4G2 



SECRETION. 



of cases referred to by the last of these authors of the different forms of this curious affec- 

 will give some idea of the relative frequency tion : 



It is to be borne in mind, however, that cases 

 of hysterical ischuria are frequently compli-. 

 cated with that strange moral perversion, 

 which leads to the most persevering and in- 

 genious attempts at deceit ; and there can be 

 little doubt that a good many of the instances 

 on record, especially of urinous vomiting, are 

 by no means veritable examples of metastasis. 

 The proofs of the fact we are seeking to 

 establish are, therefore, much more satisfac- 

 tory when drawn from experiments upon 

 animals, or from pathological observations, 

 about which, from their very nature, there 

 can be no mistake. 



Thus Mayer* found that when the two 

 kidneys were extirpated in the guinea-pig, 

 the cavities of the peritoneum and the pleura, 

 the ventricles of the brain, the stomach, and 

 the intestinal canal, contained a brownish li- 

 quid having the odour of urine ; that the tears 

 exhaled the same odour ; that the gall-bladder 

 contained a brownish liquid not resembling 

 bile ; and that the testicles, the epididymis, 

 the vasa deferentia, and the vesiculae semi- 

 nales, were gorged with a liquid perfectly si- 

 milar to urine. Chirac and Helvetius are 

 quoted by Haller as having tied the renal ar- 

 teries in dogs, and having then remarked that 

 a urinous fluid was passed off from the sto- 

 mach by vomiting. A remarkable case is 

 quoted by Nysten from Zeviani, in which a 

 young woman having received an incised 

 wound on the external genitals, which would 

 not heal, the urine gradually became more 

 scanty, and at last none could be passed even 

 with the assistance of the catheter ; at last 

 dropsy supervened, with sweats of a urinous 

 odour, and vomiting of a urinous fluid, which 

 continued daily for thirty-three years. On 

 post-mortem examination, the kidneys were 

 found disorganised, the right ureter entirely 

 obliterated and the left nearly so, and the 

 bladder contracted to the size of a pigeon's 

 egg. In some other instances, the urine ap- 

 pears to have been secreted, and then re-ab- 

 sorbed in consequence of some obstruction to 

 its exit through the urinary passages. Thus 

 Nysten quotes from Wrisberg a case in which, 

 the urethra having been partially obstructed 

 for ten years by an enlarged prostate, the 

 bladder was so distended as to contain ten 

 pounds of urine ; and the serosity of the 

 pericardium and of the vesicles of the brain 

 exhaled a urinous odour. He cites other in- 

 stances in which the presence of calculi in the 

 bladder prevented the due discharge of the 

 secretion ; and in which a urinous liquid was 

 ejected from the stomach by vomiting, or was 



* Zeitschrift fur Physiologic, torn. ii. p. 270. 



discharged by stool. A still more remarkable 

 case is recorded, of a girl born without either 

 anus or external genitals, who nevertheless 

 remained in good health to the age of fifteen 

 years, passing her urine from the nipples, and 

 getting rid of faecal matters by vomiting. 

 There are cases, moreover, in which it would 

 seem that the mucous lining of the urinary 

 bladder must have had a special power of 

 secreting urine ; the usual discharge having 

 taken place to the end of life, when, as ap- 

 peared by post-mortem examination, the kid- 

 neys were so completely disorganised that 

 they could not have furnished it ; or, having 

 been prevented by original malformation, or by 

 ligature of the urethra, from discharging it into 

 the bladder. A considerable number of these 

 have been collected by Burdach.* In all the 

 older statements of this kind, there is a defi- 

 ciency of evidence that the fluids were really 

 urinous, urea not having been obtained from 

 them by chemical analysis, and the smell 

 having been chiefly relied upon. The urinous 

 odour, however, when distinct, is probably 

 nearly as good an indication of the presence 

 of the most characteristic constituent of hu- 

 man urine, as is the sight of the urea in its 

 separated form. The passage of a urinous 

 fluid from the skin has been frequently ob- 

 served in cases in which the renal secretion 

 was scanty ; and the critical sweats, by which 

 attacks of gout sometimes terminate, contain 

 urates and phosphates in such abundance as 

 to form a powdery deposit on the surface. 

 It has lately been ascertained, that in warm 

 climates urea is an element of the perspiration 

 even of healthy persons.f 



The metastasis of the biliary secretion is 

 familiar to every practitioner, as being the 

 change on which jaundice is dependent. It is 

 not, however, in every case of yellowish 

 brown discolouration of the tissues, that we 

 are to impute such discolouration to the pre- 

 sence of biliary matter ; and we can only 

 safely do so, when we have at the same time 

 evidence of concurrent disturbance of the 

 biliary apparatus. This disturbance may be 

 of two kinds : either the secreting function 

 of the liver itself may be diminished or sus- 

 pended, so that the original elements of bile 

 accumulate in the blood ; or, the secretion 

 being formed by it as usual, its discharge may 

 be prevented by obstruction of the gall-ducts, 

 so that it is re-absorbed into the blood. The 

 former condition is much the most dangerous 

 of the two ; the re-absorption of the secretion 

 after it has been once eliminated not being 



* Op. cit. pp. 253, 254. 



f Landerer in Heller's Archiv. vol.. iv.-p. 196. 



