, spare man weighing about 120 pounds, of a sallow, haggard complexion. No history of syphilis; habits temper ate. Complains of aching pains especially in the loins, shooting down the hips, and occasionally affecting the bladder and testicles. Alleged loss of virile power. Abdominal organs and thoracic organs apparently healthy. Digestion fair, bowels constipated. Feels very wretched and depressed. Urine passed at the time of visit (11 A.M.) acid, sp. gr. 1.028, containing 8 gm. of phosphoric acid in 1,000 c.c. The secretion of urine, he said, was not excessive; he was rarely troubled during the day but frequently at night with calls to micturate. He was requested to collect and measure the urine for a few days, and send a note with regard to the quantity passed in the twenty-four hours. This proved to be just under two pints, or about 1,100 c.c. The urine he passed at the time of his visit deposited in a few hours an enormous quantity of oxalate of lime, but contained no sugar, iio albumin. Ordered codeine pill, a quarter of a grain, at night, and a mixture of hydrochloric acid in nux vomica and cod-liver oil.
November 18th: Is much better. Less pain in loins, is not so despondent, though he still fears he is impotent; confesses, however, to occasional manifestations of "his nature." To discontinue codeine and to take phosphorus pills, one-sixtieth of a grain instead. To collect urine for twenty-four hours, and to send it for examination.
December 1st: Quantity 1,520 c.c., sp. gr. 1.022. Urea 41.2 gm., phosphoric acid 5.2 gm. Still under observation.