344 
PATHOLOGY. 
local tumours, retroverfion of the uterus in pregnancy, 
or defcent of the child’s head in labour. 
e. Helminthica ; accompanied with a difcliarge of 
worms of a peculiar kind. This variety is given by Dr. 
Good upon the authority of Mr. Lawrence’s very Angu¬ 
lar cafe inferted in the Medico Chirurg. Tranf. vol. ii. p. 
382. The patient was a female aged 24: had long la¬ 
boured under a fevere irritation of the bladder, which was 
afcribed to a calculus. She at length difcharged three or 
four worms of a non-defcript kind, and continued to dif- 
charge more, efpecially when the difcharge was aided by 
injections, or the catheter remaining in the urethra for 
the night. The evacuation of thefe animals continued 
for at lead a twelvemonth. Twenty-twm were once dif¬ 
charged at a time ; and the whole number could not be 
lefs than from 800 to 1000. A fmaller kind was alfo oc- 
caitonally evacuated. The larger were ufually from four 
to fix inches in length; one of them meafured eight; 
(lender in the middle ; filiform at the extremities; thicker 
in the inter-fpaces: they were foft when firft voided, and 
of a yellowifii hue. For the mod part they were dif¬ 
charged dead. 
Polypofa; the bladder or urethra, or both, obftrudfted 
by the formation of a polypous excrefcence; fometimes 
(hooting to the external extremity. 
4. Paruria mellita, diabetes. 
The derangements which the kidneys are fubje£t to, 
in regard to the quantity and quality of their fecretions, 
are very numerous. In a (late of comparative health, the 
urine is liable to many (light changes in the relative pro¬ 
portions of its conftituent parts, and fometimes indeed 
acquires additional conftituents. In faft, fo much va¬ 
riation is obferved in the quality of the urine, that we 
fee every reafon to concur in the ftrongly-expreffed opi¬ 
nion of a late phyfiologift, that the kidneys are the com¬ 
mon fewers of the conftitution. Yet, notwithftanding 
the various produ£ts derived by the kidneys from the 
blood, Berzelius has accurately remarked, that acidifica¬ 
tion is the chief employment of thefe glands. Thus the 
fulphur and phofphate of the blood is converted by the 
kidneys into phofphoric and fulphuric acids, and a new 
acid, the lithic, is formed. The analyfis of difeafed urine 
(hows, that this acidifying procefs is fometimes carried to 
excefs; and nitric, oxalic, and other acids, are produced; 
while, on the other hand, it is fometimes diminiftied, or 
totally fufpended, and neutral or alkaline fubftances, or 
even pure blood, are predominant in the urine.' Some 
authors, keeping in view this diftindtion as to the pro- 
dudts of the difordered glands, and probably led alfo by 
the general principle, that inflammation is marked by ex¬ 
cefs of the fundtions of the affedted ftrudture, have en¬ 
deavoured to (how, that in mod cafes “when acids are ge¬ 
nerated in excefs, the urine is commonly fmall in quan¬ 
tity, and high-coloured, and the difeafe inflammatory; 
when neutral or alkaline fubftances, the urine, on the 
contrary, is generally pale-coloured, and larger in quan¬ 
tity ; and the difeafes are thofe of irritation and debili¬ 
ty.” Prout on the Nature and Treatment of Gravel, 
P- 3 1 - 
It feems to us that this generalization is not borne out 
by experience ; or that, at all events, the exceptions to 
the rule are very numerous. The matter is (till, how¬ 
ever, fub judice. Animal chemiftry is now very ufefully 
employed in analyzing the compofition of morbid urine; 
and, if the connexion between a particular (late of the 
fecreted fluid and a particular (late of the fecreting vef- 
fel (hould ever be pointed out, it will no doubt be very 
ufeful. We are much inclined to doubt, however, whe¬ 
ther this happy confummation will ever be attained. We 
find in other fecretions great differences, yet all dependant 
on one caufe, (viz. inflammation, and more or lefs energy 
in the nervous fyftemofthe difeafed part;) and we find that 
the ordinary methods which relieve cafes fecreting one 
kind of fcab are equally ufeful in thofe fecreting a differ¬ 
ent one. We are not endeavouring to undervalue the ufe 
of chemiftry as applied to the analyfis of difeafed urine 5 
but we wiih to (how, that, in the prefent date of our 
knowledge, more fuccefs will attend that pradtice which 
is diredted to the adtion of difeafed veffels, nerves, and 
fecernents, than to the corredtion of chemical errors in 
the fluids fecreted. Indeed we find as much contradic¬ 
tory evidence in the works of different authors as to the 
connexion between certain difeafes and their chemical 
analyfis, and we have fo many recolledtions of oppofite 
appearances of this fluid in common febrile and inflam¬ 
matory diforders, that we look with very little confidence 
to the mode of inveftigation before alluded to. 
