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

Date:
1861
Catalogue details

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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    element (whatever it may be) in the blood acts probably m a r manner \i. e., to that in which narcotics act]. There is not, tern appears to resemble, in its pathologic conditions, the spinal (or reflective) centre, rather than the cerebral (or intellectual). It is in a state of exalted rather than depressed activity, although both sensation and motion are severed from their purely cerebral relations (i. e., from forming parts of perceptible and effective volition). There are several poisons which appear to act in a directly opposite manner upon cerebrum and spine (inducing at the same time coma and convulsions), but whether they contain different elements, whose action is thus separated, as Dr. Walshe once suggested, in a clinical lecture, the poison of urinoemia might be, I leave for future researches to decide. 5. Special Functional and Organic Manifestations.—In addition to the external appearances of the patient, as exhibiting deranged function of the skin, and perverted nutrition, the stomach and bowels may become ex- cessively irritable. The vomited and other excreted matters, we are told by several observers, exhale ammonia when tested by hydrochloric acid; and the air expired from the lungs sometimes reacts similarly under the same agency (Frerichs, Johnson, Litzmann, Braun, et al). The pulse, in the comatose state somewhat slow, rises, and is, at the same time, weak and irritable, in the convulsive periods.1 2 6. State of the Urine.—Confirmatory of the existence of obstruction to elimination and excretion. Depuratory processes at fault. The secretion is generally acid in reaction to tests, and albuminous—although cases of uringemia occur in which albuminuria is not an element—casts of the tubuli uriniferi, and also blood-corpuscles and mucus-corpuscles are discovered by the microscope; and the urea is notably diminished in the specimens of urine passed. (Frerichs, Thudichum, Rees, Braun, Reynolds.) A febrile condition, very similar to that of genuine typhus, is observed; and especially in connection with diminished excretion of the urine, or with its entire suppression. This is denominated by Frerichs, febris urinosa; the French writers designate it by the same term—“ fibvre urineuse.” There is delirium, excessive prostration, and a urinous odour pervading the ex- cretions ; and death is then imminent. Death may, in certain cases where the blood has been exceedingly impoverished and contaminated, follow epileptiform convulsions which are due simply to the deteriorated and devitalized blood. These convulsions should be distinguished from those arisiug from other causes. Sometimes, even in such cases, rupture of cere- bral vessels may cause apoplectic coma, by effusion of blood.3 1 It may be very much accelerated, and sometimes remains frequent throughout the affection. 2 Drs. Watson, Todd, and George Johnson, have called attention pointedly to the fact of epileptiform convulsions springing from the circulation of impoverished blood in the cerebral vessels.