1. health and fitness
2. disease
3. incontinence

MO
A
A
GUIDE
UEINAEY
TO
DISEASES
BY
ADOLPHE
O.B.E.,M.D.
ABEAHAMS,
(LOND.)
M.E.C.P.
PHYSICIAN
TO
ROYAL
THE
WESTMINSTER
HOSPITAL
GENERA!/
CHEST
;
HOSPITAL;
CONSULTING
(CANTAB.)
ASSISTANT
HOSPITAL;
PHYSICIAN
LATE
TO
AND
B.A.M.C.,
MAJOR
PHYSICIAN
OUT-PATIENTS,
PHYSICIAN
TO
HAMPSTEAD
DISTRICT
COMMAND
ALDERSHOT
AND
A. CLIFFOED
BURGEON
TO
SURGEON,
OUT-PATIENTS,
ST.
PETER'S
GHNITO-URINAHY
AND
TO
O.B.E., F.E.C.S.
MOESON,
SURGEON
WHIPP'S
CROSS
HAMPSTEAD
GENERAL
FOR
HOSPITAL
TO
HOSPITAL
JOHN'S
ST.
; LATE
ASSISTANT
HOSPITAL;
URINARY
DISEASES
HOSPITAL,
TEMPORARY
;
CONSULTING
BLACKHEATH,
BUBGEON
LONDON
EDWAED
AENOLD
1921
[All rights reserved,}
"
(ENO.)
CO.
B.N.
PREFACE
IN
urinary
is
of
branch
no
and
tract
from
of
aim
this
small
of
the
authors
work
which
symptoms
details
essential
has
pathology
been
not
and
to
the
the
tion
prepara-
assist
the
from
the
regarded
only
the
barest
of
gation
investi-
methods
of
skill
a
of
as
clinical
elementary
resources
The
pathological
strictly
those
technical
the
to
lesion
neglected,
made
the
such
whilst
of
reason
justification.
Only
be
and
;
demand
which
laboratory
end
this
a
the
separation
primarily
can
of
micturition
of
in
identifying
as
been
has
reference
the
no
present.
are
this
to
been
in
included
are
in
surgeon
requires
has
practitioner
general
act
For
and
diseases
in
the
conditions.
physician
of
of
experienced
surgical
co-operation
than
more
disturbances
difficulty
greater
medical
medicine
well-equipped
experienced
an
pathologist.
It
of
methods
could
consider
LONDON,
treatment,
has
as
to
been
urgent,
given
and
which
legitimately
come
September,
which
1921.
elaborate
certain
surgical
specialist
to
unnecessary
only
a
but
undertake,
adequately
description
regarded
thought
been
has
of
a
which
measures
a
within
detailed
more
would
practitioner
his
are
province.
A.
A.
A.
C.
M.
CONTENTS
CHAPTER
PAGE
PBBFACE
I.
.
UBINE
ITS
:
.
NORMAL
.
VI.
.
.
.
.15
H.EMATURIA
.
.
.
.
.
.
.
.
.
.27
PYTJRIA
.
.\.
GLYCOSURIA
CHANGES
OTHER
.30
IN
DEFECTIVE
THE
UBINE
DUE
ABNORMALITIES
OF
.
45
MICTURITION
.
Vin.
ESTIMATION
OF
TO
.38
METABOLISM
.
VII.
.
.7
.
V.
,
ALBUMINURIA
.
IV.
AND
1
.
.
III.
T
9
.
CHARACTERISTICS
VARIATIONS
II.
.
RENAL
THE
.
65
FUNCTION
.
'
IX.
.70
."
NEPHRITIS
.
X.
SUPPURAT1VE
.
LESIONS
OF
THE
.
80
KIDNEY
.
XI.
.84
BACTEBIUBIA
.
.
XII.
TUBEBCULOSIS
OF
THE
.
.
UBINABY
87
TBACT
.
XIII.
XIV.
XV.
XVI.
XVII.
.91
CYSTITIS
.
BLADDEB
OF
STBICTUBE
IN
.
THE
.
.
.
.
.
.
.
.99
PBOSTATE
THE
OF
.
.95
TUMOUBS
DISEASES
STONE
.
THE
108
UBETHBA
UBINARY
.
.114
TRACT
.
INDEX
11Q
......
vii
A
TO
GUIDE
DISEASES
URINARY
I
CHAPTER
URINE
CHARACTERISTICS
NORMAL
ITS
:
AND
VARIATIONS
A
chapter
BRIEF
introduction
of
the
to
may
first
micturition.
the
are
existence
of
strictly
clear
At
a
of
mucus
limpid
variable
chief
the
urine
occurring
the
A
vulval
as
such
of
urine,
as
and
a
a
vaginal
rule
turbidity
easily
shown
in
conditions
freshly
a
of
bottom
which
and
denser
and
secretion
in
be
due
its
2
cloud
specimen
it
In
should
threads
women,
admixture
epithelial scales.
pus
merely
large quantity
by
faint
from
freshly
of
hours.
prostatic
gleet.
has
for
is that
and
casts
voided
of the
which
presence
may
that
substances
excretion,
the
present
the
siderable
con-
health, and
so
normally
is
way
that
remains
gonorrhoea
phosphates
is
to
tube
cloudiness
general
denotes
but
cloud
mucus
with
for
chronic
in
its
importance
mistaken
be
not
after
period
this
abnormal
in
and
appearance,
gradually settles
glass,
with
may
disease.
Characteristically, healthy
a
In
circumstance
admittedly
termed
be
conditions
which
systems
occasionally encountered
be
cannot
other
other
convenient
a
pathological
compatible
variations
the
of
emphasised
be
affords
of
of
disturbances
lead
may
and
tract
and
appearance
urine
study
the
to
urinary
even
normal
of
characteristics
the
upon
complete
voided
of
or
to
in
the
an
urine
bacteria,
tation
precipialkaline
disappearance
GUIDE
A
2
acetic
dilute
when
of urates
In
known
colour
yellow
due
to
urochrome,
Thus
the
the
In
day.
the
of
pigments.
natural
fevers, also, .the
encountered
dilute
in
urine
a
is
But
low
of
is
urine
the
insipidus
seizure.
of
urine
and
and
alone
specificgravity,
colour
of sugar
may
be
circumstances
excreted
others
adventitiously
introduced
have
been
and
fruits
and
dark
other
and
of urine
certain
pf
of
santonin
a
is
deep yellow
drugs
which
may
A
colour
very
in
light
hysterical
tion
indica-
light-coloured
by
in
the
presence
urine
but
excessive
in
quantity,
certain
drugs
or
beetroot, bilberries,
may
lead
to
followed
from
which
resorcin
of
similarly
certain
very
if
colour
colouring materials
salicylates and
is
administration
usually
from
high specificgravity.
Thus
the
excess
imbibition
an
no
of
mellitus, containing
in
vegetables
coloration, whilst
senna
The
taken.
rest
from
colour
present
certain
foodstuffs
the
modified
normally
some
a
of
and
more
results
after
is
for
a
specific gravity
in diabetes
seen
of urine
pigments,
low
with
dark, partly
urine
light
of
of
partly
passed
coloration
frequently
is
upon
a
amber
generally
the
granular kidney.
sometimes
large quantity
The
colour
consequent
is
during
Very light-coloured
dilution
is
rising
voided
large quantities of fluid, and
diabetes
urine
on
concentration
faint
a
to
passes
intensity varies
summer,
that
is due
40.)
naturally
its
ing.
heat-
on
particles of fat,
normally
passed
than
of
result
as
is
and
in
urine
yellow
intense
This
presence
up
(See page
one
which
appearance
divided
appearance
of the
clears
cloudy
a
chyluria.
as
urine.
darker, and
indication
an
finely
of
concentration.
the
of
considering
the
only
Turbidity
added.
occasions
rare
suspension
condition
a
is
is
DISEASES
turbidity rapidly
very
the
to
such
:
On
acid
standing
on
appears
URINARY
TO
are
the
by
the
these
two
a
distinctly
of
rhubarb,
the
passage
excretion
drugs
other
urine
dark
of
contain.
examples
brown,
The
"
CHARACTERISTICS
URINE:
aniline
colour
which
dyes
cheap
sometimes
are
and
sweets
VARIATIONS
ices
employed
frequently give
greenish-fluorescent appearance
blue, whether
Methylene
directlyas
or
from
deep green-blue
a
the
ingested
of
quantity
None
of
the
the
to
be
cases
conditions.
of
presence
By
of
blood
detected
(see page
of
blood
of
greater
less
or
of
blackness.
Black
in
those
metabolic
rare
when
is
profound
a
responsible.
the
by
clear, and
Bile
although
It
not
is of
and
foam
a
To
urine
rich
the surface
which
up,
be
may
large quantity
drugs
in
and
then,
due
to
an
the
of certain
urine,
only
or
to
an
rapidly
be
coloured
be
be
the
degree
encountered
melanuria
and
indicanuria,
of
putrefaction
distinguished
are
urine
on
the
pigment
to
also
of
or
voided
when
to
exposure
is
air.
which,
appearance
characteristic.
yellow, possessing a greenish tint,
colour
sum
present
orange
will
describe, is very
to
easy
and
intestinal
the
leads
urine
composite
the
on
the
urine
former
two
black
becomes
in
of
that
circumstance
pigment
be
blood
in the condition
the
the
means
the
may
degree
But
denote
course
disturbances,
as
pathological
of
intensity even
urine
well
alkaptonuria, as
of
Should
present in larger quantity the
brown
what
some-
haemoglobinuria,
can
all
in
from
appropriate
pigment
15).
result
may
of
hsematuria,
presence
to
have
cannot
alone
colour
quantity
hsematoporphyrinuria.
varying
according
they
the
are
pink
a
small
a
of
state
a
which
Thus
urine
colorations
above-mentioned
colours
manner
green
distinguished by inspection
similar
urine.
taken.
drug
pathological significance,but
any
tinctly
dis-
same
to the
light
a
to
a
the
to
in the
colour
drug, gives a
a
3
to
foodstuffs,or
is
is
particularlyevident
readilyproduced
abnormal
presence
pigments
pigments
to
shaking.
on
coloration
of
an
which
of
the
exceptionally
are
present
pigments
in the
derived
normally
in
certain
from
the
GUIDE
TO
URINARY
4
A
blood
(and bile). Since
the
constitute
these
alone
these
will
special tests
found
odour
The
under
normal
of
familiar
it is too
marked
when
and
occurred
decomposition.
urine
In
diabetes
sweet
certain
the
of violets
odour
the
The
acidity
is due
dihydric sodium
proportion
be
of
not
turning
amphoteric
The
able
red
rich
exists
is acid
salt
;
The
acid
the
salt,
is normally
salt
ever,
how-
may,
and
the
in
both
as
specificreaction,
own
the
and
garlic
identified.
(Na2HP04)
amount
their
and
which
the
bute
contri-
litmus.
to
to
monohydric
blue
litmus
present
may
usually be
exhibits
are
turpentine gives
acid, but
exert
distinctly
substances
can
increased
to
any
odours
asparagus
urine
infrequently
curious
blue
litmus
property
red
"
its
reaction.
of
is taken.
being
also
are
acidity
excess
Other
; and
which
The
in
the
for
a
peppermint
monohydric
3:2.
present
phosphates
urine
of
of
nature
possess
phosphate (NaH2P04),
the
present with
and
free
to
teristic
charac-
exposed
may
Thus
smell
odours
not
more
perfectly healthy
even
of aromatic
of normal
reaction
is
ammoniacal
and
left
urine
copaiba
;
familiar
other
degree
foods.
or
It
time.
their characteristic
are
become
degree
if
presence
drugs
but
extra-corporeal,
(ripe-apple)smell.
acetone
or
imparted by
in
mellitus
peculiar
The
or
has
ammoniacal
of
is
aromatic,
as
intra-
the
to
and
pathological conditions
in
urine
lesser
length
urine
is concentrated.
the
In
becomes
considerable
it is for
performed,
description.
either
putrid, according
or
which
named
corresponding headings.
described
altered
be
decomposition,
has
the
is
urine
may
be
must
demand
to
the
when
odour
last
freshly voided
It
unmistakable.
and
the
is
only pathological constituents,
that
be
it
DISEASES
urine
On
in
bases,
for
the
the
is increased
other
reduce
acidityto
the
hand,
in
vegetable foods,
acidity.
diminish
food
if animal
A
after
tendency
any
meal,
CHARACTERISTICS
URINE:
the
as
free
sets
of
secretion
sodium
leads
secreted
as
satisfied
or
is
example
in
carcinoma
fluid
acid
and
become
of
Such
acidity.
vesical
stagnation
of
the
urine
administration
of
acetates
the
from
any
be
of
the
whether
of
the
place
into
ture
stric-
alkaline
the
the
by
citrates,
reverse
acid
an
in
from
carbonates,
alkaline
an
by
spinal disease.
or
rendered
potassium, although
conversion
bladder
alkalinity occurs
of
cause,
can
normal
a
taking
urethra, enlarged prostate,
Finally, the
oral
condition
a
is
urine
as
the
alkalinitythus
urece,
achylia
the
in
for
as
in
or
secreted
decomposed
be
thus
being rapidly
when
been
monohydric
produced,
stomach
the
commonly
actually
Micrococcus
the
of
stomach
may
is
being normally
more
has
it
acid
5
the
of
urine
hydrochloric
not
But
gastrica.
alkaline
if
in
increase
an
alkaline
An
phosphate.
such
to
VARIATIONS
acid
hydrochloric
and
bases
"
or
process,
urine, is
not
easily performed.
so
The
specificgravityof
1012
and
many
quite
from
natural
if
the
on
concentration
gravity
to
easily
may
In
of
pectation is a
urine
one
may
that
low
specificgravity
say
in diabetes
of
hand,
the
low
condition
but
that
In
gravity
higher
the
been
hot
weather,
1005
the
;
specific
normal
in
with
the
always
ex"
general
is associated
this is not
case
light-colouredurine
very
frequently present.
specificgravity
insipidus.
no
is
has
any
as
mellitus, the
a
of
low
raise
light-colouredurine
of
as
high specificgravity,and
mellitus, in which
of
divergences
fluid
very
to
occur
diabetes
high specificgravity
Urine
of
during
upon
absence
fall to
may
much
so
the
large quantity
a
other
1030.
in
between
average
marked
that
possible
ingested the specificgravity
whilst,
the
on
depend
conditions
figures are
Thus,
disease.
is
Variations
1022.
these
urine
granular
last
named
than
1001
generally
is
kidney
a
may
urine
be
and
with
found
in
diabetes
in
a
encountered.
specific
A
6
The
is
the
of
subject
and
sweat
glands
also
may
channels.
the
during
diabetes
reduced
of
whole
The
later
that
cerebral
after
fluid
ingested,
supply
the
40
is
of
in
blood-pressure.
loss
haemorrhage,
it
is
of
fluid
is
total
quantity
of
occurring
to
circumstances,
taken.
the
to
in
hours
Diminution
in
cardiac
accompanied
after
body,
conditions
its passage.
any
by
siderable
con-
particularly
and
vomiting
diminished
obstruction
of
diminished
from
ditions.
con-
quantity
twenty-four
conditions
protracted
naturally
and
It
increased
Bright's disease,
and
is
the
normal
in
to
passed
much
tissues
fluid
the
acute
fevers
failure, in
in
passed
ounces
seen
the
detail
hysterical
that
the
'although,
two-thirds
represent
urine
50
of
desiccation
excess,
or
exceed
day.
suffices
it
some
noted
be
substantially
may
in
the
granular kidney,
frequently
and
tone
influence
in
urine
diabetes,
It is
attack
also
may
of
is
excretion
during
present
quantity
in
the
and
is considered
the
sclerosis,
arterio-
in certain
recuperating
secretion
For
in
but
retained
is
urine
secretion
demands
polyuria
increased
epileptic
an
urine
And
fluid
injuries.
It
low
the
total
the
pathologically
of
that
exercise
of
diurnal
the
so
46).
lungs
if violent
the
under
of
subject
(see page
mention
and
of
night
the
mellitus, and
circulatory
system
loss
secretion
and
the
consequent
it is increased
:
when
sleep improves
at
the
fluid
of
activity
through
factor
insipidus
to
vascular
occurs
the
night
diseases
owing
of the
Excretion
The
of
amount
with
may
health.
perfect
relative
hours
but
ounces,
the
upon
Normally,
in.
cardio-renal
'in
important
an
50
bowels,
the
twenty -four
in
to
the
upon
and
be
indulged
reduced
partly
partly
these
through
40
variations
depends
taken
DISEASES
passed
from
wide
to
URINARY
urine
average
quantity
is
TO
quantity
on
be
GUIDE
diarrhoea.
of
pression
sup-
11
CHAPTER
ALBUMINURIA
THE
regarded
and
the
still
that
less
be
does
it
in
desirable
is
of
the
for
urine
constitute
least
at
for
responsible
the
constituents
It
will
which
stage
the
few
a
usual
(not
the
urine
Nitric
height
is
for
gently
detected
been
specimen
themselves
in
One's
1
acid
inch.
poured
consider
substance
of
view
that
be
not
those
a
such
cases
albuminuria.
of
out
for
which
in
tion,
examina-
microscopic
on
albumin
Test
nitric
of
symptom
a
discovery
simple
following
Acid
fuming)
of
may
the
are
purposes
(1)
words
tests
to
is discovered
conditions
i.e.
diseased.
protein
test.
the
first
convenient
deposit
no
;
present.
are
be
with
not
present
are
must
the
positive
alters
completely
case
of
part
a
does
is
as
has
which
casts,
or
disease
any
centrifugalised
a
occur
circumstances.
albumin
examine
cells
considered
associated
all
menon
pheno-
then,
kidneys
the
present
even
of
absence
presence,
be
be
may
that
which
to
it
far
is
transient
a
and
tract
however,
condition
with
case
urinary
pathological
always
frequently
may
as
the
Its
prove
must
any
in
tract.
correlated
In
This,
extent
condition
some
Albuminuria
it
large
is
the
albuminuria
:
case
urine
of
kidneys.
the
urinary
indicate
disease
negligible character,
persistent
a
the
in
of
comparatively
a
of
to
of
the
being
of
as
albumin
evidence
as
especially
from
to
of
presence
At
this
place respecting
clinical
ordinary
:
(Heller's).
"
is
poured
The
tube
concentrated
Pure
into
is
a
then
(preferably through
test-tube
slanted
a
to
and
pipette)
GUIDE
A
8
down
side
the
The
tube
A
cloud
positive
in
then
Certain
this
but
higher
colour
should
nitric
of
and
acid.
addition
of
nitric
(2) The
Test.
drops
acetic
part
of
obliquely
of
column
in the
albumin
"
is
the
of
nitrate, but
If any
before
doubt
the
precipitatej
added
of
patients
turbid
The
reaction
urine
being
urine
become
of
amount
urea
the
level.
junction
large
may
acid
is
flame
indicated
by
the
urine
tube
the
turbidity
of
acid
upper
presence
the
portion
turbidity varying from a faint haze
be practicallysolid.
coagulum which
may
is then
should
of
the
the
cloud
to
be
present
Many
been
or
urine
;
persistence or
if albumin
occurs
disappear,its presence
definitely acid,
should
the
turbidity
carbonates
or
is
added
added
only.
a
few
after
In any
drops
case,
of
is
even
dilute
boiling, whether
to
a
Acetic
even
crease
in-
present
due
was
is
being held
The
purpose.
few
a
test-tube
and
capacity
boiled, the
this
A
added.
are
its
for
of
boiled, such
dense
the
on
distinctly acid,
not
or
three -fourths
the
the
acid.
If alkaline
filled to
several
connection
in
a
warmed
is first taken.
then
if
clearly visible.
white.
Sometimes
Boiling
of dilute
a
forms
event
is
at
than
rather
taking copaiba
are
than
precipitate
nature
diluted
is
occasionally precipitates out,
a
yellow
the
to
be
the
who
is
latter
necessary
containing
yields
fluids
two
coagulum
cloud
the
position.
opalescence only
the
urine
urine
often
as
the
in
up
faint
are
Mucin
test.
Concentrated
exists
before
the
dense
a
In
precautions
with
urates
:
large, a
elapse
may
of
acid.
the
on
vertical
the
to
junction
concentration.
minutes
to
is
it floats
that
so
albumin
percentage
lower
the
the
for
test
tube
restored
at
DISEASES
URINARY
of the
is
white
if the
TO
to
phates
phos-
if the urine
acetic
acid
turbidity
is
no.
other
more
elaborated, but
delicate
for
tests
clinical
for
purposes
;
albumin
the
have
above-
ALBUMINUBJA
mentioned
only sufficientlyreliable
not
are
Before
delicate.
a
of
point
test
and
it
be
the
dissolve
completely
This
myelomata,
and
phenomenon
to
is
terms
"
such
that
these
exhibited
neuro-circulatory
owing
at
all
of
cases
various
have
attacks
of
fainting
food.
type
of
upon
The
in
the
period
that
from
the
element
whilst
albumin, that
subject
has
the
passed
been
up
"cyclical,"
of
have
leaky
certain
the
stance
circum-
and
the
the
vaso-motor
in
is
who
under
present
observed
is prone
and
of
deprivation
early morning
10
such
to
attacks
to
is indicated
about
gation
investi-
estimation
been
liable
duced
pro-
system
the
It has
cold
be
to
important
subjects
also
most
adolescence, when
likely
An
and
"
and
are
adult
to
intermittent,"
asthenia
albuminuria
is
"
condition,
question displays
stress.
exposure
postural
overlooked
this
common
vasomotor
young
albuminuria
urinary
Disease.
terms
in
blood-pressure which,
the
the
albuminuria
consideration, is invariably low.
that
present.
multiple
"adolescent,"
disturbances
of metabolic
of
to express
instabilityof
to
this time
in
in
boils,
with
be
might
postural,"
individual
peculiaritiesfamiliar
of the
"
"
familial
the
is
that
rise
until
urine
albumosuria
use
"transient,"
"
is heated
urine
the
Evidence
in current
Whilst
frequently
boiling
carefully conducted.
not
special features, they
at
gives
without
orthostatic,"
kidneys."
the
is continued
when
Jones
physiological,"
as
"functional,"
"
it
were
are
heating
conceivable
is
which
Albuminuria
the
associated
specifically
it
boiling test
Many
the
as
of Bence
protein body
if the
when
disappeared
condition
rare
ciently
suffi-
subject, however,
relating to
precipitateappear
a
the
but
mentioned.
gradually
has
leaving
special consideration
must
Should
9
or
about,
by
the
urine
11
a.m.,
exhibits
of
cumstance
cir-
is free
after
the
GUIDE
A
10
which
phenomenon
remains
all
bed,
in
the
day,
is
from
it has
in
left
suggested,
for
kidneys
claimed
exhibits
of
pressure
any
appear
to
be
of
the
the
only
the
chloride
It may
is
lactate
or
be
noted
frequently
all
The
pathological
several
of the
of
present
the
has
failed
and
long
alone
exertion
In
cold
oarsman
some
bath,
phenomenon.
renal
does
be
must
decreased
some
coagulability
of
the
calcium
albuminuria.
cases
and
compound,
not
during
to
has
been
hard
in
the
his exercise
persons
all
One
race.
experience
of both
urine
after
even
it may
on
athletics,and
be
responsible,but
susceptible
observed
boat
track
of
very
considered
considerable
had
runners
reason
follows
be
hardly
very
effects
albumin
in
left
element
there
;
It
has
is not
again
the
on
occasionally
a
authors
distance
it is
prevent
again
after
exertion, for which
of the
is
detect
to
peculiarity,due,
globulin.
which
physiological
urine
of
nuclein
or
condition.
occasions
the
part of the protein in these
or
exercise
Continental
administration
often
mucin
a
albuminuria
strenuous
a
will
that
albumin
serum
the
since
blood,
with
veins
determining
mechanical
as
It
catheterisation
by
one
in
hour.
some
ureter
the
case
induce
to
albuminuria
the
markedly
an
the
by
(as shown
kidney
in
be
the
subject
renal
the
may
type
the
of
quarter
of
In
possible
placing
a
position,
is
spine
it is
physiologicalpeculiarity,such
of
If he
albumin.
lumbar
the
by
been
horizontal
from
cases
this
But
vein.
not
to
the
distension
ureters) alone
the
free
certain
the
that
the
be
posture
of
factor, and
workers
in
will
that
suggested
congestion
least
albuminuria
appropriate
an
at
subjects
in
temporary
a
or
urine
lordotic, and
DISEASES
again disappears by evening.
of such
majority
URINARY
TO
that
as
be
the
posture
a
factor.
follows
albuminuria
probability
that
the
also
may
short
severe
very
assumed
he
a
vaso
-motor
a
12
GUIDE
A
?0
Albuminuria
cardiac
of
of
inferior
vena
pressure,
and
anaemia,
again
small
in
which
alcoholism,
of
also
may
due
as
this
to
of the
to
variety
a
urinary
distinguish those
to
index
of
been
said, the
the
in
renal
a
The
casts.
for
whole
the
and
These
of
in
the
of
or
of
presence
greater
The
to
the
chronic.
in
Chapter
remainder
subject
of
of
elements
tance.
imporcells,or
responsible
until
their
the
less
the
constitutes
as
considered
or
to
which
consideration
in
pus
already
is of
be
an
cumstance
cir-
amount
background.
is referred
regards
has
established
(or haemoglobinuria),
as
is
cellular
not
may
in
disease
cells, blood
haematuria
Similarly
when
necessary
as
examined
been
blood
aseparate
now
present, but
albuminuria
the
which
which,
pus
albumin
into
commonly
un-
regarded
albuminuria
of certain
significance has
recedes
present
The
and
may
not
been
It is
which
in
consist
may
that
is
included.
identification
deposit
and
Disease.
among
deposit microscopically
urinary
origin
Renal
of conditions
disease
sufferers
in
present.
has
cases
conditions.
frequently present
albuminuria
is not
tract
these
or
epilepticattacks,
and
and
point
disturbances
myxcedema,
be
secondary
subjects,
gouty
and
Albuminuria
Up
is also
external
or
severe
in
occur
apoplectic
sugar
and
circulatory
in
disease
after
traces
thrombosis
of albumin
Graves's
from
blood
in
occurs
liver,in obstruction
anaemias
the
degree
the
from
from
amount
chronic
of
cava
primary
the
in
changes
in
DISEASES
moderate
slight or
failure, in cirrhosis
the
A
URINARY
:
the
subject
condition
the
reader
Chapter III.
of
pyuria
is
IV.
this
casts,
chapter
i.e.
will
be
nephritis,
devoted
acute
and
ALBUMINURIA
13
Casts.
Whilst
the
cannot
be
they
denote
considered
of
for their
The
of
called
is
relative
form
of
of
of
and
and
drawn
red
which
the
casts
alone
casts
their
existence
casts
are
is
also
may
disease
of
of
malignant
by
anaemia
as
be
of
(The
tion
aggrega-
held
may
fat
an
together
resemble
to
renal
a
recognised
blood
white
globules, according
fatty
epithelial,blood,
respectively.
casts
condition
present in any
not,
or
and
other
nephritis unless
also
following
of
the
will almost
urine
the
kidney.
conditions
kidney.
the
fragments
of
In
the
other
form
clinical
occur.
