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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    —i ON THE EFFECTS OF THE RETENTION with destruction^ of the right corpus striatum and outer portion of the optic thalamus, in one patient; together with encysted and degenerated kidney (morbus Brightu), and purulent-like matter, with adherent lymph or false membrane, in another. In a third case, purulent-looking matter could be pressed out from the renal papillae; no effused fibrin or coagulable ymph was discovered. The microscope did not decide the “ whitish turbid fluid” to be pus—only epithelial cells, in large quantity, were found. The last patient had repeated convulsions, and died comatose, but no mention is made of any cerebro-spinal lesions being observed. The effusion of blood, and the laceration of cerebral substance in the first case related by Dr. Simpson, were truly apoplectic, and not referable to the intrinsic action of urea contained in the blood; although doubtless the amount present therein must have been considerable, since Bright’s disease existed. Di. Watson {op. supra cit., vol. i. p. 493), speaking of the appearances observed after death from apoplectic coma, after having referred to such a lesult fiom the action of retained urea, uses the following language: “ On examining the brain, we may find a large quantity of extravasated blood spread over its surface, or lying within its broken substance; or a considerable effusion of serous fluid collected within its ventricles; or we may detect no deviation whatever from the healthy structure and natural appearance of the organ. The congestive pressure (if, indeed, it existed) has left no prints of its action.” The following observations, from the Manual of Pathological Anatomy, by Drs. Jones and Sieveking, are exceedingly apposite in this connection “ The researches of Bright, Frerichs, and others have demonstrated the close relation of the state of the blood to cerebral disease; and science has shown, what, previously, was purely hypothetical, that the most fatal conditions may be thus induced without any palpable changes being wrought in the cerebral tis- sues. It does not, however, follow, that because we see no changes, none have taken place. The poison that we know to be in the blood may elude our che- mical tests, and yet cause death. Then, seeing how limited our knowledge of the nervous system is, it is not to be wondered at that, although the manifesta- tion of altered function is so great as to force the belief in its altered constitu- tion, it is not in our power to prove the latter to the perception; but, as Dr. Watson remarks, ‘whatever may be the nature of the unknown, and, perhaps, fugitive physical conditions of. the nervous centres, thus capable of disturbing, or abolishing their functions, it is useful to keep in our minds a distinct and clear conception of the fact, that there must be some such physical condi- tions.’ ” Mere uraemia, therefore—presuming the occurrence of convulsions and coma—it would appear, leaves the brain anaemic in appearance, and pos- sibly somewhat softened (more dense, according to Romberg; refer to page 20); the more decided and destructive appearances are owing to rupture of vessels, and consequent extravasation, with its consequences, and to dilata- tion of the ventricles with serum.