Front matter
UEINAEY AND EENAL DISEASES.
1. Pals-~YeZLow
VOGEL’S SHALE OF URINE-TINTS.
Preface
The design of the present work is to give an account of the organic diseases of the kidney, and of those diseases and disorders of which the chief characteristic is some alteration of the urine.
The work naturally falls into three parts.
The first part — which may he regarded as introductory to the other two — is devoted to the physical and chemical properties of the urine, and to the various alterations which it undergoes under different circumstances of health and disease, in so far — and only in' so far — as they seem to have a practical bearing. The methods of examining the urine for clinical purposes are explained ; and the significance of the diverse changes experienced by it pointed out. The naked-eye and microscopical appearances of urinary deposits are described and figured, together with those of the extraneous matters which accidentally find them way into the urine.
Of the vast array of researches on the composition of the urine, and the rate of excretion of its several ingre¬ dients, accumulated in recent times, it has been found impracticable to give even an abstract, without greatly
VI
PREFACE.
exceeding the limits of practical utility. It has seemed to the author more convenient to consign these purely chemical and physiological materials to separate treatises, in the manner adopted by Neubauer and Vogel and Dr. Parkes, — at least provisionally, that is, until such time as they can he shown to possess some clinical value. Further, these subjects are treated so amply in the works (in addition to those of the authors just mentioned) of Beale, Thudichum, Hassall, and others, that the omission of them has caused the author little regret, It is hoped, however, that nothing has been omitted a knowledge of which possesses any interest for the actual practice of medicine.
The second pail treats of a group of affections which may he designated brietfy as “urinary diseases,” viz. diabetes insipidus, diabetes mellitus, gravel and calculus, and chylous urine. In his description of these diseases (with the exception of gravel and calculus), the author has endeavoured to present an analysis of all the facts hitherto published in relation to them, together with those which have fallen under his own notice. In the chapter on gravel and calculus, prominence has been given to the medical treatment, and especially to the author’s own researches in this direction.
The organic diseases of the kidney form the subject of the third and largest part of the w ork. The most im¬ portant of these — Bright’s disease and its allies — are treated with a fulness commensurate with their gravity
PREFACE.
Vll and frequency, and mainly from a clinical point of view.
Tlie less frequent affections of the kidney — hydrone¬ phrosis, cystic degeneration, cancer, tubercle, parasites, malpositions and malformations — are treated analytically, and at considerable length. The extreme poverty of the older English systematic works on these subjects seemed to demand this compensation.
To prevent the needless multiplication of foot-notes, the principal references have been placed at the heads of the several chapters.
The third edition of this work has been exhausted for some years — but I have been hitherto unable, for want of leisure, to undertake the preparation of a fourth edition. Having, however, obtained the valuable assistance of Dr. Robert Maguire, this object has been accomplished. Dr. Maguire has carefully revised the entire work ; and has brought up the several articles to the level of our existing knowledge.
I have almost entirely re-written the articles on albu¬ minuria and on micro-organisms in the urine. Much new matter has been introduced into the chapters relating to Bright’s disease. The observations of Bancroft, Manson, and Dr. Stephen Mackenzie on the filaria sanguinis hominis in relation to the causation
Till
PREFACE.
of chyluria will be found incorporated in the chapter on entozoa in the kidneys.
The practical aim of the work has been steadily kept in view ; and no alterations or additions have been intro¬ duced which are not designed to enhance the clinical value of the book. Nevertheless an endeavour has been made to give full references to pathological researches, with a view of facilitating the labours of special workers.
W. R.
Manchester, 89, Mosley Street, January, 1885.
Part I
The Physical and Chemical Peopeeties of the Ueine in Health and Disease — Ueenaey Deposits.
CHAPTEK I.
INTRODUCTORY.
PAGE
I. Summary of the properties and composition of the urine : its
physiological and pathological variations .... 1
Physiological alterations ....... 3
Pathological alterations ...... 3
II. Methods of examining the urine — Apparatus required . . 4
Scheme for the examination of the urine ... 5
III. Extraneous matter in urine ....... 6
IV. Changes in the urine on keeping ...... 9
Acid urinary fermentation ...... 10
Ammoniacal decomposition . . . . 10
CHAPTEK II.
PHYSICAL PROPERTIES OF THE URINE.
