Personal inclination is to the view that the conception of the term uraemia should be extended to include every case of renal insufficiency for urea, although well-defined urcemic symptoms be want ing. Typical uriemic symptoms may arise in persons whose blood shows no in crease in urea, but this fact does not de prive the accumulation of urea, salts, etc., of clinical significance; it merely illustrates that the pathological basis of what is clinically termed uremia is not always the same. It seems desirable that any toxemia should be regarded as urm inic which can be shown to depend on the incapacity of the kidney to perform the functions of a healthy kidney, whether these functions consist simply in the elimination of substances as they exist in the blood furnished by the renal artery, or whether they shall be shown also to consist in the transformation of certain elements of the blood previous to elimination. C. A. Herter (Montreal Med. Jour., May, '9S).
Experiments regarding the relation of an excess of urea in the blood seem to show that a large excess of urea in the blood is capable of giving rise to dis turbances which manifest themselves clinically, although in some examples of conditions included by clinicians as urcemic it is quite clear that urea can play no part in occasioning the symp toms. C. A. Herter (W. H. Welch Fest schrift; Phila. Med. Jour., June 2. 1900).
Ordinary urine contains an organic liquid substance about twice as abundant in volume as urea, personally named "ureine." It resembles olive-oil, is slightly bitter, and seems fatty; the specific gravity is 1.270, and it mixes freely with water and alcohol. It prob ably belongs to the alcoholics of the aromatic series, is easily disintegrated at a temperature of SO° C., and has a re markable power of absorbing oxygen. Ammoniacal fermentation of the urine cannot proceed in its absence except in the presence of considerable heat. Its potential energy is about 130° C., but this varies considerably in different speci mens. W. 0. Moor (Med. Record, Sept. 1, 1900).
Prognosis. — The occurrence of urte mia is always grave. The acute forms arc often recovered from, or subside spon taneously. When they arc due to chronic renal disease, recovery is, as a rule, out of the question; they may be looked upon as the messenger of death. When they are due to acute disease, the prognosis is more hopeful, as the conditions leading up to them are often amenable to treat ment. Puerperal cases are very fre
quently recovered from, as the combina tion of circumstances upon which they owe their origin is of short duration.
The chronic form of urfcmia is utterly hopeless, and, when it appears, the pa tients' days are numbered.
Treatment.—The first indication is to restore the secretory functions of the kidneys. To this end we may apply cups, leeches, or poultices over the loins and administer bland diuretics. It is often found that the action of diuretics is de layed until the bowels have been well emptied by means of jalap, elaterium, or calomel purges. The use of the hot pack or of diaphoretics will hasten and assist the action of a diuretic. Venesection has its advocates, especially in puerperal and acute inflammatory cases.
Experiments undertaken for the pur pose of finding some explanation of the beneficial effects claimed for venesection in uraemia. While in uraemia there is usually an increase in molecular concen tration, the experiments in no case showed that venesection, with or without saline infusion. produced any diminution of this concentration or osmotic pressure. Some other explanation must, therefore. be found. P. F. Richter (Berliner klin. Woch., Feb. 12, 1900).
In the selection of drugs for the treat ment of ummia, the following clear and scientific directions are given by Francis Delafield, of New York: "As disturbance of the circulation, with dyspncea, vomit ing, or cerebral symptoms are liable to come on at any time, we constantly watch the heart and arteries. If the arteries be come contracted and the pulse tense, we at once give iodide of potash, nitroglyc erin, chloral-hydrate, or opium. If the heart's action becomes feeble, we use digi talis, caffeine, or strophanthus. As re gards the use of opium, it is apparently safe and beneficial to use it if the arteries are contracted; if they are not, even a little opium may cause poisoning and death. So with general convulsions or sudden coma—an hypodermic injection of from to V, grain of morphine may be of decided benefit; and in protracted contraction of the arteries, with sleepless ness and restlessness, grain of mor phine every three hours may give great relief." Tonic remedies and milk diet (nour ishing, diuretic, and supplying little ex crementitious matter) may be given to prevent, if possible, a return of the symp toms. In puerperal cases delivery should be completed with as little delay as pos sible.