A
scopical
micro-
certainly
great majority
is
present
evidence, notably cardiac
pyrexia, the
of
:
growth.
new
(infective)endocarditis
infarcts, e.g. the
will
result
a
for
urates
as
of
among
unimportant.
or
of
intermittent
e.g. in the
other
it
corpuscles,
evidence
in the
occur
(2) Infarction
of
regard
matrix
be
(and
dispute
or
this
present.
presence
definable
a
composed
matrix,
nephritis is present
examination
the
is
of
so
and
may
no
(1) Malignant
murmurs,
responsible
matter
designated
are
haematuria, whether
and
character
formation
exact
employed
debris
leucocytic, granular,
cases,
a
blood
corpuscles,granular
of
is
which
therefore
out
in such
epithelial cells,
show
which
is of
cast
the
assess
one
its
sometimes
cast.) Embedded
Casts
the
transparent
salts, e.g. phosphates
mucus
of
is
cast
whom
of mucus,
cylindroid is
Blood
to
lesion
still
significance)is
coagulation
to
in order
hyaline, and
pathologists, some
term
of
nature
structureless, almost
type
casts
production.
simplest
a
by
The
renal
the
isolated
pathological,speaking generally
as
importance
severity
of
presence
nephritis.
considerable
and
occasional
presence
petechiae,or
spleen
or
in the
lung.
of haemorrhages,
retina
or
Increasing
of
disease
lardaceous
with
long-standing
accompanies
viscera)
other
nowadays
kidney,
the
(together
which
condition,
rare
a
of
disease
Lardaceous
(3)
-
and
suppuration
tuberculosis,
chiectasis,
lardaceous
which
casts
iodine
the
evidence
one
of
of
the
genital
Such
pneumonia,
Nephritis
{5)
be
elaborated
(6)
an
special
a
toxin
Chronic
acute*
epithelial
of
in
the
and
an
scarlet
chronic
smallest
and
are
numbers.
of
by
The
influenza,
previously
would
appear
due
the
to
some
mother.
and
nature
casts
which
denote
condition
(See
course
quantity
Blood
casts
the
a
nephritis
or
taining
con-
70.)
page
absent,
are
comparatively
nephritis
in
occur
This
foetus
and
descriptions.
diphtheria,
(See
acute
considerably.
ankles
all
or
variably,
in-
not
urine
exacerbation
of
the
of
pyrexia,
face,
any
pregnancy.
form
by
the
fever,
acute
inflammatory
casts
of
nephritis.
in
but
characteristic,
primary
e.g.
from
presence
concentrated
casts
be
the
cases,
of
nephritis.
varies
casts
cases
as
(chronic)
existing
of
or
is
scanty
may
illness,
acute
an
cells
most
oedema
witH
disease
a
to
condition
organs,
blood
of
In
especially
anasarca,
inferred
to.
nephritis.
Acute
in
with
reaction
is
disturbance
referred
although
disease,
diagnosis
renal
diseases
the
(4)
The
special
No
typical
the
give
occur.
may
this
bron-
e.g.
syphilis.
tertiary
characterise
features
urinary
diseases,
wasting
chronic
scanty.
are
page
to
be
74.)
In
found
and
many
only
III
CHAPTER
H^MATURIA
IN
first
admixture
all
all
with
the
haemoglobin
the
by
enables
alone
decide
to
one
red
by
given
the
presence
the
tion
identifica-
blood
that
means
Whilst
are
on
feature,
of
microscope
colouring
blood.
blood
depend
they
must
proper
of
for
there
the
haematuria
:
essential
the
"
urine
with
tests
since
"
the
constituents
the
chemical
various
conditions
both
of
only
(haemoglobin)
matter
in
admixture
distinguished
be
blood
of
consideration
the
corpuscles,
haematuria
true
is
present.
The
only
alone
haemoglobin
of
identification
detected
be
by
(1) The
a
A
of
and
the
is
brown
with
crystals
bevelled
Although
in
then
of
certain
(2) The
one
Gfwawm
of
it
placed
the
would
not
delicate.
employed
are
of
will
be
the
urine
obtained
is
placed
added
the
On
of
acetic
acid.
whole
and
cooling,
rhombic
visible
small
plates
microscopically.
this
superseded
grain
a
glacial
are
circumstances
it is
The
over
which
haemin,
Crystals.
are
boiling.
to
edges,
special advantages,
practice by
and
ensures
"
deposit
drops
two
heated
mixture
Hcemin
To
slide.
and
chloride
cover-glass
the
it
frequently
most
not
blood
which
however
means,
Preparation
microscopic
sodium
but
present,
is
:
centrifugalised,
on
that
quantities
tests
following
the
other
examination
evidence
is
minute
chemical
The
microscopical
unequivocal
obtain
to
not
is
of
advantage
in
test
may
ordinary
have
clinical
following.
Test.
A
"
15
few
drops
of
.freshly
A
16
TO
GUIDE
prepared
tincture
urine
a
in
slowly
of
URINARY
guiacum
test-tube.
down
side
the
DISEASES
added
are
Ozonic
ether
of
tube.
-the
is
the
the
of
tincture
A
urine.
blue
blood, but
the
ozonic
in
latter
not
may
appear
until
The
guiacum
slightly warmed.
been
blood
specific for
for
but
is
benzidin
(3). The
of pure
The
should
test
Benzidin
benzidin
urine
allowed
of
twenty
drops
positive
reaction
half
within
To
a
minute.
its
clinical
employment
observed, there
its
in
use
diluted
before
will
haemoglobin
the
in
by
of
state
be
evident
spectrum
a
In
single
rare
"
broad
cases
is
site
in
by
A
coloration
delicate, and
objection
an
and
care
to
cleanliness
real
disadvantage
very
dark,
dealing
the
The
the
by
or
by
in
should
it
presence
of
additional
The
reduces
haemoglobin
oxy-
characteristic
two
the
present.
solution
reduced
"
band
addition
of
haemoglobin
to
characterised
band.
the
special absorption spectrum
haematoporphyrinuria
Before
is
examination.
sulphide
ammonium
the
no
urine
the
methaemoglobin
if
as
if
tion
solu-
vols.).
(20
is very
test
then
added, followed
bluish-green
or
and
benzidin
peroxide
be
can
If
"
bands
is
but
;
boiled
prepared.
ordinary practice.
Spectroscopy.
be
satisfactory
is first
the
advanced
is sometimes
is not
possible, the
acid
urine
of
The
delicacy
has
supersaturated solution
of
blue
a
whole
drops
hydrogen
is
to
presence
reaction
thoroughly
ten
its
are
is
quantity
same
A
"
glacial acetic
tested
cool.
that
performed.
Test.
in
be
to
to
the
be
solution
test-tube
Whenever
ordinary clinical practice.
may
quantity only,
the
the
on
test
the
small
is in
poured
adding
indicates
of
c.c.
then
dilute
a
and
coloration
if the
reaction
ether
10
The
alternatively be performed by making
of
to
may
with
urinary
the
tract
be
detected.
differential
from
of
which
diagnosis
the
blood
of
the
may
ILEMATURIA
be
derived
will
it
of the
Diseases
(1)
convenient
hsematuria
of
possible causes
A.
be
17
systematise
to
follows
as
the
:
Tract.
Urinary
Renal.
Calculus,
Neoplasm,
Trauma,
Acute
Granular
Nephritis,
"
Bacilluria,
turia."
such
Idiopathic
(Under
causes
turpentine
Essential
of
Hsemaincluded
be
may
irritation
Coli
Kidney,
or
trauma
as
Tuberculosis,
the
kidney by
cantharides.)
or
(2) Ureteric.
Calculus, Neoplasus.
Impacted
(3) Vesical.
Neoplasm,
Trauma,
Acute
Tuberculosis,
of
An
Cystitis, Deposition
Hsematobia.
Bilharzia
enlarged (vascular) prostate
in
Calculus,
Papilloma,
this
be
may
cluded
in-
category.
(4) Urethral
Calculus,
Trauma,
Extra-Urinary
Causes.
(1) HcemorrJiagic Fevers.
due
be
This
to
ad
"
acute
in
case
when
Kidney.
endocarditis
are
the
may,
ever,
how-
nephritis.
the
last
haematuria, apart
not
in
seen
cases
hoc.
the
(2) Infarction of
surface
actual
nephritis,was
investigated
(3) Arterio-sclerosis.
haematuria
an
pandemic,
acute
infective
The
"
certainly
was
influenzal
from
Acute
Disease.
Urethritis, Malignant
B.
Naevus,
Caruncle,
"
In
this
condition
is
invariably present.
Haemorrhages from any mucous
not
high
blood-pressure,
occur
from
this
in conditions
uncommon
cause
3
and
alone.
haematuria
of
may
GUIDE
A
18
TO
URINARY
Blood
(4) Primary
DISEASES
Diseases
the
:
leukaemias,
splenic
anaemia,
anaemia,
nicious
per-
purpura
haemorrhagica, haemophilia.
Notwithstanding
is almost
it
down
the
of
the
It
be
onset
first and
to
would
and
nephritis
acute
Further,
fevers.
character
possible, though
is
oantharides
A
distinction
whether
sudden
and
accompanied
of
frank
haematuria
attention
the
that
is
of
the
macroscopically conspicuous,
but
It
poisoning by
is
ascertain
to
haemorrhage
In
dealing
quantities of
producing
affected.
that
blood
which
was
this
tion
connec-
a
condition
with
the
abnormality,
the
case
haemorrhagic
that
pain.
are
the
overlooked.
conspicuous
to
of small
presence
by
we
so
drawn
be
of
be
viscus
importance
onset
is not
sufficientlysevere
a
the
could
great
the
it is manifest
of
the
commonest
the
hardly probable,
of
not
or
be
from
patient
capable
to
turpentine
or
the
of
injury
attention
the
naturally
any
certainly
call
to
in
any
would
haematuria
that
narrow
circumstances.
eliminate
to
causes,
to
lesion
associated
assume
obviously acutely ill,as
in
of the
from
or
best, perhaps,
conditions
of
possible fairly rapidly
likely situation
most
history
will
always
list
formidable
this
patient's
and
not
which
to
not
are
discovered
are
during microscopical investigation.
Sudden
onset
with
renal
origin.
The
kidney
These
features
a
on
one
palpation.
define
to
renal
however,
may
symptoms
of
in
occur
blood
of
in
infective
urine
unduly
tender
not
always
enable
renal
the
confirm
It
slight degrees
by
lesion, but
the
in
fact
be
must
of
microscope
tioned,
men-
haematuria
without
the
an
suspicion
any
endocarditis
infarction, and
the
pain suggests
be
occurred.
had
that
do
would
heart
infarction
lumbar
may
of
nature
of the
examination
that
the
unilateral
the
identification
has
pointed
A
20
too,
occasionally
body
has
of the
been
which
nor
will
there
confined
and
passed
stricture
for
to
invariably
But
catheter
or
(No.
the
solution,
collect
in
the
A
urethral
scope,
but
heard
when
Sometimes
the
For
its removal
a
the
operation
into
the
urethra
five
minutes
for
If the
then
stone
be
2
by
warm
out
any
of
case
cases
of
nitrate
clots
which
will
in
addition
to
is
the
solution
syringe
anterior
crocodile
be
evacuator
preferable,but
and
of
and
anaesthesia,
held
the
urethra,
forceps.
forced
urethra,
being injected
by digital compression
in the
stone.
haemorrhage.
local
novocaine
click
a
in the
impacted
suitable
its passage
suffice ;
touches
anaesthetic
urethro-
the
find
%
Bigelow's
large
such
diagnosed by
sound
a
posterior urethra, it should
bladder
the
with
under
with
and
inserted
be
In
performed
a
it will
to bed
put
in
as
be
with
the
bladder.
general
is situated
extracted
wash
becomes
distress
not
which
size) should
instrument
causing urgent
of
is
practitioner not
of
stone
drachms
to
is best
use
size) is
bleeding persist,a
bladder
or
the
two
is
Eventually
of
mentioned.
8,000,
the
may
once
should
days.
retained,
just
urethra
latter
patient
French
24
1 in
the
is at
instrumentation,
if the
calculus
convenient,
of urine
French
22
The
follows
and
should
in
109.
irrigatethe
to
(No.
should
rupture
it is well
urgently
incomplete,
treatment
page
urethra
incomplete
silver
22
rupture
is
patient
seven
the
cease
given morphia.
is
than
longer
haemorrhage
almost
be
the
position.
develops,
When
into
catheter
in
is referred
reader
Should
injection of morphia, J grain,
a
tied
foreign
extravasation
neither
perineum,
an
and
retained
other
or
urethra.
rupture
be
the
bed,
to
administered,
be
the
swelling in
a
the
into
pin
a
complete, surgicaltreatment
be
Should
case
DISEASES
when
occur
pushed
urethra
necessary.
URINARY
TO
GUIDE
back
If
there
penis.
it may
in
the
into
the
cannula
(an
ILEMATURIA
demanding
operation
and
experience)
trite.
A
the
urethrotomy
must
stage of the
as
If
be
the
evident
such
of
site
bladder
the
see
evidence
from
urine
exclude
can
both
cells, the
crystals
of
other
kidney
which
side
correlate
the
some
the
the
referred
groin
by
or
pain
testicle
exertion
rough surfaces,
Such
attacks
in
or
is the
of
collect
and
obtain
so
and
material
the
of
nature
if
example,
blood, the surgeon
should
renal
the
or
these
from
from
evidence
But
condition
of
urine
be
may
one
of
casts,
obtained
urine
whilst
to
blood
to
any
unequivocal
pathological
Unilateral
orifices,to
is obtained.
of
other
if
the
to
as
separation
compelled
the
with
urine
side
to
with
in
results.
misleading
cases
observer
cells, fragments
the
practicable, one
symptoms
the
hsematobia,
in
normal,
is affected
been
not
when
cases
addition
Naturally,
separation
is
those
For
pus
Bilharzia
identified
by
Furthermore,
fault
In
"
contain
of
be
will
growth.
oxalates.
ureter
has
contains
may
ova
constituents
one
ureters
Examination.
urine
growth,
secured.
ployed
em-
vesical, this
of
be
renal
a
is at
evidence
may
Microscopical
new
side
At
108.)
page
kidneys,
two
cause
be
must
enable
ureteric
the
which
lesion
in
even
not
occurs.
examination.
the
supplementary
renal
the
show
to
whereby
the
from
separately
urine
of
also
is
exonerated,
condition
stricture,
does
ulceration
haemorrhage
be
can
litho-
a
a
urethroscope
investigation will,
an
the
the
cystoscopic
on
urethra
diagnosis. (See
to
special
performed.
the
the
with
lie behind
until
disease
aid
an
crushed
be
of
growth
of
amount
stone
haemorrhage
spontaneous
to
subsequently
malignant
this
certain
a
Finally, should
external
21
the
of
lumbar
that
jolting,as
region radiating
side, produced
in
are
vated
aggra-
riding or driving
typical history
pain
or
of
renal
to
over
calculus.
intermittent, colicky in
22
A
nature,
and
In
the
GUIDE
be
A
throw
shadow
for
upon
such
no
rely
condition
the
such
producing
in
with
In
The
of
fever
the
Tuberculous
from
the
and
may
of
the
renal
on
115.)
page
blood
passed
are
particularly
the
these
of
chapter
persons
features
point
"
of
ingestion
shadow
X-ray
no
to
casts
a
"
following
or
only sign.
disease
be
(See
condition
suggested
for
discovered
the
involve
from
The
rectal
examination,
routine
the
be
patient, but
from
the
with
not
and
gation
investi-
is
urine
Specific
essential, and
into
epididymes
vesiculae seminales
of
urinary
adult.
young
of the
suspected
circumstance
pyrexia
bacillus
of
70.)
kidneys
the
of the
tubercle
palpation
page
74.)
page
a
with
attack
recent
a
may
injection
pig.
illness
kidney
in
blood
as
diagnosis. (See
the
of the
occur.
well
as
severe
nephritis, haemorrhage
frequency being
this
"treatment
and
contains
persistent slight haematuria
examination
attacks,
the
localising symptoms
no
onset
general
may
the
"
(See Oxaluria, Chapter VI.)
sudden
chronic
of
must
capable
after
In
tomatoes.
available
in
some
especially
associated
The
be
in
is
may
disease
detail
(See
acid
surgeon
history
crystals
occurs
is scanty,
of scarlet
may
The
nephritis
urine
In
symptoms.
and
found.
pyrexia
other
which
urine,
acute
cells.
any
tract.
and
be
of
urinary
in
in
generally
the
as
the
the
predisposed,
will
tion
examina-
not
uric
and
and
in
the
rhubarb
diagnosis
calculus
a
is
pure
evidence
considered
Oxaluria,
of
example,
is
calculus
of
description
urine
absence
the
stone
The
found.
outline
calculus
large
of
of
visible.
ratified.
with
be
the
stereotyped
a
then
of haematuria.
degree
crystals, particularly
to
shadow,
a
was
appearance,
Such
fair
a
and
often
are
DISEASES
strongly supported by radiographic
which
in
cells
pus
oxalate,
would
by
accompanied
urine,
calcium
URINARY
TO
and
a
guinea
and,
by
prostate
ILEMATURIA
of
must
consideration
tuberculous
of
vesical
of
tenesmus,
vesical
vesical
calculus
diurnal
but
is
the
and
usual
causes
not
end
of
urethritis
of
gonorrhoea,
of
history
a
accompanying
or
calculus.
as
caused
is to
In
cystitis,
be
expected.
considered
bleeding
micturition.
with
of
frequency
encountered
commonly
early
history
Such
yet
be
to
now
the
at
onset
frequency
is
The
in
which
same
the
acute
confusion
is
likely.
not
If
the
In
history
such
is
a
sudden
of
the
the
on
mixed
intervals.
Cystoscopy
bladder.
other
in such
and
the
painful
render
for
and
blood
pain
both
tion.
micturi-
acute
matory
inflam-
membrane
such
as
of
eliminates
time
same
at
of
of
coli is the
so
the
is of the
(by
if,
papilloma,
long
urine
cocci
acid
as
will
is
fever
as
ally
gener-
frequently
organism responsible,
bicarbonate
maintain
acid
bed
and
pain,
sodium
isolated
in
persist. Morphia
the
Bacillus
and
rendered
remain
micturition
the
doses
organism
the
blood.
of
an
mucous
haemorrhage,
should
needed
case,
large
at
of
quantities
deal
shows
mediately
im-
bilharziasis.)
patient
be
small
independently
whole
the
of vesical
or
The
of
followed
rises
good
a
case
a
(Cystoscopy
causes
stone,
and
suggested by
drops
soon
in
is
urine
condition
the
urine
There
of
few
a
temperature
with
passage
of
passage
be
micturition
urgent
the
case
passed
frequent
it will
cystitisis present,
acute
by
be
urinary
or
a
of
such
has
nocturnal
not
be
night.
condition
symptom
to
special
the
tumours
and
of acute
which
vesical
most
of
will
pain
day
cystitis,either
other
In
by
than
there
suprapubic
both
micturition
some
disease
disease, other
prostatic enlargement,
denotes
the
(See
87.)
tract, page
In
omitted.
be
not
course
23
group,
sodium
are
administered
alkaline.
the
urine
If
the
should
phosphate),ancl
A
24
GUIDE
is
urotropin
TO
and
should
tolerate
Stone
in
the
cystoscopy,
but
assistance,
of
bland,
contra-
consisting
water.
be
in
employed
membrane
mucous
bladder
is
the
is
of
case
irritable
too
be
Unless
with
made
the
by
enlarged prostate
an
the
is
stone
by
be
sometimes
may
diagnosis may
identified
easily
most
skiagraphy
sound.
associated
be
is
treatment.
the
or
bladder
a
and
a
barley
alcohol
case
should
never
such
DISEASES
either
diet
cystitis,the
acute
to
the
milk
Lavage
In
given.
indicated, and
chiefly of
URINARY
of
passage
large
very
lying
or
in
diverticulum, litholapaxy will suffice for its removal.
Suprapubic
is
cystotomy
alternative
an
treatment.
(See further, Chapter XVII.)
Whilst
adenomatous
prostate is
will
Cystoscopy
which
be
may
a
in
patients
who
authors
had
who
disease
The
Chapter
This
condition
lived
have
be
and
very
returned
from
had
question
seen
therefore
be
is under
not
the
East,
and
the
and
Egypt.
in soldiers
War
frequently
overlooked
been
suspected
consideration
Africa
during
characteristic
the
will
ova
a
be
deposit
the
unfamiliar
as
end
of
at
the
in
the
some
is
symptom
appearing
evident
upon
In
cystoscopically.
of blood
at
to
tumour
a
country.
may
Until
of
should
in South
cases
many
characteristic
two
the
XV.
hsematuria
microscopically, and
or
of
haemorrhage.
presence
see
saw
in
this
in
"
prostate
examination.
possibilitywhen
as
the
by
entirely intravesical, and
treatment,
Bilharziasis.
The
reveal
rectal
palpable by
For
usually accompanied
not
the
disease
carcinomatous
hsematuria,
cause
may
of
enlargement
the
urine
bladder
wall
cases
a
present, viz.
urethral
curious
a
drop
orifice absolutely
micturition.
comparatively recently
benefit this condition.
no
Many
treatment
observers
appeared
have
now
H^MATURIA
reported excellent
results
of
form
Christopherson's articles
June
1918, and
dosage
first of
at
is then
increased
maximum
of
The
\ grain
of
the
upon
have
reveal
itself
of
link
a
this
as
September
is
injected
the
watch
of
that
in
then
kept
We
haemorrhage.
endocarditis
urine
centrifugalised
corpuscles,often
blood
of evidence
chain
for
been
has
is
a
may
feature
infective
of
of
to
given.
are
diagnosis
a
dose
diseases
blood
7,
in
The
isolated
evidence
presence
in the
Dr.
of
grains
an
close
examination
the
this
to
week.
a
in
usually
mentioned
already
times
all, 25
itself
for
urine
microscopical
may
In
particularly
a
drug
haematuria
More
explanation.
of
subsequent injectionup
2" grains.
occasionally present
and
three
each
at
occurrence
made,
The
1919.
14,
referred
is
Lancet
the
emetic
tartar
description
reader
in
of
use
detailed
the
treatment
the
by
For
given intravenously.
25
of
doubtful
a
in
case
disease.
*****
As
turia
will be
the
at
in the
seen
head
of
question-begging
occasionally
elaborate
a
diagnosis of
supply
to
is
blood-pressure
in
origin
"
call for
and
the
to
authors'
observation,
lost
at
compelled
each
to
"
to
the
although
One
subject.
care
during
and
of
the
present,
are
of
cases
symptom
is
such
wise
Other-
amount
haemorrhage
do
to
of
was
not
naturally
under
came
case
a
idiopathic
such
submitted
was
which
period
the
of
urinary
possibilityof
epistaxis
Most
a
justify
hand.
at
the
assume
gastrostaxis.
treatment,
alarming
If
to
present
is
most
reason.
kidney
granular
and
the
arterio -sclerosis,especiallyif the
analogous
renostaxis,
a
of
residue
remain,
always
must
fairly satisfactory explanation
is
small
a
presents itself for which
case
familiar
one
of hsema-
possible causes
section,
investigation fails
symptoms
a
this
causes
sufficientlyhigh
a
list of
prolonged
blood
thus
estimated.
A
26
It
GUIDE
found
was
imparting
a
has
decided
in
lesion, but
such
after
although
extent,
colour
in
nephrotomy
no
DISEASES
trivial
really
very
of
discovery
URINARY
be
to
Exploratory
cure
TO
the
to
urine.
leads
cases
incision
the
to
of the
kidney
followed.
sometimes
Haemoglobinuria.
This
condition
making
condition
within
the
the
free
plasma
or
of
the
to
the
destruction
certain
fever, but
it
the
poisons,
of
pathology
is
which
of
time
in
is
Wassermann
not
typical
look
like
rather
a
character
Filtration
case
blood
of haematuria,
microscope
reactions
to the
mixed
liquid,
which
is
and
blood
in
to
cold.
In
occurs
at
the
vasomotor
been
noted
that
hsemoglobinuria
blood
the
is induced
a
is
positive,so
hsemoglobinuria
but
the
that
As
is the
of
a
we
have
urine
on
colour
the
in
resembles
which
dilution.
in
the
globin
haemo-
already mentioned,
distinguishing test,
the
chemical
spectroscopic peculiaritiesbeing
pigment,
does
hsemorrhagic
evident
more
urine
but
porter, the
e.g.
not
the
water,
diminishes
present.
the
with
becomes
perceptibly
alone
the
of
case
black
of
of
with
part in its causation.
a
a
reason
paroxysmal
reaction
syphilis plays
In
of
subjects
most
which
has
water
condition
exposure
it
chlorate,
e.g. black
It
also
But
supposed.
be
may
hcemoglobinuria,
disease
for
exposure,
blood
the
potassium
is obscure.
Raynaud's
cases
influence
from
paroxysmal
susceptible subjects through
same
hsemoglobinaemia,
clinical
important
most
found.
corpuscles
destruction
e.g.
on
obviously
of red
pathological states,
associated
is
Such
kidneys.
in certain
certain
urine
a
corpuscles are
no
or
bloodvessels, resulting in
by
which
suspected until,
haemoglobin .being removed
occur
the
is due
by
caused
blood, few
much
be
hardly
examination
systematic
a
containing
The
will
due
A
28
recalls
us
from
attack
of
been
had
the
of
demonstrated
If
diagnosed
commencing
a
the
glass
If
vesical
the
is
possible
from
to
is
urethra, it is
and
ureters
the
The
is
each
aided
side.
valuable
data
organs.
In
with
are
presence
organs.
able
or
The
of infection
of
each
medical
way
regard
of the whole
judge
absence
more
of
of
the
common
cystoscope
it
urine
is escaping
excluded
the
bladder, and
from
the
both
of
examination
kidney.
the
of
of
kidneys
urinary
obtain
may
of
the
in
causes
of
By
of
of
the
pyuria
or
gained
its
kidney,
any
one
be
may
tract.
from
urine
involvement
information
size
the
the
physician
the
shadows
of
catheterise
diseases
to
primarily
part
the
to
the
necessary
infection
examination
Finally, much
to
the
bacteriological
an
be
is
Having
spread
of
diagnosis.
another
in
two-
cystoscope
the
will
of
procedure
this
by radiography
we
by
in
both.
from
of
the
purulent
a
of
a
diagnosis
greatly
both
make
excreted
urine
aid
or
wise
a
the
whether
evidence
no
lesion
the
origin
condition
a
matory
inflam-
chronic
it
this
source
early malignant
the
then
be
may
Should
assist
to
to
ureter
the
of
established
Thus
kidneys,
or
By
note
one
genitalia as
that
discovered,
tract.
been
prostate.
view
secondary
urinary
if there
the
"
whether
or
tuberculosis
and
stone,
requisitioned
determine
origin
bacillus, and
extensive
stricture,
bladder
cystitis is
to
tubercle
performed.
the
the
in
be
must
of
favour
test
is
be
urethra,
affections
pus
the
origin for pyuria has
should
of
venereal
bacteriologicalexamination
of
urethroscopy
disease
previously, and
of bladder.
base
urethral
a
of
history
a
prostatitis of
presence
and
prostate
was
months
investigation revealed
further
the
twelve
However,
the
slight muco-purulent
urethra.. There
chronic
made.