I. Odour . . 12
II. Colour . 12
Normal pigments of healthy urine . . . .13
Pathological pigments . 15
Derived pigments . . . . . . .17
Adventitious pigments ....... 19
CONTENTS .
x
III. Density or specific gravity .
Puinge in health ........
Clinical significance of variations in the density of the urine .........
Estimation of the solids of the urine from the density .
IY. Quantity of the urine . .
Variations in health .......
Solid urine ........
Clinical significance of variations in the quantity of the
urine . . .
Y. Suppression of urine (anuria) ......
Non-obstructive suppression ......
Obstructive suppression .
Causes . . .
Symptoms ........
Illustrative cases .......
Duration of life .......
Treatment .....
YI. Reaction of the urine .
Effects of food and fasting Effects of medicine ....
Effects of the cold bath ....
Effects of disease .....
Arnmoniacal urine — D composition of urea
CHAPTER, IH.
CHEMICAL CONSTITUENTS OF THE URINE AND THEIR VARIATIONS
INORGANIC DEPOSITS.
I. Preliminary remarks on urinary deposits and their classification
Naked-eye characters .......
Micro-chemical characters ......
Quantitative determination . . . . . .
Origin and, occurrence ......
Clinical significance .......
III. Amorphous urates .
Naked-eye characters .......
Micro-chemical characters ......
PAGE
28 31 31 34 34
65 65 65 68 69
CONTENTS.
Clinical significance ......
Treatinernt ........
IV. Crystalline urates ........
Urate of soda .......
Urate of ammonia .......
V. Oxalate of lime ........
Naked-eye characters ......
Micro-chemical characters .....
Production and occurrence .....
Clinical significance ......
Oxaluria ........
Treatment ........
VI. Cystine .
VII. Xanthine . .
VIII. Leucine and tyrosine .
IX. Phosphoric acid and the phosphates ....
Excretion of phosphoric acid, in health o,nd disease . Deposits of earthy phosphates .....
Amorphous phosphate of lime, or bone-earth .
Crystallised phosphate of lime, or stellar phosphates Phosphate of ammonia and, magnesia,, or triple plios phate ........
X. Carbonate of lime ........
XI. Sulphuric acid and the sulphates .....
XII. Chlorine and the chlorides .
Supplementary remarks on the excretion of phosphorus
sulphur, and chlorine .
XIII. L rea
Excretion of urea in health .....
Methods of estimating urea in urine Pathological relations of urea ....
Azoturia ........
CHAPTER IV.
ABNORMAL SUBSTANCES IN THE URINE : ORGANIC DEPOSITS.
I. Extra-renal epithelium .......
II. Renal epithelium and casts of tubes : the deposits associated with albuminuria .
xi
PAGE
80 80 81
85 88 89 95 98 no
no
in
114 117 119
CONTENTS .
PAGE
Epithelial casts .....
• • •
Opaque granular casts ....
• •
Transparent or waxy casts
• • •
Fatty casts .......
• •
Blood casts ......
• • •
Pus casts .......
• •
Clinical significance of renal epithelium and tube-casts .
Tube-casts without appreciable albuminuria
• •
III. Fatty matter in urine
• • •
Cholesterine ......
.
Kiesteine ......
IY.
Pus in urine .......
• •
Micro-chemical characters
• • •
Clinical significance .....
• •
Y.
Blood in urine — Hematuria ....
•
Microscopic characters ....
•
Causes of hcematuria ....
Hcematuria from local lesions
•
Endemic hcematuria ....
• • •
Symptomatic hcematuria ....
• •
Supplementary hcematuria
• • •
Treatment of hcematuria .
• •
YI.
Hemoglobinuria — paroxysmal hemoglobinuria
• • •
Symptoms .......
• •
Characters of the urine ....
• • •
Illustrative cases .....
•
Etiology .
• • •
Pathology .......
• •
Treatment ......
•
YII.
Cancerous and tuberculous matter in urine .
•
YIII.
Spermatozoa in urine — Spermatorrhoea
.
Treatment .
• •
IX.
Micro-organisms in the urine ....
• • •
Torulaceous vegetations ( saccharomyces )
•
Sar cina, ......
. • •
Bacteria — Bacteruria . . . .
• .
