m 
.  aipp 
If '".il^  Zl  .lirf-?<  ^  r 
^34 
present  in  the  scanty  urine  passed  during  the  period  of  suppression 
We  may,  therefore,  surmise  that  temporary,  and  it  may  be  also  partial, 
plugging  is  in  reality  a  not  unfrequent  occurrence  in  blackwater  fever 
and  produces  for  a  time  a  partial  or  even  complete  arrest  of  the  flow 
of  urine  from  a  few  or  from  the  majority  of  the  renal  tubules,  sucli 
obstruction  afterwards  passing  away,  the  plugs  Ijccoming  dislodged 
by  the  pressure  of  urine  behind.  This  condition  may  be  suspected 
whenever  the  granular  casts  found  in  the  urine  are  large  and  very  firm, 
It  is  well  known  that  the  amount  of  urine  passed  when  haenio- 
globinuria  makes  its  appearance  may  be  scanty.  This  is  illustrated 
by  the  following  cases,  coming  under  our  observation,  in  which  the 
quantity  of  urine  secreted  during  the  first  twenty-four  hours  of 
haemoglobinuria,  was  248  c.cm.  in  Case  2  ;  344  c.cm.  in  Case  3; 
170  c.cm.  in  Case  Ga  (next  day  85  c.cm.);  530  c.cm.  in  Case  10 ;  and 
800  c.cm.  m  Case  15.  So  marked  a  reduction  as  occurs  in  the  first 
four  cases  can  only  be  attributed  to  renal  blocking. 
The  fluid  passing  into  the  bladder  during  suppression  obviously 
consists  in  part  of  urine.  This  is  shown  by  tire  circumstance  that  the 
suppression  exhibits  in  different  cases  varying  degrees  of  incomplete¬ 
ness,  indicating  that  the  blocking  of  the  renal  passages  is 
correspondingly  incomplete,  as  is  further  illustrated  by  the  occasional 
re-establishment  of  the  flow  of  urine  after  suppression  of  several  days' 
duration.  It  does  not,  however,  follow  that  the  whole  of  the  fluid 
passing  into  the  bladder  during  suppression  is  urine.  The  coagulable 
proteid  contained  in  the  urine,  which  was  considerable  in  amount  in 
Cases  7a  and  1 1,  varying  from  1  column  to  f  column,  may  enter  the 
renal  passages  as  a  result  of  damage  to  the  renal  epithelium 
consequent  upon  plugging  of  the  collecting  tubules,  but  a  certain 
amount  probably  comes  also  from  portions  of  the  tubules  in  whicli 
plugs  carrying  renal  epithelium  (Figs.  27,  31  and  32)  have  become 
detached  and  have  been  discharged  into  the  renal  pelvis,  so  that  the 
basement  membrane  of  the  tubules  has  become  exposed.  In  sucli 
cases  the  lymph  contained  in  the  tissue  spaces  of  the  kidney  would 
drain  into  the  tubules  and  mix  with  the  urine.  Our  investigation, 
unfortunately,  came  to  an  end  just  as  the  study  of  this  problem  was 
commenced.  It  is  desirable  that  further  information  should  bf 
olitained  as  to  the  nature  of  the  proteids  present,  as  well  as  thf 
amount  of  urea  and  other  nitrogenous  substances  in  the  urine  clurin| 
suppression. 