DISEASES
with
pyuria
gonorrhsea
diagnosis
a
URINARY
of
case
a
discharge
an
TO
GUIDE
means
and
the
urinary
are
set
PYURIA
out
in
discussed
treatment
with
table, and
following
the
I.
the
in
affections
29
chapters
different
of the
Diseases
of
the
diagnosis
their
that
deal
urinary
and
ally
specific-
organs.
Urethra.
(a) Urethritis.
Gonococcal.
(1)
from
(2) Traumatic,
catheter
or
presence
stone.
Tuberculous.
(3)
disease
(6) Malignant
(c) Stricture
of
of
urethra.
urethra.
II.
Diseases
of Prostate.
(a) Prostatitis.
Gonococcal.
(1)
(2) Non-gonococcal
(6) Stone
in
:
the
III.
gland.
prostate
Diseases
of
Bladder.
(a) Cystitis.
(1) Primary.
(2) Secondary
and
lous.
non-tubercu-
disease,
(6) Malignant
(c) Bursting
tuberculous
"
of
abscess
IV.
into
Diseases
of
bladder
the
from
without.
Kidney.
(a) Pyelonephritis.
(1)
Tuberculous.
(2)
Non-tuberculous.
(6) Pyonephrosis.
(1) Primary.
(2) Secondary
to
calculus
or
growth.
of
CHAPTER
V
GLYCOSURIA
THE
of
capacity
Thus
of
the
will,
tolerance
kidneys
In
from
extend,
not
much
and
liberal
regarded
and
In
class
after
exhibit
and
Quite
a
small
addicted
Graves
certain
's
when
sugar
degree
of
to
alcoholic
in
diseases
of the
so
ordinary
tities,
quan-
diabetes
food
is
protein.
of
alimentary
the
of
nervous
is
often
the
those
present
brain
system,
frequent
in-
not
in
especially
is
Thus
urine.
glycosuria
and
suria,
glycodiabetes
not
are
in
It
tumours
carbohydrate
carbohydrate
appear
excess.
persons
from
which
In
disease.
chronic
all
subjects,
gouty
such
excrete
intermittent
in
of
who
food
;
ingestion
individuals
question
may
majority
diabetes.
conditions
other
many
noted
the
from
apart
glycosuria
the
the
sugar
for
it from
metabolise
in
sufferers
when
natural
a
candidates
severe
even
ounces
metabolise
to
inferior
carbohydrate
most
glycosuria
withheld,
are
the
likely
4
has
after
an
placed
are
taking
whilst
be
to
of
allowance,
sugar
the
glycosuria
person
than
only
possessing
as
metabolism
another
be
may
sugar
by
alimentary
some
sufferers
"
("alimentary
individual
in
ounces
sugar
administration
capacity
that
this
comparatively
sugar
his
so
of
healthy
every
one.
abnormal
an
hour
readily produced
more
although
are
with
excretion
the
6
as
exceptions
rare
average
which
beyond
does
a
result
the
variable
a
quantity
a
following
glucose, although
limit
is
the
the.
glycosuria ").
of
in
within
not
in
save
result
"
large
so
is
sugar
insufficiency
pituitary
will
of
ingestion
glucose
from
metabolising
and
in
in
especially
GLYCOSURIA
the
when
meninges
the
are
disease, sugar
may
phenomenon
is to
same
of
excess
the
31
of
seat
urine, and
the
in
appear
secretion
long-standing syphilitic
be
expected
of
the
the
acromegaly
in
of
lobe
posterior
"
the
pituitary gland.
Glycosuria
after
condition
possess
sometimes
"
leaky kidneys
in
renal
urine
in
the
but
mothers,
the
of
the
but
this
and
pass
In
the
to
this
so
of
type
itself
metabolism
rise
be
and
loss
malignant
and
ceases
presented
being pentose.
ance,
disturb-
metabolic
some
referred
for
for
the
first time
The
of
complaint
neuritis
disease
;
during
diabetic
to
may
may
the
be
be
of
of
pains
tract.
the
in
present.
may
symptoms
Or
For
legs,
there
lassitude, weakness
tuberculosis, Addison's
being
routine
subject
urinary
of
a
time
and
whatever,
large variety
a
symptoms
weight
later.
symptoms
urine.
any
to
comparatively long
a
referable
general
of
is
urine
instance
of
be
any
with
peripheral
may
its presence
:
the
this
result
to
the
those
the
in
will
detected
than
glands
mammary
in
sugar
exist
may
investigation of
example,
of
It
giving
present himself
glucose,
is not
sugar
unchanged
nursing
of lactation.
sugar
disease.
be
the
and
women
the
frequently
is
sugar
diabetes, although frequently mistaken
is not
without
and
liver
It is the
Glycosuria
other
from
condition
rare
it may
to
11).
pregnant
condition
termination
glucose.
for
albumin
carbohydrate
this
in
by pentosuria, the
or
"
urine
passed through
not
allow
kidneys
the
analogous
sugar
(see page
lactose, absorbed
A
for
which
physiological phenomenon,
present
with
shortly
fault.
at
a
but
in
occurs
which
glycosuria
is not
As
the
not
pertussis.
permeability
a
appear
"
of
attack
an
A
"
children, particularlyduring and
in
uncommon
is
phenomenon
transient
a
as
simulated.
Ocular
disease,
symp-
A
GUIDE
may
be
32
toms
diabetic
retinitis
complain
boils
or
ulcer
of the
of
A
body.
hunger
Whilst
routine
a
is
this
precaution
the
above-mentioned
It
will
tests
for
clinical
be
employed
tartrate
of
34-64
500
c.c.
in
(B)
solution
500
to
These
At
occur
a
"
yellow
of
urine
is
%
test
The
glucose.
of
is
potassio-
:
dissolved
sulphate
70
the
by
of
grams
of distilled
c.c.
should
performing
the
boiled
brick-red
may
added
be
a
be
to
An
water
sodium
when
:
of distilled
addition
and
separately, as
kept
self-reducing.
become
test,
equal
equal parts
Should
hydroxide)
In
few
drops
at
a
the
practice
time,
is
not
oxide)
"
are
urine
reduction
precipitate (cuprous
assumed.
of
quantity
added.
precipitate (cuprous
sugar
Benedict's
composition
tends
boiled.
separately
For
glucose.
solution
copper
is diluted
of
and
the
describe
to
0*02
salt and
250
reagent
time
mixed
presented.
be
or
of
any
water.
solutions
two
the
patient,
any
c.c.
combined
the
in
be
never
employ.
its
Rochelle
grams
creased
in-
polyuria
should
means
Fehling's
pure
of distilled
dissolved
the
water
of
the
of
be
of
stage
alkaline
an
than
should
symptoms
this
to
and
copper,
grams
180
hydrate
cold
is
abnormal
an
although
sugar
will demonstrate
test
portion
condition.
one
either
perforating
may
examination
which
by
solution
(A)
for
at
convenient
Fehling's
is
of
crops
distal
some
particularly desirable
convenient
most
real
test
purposes
the
the
patient
commonly
more
signs and
sugar,
from
complaint
detailed
the
in
neglected
of
micturition,
pollakiuria is
not
are
latter
of
frequency
and
suffer
symptom
common
The
repeated
and
or
finally,the
And,
former.
identified.
of gangrene
thirst, the
or
be
eczema,
or
and
subjective manifestations,
persistent
of
foot
DISEASES
cataract
or
attacks
the
first
the
may
of
TO~URINARY
or
a
absence
the
whereby
boiling
some
GLYCOSURIA
impression
obtained.
the
of
An
and
since
boil
not
with
the
mixture, but
liquids,which
exclude
or
Precautions.
first be
tends
the
(2) Avoid
albumin
acid.
creatinin
do
will
interest
and
is that
it may
not
to
be
sufficient
is
present, it should
and
to
detect
filteringbefore
urine
only
so
the
acid,
give
to
creatinin
will
rarely
the
reaction
urine
glycuronic
to
stances
sub-
Fehling's
prolonged boiling.
on
in the
appear
uric
attaching
importance
reduce
first named
quantity
enable
may
to
are
The
sufficient
in
present
normal
substances
glycuronic
such
separately boiled
prolonged boiling,which
Such
;
performed.
present in
solution.
seen
produce
to
two
should
separated by boiling
is
sometimes
of sugar.
(1) If
Fehling'stest
and
mix
to
presence
"
greenish-yellow
a
"
be
may
urine, it is advisable
procedure
the
reaction
boiling
normal
a
present
sugar
precipitate,is
a
prolonged
colour
a
of
quantity
equivocal
coloration, but
33
be
;
The
acid
of
a
of
sugar-containing
patient taking
chloral.
the
(3) Although
urine
is
low
perform
the
Benedict's
a
is not
the
a
of
mellitus
of
composition
and
Copper sulphate,
Distilled
drops
of
is
urine
covered
dis-
1008.
are
solution
less
is
equivocal.
:
17-3.
Crystallisedsodium
test
been
to
(or potassium) citrate, 173.
Sodium
The
neglecting
frequently employed,
its results
Benedict's
The
is comparatively
has
specificgravity
test, although far less
simpler
for
reason
Diabetes
urine
necessarilyso.
specificgravity
be
never
test.
reallymuch
The
that
should
with
is
this
usually high,
circumstance
mere
specificgravity
water
carbonate,
to
1,000.
performed
are
200.
added
4
as
follows
to
5
c.c.
:
of
Eight
the
to
ten
solution
;
A
34
GUIDE
of
excess
boiled
minutes
two
of
amount
should
urine
for
URINARY
TO
is
sugar
be
avoided.
and
then
present,
forms
precipitate slowly
DISEASES
a
glucose
do
solution,
a
which
disadvantage
%
great delicacy.; O'Ol
its
Tests.
Confirmatory
alcohol
into
sugar
the
identifying
of
prejudices
appeal
strong
is
procedure
for
accurate
the
to
be
is
made
by
follows
as
Fehling's
with
the
presence
size
of
the
amount
a
is
urine
left
temperature
time
the
longer
urine
:
a
reducing
is
then
of
is left
or
about
77"
again tested,
a
is
cannot
of
already
glucose
is
test
first be
can
formed
per-
tested
solution, and
identified.
piece
of
The
yeast the
pieces according
added,
and
hours, preferably
Fahr.
of
reaction.
has
The
utilised, is then
fermentation
for
A
three
twenty-four
is
urine
occurs
two
urine
for
noted.
of uric
become
the
as
quantity
substance
be
can
detected, hence
Benedict's
or
place,the
sugar)
should
a
sufficiently
acid
will be
urine
make
presence
into
enter
calculation.
The
filbert,or
of
not
of
quantity
sugar
glycuronic
of the
solution
of
specificgravity
place,the
both
first
%
of
by yeast
yet
glucose. Fourthly,
simple
a
and
is
use
detected.
always
non-fermentable
a
be
the
In the
O05
sugars
stated, estimation
been
be
do
fermentable
for
mistaken
and
they
as
(which
pentose
will
"
Perhaps
method
a
reasons
second
the
thus
estimating
purposes
creatinin
consequence,
Thirdly, only
and
Fehling's
general
more
can
exceedingly simple,
In
acid, xanthin,
its
affords
C02
other
solution.
practitioner.
clinical
reduce
the
place.
substances
decomposition
for several
demonstrated.
no
and
presence
which
sugar,
the
sugar
The
"
red
or
takes
cooling
Benedict's
reduce
not
small
a
yellow,
which
enumerated,
above
If
is
large quantity,
a
rapidly before
precipitate appears
An
important advantage is that
than
mixture
cooled.
green,
if
;
The
At
and
the
end
of
if reduction
complete,
otherwise
to
the
at
a
this
no
the
^Vhen fermentation
longer peripji,
A
36
GUIDE
Assuming
in
of
"
reaction
one
is
is
all
or
chloride
colour
patient
who
been
on
the
of
one
at
least
The
case
abolish, but
rather
tends
to
of
the
chloride
ferric
of
full
of
make
to
potassae
of
addition
It
mellitus,
when
In
that
the
its
presence
is not
the
being
of
case
patient
presence
of
excessive
of
food
ruby-red
the
on
presence
iron
reaction
in
present
is
addition
in
being
not
to
expected
liquor
the
be
may
test-
a
diabetes
starvation
and
in diarrhoea
But, naturally, in
glycosuria
glycosuria
an
the
being retained,
be
of
being ingested, in persistent
would
should
solution
A
indicates
in
be
absorbed.
circumstances
any
that
may
it is not
when
it is not
of these
So
utilised.
:
deeper
that
or
be
acetone
third
a
;
clinical
saturated
becomes
carbohydrate
colour
presence
solution
acidosis," and
carbohydrate
vomiting
when
"
the
to
for
for
to
noted
a
volatilised.
are
alkaline.
acid
be
when
condition
adequately
which
of
disappear,
employed
mixture
should
indicates
merely
will
sufficient
glacial acetic
of acetone.
any
the
colour
amethyst
or
with
urine
the
to
test
added
nitroprusside are
of sodium
exactly
the
deepen
freshly prepared
a
is
ferric
urine
suitable
quite
be
may
the
bodies
special
a
following
drops
is
test
the
An
is due
these
as
reaction
thorough boiling
bodies, it
should
but
the
colour
acetone
reduced,
be
few
if the
hand,
other
/?-oxy-
drug belonging
a
latter
required
tube
given
presence
when
by
in the
purposes,
A
produced
the
no
and
excess.
but
ealicylategroup,
not
be
may
or
positive
in
step
"
acid
colour
added
is
has
A
blood-red
a
solution
similar
does
indicated.
next
positive, the
diacetic
acetone,
of
The
the
in
glucose
whether
If
positive.
is
formation
the
of
presence
establish
to
of
acid
butyric
the
definitely established.
been
investigation
iron
DISEASES
URINARY
that
now
has
urine
TO
it is of
tested
for
be
vital
none
present.
importance
hyper-glycsemia,
quantity of
sugar
in
the
GLYCOSURIA
blood.
blood
Normally,
diabetes
mellitus
The
from
method
of
requiring
The
practice
confirmatory
is
the
the
is
urinary
of
to
the
disease,
and
has
no
method
this
consulted.
small
of
but
of
could
and
special
details
The
place.
the
of
possibly
text-books
a
pancreas,
with
from
apart
details
not
ance
import-
connection
Quite
it
generally,
pathological
elaborate
urine
any
of
speaking
secretion
the
practical
out
of
diseases
to
the
is,
internal
treatment
work,
*
devoted
quite
which
mellitus.
*
micturition.
the
of
be
particular
of
organs
diabetes
for
tests
disease,
glycosuria,
mellitus,
the
special
to
considered
would
technique.
accurate
abnormalities
phenomenon,
of
circumstance,
in
have
diabetes
disturbance
the
and
treatment
tory
labora-
*
specially
to
well-equipped
pancreatic
of
*
organs
sufficient
as
of
contribution
a
described,
ensure
concomitant
*
be
apply
evidence
usually
In
to
in
;
encountered.
not
thoroughly
a
sugar
be
may
need
considerations
same
%
0'4
estimation
frequent
and
to
%
(H
contains
O2
does
it
as
37
this
the
modern
be
sketched
should
be
VI
CHAPTER
CHANGES
OTHER
IN
URINE
THE
DUE
TO
METABOLISM
DEFECTIVE
Phosphaturia.
IT
is doubtful
importance,
of
person
as
opinion
the
in
is
his
but
is the
of
type
A
pyuria).
calcium
the
urine,
at
functional
from
may
who
to
impart
interrogates
the
as
to
prone
be
sufferer
morbidly
excreta.
the
lies
physician
albuminuria
suffices.
the
precipitate
once
disappears
(unlike
on
the
in
(or
of
Phosphates
precipitated
are
on
heating
Ca3(P04)2
=
precipitates out,
big
frequent
by
heat
of
that
addition
acid.
acetic
former
a
but
albumin)
4CaHP04,
After
magnesium
phos-
phosphates
from
test
that
appearance
his
to
matter
a
cloudy
particularly
of
nervous
whether
exceedingly
especially
more
simple
doubt
no
patient
a
phosphaturia
and
coagulated
The
to
importance
very
alkaline
of
peculiarities
to
distinguishing
dilute
alarm
person
as
the
the
equally
suffering
quantity
a
is
a
regarded
and
doubtful,
is
degree
those
accordingly,
Clinically,
of
less
of
tear
least
at
with
popularly
present
infrequently
of
observant
in
is
and
which
doctor
or
is
pathological
identified
is
and
is
there
Not
matter
a
and
so
metabolism
neurotic
urine
is
real
any
usually
wear
this
greater
disorders.
is
excessive
far
;
has
disposition
of
error
the
it
How
phaturia
in
although
of
system.
of
condition
nervous
evidence
some
if this
meal
requiring
88
but
an
is
-f
very
increased
Ca(H2POJ2.
soluble
in
acid.
quantity
of
DEFECTIVE
acid
of
free,
set
exceeds
the
be
monohydric
in
out
phosphate
salt, and
phosphate
urine
the
being
small
as
crystals.
produced
and
urea,
ammoniacal
the
by
be
and
of ammonium
triplephosphates
may
the
precipitates
needle-like
The
that
so
39
relativelya superabundance
is
dihydrogen
soluble
less
of
there
in the stomach,
bases
METABOLISM
recognised
magnesium
decomposition
knife-rest
as
coffin-lid
or
shaped crystals.
The
method
of
Whether
described.
result
might
condition
than
in
the
or
its
which
of
no
call
not
patient
a
form
any
disappearance
does
reassurance
has
recognising phosphaturia
it
for
who
of
been
treatment
certainly
is
other
treatment
observed
himself
has
a
peculiarity.
Oxaluria.
Oxalates
Their
crystals.
When
in the
appear
regarded
is
presence
small
in
occurring
metabolism
akin
to
Once
again
a
In
the
in
denote
in
; in
turia
case
the
are
an
their
vesical
be
invoked
been
factor, and
by
oxaluria
person.
endogenous
and
is due
presence
responsible.
may
as
it is
and
phosphaturia
"
above.
acid
exogenous.
synthetic
to
yielding
foods, particularly rhubarb,
produced,
calculus
has
latter, to oxalic
greater importance
may
pathology
considered
associated
both
tively
compara-
peculiarity
a
of
be
cannot
in
merely
is
system
same
be
certain
tomatoes,
far
which
for
the
may
former
production
and
least
when
even
envelope
microscopically.
border-line
nervous
unusual
Oxalates
or
at
alternate
to
of
the
or
means
no
the
on
"
phosphaturia,
causal
detected
pathological, and
as
of
shape
quantities they
large quantities they
of
in the
urine
than
and
be
Oxaluria
is
spinach
clinically
Hsema-
phosphaturia.
the
in
existence
question.
stances
sub-
of
In
a
renal
many
A
40
of
GUIDE
such
TO
crystals
alone
and
aggregation
should
of
irritation
cases
no
URINARY
there
be
may
renal
the
the
is
DISEASES
of
cause
the
microscopical discovery
the
urine
would
be
with
the
of
the
the
by
haemorrhage,
But
of stone
valuable
a
the
existence.
in
clinical evidence
be
substance
naturally,
(see page
114),
typical crystals in
of
piece
confirmatory
evidence.
Persons
wise
avoid
to
yielding
may
lead
in the
constitute
calculus
may
Clinically,oxaluria
is
a
credited
This
with
the
subject
factor
this
be
in
also
fluids, as
collection
to
of
importance
in
of
enuresis
children.
detail
in
the
on
initiatingand
at
whole
connection, such
in
potent
is
keep
to
occur.
treated
oxaluria
sufficient
time
production
is
although
in
of
oxalic
which
; and
bland
by drinking
course
in
conditions
urine
the
be
will
rich
are
avoid
of
"
diathesis
which
to
;
flushed
well
kidneys
otherwise
substances
concentration
to
acid
oxalic
foodstuffs
those
acid
the
"
in
50,
page
and
unimportant
an
element
an
being
might
the
perpetuating
well
disability
predisposed subject.
a
Chyluria.
A
to
a
milky
condition
dilute
chyluria
is
droplets
of
soluble
clear
once
if
a
acid
The
by
is
acetic
But
(but
of
large excess
This
drop
or
of
appearance
a
easily
definable
the
to
fat, which
in
or
Sudan
commonest
be
may
by
instantly
condition
rare
due
urine
due
of
not
are
the
the
clears
milky
suspension
ether), and
of
III,
the
familiar
are
added.
cause
of
sanguinis
this
hominis.
the
up
known
urine
of
finely
soluble
nature
addition
in
of
stains
which
Diagnosis
bidity.
turas
acid
is at
especially
for
condition
of
divided
acetic
microscopical examination,
two
merely
phosphates spontaneously deposited.
acid, which
on
the Filaria
the
fat,
osmic
is infection
is
absolutely
METABOLISM
DEFECTIVE
made
examined
at
the
of
identification
by
be
may
the
mentioned
of
presence
A
In
by
the
and
pressure
of
of
blocking
cases
blood
this
support
blood.
in the
is also
chyluria
possible.
the
occur
lymphatics must
duct, usuallyby secondary
the thoracic
upon
in
is
elephantiasis and
of
eosinophil cells
of
cause
evidence
as
existence
excess
an
non-parasitic
such
the
in
parasite
appropriate period, although
an
always easilydiscovered,
not
41
malignant glands.
Choluria.
Urine
is
variable,
closed
and
stains
depend
The
cotton-wool
and
of iodine
the
iodine
urine, when
a
readily formed
is
bile
bile
to
employ
an
equal quantity
add
test
pigments.
also
gently
will
be
to
on
colour
performed
surface
the
formed
be
1%
a
olive-green
an
may
ring
green
for
Tests
is
:
solution
test-
a
or
and
The
in
salts
test
if necessary
positive reaction.
the
bile
element
urine
yellow.
simplest
solution
by pouring
of
the
urine, diluted
a
the
cotton-wool, foam
with
tion
colora-
of
iridescent
shaking
on
characteristic
a
degree
exact
with
quickest
of
is
and
reactions
on
alcoholic
the
usually
yellowish-green
a
always present,
tube
has
Although
appearance.
is
bile
containing
the
at
junction.
Gmeliris
acid
this
bile
to
(i.e.containing nitrous
be
may
It may
in
a
to
flow
the
test relates
be
added
from
reaction
of
or
being
a
drop
with
a
white
is
better
pipette
a
test-tube
piece
acid)
urine
poured carefullyon
test-tube,
contact
the
to
a
still the
held
of
the
drop
of
play
of
a
urine
or
colours
a
urine
reagent, and
of
variety
surface
may
of
nitric
on
a
filter
at
be
may
be
the
the
urine
allowed
reagent,
natively,
Alter-
brought
porcelain
paper.
ways.
of the
slanting position.
reagent
blotting
in
surface
the
in
is the
to the
upon
Fuming
pigments.
A
slab
into
or
a
positive
junction, yellow
A
42
changing
to
in the
red, then
to
last
the
green,
reagents
sulphuric acid.
is
and
blue, and
being
the
essential
A
of
due
is
are
Hay's
concentrated
and
colour
deep purple
or
bile
of
presence
sugar
cane
the
through
the
urine.
If
through
the
purposes
it is
particles sink
the
on
clinical
iodine
test
of
large variety
be
may
of
disorders
of
substances
Deposits.
may
the
form
Uric
from
them
of
3
in
Acid.
"
either
in the
urine
the
calices of the
shape
of
masses
a
a
from
urine
These
invariably
pink
to
0'3
to
conditions
are
carry
colour.
the
crystals may
whetstone
dumb-bell
or
of
a
shapes
%.)
this is
the
displaced
of the
bladder,
be
or
urine
after
recognised
barrel
are
of
extent
O'l
crystallisesout
kidneys, in
The
:
:
normally
blood
and
is voided.
in
imparts
certain
its combinations
the
precipitationuroerythrin, the
their
in the
Under
uncommon
concentrated
almost
are
include
following
in very
they
which
and
with
encountered
present in urine
%,
only
tion
examina-
Some
:
prismatic crystals.
but
urine
is
(Urea
rhombic
white,
conditions
The
commonly
of
with
to
metabolism.
stances
sub-
amorphous
microscopical
associated
precipitate out
themselves
pigment
in the
various
and
rare
employ
to
of bile.
presence
crystalline and
under
most
Urea
%
sulphur
remaining
sufficient
quite
the
identified
urine
relativelyvery
down
of
instead
the
on
the
is present,
fluid
determine
to
Urinary
A
sulphur
is
surface.
For
the
bile
of
surface
salts, and
bile
flowers
surface
-of
of
presence
sprinkling
of
reduction
the
upon
by
of
the
to
performed
the
feature
biliverdin.
reddish-purple
depends
-test
tension
2
finally
positive reaction.
a
in
DISEASES
purple
named
's test
Pettenkoffer'
The
to
formation
test, the
salts.
URINARY
?0
GUIDE
and
less
as
merated
agglo-
frequent.
GUIDE
A
44
seen,
dumb-bell
e.g.
rounded
the
from
organ
cuboid
latter'
;
thin
as
or
from
plates
is not
with
of
denotes
large quantity
a
the
small
A
cubical
the
arise, e.g.
bladder.
catarrh
flat
large
of
quantity
tion
condi-
pathological
a
of
parts
appearances
kidney,
the
evidence
an
various
characteristic
they
from
the
from
the
which
cells
cells
derived
display
tract
columnar
and
the
cells
epithelial
urinary
of
hour-glass
or
ends.
The
the
DISEASES
URINARY
TO
inflammation.
or
Pneumaturia.
This
in
of
one
(1)
of
peculiarity,
rare
the
two
In
bladder
with
(2) Through
(a) Fermentation
and
yeast
urine
of
the
sulphuretted
The
An
if
the
to
the
appropriate
other
Treatment
will
will
be
urine
B.
or
be
may
of
of
nitrogen
could
not
faeces
readily explain
formed.
produced.
were
the
by
aerogenes.
gas,
fistula
fistula
or
organism,
lactis
marsh
of
infection
by
gas-producing
passage
referred
cases
may
C02
of
action
and
recto-vesical
examination
the
C02,
hydrogen,
if the
even
cause
necessary)
a
bladder
the
of
some
hydrogen
of
presence
overlooked,
large
and
itself.
urine
evolution
communis,
C02
to
by
the
by
non-saccharine
tract
coli
canal,
alimentary
in
diabetes
in
hydrogen
of
case
urinary
addition
and
be
the
both
Bacillus
e.g.
In
In
communication
in
gas
occur
consequent
bacteria, when
(6)
of
may
the
arise
may
rectum.
production
sugar-containing
fistulous
a
part of the
some
the
urine,
:
of
consequence
commonly
most
viz.
ways,
the
in
gas
urine
the
per
hardly
sufficiently
urethram.
