Issue 10, pp. 753-832, October 1861, SMSJ

818 Ammoniamia. [October,v^^%/\yof the* disease, and it appears, therefore, better to describe thedifferent forms according to their cause and predominantsymptoms, after having mentioned what is common to all theforms, and necessary to the diagnosis.Most frequently, ammoniajmia is produced by diseases ofthe urinary bladder—more particularly torpor and paralysis ;a morbid condition of the ureters or kidneys but rarely causesit. Torpor of the bladder may develop itself gradually, turninginto complete paralysis only after a long time, or it mayarise rapidly. Accordingly, the symptoms of ammonisemiawill be either manifest, to a slight degree, but for a long time,so that they are scarcely heeded and easily overlooked ; orthey appear more suddenly and with great intensity, so as togreatly embarrass both the patient and his physician. Thetorpor can be induced by some impediment in the urethra orprostate, or by a want of innervation or change in its texture(hypertrophy, catarrh, inflammation, ulceration, carcinoma.)In consequence of the paralysis, some ulcerative or diphthericprocess, or gangrene may be produced by the stagnant anddecomposing urine in the bladder. The progress of the diseasedoes not, however, depend entirely on pathologicalchanges in that organ, but also on the action of the organsserving to the excretion of ammonia ; the lungs, skin, kidneysand intestinal tract ; further, in the age and constitution ofthe patient, as well as on external influences. A sojourn inthe country, for instance, proves very beneficial in chronicammoniremia.For a correct diagnosis, the following points must be considered:1. The degree of torpor or paralysis of the bladder, and thecause of the same. In the chronic form, sensible and motoryparalysis are generally developed at the same time. Althoughthere is a large quantity of urine accumulated, distending thebladder above the symphysis, and not unfrequently to thenavel, the patient experiences no pain, or some dull, painfulsensation, and no inclination to void his urine, unless thebladder be extended beyond the already habitual measure ;even then, only this surplus of the accumulation is evacuated ;the stagnant quantity remains unchanged, or increases evenwith the torpor. Acute paralysis commonly produces, in thebeginning, violent tenesmus and pain, which decrease whenthe paralysis has reached a certain height, and disappearswith the more developed distension of the bladder.. 2. With the torpor and paralysis, and usually before theyhave been carried to a very great extent, commences the de-