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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    the legs, never gout. Albuminuria, generally a trace only. Spends three weeks m year at Homburg with much benefit. Was there three weeks ago. Father died, aged 62, of apoplexy ; his family mostly died of paralysis. Mother died of carcinoma. Seven years ago his eyes were tested, and renal hajmorrhages found. One morning, five years ago, he lost use in one arm, and could not write or brush his teeth, later lost speech. Shooting pains about head for twelve months {neuralgia ?). Has sensations down right leg and arm. His doctor advises a quieter life. Has vertigo on going downstairs, or turning suddenly. Has had slight epistaxis this morning, and often before. Wakes any time from 2 to 5 a.m., and remains awake. Knows his B.P. is high; it has been reduced by iodide of sodmm, taken for the last month. Pulse 96 (later slowed to 84). C.R. 9-5; B.P. 200. Apex beat in anterior axillary line, impulse heaving. First sound long; second sound very loud. Heart large (cor bovinum). Bowels constipated ; uses liver pills, or liquorice and rhubarb. Not thirsty, drinks very little. Urine sp. gr. 1010 to 1012. Albumin a trace to a cloud. Weight 14 st. 7 lb. Weight to be nourished (i.e., at 25), probably 12 st. Height 5 ft. 11 in. Present diet: poultry twice, fisla twice, bacon once, tea or cofiee once, soup twice, cider or lemonade twice. Has taken no beef or mutton lately, only occasionally veal or lamb (unfortunately for him the latter are mare iMisonous tJuin the former). I advised a gradual change to a dry form of U.A.P. diet and a continuance of iodides and the things necessary for the bowels. Four weeks later he was on U.A.F. diet, except for a little fish or fowl at dinner; has been trying to measure his B.P., and thinks it is lower. Iodide continued and dose increased. In all probability this man will go the same way as his ancestors, and before long. Obviously he has a granular kidney and an enormous heart, which is just beginning to fail a little, as shown by the quickening pulse-rate. These are the people who go to spas every year till the fatal stroke comes. As to his arteries being inelastic, a strain of 200 mm. (and this, mind, was a pressm-e re- duced by the use of di-ugs), along with defective circulation and nutrition, would make any vessels atheromatous and degenerate before long. This man had an original structure that should have lasted to 100 or 110: he will be more fortunate than I expect if he ever sees 70. I conclude he did not go on with the U.A.F. diet, as I did not see him again. Case 31.—A. H. H., male, aged 70. Complains of feeling ill, depressed, and worried, has occasional attacks of dyspncea or syncope, or a mixture of them. Seen with Dr. Creasey at Windlesham. Suffers much from chronic bronchitis and a certain amount of potus for years. Has been going downhill for some months ; urine trouble for twenty years. It is a wonder he has lived so long. Eyes prominent, with folds of loose skin round and under them. Sleeps very badly, and has taken paraldehyde and sulphonal for some time, the former more regularly. Pulse 44 ; C.R. 10 ; B.P. 120. Respiration 37 ; temperature 99° to 100°. Heart sounds distant, and covered by rhonchi and sibili in the air tubes. First sound feeble, second sound more distinct. Heart's rate 44. ]Much emphysema; lungs, catarrhal sounds. Expectoration frothy. Pulse-rate was 88 and above, but lately and suddenly sank to 44. Liver enlarged, but dulness largely covered by emphysema; its lower edge can be felt all across the epigastrium. Bowels generally act once or twice a day (i.e., congestion). Urine, sp. gr. 1003, trace of albumin (no doubt granular kidney). Diet ordinary, and takes wine freely. I gave iodide, chloride, mix vomica, and strophanthus in small doses, also some small doses of blue pill night and morning, so far as the bowels would stand it without purging. Two days later temperature 99. Pulse 46 to 48 ; respiration 25 ; B.P. 110. Heart sounds as before. Still has to take paraldehyde to get any sleep. Bowels open twice a day. Gets excited at times ; best in morning, gets