(bacteriological
phenomenon
in
to.
obviously
be
that
of
the
cause
itself.
NORMAL
urination
necessitated
fulfilled.
the
Whilst
vesical
10
of the
times
the
ounces
of
act
micturition
Considered
abnormalities
hours,
on
subjective
as
of
occurs
voided
normally
are
on
each
be
the
to
taken,
of
degree
becomes
an
that
so
average
from
8
to
occasion.
the
symptoms,
micturition
the
individual
an
twenty-four
add,
for
cannot
of exercise
may
which
if
according
occur
we
bladder,
pain
bladder
quantity
skin, and,
the
in
the
process
abdominal
the
acute
the
variations
to
of
an
empty
ingested,
distension
habituated,
five
wide
of fluid
activity
to
of
feeling
a
become
desire
painless
a
distension
may
the
reason
amount
from
arising
discomfort
any
course
periodically by
discomfort
which
of
is
following
:
occur
(1) Frequency.
(2) Difficulty.
(3) Pain.
(4) Peculiarities
(5) Sudden
the
in
stoppage
stream.
of
the
flow.
(6) Precipitancy.
(7) Retention
absolute
or
incapacity
to
micturate.
(8) Incontinence.
it must
Suppression, though
not,
of course,
disorder
a
of
receive
is
consideration,
micturition,
but
of
urinary
secretion.
Frequency.
It
is
conditions
:
micturition
quantity
to
necessary
viz.
is
of
increase
postulate
in
and
performed
urine
the
passed.
45
The
here
two
distinct
number
of
times
that
increase
in
the
total
former
condition
is
A
46
GUIDE
URINARY
TO
DISEASES
latter
correctlydesignated pollakiuria,the
is
Polyuria
associated
fact, or
as
or
may
obvious
micturition
hour, but
an
each
occasion
associated
only
drops
conditions
in such
It
is
manifest
the
frequency
four
hours
the
that
total
must
of urine
These
dealing
are
with
Polyuria.
transient
or
due
being
in
occurs
in
twenty-
to
exclude
increased
to
a
number
at
this
of conditions.
stage before
frequency.
encountered
be
may
seen
increased
of
in order
considered
Polyuria
"
on
enlarged
or
passed
review
increased
genuine
stricture
of urine
symptom
best
expelled
condition
any
under
which
be
times
bladder.
quantity
the
several
may
as
the
polyuria, e.g.
polyuria is sometimes
the
in
come
possibilityof
secretion
of
pollakiuria
:
performed
few
a
tuberculosis
early
with
be
may
prostate. Frequency without
in
if unobserved
subjective symptom
be
not
invariably,
not
in actual
either
pollakiuria,
an
may
of
act
in
with
generally, although
uria.
poly-
is true
of
phenomenon
porary
tem-
a
pathological
no
obvious
importance,
and
often
Thus,
the
ingestion of large quantities of liquid
the
after
must
result
of
applicant
athlete
to
the
organic
copious
cause.
upon
to
for
the
disability,and
of
urine, are
of
anginapectpris,and
exhibit
of
and
familiar
the
are
increased
of
the
influence
the
which,
again
attacks
the
certain
of
nervous
orator,
of urine
which
exemplifiedby
very
a
nervous
possess
passage
with
examination,
disorders
character,
the
the
contest,
Nervous
by
is
an
secretion
the
insipidus.
character
a
itself be
may
micturition
life insurance,
in
accompanied
diabetes
candidate
micturate.
functional
by
of
just previous
ordeal
polydipsia
functional
a
for
the
induced
association
Thus
an
that
note
disorders
of
an
a
of thirst
The
one.
to
of urine
correspondingly large amount
specificgravity is to be expected. Incidentally
of
passage
of low
we
attributable
as
desire
although
features
of
frequently
quantities
spasmodic asthma,
major epilepsy. Jn hysteria,
OF
ABNORMALITIES
large quantities of
too, very
attack
an
of
terminated
the
at
the
encountered
polyuria
urine
paroxysmal
by
crisis of fevers.
of
exceptional quantity
properties,e.g.
caffeine
frequently
which
the
with
alcoholic
and
changes
certain
susceptiblepeople similarlyeffective.
associated
of the
with
of
organ
be
may
of
body
tissues
and
of
care
of
responded
on
the
he
fourth
passed
day).
day
On
this
The
70
time
apart from
correlated
the
passage
turn
as
fluid
addition
into
may
to
now
polyuria, so
of
the
leads
the
to
the
could
a
after
the
dropsy.
previous
the sixth
on
day
that
instituted
the
ounces,
210
ounces.
hydronephrosis
a
be
by
of urine.
continued
chronic
character
inebriates.
leads
imbibition
determined
disappearingwith
quantity
of
may
diagnosis of which,
tumour
polyuria
regular
the
so
digitalis,
on
only
polydipsia
a
110
of
first, in
from
completely disappeared.
to
of
a
a
action
temporary
large quantities
of alcohol
time, the effect upon
productionof
:
Just
regularpolyuria, especially as
persistentdiuretic
play, and,
be
had
of
nounced
pro-
in
was
seventh
increased
of the
occasional
an
the
of
ounces
polyuria, the
condition
encountered,
is
passed
pyelography,
the
(35
evacuation
for transient
account
it
treatment
oedema
the
periodic
To
the
on
a
expulsion
extensive
after
and
ounces,
had
action
he
by
myocardial degeneration
the
day
functions
accumulated
and
of urine
ounces
the fifth
190
By
day
liver
patient recently under
a
fibrillation
rest
to
had
in
are
or
of the
the
to
sufferingfrom
us
auricular
He
which
Thus
cavities.
one
and
fluid
the
heart
accompanied
polyuria corresponding
the
the
improvement
anasarca,
diseased
diuretic
atmospheric temperature
conditions
diseased
some
an
beverages.
Sudden
In
also
is
ingestion of
substance
theine
and
Finally, transient
by
some
or
in the
for
passed,
is
phenomenon,
same
47
be
may
tachycardia
accounted
be
may
MICTURITION
the
in
comes
kidneys,
nephritis,
a.!} interstitial
48
A
GUIDE
Polyuria
of
condition
insipidus
urine,
the
in
pints
In
even
this
polyuria. Indeed,
diagnosis
of
not
so
characteristic
no
such
such
glands
condition
a
aid
diagnostic
accompanied
by
infrequently
aids
insufficiency,the
of
in
and
in
thyroid
of
the
generally
are
disease
cystic
feature
ductless
overaction
compensatory
lardaceous
the
polyuria
expect
that
requires
suggestive
pituitary resulting in this symptom.
Finally, large quantities of urine
secreted
add
acromegaly
mere
been
takable
unmis-
an
to
necessary
as
a
have
of
not
inter-relation
to
us
prepares
as
The
polyuria.
as
the
may
but
hardly
dependent
of
are
suggested by general symptoms,
It is
unusual
diseases
most
symptom
20
as
an
insipidusare
and
type
enormous
much
not
are
74.
of the
as
dyspituitarism, which
character.
at page
former,
to
up
acromegaly,
e.g.
whole
a
the
types of diabetes
pituitary body,
a
as
diabetes, whether
pituitary disturbance,
upon
of whatever
kidney
twenty-four hours,
Some
feature.
in
mellitus.
or
of
quantities
DISEASES
is treated
rule
is the
Polyuria
URINARY
rule in contracted
is the
This
origin.
TO
of
the
made
to
kidney.
Insipidus." As
Diabetes
stage the few
in
to
it will
condition,
this
a
distinguish
be
hesitation
When
as
mild
much
whilst
labelling the
incompetence
concentration.
the
10
as
twenty-four hours,
in
of
what
of
kidneys
Differentiation
chloride, which
of
to
need
the
easy
without
a
of
boundary
pathological.
as
of
course
to
urine
be
ordinarilybe
in
passed
are
administering
will
always
appears
secrete
may
priate
appro-
insipidus from
urine
which
as
might
regarded
pints
this
at
regarded
overstepping
be
been
include
to
diabetes
as
condition
of the
has
It is not
hesitation
no
simple expedient
sodium
be
may
degrees
hardly
can
well
as
of this nature.
described
polyuria, which,
normality,
be
which
words
work
reference
occur
be
of normal
afforded
20
an
grains
followed
by
of
by
OF
ABNORMALITIES
concentration, but
in
increase
an
MICTURITION
in
not
49
increase
any
quantity of urine passed. In true diabetes
remains
insipidus,on the other hand, the concentration
unchanged, but the quantity of urine is increased.
in withholding
there is no
For this reason
justification
the
in
leads
fluid which
merely
the
organism
to reduce
sufficiently
since
Some
of
Such
beneficial.
due
cases
to
which
for
of
disease
has
in three
treated
improvement
indicating
To
turn
urine
to
now
this
compare
As
a
the
rule, the
in
interstitial
:
is most
often
a
being
nocturnal
former
cystitisand
:
these
present,
conditions
a
such
which
would
one
bladder
and
concomitant
the
case
the
creased
in-
of renal
first
state.
care
is
particularly
well
5
prostate
is
as
prostatitis,
time-relationship.
have
frequency.
as
increased
occurs). In vesical calculus, diurnal
to
predominate unless cystitis is
of the bladder, frequency
carcinoma
is
diurnal
predominates,
nephritis (when
there
perfectlyhealthy
a
with
in
of
amount
encountered, but
familiar
in
total
as
of the
is also
latter
of
one
the
the
affections
investigationof
to
evident
where
excessive, but
disease, the bladder
the
in
glycosuria were
frequency
symptom
responsible.
mellitus.
cases
is not
frequency
In
of
those
present authors
relationship between
some
passed
of the
one
is
other
in
nor
base
inability
for the
apparent, and
attacks
genuine increased
expected, it is in
that
by
in
with
is
pituitary
recommended
insipidus and
of diabetes
kidney
concentration,
been
was
intermittent
cases
service
no
of the
the
Pituitaryextract
no
is of
of normal
so
depend
to
the
defect
primary
cases
insipidus appear
of
water
of urine.
concentration
treatment
urine
secrete
obtain
cost
any
tissues,
meninges at the
treatment
these, anti-syphilitic
In
brain.
the
to
the
syphiliticdisease
upon
at
diabetes
of
cases
must
of the
desiccation
to
as
in chronic
also
secretion
frequency
also
has
tends
present.
no
In
particular
GUIDE
A
50
It
must
often
the
of
be
pointed
first,and
for
nephritis. When
In
e.g.
phimosis
as
or
the
irritation,
Appropriate
speedy
to
cause
Bacillus
coli
excessive
acidity.
be
Chapter
be
of
commonest
The
responsible.
of
invariable
is
bladder
this
ditions
con-
child, any
a
abnormality
the
of
of
presence
oxalates,
or
of
even
increased
quency
frecauses
referred
is
to
becomes
control
is
muscles
to
start
of the
Voluntary
social
this
the
control
to
presupposes
a
associate
circumstances,
obligations.
control
is
centres
In
the
under
is
spinal
cord.
and
the
ciently
suffi-
tension
condition
a
of
which
the
until
becomes
intravesical
the
intervals
training,
contraction
in
to
higher
process
centre
learn
certain
the
With
micturition
raise
reflex
lumbar
stabilityfirst
with
to
independent
fairly regular
involves
which
abdominal
by
when
established,
act
micturition
at
:
influenced
voluntary
Urine.
of
automatically.
contracts
this act
infants
in
of these
some
reader
infants, periodic reflex
sway
balanitis
XIII.
volition
the
cause,
large variety of
a
of
cause
worms
Thread-
and
any
cause
which
present
included
suspected, e.g.
Incontinence
In
is
investigation.
If, in
excluded,
or
for
cystitis,
is
may
the
of
amelioration.
communis
adult
an
urine
meatus.
be
to
treatment
be
can
should
urine
interstitial
and
the rectum,
are
also
generally the
congenitallysmall
a
reflex
a
local
In
prostate and
of the
is
reflex irritation from
leads
such
the
only, symptom
calls for considerable
children, a local condition
category.
of
of
the
is
frequency
explanatory lesion, the
an
often
symptom
by
also
time
some
abnormality
no
point directlyto
a
increased
disease, particularlytuberculosis
of renal
such
DISEASES
that
out
hypertrophy
commencing
to
URINARY
TO
the
of mental
process
turition
of mic-
later to understand
large majority
fairly easily accomplished,
of
and
A
62
whole
the
on
200
GUIDE
in the
equally
that
cases
URINARY
TO
102
the
opportunities for
reflex
vaunted
first
be
may
condition.
In
of
be
or
of
even
of
the
But
made
-skin,
tend
irritabilityin
does
the
that
not
only
one
An
obvious
any
should
not
encourage
the
urine, which
is
and
of
so
a
likelyto
diuretic
and
influence
disposed
of the
to
mise
mini-
to suppose
of
increase
already predisposed.
what
too
the
of their elimination,
is
the
undoubtedly
condition
is the
basic
the
be
of
adopted
before
day,
thereby
contribute
character, and
to
the
is the
bed- time.
wholesale
so
causing
rendered
of
has
and
case.
avoidance
But
this
restriction
a
a
of
concentration
more
incontinence.
those
of
removal, then, is
their
;
treatment
too
influence
the
general health,
value
hours
liquid throughout
of the
vulvitis,
enthusiasticallyaccepted.
in
two
causes
be
precaution to
fluid
character
reasons
improves
element
the
similar
high psychical
a
of
(e.g. oxaluria).
the value
important
For
must
often
child
or
which
balanitis
general
a
up
deny
not
most
removal
Their
direct
is rather
a
possible
threadworms,
the
set
of the
local
with
urine
merely emphasises
temperament.
of
to
which
branch
incurable
an
the
; he
with
epispadias
as
of direct reflex action, but
causes
course,
the
pin-hole meatus,
a
causes
the likelihood
such
of
rectal
sceptical as
reflex
commoner
adenoids
often
sphincter
to
to
Still is
case,
so
spina bifida,in
connection
Dr.
but
micturition
perpetuation
in
of
This, of
more
defects
incontinence
be
fore
nervous
this
of
mention
healed
a
pathological conditions
that
"
of local causes,
may
congenital
nerve
may
tight
a
to
and
girls
male
in the
passing, one
present.
reference
the
exclusion
item
involvement
long pudic
may
in
quotes of
practitioner confronted
is the
such
hypospadias,
through
stimuli
the
important
an
existence
98
existence
of
care
of enuresis
case
a
and
Still
exciting causes.
as
The
Dr.
sexes.
boys
were
notwithstanding
DISEASES
strong
irritating,
Foodstuffs
or
highly
ABNORMALITIES
spiced flavours,
examined
of
or
the
for
urine
of five with
of
be
really be
due
the
to
rapid fillingof
the
possibilityof organic disease
spinal cord should receive at least
and
as
the
into
"
all, the
forms
of
attack
direction
The
bladder,"
the
of
first
of
want
cases
control
of
the
bladder.
of
the
brain
passing
sideration
con-
that, when
been
all
"
"
weak
subsidiary
completed,
definite
a
is necessary
system
nervous
fall
cases
co-ordination, of
so
have
treatment
upon
and
great majority of
very
category of
irritable
or
member
re-
possible factor.
a
But, after
to
(mellitus and
failure
the
after
It is well
frequently overlooked,
enuresis," when
as
be
calculus,
performed
diabetes
to
should
vesical
ease.)
of
equally
tract
of
cystitis,
can
53
salt, are
urinary
polyuria
been
"
diagnosed
the
in
specialtrainingtowards
periodicmicturition.
step is
degree
resultingfrom
establish
to
a
of
confidence
sympathetic reception of the disability.
infrequently the little boy has
already been
Not
subjected
from
a
various
to
and
promises
similar
bear
hope
to
that
the
realisation
much
alone
time
it is of
of
to
of which
makes
bladder.
a
cure
is
to
as
the
found
efficient.
hours
in
Gradually
the
these
The
in
be
to
in
ferred
pre-
is
are
quite
repetition
treatment.
training
order
intervals
to
produce
sufferer's
future
the
child should
night
to
causing the
of
methods
brought
introspection. The
resistant
subject more
is very
is to
perpetuate the catastrophe,every
first,elementary
two
is
profound importance
which
"
simple neglect
even
an
ridicule, and
neurosis
attention
of
perturbation
sufficient
threats,
will effect
condition
a
influence, ranging
anxiety
encouragement
parents much
tried and
to
"
An
of
condition, and
that
rapid cure
every
bribes,
if too
the
upon
At
methods
persecutions.
easily established
a
and
reasonable
the
insipidus) has
the
of
excess
evidence
that
Even
MICTURITION
pyelitis. (Cystoscopy
age
may
with
or
The
avoided.
be
OF
may
be
be awakened
to
empty
made
his
longer
A
54
and
GUIDE
until
longer,
normal
a
since
the
entirely strange
environment
circumstance
much
of
of
psychical
view
by
no
no
the
by
the
the
the
successful
But
it is very
for
it has
related
is
methods
of
caustics
his
in
faith
in
the
suffering.
to
used
character
recently
seen
by
took
form
of
the
conversation
had
been
the
perpetuate
another
of
be
"
a
revealed
ill-treated
of
us
defence
the
at
for
reallyoccurs,
of
cure
the
the
operation
Such
application
their
just as easilyproduced
which
neurosis."
circumstance
school, and
"
neurosis
anxiety
A
established,
in
enuresis
only by
act
condition.
the
may
one
"
term
injecting,
cystoscopy.
without
infliction
be
for
procedure
if
fortiori
probability
an
incontinence.
electricityor
all
by
the
this
that
a
act
vicinity of
local action
bladder, e.g.
in
in
nocturnal
observed
the
forms
anaesthesia
consisted
but
operation,and
such
ago
can
likely
for
this
time
local
if any
been
may
have
With
that
Some
psychical influence,which
We
calls
than
of
intra-vesical
the
the
of the
basis
rather
which
rectum,
doubtful
to
as
that
not
upon
treatment
any
so
has
electricitymay
influence.
stated
long
follow
may
view
sexual
a
question
spinal canal,
equina,
the
to
an
is
incontinence
they produce
investigator
into
cauda
effect
organic
operation upon
not
without
suggestive
American
of
incontinence
pollution, and
intra-vesical
as
actual
any
more
concern.
means
treatment
far
potent factor.
special character.
a
patient's
stimulus
very
has
seminal
of
treatment
have
we
It is
of
micturition
vicarious
a
a
diurnal
than
involuntary
nature
is
psycho-pathologists
encouraged
the
psychical
of
process
disciplineis
nocturnal
that
common
more
act
the
a
from
necessary
whilst
tolerate
can
Such
away
easily enforced,
The
bladder
distension.
conducted
best
is
home,
own
of
DISEASES
the
eventually
degree
training
URINARY
TO
as
neurosis
in
as
the
a
of
case
incontinence
A
sympathetic
that
had
the
boy
developed
ABNORMALITIES
"defence
this
ordeal
the
OF
neurosis"
of further
merely
point
to
of which
be
may
with
the
the
psycho-analysis might
obstinate
cases
do
said to demand
feel
not
Turning
recommended
for
their
On
contrary, it is the
accustomed
result after
may
different
do
likely to
most
in
leads
drug
large
much
doses
10
as
for
day
zonum
and
gained
a
the
the
"
the
as
fast
incontinence,"
bladder,
nature
to
arising in
dribbles
false
The
of
an
and
some
the
well
produce
an
entirely
may
true
incontinence,
the
The
sphincter ;
mechanical
be
case.
separated
in
which
distension
to
is
prove
bladder, and
the
incontinence
former
have
which
life must
due
times
ergot, phena-
adult
is
as
of Rhus
individual
it enters
to
up
"
of these
one
drug
three
drugs
for any
in which
vesical
to
administered
tincture
other
one
is the
be
vomica,
are
which
overflow.
paralysisof
with
as
action.
liquid extract
nux
serviceable
most
the
any
conditions, viz.
two
urine
of five.
reputation, and
Incontinence
into
of
minims
not
with
case
it
been
physicians
success
another
tolerate
bromides,
of all
it should
thyroid extract,
aromatica,
to be
child
selective
Belladonna
and
a
more
it does
all others
success.
good,
12
that
of
in
children
"
or
a
to
really
failure
in
have
Many
experience
whilst
improvement,
any
a
total
of
opinion.
an
express
cases
one
any-
analyticalinvestigation
drugs.
a
such
treat
to
has
one
any
by
of value
prove
specificeffect,but
that
cause
arise therefrom.
may
to
of
use
appear
the
germinating
circumstances
such
competent
the
to
now
highly susceptible
ordinary
Whether
we
is mentioned
case
the
which
possibilities
the
precluded by
was
a
set up,
himself
comparatively easily detected
acquainted
boy's life and
be
in
55
save
This
that
may
to
which
symptom.
out
neurosis
a
person
order
attendance,
of this
existence
in
MICTURITION
of
is of
the
necessarilydue
the
latter
obstruction,
is
ciated
asso-
particularly
A
56
GUIDE
TO
when
enlarged prostate,
an
has
In
of
tabes,
the
Nocturnal
the
preliminary. By
present the familiar
The
and
and
of
is
changes
atony.
As
unlike
rule
of
the
a
the
apparatus,
a
or
In
XV.)
be
typical.
The
also
De
In
of
contraction
but
be
distension
in
But
is
if, as
the
usually
Riddoch
as
xl., pp. 149-263,
21, 1918, p. 839), the
infant
be
can
and
elicited
by
incontinence
reached
a
may
sufficient
to
that
will
will
in
occur
permitted.
power,
pointed
(Brain,
the
this
out
ber
Lancet, Decem"
reflex
mass
of
of the bladder
of
way
bladder
his
of
this
catheterisation
stimulation
empty
degree
Should
been
contraction
can
from
urine
its contractile
primitive
cutaneous
added
be
and
"
has
regular
have
that
paraplegic patient
a
reflex
It
so
re-appears,
of
incontinence
recovers
1918, vol
the
result
first effect
condition
case,
Head
of
diseases
the
sphincter.
same
the
and
(See Chapter
other
retention
of urine
undertaken, the bladder
and
rubber
atony of the sphincter.
overflow
accumulation
is
portable
a
spinal cord
of
neglected,
when
coma
is treated,
is inserted.
internal
ultimately result, and
wear
and
of the
wall
primary
equina, dribbling may
is that
the
present.
ever
is intractable, how-
sclerosis and
the bladder
bladder
the
to
tube
cauda
lesions
transverse
upon
Pezzer
and
of
flaccidity
from
compelled
are
bladder
lesion
incontinence
disseminated
spinal cord
the
is
patient
common
Argyll-Robertson
rigorously the parasyphiliticcondition
and
XV.)
symptoms
should
other
any
Ch.
anaesthesia
is
urinary
reflexes
cystoscopicappearance
exhibits
from
incontinence
time
bladder
(See
occur
concomitants
absence
a
atonic.
dribbling may
true
bladder.
pupils
over-distended
the
flaccid
finallybecome
DISEASES
URINARY
the
thigh,
utilise
his
it has
when
distension.
true
incontinence
does
not
with
hysteria,although frequency combined
result in a state of perpetual wetness
carelessness
may
occur
which
in
may
If urethral
be
mistaken
stricture
for
is the
actual
cause
incontinence.
of incontinence,
there
ABNORMALITIES
will be
of
of
ages
57
of
atony
discovered
is
there
:
the
and
twenty-five
the passage
is demonstrated
the
by
by urethroscopy. (See Ch. XVI.)
bougies and
Primary
lesion
The
stream.
of
passage
MICTURITION
and
history of progressivedifficulty
a
small
a
OF
bladder
The
forty.
has
cause
of
evidence
no
between
appears
the
been
not
organic
nervous
disease, although cystoscopicallya similarityis presented
the
to
is
of the
appearance
progressive,and
micturition
of
in
which
urethrse
by
of
tearing
condition
of
sneezing
increase
Such
will
conditions
trivial discomfort
appropriate
has
actual
or
result.
may
The
be
in
e.g.
vated
aggrain
as
and
when
or
pregnancy
partialincontinence
by
nervousness
considerable
a
some
pressure,
exertion,
of
use
such
causes
a
degree
portable
as
urinal.
prolapse
must
treatment.
devised
in
the
compressor
naturally
of
to
case
parturition,
head,
increased
up
the
responsible for
be
violent
anticipation
Marion
to
foetal
develops,
contributory
success
the
may
or
disabilitydemanding
receive
caused
intra-abdominal
tumour
a
morbid
of
coughing
or
from
Local
to
for
causes
in
incidental
the
prolapse, too,
pathologically.
of
of
preceding
peri-urethraltissues
abdominal
or
be
may
pressure
the
disease
eventually
supplemented
incontinence, which
by
vary
be
must
injury
of
degree
an
The
"
by special causes
during
The
of control
partialloss
Women.
incontinence
women
bladder.
completely involuntary.
becomes
Incontinence
adult
from
tabetic
for
women
operation
an
which
he
for
the
of
cure
continence
in-
considerable
claims
.
Difficulty in Micturition.
Difficult
and
concomitants,
of
the
the
patient's
painful
but
other,
different
may
although,
mind
sensations
only by
either
as
is
micturition
be
these
likelyto arise, and
detailed
frequent
present independently
naturally,
regards
are
cross-examination.
confusion
two
may
in
distinctly
be
ciated
disso-
A
58
GUIDE
TO
Difficulty in
a
of
mechanical
the
micturition
flow
urinary
Obstruction
in
in the
In
of
male.
the
is very
well
is the
In
in micturition.
of
is almost
entirely restricted
urethra
a
mechanical
detailed
In
restricted
obstruction
female, occlusion
from
verted
able
gravid
routine
by
undertaken
Partial
occlusion
already
of
to
now
both
to
extensive
membrane.
An
extend
orifice,but
in
The
than
occluded
from
difficultyin
In
by
and
these
conditions
of
the
latter
are
the
an
pressure
a
or
tro
re-
naturally
in the
female.
by
sion
exten-
in the
The
prostate
has
causes
are
vesical
vagina.
of
the
blood-clot
after
an
bladder
mucous
orifice
of the
obstruct
bladder
likely to
tabes
innervation
arise
of urine
(q.v.).
associated
and
may
urethral
the
retention
system
nervous
micturition
the
is
in
diagnos-
is
occur
15.
page
mass
the
into
difficultyonly
diseases
myelitis.
both
also
the
see
are
which
vesical
infiltrating
growth
eventually
rather
The
again
"
fibroid
conditions
other
;
haemorrhage
a
of micturition
sexes.
become
may
Here
and
bladder.
the
inflammatory
dragging
may
it,
trophy,
hyper-
arises
carcinomatous
a
considered
been
common
urethra
disorder
of the urethra
into its walls
simple
urethra
pelvic examination,
in any
Turning
Such
uterus.
obstruct
results
frequently
most
calculus
prostatic disease,
entirelydifferent fashion, viz.
but
frequent
or
urination
to
of
pelvic tumour,
difficulty
(from gonorrhoea)
male.
to the
the
a
of
male.
