370 AZOTURIA. 



a result of tlio pathological changes which have taken place. 

 While, from the necroscopic appearances, the hyper;emic, and 

 altered state of the gland-structures, it seems not at all an im- 

 probable theory or mode of accounting for the changes to 

 regard the excess of albuminoid materials which enter the 

 system through the exercise of peculiar dietetic conditions as 

 altered or broken up at the gland-structures, from whence the 

 extra urea may proceed to join the blood-stream, from which it 

 is again separated by the kidneys. 



To urremic intoxication or poisoning, the result in all animals 

 most probably of retained etfete materials, which by disturb- 

 ance of function in some steps of the assimilatory process are 

 prevented from undergoing the changes requisite for their final 

 removal, this peculiar condition bears some resemblance. Hoav- 

 ever, although it may resemble uraemia in the character of 

 certain of the symptoms exhibited, such as the action developed 

 in connection with the phenomena of disturbance of the great 

 nerve-centres, it seems somewhat to differ from that in the 

 causes which produce the ur^emic condition of the fluids, and 

 probably also in the mode of production. In uremic poison- 

 ing we may have the major part of the symptoms intimately 

 associated with or dependent on the cranial nerve-centres 

 being chiefly involved, marked by coma, rapidly developed, and 

 more or less profound, with stertorous breathing. Of cases 

 of azoturia simulating this form of uraBmia we see fewer than 

 of the other more resembling epileptic spasms, which are always 

 developed suddenly but are of varying intensity, in which the 

 muscular system is largely implicated, either directly through 

 defective nutrition of muscular tissue, or from disturbance of 

 nerve function from direct or reflected irritation, or probably 

 from both. It is of this latter mode of development that the 

 cases of so called azoturia most frequently present themselves ; 

 sometimes the forms are combined, and we have coma with 

 muscular spasms and convulsions. 



It is nowise essential to the development of s^nnptoms of 

 umemic poisoning, nor to the appearance of azoturia, that the 

 urine be suppressed, nor does the mere presence of urea insure 

 the existence of uncmia. Rather are we led to infer that the 

 existence of the nervo-muscular phenomena, so characteristic 

 of both uraemia and azoturia, is dependent on the existence in 