Before any analyfis of urine is attempted, it feems to us, 
that the (late of the blood (hould be firft afcertained; 
fince, this known, we (hould clearly fee whether the dif¬ 
eafe had its origin in local difeafe of the fecernents, or in 
adtual depravation in the quality of the fluid when its fe- 
cretion is to be made. Now it is pretty obvious that it 
muft be in one or both of thefe two modes that alteration 
in the quality of the urine can be produced. And firftly, 
that difeafed blood often produces difeafed urine no one 
can doubt, when they fee the frequent, nay almoft inva¬ 
riable, precurrence of dyfpeptic ailment to thofe of 
the urinary organs, and efpecially the clofe relation that 
is traced between lithic difpofitions and peculiar regimen. 
That difeafed fecretion may refult from local difeafe of 
the kidneys, even when the blood is healthy, is not only 
fufficiently probable, from its coinciding with the known 
laws of the fecretory fundtion all over the body, but is 
borne out by the fadts. Simple nephritis, or a blow on 
the back, or even mental uneafinefs, nervous maladies, 
efpecially hyfteria, fuddenly derange the fecretion in 
queftion. 
To return, however, to the hiftory of the prefent fpe- 
cies. Diabetes is thus defined by Dr. Good : “ Urine 
difcharged freely, for the moft part profufely; of a fweet 
fmell and tafte ; with great thirft, and general debility.” 
The fymptom of profufion of urine is one of fome varia¬ 
tion ; but it is fo generally met with, that it mayjuftly be 
confidered as one of the chief fymptomsof the complaint. 
The faccharine tafte of the urine is however the grand 
pathognomonic fign of the difeafe. This charadteriftic is 
always prefent, though it is fometimes obfcured by the 
faline matters of the urine, and requires therefore that 
the urine be fomewhat concentrated by evaporation be¬ 
fore it is apparent. As to other changes in diabetic 
urine, it feems that the neutral falts of the urine bear 
the fame relative proportion to each other asunder ordi¬ 
nary circumftances, but that the aggregate of them is di- 
miniftied. A like diminution, and fometimes indeed 
total abfence, of the urea, is alfo met with. The fpecific 
gravity of the urine is alfo increafed in the complaint 
under confideration. It increafes on that of healthy 
urine, which ranges from 1010 to 1020, till it rpns as 
high as 1038 or 1040, or in fome rare inftances as 1045. 
Diabetes fometimes comes on (lowly and imperceptibly, 
without any previous diforder; and it now and then 
arifes to a confiderable degree, and fubfifts long, without 
being accompanied with evident diforder in any particu¬ 
lar part of the fyftem, the great thirft which always, and 
the voracious appetite which frequently, occur in it, be¬ 
ing often the only remarkable fymptoms ; but it now and 
then happens, that a confiderable affedlion of the fto- 
mach precedes the coming-on of the difeafe, and that in 
its progrefs, befides the fymptoms already mentioned, 
there is great drynefs of the (kin, with a fenfe of weight 
in the kidneys, and a pain in the ureters, and the other 
urinary paffages. The temperature of the body is 
ufually below the (tandard of health. The fpirits are 
depreffed, the difpofition is equally indifferent to ftudy 
or amufement, and there is evidently a decline of mental 
energy, with a lofs of the power of virility. Ulceration 
of the tongue and gums are of frequent occurrence in 
diabetes, owing probably to the derangement of the di¬ 
gestive functions, Some morbid change in the alvine 
excretion 