(whether
of
of
sequela
less
the
to
disease
consideration
the
common
cause
enlargement,
course
frequent
partiallyto
as
so
carcinomatous
is of
more
difficultyarising from
in
Thirdly, prostatic
nervous
micturition.
female, stricture
impacted
change)
a
Similarly, the
form
the
is
commonest
the
rare.
recognised
far
is
passage
the
of
act
stricture
the
to
with
the
urethra
this sex,
and
gonorrhoea,
obstruction
governs
involve
necessarily
interference
or
which
DISEASES
must
either
cause,
mechanism
URINARY
with
transverse
of the
bladder
A
60
and
GUIDE
when
it
Urethral
due
pain
the
to
Pain
in
of
micturition
on
of
existence
intense
so
vesical
which,
is
generally
caruncle.
a
after
and
micturition
tip of the penis is traditionallyidentified
the
to
character.
a
female
in the
experienced immediately
referred
with
is not
occurs
DISEASES
URINARY
TO
arise from
calculus,but it may
is inflammation
there
of
the
condition
any
of
trigone
the
bladder, e.g. cystitis,prostatitis,
malignant disease,
well
calculus.
as
As
a
rare
Pain
impacted
sensation
urine.
the
to
Prostatic
of
pain
vesical
well
as
disease
of
should
the
to
not
peculiar dragging
a
the
during
as
ureter.
a
referred
as
be
it is also
although
be mentioned
must
end
be
may
perineum,
felt after
symptom,
the
at
micturition
during
urethra, but
a
of this sort
cause
calculus
a
as
of
passage
encountered
such
in
suspected
vesical
in
carcinoma.
Oliguria
Reduction
in
as
in
Suppression o! Urine.
:
the
becomes
insufficient
which
of the
excites
be
must
reduced
collects
condition
added
is
of
suppression
occurs,
that
suppression
may
in
present
the
the
body
if whilst
in ascites
urine
be
any
condition
much
in other
and
the
it accumulates
cavities, as
may
the
although
have
it
purely
a
or
ways,
the
skin
there
in cardiac
a
as
low
or
The
hydrothorax.
accompanied by
whenever
for
example
effect
same
actually lost
fluid is not
"reduced
The
The
vomiting.
under
states.
febrile
most
body
persistentdiarrhoea
produced
degree
a
(vide infra).
is loss of fluid from
is
that
micturition,
secretion, too, is proportionatelyreduced
in
to
as
When
so
bladder
the
countered
en-
well
as
minimum
a
reflex
normal
is
organs.
as
cause
Oliguria
urinary
to
distend
to
the
known
mechanical
secreted
urine
physiological phenomenon
a
pathologicalconditions
secretion
of
quantity
in the
from
body
secretion
of
and
in
failure
blood-pressure.
The
is
guria
feature
a
When
suppression
found
be
Any
mechanical
must
be
a
carcinomatous
and
the
blocking
of
evidence
of
pain
a
rectal
or
that
the
discovery
Similarly,
the
produce
effect
the
of
ureter
that
too,
pains
the
for
which
reason
that
non-obstructive
mentioned
and
that
be
may
careful
watch
micturition
bladder
A
no
the
on
made
fills in
an
unless
means
time
subject
the
abdominal
usual
follows,
of
a
at
absent.
hysteria
been
The
examination,
be
kept
and
first
must
in
it has
be
of
nephrectomy.
a
of
tained
mainbladder
but
if
a
surreptitious
found
suppression
operation
unfamiliar,
of
;
the
that
way.
alarming
it is realised
rare
functioning
is
passed.
will
is
the
always
are
simulation
been
of
functionally
suppression
impossible, it
somewhat
follows
the
at
empty
has
might
It
was
when
the
to
blockage
kidney
of
situ,
removal
congenitally
malingering
urine
no
from
organ
possibilityof
deliberate
in
and
be
causes
the
possible,
performance
kidney, too, might
As
be
the
lead
openings
from
other
in
kidney
surgeons
the
pyuria.
growth
kidney.
result
by
is infiltrated.
upper
results
anuria
before
satisfactorily
One
the
remaining
ascertain
to
and
will
though
would
anuria
impaired,
preceded
the
solitary functional
a
when
kidney
at
occurrence,
the
the
of
into
quency
bladder, e.g. fre-
the
bladder
calculus
e.g.
condition
a
be
examination
of the
base
same
frequently
more
pelvic
double
This
ureters.
Such
will reveal
as
extending
micturition, hsematuria
on
examination
Cystoscopic
bladder
of
suppression
bladder,
certainly
disease
will
passed.
is
to
the
orifices.
almost
malignant
and
whilst
ureteral
will
suppression
of
the
71).
bladder
leading
of
growth
(q.v.page
catheter
a
side
proximal
oli-
the
when
empty
which
in
disease
occurs
obstruction
the
on
Bright 's
is acute
true
naturally
condition
pathological
commonest
that
as
a
such
considerable
reflex
a
occasionally
phenomenon
condition
perturbation
is
;
by
may
GUIDE
A
62
excited.
be
than
of
It
cupping
for-
hot
below,
Turning
and
result
from
which
the
through
impairment
the
and
disease
polycystic
activity is
in
characteristic
For
further
Anuria
relieve
and
much
from
back
Such
anuria
care
is
such
cases.
always
anuria
condition
"
from
of
the
a
mechanical
again
headache,
in
and
such
to
where
cases
kidneys
if the
the
73.
have
septic.
distension
an
is
occurrence
bladder
slowly
in
of Urine.
been
distinguished from
of urine.
which
as
In
in
commonest
be mentioned
a
to
less
a
of
case
from
or
due
the
in
as
cause,
retention
condition
the
catheter
a
the
obviate
innervation.
nervous
difficulty.As
must
arise
already
arise,
may
regard
may
of
a
has
suppression
Retention
and
empty
Retention
This
of
distended
to
to
and
page
bladder
likelyto
taken
normal
kidney's
see
passage
become
rapidly relieved, and
very
and
all circumstances
imminent,
of uraemia
long standing
more
of
excretion
drowsiness, with
the
pressure
is
In
is
over-distended
is of
obstruction
also
may
vomiting gradually develop.
consideration
follow
It
inflammation
the
uraemia
of
seen
function, e.g. cantharides,
when
others
the
nephritis,
acute
poison, the
phosphorus.
phenomena
may
a
of its
of
commonly
as
excites
kidney
dyspnoea
convulsions,
kidney
the
abeyance,
as
operations,
conditions
most
a
these, and
as
is
ingestion of
turpentine, mercury,
such
follows
pyelonephritis.
abolition
or
It must
retention, which,
pathological
of
loins.
appendicectomy.
suppression
diseases
the
other
treatment
the
sometimes
to
now
organs,
such
in
active
no
applicationsto
especiallyherniotomy
urinary
DISEASES
distinguishedfrom
mentioned
is
URINARY
calls
or
be
course
TO
disturbance
some
this
more
connection
urethral
form
then, of
stricture
and
one
degree
extreme
pronounced
causes,
difficulty,
causes
retention
prostatic
ABNORMALITIES
result
from
become
having
urinary
as
of
from
or
of
with
the
will have
lesion
difference
orifice
Retention
"
the
will
itself
Urine, page
Retention
immediate
in
operations upon
ensue
the
upon
the
defensive
termed
In
with
aid
the
such
of
cases
defective
relaxation
be
as
of
instinctive
an
which
in
turition
mic-
of
"
the
movable
leads
flow
calculus
to
urine
in
that
A
achalasia
orifice
the
sphincter
much
as
tonicity.
be
of
the
the
retention, may
obvious
as
a
more
ally
occasionstomach.
sudden
causation.
urethra, which
become
the
vesicse,
peculiarity of
has
what
easilypassed,
cesophagismus,"
cardiac
of
be
spasm
would
the
the
it is evident
normal
variety of retention,
of
of
can
active
an
the
at
disease, from
any
catheter
a
it is to
witnessed
impacted
be
may
quite spontaneously
contraction-
therefore
term
small
as
may
anaesthesia, and
may
stoppage
although
retention
condition
any
absence
condition
a
reflex
retention
spasmodic
vesicse.
As
for hernia,
retention
in
persons,
in
analogous
operations
painful.
occur
correct
and
of
voluntary
neurotic
the
tinence
Incon-
laparotomy.
cause
mechanism
is
reflexlyafter
arises
rectum
any
special
instanced
that
affected.
(See
occur.
the
(and temporary) condition, particularly
an
a
or
is
centre
not
of
56.)
frequently
as
is
does
condition,
micturition
the
contains
situation
portion
a
as
result
myelitis
the
upon
for
centre
latter, retention
of
In
influence
an
lumbar
the
which
portion
As
the
by
for micturition,
spinal centre
resulting according
above
it may
free
bladder
compression paraplegia, or transverse
inflammatory or degenerative origin. The
In
may
the
the
vesical
the
into
urethra
in
cord
A
the
tumour
of Retention.
Causes
interference
of the
a
washed
63
stream.
Nervous
from
pedunculated
a
of
calculus
impacted
an
of
portion
occlusion
Complete
enlargement.
MICTURITION
OF
when
impacted
GUIDE
64
A
during
the
A
by
similar
occlusion
villous
a
of
of
tumour
when
nervousness
absolute
flow
and
of
asked
such
has
In
of
persistently
in the
stream
small
and
fact, no
the
urine
the
bladder
the
resistance,
the
of
In
way,
not
lead
to
termination
of
the
Stream.
hypospadias,
as
urinary
stream
is
proper
cases
On
of
from
is
On
prostatic
with
is
and
to
is known
;
but
hand,
overcome
stream
the
power
other
be
may
feature,
prominent
a
whole,
gradual
the
good
be
passed,
first
at
what
the
(See Chapter
associated
stream
ever
the
in
may
projectile
urgency
suffers
It
seen.
feeble
very
increasing difficultyin
stream.
be
away.
a
variability
great
of
that
so
such
patient
(3) In
are
intervals
same
may
normal
a
hypertrophy
may
stricture
with
dition
con-
exhibit
may
the
defects
may
dribbles
merely
micturition.
of
In
Urinary
stricture
the
in
sometimes,
and
the
started.
developmental
urethral
character
passed.
urethra
impossible.
course
(2)
the
alternating
sudden
a
epispadias, ectopia vesicae,
is of
to
urinate
to
to
micturition
Peculiarities
(1) In
with
of
the
by
Again,
retention.
retention, but
after
orifice
referred
above
activity
flow
afforded
bladder.
the
normal
in
began
is
vesical
the
achalasia
normal
of
which
stream
a
phenomenon
of
intermittent
an
DISEASES
URINARY
of
passage
fashion.
sudden
TO
tate
precipi-
as
typical history
progressive narrowing,
micturition
and
feebleness
XVI.)
disease.
in
Changes
difficultyin
the
stream
and
micturition
sional
occa-
retention.
(4) Nervous
to
disorders
of the
diseases.
of micturition
bladder, and
Changes
associated
in
We
the
with
no
due
further
have
to
defective
innervation
description
character
of
the
variations
in
vesical
referred
already
stream
is necessary.
are
naturally
distension.
THE
estimation
of
capacity
various
the
has
"
an
which
conditions,
operation
indicate
lesion
how
far
the
lower
in
produce
will
the
of
the
is
the
result
(l) The
the
of
regular
first
functions
Functional
The
complaint
fails
to
of
other
of
is
the
and
condition
true
evidence.
of
the
kidney,
general
the
in
the
clinical
the
chemical
state
of
condition
and
urine,
made.
normal
a
(3)
When
the
urine,
disturbed.
are
are
the
Patient."
the
organs
6
will
tests.
disorders
is
from
urine,
by
excrete
impaired,
thirst
of
which
kidneys
the
changes
Condition
gastric
appetite
the
(1)
chemical
certain
or
disturbances
the
consider
General
kidney
the
demonstrate
(2) the
patient,
a
based.
tests
suffered
of
supported
to
necessary
to
suitability
similar
has
of
studying
when
condition
stricture
the
by
cortex
tract.
character
when
patient
to
action
certainly
more
Therefore,
it
the
in
renal
accurately
as
constitutional
extensive
alterations
of
urinary
physician
assessed
urethral
kidney
the
be
be
influenced
inefficient
Although
signs
be
may
the
as
judgment
prostate,
ance
appear-
the
to
can
can
such
restrain
degenerative
")
prognosis
a
both
or
kidney
selective
or
pass
which
infective
some
i.e. the
corresponding
damage
medical
other
enlarged
to
their
The
by
upon
In
substance
with
surgeon.
called
degree
efficiency,
urine, is of advantage
sustained
(so
renal
the
the
renal
the
substances
in
and
of
to
be
tongue
Flatulence
is
expected.
dry,
is
and
very
"
A
66
GUIDE
TO
and
vomiting
frequent,
elasticityand
its
In
is
These
their
changes
in
meaning
a
subnormal
very
in
another
of
meaning
of the
and
of low
in
renal
the
of
the
when
urine
been
aniline
blue
and
its
in
urine
the
the
emphasise
of
the
extent
a
for
can
how
of
that
it is associated
decrease
in
with
the
disease
Efficiency." The
renal
be
put
outeven
The
much
which
substance
used
substances
means
dye
a
and
have
methylene
and
of
has
fied
identi-
velocity
the
indigo-carmine
By
ciple
prin-
efficiencydepend
conveniently
regards
as
phenol phthalein.
detect
of albumin
trace
large quantity
inert
some
excretion.
as
polyuria,
a
normal.
and
both
by
necessarily mean
the
Renal
of
dyes, such
possibleto
of
of extensive
tests
urine
estimated
of
but
for
the
in the
and
it is
;
administration
is excreted
extent
Tests
which
upon
the
not
otherwise
is
(3) Chemical
is
does
evidence
sure
urine
made
is
to
A
excretion.
excretion
is
persistent
character
activity is failingunless
urea
A
is denoted
failure
urea
failingurea
tions.
observa-
disquieting phenomenon.
specificgravity, with
the
interpret
function.
renal
decreased
albumin
a
of
same
failure, and
indicative
as
the
other
renal
suffice
here
ness.
drowsi-
to
Reference
"
the
to
changes
renal
onset
urine
it will
certain
altered
The
a
Urine.
chapter (page 71)
nephritis, and
in
the
of
face
gradual
a
at
able
his
another
is
the
tubular
and
condition.
grave
temperature
(2) Changes
will be
sign
the
is
noted
be
to
with
late
a
There
headache
by
association
and
in chronic
puffy.
clinician
is
Hiccough
sallow
and
not
loses
back-pressure,
hand,
are
skilled
the
indicates
and
accompanied
energy,
of
other
face is white
nephritisthe
time, but
the
skin
The
dry.
result
muddy
On
slightly drawn.
of
abnormally
becomes
complexion
loss
occasional.
nephritis, the
acute
DISEASED
URINARY
colorimeter
been
excreted
A
68
runs
its
TO
of
piece
a
tube
GUIDE
and
The
the
when
'Gentle
flask.
of the
water
in
to
cool, when
column
is
of the
level.
The
the
read
from
this the
seen
or
calculated
the
100
of
c.c.
This
orange.
preferably
should
of
grams
hour
urine
of
This
busiest
is
and
is
necessary
The
Two
bladder
hours
later
of
interval
of
urea
of another
and
the
centage
per-
specimens
is considered
above
gives
T5,
a
the
to
centage
perrenal
normal.
and
results
in
be
can
performed
satisfactoryand
are
by
the
rarelygive
information.
Test.
Diastase
intestine, and
degree
the
:
man
simple
the
stomach,
empty
specimen
second
the
in
tincture
If in both
first
the
approximately
test
misleading
The
If
normal.
below
with
function
be
urea
dissolved
collected
estimated.
renal
directly
concentration
an
off,
formula.
that
morning.
more
1'5, the
above
an
on
water
read
is either
are
After
once
again
urea
it falls below
function
is
is left
its estimation
to
the
is determined.
the
below
and
column
adjustment
is then
the
to
the
the
displaced
flavoured
in
with
generating
suitable
urea
is taken
patient micturates,
in the urine
the
completely emptied.
be
the
apparatus
urea
water
rising
on
of
previous
solution
then
the
recommended
has
distilled
closed
contact
down
nitrogen
according
mouth
Fifteen
urine.
of
percentage
Maclean
with
complete decomposition
making
volume
The
into
of
reading
after
off
filled
tightly
forces
nitrogen
final
is
by inclining the
measuring-tube,
and
given by
is
the
for
arrangement
come
agitationensures
the
Recently
to
measuring-
a
tube
apparatus
solution
urea.
of
suitable
gradually
hypobromite
to
up
measuring
the
is allowed
urine
be
with
containing water,
water,
DISEASES
connected
tubing
displacement.
the
URINARY
which
to
is
"
Diastase
excreted
normally
is measured
explain the
is absorbed
as
10
to
rationale
in
22-2
of
the
units.
the
from
urine
the
to
a
It is not
estimation,
ESTIMATION
which
OF
briefly
consists
the
and
urine,
still
exert
used
the
nephritis
units,
or
It
be
the
must
be
kidneys.
chemical
tests,
condition
of
perspective.
and
is
the
conversion
low
reduced
has
only
picture
changes
patient
in
the
are
the
that
guide
is
persists
from
emphasised
urine,
placed
even
urine.
these
the
to
only
perhaps
to
value
disappeared
the
The
the
this
often
too
not
index
have
may
cannot
se
diastatic
lower,
even
albumin
after
of
of
occurred.
In
per
production
that
version
con-
Iodine
maltose.
the
can
the
by
and
of
which
measured
denotes
coloration
dilutions
dilute
most
as
and
indicator,
an
blue
not
5
the
dextrin
into
69
graduated
using
action
starch
as
familiar
in
diastatic
FUNCTION
RENAL
ascertaining
a
of
is
THE
tests
condition
complete
and
the
in
their
when
general
proper
IX
CHAPTER
NEPHRITIS
Acute
the
TYPICALLY,
cold
to
and
the
irritating to
The
toxins
and
pneumonia
similar
also
of
variety
utensils
vitality
but
existing
mentioned
generally
be
a
true
that
to
seems
which
is
but
of
and
a
agent,
but
cold
vomiting
fever
is
of
present,
70
the
cooking
a
of
previously
But
without
above-
the
the
now
one
shown
which
and
type,
or
to
closely
tibility
suscepexposure
of
cause
organism
micro-
recognisable
variable
and
through
actual
the
not
service,
respects
in
large
active
been
origin,
part, and
factors,
of
many
ultra-microscopic
Characteristically,
rigors
in
A
of
has
nephritis
infective
an
cases
favour
scarlatinal
predisposing
kidney
a
unmasking
of
in
or
play
toxin,
suggested,
from
nephritis.
nephritis
of
on
contradictory
trench
acute
resembling
be
evidence
held,
virulent
been
metal
of
number
hypotheses,
chronic
mention.
diet
field, the
the
a
are
occur
of
affect
have
causes
unrecognised
the
recounting
of
to
which
not
special
protein
in
alluded
less
some
would
particles
employed
lowered
to
of
ingestion
of
demands
excessive
diphtheria,
vitality.
setiological
the
as
fever,
subjects
in
which
nephritis
turpentine.
exacerbations
result
and
substance
or
already
acute
the
structure
Trench
the
The
autogenous,
normal
such
others
spontaneously
are
perhaps
scarlet
exposure
some
catharides
as
diseases
and
irritants.
nephritis
of
the
of
ingestion
such
kidney,
follows
and
acute,
the
or
in
apparently
is
onset
wet
Nephritis.
a
toxin.
degree
complaint
may
with
be
NEPHRITIS
made
of
in
face
is
and
by
in the
the
abdomen.
ankles
no
if the
pain
lumbar
has
with
which
nephritis
routine
point
In
all
to
of
of
heart
The
urine
will be
will
be
of
blood
the
Albumin
is
present often
is
reduced,
the
and
of
be
present if, as
exacerbation
In
a
to
be
which
acute
has
primary
of
a
are
of
condition.
or
less in
even
there
is
complete
Its colour
from
or
will
of which
almost
the
produce
blackness.
to
amount,
urea
diminished.
On
centrifugalisedspecimen
(hyaline, granular, epithelial),
heart
seen.
is
some
a
valuable
sent
really
condition.
changes
recent
to
a
acute
an
case,
chronic
arterial
sometimes
are
the
a
upon
fever
blood-pressure
raised
frequently
history of
nephritis," which
are
and
attack,
suggests scarlet
Cases
ounces
are
accountable
un-
a
supervened
but
of
of disease
considerable
in
is
acute
expected,
diagnosis.
"
the
to be
dyspnoea,
concentration
epithelialcells
Hypertrophy
will
12
chlorides
deposit
cells and
nephritis.
Similarly,the
presenting
light pink
microscopically, casts
blood
present.
shown
absence
quantity
from
examining
chronic
as
sometimes
from
a
to
overlooked,
high specificgravity.
variations,
much
the
to
and
It is of
cases
lead
be
may
become
cases
be
reduced
dark, either
admixture
kidney
in the
say
twenty-four hours,
suppression.
such
nothing symptomatic
unaccountable
with
is to
for
diseases
would
urine
all evident.
at
lungs, may
or
the
bed
acute
In
absent
yet the typicalsymptoms
not
pyrexia
that
the
themselves
frequent occurrence,
occurrence
the
such
oedema
to
epidemic, nephritiswas
nephritis were
the
of
of the
to manifest
In the last influenza
acute
of
nephritis,since
probability,many
of very
present, the
especiallybe
associated.
is
affection
an
subsequently
often
confined
one
examination
discovery
will
been
already
suffering from
to
is
invariable,and
means
time
the
ised
indistinctlylocal-
or
particularlybeing affected, but
patient
a
region
(Edema
some
only
71
are
not
condition
aid
in
the
hospital
manifestation
as
of scarlet
a
fever, and
of
recurrence
Pallor
is often
fever
hospital
in
treatment
is not
marked
a
their
during
the
DISEASES
URINARY
TO
GUIDE
A
72
uncommon.
with
early feature,
gradually
increasing anaemia.
TREATMENT.
under
include
work
the
be
thrown
Since
in
some
orthodox
The
possible.
as
daily,and, indeed,
inasmuch
and
the
demands
vomiting
that
in the
nourishment
practicallynothing
being
With
taken.
in the
and
disappearance
urine, the
diet
but
and
Secondly, indirectlyto
work
by
through
other
its
To
end
this
ensured
by
the
the
salines.
The
action
by diaphoretics,such
as
of the
hot
former.
pack
or
the
Pilocarpine
;
mation,
its sudorific
is
serious
by
is
tion
condithe
by
of albumin
in the
kidney, reducing
excretion
the
and
skin.
stools
the
skin
ammonii
the
of
or
is
is
trated
concen-
promoted
and
acetatis
stimulating influence
bath, preferably the
generally regarded
action
are
hydragogue cathartics,
vapour
bronchorrhcea, and
oppose
of
liquor
spiritusaetheris nitrosi,and
juices,so
general
type of pulvis jalapss compositus,
of the
which
of
restrict
to
copious watery
administration
but
little sugar
a
bowels
of
passage
fruit
encouraging
channels, the
of
of any
to
the
and
is
extended.
conserve
promoting
milk
objections,
demonstrated
reduction
gradually
be
can
of
occurrence
well
in the
as
far
therein
be
and
water
condition,
of casts
has
avoidance
stage
improvement
local
diet
of
as
pints
3
of
appears
withheld
is
It may
acute
will
retention
frequent
the
simple digestiblefoodstuffs.
the
the
to
and
oedema
constituent
Furthermore,
considerable.
nausea
diet
albuminous
the
as
of
be
this bland
even
foodstuffs
with
should
food
chlorides, salt in the
directly
kidneys, which
nitrogenous
associated
way
First,
:
production
the
nephritis falls
acute
the
upon
of
reduction
the
extractives.
to
of
treatment
following headings
the
diminish
The
"
accompanied
as
sirable
unde-
by lachry-
respiratoryembarrassment,
objections to
its
application.
NEPHRITIS
of the
Cupping
local
direct
at
inflamed
the
by
the
In
measures.
avoided
be
may
which
is
of
retention
(The
of
reduction
of salt
must
the
from
eliminate
the
accompanied
be
must
of
be
by
have
to
seen
certainty result
with
its
particularly with
large
whilst
the
The
state
is necessary
of
the
administration
of
and
chloral.
diet
of
to
be
urine.
formulate
continued
although
of
of
a
tonic
iron
character,
in
doses
will tolerate.
regulated
But
some
we
definitelyand
in
with
this
ruling as
albuminuria, which
as
Arsenic,
haematinic, is irritating to
must
the
Lumbar
employment.
digestive system
excellent
an
kidney.
to
the
as
to
attempt
by venesection,
benefit
exhibition
the
necessarily
vulsions
Con-
will be
Finally, after-treatment
producing
infusions.
any
from
and
urinary
of
An
made
toxic
a
metabolism.
not
saline
checked
is
normal
does
In
requisitioned.
frequently recommended,
is
claim
the
fluence,
in-
performed.
the
urine.)
bromides
hypnotics, particularly
puncture
be
incapable
intravenous
by
hydrothorax
disordered
of
should
toxins
of
formation
condition
suppression
pleuralcavity
due
of
be
again
a
will be
to
be
to
oedema, in
This
apparently
is
is
its mechanical
may
blood
the
in
direct
of uraemia.
product
uraemia, for this
cannot
by
Southey's tubes
some
constituents
result
degree
heart
probably
retention
acute
aspirationof
treatment
is
fluid
in
other
more
any
causation
a
cases
through
of
paracentesisabdominis
which
the
succeeds
water
excess
an
reduce
to
the
most
the
embarrassing
Fourthly,
In
obviate
to
cases,
some
of the limbs
case
state
the
necessary
or
the
addition,
In
mentioned.
of
congestion
oedema.
of
sufficient
connection
attempt
an
described, which
contributing to
as
which
of
excretion
channels, will be
as
counter-irritation.
above
the
regarded
relieve
to
treatment
treatment
promoting
be
may
treatment
organs
Thirdly,
loins
73
due
the
regard
connection
to
is the
the
it
tion
condi-
legacy
of
A
74
GUIDE
TO
nephritis,and
which
other
signs
these
subjects
which
complete
absence
of
gained by
such
estimation
of
loss is
in
In
of
of
ounces
urine
contributed
amount
of
whites
two
estimation
tends
dietetic
eggs
become
But
treatment.
is
cases
will not
in
gratuitous ;
alter
the
that
persuaded
avoiding
and
taking
ferri
liquor
cold
the
most
the
identified
the
may
In
comparatively
kind,
with
or
made
is
his
until
due
occur
to
the
routine
the
On
care
other
the
likelyto precipitate
not
be
encouraged
of
excesses
the
or
kind,
any
in the
of
patient
form
of
not
be
be
cases
are
without
so
will
urinary symptoms,
urine
time
symptoms
signpost towards
in
of
for
existence
of
symptoms
trivial
development
a
nor
that
no
a
any
complaint
uraemia
and
apoplectic
attack
Haemorrhages
may
acute
death.
cerebral
A
of
scrupulous
preferably
cases
of the
long
elsewhere,
turia.
leads
of
first indication
to
of
absence
Nephritis.
fact, many
rapidly ensuing
The
the
or
albuminuria
the
condition.
and
complaint
condition
diagnosis.
an
pernitratis.
majority
by
only,
healthy life,obviously
iron
Chronic
In
albumin
%
rigidtreatment
case
normal
a
to
exposure
continue
to
the
live
to
the
that
milk
the
in
should
patients
careful
a
ounce
of
be
to
again, systematic
any
underlying
Such
^
cases,
hand, neglect to diet strictlyis
uraemia.
