The morbid effects of the retention in the blood of the elements of the urinary secretion / by William Wallace Morland.

  • Morland, W. W. (William Wallace), 1818-1876.
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 National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    various parts of the body;1 lowness of spirits, amounting at times to me- lancholia; restlessness; dizziness; headache; fretfulness; partial anaesthesia and delirium. Nausea, retching, vomiting, and rigors, are likewise noticed. There are often, also, impaired vision, amblyopia, muscoe volitantes, and amaurosis. These latter symptoms, as indeed all the others, are especially mentioned by Dr. Braun, of Vienna, in his late work on Midwifery; a chapter from which, devoted to Urasmic Eclampsia, has been ably trans- lated by Dr. Duncan, of Edinburgh, and has furnished us with a great deal of new and valuable information. While Dr. Braun's views with regard to the subject of uraemic eclampsia will, doubtless, not be at present re- ceived as a whole by the profession, and are, indeed, questioned in many points by his translator, yet his extensive research, accurate observation, admirable description, and ingenious reasoning, render the chapter to which we refer at once entertaining, instructive, and full of practical suggestions. We acknowledge our great indebtedness to the author and his translator. When stupor and coma finally supervene, a greater or less degree of apoplectic stertor accompanies the respiration. It is uniformly noticed that this stertor has a peculiarly high tone—a sort of shrillness, distinguishing it from ordinary apoplectic snoring. Reference was first made to this fact by Addison (Guy's Hospital Reports, 1839, No. VI.), and is repeated by Reynolds (Diagnosis of Diseases of the Brain, &c., London, 1855) and by Rees (On Diseases of the Kidney, 1850).3 1 This peculiar feature of the affection deserves especial notice. Its seats are chiefly the upper part of the body, the face, and the extremities—both upper and lower. The labia majora not infrequently exhibit it. Change of the patient's position often causes its disappearance, temporarily; and it frequently becomes less marked, or even vanishes, towards the end of pregnancy, even while the albumen of the urine and the structural disease of the kidneys is increasing. (Braun.) The skin of the non-cedematous parts of the body appears very dry, and as white as chalk (chlorotic, hydremic, leukemic), and has a low tempera- ture. Only those oedemata of pregnant women which exist contemporaneously with albumen, fibrin cylinders, and fatty degenerated scales of Bellini's epithelium in the urine, have a connection with uraemic eclampsia. The oedema of the lower extremities, ascites, and hydramnios, which are not complicated with albuminous urine containing fibrin cylinders, are not followed by uraemic eclampsia in preg- nancy and labour. The affection of the kidneys with disease cannot certainly be inferred from the appearance of dropsy, as distinct causes may, at the same time, or one after the other, produce dropsies. (Braun, Uraemic Eclampsia; Duncan, p. 17.) 2 Dr. Reynolds, commenting upon this characteristic, writes thus : The stertor exhibits a peculiarity first noticed by Dr. Addison. It is not of low, guttural tone, but of much higher pitch, and appears to be caused by the mouth rather than the throat, either by some position of the tongue against the roof of the mouth or teeth, or by some movement of the arches of the palate, not like that causing ordinary stertor, from which (although its mechanism is obscure) it presents the most obvious difference. (In several obscure cases—i. e., obscure from the fact of the