But, whatever may be thought of Haig’s theories or statements regarding uric acid, there is no question but that many maladies of many kinds have their origin in the concatenation of processes which has long been recognized clinically as lithemia. Personally I believe that sooner or later it will be generally recognized that the starting point of cancer occurs in some cell or cells, previously normal, probably as the result of local irritation, in which there is a deposit of some of the elements of faulty nitrogenous partition, induced by undue ingestion of animal protein: and that the malignant, reproductive process in the cells is kept up by a continuance of the same supply of imperfectly disintegrated nitrogenous matter.
The condition of the urine furnishes a most invaluable indicator and guide as to the systemic derangements and their correction. This has not reference to the presence of sugar, albumin, or casts, but rather to other features, reflecting the manner in which metabolism is performed. This subject was gone into pretty thoroughly in my former lectures, but must be briefly considered here, because of the great importance of the subject.
It is well known that, while the products of the digestion and disassimilation of carbohydrates and fats pass off by the lungs, generally without harm, those of protein and salts are eliminated by the kidneys, and may be the cause of various systemic derangements. The urine, therefore, when most carefully analyzed volumetrically, exhibits in the clearest possible manner how the metabolism is carried on and where the error lies.
From a study of hundreds of complete volumetric analyses of urine in dozens of cancer patients, both in the very early and late stages of the disease, I have found that this excretion almost invariably exhibits departures from normal which are significant.
First to be mentioned is the relation of the total solids excreted daily to the body weight of the individual; for it is evident that a person weighing 200 pounds should pass off more than a smaller person. The following table represents fairly well the total solids that should pass daily in order to maintain a healthy equilibrium:
| Body Weight | Total Urinary Solids | ||
|---|---|---|---|
| 90 | pounds | 500 | grains |
| 95 | 〃 | 535 | 〃 |
| 100 | 〃 | 570 | 〃 |
| 105 | 〃 | 605 | 〃 |
| 110 | 〃 | 640 | 〃 |
| 115 | 〃 | 675 | 〃 |
| 120 | 〃 | 710 | 〃 |
| 125 | 〃 | 745 | 〃 |
| 130 | 〃 | 780 | 〃 |
| 135 | 〃 | 815 | 〃 |
| 140 | 〃 | 850 | 〃 |
| 145 | 〃 | 885 | 〃 |
| 150 | 〃 | 920 | 〃 |
| 155 | 〃 | 955 | 〃 |
| 160 | 〃 | 990 | 〃 |
| 165 | 〃 | 1025 | 〃 |
| 170 | 〃 | 1060 | 〃 |
| 175 | 〃 | 1095 | 〃 |
| 180 | 〃 | 1130 | 〃 |
| 185 | 〃 | 1165 | 〃 |
| 190 | 〃 | 1200 | 〃 |
| 195 | 〃 | 1235 | 〃 |
| 200 | 〃 | 1270 | 〃 |
| 205 | 〃 | 1305 | 〃 |
These figures do not represent much active exercise, and with increased bodily exertion the solids passed should be more. Men excrete about one-tenth more than women; there are also less urinary solids passed with advancing age, and about five per cent may be deducted for each ten years after forty.
The estimation of the total solids is easy with Haines’ modification of Hasser’s method. Multiply the last two figures of the specific gravity of the urine by the number of ounces voided in 24 hours, and add ten per cent to the product. Thus, if the amount passed in 24 hours was 36 ounces with a specific gravity of 1.021, it would be 36 × 21 = 756 + 10 per cent = 832 grains of solids in the whole amount of urine excreted that day. By comparing this with the table it can be readily ascertained if the amount is above or below the normal standard for the body weight of the patient. For many years I have employed this method of determining the urinary output in hundreds of patients with various diseases of the skin and cancer, and have found it of inestimable value. It is understood, of course, that by dietary and medicinal measures the urinary solids are to be brought up to and maintained at normal.
The actual acidity of the urine, as measured by the oxalic acid and phenolphthalein test, is also of the greatest importance. This is not difficult of application and is daily used in my laboratory; the litmus paper test is of relatively little value in comparison with an actual chemical measurement. Thus, with an average standard of 300 we not infrequently find an acidity of 500 or 600, or even 1000 or more, or it may sink to 200 or 100, or even be strongly alkaline. In cancer I have striven, by diet and remedies, to keep it a little below normal, as it has been shown that the blood in this disease exhibits a constantly increasing tendency to diminished alkalescence, or, wrongly called, increased acidity.
But further and very careful volumetrical urinary analysis is very important to determine and maintain the metabolism in its proper condition. Time does not permit such an elaboration of this subject as might be desired, and I can only call your attention briefly to some of the points brought out in my former lectures.