The clinical examination of the urine in relation to disease / by C. Black.

  • Black, C.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: The clinical examination of the urine in relation to disease / by C. Black. Source: Wellcome Collection.

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    renal vessels, without any show of dropsy of the lower extremi- ties, or any portal engorgement, the urine is slightly increased in quantity, and either natural or slightly diminished in density ; hut when it offers to the hlood returning to the right side of the heart a sufficient obstruction to cause a baclc-flooding upon the portal vein and its tributaries, and upon the inferior vena cava, the urine is diminished in quantity, but generally increased in density. Similar results, although somewhat different in degree, are asso- ciated with the existence of abdominal tumours. So long as these do not interfere with the natural functions of the abdominal organs, the density of the urine is uninfluenced by them ; but when, from the growth which they have acquired, and from the conse- quent pressure and displacement of the abdominal organs, digestion is impeded, and the natural secretions are disturbed, the specific gravity of the urine exceeds its usual limits, and not mi frequently reaches 1-030. Tumours of a malignant character, from their more rapid growth, by which pressure and displacement are more suddenly brought about, and from the more depressing influence which they exert upon the vital powers, more readily and more quickly influence the density of the urine than tumours of a be- nignant character. I have seen a tumour, diagnosed as omental and harmless in its nature, exist for years with scarcely any increase of growth, and without influencing, in the slightest degree, the urine in either its quantity or specific gravity. Mesenteric tumours, on the contrary, which are often malignant, frequently grow rapidly, and by their influence on the digestive organs and on the circulatory system of the abdomen, render the urine, even from the moment of their possible detection, of higher specific gravity than that of the healthy secretion ; whilst ovarian tumours may continue to grow for months, and may even attain a consider- able size before the urine is at all effected in its density. Hence, in a case of abdominal tumour surrounded by doubtful symptoms, the diagnosis may be assisted by closely watching, for a short time, the density of the urine. It has been already stated, that gout and rheumatism greatly influence the specific gravity of the urine. Under their influence, in their acute character, the density often reaches 1-030, below which it seldom falls further than 1.026 until the attack ends in convalescence. In muscular rheumatism and in masked gout, in which there are flitting pains and but little disturbance of the general system, the density of the urine varies considerably. At