Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    176/976 (page 156)
    passes on, the patient does not get stronger; he lives three or four days, and then sinks from exhaustion, with disturbed respiration and coma. It may, ultimately, if the case is sufficiently prolonged, pass into the typhoid state. There is no pyrexia with this imperfect reac- tion. It is not always fatal, but very frequently is so. Uraemia.—This is very common. The symptoms of collapse pass off. If. the urine is not secreted we are not long without indications of mischief. Vomiting often returns soon, the ejecta not now colourless, but generally grass-green. Uraemia shortly succeeds. The patient has weight about the loins, listlessness, delirium, drowsiness, coma; the eyes become injected and dark, the tongue dry, the teeth foul. Before coma comes on there often exists a singular state of muscular resist- ance ; the patient opposes all attempts at overcoming the ordinary contraction of the muscles. He strongly resists the opening of the eyelids, the depression of the lower jaw, or the straightening of the fore arm. There is not spasm but simple resistance. Dr. Morehead notes that uraemia is preceded by preternatural slowness of pulse. If the renal secretion is not established the coma becomes deeper and deeper, and death may occur within forty-eight hours after the full re- action ; but it is generally delayed longer than this; and even after secretion is apparently restored, the patient may pass into the typhoid state. The length of the collapse has doubtless an influence upon the suspension of the renal secretion; the shorter it is,—its duration not exceeding eight or ten hours,—the greater probability is there that the kidneys will act easily and within twenty-four hours. We must not despair, however, if the secretion is retarded for twenty-four or even thirty-six hours after reaction. In extreme cases even this limit may be passed. Dr. Morehead notices that when the collapse has lasted eighteen hours or more there is much greater danger of consecutive disease depending on defective secretion, and the more speedily the full circulation has been restored after long collapse, the greater is the risk from continued suppressed urinary secretion. The comatose cases are very frequently fatal, but not necessarily so. If the kidneys act, bad symptoms will probably diminish, but if they do not, death is in- evitable. The secretion of urine, however, does not always relieve the head symptoms, as Dr. Morehead has also pointed out. The bowels are sometimes relaxed, sometimes constipated ; the evacuations yellow and feculent. Diarrhoea may carry off some urea, and should not be checked. The whole train of symptoms of uraemia need not be de- scribed here. They are the same as in uraemia generally. There is no febrile action, or it is but slight.