On the variations in the alkaline and earthy phosphates in disease

Abstract

The analyses, of which the results are given in a series of tables, were made by the author, chiefly from the urine of patients labouring under different diseases in St. George’s Hospital, and therefore nearly under the same circumstances as far as exercise was concerned. He found that the variations in the earthy phosphates were in general independent of the nature of the disease. In fractures of the spine and paraplegia, however, the total amount of these salts was slightly above the healthy standard during the early period, and when inflammatory action might be considered as prevailing; but when this action had subsided, and the affection had become chronic, the total quantity of phosphatic salts was less than natural. In chronic diseases of the brain, and in chronic and even in acute diseases of the membranes, no increase of these salts was observed. In fractures of the bones of the skull, when inflammation of the brain supervened, there was a slight increase of the total amount of phosphates; but no such increase occurred when the head was not affected, even although acute inflammation of other organs existed. In acute inflammation of the brain there was an excessive secretion of phosphates, which returned to the natural quantity as soon as the inflammation passed into the chronic state. In some functional diseases of the brain, attended with delirium, the secretion of the salts was excessive; but the excess ceased with the disappearance of that symptom. In other functional diseases, as in fevers, no excess was observable. In delirium tremens, when food could be taken, there was neither excess nor deficiency; but in the most violent cases, where no food could be taken, the quantity of the phosphates was diminished in a most remarkable degree. In the general paralysis of the insane, no increase of phosphates was observed. One case of acute paroxysm of mania showed a small in­crease during the paroxysm; in two other cases of mania there was a diminution of phosphates approaching to that occurring in delirium tremens. Bright’s disease, even attended with acute inflammation, showed no increase. When only a few ounces of urine were secreted, as in dropsy, no increase was observed; and none also in a very extreme case of exostosis. In the case of mollities ossium, there was a decided increase of the earthy phosphates; and at last, the alkaline phosphates were also in excess, although there was no indication of affections of the nervous structures. The following are the general conclusions which the author draws from his inquiries: first, that acute affections of the nervous substance, organic and functional, are the only diseases in which an excess of phosphatic salts appears in the urine; and in acute inflammation of the brain, its amount is proportional to the intensity of the inflammation; secondly, that in a large class of functional diseases of the brain, of which delirium tremens presents the most marked example, the secretion of phosphates is most remarkably diminished; and lastly, that no chronic disease exhibits any marked excess in the total quantity of phosphatic salts secreted, at least as far as the mode of analysis employed by the author can be regarded as conclusive.