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
Catalogue details

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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    fails to reach its proper ratio to capillary reflux; later, when the heart has had time to hypertrophy and get level with its work, it may rise, not only to its proper ratio, but above it; and this, again, is most useful in prognosis as well as for a correct estimation of the action of drugs. Again, when one sees Bright's disease in pregnancy one may find a wi'ong ratio between capillary reflux and blood pressure at first, with much albumin and a doubtful prognosis, but in a subsequent pregnancy, when the heart has had time to hypertrophy and get equal to its work, the ratio may be more normal and the loss of albumin less. And indeed the whole treatment of Bright's disease is to strengthen the heart (if it is weak), clear the blood of m'ic acid by di'ugs and diet and get the capillary reflux and the capillary reflux to blood pressure ratio as near normal as possible. I may here describe the method of using the capillary dynamo- meter to estimate the capillary reflux. Take the instrument in the right hand and place the thumb opposite the mark which indicates 15 oz. of pressure. The thumb feels the button on the piston rod impinge on it when this pressu.re has been reached, and so the amount of pressure used is regulated. Now place the padded end of the piston on a sm'face of skin, preferably the front of the chest about the heart level (though, if the patient is horizontal in bed, other surfaces will do), feel that the button just touches the thumb and keep up the 15-oz. pressure for six half-seconds by metronome. Then withdraw the instrument and count the time in half-seconds that the coloiu- takes to return into the whitened patch. It is well to make three or four observations on different spots and take the mean of them, and this is so quickly done that there is no appreci- able loss of time. A skin surface which is irritated, rubbed by clothing or made red by erythema must be avoided, as here the capillary reflux will be quicker than on normal skin. On the other hand, a surface exposed to cold must be avoided, as, other things equal, this will make the capillary reflux too slow. For rough work in the out-patient room a mere touch with the end of the finger, with time and pressure left uncertain, and the rate of return being measured by counting half-seconds (which it is easy to learn to do with considerable accuracy), will give interesting and very usefvil indications; but for more careful work and especially in measuring various physiological conditions, or the effects of drugs, or where you wish to gauge the strength of the heart, it is well to use the capillary dynamometer, though those who can count half-seconds