1290 



URINE. 



no doubt that the change in the constitution 

 of the urine must be in relation to the same 

 cause; for the urine is separated from the blood, 

 and was previously an integral constituent of 

 it : and because, further, every alteration in 

 the constitution of the blood must involve 

 corresponding changes in the secretions and 

 excretions, and more especially in the urine. 

 Since like effects follow like causes, and since 

 in inflammatory affections the vascular system 

 similarly participates in the disturbance, we 

 may assume a priori that similar changes will 

 occur in the urine, a point confirmed by ex- 

 perience. 



" The urine discharged during inflammations 

 is usually termed febrile urine. There is no 

 objection to this term, since the cause of the 

 change in the urine must be sought for in the 

 fever. I shall not, however, introduce the 

 term ' febrile urine ' here, since it is more 

 than probable that the changes in the compo- 

 sition of the urine vary according as the cha- 

 racter of the fever is synochal or torpid. 



" My analyses show, in fact, that the relative 

 proportions of urea in fevers of a torpid and 

 of a synochal character are different ; and al- 

 though the analyses are not yet sufficiently 

 numerous to establish the difference with cer- 

 tainty, it still appears to me to be a point of 

 sufficient importance to demand attention, and 

 one that should be carefully worked out. In 

 order to take a correct view of the compo- 

 sition of the urine, we must bear in mind the 

 composition of the blood, the reaction of the 

 vascular system, and the diet, since the mix- 

 ture of the proximate constituents is de- 

 pendent upon these circumstances. 



" The following are the general characteris- 

 tics of the urine in inflammatory affections. It 

 is darker than usual, and of a yellow, brown, 

 or reddish-brown tint ; it has an acid reaction, 

 and is generally of a high specific gravity. 

 With respect to its most important consti- 

 tuents, the urea is either absolutely increased, 

 or is at the ordinary physiological average, or 

 may be a little below it ; the uric acid is 

 always absolutely increased, and so are the 

 extractive matters, especially the alcoholic 

 extract. The salts are always absolutely di- 

 minished, especially the chloride of sodium. 

 The sulphates, on the other hand, either ap- 

 proximate to the physiological average, or are 

 not far below it. 



"Assuming as the mean of numerous ana- 

 lyses, that the urea constitutes 39 per cent, 

 of the solid residue of normal urine, I have 

 found it as high as 46*8 in inflammatory af- 

 fections. (In abdominal typhus, with a quick 

 small pulse, I have seen it as low as 22.) 



" The physiological average of uric acid may 

 be placed at 1'5 per cent, of the solid residue ; 

 in the phlogoses I have observed it amount to 

 nearly 3 per cent., and Becquerel even found 

 it rise as high as 5'9 per cent. The quan- 

 tity of extractive matter, c., which in normal 

 urine amounts to 23'5 per cent, of the solid 

 residue, rises in inflammations to 43 per cent. 

 The fixed salts, which in healthy urine con- 



stitute about 25 per cent, of the solid residue 

 diminish here to 12 per cent. The sulphate 

 of potash, which in healthy urine forms about 

 10 per cent, of the solid residue, I found to 

 vary in inflammation between 7 and 9 per 

 cent. 



" The composition of the urine becomes 

 changed if much blood is abstracted during 

 the inflammation. It becomes clearer, speci- 

 fically lighter, and the amount of urea de- 

 creases absolutely and relatively. 



" At the height of the inflammation, or (per- 

 haps it would be better to say) at the time 

 when the fever puts on the synochal type 

 most strongly, the urine is usually clear and 

 deeply coloured ; it subsequently forms a 

 sediment of a yellow or red colour, composed 

 of uric acid and urates." 



I shall now proceed to describe the state of 

 the urine as it is observed in different diseases. 



Pericarditis. A managed 36. Acute pe- 

 ricarditis ; pulse 108, full, and hard ; urine 

 clear, deep red colour; specific gravity 1023-5; 

 indications of albumen by heat. Analysis 

 showed : 



Water - 

 Solid residue - 

 Urea - 

 Uric acid 



Extractive matters - 

 Earthy phosphates - 

 Sulphate of potash - 

 Phosphate of soda - 



- 937-50 



- 62-50 



- 29-30 



1-50 



- 22-70 



0'55 

 4-89 

 0-56 



Chloride of sodium, and carbonate 

 of soda - 



1-40 



In the above case, after a large quantity of 

 blood had been drawn, the urine changed as 

 follows. Colour, that of health ; acid re- 

 action ; devoid of albumen ; specific gravity 

 1018. Its composition was now, 



Water - 

 Solid residue 

 Urea 

 Uric acid 



Extractive matters 

 Fixed salts 



960-10 

 3990 

 17-50 



0-99 

 15-10 



3-65 



The first of these analyses is that of in- 

 flammatory urine. The second shows the 

 effects of the copious bleedings in reducing 

 the excretion nearer to the normal standard. 



With respect to the presence of albumen 

 in the urine in this and other inflammatory 

 affections unconnected with disease of the 

 kidneys, there is in my mind no doubt what- 

 ever that the opinion is founded in error. 

 There is no institution in the world at which 

 the question has been so thoroughly investi- 

 gated as at Guy's Hospital; and our daily ex- 

 perience still confirms the opinions arrived at 

 by Dr. Bright in his first experiments. It 

 will be observed that the test of heat (a most 

 inefficient one in itself) is alone referred to 

 in the above-described case ; and I have little 

 doubt the precipitate produced was composed 

 of phosphate of lime, a common source of 