Bacteruria associated with incipient putrefactive
changes in the urine
•
Bacteruria with ammoniacal fermentation of the urine 175
Bacteruria without decomposition of the
CONTENTS. xiii
PAGE
X. Albumen in the urine . 183
Albuminoid substances . . . . . . . 184
Tests for albumen . . . . . . .185
Quantitative determination . 190
New process of the author . 191
Saturnine albuminuria . . . . . .195
Functional albuminuria . 196
Neurotic albuminuria . 198
Pathology of albuminuria . 201
XI. Sugar in urine . 207
Tests for sugar (< qualitative ) . 208
Ditto ( quantitative ) . . . . .218
Part II
Urinary Diseases — Diseases of which the Chief Charac¬ teristic is an Alteration of the Urine.
Chapter I. Diabetes Insipidus
Synonyms — Classification . 230
Duration . 237
Nature . 244
Appendix. — Cases characterised by diuresis, with slight
traces of sugar in the urine . 251
Chapter II. Diabetes Mellitus
Classification of cases of saccharine urine . 253
Etiology of diabetes mellitus . . . . . . . .254
XIV
CONTENTS.
PAGE
Course, duration, termination . . . . . . . 266
Physiological and theoretical considerations relating to diabetes . . 280
Appendix. — Milder types of diabetes . 305
Chapter III. Gravel And Calculus
General etiology .
Classification of urinary calculi ; their chemical characters,
origin, growth, and general clinical history ....
• •
Of the particular varieties of urinary calculi
• •
Uric acid calculi ......
• •
Urate concretions ......
• •
Oxalate of lime ......
• •
Xanthine .......
• •
Fatty or saponaceous — Urostealith
• •
Carbonate of lime .....
* •
Basic phosphate of lime .....
• •
Mixed or secondary phosphates
• •
Fibrine and blood-concretions ....
•
Indigo .
•
Prostatic calculi ......
• •
On the diagnosis of the species of urinary calculi within the bladder
or kidneys .
• •
Medical treatment of gravel and calculi ....
• •
A. — Preventive treatment .....
• •
B. — Solvent treatment .
• •
Preliminary remarks .
Solvent treatment of uric-acid calculi .
• •
Experimental inquiries : —
Comparison of potash and soda
a a
Effects of strength of solution .
a a
CONTENTS .
xv
PAGB
Effects of quantity of solution .... 343
Absolute rate of dissolution . . ... 344
Best method of alkalising the urine . . . 344
Experiments with alkalised urine . . . . 345
Illustrative eases . 346
Discrimination of the cases to which the solvent treat¬ ment is suitable . 353
Rules for carrying out the solvent treatment . . 356
Objections answered . 357
Experiments on the solvent treatment of uric acid by injec¬ tions into the bladder . 359
Experiments on the solvent treatment of cystine calculi . 361
Experiments on the solvent treatment of oxalate of lime
Solvent treatment of phosphatic calculi . . . . 362
CHAPTER IY.
CHYLOUS URINE.
Characters of the urine . . . . . . . . .364
Duration and termination . . . . . . . . . 374
Chapter I. Congestion Of The Kidneys
Preliminary observations — Experimental researches . . . 388
Active congestion .......... 392
Passive congestion . 398
Appendix. — On the connection of renal congestion , albuminuria, and Bright's disease, with pregnancy and eclampsia . .
XVI
CONTENTS.
CHAPTER n.
bright’s disease.
PAGE
General etiology of Bright’s disease . 416
Chapter III. Acute Bright’s Disease
Anatomical characters . 421
Chapter IV. Chronic Bright’s Disease
Anatomical changes in the kidneys ...... 437
1. Smooth white kidney . . . . . . . . 438
Synopsis of symptoms and conditions of origin . . 439
2. Granular contracting kidney . . 441
Synopsis of symptoms and conditions of origin . . 444
Oneness or multiformity of Bright’s disease . . . 445
3. Lardaceous or icaxy kidney ....... 447
Synopsis of symptoms and conditions of origin . . . 449
General course and symptoms . . . 450
Particulars of symptoms, and complications . 458
Blood . 462
Dropsy . 462
Pulse . 463
Retina . 464
Complications, and connection with other diseases . . . . 464
Bright's disease and phthisis ....... 465
Bright's disease and cardio- vascular changes . . . . . 470
CONTENTS .
xvn
PAGE
Uraemia . 475
General features . . . . . . . • 475
Urcemic amblyopia . . . . . . ■ . .475
Convulsions and coma . . . . . . . . . 476
Distinction of urcemic coma from narcotic poisoning and apo¬ plexy .......... 479
Urcemic vomiting and diarrhoea . . . . . . . 480
Urcemic dyspnoea ......... 480
Theories of uraemia . . . . . . . ..481
CHAPTEE V.
