The morbid effects of the retention in the blood of the elements of the urinary secretion / by William Wallace Morland.

Date:
1861
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Licence: Public Domain Mark

Credit: The morbid effects of the retention in the blood of the elements of the urinary secretion / by William Wallace Morland. 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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    slower advances of renal disease, or by the action of a progressive obstruction, the system may become somewhat accustomed to the presence of the delete- rious agent. May not this be, in some degree, the explanation of the mnocu- ousness of those very considerable amounts of urea the presence of which in the blood, and for a prolonged period, was ascertained by such accurate observers as Bright, Christison, Frerichs, and Rees; in conjunction, as we have previously intimated, with a possible greater power of resistance to the urea-poison in some constitutions than in others ?l 2 If this explanation be not in any degree admitted, the only alternative seems to be to accept the theory of Frerichs, that carbonate of ammonia is the toxic agent. In support of this view, we have the experiments upon animals, already re- ferred to, in part, where extirpation of the kidneys was practised—as by Prevost and Dumas, Segalas, Tiedemann, Gmelin, Mitscherlich, Claude Bernard, Barreswil, Stannius, and Frerichs, all cited by Dr. Bedford to prove this point (op. cit.)] and the test by injection tried by Bichat, Cour- ten, Gaspard, Yauquelin, Segalas, Stannius, Frerichs; both methods without inducing convulsions. (Idem.) Dr. Bedford also mentions the significant fact that Yauquelin and Segalas proposed to give urea as a diuretic, so little did they consider it a poison! It is, under the present aspect of the subject, as well not to try the experiment. Orfila—to come to direct experiments—caused fatal convulsions in an animal by the administration of carbonate of ammonia; and Bernard and Barreswil found carbonate of ammonia in the stomach and intestines of animals after extirpation of the kidneys. Dr. Rees’s idea that a peculiar “tenuity” of the blood may be requisite, in order to have full toxmmic action, when urea is retained, is certainly plausible; for we may at least suppose that the poisonous matter will be more readily and abundantly distributed through the circulating medium, and will consequently more thoroughly pervade and act upon the system.3 And here we cannot refrain from adducing the exceedingly acute and ingenious remarks made upon this point by Prof. Simpson, of Edinburgh (Obstetric Works, vol. i. p. 311, American edition), in the article containing his state- ments in reference to puerperal convulsions, which latter, as we have already mentioned, recent observers have distinctly referred, in a large majority of cases, to toxmmia by the retention of urea, or of the product of its decom- position, in the circulation. In this particular connection, however, the patients were children—so that here we have remarkable instances of direct 1 Frerichs states that the presence of the as yet unknown ferment in the blood is necessary, in order to the production of toxsemic symptoms by generation of the carbonate of ammonia. He thus explains the toleration of so much urea in cer- tain cases. 2 Dr. Todd (“Lumleian Lectures on Delirium and Coma,” Med. Gaz., 1850) also favours this idea. He believes the poisonous action of urea is facilitated by impoverished blood.