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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    chlorine is not found to be solely characteristic of pneumonia, the cases of that disease in which it has been observed afford very striking illustrations of the fact. For detailed accounts of these, the recent work of Dr. Bennett, already referred to, may be consulted with great advantage. Dr. Beale, of London, has also given us much reliable information upon this important topic. (See Medico-Ghirurgical Transactions, vol. xxxv.) The rule in pneumonia seems to be that the diminution of the chlorides indicates the progressive stage of the disease; at its height, the chlorides may wholly disappear; their reappearance is a sign of improvement, with cessation of the inflammatory action, and occurrence of the crepitus redux. Dr. Bennett thinks it established that, although absence of the chlorides may be found to exist in some other diseases, and may thus lessen the value of the sign in pneumonia, it yet leaves it unaffected in importance, “ as pointing out the onward progress of that disease.” (Op. cit., p. 640.) The appearance of the chloride of sodium—thus excluded from the urine of pneumonic pa- tients—in the sputa, and its desertion of the sputa when it again becomes manifest in the urine, is another remarkable fact connected with these ob- servations. Experiments conducted by Mr. Seymour, Clinical Clerk, upon more than sixty pneumonic patients in Dr. Bennett’s wards, established the fact that the chlorides were absent in all but one ; and that was a case of phthisis, with intercurrent pneumonia. The question to which we now recur* is virtually that at the foundation of our present researches, viz., does any morbid action result from the re- tention of the chlorides in the blood ? Irrespective of what we have already said of the avidity with which the chloride of sodium is sought by man and animals, and its innocent nature unless inordinately ingested—when, indeed, it would in all probability be either vomited or discharged from the bowels —we learn from chemical and medical authority that the blood always re- tains a portion of the chlorides. The fact of the chlorides being found in large quantity in pneumonic sputa, is explained on this ground by Dr. Thudichum, viz., that sputa being, in part at least, “ extravasations and exudations from the blood,” the chlorides would naturally appear in a sub- stance partly composed of exuded and “ stagnant” blood. It does not seem, then, from all that we can discover is as yet known, and considered as material from which to draw conclusions, that pneumonia, or the other diseases in which the absence of the chlorides from the urine is remarked as a feature, can be distinctly ascribed to that fact as a prime cause. Were this to be predicated of any one affection, however, it would certainly be of pneumonia.. An extensive field is open for important and interesting ob- servations in the direction of the present inquiry ; but should it be here- after ascertained that the amounts of chlorine absent from the urine and therefore presumed to be circulating in the blood, are to be considered as more or less poisonous, either by their quantity or quality, we still must remember, in estimating such an action, that there are other channels of