Excerpt from The Canadian Journal of Medical Science, Vol. 5: A Monthly Journal of British and Foreign Medical Science, Criticism and Mews
Dr. Andrew Clark, at a meeting of the London Medical Society, read a paper "On Renal Inadequacy." He began by remarking that he was often painfully struck by the great number of people suffering from ill-health of which no sufficient explanation could be given. There was, he said, no doubt that the progress of knowledge was steadily lessening this ignorance, and explaining, by the discovery of dynamical or statical conditions hitherto overlooked, cases supposed to have their origin in the distant ancestry of the patient, and believed to be practically inexplicable. Some of these cases, he believed, took their rise in a feeble and disorderly nervous system, some in a vicious digestion, some in an imperfectly acting skin, some in unsuitable conditions of life and work, some in abuse of tea, coffee, tobacco, alcohol, and other narcotics, and some in the derangement of the chemical changes which accompany and determine assimilation and disassimilation. There remained, he thought, numbers sufficient to demand and reward inquiry. Many of these cases of ill-health found their explanation in deficient excretion. As examples of this, he mentioned cases of anaemia and chlorosis due to f?cal poisoning, and curable by purgatives. But a far larger number, he believed, were due to a deficient excretion of urinary solids. "By renal inadequacy I mean that state of kidney in which it is unable, without material diminution of quantity, to produce a urine containing the average amount of solids and of a specific gravity greater than 1014." The deficiency of solids chiefly affects the urea and uric acid. The urine was pale, almost invariably free from albumen, and deposited no casts. He did not profess to determine what was the exact pathological state of the kidney; but he conjectured that it was one of slight withering and induration, just as sometimes the skin is found withered, hard, and incapable of producing a true unctuous sweat. This renal inadequacy had, so far as he could see, no characteristic symptoms, and we found it out only by searching for a cause which should be found adequate to the explanation of the patients trouble. The symptoms and signs most commonly associated with renal inadequacy were flatulent dyspepsia; palpitation, with a very feeble and interrupted capillary circulation; a dry, shiny, waxy skin; numbness, tingling, cramps and pains in the limbs, occasional flushes, worry of brain, and general nervousness; sometimes thickening of the terminal joints of the fingers, and sometimes, but rarely, evidences of gout. One knew in a given case that these symptoms were due to renal inadequacy, not merely because there was a grave deficiency in the excretion of urinary solids, but because whatever diminished that secretion, or whatever added to the amount of solids to be excreted, invariably within a short time aggravated the patients sufferings. Three things were of great importance in these subjects. They are exceedingly vulnerable; they repair very slowly the damage done by accident or disease; they bear very badly the shock, however slight, of surgical operations - a fact mentioned by Sir James Paget (Clin. Lectures, p. 44).
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