Physiology and pathology of the urine : with methods for its examination / by J. Dixon Mann.

  • Mann, J. Dixon (John Dixon), 1840-1912
Date:
1904
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Licence: In copyright

Credit: Physiology and pathology of the urine : with methods for its examination / by J. Dixon Mann. Source: Wellcome Collection.

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    Quincke’ observed, in patients sufiering from certain diseases, that the day urine may be exceeded by the night urine in amount; instead of being loo : 50 or 60, it may be 100 : 100 or 200. This nocturnal polyuria is not due to simple increase of water, there is at the same time an increase in the solid urinary constituents. It occurs in heart and kidney disease, in elderly people with .arterio- sclerosis, in prostatic hypertrophy, and in diabetes insipidus. Laspeyres ^ has also observed in disease of the cardiac valves and musculatui'e, in I'enal disease, in some vesical diseases, and occasionally in diabetes, that the normal relation may be inverted to the extent of 100 : 385. He attributes the nocturnal increase to the numerous claims on the circulation during the day, even when the patient remains in bed ; under the recuperating influence of more complete repose, the tonus of the heart-muscle and of the vascular walls improves, with the result that some of the liquids which were retained during the day are excreted in the night. The pathological conditions in which the quantity of the urine excreted in the twenty-four hours is increased are: Diabetes insipidus and mellitus, contracting and lardaceous kidney, at the crisis of some fevers, in various nervous aftections—especially in hysteria and epilepsy—and also in some injuides to the brain. In some of these conditions the increase is due to the amount of liquids imbibed ; in others, of a more temporary nature, to the rapid rise of the blood-pressure. The amount of urine passed may considerably exceed the volume of liquid imbibed, as when absorption occurs of fluids which have accumulated in the cavities of the body or under the skin. In diabetes insipidus enormous quantities of urine may be passed, even up to 800 ounces daily, and for a time the daily amount of urine may exceed the amount of liquid that is drunk ; as soon as the tissues have parted with all their spare fluids the excess comes to an end. When the proportion borne by the urine to the imbibed liquids is estimated, allowance must be made for the watery constituents of the solid food that is eaten. The secretion of urine may be diminished in the acute stage of Bright’s disease, in heart disease when the blood pressure is low, in fevers and febrile conditions, in gastric catarrh attended by vomiting, in diarrhoea, in cases where accumulation of fluid is taking place in the cavities of the body or under the skin, and in suppression of urine, or when thei’e is a mechanical obstruction to its flow. The colour of healthy urine varies in accordance with its con- centration ; it is therefore darker in summer than in winter, and ’ Arch. f. exp. Pathol., 1893. * Doutsch, Arch. f. Min. Med., 1900.