Uric acid in the clinic : a clinical appendix to "Uric acid as a factor in the causation of disease" / by Alexander Haig, assisted by Kenneth G. Haig.

Date:
1910
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Licence: In copyright

Credit: Uric acid in the clinic : a clinical appendix to "Uric acid as a factor in the causation of disease" / by Alexander Haig, assisted by Kenneth G. Haig. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    and the surface skin was warm. A few days later urea had fallen somewhat ^ (this is often the case, as the large rise of urea at the time of the fall of albumin rep-esents the combustion of old accumulated nitrogenous waste products {kreatin, leucin, etc.), and this is not continued as they are cleared out and got rid of). A month later she was up and about and albumin a mere trace. She was allowed to go out, her parents being cautioned against cold or wrong foods. It is children like tliis who react best to retentives (and iodide of mercury is the most powerful one we have), as their combustion is naturally active, and takes more to depress it and keep it down than the slower combustion of an adult does. If she lives and feeds properly there should be no relapse, and in six to nine months all trace of albumin should be gone, and no one would probably believe that she had had acute Bright's disease. Here is a case in which the same drugs quite failed, as they at once produced iodism or mercurialism. Case 13.—G. A., male, aged 24. Suffering from Bright's disease. Urine sp. gr. 1010, and albumin 2 per 1,000. There is ascites and general anasarca. Pulse 72, first sound long or reduplicated, second sound very loud everywhere. Left radial measured 1'9 by Oliver's arteriometer. He was put on iodide of mercury mixture, but a week later he was suffering from iodism and mer- curialism, with cold surface; pulse 72; left radial 2-2. The first sign of iodism was a nasal catarrh, and this was followed by a severe erythema of face, with much swelling of eyelids. The medicine was changed for phosphoric acid and strychnia, but urine did not increase. Pulse remained 72, and left radial went up to 2-5, and he had some headache, i.e., due to strychnia. Strychnia left off, and as face was now bad some salicylate of soda was given to try and aid the resolution of the iodism; but four days later he was put back on strychnia and phosphoric acid. Five days later face, eyes, and ears were still much swollen and discharging. About two weeks later, being still on acid mixture, he got some general eczema, which began on face and spread to body, and cleared up first on face. I did not see him again for two months, and I then tried' some iodide of sodium; but he at once got coryza and conjunctivitis, and these kinds of retentive drugs had to be given up. He went on with gradually increasing heart failure, in spite of tonics, the abdomen being frequently and the pleura occasionally tapped, till some nine months later he died owing to heart failure and and increasing dyspnoea. Here was a case which, perhaps, might have been saved at first if iodide of mercury had done good, and acted as a retentive without causing acute symptoms in face and skin ; no doubt these were the places where it retained, and the salicylate, in clearing out the retention, did good just as alkalies do good in general (non- toxic) dermatitis. What we wanted it to do was to retain, without inflammation, in such places as the liver and spleen, and to clear the blood by such retention. We might, perhaps, have done more than we did by cutting down fluids, but the poor and ignorant are not very amenable to such treatment, which they do not understand, and for the sake of which they will not put themselves to any discomfort.