Researches in clinical physiology / by Sir Almroth E. Wright.

  • Wright, Almroth, 1861-1947.
Date:
1943
Catalogue details

Licence: In copyright

Credit: Researches in clinical physiology / by Sir Almroth E. Wright. Source: Wellcome Collection.

    58/178 (page 46)
    Lastly, we have the case of man. In man, as we have seen, the same sort of provision for neutralising acid exists as exists in the carnivora. We can now appreciate that this is in conformity with the fact that man under normal circum- stances feeds on a dietary in which the acid food-stuffs preponderate over the alkaline food-stuffs. But, on the other hand, that in man the provision which exists for neutralising acid is not by any means as effective as in the carnivora. We now see that this is in conformity with the fact that under ordinary circumstances there is in our dietary a comparatively small preponderance of acids over alkalies. This is due to the fact that we are continually neutralising some of the excess of acid, which we ingest in the form of acid food-stuffs, by the excess of alkali, which we ingest in the form of alkaline food-stuffs. Our next step, after we have thoroughly digested these facts, must be to con- sider carefully what would inevitably happen if this process of setting off the alkalies of our vegetable food against the acids of our animal food were to be forcibly inter- rupted by the omission of all fresh vegetables and fruits from our dietary. It is obvious to reflection that under these conditions we should inevitably lapse into a condition of acid-intoxication. But, again, experience shows that it is precisely under these conditions that man falls a victim of scurvy. We may, therefore, at least provisionally conclude that scurvy is a condition of acid-intoxication. This conclusion has a very important bearing upon its differential diagnosis and upon its treatment. Before, however, proceeding to base either a method of diagnosis or a method of treatment upon this theory of scurvy, it will be expedient further to test the correctness of our inferences by considering whether this theory of scurvy will suffice to explain all the symptoms which come under observation in cases of scurvy. It will hardly be necessary in this connexion again to point out, for I have already pointed it out in the introduction to this paper and also elsewhere, that, on the one hand, purpura, bleedings from mucous membranes, intramuscular extravasations, and such like ; and, on the other hand, oedema of the cellular tissue, pleural and serous effusions into joints, serous cavities and intestinal tract, are generally nothing more nor less than manifestations of an existing defect of blood- coagulability. Neither will it be necessary again to point out that a tendency to suppuration is often only one of the manifestations of a condition of extremely defective blood-coagulability.1 We have merely to note here that the occurrence of one and all of these symp- toms in scurvy is readily explicable on the assumption that scurvy is an acid- intoxication which eventuates in a defect of blood-coagulability. In connexion with the suggestion that defect of blood-coagulability may be due 1 J may, however, note in passing that in a ease of defective blood-coagulability which came under my notice, not only was there severe oedematous urticaria, but there was also such a pronounced tendency to suppuration, that every accidental scratch gave rise to suppuration, and every blister that was raised on the hands by rowing filled up with pus instead of with clear serum.