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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    of uric acid in the blood and the phenomena of gout. Writers upon the subject, both near the time of Dr. Garrod’s first researches, and later, have varied somewhat as to the completeness with which they have expressed themselves in respect to establishing uric acid as the active agency in gout. The majority of testimony seems to be affirmative. Dr. Watson {Prin- ciples and Practice of Medicine, 1848) seems to have then regarded the morbid agent as recognized. We find, indeed, in the edition of Dr. Car- penter’s Physiology published in 1846, very positive language as to the conspicuousness of uric acid in gouty affections ; he says : “ When it [uric acid] is imperfectly eliminated, we are assured of its accumulation in the circulating fluid, by its deposition, in combination with soda, in the neigh- bourhood of the joints—forming gouty concretions, or chalk-stones.” He thus appeared to recognize the cause of the diseased condition as lithic acid. There are those, however, who, even at the present day, speak with less distinctness as to an excess of uric acid being the sole and sufficient materies morbi. Thus, Dr. Barclay (A Manual of Medical Diagnosis, London, 1851) writes: “The researches of recent times have gradually led to the discovery of an important element in gout—the presence of an excess of uric acid in the blood. This knowledge holds out a prospect of our arriving ultimately at more accurate diagnosis; at present, it is only in the hands of a few that such a chemical test can be relied on.” The opinion is a very guarded one—decidedly non-committal; we think more influence than it implies may safely be allowed to the “ element” in question. It will, at least, not be disputed that gout is a blood-disease. Amongst many other observers who might be cited on this point, we select Dr. George Johnson, as furnishing comprehensive testimony. Referring to gout as a cause of renal disease, he says: “ It would be useless to occupy the time of my readers by lengthened arguments to prove that gout is a blood-dis- ease, since all the phenomena of the disease clearly indicate such an origin, and can be explained on no other supposition.” {Op. cit., p. 18.) He then alludes to the intimate connection between gout and the uric acid diathesis. Thus, then, when such a diathesis prevails, or when, by some obstructing agency, the elements of the urinary secretion are retained and accumulate in the blood, the gouty accidents, amongst others, prevail. If uric acid be prominent, the corresponding series of symptoms seems as sure to occur, as does that following the retention of urea when that substance is retained, in excess, in the circulation.1 If the uric acid, therefore, is received as the true materies morbi in gout, we have, at once, the following easily-deduced sequence of morbid effects:— First, deficient depuratory action ; next, accumulation of uric acid in 1 The blood contains, as Dr. Garrod remarks, “mere traces” of uric acid in health. This fact, however, in no degree invalidates the agency of the acid as a causative element in gout.