454 Urinary Disturbances. 



violent respiratory paroxysms by increasing the abdominal pres- 

 sure may force the abdominal viscera into abnormally or normally 

 existing openings and thus cause displacements [hernia]. 



Disturbances of the TJrinary Excretion. 



The excretion from the blood of material no longer useful to 

 the system through the kidneys, is subject to pathological faults 

 if the quantity and quality of the blood passing through these 

 organs are seriously changed, and if the renal parenchyma is the 

 seat of pathological lesions. Increase in the quantity of the urine 

 (polyuria), especially of the proportion of water in it, is met 

 when the quantity of blood passing through the kidneys is greater 

 than usual, that is. where arterial pressure is increased without 

 any narrowing of the renal vessels, or where with the ordinary , 

 blood pressure the renal vessels are dilated. A more or less 

 marked polyuria is met in a number of the acute and most of the 

 chronic inflammations of the kidneys, and, too, after administra- 

 tion of diuretic drugs, in connection with certain intoxications 

 (mouldy oats, cantharidts, colchicum, oil of turpentine), after 

 resorption of transudates and exudates, in the stage of crisis in 

 febrile infectious disease and in the conditions spoken of as dia- 

 betes insipidus and diabetes mellitus. It may be readily under- 

 stood that to a certain degree this phenomenon is due to chemical 

 stimulation of the renal parenchyma with secondarily increased 

 permeability of the dilated blood vessels, or to increased secretory 

 action of the vascular endothlium and renal epithelium: on the 

 other hand the causes of the increase of blood pressure, apart 

 from increased ingestion of fluids, are as yet by no means clear. 

 Cardiac hypertrophy, vaso-motor disturbances originating in the 

 medulla, and paralysis of the renal nerves are worthy of consid- 

 eration in this relation. The causative factors underlying the 

 large output of urine occurring in so-called urinary flux or diabetes 

 isipidus ( Siapaivu. to pass through; insipidus, tasteless — in dis- 

 tinction from diabetes mellitus) are equally obscure. 



Better information obtains in regard to the causes of diminu- 

 tion of the quantity of urine (oliguria) and of total suppression 

 of urine (anuria). It must be obvious that all conditions in 

 which the urinary passages are obstructed, as the urethra and 

 ureters, by calculi, tumors, strictures, occlusion of the collecting 

 tubules of the renal papill?e by the shrinkage of the connective 

 tissue about them or the retention of urinary casts, plugs of 