SUPPURATION IN THE KIDNEY : RENAL EMBOLISM.
Phlegmonoid abscess . 500
Multiple or metastatic abscesses ....... 502
Renal embolism . 504
CHAPTEE YI.
PYELITIS AND PYONEPHROSIS.
CHAPTEE VII.
CONCRETIONS IN THE KIDNEYS.
Precipitation of uric acid and urates in tlie kidneys of infants . . 529
Symptoms of renal calculi . 530
Extirpation of the kidney . . . . 534
b
CONTENTS.
CHAPTER YKE.
HYDRONEPHROSIS. PAGE
Terminations . 553
CHAPTER IX.
CYSTS AND CYSTIC DEGENERATION OF THE KIDNEY.
Scattered cysts in kidneys otherwise healthy . .... 560
Disseminated cysts in the atrophic form of Bright’s kidney . . 561
Congenital cystic degeneration of the kidneys . . . . . 561
General cystic degeneration of the kidneys in adults . . .564
CHAPTER X.
CANCER OF THE KIDNEY.
A. — Primary cancer of the kidney . . . . . . . 575
Symptoms and physical signs . 581
Duration . . 585
B. — Secondary cancer of the kidney . 601
Appendix. — Sarcoma of the kidney . ..... 604
CHAPTER XI.
benign growths in the kidney.
Osseous growths . . 606
Pibrons and fibro -fatty growths . 607
Lymphatic growths . . . .607
Syphilitic deposits . . . . . 608
Mixed growths . . . .609
CONTENTS .
xix
CHAPTER XII.
TUBERCLE OF THE KIDNEY.
PAGE
Comparative frequency of tubercle in the kidneys . . . . 611
A. — Primary tubercle of the kidney . . . . . .611
Duration . 622
B. — Secondary tubercle of the kidneys ...... 624
CHAPTER XIII.
ENTOZOA IN THE KIDNEYS.
I. Hydatids in the kidney . 626
Natural history . . 627
Duration . 642
Termination . 642
II. Bilharzia hsematobia . 648
Natural history . 648
III. Filaria sanguinis hominis . 655
IV. Strongylus gigas . 659
V. Pentastoma denticulatum . . 660
VI. Erratic worms . 661
VII. Spurious worms . . . 661
XX
CHAPTER XIV.
ANOMALIES OF POSITION, FORM, AND NUMBER OF THE KIDNEYS.
PAGE
I. Anomalies of position ....
A. — Fixed malpositions of tlie kidneys .
B. — Movable kidneys
Physical signs and, symptoms .
Illustrative cases Etiology . ... .
Diagnosis ....
Treatment . . . .
II. Anomalies of form .
Horse-shoe kidney .
III. Anomalies of number ....
Solitary kidney
684 684
Part I
THE PHYSICAL AND CHEMICAL PROPERTIES OF THE URINE IN HEALTH AND DISEASE — URINARY DEPOSITS.
Prout — Stomach ancl Renal Diseases. 5th edit., Lond. 1848,
Willis — On Urinary Diseases. Lond. 1838.
Becquerel — Semeiotique des Urines. Paris, 1841.
Bence Jones — Animal Chemistry. Lond. 1850.
Bird — Urinary Deposits. 5th edit., Lond. 1857.
Beale — Kidney Diseases, Urinary Deposits, etc. 3rd edit., Lond. 1869. Parses— Composition of the Urine. Lond. 1S60.
Thudichcm — Pathology of the Urine. Lond. 1858 ; 2nd edit., 1877. Xeubauer and Vogel — Analyse des Harns. Wiesbaden, 8th ed., 1881. Vogel (J.) — Krankheiten der Harnbereitenden Organe (Virchow’s Handbuch d. Path. u. Therap., Bd. vi.), Erl. 1863.
Hassall — The Urine in Health and Disease. 2nd edit., Lond. 1863. Rabuteau — Elements d’Urologie. Paris, 1875.
Loebisch — Anleitung znr Harn-Analyse. Vienna, 1881.
Salkowsky and Leube — Die Lehre vom Harn. Berlin, 1882.
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