1
even
reduced
gradually
ing
Grant-
shows
pint
shows
lesion
nothing
cases
to
in other
;
is
albumin
extra
an
intervals
at
to
by
renal
many
amounts
regard
to
rigid diet.
a
there
symptoms,
amount
fashion
all
of
absence
severe
really comparatively small,
50
such
a
and
rest
procedures.
the
the
It is the
sufferingfrom
as
demands
the
persists in
symptoms.
or
DISEASES
URINARY
may
be
haemorrhage.
most
commonly
examination
discovery
of
of
an
epistaxis or haemathe fundi occasionally
retinitis,demanding
a
rigid
A
76
the
on
TO
GUIDE
other, denote
URINARY
that
DISEASES
renal
the
factor
myocardial
or
respectivelypredominates.
The
urine
intestitial
of
of albumin
examination
the
In
failure, the
not
of
one
which
of
is still
normal
Any attempt
the
The
of
The
influence
and
gout in the
the
be
influence
than
cardiac
and
by
by
towards
the
by
an
ment
replace-
fibrous
tissue.
of the
kidney
treatment
conserving
they arise,
as
process
produced
substance
symptoms
looked
irritants
and
the
the
of
eliminated,
the
the lesion has
factor.
all
factors
further
any
perhaps
is problematical,
developed
causal
possibilityof
of
most
causal
granular kidney
irreparable. Still,such
for and
"
lead, alcohol, syphilis
as
when
case
by
met
possible
any
production
in any
is
will be
of
of such
mischief
should
rather
"
safeguards against complications.
removal
and
subsided
at direct
first consideration
(1) The
casts
nephritis is
chronic
effect
is directed
care
relief of
institution
of
an
kidney
therefore
useless,and
kidney,
few
very
increases.
condition
has
the
microscopical
stage, especiallywith
active, but
put
out-
Usually
degeneration
albumin
originalactivitywhich
is
of
the
total
slowly progressing inflammatory
a
of the
diminished.
of
later
a
and
increased
is
presence
one
The
"
rule
a
the
amount
TREATMENT.
specificgravity (1005-
present is very low, and
being
inflammation.
low
passed
as
reveals
condition
granular kidney (chronic
lowered, although the
is
urea
is not
.urea
amount
of
quantity
percentage
of
condition
nephritis) is
The
1012).
the
in
regards
as
syphilis.
(2) Reduction
The
so
diet
that
and
should
meat
such
avoided.
contain
should
Alcohol,
are
strain
too,
renal
minimum
taken
as
the
upon
a
be
substances
Sweetbread,
salmon
of
of
in small
contain
must
be
relativelyrich
; whilst
extractives,
quantity only,
purins
taken
liver, beef, pork, mutton,
function.
in
excess
sparingly.
chicken, veal,
oatmeal, vegetables,
NEPHRITIS
milk, eggs,
tively
cheese, butter, sugar, are free from or relain purin bodies.
and malt
Tea, coffee,cocoa
poor
liquors again
wines
the
It
that
opposed
as
is the
purins
purin
In
general, too,
of
there
be
a
by
nephriticit
It
is
taken
than
As
an
potato
protein
2
milk.
of
For
and
the
be
intervals.
regulation of
taken
the
lungs
permits,
be
a
taken.
should
be
is
avoidance
be
the
of
chief
appears
achieved
be
by
defeated
carbohydrates.
quantity
of
food
suggested by
It
mutton
consists
of
fish
or
3
one
ounces,
Dr.
bread
ounces,
egg
and
dietary yields 2,690 calories.
be reduced
the kidney may
by
a
other
the
channels, the
such
is
in
this
morning
next
at
or
kept gently
only
or
the
a
too,
way,
If
the
bath
Turkish
mixture
a
aperients or
pulvisjalapaecompositus,
as
encouraged.
Flannel,
saline
bowels
the
demands
weekly
worn
regulation
constituents.
quoted.
every
skin
exercise, which
and
the
them.
skin.
the
The
exertion,
is the
that
through
hydragogue cathartics,
should
regards
as
the
e.g.
vegetables 4
Such
work
the
sparers,
ounces,
green
in
white
avoidance
between
proteins,will
certain
be
increasing elimination
bowels
the
should
restrict
to
may
6 ounces,
Secondly,
of
proteins (which
daily diet,
butter
of
of
eliminate
Brown
pint
contain.
regimes), whilst
intake
of
that
which
of
most
total
to
ounces,
one
of
average
Langdon
16
of food
important
more
said
oxidation
increase
an
is little to choose
chronic
aim
lessening the
they
unjustifiedif
be
kind
any
the
is
in
inadmissible
are
selection
it may
indication, since
to
latter
traditional
red
to
content
of the diet for
the
deficient
are
important consideration,since
the
excess
which
of alcohol
large proportion
is evident
meat
of
contain
purins
spirits,although the
and
from
77
fairlyfrequent
active
moderate
by regular
degree of
elimination
through
patient's
with
may
of
condition
advantage
wool
and
silk,
skin.
Thirdly, general hygiene.
The
sufferer from
chronic
GUIDE
A
78
nephritisshould
and
URINARY
TO
be
regarded
appropriate
regulations,care
suitable
clothing,as
always
are
best
residence
such
of
iron
condition
is
is
in many
cases
if
nitrite,
of
and
has
its
to
for
and
possible
to
appears
a
nitrate,
syphilis
in
relation
The
far
But
whilst
arise
from,
there-
do
appear
of
mixture
a
or
sodium
grains,
10
traditional
the
nently
perma-
how
high blood-pressure,and
sodium
of
whether
mild
a
may
of
employment
interest
the
in
view
production
between
this
really be
may
of
condition
this
great reputation which
Bradford
this
the
degree
condition, and
later
at
night
indica
due
20
diet
stimulation,
pack.
far
so
as
"
by
of
or
in
particularly
best
chloride
sodium
baths
a
particularly
rigorous
require more
hot-air
notic
hyp-
demand
and
diet, and
of
doses
of the tincture.
minims
will
small
sleep,the
possible
vapour
Pilocarpine
the
skin
is
develop
may
as
). The
headache
to 30
Sir John
toxaemia.
prevents
stages oedema
reduction
sure
high blood-pres-
pilocarpine in
and
"
of
of chronic
if the
rigid regulation
(" salt-free
result
recommends
is cannabis
the
sure.
blood-pres-
advisable.
quite deservedly obtained
troublesome
In
the
anti-syphyliticaction.
or
Rose
it is
is
doses,
of
(6) Headache,
more
to
granular kidney.
drug
whenever
acquires additional
influence
the
tration
adminis-
blood-pressure and
The
arterio-sclerosis
wet
full
in
iodide
potassium
patients
regular
distressingsymptoms
cases
administered.
be
The
far
possible
grains, and
2
such
(a) The
inconvenience
no
mtro-glycerine
avoidance
to, the
recommended
raised
definitelyrelated
be
of
selection
ever
equable climate, when-
an
how
a
in certain
to
be
doubtful
reduction
such
in
TREATMENT."
reduce
to
and
to
digestion permits.
(3) SYMPTOMATIC
It
referred
possible.
is to
of the
skin
the
fatigue. Naturally
their
at
of
addition
in
includes,
already
of undue
of chill and
perpetual convalescent,
a
as
treatment
dietetic
DISEASES
or
sufficientlylarge
the
doses
hot
to
NEPHRITIS
produce
considerable
a
recommended,
be
the
upon
it is liable
caffeine, theobromine
be
i.) may
vomiting
and
diarrhoea.
(See
also
In
the
The
at
chief
possessing
this
therapeutic
the chest
the
abdomen,
or
of the
case
legs.
with
progress
latter
left
is best
their
there
is
checked.
un-
employment,
evidence
no
empirical
of the
At
the
to
appears
specific
recommended.
been
secretion.
measure
the
nephritis
sometimes
to
internal
an
to relieve
may
chronic
has
rate, is that
any
standing
Notwith-
day.
a
75.)
of
objection
of
pill (Pulv. digitalis
in the
The
page
extracts
diuretics,
sometimes
are
symptoms
treatment
of renal
use
uraemic
As
be necessary
tubes
Southey's
still
to
distressing effect
cause.
twice
or
it may
Later
not
hydrarg. gr. i.,Extr. hyoscyam
directlyas by aspiration of
by employing
or
to
diuretic
once
methods,
such
oedema
known
given
the
diuretin
Scillae. gr. i.,Pil.
gr. i.Pulv.
gr.
and
well
perspiration is
of
account
on
the
of
degree
lungs, etc.,
value, and
79
kidney
day
present
minent
pro-
no
possess
supporters.
for
Decapsulation
for
many
been
who
is
into
instances
difficult
succesful.
with
oedema, polyuria, or
that
centra-indication,
who
pressure
The
have
operation
lymph
drainage
to
of
eliminated.
of
although
toxic
that
of
of
date
and
likely
a
one
afford
the
also
an
kidney,
elements,
who
is
the
high
been
additional
so
which
It
to
be
is passing
changes
with
have
in
subject
young
albumin,
cases
benefited
out
of recent
operation.
case
oliguria,and
to
been
investigators,
the
cardio-vascular
appears
flow
the
by
class
quantities
and
favourable,
not
cured,
the
several
has
greatly benefited,
cases
generally agreed
considerable
for
of
even
It is
by
prominence
select
to
nephritis, which
consideration, has
examples
quote
certain
under
years
brought
chronic
most
are
a
blood-
reported.
passage
ensuring better
are
otherwise
CHAPTER
SUPPURATIVE
THE
LESIONS
of
formation
of
primary
to
diseases
is
determined
by
of
in
the
and
the
shadows,
e.g.
those
their
which
of
the
the
cause
can
organisms,
the
most
in
pyelitis
or
one
these
small,
be
may
the
of
the
from
the
both
is
doubt
earliest
calculous
is
for
kidney
The
the
resemble
in
but
in
certain
to
is
tococcus.
strep-
excreted
pus
urine
seen
affects
disease
other
loin
is
order
dual
it
quite
treatment,
and
the
off
draw
of
one
one
established
such
internal
and
as
urine
estimating
whether
of
healthy
surgeon
catheterisation
purpose
is
lous
tubercu-
the
to
to
Removal
strep-
e.g.
and
and
determining
unless
Palliative
the
the
diseased.
contra-indicated
referred
in
and
are
organs
to
caseation.
the
respect
moment,
necessary
function
normally.
of
which
pyonephrosis
be
should
possible
ureters
that
abnormal
pus-formation,
primary
nephritis,
renal
the
of
traced
of
origin.
of
hsematogenous
amount
this
in
Skia-
kidney,
of
the
coli
size
medical
definitely
bladder,
the
closely
common
diagnosis
urine.
certain
result
kidneys.
of
each
be
secondary
the
patches
which
cases
pyonephrosis
at
to
so-called
Bacillus
Treatment
tococcal
made
simulating
of
both
and
kidney
the
In
stone
be
the
absence
or
the
to
in
changes
be
The
tract.
referred
presence
be
symptoms
it may
demonstrating
must
of
urinary
KIDNEY
may
or
organ,
by
by
and
infections
that
THE
kidney
symptoms
kidneys
Reference
OF
the
lower
by
assists
in
pus
disease
cystoscopy
graphy
X
or
kidney
beyond
functioning
local
cations
appli-
administration
LESIONS
SUPPURATIVE
of
should
drugs,
unavoidable
disease
the
A
cases.
is
relieve
and
Aspirin
One
morphia
of the
Treatment
order
render
to
further
bicarbonate
the
the
of
be
given four-hourly.
of
the
and
bacillus.
In
water.
thus
prevent
potassium
or
grains
30
treatment
weak
a
is
non-alcoholic
sodium
Additional
with
pelvis
severe.
diseases
barley
less than
not
is
pain
practitioner. The
or
organisms,
of
an
possesses
coliform
a
alkaline
urine
loin ; this
infective
by
Contrexeville
doses
renal
hot-
if the
primary
of the
in
pliable rubber
indefinitelyrenewed.
given
with
to
these
large quantities
the
growth
be
can
be
rests
drink
Vichy,
e.g.
"
it
to infection
usually
patient should
very
applied
to
analgesic,and
may
is due
a
is
the
or
common
closely round
common
more
pyelitis,which
fluids
is
an
as
since
advantage
there
interference
aching pain
will fit
which
efficacious
equally
added
the
81
when
to
turpentine stupe
popular remedy
bottle
water
A
KIDNEY
resorted
operative
bilateral.
will
loin
in
delay
is
be
only
THE
OF
must
is
lavage
of
silver
solution
nitrate.
Stock
by
and
given
once
a
dose
are
at
do
essential, and
the
least
are
measures
of
pain
long
or
intervals.
of
night
No
ceased.
be
careful
The
and
fever.
In
to
seldom
need
for
many
acute
avoid
symptoms
be
authors
and
warmth
in bed
complete
for
pearance
disap-
pyelitis,
operative
to
felt at
weeks
the
after
chill until
they
of the adult
form
but
have
attacks
even
recur,
symptoms,
7
large
as
required, but
liable
be
disease,
the
remain
the
are
of
Best
should
the
stages
opinion
good.
should
of
later
after
alarm
more
doses
hours
both
sweats
of the
must
little
fortunately
or
the
patient
pain
fever
in the
In
as
forty-eight
of both
Small
considered
are
early stages
bacilli,and
and
no
the
in
harm,
they
vaccines
good.
millions.
200
as
much
week
million
e.g. two
a
do
to
some
coliform
autogenous
at
tion
continuathe
the
pearance
disappatient
gradually
of this
disease,
82
A
GUIDE
which
is
chiefly
observed
are
remarkable
and
although they
for
at
When
caused
commencement
the
suppurating
urinary tract,
of
reflect
for
as,
the
be
borne
the
kidney
the
cause
carrying
temporary
relief
following
and
bladder
irrigated
solution
(silvernitrate
1 in
Should
a
5,000,
the
catheter
urethra
some
a
view
with
pubes
The
tube,
the
holds
the
kidney.
whole
free
drainage
septic
that
it
in
By
the
should
the
lower
5,000).
retaining
there
be
of
case
of
be
sulted
con-
above
the
of
be
suppurative
into
drained
sure
urinary
tract
is
the
mation
pus-for-
immediately
catheter
a
is
tract
must
we
ganate
perman-
insertion
whenever
tying
urinary
antiseptic
1 in
the
the
106).
page
body
good
the
order
see
weak
bladder
and
cystotomy
as
in, and
of mercury
the
larged
en-
catheter
a
tied
to
by
for
urologist must
draining
rule, that
golden
in
of
to
Both
a
tract
obtained
5,000, potassium
the
days,
(suprapubic
Pezzer
De
in
with
of
unless
urinary
be
can
ever,
how-
infection
cured
lower
intolerant
be
will
It must,
or
be
oxycyanide
or
for
daily
1
largement
en-
successful
prove
large
as
should
twice
either
to
is
lower
the
treatment.
stricture,
obstruction
the
he
ameliorated
but
the
be
kidney
from
ascending
an
in the
out
pass
if
obstruction
prostate
will
be
unlikely.
should
the
symptoms.
that
never
is
stricture, great credit
or
of the
removed,
is
of
infection
acute
in mind
can
kidney
example, cystitis,due
more
succeeding
pregnancy.
practitioner
relieving the
in
appendicitis ;
each
condition
prostate
the
upon
of
ascending
an
women,
bicarbonate
potassium
the
by
with
to the
damage
of
pregnant
similarity to
return
may
doses
Prophylactic
DISEASES
amongst
their
permanent
pregnancy,
given
URINARY
TO
of
the
freely.
free
may
uated,
evac-
lesions
bladder
Besides
irrigation,in
be
cleared
of
material.
Irrigation
of
the
upper
urinary tract,
that
is
the
CHAPTER
XI
BACTERIURIA
THIS
term
in
organisms
urine
healthy
sterile
presence
of
It
collected
catheter
by
is
under
from
or
however,
kidney
and
the
two
latter, of
But
the
urinary
is
specimen
a
since
of
variety
organisms
cause
be
may
which
urinary
is
the
For
of
The
the
the
bacillus,
isms
organ-
the
the
in
prostate
of
case
conditions
These
gonococcus.
which
same
bladder,
addition,
the
example,
tubercle
coli, the
from
infection
meant
organisms
urine
generalised
a
tract.
pneumococcus.
with
infected
definitely
the
are
elsewhere.
chief
of
urinary
no
a
Sometimes
focus
84
of
or
of
sepsis
such
tooth
carious
such
of
source
bility
possithe
contamination
the
cases
the
disease
without
some
tract.
e.g.
frequently
such
from
arises
lies in
bacteriuria
infection
In
organs.
ascertainable,
in
interest
general
a
necessarily
but
the
the
aureus,
urethra,
considered
the
a
derived
be
may
to
that
Bacillus
are
Staphylococcus
of
diagnosis
a
that
a
contribute
may
commonest
the
upon
aseptic precautions,
lesion, by
of
part
some
the
local
a
made
contains
consideration,
infection
covered
un-
character.
non-pathogenic
Assuming,
the
stand
to
before
all
with
normally
exhibit
circumstances.
necessary
is
perfectly
a
depending
other
bacteriuria
urethra
of
and
obviously
since
allowed
period,
temperature
is
if
of
presence
eventually
may
variable
a
pathological
the
urine
the
to
voided,
freshly
micro-organisms
for
external
restricted
be
must
a
a
external
is
source
septic tonsil,
infection
can
with
BACTERIURIA
certainty be detected,
in infection
of
the
isolated
be
can
An
of
the
In
infected
appendix
such
cases
we
organisms
the
from
be
stream.
blood-
the
at
constitutional
elucidated
bottom
normal
in
The
is
blood
cases
characteristic
be
may
of
The
the
illness
strating
demon-
latter
may
it
exhibits
generally
The
a
In
its
impart
is
reaction
micturition
be
filtration.
present, and
appearance.
Frequency
of
dispersed by
not
physical
examination
urine.
but
illness
an
without
nature
routine
a
appearance,
which
turbidity
acid.
by
with
disturbance, pyrexia,
rigors, but
pathological
a
some
and
description.
any
only
confronted
often
are
vomiting
of
signs
usually
generally, although
is
invariably, present.
not
TREATMENT."
Any
ascertained
is
to
of
source
be
suspected,
or
disinfected
the
administration
the
by
bed
the
fever.
bland
The
drug
in
urotropin,
with
a
only
in
acid
the
It
urine.
alkaline
urine
this
end
phosphate,
salt
taken
are
to
is often
acid, and
more
has
this
be
usually
together
as
to
with
this
ensure
far
the
benzoic
arisen
before
a
from
acid
the
the
and
latter.
placed
of
cases
is
employed
three
times
tered
is adminis-
suitable
which
the
a
is efficient
drug
easy
only drugs
is confined
in
Urotropin
water.
that
so
be
to
and
and
employed
grains given
10
of
urine,
illness
excellence
of
tumbler
must
care
commonly
par
doses
day
an
diet
colon
calomel
patient
acute
if
must,
The
of
The
stage of
the
during
infection
removed.
injection of large enemata.
upon
to
the
not
may
and
mischief.
perhaps
in
denizens
properties
which
in
urine, if
the
displaying profound
is
pathogenic
infection
from
particularly
appear,
coli,that the normal
acquire
generalised
a
it would
the Bacillus
by
intestine
induce
and
85
to
reaction
render
are
acid
an
utilised
sodium
Considerable
troversy
con-
principle of administering
urotropin,
and
until
com-
A
86
paratively
in
the
and
the
acid
the
fact
nowadays
But
the
at
does
if
it
as
produced
by
and
it
the
administer
to
desired
is
that
phosphate,
practice
the
contact
appear
thus
is
be
in
of
time
not
bad
would
urotropin
sodium
common
simultaneously
two
it
acid
in
a
desired,
be
to
acid
the
the
formaldehyde
hydrogen-ion
is
of
from
is
as
urine.
of
matter
a
not,
held
was
effect
the
formaldehyde
mixture,
with
practice
a
that
expectation
DISEASES
URINARY
such
recently
liberate
to
TO
GUIDE
render
to
the
urine
the
urine
acid.
An
is
alternative
render
to
of
quantities
and
Bacteriuria
and
absence
it
of
treatment
as
refrain
with
which
in
of
citrate
the
large
potash,
Bacillus
better
vaccine
specimen
desirable
nor
coli
persist
regards
restriction
of
diet
will
prepared
the
and
occupation
of
be
in
treatment
Although
a
in
case
the
obtained
by
other
the
patient's
by
stock
vaccine
use
cultivation
own
urine.
in
rigid
a
advice
activities.
urinary
the
in
and
all
of
persisting
necessary
to
particularly
of
long
indications
form
results
chronic,
very
neither
is
vaccine-therapy.
employed,
a
definite
from
efficient
very
be
may
condition,
is
milieu
of
administration
bicarbonate
a
of
flourish.
cannot
to
the
by
sodium
provide
so
the
alkaline
it
disinfection
to
measure
infections
may
coli-infection,
of
from
an
A
autogenous
a
catheter
be
far
XII
CHAPTER
TUBERCULOSIS
TUBERCULOUS
affections
commonly
most
and
forty
or
both
is
always
genital
all
cases
the
urine
and
from
above
it is
important
vesicles
of
cystitis.
to
micturition
the
a
The
of
young
disturbance
of
micturate,
to
that
pale
and
his
night's
rest
if
on
found,
not
later
date,
this
the
is
another
for
the
medium.
constituents
should
of
the
organism
a
be
made
is
not
sometimes
tuberculous
urine.
soreness.
of
complains
desire
frequent
aroused
once
ill
of
tubercle
should
painful
of urethritis,
at
his
and
87
of
of
of
the
examination
Pus
a
must
occasion
to
due
micturition
made
be
cause
examination
first
due
only
as
symptom
who
thin,
that
rare
so
sensation
a
in
Hsematuria
development
causes
man,
tuberculosis
and
the
to
suspicion
bacteriological
in
urine
of
be
may
in
themselves
common
frequency
complaint
owing
tuberculosis
is
The
the
infection.
manifest
symptoms
is
of
infected.
comment.
lesion
when,
passage
In
vesical
of
testicles, prostate,
renal
rarely
the
found
been
source
becomes
passing
a
of
onset
of
but
concerned,
the
possible
disease
other
tuberculous
a
a
bladder
any
merit
to
the
the
without
as
spread
has
one
bladder
affections
bacillus
to examine
the
is
of
symptoms
before
tubercle
the
in
The
direct
With
eighteen
situated
is
organs.
by
organs
of
ages
immediately
not
where
insidious
genital
below.
or
are
we
organs
genito-urinary
lesion
affected
secondarily
seminal
So
the
TRACT
the
primary
in
or
the
between
The
kidneys
infection
of
appear
years.
URINARY
THE
OF
be
readily
blood
Even
health.
the
A
urine,
bacillus
made
is
at
a
discovered
are
also
if tubercle
88
A
bacilli
are
be
not
disease
until
be
has
been
to
ascertain
is
unilateral
of
still
;
and
is
the
genitalia as
contra-indicate
in
when
After
to
they
the
each
definite
a
subjected
does
kidney
one
to
tubercle
of the
complete
the
the
urinary antiseptics by
in
these
it is necessary
This
of
consists
of
administration
the
(2)
and
infected.
cystitis.
restrictions,
cure,
disease
focus
primary
tuberculous
(1) dietetic
in
secondarily
are
of
be
in
as
of
improvement
the
both
from
thus
presence
well
occasionally
removal
treat
of
urine
and
may
operation, for experience shows
this
results
invariably
organs
the
of the
bacillus
it
bladder
evidence
should
patient
Evidence
that
the
diseased, surgical interference
nephrectomy.
the
possible
made.
kidney only
in
in
is
appearance
Subsequently
be
is indicated,
not
the
comparing
ureters
if present,
It
valuable
more
bacteriologicallyexamined,
one
both
whether,
tubercles
should
performed.
and
bilateral.
or
presence
by
diagnosis can
If
cystoscopy
order
orifices.
is
ureter
diagnosis
in
obtained
ureteric
the
cystoscoped
.membrane
mucous
urine
be
the
detect
to
in the
DISEASES
should
patient
catheterised
URINARY
found
not
rejected
The
the
TO
GUIDE
(3) tuberculin
and
mouth,
injections.
(1) Dietetic
end
the
at
Restrictions.
bilateral
of
the
drugs
"
taken
be
to
urinary antiseptics.
boric
has
the
the
least.
increases
the
in
mucous
the
of the
minims
is
only
are
an
a
which
The
are
few
act
as
urotropin,
first
named
;
boric
acid
of
cases,
urotropin
micturition
bladder.
for
kidneys.
oil.
power
discussed
is
treatment
important
more
of
the
mouth
percentage
frequency
5
the
wood
certain
a
membrane
capsules of
The
the
There
antiseptic
greatest
In
by
sandal
and
acid,
of
disease
Antiseptics.
subject
under
chapter
tuberculous
(2) Urinary
This
"
by
Sandal
excellent
has
irritating
wood
substitute
oil
in
OF
TUBERCULOSIS
such
should
and
cases,
continued
for
other
risk
of which
of
infection
is
organisms
such
those
to
employed
for
Whilst
there
well
pyrexia, as
of
focus
infection
which
in
affection is
renal
the
ensue
But
the
where
to
lines
and
of
renal
a
the
with
the
limitations
lesion.
headings
A
most
rather
practitioner
of
be
the
which
of
out
stated
the
as
renal
a
be
climate
but
preferable,
whereas
for
such
that
much
a
arisen
a
the
may
be
general
patient
subject.
under
the
drugs.
respecting the
patient.
maximum
the
inevitable,
considered
has
will
existence
are
regarding
at
upon
the
by
restrictions
to
question,
climate, food, general hygiene and
desirable
that
between
subject
imposed
great deal of controversy
the
focus.
compromise
must
case
bladder
primary
clearly
than
a
of tuberculous
may
of
the
a
limited
a
centra-indication
no
aims
pretty general agreement
is
is
Whilst
treatment
of
It
such
continued
in
or
evidence
by
tuberculous
deal
tuberculous
Medical
is
be
a
and
the
involved,
of
removal
must
be
must
treatment
improvement
position adopted
a
the
body.
operation
treatment
attempt
as
the
upon
pain
kidney,
are
cystitis
since
nephrectomy,
they
rigidly
surgical indications,
with
in the
of
presence
be
Tuberculosis.
accompanied
elsewhere
disease
when
one
kidneys
both
reason
same
prospect of eradicating
confronted
is sometimes
the
purposes.
in
as
intra-vesical
should
paroxysmal
the
as
For
Urinary
acute
the
complication
by avoiding
definite
are
pyonephrosis,
serious
occasions
Inoperable
bladder
tuberculous
the
instruments
diagnostic
90.
page
lavage.
as
urethral
of
restricted
See
a
hours, and
four
every
89
months.
obviated
be
can
passage
as
of three
"
manipulation
the
given
Injections.
