The clinical examination of the urine in relation to disease / by C. Black.

  • Black, C.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: The clinical examination of the urine in relation to disease / by C. Black. Source: Wellcome Collection.

    23/60 (page 19)
    abscess of that organ, when the resultant obstacle to the portal circulation has become well marked, the renal vessels become, not as a necessary consequence, but as a co-oidinate condition, tuigid with blood surcharged with material, part of which ought, in the common course of healthy action, to be eliminated by the liver, but which, owing to disease of that organ, and to the consequent interruption to its function, is now cast out of the body by the kidneys, with the necessary effect of increasing the density of the ru’ine. Such, too, is the effect of any mechanical obstruction to the flow of bile from the biliary duct into the duodenum. Here, the obstructed action of the liver is, in the manner just stated, supple- mented by a vicarious action of the kidneys, by which a portion of the bile is removed with their natural secretion, which thus acquires an increased density in proportion to the quantity of biliary matter present. Bile, per se, always increases the density of the urine; but the urine may contain bile, and yet its specific gravity shall not exceed the specific gravity which the urine itself Avould, under ordinary circumstances, have acquired without any admix- ture whatever of bile. This sometimes occurs in the passing of gall-stones, when the pain is not only severe, but more or less persistent for hours. The nervous excitement produced by the pain of an impacted biliary calculus, is reflected through the sym- pathetic nerve to the kidneys ; their secretory action is thus inor- dinately excited; a large quantity of fluid is secreted; the bile being already prepared and existing as such in the renal vessels, is at once filtered off in preference, as it were, to the natural consti- tuents of the urine; and thus, the increased density produced by the presence of bile being neutralized, or more than neutralized, by the more or less absence of the urinary solids, a urine, im- pregnated with bile, may be passed without its specific gravity exceeding, or, in some instances, even equalling, that of the urine of health. Such, however, is the exception to the ordinary result; and, therefore, the rule must always be—that the presence of bile in the urine increases the density of the latter secretion. If we compare the influence of heart-disease with that of disease of the digestive organs on the density of the urine, we find that it is much less in the former than in the latter. When heart- disease is not producing any of the secondary results which usually flow from it, the density of the urine may remain natural for years. When it simply causes a gentle turgesence of the