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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    Should life be prolonged, and in cases where recovery is possible, and occurs, there may remain permanent injury to the general health; or special organs may be particularly acted upon. Hemiplegia, hemerolopia, amau- rosis, and impaired mental vigour may be mentioned. (Edema of the lungs and serous effusion into the cavities are noticed—the cerebral ventricles, even, being invaded by an urea-bearing serum. Life is too frequently destroyed, however, to enable observers to enumerate many cases and facts bearing upon this portion of our subject.1 II. Post-mortem Appearances.—It is universally conceded that very few structural changes, of consequence, and often none whatever, are found on necroscopic examination—after death from the mere action of urmmic poisoning—in the cerebro-spinal system. The apoplectic effusions and lacerations of the cerebral substance are only indirectly, if at all, referable to uraemia. The condition of this system is that which chiefly concerns us at this time; for we are seeking strictly for the effects, both vital and post-mortem, legitimately due to the toxic agent derived from the pre- sence of urea in the blood. A full description, therefore, of what is found after death in the kidneys, does not seem to us pertinent to the question ; for the usual and well-known renal lesions of Bright’s disease are not the product, but simply the frequent cause, of the uraemic condition. We shall, therefore, endeavour to particularize the appearances presented after death by those organs which during life most strongly manifest the effects of the toxic agent, and with which it is most intimately brought into con- tact and relation—mentioning more succinctly such other concomitant lesions as have been observed. And in noticing the necroscopic pheno- mena in the cerebro-spinal system, we shall speak of such cases as have afforded the gravest indications of disturbance of the nervous centres during life, and especially decided coma and convulsions. Brain.—Anaemic appearances, and a somewhat infiltrated condition, are noted; the consistence being most frequently diminished.3 This state i 1 The mania which sometimes follows the comatose state in urajmic eclampsia, is generally well recovered from; but should not be confounded with that symp- tomatic of puerperal pyaemia.—Braun; who refers to Helm, Litzmann, “ and others.” 2 Romberg (Nervous Diseases of Han, London, 1858, Syd. Soc. Ed.) when men- tioning the results of cadaveric inspections in cases of eclampsia parturientium which affection, it should be borne in mind, is now referred by such high authority to uraemic intoxication—says—rather adversely to what we find recorded by others —that in the cranial cavity we generally find considerable congestion, increased density of the cerebral tissue, plastic and sanguineous extravasations between the membranes, and in the ventricles, in the latter chiefly when apoplectic symptoms, a profound sopor, stertorous breathing, &c., have been associated with the con- vulsive affection.” (Loc. cit.) The points in which this account chiefly differs from that given by Dr. Braun, are the frequency of congestion, and the increase