Secondary
TRACT
URINARY
be
period
a
(3) Tuberculin
with
THE
of
said
There
is
sunlight
in favour
A
90
of
GUIDE
cold
a
renal
patient
Otherwise
As
the
phthisicalpatients generally,
best
the
by
relatively
a
Mediterranean
the
of
advantages, provided
tolerate
and
suited
level,
sea
can
west
regards food,
constituents
the
travelling.
necessary
south-west
in this
coast
be
indigestible
liable
are
as
function, e.g. the
to
for
country
.be recommended.
to
are
at
offeringperhaps
the
DISEASES
will be best
subject
climate
temperate
course
URINARY
dry atmosphere
the
littoral
TO
avoided,
asparagus,
which
contain
kidney.
Alcohol,
too,
the
whole
Cod
be
renal
fish,are
such
as
to
irritate
the
forbidden.
oil,which
in
the
and
meat
known
salts
must
as
such
vegetables,
consist
liver
foodstuff, is given,
of
those
as
should
diet
vegetables.
kinds
well
as
and
over-burden
to
heavier
materials
largely
of
is both
a
most
the
and
milk
and
drug
of
cases
On
a
tuberculous
disease.
considerations
Hygienic
a
of fresh
maximum
with
exercise
in
a
is
should
always
be
cod
and
mentioned,
will
be
given
symptoms
as
Tuberculin
frequently
They
the
are
not
oil, which
they
recommended.
the
has
arsenic,
to
necessary
be
to
residence
words,
next
worn
perhaps
are
to
without
adapted
In
skin.
been
already
such
only
combat
drugs
relieve
or
arise.
injectionsrequire mention,
recommended
of
treatment
as
liver
other
of rest,
patient's capabilities.
not
are
In
itself
to
the
to
which
requirements.
addition
proportion
disciplineis desirable, but
sanatorium
Flannel
part comprise
most
due
a
strictlygraduated
regulations
individual
the
air, with
Sanatorium
arbitrary
for
as
tuberculosis
administered
of
the
special
^^
at
gradually
to
^ milligram.
continued
for
at
two
Such
years.
they
value
in
genito-urinary
subcutaneously
dosage commencing
least
of
since
once
a
are
the
organs.
week,
milligram, increasing
treatment
must
be
A
92
URINARY
TO
GUIDE
micro-organisms
of
the
TREATMENT.
"
the
;
DISEASES
of
diagnosis
-
bladder
will
mation
inflam-
primary
confirmed
be
by
cys-
confined
to
normal
for
toscopy.
until
bed
least
at
the
is
the
cocci
contra-indicated.
in the
disappears
disease
that
vaccine
doses, which
and
nitrate,
three
1 in
5,000.
hsematogenous
excuse
for
after
the
may
Search
for
focus
neglecting
to
has
be
of
make
be
the
which
will
source
recognised
should
always
possible
as
receive
be
should
a
of infection
large
is
number
never
small
be
passed
in
An
given
weekly,
10,000
silver
carried
in
focus
strength
in
must
out
of
cases
be
never
found, but
that
attempt.
Boils,
chronic
of
causes
appropriate
it is then
very
bladder
tonsillitis,pyorrhoea and
are
obviously
useful.
increased
the
useless
occasionally
been
primary
a
rarely
can
1
of
tion
inflamma-
are
be
with
lavage
times,
infection
A
neglected.
should
irrigated
is
with
commencing
catheter
bladder
or
two
to
A
which,
lavage
cases
determined,
is
no
buncles,
car-
constipation
infection, all of
treatment
of
of
one
are
stage, and
gradually increased,
are
week.
the
bladder
but
every
by
the
of cases,
chronic
the
and
autogenous
a
into
passes
vaccines
once
lavage
treatment
the
by
tincture
bladder
majority
is
and
Vaccines
this
according
If
mouth.
four-hourly.
Under
given
grains
30
grains
10
latter
be
If infection
the
given by
supra-
if the
vary
bicarbonate,
stage, and
acute
will
treatment
organism.
1 drachm
the
to
should
morphia
urotropin
group,
the
during
be
must
hyoscyamus
the
of
coli, potassium
hours,
the
the
applied
strangury, but
the
Drug
of
nature
Bacillus
four
bottle
J grain
severe
very
hypodermically.
to
hours.
relieve
will
be
remained
has
temperature
hot-water
pubic region
should
patient
forty-eight
rubber
A
The
;
in
but
which
there
the
CYSTITIS
Cystitis Secondary
Bacterial
down
to
of
infection
the
ureters
the
to
93
Lesion
a
the
of
the
Kidneys.
kidneys commonly
bladder
and
sets
spreads
localised
a
up
cystitis.
of
Examples
in
pyelitis of
the
A
certain
fever
around
left
the
left
and
the
to
examined
urinary
of
acute
in
for
is
tract
to
cells.
pus
inflammation
change
no
the
on
deep
on
pation.
pal-
pointed, therefore,
a
secondary
bed
while
of
localised
the
large
fever
of
doses
(30 grains four-hourly) by the
rapid disappearance
point
renal
a
in
rest
and
tender
administration
symptoms
secondary
blood
pyelonephritis, with
resulted
When
few
was
found
and
symptoms
by
of
slight frequency
orifice, but
kidney
bicarbonate
potassium
a
area
and
Treatment
persisted,
mouth,
an
signs
unilateral
a
cystitis.
to
attack
an
lesion,
bacteria, but
of
only
not
of
to
exclude
toms.
symp-
cystitisbeing
should
radiography
recommended,
the
the
of the
the
urine
whole
presence
stone.
It
must
and
not
remain
in
for
a
and
undermining
to
number
the
and
In
and
attacks
recurrent
examined
was
ureteric
The
side.
when
coli and
revealed
The
of
observed
are
pyelonephritis
with
urine
Bacillus
the
recalled
associated
The
Cystoscopy
right
is
were
contain
be
infection
acute
pregnancy,
case
micturition.
to
of
spread
tuberculosis.
renal
of
this
lowered
cause
a
stone
an
few
is
days
"
be
forgotten
the
kidney
of
years,
the
the
silent."
but
all
of
these
fever
symptoms
the
stone
a
silent
vitality of
resistance
attack
"
that
"
and
the
pass
a
form
unsuspected
while
renal
tissues
and
may
damaging
cells.
become
localised
off, and
Owing
infected
cystitis.
again
the
GUIDE
A
94
TO
Cystitisdue
Urethritis
URINARY
DISEASES
Spread from
to Direct
the Urethra.
gonococcal origin, if treated
during
the
local
acute
severe
stage of the disease by such
manipulation as the passage of bougies, catheters, etc.,
of
spread
may
cystitis. So
actual
acute
fatal
been
made
rise to
give
which
in
attack
an
of
that
occur.
may
had
attempt
an
urethritis
acute
Gangrenous
instrumentation.
acute
an
become
membrane
mucous
record
on
abort
to
of
means
is
case
and
this inflammation
may
of the
gangrene
A
bladder
the
to
by
cystitis was
caused, resultingin the
whole
bladder
and
from
gonococcal septicaemia.
death
taking place
Such
cases
coccus
in
causes
profuse
haematuria.
condition
is prone
This
rare
are
;
initial
the
Local
silver
and
of
nitrate, potassium
the
gono-
severe,
and
to
chronic
and
lavage
prove
years.
with
in
10,000
in
5,000,
1
1
permanganate
hydrogen peroxide.
of
familiar
bladder
the
and
occurrence,
scrupulous preventive
changes,
disease
of the
which
more
find
the
first indications
are
usually
the
in the
of
the
the
"
on
in
urethra
in
of
the
an
"
or
Pus-forming
excellent
part of the
no
the
presence
bladder.
of
a
vesical
soil
body
In
Tuberculosis
is
fact,
growth
plication
cystitis. It is this compatient'slife by spreading
kidneys.
tuberculosis
to
Growth.
disease
than
symptoms
to
chapter
and
of the
terminates
which
Cystitis due
fection
in-
undergone degenerative
stricture
malignant
in
pronounced
infection
has
most
eliminate
cannot
Vesical
to
multiply,
to
the
prostate.
Cystitis Secondary
organisms
aseptic
unfortunately a
is
measures
of
result
the
of
occasionally even
bladder
the
when
through neglect
instrumentation
in
precautions
the
become
to
consists
treatment
Infection
this
cystitisdue
stages is always
but
sloughing,
intractable, pyuria persistingfor many
very
on
wall
is
separately considered
of the
Urinary
Tract."
CHAPTER
XIV
TUMOURS
BLADDER
THE
examination
point
disease
to
lesion
the
is
bladder.
is
tumour
in
of
the
and
neoplasm,
the
in
or
usual
the
ease,
dis-
papillomatous
or
simple
tumours
from
apart
cancer,
cystitis
and
in
pain
the
the
in
the
the
into
passed
cystoscope,
being
was
of
action
is
malignant
the
the
several
before
necessary
growths
pre-operative
application
of
and
be
may
post-operative
suitable
methods
cases.
(1) PRE-OPERATIVE
patient's
a
of
current
of
from
to
aid
the
treatment
inoperable
electrode
The
it
operation,
open
the
by
recent
whereas
by
them
in
cured.
is
and
growths
destroy
to
has
for
change,
these
remove
of
patient
the
of
is
be
marked
a
with
considered
of
growth
advanced
vesical
to
may
current.
bladder
the
in
whether
hsematuria
respect
possible
applications
by
in
reveal
whether
villous
simple
to
diathermic
aspects,
and
cystoscope,
than
be
never
region.
now
The
can
malignant
intermittent
there
customary
the
symptoms
growth.
undergone
is
the
will
a
or
the
tract
apparent
latter
treatment
years
to
the
with
suprapubic
the
cystoscope
of
haematuria,
of
The
of
but
aid
the
whom
urinary
more
painless
symptom
it
the
this
of
early stages
The
in
in
patient
papilloma
a
respect
A
a
without
complete
no
of
TREATMENT.
medical
minimum
surgeon.
"
attendant
before
Attacks
he
of
95
Much
to
reduce
under
comes
pain
may
and
be
his
the
done
comfort
discare
haemorrhage
GUIDE
A
96
immediate
require
is relieved
Less
off free
hypodermic
that
from
Haemorrhage
the
tax
be
may
and
passed
1 in
nitrate
This
be
should
In
passing
be
must
sepsis
recommended
the
these
and
iron
The
from
patient
bleeding
should
will
that
the
increased
The
in
no
delay
any
found
the
in
In
the
should
catheter
a
of
solution
a
of
Fahr.
120
aseptic
the
the
of
is
growth,
a
been
have
drugs
of
tions
precau-
introduction
of
seat
persistent haemorrhage.
ergot, calcium
have
seen
lactate
good
no
ever
what-
administration.
warned
be
from
ensue
etc.
against
;
also
caused
of
by
the
severe
exercise, such
all violent
recommended
way
in
be
for
considered
operative
the
the
of
danger
high living
and
the
persistent bleeding
to
replace
opportunity.
bleeding
should
advice
is
In
often
be
of
cases
so
or
cause
blood
When
interference.
urine, expert
earliest
haemorrhage,
The
alcohol.
in
treatment
must
for
are
blood-pressure
indulgence
will often
intermittent.
Numerous
horse-riding,running,
as
occurs
patience.
strictest
authors
their
a
daily.
out
arrest
The
this
temperature
a
known
better
salts.
result
the
blood-clots
bladder
severe,
bladder, the
for
are
necessitate
irrigated with
at
5,000,
complication.
serious
three
growth
When
and
or
less
adopted,
the
into
the
catheter
a
of
to
of the
growth
carried
doses
delayed.
bladder
the
hyoscyanus
large
as
morphia.
persistent
usually
case,
silver
that
or
practitioner's ability
bleeding
former
a
of
portions
pain
of
be
not
strangury,
a
drachm
than
acute
injection
of
nature
of tincture
bladder,
such
pre-operative
ineffectual.
found
the
should
operation
at
be
into
causing
form,
Of
the
occasionally happens
cast
be
is of
mouth.
will
the
during
doses
day
a
DISEASES
treatment
by repeated
the
given by
It
URINARY
Pain, which
period.
times
TO
is
obtained
intermittent
profuse
as
to
BLADDER
result
in
urine.
acute
attempt
it
is
but
purely temporary
a
immediate
OPERATIVE
bladder
a
wound,
the
of
wise
a
and
patient
should
the
is
only
the
more
of
of
in
send
the
suprapubic
instructed
be
to
report
the urine.
rence
Recur-
and
its onset,
his
cases
Following removal
"
healing
is insidious
such
patient
if he
least
at
urologistfor cystoscopicexamination.
an
it
of
required.
is
examination
practitionerwill
to
year
for
growth
In
TREATMENT.
tumour
six months
every
retention
relieve
to
measure.
surgical interference
(2) POSTof
made
be
may
with
by evacuating the clot with Bigelow's
best
at
blockage usually results, and
symptoms
evacuator,
97
clot-formation
extensive
An
TUMOURS
possible
detect
to
early
an
is
once
Thus
of
return
the
disease.
(3) TREATMENT
that
the
INOPERABLE
OF
practitioner'sefforts
severely
are
submitted
to
treatment
by
tested.
the
is such
be
If
frequency
called
to
the
of
the
such
pain
as
experience
of
internal
will
be
hands
to
the
of
expected
euprapubic
fistula
excoriated,
and
The
a
is
as
tress
disbe
view
a
to
permanent
or
severe,
to
prevent
render
the
his
advise
to
may
what
application of
usual
medical
ointment
the
growth,
the
skin
will
from
be
or
exhausted.
inoperable
cystotomy.
again
attendant,
prevented
8
all
will
patient
dressings
an
patient
suprapubic
how
be
by
is that
authors
of
impossible owing
meatus
eventually require a
Following this operation the
the
and
Irrigation
become
may
cases
into
or
micturition
is here
should
cases
haemorrhage
of
It
pain
with
cystotomy.
urethra
blockage
cause
The
via
such
"
getting a good night'srest, an urologist
view
to performing a perin with
a
manent
suprapubic
bladder
All
relieve
fulguration, radium,
patient from
should
to
expert examination
an
suprapubic cystotomy.
there
CASES.
around
pass
who
the
becoming
necessary.
consisting
of
zinc
GUIDE
A
98
and
oil
castor
whole
it
of
in
best
of
end
being
the
flange
by
For
favour
doses
of
analgesics
In
order
it
should
of
great
15
be
of
mental
distress
Between
of
layer
a
to
a
degeneration
those
That
The
grains
three
aspirin
as
the
to
all
other
illness.
be
may
of
repeated
constitutional
produce
patient
him.
resorted
phenacetin.
effects
marked
given
daily.
the
with
the
character
around
of
of
alternately
in
be
to
stages
cause
be
only
effect
the
times
resistant
that
which
should
which
last
given
are
to
other
ointment.
used.
become
forgotten
such
the
placed
should
very
be
morphia
disturbances
than
analgesic
should
not
of
doses
aspirin,
has
the
fistula
through
urinal.
zinc
be
may
is
the
in
that
and
keep
this
passed
be
preparations
patient
or
prolonged
It
less
its
the
when
drugs
not
will
the
daily.
most
and
Morphia
to
various
pain,
authors
in
changed
be
region
from
portable
oil
over
bladder,
should
castor
spread
tube
the
a
skin
with
must
gauze
rubber
a
to
the
urine
into
attached
smeared
gauze
suprapubic
The
flange
and
thickly
parts
the
drained
be
DISEASES
condition.
indiarubber
an
in
skin
the
URINARY
equal
in
healthy
a
can
TO
which
a
tion
condiresults
GUIDE
A
100
times
TO
will
pus
which
and
for
of
cases
In
such
itself
empty
rapidly
In
few
a
and
severe,
interference
is
the
between
the
and
the
swollen
prostate
The
abscess
avoid
to
the
into
be
On
prostate.
opened
by
rectal
the
the
origin the
of chronic
treatment
is referred
reader
toms.
symp-
extremely
surgical
is made
being
should
with
the
the
the
avoid
the
anus,
urethra.
plunging
to
in the
the
the
care
when
infecting the peri-prostatictissues
For
acute
and
drained,
route,
immediate
behind
account
no
urethra.
ill that
incision
felt
majority
are
so
An
urethra
the
the
symptoms
and
opened
injuring
into
bulbo-cavernosus
perineum
is
the
the
becomes
necessity.
in
obtains
from
recovers
patient
a
recommended
will
patient
a
micturition
on
treatment
by bursting
cases
the
both
abscess
the
event
an
and
relief
the
prostatitis,the
acute
prostate, producing
pain
causes
Under
defascation.
the
in
develop
large abscess,
DISEASES
URINARY
taken
knife
abscess
danger
Bacillus
of
coli.
prostatitisof gonococcal
to the
literature
venereal
on
disease.
Infection
Non-Specific
The
than
"
the
sexual
of
and
roscopy,
by day
The
appetite.
examination
The
both
the
be
his
from
while
made,
the
the
statement,
is of
in
connection
desire.
There
night
diagnosis
termed
inflammation
phenomena
and
be
may
other
is
and
made
is
an
by
a
frequency
abnormal
bacterial
examination.
specificinfection,
discharge
organisms,
prostatic secretion, posterior ureth-
rectal
patient,
sexual
Prostate.
what
the
say,
irritative
and
micturition
of micturition
of
is to
the
with
becomes
degree, causing
with
infected
gonococcus,
irritable," that
low
to
when
prostate
of
strenuously
will
admit
urethra, and
tendency will
a
exposure
slight muco-purulent
unless
be
denying
careful
to doubt
the
tion
examina-
veracity
DISEASES
By
the
OF
the
massaging
patient
to
and
prostate,
the
pass
PROSTATE
THE
first
101
then
instructing
of urine
ounce
into
bottle, a specimen of the prostatic secretion
when
which,
subjected
will demonstrate
Bacillus
the
Posterior
around
the
the
the
of
The
kidneys
of
be
must
the
removal
in
seminal
the
tuberculin
injections,
fresh
urethral
by
worse
TREATMENT,
if the
The
disease
The
:
is
organism
vaccine
is
be
be
must
isolated, and
which
made,
is
patient subcutaneously, commencing
(e.g. 50 millions),and
of
a
week
of
massage
followed
weak
The
and
10,000
is
prognosis
Simple
With
in
the
1901,
a
prostate
radical
the
and
lesion
by
Bacillus
the
the
on
from
following
it
injected
be
into
the
doses
intervals
at
this
with
genous
auto-
an
small
with
is
irrigation.
or
must
course
tonics
ment,
treat-
undertaken,
posterior
of
a
prostatic
potassium
as
oxycyanide
urethra
with
permanganate
1
mercury
in
10,000.
good.
of the
Enlargement
introduction
the
and
Associated
irrigation of
by
antiseptics, such
in
1
the
consists
by
gradually increasing
millions.
500
to
demonstrate
then
caused
and
genitalia
to
instrumentation
coli, staphylococcus, etc.,
lines
order
air
general hygienic precautions.
made
the
focus, followed
primary
bacillus
tubercle
Treatment
focus.
primary
of
in
in
vesicles.
the
of
conducted
and
;
type of organism
the
on
examination
thorough
site of
the
changes
nodules
reveals
rectum
depend
bacillus,
ducts
prostatic
If
bacteriologist.
the
by
found,
the
will
treatment
isolated
is
thickening
tubercle
organism.
and
verumontanum
and
the
inflammatory
shows
finallypalpation through
gland
of
non-venereal
urethroscopy
obtained,
bacteriologicalexamination,
to
presence
other
coli,or
is
sterile
a
treatment
change.
of
total
of
Until
Prostate.
enucleation
by Freyer
enlarged prostate
then
this
condition
went
underhad
A
102
been
GUIDE
treated
of
the
with
the
reducing
procedure
St.
was
Peter's
of
in
of
the
popular
and
Hospital prior
the
forceps.
indirect
For
an
portions
and
an
gland.
method
time
a
this
practised
commonly
Freyer's
to
by
or
away
scoops
as
tion,"
conges-
catheter,
a
picking
employed
size
reduce
to
scissors,
also
was
"
passage
consisted
organ
Vasectomy
of
constant
which
operation,
DISEASES
by drugs
either
the
by
URINARY
TO
at
epoch-making
innovation.
The
necessity of removing
changes
be
cannot
the
in the
occur
of
percentage
operative
lower
is
operation has been
with
changes
He
years.
night's rest
Besides
this
required
not
the
expel
be
manifest
the
the
medical
advice.
the
Commencing
recognised by
will
gland
give
rise
increase
per
to
methods
rectum
symptoms
in
the
relief.
always
symptoms
early stages
observes
medical
between
than
more
practitioner
the
in discomfort
of
the
he
cystoscopy.
similar
to
the
becomes
a
necessitates
prostate
examination
of
onset
life
when
of
and
these
;
evidence.
pass
enlargement
two
is
of
his
twice
perhaps
slightstrain
and
condition
gradual
to break
obliged
for
All
the
of advancing
urgency
seldom
layman
of
a
associated
patient generally
an
once,
of urgency.
once,
comes
the
consequence
is
micturate
at
may
years
burden,
he
elicit further
and
symptoms
natural
control
ably
consider-
when
measure
the
cases
expert
be
the normal
that
urine.
prudence
should
Although
the
the
to
a
from
that
desire
lessening of
the
consults
of
as
the
as
finds
the
disease
but
one,
eliminated
by rising to
with
moreover,
of
cases
is the deviation
such
regards
may
it would
undertaken
all
under
occurring
enlarged prostate
an
ary
second-
kidneys,
In
upon.
low, but
those
were
So insidious
insisted
deaths
treatment
prostate before
bladder, ureters, and
strongly
too
the
"
As
those
be
can
palpation
stricture
of
com-
DISEASES
THE
other
possible
of
causes
straining and
precipitancy
The
of
quantity
urine
residual
in
remaining
the
1 and
The
superiorly
the
rectum.
the
bladder
palpable
the
into
When
be
the
themselves
the
presence
but
if the
internal
is
between
When
viz.
hand
the
above
the
one.
A
the
amount
and
a
of
case
all the
the
gland
present
made,
residual
is
bladder,
bimanual
of
and
rectum
the
rectum
pressure
of
any
his
be
must
he
medical
the
in
largement
en-
adopted
into
can
a
in the
by
order
a
to
so
urinary
A
:
glass
adviser,
urine.
followed
passed
urine.
Thus
bimanually.
alteration
of
and
is felt
gland
suspected prostatic
urine
appearance
catheter
of
the
the
means
is mobile
study
may
the
Coude
mortem
post-
pubes.
the
presence
is then
examination
a
ance
appear-
and
ante-
within
by
the
towards
patient passes
and
the
it is when
following procedure
latter
always
flaccid, occasionally this
is
finger in
one
investigating
the
is
prostate
urinary symptoms
detected
swelling
in
abnormal
cystoscope it is possible to detect
wall
be
enlarged
receptacle
is towards
by
both
in
prostatic growth
can
elastic
towards
the
latter
Moreover,
abdominal
other
of
is confirmed
the
directions,
two
nothing
or
This
and
that
in
projection
meatus
of the
of
examination,
stream
made,
quickly.
aid
projection
that
been
enlargement
intravesical.
most
the
The
voluntary
posteriorly
little
the
rectum,
enlarges superiorly
when
the
has
and
main
may
examinations.
an
after
of
amount
prostatic enlargement
the
there
per
of
as
excluded.
are
is, the
contents
bladder
pathological condition,
of the
frequency,
micturition,
enlarges principally
chiefly
With
necessary.
ounces.
gland
being
of
be
nocturnal
bladder,
whole
early stages
3
of
103
may
urine, that
the
the
expel
to
attempt
in
PROSTATE
enlargement, urethroscopy
mencing
Thus
OF
rectal
bimanual
estimate
GUIDE
A
104
Should
catheter
the
of
presence
TREATMENT.
as
whole
should
gland
be, cystitisis certain
the
at
present
later
the
relieve
to
enucleation
of the
of
the
insidious
is that
Two
clinical
variety
and
the
itself
stages, and
is
without
aid
the
The
of
presence
the
gland
function
of
Patients
in
a
hard
the
failure
patient,
bladder
the
is
At
symptoms.
their
function,
of
operation
chronic
attacks
adeno-carcinomatous
as
total
with
of
soon
the
scirrhus
the
in
latter
the
as
early
cancerous
microscope.
cells in
malignant
in
of
prostate
but
;
difficultydiagnosed
of the
forms
the
simple enlargement
a
which
favour
it
as
a
simple,
clinicallyare
of
removal
number
certain
by operation
interferes
with
the
is
of
normal
micturition.
suffering
from
malignant
simple enlargement
perineum, especially on
on
generative
de-
the
to
recognised,
are
universally complain
prostate
absent
as
of
and
which
types
enlarged prostates,
strong evidence
of
the
patient
If renal
recover
with
the
owing
wall.
however
of the Prostate.
most
gland.
manifests
for
instrument
urgent
kidneys
dangerous
a
gland.
disease
malignant
is
occur,
more
Carcinoma
One
Cathe-
drainage
proceed
can
surgeon
by operation.
examination
the
date, if the
be
may
disease
bladder
preliminary suprapubic
necessary
to
of
time
exclude
to
this
discouraged,
of the
in the
for
measure
be
sterilisation
in the
required
treatment
alternative
an
changes
a
is
in the
diagnosis.
correct
the
and
practice
careful
The
of
terisatipn
the
obstruction
an
Finally, cystoscopy
stricture.
"
is removal
is
with
meet
confirm
to
necessary
may
DISEASES
urethra, urethroscopy
anterior
the
URINARY
TO
seat.
As
the
"
pressure,
disease
disease
of
pain
in
the
such
region
as
progresses,
the
symptom
a
"
of
when
of
the
sitting
pain
may
105
be
referred
of
stream
urine
smaller, and
the
symptoms
an
Thus
in
the
disease
the
to
base
pelvis,cachexia
of
Palpation
help
the
quantity
disease
The
gland,
when
the
found
Owing
sized
to
the
to
be
to
the
some
If, on
the
be
can
bimanually,
around.
organs
is discovered
and
The
choice.
perineal route
trial
in
full-
a
early and
interference
should
growth
therefore
be
can
moved
re-
suprapubically through
or
the
long
as
the
is the
normal
the
disease
prostate,
correct
the
applied
with
has
but
tissues, e.g.
the
of
effect
care
and
irradiation
the
so
capsule
by operation
growth
base
neum,
peri-
Therefore,
body.
it
worthy
the
via
meticulous
when
the
is
by
inoperable.
growth
the
the
of
;
that
spread beyond
not
removal
procedure
surrounding
of
tissues
removal
of
considered
into
of
fixed, little hope
remedy
a
are
knowledge
exact
an
upon
be
is
results
have
we
is inserted
gland
the
which
cases
must
the
from
radium
all
radium
with
hand,
other
In
and
the
hard, and,
stony
passed.
of success,
entertained
knife.
