Campbell De Morgan
1871 The Lancet  
118 .appearance was certainly more like urates than phosphates, I And I found, on examining it for myself, that the acid only dissolved the precipitate with heat, but had no action on the old urine. It was consequently placed under the microscope, and was found to consist almost entirely of globular -urates, with high refractive powers, mixed with some crystals of oxalate of lime. Their presence in nearly neutral urine was readily explained by the scanty amount of se-'cretion consequent on the
more » ... revious severe diarrhoea, but --their insolubility by heat was a phenomenon for which I was not prepared. On the following day the urine was more decidedly acid, but there was no precipitate. On boiling, :i3owerer, a copious precipitate was thrown down, which was immediately dissolved on the addition of a few drops of *a,ci.d. I have already alluded to the difficulty of explaining -the precipitation of phosphates in the presence of acid ; .,twhen the deposit only occurs after the application of heat -the change is still more difficult of explanation, because the urine after being boiled becomes rather more acid than before, as I ascertained distinctly in this case, and the granzular precipitate does not dissolve readily with acid after it is;allowed to cool. Bormerly we used to be taught that the presence of urates was only due to acidity, of phosphates to alkalescence of the urine; but that is a very limited view. It was probably only put forward in this broad form as antagonistic to the common expression of those days, that ;one,or other deposit showed an excess of uric or phosphoric acid, the C( lithic-acid diathesis" and the H phosphatic diathesis" of Dr. Prout. It is certain that such a conclusion is very likely to be erroneous, although, perhaps, it contains some element of truth. All that can be said with certainty at present in regard to the uric-acid salts is, that when .they are precipitated there must be a certain excess of .,cidity, and if not an excess of the salt, at least a disproportion between it and the water as ingredients of the 1urinè. . With reference to the presence of phosphates, I conceive :that we must assume the same disproportion to exist between the water and the earthy salts whenever the precipitate is abundant, especially when the urine is not âecidedly alkaline. It is not an uncommon practice in the 'present day to maintain a certain degree of alkalescence of the urine both in rheumatism and gout. In such cases it is quite remarkable how the amount of earthy deposit varies while the urine is freely alkaline, but I have long learned .by experience that a copious deposit is an indication of depression, and is sure to be followed, if not accompanied, by o'ther symptoms of a corresponding kind. At one time I 'tised immediately to diminish the dose of the alkali, but I have recently observed that, without making any other kliadge in treatment, the addition of a few grains of quisune. daily will have the effect of at once diminishing the amount of deposit, and will enable the patient to persevere .iih such a dose of alkali as he could not otherwise have iMcem with impunity. Believing as I do that in both forms t<&S. disease it is desirable to neutralise as far as possible expassive acidity, the effect of the quinine is to me a point of -great, importance in the treatment of these disorders.
doi:10.1016/s0140-6736(02)62380-3 fatcat:oaukdoxtm5agdfd4rjzlx5d73q