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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    tion and general defective combustion, partly due to heart failure and partly to colltEmia, though no doubt the heart failure itself was due to coUaamia and the defective nutrition which colla3mia produces in the heart as elsewhere. When the relation of albumin to urea was 1 to 6, there were very numerous casts, hyaline and granular, with degenerate epithelium and fat on them. Ten days later he was allowed to go out, being given full directions as to diet and all hints that might help to keep it correct. His farther history, how he again failed to keep to the diet and again relapsed, and how all drugs then failed to do any good, because in the meantime the condition of the heart became worse and its muscle less well nourished, and how ascites and anasarca eventually put out the fires in spite of all the drugs, tappings and diminished fluids, that had succeeded before, has been told in Uric Acid, q.v., p. 583 et seq. He had several chances of life and they were all lost because he was poor. Before the last admission some ignorant but well- meaning philanthropist had sent him to a convalescent home, where for some weeks he was fed up on what is called the fat of the land, meat, meat soups and extracts introducing a large quan- tity of poison, which, of course, only made matters much worse for him later on. Case 15.—W. S. K., male, aged 60. Complains of short breath and asthma, worse when nervous or excited, better at night and in bed. Had much headache two or three years ago, no gout for ten years. Used to have rheumatic gout in toe twenty years ago, took salicin and it cleared him. General good health, hardy and strong at shooting aud mountain climbing, Influenza two years ago and once since that. Face vascular, but pale {cardiac failure), no headache. Pulse 95 ; apex beat, with forcible impulse, in anterior axillary line, first sormd markedly reduplicated over septum, second sound very loud everywhere. Slight Dupuytren's contraction in some fingers. Bowels act irregularly, takes Eno's fruit salt. Liver dulness, covered by emphysema. Urine, sp. gr. 1035, acid, cloud of albrmiin, no sugar. No casts found. Slight oedema of ankles. Present diet: meat twice, fish once, bacon once, coffee once, tea once, whisky twice. I gave him some nux vomica with perchlorides of iron and mercury as retentives, but they caused dyspepsia and so did no good. This is a condition in which it is most difficult to do any good ; sixty years of poisoning, and the poisons still being taken. We have here gout adSBmtii' by solvents, with the production of chronic collaemia and a large heart, in an athletic individual, possibly chronic nephritis, then progressive anaemia and heart failure leading to congestion of liver, stomach and kidneys, emphysema, asthma, dyspepsia, and short breath. It is easy to see liow they were all produced. But such people will not diet, will not cut down fluids, and expect to be cured by drugs in spite of poisons continued. One can only feel sorry for the ignorance which expects the impossible. Case 16.—A. P., female, aged 16. In Royal Waterloo Hospital. Had scarlet fever just before she came here. Urine contained 2 per 1,000 of albumin (Esbach); very niunerous casts, hyaline, large and granular, some epithelial and some fatty. Some compound granule cells, and much renal epithelium (post-