The
of
early
bladder.
the
of
of
in
urine
bimanually, operative
of
the
establish
prostatic urethra
disease
the
measure
treatment
by
the
If
of the
simple enlargement,
and
tissues
of the
be
is movable
gland
the
into
cannot
"
the
themselves.
immobile
advanced,
narrowing
TREATMENT.
is
rectum,
per
is
merge
catheter
leads
felt
disease
of
negligible.
is
as
the
examination
residual
of
of
will
exclude
to
empty
glands
manifest
additional
will
malignant
the
get
subjective
spread
rectum
per
catheter
for
the
gland
the
a
and
weight
diagnosis, although
passing
and
loss of
the
the
the
bladder
of the
and
with
to
condition
general
but
good,
to
strain
early stages
the
The
thighs.
observed
increasing
few, and
remains
is
micturition
on
is
are
patient
genitalia and
there
bladder.
the
external
the
to
has
of
infiltrated
the
bladder
and
seminales,the
vesiculse
the
Retention
in
of
The
method
one
of
of
the
is
difficulty by
other
are
follows
The
16
the
with
the
the
latter
through
the
the
and
in
tube,
After
the
walk
leakage
wound
end
of
in
position.
that
rubber
when
of
rise
the
cut
then
are
is
trocar
stilette, is passed
a
The
tube
the
and
cannula,
tube,
The
;
cannula
tube
mushroom-
is
securely, automatically
of
urine
the
to
the
moreover,
;
size
of
the
impossible.
healed
(usually
is
stopper
the
without
garter
So
and
trocar
bladder.
tube, and
comfort
just
stilette, leaving the
wooden
the
tube
device
is
has
A
by
in-
separated
are
exactly equal
is
An
is then
wall.
the
least
at
rectus
bladder
orifice
the
clothes.
in
operation
is made
Pezzer
end
later), a
about
hospital,
inch
an
A
the
the
bladder
the
of
De
into
with
that
distal
out
with-
with
fibres
the
guided
The
out
hours
eight
the
performed
cottage
a
of the
28
then
plugs
the
so
No
tube,
and
flattening
of
temperature.
beneath.
the
bladder.
shaped
hole
felt
cannula
withdrawn
the
finger
through
;
in
the
fitting a
removed
body
at
sheath
The
wall
plunged
by
The
steps of the
three-quarters
of
tip
bladder
pubes.
Pezzer.
distended
be
lotion
pubes.
the
is
should
of about
above
De
in
a
:
of boric
incision
the
insertion
be
can
The
place.
bladder
ounces
and
one,
make
to
introduced
as
M.
by
is
operation
above
the
practitioner
a
convenient
as
in
those
in
necessary
drainage,
invented
simple
a
by
bladder
consists
authors,
feature
uncommon
growth
found
suprapubic
self -retaining tube
operation
be
cated.
is indi-
radium
prostate, and
the
the
in
not
a
the
it will
opening
permanent
is
of
removal
where
contra-indicated,
or
urine
carcinoma
extensive
cases
of
of
use
simple
patient
the
and
of
into
is able
wetting
thigh
holds
practical
desires
forty-
inserted
patient
fear
round
about
to
is
to
his
the
this
micturate
IN
is
it
male,
the
due
usually
is
narrowing
of
to
or
trauma
in
congenital
seldoms
The
of
severity
of
rupture
membrane.
is seized
passes
a
the
direct
injury
of
intra-urethral
of
history
at
later
a
on
date
micturition
is
Urethroscopy
give
due
to
is
roscopy
urethrae,
a
even
in
retention
and
will
stricture.
the
sometimes
other
are
perineum
The
followed
penis
and
urinary
the
urethritis
difficulty
Other
the
for
causes.
or
strain
confirm
the
when
such
The
result.
on
characteristic
stream
pain
:
which
causes
diagnosis
An
of
then
advantage
of
of
the
is found
in
certain
urine.
of
Malignant
108
may
is
spasm
difficulty
in
except
examination
an
obstruction
disease.
elimination
of
of
mately
ulti-
is
usual.
not
condition
individuals,
and
tuberculous
;
stricture.
prostatic
the
is
is
rupture
responsible
is
increasing
patient,
negative
a
by
micturate,
to
the
urethra
the
labour.
the
on
changes
elderly
the
mucous
accident,
degree
strictures
suggests
are
an
to
chancre
blow
a
micturition
signs
variable
the
forms,
tissue
inflammation
highest percentage
urethra
complete
of
the
Whether
a
of
consequence
Gonococcal
and
after
fibrous
by
female
the
from
varies
slight tearing
a
blood.
pure
followed
urethra
occasionally
of
pain, and, attempting
partial,
or
the
;
Stricture
injury
to
with
little
complete
In
the
Immediately
patient
of
female.
urethra
the
lumen
inflammation
origin.
the
in
occurs
the
ably
probureth-
compressor
nervous
and
micturition
disease
of
the
STRICTURE
urethra
in
of
its
OF
THE
exhibits
early stages
stricture, and
URETHRA
the
typical
be
diagnosed
only
can
109
toms
symp-
by
urethroscopy.
TREATMENT.
of
If
"
inflammatory origin
interference.
bougies
and
possible
urethral
the
successful
sounds
"normal
Excessive
other
cystitis
undertaken
to
with
wise
other-
non,
will
tighter stricture.
urine, and
of
which
fatal
result
may
from
Finally,
instruments.
the
as
For
membrane
therefore
from
far
as
qud
mucous
urethral
with
urethra.
sine
a
operative
restore
the
extravasation
result
may
is
complications
rough manipulation
be
of
the
to
scarring and
bleeding,
are
need
as
passage
handling gentleness
increased
syncope
so
stricture
never
must
repeated damage
cause
should
Treatment
urethral
early,
diagnosed
of
neglect
aseptic
precautions.
The
If
of
treatment
catheter
a
for
cystotomy
be
can
passed
Should
week.
a
ruptured
a
this
be
must
the
be
effective
is detailed
In
order
graduated
resistance
the
A
This
at
At
bougie,
is
bougies
the
to
be
the
gripped by
suffices
for
the
noted
exact
the
the
should
of
of
ternal
ex-
lacerated
the
early
an
stricture
seven
passed.
of
this
instrument
and
bougie
withdrawn.
the
part of the whip
must
then
be
A
week
treatment.
passed,
one
the
this
a
When
passage
stricture,
days
contraction,
be
size of that
first
be
of
degree
should
previous treatment,
intervals
subsequently
treating
the
bougie
position should
which
two
whip
is offered
second
suprapubic
a
:
ascertain
to
and
in
Stricture.
of
method
follows
as
tied
urethra.
Early
An
prompt.
remain
impossible
excision
with
be
must
it should
performed,
urethrotomy
portions of
urethra
the
second
should
be
later
size
same
a
passed.
size
as
larger.
continued,
A
110
GUIDE
gradually
No.
size
metal
onwards
fortnight,
will
urethra
takes
admit
Provided
From
substituted
each
at
need
be
that
six
further
time
intervals
at
sound.
of alcohol
him
this
of
until
treatment,
leads
patient
amount
until
bougies
The
the
intervals
until
treatment
months.
the
every
against
the
passed.
full-sized
six
every
upon
of
gradually lengthened
complication
no
be
are
a
that
the
DISEASES
size
can
only
be
place
reduces
'the
sounds
two
then
should
URINARY
increasing
French
22
a
TO
he
takes
feared
the
is
a
of
contraction
minimum,
a
it must
of
passage
months
to
but
;
a
be
pressed
im-
full-sized
strument
in-
precaution
necessary
the
life and
healthy
a
stricture.
Neglected Stricture.
Such
false
condition
a
occasioned
passages,
and
is often
ulceration
by
to handle
even
pass
much
TREATMENT.
the
bougie
made
is
successful, the
be
to
another
passed.
the
false
Thereafter
indicated
When
can
be
patient
The
if
then
can
later
rarely
necessary
of
in
urine
bed
is
and
filiforms
should
after
filiform
are
side
along-
operation
instrument
a
with
pass
If this
of
passage
of
is
attempt
an
get up,
can
number
three
should
bougie
first inserted
passages.
the
patient
previously
a
rest
slightly larger
initial
a
urine
:
be
tomed
accus-
of contraction.
larger instrument.
and
is facilitated
into
a
pass
in
hours
Twenty-four
be
days
tied
stricture
may
should
patient
those
Retention
high degree
a
The
"
filiform
it.
by
bougie.
To
a
patience
numerous
instrumentation
stricture.
instruments
filiform
produced
often
the
urethral
a
careless
by
behind
impassable, although
to
complicated by
filiform
passed, and
impossible, the
for
should
early
be
is the
further
dilatation
of
on
the
lines
stricture.
bougie
operation
treated
only
instrument
of the lumen
internal
which
seems
urethrotomy
is
OF
STRICTURE
The
recommended.
urethra, and
THE
stricture
that
provided
is
the
111
from
cut
within
the
post-operative treatment
the
carefully regulated
is
URETHRA
subsequent
results
are
satisfactory.
In
where
cases
should
urethrotomy
this
operation
of
relieved
urine
the
three
of
this
end
the
be
prevented by
surface.
cut
with
daily
sounds
should
the
The
bladder
weak
a
in
passed
10,000.
should
leave
can
the
required,
the
the
on
bath
a
from
at
septic,
anti-
;
patient
is
treatment
be
pressure
1
month
one
the
is removed
week
a
for
urethra
date
but
two
termination
period.
months
is
After
a
until
the
the
of
percentage
the
of
passage
wise
external
large
a
catheter
wound
of
the
post-operative treatment
six
be
tied
healed, after
as
for internal
required.
is
URETHRAL
instruments
should
be
antiseptic solution,
instruments
are
every
must
has
perineum
OF
1%.
cures
sound
a
STERILISATION
formalin
permanent
precaution.
urethrotomy,
same
urethrotomy
of
of
further
effected, but
All
the
temperature,
For
home.
considerable
which
in
catheter
of
rise
no
no
operation
to
the
day
is
At
nursing
tied
twice
out
fourth
fifth,if there
in
tention
re-
rotomy
ureth-
internal
potassium permanganate
as
given.
is
against the
washed
be
A
and
should
patient
After
"
be
Haemorrhage
such
of
should
instrument
should
the
the
complete,
facilities for
available
immediately
TREATMENT.
catheter
days.
of the
be
is
passed, external
If the
performed.
not
are
OPERATIVE
a
On
be
be
can
temporarily by suprapubic cystotomy.
POST-
three
instrument
no
such
It is most
dry
preservation
when
and
not
as
INSTRUMENTS.
boiled
and
carbolic
important
in use,
asepsis,
A
placed
acid
to
both
keep
for
1
in
in
an
80
or
all urethral
the
satisfactory
purpose
way
to
A
112
keep
for
a
GUIDE
is in
metal
Thus
the
urinary
Extravasation
of
whether
of
of
is
is
has
urine,
the
of
trauma
of
urethral
urethritis.
see
patient
a
good
apparent
examine
to
infective
ascending
an
itself.
and
be
stricture
packed
with
elapsed,
and
on
so
is
as
tissue
gauze.
focus
in
Should
to
it
as
of
the
either
tion
extravasa-
the
kidneys
pressure
on
of the
be
stricture
that
allowing
infection
other
can
a
suppose
in
cause
any
urethra
rigor, tenderness
of
the
malaria
as
slight oedema
symptoms
must
necrosing
A
not
the
behind
assist
not
be
process.
failed
has
urinary stream,
will
disease
a
or
perineum
treatment
of
and
the
primary
a
place
and
Treatment
the
in
stricture
taken
perineum,
signs
to
unobservant,
such
wise
of the
manifesting
All
by
subjective symptoms
no
discovered, it is reasonable
in the
powder.
peri
or
rigor when
a
If
and
body
it
ulceration
result
stricture
urethral
fever.
possible site
thesia
is
surrounded
complication
a
closely questioned
sudden
excluded,
with
patient
although
part of the
the
formalin
are
the
gradual narrowing
a
discovering
of
which
Urine.
not
it is
complains
the
notice
is
of
ready
disease.
Perhaps
be
and
end
open
practitioner is required
who
urinary
the
is
with
seized
health, and
of
tube
organs,
the
been
has
and
the
at
the
associated
be
may
to
of
condition
this
ulceration
of
sterile
always
glass tube,
a
DISEASES
vapour.
the
who
catheters
contents
When
It
URINARY
perforated stopper containing
formalin
to
and
bougies
use
TO
skin, will be
extravasation.
commencing
prompt.
Under
fully dilated
and
an
area
of extravasation.
the
to expose
should
be
When
excised
anses-
incision
made
and
the
forty-eight
hours
the
patient
the
principle adopted
has
general
recovered
in
pelluljtigin other parts of the body should
from
cases
wound
have
shock,
of
septic
b" undertaken.
STRICTURE
For
hour
one
bath
hip
containing
is
case
While
septic
soaking
in
all
the
The
date
ally
fistulse
in
the
The
the
wounds
perineum
for
should
the
the
added.
are
should
be
freely
returning
fistulse
deal
to
be
perineum
the
drained
have
pubes.
at
of
treatment
local
through
and
excised,
the
the
away
above
treated
is
with
drained
are
If
a
repacked.
bladder
the
in
sanitas
On
to
be
must
urine
of
multiple
attempting
recommendations
out.
until
with
into
temperature.
removed.
be
lifted
is
wound
the
must
into
113
patient
drops
being
urine
inserted
carried
few
URETHRA
body
at
wound
the
the
the
bath
the
Before
condition
tube
day
extravasation
differently.
a
a
dressings
perineal
Chronic
THE
water
very
exposed,
bed
every
OF
a
later
stricture
suprapubichealed.
A
STONE
and
unless
give
its
be
cases
where
equally
in
If
to
important,
vesical
its
cause,
to,
the
for
will
duct,
the
to
clear
to
the
be
passed
between
by
will
skiagram,
a
it and
the
the
up
the
detected.
line
the
adjacent
tinguishable
indis-
X-rays
In
calculus.
a
which
is opaque
and
ureter,
which
anatomical
the
give
of
determine
or
on,
bougie
a
is
bladder
the
to
lying
to
all
in
in the
produced
point
therefore,
be
necessary
shadow
will
Cystoscopy
can
shadow
gland,
a
acid
uric
in
ureter
is
tract,
examination
stone
a
a
give
this
up
in
relationship
of
that
must
rays
therefore,
thereby
calcified
a
pure
urinary
suspected.
investigation
from
order
is
end
of
the
of
part
for
the
Skiagraphy,
X-rays.
demonstrates
further
ureter
the
of
consist
calculus
a
skiagram
a
part
any
essential
an
the
in
composition
shadow
a
must
or
form
may
shadow.
Symptoms.
The
symptoms
the
according
vary
organs
presence
Pain.
"
A
from
of
or
absence
dull
ache
for
and
in
a
rule
calculus
there
When,
is
in
no
however,
the
violent
the
renal
the
the
in
stones
position,
urinary
size, and
their
suppuration.
increased
disturbance,
of
their
of
months,
many
by
to
lumbago,
trunk
the
caused
loin, difficult
exercise,
and
is
causing
of
tenderness
114
on
lies
in
tently
intermit-
no
marked
of
the
the
guish
distin-
movements
persisting
suspicious
substance
stone
lateral
by
to
stitutional
con-
presence
kidney.
As
a
palpation.
the
renal
pelvis,
A
116
flow
the
GUIDE
of urine
in
the
the
flow
by
tract.
depends
with
the
upon
regard
be
On
the
to
size
changes
the
attack
an
other
in
hand,
the
the
substance
absent
voided
be
turition.
mic-
on
colic, hsematuria
ureteric
stone, should
small
rise to
Bladder,
alteration
no
Prostate
hsematuria
lies in
stone
of
will
free
place, and
takes
kidney
pus
of
a
give
intermittent
a
the
of
quantity
stationary, may
when
of
the
obstruct
to
as
prominent sign.
a
Stone
size
a
urine, infection
After
part
Much
"
is of such
stone
considerable
and
urinary
damaged
are
urine.
of
may
kidneys
in the
Ureter.
DISEASES
both
in this situation
stone
If the
a
of calculi
in
of the
URINARY
when
occurs
presence
Stone
TO
the
the
Pyuria
"
nrted
in
lodged
calculus
is in
any
the
be
will
haematuria
gland,
prostate
urine.
changes
is
or
if the
urethra, whereas
of
the
bladder
in the
Urethra.
or
are
it remain
inconspicuous.
or
Treatment.
Kidney.
of
cases
Operative
"
calculus, unilateral
renal
exception
one
The
latter
skiagrams
case
Ureter.
"
single small
a
should
be
at
intervals
taken
in the
change
of
size
A
large
by operation,
but
months
hope
in the
If at
by
a
end
vesical
ureteric
is
end
of the
duct
where
cases
in order
to
time
changed
Small
can
the
be
aid
be
lines, and
any
calculus.
can
removed
be
be
left for
passed during
the
its
the
cortex.
observe
to
always
calculus
of this
not
the
in the
medical
order
in
it may
advisable.
orifice with
In those
that
lying
all
in
bilateral,with
on
should
small
has
skiagram,
interference
upon,
the
treated
stone
a
or
stone
position of
or
indicated
is
treatment
stone,
as
six
rition.
mictushown
position,operative
stones
lying
in
the
dislodged by dilating the
of the
immediate
assist the stone
operating cystoscope.
removal
is not
in its passage
decided
down
the
URINARY
THE
IN
STONE
of
urinary tract, large quantities
water, Imperial drink
The
the
Bladder.
of
operation
unless
moment,
with
the
cases
is removed
stone
Prostate
The
in
the
the
patient
gland
and
stones
in
the
by
possible
In
such
cystotomy.
lies
the
in
above
opened
the
Trendelenburg
removed
are
taken.
diverticulum,
a
stone
be
must
with
pubes, and,
both
bladder
the
be
prostate.
If
"
barley
removed
suprapubic
by
Urethra.
and
gland,
prostate
enlarged
an
as
earliest
the
at
large, lying
it is very
associated
or
litholapaxy
must
be
should
stone
117
fluid, such
Contrexeville,
and
The
"
TRACT
tion,
posi-
the
at
same
time.
the
Should
be
made
to
the
external
of
is
It
after
his
crocodile
this
may
forceps
fails,
procedure
obtained
is
been
has
stone
the
by
operation
question
for
removed
from
ask,
to
of
portion
some
calculus
of another
formation
the
how
patient
a
avoided.
be
First, he
where
In
If
attempt
an
of
means
urethra.
unusual
not
urinary tract,
can
urethra,
urethrotomy.
a
a
by
calculus
the
to
access
the
in
it
remove
down
passed
be
stone
of
most
warned
body
the
words,
other
be
should
against living in
moisture
of
concentration
urine
skin.
the
via
escapes
climate
a
predisposes
to
calculus-formation.
Secondly, vegetables containing
strawberries,
beetroot, etc.,
must
oxalic
acid, asparagus,
be
excluded
no
alcohol
his
from
diet.
And
and
lastly, it
that
he
Contrexeville
also
be
is
drinks
is
such
must
If
discovered,
not
be
that
large quantities
drink.
Imperial
or
avoided.
stone
important
a
e.g.
cause
for
chronic
neglected,
of
Hard
the
be
taken,
barley
water,
water
must
formation
cystitis,treatment
of
the
for
INDEX
in
Acetone
urine,
AchalnsJa
vesicso,
albuminuria,
Adolescent
Albuminuria,
adolescent,
in
in
pressure
Calculus,
9
9
of
kidney,
of
prostate,
of
ureter,
of
urethra,
10
10
11
pregnancy,
Casts,
12
disease,
Chronic
congestion,
Albumosuria,
Alimentary
glycosuria,
Alkaptonuria,
Anurin,
64,
Bile
in
Creatinin,
30
81, 84,
by, 23, 44,
86, 91, 92,
63,
103,
99,
91
88
21,
19,
56,
88,
61,
24,
23,
92,
28,
102,
95,
116
104,
117
110,
97,
84
albumosuria,
Jones
Benedict's
test,
De
blood,
16
Diabetes,
3, 41
urine,
Diabetes
for, 41
Bilharziosis,
24
3
Blackwater
of, 24,
disease
malignant
49,
from,
115,
Difficulty
53
renal
48
function,
95
in
chronic
of
76
57
micturition,
Endocarditis,
61, 94,
95
Enuresis,
13, 18
of
Incontinence
see
urine
of, 19
papilloma
tuberculosis
Exercise,
of, 46, 87
albuminuria
Extravasation
of
after,
urine,
112
of, 95
tumours
Blood
diseases
Blood
in
urine,
and
see
68
117
21
of, 49,
106
82,
treatment
nephitis,
of, 56, 57
atony
calculus
26
for
test
in
Diet,
56,
2, 4, 30, 48,
Diathermy,
fever,
haemorrhage
tube,
insipidus, 5, 46,
Diastose
Black
urine,
Pezzer
79
kidneys,
of
Decapsulation
9
32
for
test
Bladder,
9
13
Cystotomy,
Benzidin
culosis,
tuber-
of
34
33,
tuberculous,
101
Bacteriuria,
urine
74
Cystitis, 23, 28, 60,
25
coli, infection
80,
in
treatment
Cylindroids,
85, 115
17,
117
2, 40
Cystoscopy,
50,
116
20, 63, 115,
Cyclical albuminuria,
Arterio-sclerosis,
Bacillus
117
90
3
Appendicitis,
117
113
93,
115,
115,
10
114
tests
78
113
43,
49, 115,
24,
nephritis,
Climate
albuminuria,
in
3
nephritis,
39,
see
Chyluria,
12
9
Alimentary
Bile
urine,
7, 13, 71, 113
Choluria,
7
for,
venous
Bcnce
in
in
21,
bladder,
11
renal
tests
Blood
of
exercise,
fever,
in
pigments
7, 73
alimentary,
in
63
Blood
36
Acidosis,
after
36
for,
tests
heematuria,
Familial
25
Hsematuria
Fehling's
118
albuminuria,
test,
32
9
10
INDEX
Pilariasia, 43
Melanuria,
of micturition,
Frequency
119
49, 87, 91, 99
Functioned
albuminuria,
23, 45,
3
Microscopical
examination
of
urine, 21
9
Micturition, disorders
of,
disorders
Gastric
in renal
disease,
Painful,
GlycoBuria, 30,
tests
Gmelirfa
Mucin
44
in
urine, 8, 10
Nephritis, 14, 49, 50,
34
test, 41
by, 1, 23,
chronic, 22, 49, 60
Nervous
58, 59, 84, 94, 99, 108
diseases, urinary
in, 56, 58, 63
43
Granular
kidney,
Guiacum
test
Neuroses,
5
Odour
15, 39,
causes
74,
61,
94, 96, 108, 115,
in blood
54
91,
116
of urine, 4
Oliguria, 6,
60
Orthostatic
albuminuria,
Osazone
diseases, 25
of, 17
9
crystals,35
Oxalates,
22, 39, 43, 50, 69
for, 15
tests
crystals,15
Hsemin
Hsemoglobinuria,
24
Pelvic
pain in, 60, 104
Pettenkoffer'atest, 42
Phenylhydrazine test, 35
47
Hyperglycsemia,36
50
Phimosis,
of urine, 40, 50
Phosphates, 13, 38, 39, 40,
Physiological albuminuria,
3
Instruments,
sterilization
Intermittent
albuminuria,
reaction
31, 34
Perinaeum,
Hydronephrosts,
Indioanuria,
of, 111
9
in urine, 36
43
9
Pituitary disease, 48
44
Pneumaturia,
infection
Pneumococcus,
by,
Pollakiuria, 32, 46
Kidney, calculus of, 21, 64, 93,
decapsulation of,
114
79
disease
lardaceous
disease
malignant
"uppuration of,
of, 14
Prostate,
of, 13
abscess
Leaky
80
disease
of, 19
kidneys,
Pus
117
of, 100
hypertrophy of, 50, 82,
disease
101
of, 104
99, 100
tuberculous,
9
64
of, 24, 58, 63, 99
malignant
in urine, 31
Litholapaxy,
9
in, 115, 117
calculus
Prostatitis,
Lactose
53
albuminuria,
Precipitate micturition,
tuberculosis of, 22, 60, 87, 93
tumours
Polyuria, 6, 32, 46,
Postural
of, 13, 17
infarction
101
in urine, 27
Pyelitis,81,
93
Pyelonephritis,93
Malignant
disease,
Bladder,
26
58
tumours,
Pentosuria,
test, 7
Incontinence
hsemoglobinuria,
Paroxysmal
prostate,
test, 42
Better's
micturition, 57, 59
Painful
26
from
Haemorrhage
Iron
toms
symp-
blood, 116
for
Hsematuria,
62
22, 69, 70
acute,
infection
Gonococcus,
a
Precipitate,
for, 32
Glycuronic acid, 33,
Hay'
nence,
Inconti-
Retention
65
Gout,
culty,
Diffi-
see
Frequency,
etc.
se"
Kidney,
Pyuria, 27, 61,94,
causes
of, 29
115, 116
99
INDEX
120
Radium
therapy, 97,
Recto-vesical
injuriesto, 19
malignant disease of,
Urethra,
105
fistula,44
Renal
extracts,
Renal
function, estimation
Renal
glycosuria,31
rupture of, 108
Urethritis, 23, 59, 94
79
of, 65
19, 28,
103, 104, 108
Urethrotomy, 110, 117
Urethroscopy,
Renostaxis,
urine, 103, 105
Retention
of urine, 62, 106
25
Residual
Salt
Sterilisation
in
16
changes in, due to calculi, 115
in chronic
nephritis,76
111
108
Trench
of urine, 60, 61
91
cystitis,
42
in,
deposits
in
in, 56
hyperacidity of, 69
microscopical examination
nephritis,70
Tuberculin
bacillus, infection
by,
of, 4
retention
of, 106
87
specificgravity of, 6
sugar in, see Glycosuria
83
in tuberculous
Uroerythrin,
Ureter, calculus in, 115, 116
Urethra, calculus of, 63, 115,
117
Vaccine
infection, 87
2, 43
Urochrome,
of, 67
estimation
of, 1
of, 4
odour
Urea, 42
42
therapy, 81, 86, 92,
of, 108
hemorrhage
from,
20
Yeast
Printed
8NWIN
characteristics
normal
reaction
Ur"mia, 62, 73, 79,
Urates, 2, 8, 13
chancre
in, 8, 10
mucin
of bladder, 46
kidney, 22, 50
urinary tract,
BBOTHEKS,
of,
21
infections, 90, 101
Tuberculosis
of, 112
extravasation
84, 99, 101, 108
of
of, 2
colour
Tubercle
of
bacteriuria,85
bile in, 3
Stricture, 20, 68, 63, 64, 82, 103,
Tabes, urinary symptoms
Transient
albuminuria, 9
101,
acid, 33, 34, 42, 43
Urine, in acute nephritis,71
albumin
in, see Albuminuria
of instruments,
Suppression
100,
Uric
free diet, 78
Skiagrapliy, 114
Spectroscopy of urine,
108
LIMITED,
in Oreat
THE
QBESHAM
test
Britain
PBBSS,
for sugar,
34
by
WOKINQ
AND
LONDON
101