The Hunterian lectures on the renal function in its relation to surgery : delivered before the Royal College of Surgeons of England / by J.W. Thomson Walker.

  • Sir John Thomson-Walker
Date:
1907
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Licence: In copyright

Credit: The Hunterian lectures on the renal function in its relation to surgery : delivered before the Royal College of Surgeons of England / by J.W. Thomson Walker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Roberts, Duckworth, and others. Achard and Castaigne10 in 1897 introduced methylene blue as a drug on which obser- vations might readily be made. Fuchsin was used with a similar object by Bouchard and Lepine11 studied the elimina- tion of rosaniline. Observations have also been made upon the elimination of iodide of potassium acd the subject has been reviewed by Lafaye.12 while See,13 Chopin,14 and others have studied the elimination of salicylate of sodium. (a) The Methylene Blue Test. If methylene blue be administered in the form of pill or injected into the muscles the urine will, after a time, assume a blue or green colour. Intramuscular injection is preferable on account of the greater accuracy. Methylene blue is absorbed into the blood from the point of injection as a colourless deri- vative and this reduction takes place only by the action of living tissues. Microscopical examination of the blood shows no colouration of the plasma or of the white corpuscles and the spectroscope shows no change. Nor can this leuco- derivative be detected in the blood by the means by which it is demonstrated in the urine. The colourless derivative or chromogen is transformed into methylene blue by the liver and the kidneys and is excreted in the bile and the urine. The blue in the bile is apparently re-absorbed in the intestine. Methylene blue is eliminated in the urine in two forms, partly as methylene blue and partly as a colourless derivative or chromogen. The latter is transformed into methylene blue by boiling with acetic acid. About 50 per cent, of the total quantity of methylene blue injected is eliminated by the kidneys in the first 24 hours, but only part of the total methylene blue is passed by the urine. The elimination of methylene blue in a healthy individual is shown in Fig. 2. In studying the elimination of methylene blue there are several points which claim attention : (1) the commencement of elimination ; (2) the duration ; (3) the quantity of colour- ing material eliminated as blue and as chromogen ; and (4) variations in the course of elimination. 1. The commencement of the elimination.—Chromogen appears in the urine 15 minutes after the injection and the blue usually commences in half an hour. This relation of chromogen and methylene blue was the rule in my cases in health and disease. In pathological conditions of the kidneys the elimination of blue is delayed and may occur after one or three or even several hours. Occasionally the blue does not 10 Bulletins et Memoires de la Societe Medicale des Hopitaux, 30 Avril, 1897, p. 637. 11 Lyon Medicale, p. 251, 1898. 12 L’Eliraination Urinaire de l’lode, Paris, 1893. 13 Bulletin de l’Academie de Medecine, 1877, p. 717. 14 These de Paris, 1889.
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