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

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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$Three weeks later, has eaten a little bread, uriue sp. gr. 1029, sugar present, no albumin. C.R. 10; pulse 80; B.P. 115. Urine passed here turns Nylander a brownish black and Pavy's solution says 1-4 per cent, of glucose (?) Is still taking codeina. A fortnight later urine sp. gr. 1022. Sugar varies in two or three specimens from nil to 6 or 1-2 per cent. (There was thus no increase of sugar on taking bread.) Three weeks later, has had a cold which ended in laryngitis, now better. Has been taking chemists' medicine and lately some quinine and iron, no codeina. Has been eating as much bread as he wants. Has no thirst. Urine sent sp. gr. 1020, acid, browns Nylander, and contains only -7 per cent of sugar. (So the sugar, if sugar at all, is diminishing in spite of an increase of bread.) 1 advised him to go on and eat as much bread and bread- stuffs as he likes. Six weeks later he reported that he had been eating bread as freely as he ever did, that he was getting steadily better, and that his weight had gone back to normal 9 st. 7 lb. ; pulse 72 ; C.R. 8 ; B.P. 125 ; urine sp. gr. 1020, turns Nylander a greenish brown, and shows -6 per cent, of glucose, if glucose it is. He is still taking fish, fowl, and coffee, and I advised him to move slowly in the direction of the U.A.F. diet. The patient thought no more of the glycosuria and kept in good health on a more or less U.A.F. diet. Five years later he died of acute intestinal strangula- tion. My son was called in and promptly obtained surgical aid, but he died of shock before anything could be done, and the post-mortem examination showed volvulus of the entire jejunum and ileum, which even on the post-mortem table could not be reduced until the abdomen had been almost completely cleared. Was this a glycosuria cured by the U.A.F. diet ? Against this it may be said that I made no alteration of diet except to increase the bread, which should have increased glycosuria ; or was it merely an excess of uric acid causing reduction of bismuth and copper, and did the excretion of uric acid, as is probable, diminish on increasing bread as nutrition improved and acidity arose ? It resembles Case 8 and had the same ending—complete cure. Case 17.—M. A. G., female, aged 19. Complains of pain in the back and head due to sleeping in a damp bed three years ago. Sugar was found in urine after this, alternating with urates, sp. gr. 1030 to 1035. Droitwich baths no use. Weir ]\Iitchell treatment for neurasthenia also no use. Father and mother have occasional dyspepsia, and mother is said to have glycosuria. No headaches in the family. Had a fall from a horse three years ago, but had headaches before that. Head troubles begin by being dull and heavy for two or three hours, then when the pain in the head is very great the face gets puffy, and both pain and puffiness subside together. Pain is worst in the morning and in heat. B.D. 75 ; pulse 84, second sound loud; C.R. and B.P. not observed. Has occasional dyspeptic pain and flatulence. Menstruation regular, scanty, no pain. Urine sample sp. gr. 1024, acid, no albumin, reduces bismuth and copper equal to -5 per cent, glucose at most. Microscope of pale deposit, small oxalates, epithelium and mucus. Uric acid to urea 1 to 19. (So there is an excess of uric acid in this speci7nen.) There is some tenderness at back of neck, fourth and fifth cervical spines. (Is tlie pain rheumatism, neuralgia or neuritis ? Neither massage nor rubbing have done any good.) Present diet consists of some milk, eggs, fish and meat or game twice a day, and tea twice a day. She had some headache while here, so I drew some blood and estimated the uric acid granules ; they were 1 to 12, which is not a great excess for a morning hour. I gave some bromide and salicylate for the head, and decided to try retentives later if necessary. I then got moroing and evening samples of urine, the morning sp. gr. 1020, only slightly affects bismuth, not so much as glucose would. Evening sp. gr. 1030, rather more effect on bismuth, (i.e., the effect ivas p)'oportional to the sp. gr., whereas real sugar would probably have shotun most in the morning, from which I argued that it was not glucose). I, however, referred the question to Mr. J. E. Saul, P.I.C., who examined the urine, and thought that it showed the fraction$