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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    albuminuria. But this is only if present conditions are continued, and we see from this history of rule breaking how any return of collasmia by introduction will at once try the heart, not yet more than able to hold its own, producing increased interference with combustion, and at once a return of the hetero-albuminaemia and albuminuria (other than serum albumin). Doubtless this relapse of collaemia would have had stiU worse effects if the heart had not by this time become comparatively strong and able to take care of itself. Case 26.—A. B., female, aged 24. Complains of general oedema and a puSy face. Pulse 85. A])ex beat well outside left mid-clavicular line. First sound long and slightly reduplicated, second sound loud. Temperature subnormal. Urine pale amber, acid, sp. gr. 1012. Albimiin 9 per 1,000, many casts, hyaline and granular, with much degenerate epithelium. Urine has a very persistent froth (sign of globulimiria, i.e., hetero-albuminuria), obviously a case of large pale kidney. Relation of albimiin to urea 1 to '8. Uric acid to urea 1 to 12. I give these imperfect and incomplete notes simply to show that in a case of large pale kidney, with all signs of high B.P. and severe collaemia with its resulting defective combustion and a subnormal temperature, there is not enough irritation in the kidney to prevent the excess of uric acid in the blood from passing freely into the urine. Urea was low for the same reason that albumin was high, because metabolism and combustion were very defective. Case 27.—C. J. H., male, aged 32. Another case of large pale kidney just like others given. I only notice it because on one occasion I separated the night and day urine, i.e., the collaemic and the relatively collEemia-free hours. In the morning hours I found sp. gr. 1016, slightly acid, albumin 7 5 per 1,000, and in the night urine, acid, sp. gr. 1013, albumin 2 5 per 1,000. This is the exact parallel of what occurs with the sugar in glycosuria and diabetes, and for the same reason, because combus- tion is poor in the hours of collaemia and better in the other hours (but I have said a great deal on this point in Uric Acid, pp. 620, 633, 635). Case 28.—M. 0., female, aged 65. Complains of liver and kidney trouble. Had swelling of feet and epistaxis seven months ago. Had congestion of lungs eighteen years ago. Occasional bronchitis. Pains in left big toe and gout. Seldom any headache, but is very much depressed. Has noises in left ear. BD -S- pulse 120; C.R. 8-5; B.P. 160; movement large, slightly irregular in force.' Occasional palpitation, apex beat well outside left mid-clavicular hue. First sound long or late systolic murmur most marked over septmn. Second sound loud. Action quick and somewhat irregular. Cough shght and in morning only. Has abdominal weight and heaviness after food. Liver dulness full size stomach down to umbilicus, no splashing. Bowels act with fruit salts or pills Urine passed three or four times in night, sp. gr. 1008, acid, albumin •2 to -5 per 1 000, some hyaline and granular casts, i.e., chronic nephritis. Weieht diminishing, very thin now. Present diet of four meals, meat twice, whisky twice a day. Cannot take milk, it makes her bilious ; cannot take cheese, or very little.