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.

    41/128 (page 35)
    “ We can understand that the peculiarity of the kidney, with reference to the excretion of uric acid, ruay be transmitted; and likewise that, when the function in question is permanently injured [viz., the ‘uric-acid-excreting’ function], it will not require an excessive formation of the acid to cause its accumulation in the blood.” (Loc. cit., pp. 93, 94.) Dr. C. J. B. Williams (Principles of Medicine), referring to the fact that gout had been generally admitted, by inference, to depend on the existence of an excess of uric acid in the system, chronicles Dr. Garrod’s experi- ments and analyses, which, as we have stated, were first made on patients under Dr. W.’s care, in hospital. He says :— “ Gout, and the commonest kind of urinary gravel are now generally considered to depend on the production in the system of an excess of lithic acid.” (Loc. cit.) The case from experiments upon which Dr. Garrod was first enabled to draw his reliable conclusions, “ was one of chronic gout; and further illustrated the pathology of the disease, by a total absence of lithic acid in the urine, until during the exhibition of colchicum, when its characteristic crystals appeared under the microscope.” Sufficient testimony, it would appear, has been adduced, to render the position tenable which ascribes the gouty paroxysm to an excess of lithic acid, circulating in the blood, and finally deposited in various parts of the body.1 It does not seem to devolve upon us to describe the phenomena of a fit of the gout—expected as we are, merely to signalize the “ effects” of retention of the various elements of the urinary secretion in the blood, we should strictly confine ourselves to such specification, and to the adduction of the best evidence afforded in its support. In the first place, then, we may refer the phenomena of gout, more or less completely, to that disorder of the eliminating function of the kidneys, which permits the latter organs to refuse the excretion of uric acid. The latter substance is then necessarily thrown into the circulation, and its tendency—under the circumstances—is to accumulation in the blood. As it accumulates, it is converted, most commonly, into urate of soda, and the deposition of the latter substance upon and into various tissues of the body is a quasi vicarious discharge of the uric acid, not excreted by its legiti- mate channels, the kidneys. This condition is accompanied by the objec- tive phenomena of gout, viz., pain, of an exquisitely acute and torturing- character ; feverishness, dyspeptic symptoms, and general malaise;'2 at the close of the paroxysm, tense, shining, and often excessive swelling of the affected part; finally, entire remission of the symptoms, and better health than before the attack—owing, of course, to the elimination of the mate- 1 See Appendix, Note B. 2 “ An impure state of the blood, arising principally from the presence of urate of soda, is the probable cause of the disturbances which not unfrequently precede the seizure and of many of the anomalous symptoms to which gouty subjects are liable.' (A. B. Garrod, op, cit., p. 341.)