2nd. The local symptoms are in some cases an aching pain in the loins, but this is, perhaps, rather an exception than the rule. They, the loins, are rather the seat of an uneasiness and feeling of weakness, which is increased upon pressure: the calls to micturate are frequent and urgent, attended with pain, sometimes referrible to the penis, sometimes to the inside of the thighs and to the perineum; the urine is not much, if at all, increased in quantity when compared with the amount of fluids imbibed. Pathological Indications of the Urine.-The usual quantity of fluids being taken into the stomach, the average daily amount of urine excreted may be stated at about fifty ounces. The specific gravity ranges from 1015 to 1035, the latter being the standard of the urina sanguinis. A gradual reduction in the weight of the urine has been observed in those cases which have been attended with frequent relapses. The colour is that of pale golden sherry; the odour is sweet; when recently passed, it has barely any action on litmus paper. A distinct alkaline reaction upon reddened litmus has not, however, been observed. When poured into a test-tube, a very slight cloud may be seen floating near the bottom; if allowed to stand for an hour or so, a small opaline deposit, easily dispersible, will form. The recent urine is unaffected by heat, or NO, HO; but if allowed to stand after their action, a small flocculent precipitate sometimes forms; occasionally, however, no precipitate is visible to the naked eye. Of that portion which is allowed to stand, the supernatant liquid is unaffected by heat and NO, HO; the deposit, however, is dissolved by the latter, indicating the presence of phosphates; and when heat is applied to the mixed fluid, as in the recent urine, a precipitate may or may not be the result. Upon submitting a drop of the recent urine to the field of the microscope, blood-discs, turgid or collapsed, single and not aggregated, together with epithelial cells and occasional casts of the uriniferous tubes, are seen; no pus-globules have been detected. Such are the usual characteristics of the urine; but the action of concurrent causes, as exposure to cold and the imbibition of diuretic fluids, renders the urine acid for a time, when crystals of uric acid and of the lithates, together with blood-discs, are seen. It will be observed that the symptoms, general and local, are those of that form of renal disease termed by Rayer "Chronic Nephritis," but that there is an important difference in the character of the urine. In treating of this "chronic nephritis," Dr. Christison states ('Lib. of Med.,' vol. iv. p. 270) "that the urine very seldom contains blood or albumen, unless other renal diseases concur." However, of that form of renal disease now under notice, blood-globules have been invariably contained in the urine, but could only be detected with certainty by the microscope. Liability to passive renal hemorrhage appears to be either constitutional or acquired. Persons constitutionally predisposed are those of lax fibre, fair complexion, with skin soft and supple, easily excited to action, but as readily depressed: persons of a tuberculous tendency, prone to . affections of the mucous membranes, as catarrh, bronchitis, diarrhoea, &c., whose arterial system is in that state which may be termed irritable. Such a constitution appears, as it were, acquired by two other classes, who are specially prone to this hematuria-viz., those who are in the habit of consuming large quantities of diluent fluids, as haymakers, reapers, engineers, stokers, bleachers, tenters, dressers, and spinners in cotton mills-persons who, after exciting great cutaneous action by severe manual labour, or by working in a high artificial temperature, check the same by exposure to a much cooler atmosphere after the cessation of their daily employment. The habitual dram drinker is most prone to the acute form of Bright's disease, or to that stage which probably supervenes upon this-viz., that in which the urine is of low specific gravity, and contains free albumen. May not the frequent use of spirits, from their direct action upon the kidneys, by over-stimulating the organs, produce this hematuria, which may ultimately pass on to "chronic albuminous nephritis"? It may be observed, that of several cases of "passive renal hemorrhage" which have occurred in the practice of the writer, not one could, as far as the patient's recollection served, be traced to any dropsical affection, proximate or remote. The average age of the persons affected was above thirty-five years; they were chiefly of the male sex, probably on account of the greater exposure of males to the predisposing and exciting causes, which latter appeared, as far as they were traceable, to be exposure to cold damp air when in a state of perspiration, frequent use of diuretic spirituous liquors-in fact, any circumstance which, depressing the heat of the body, produced congestion of the viscera. Pathology of the Disease. The presence of blood in the urine affords ample proof of the existence of hemorrhage from some part of the genito-urinary passages, the state in which the blood-discs are found, the inadequacy of chemical re-agents to detect them, the occasional casts of uriniferous tubes, and the natural colour of the urine, indicate that the hemorrhage is renal, yet not of an active kind. But the comparative paucity of the globules discharged would lead to the conclusion that the kidneys are not suffering from any organic lesions, but from an unbalanced state of their circulation. This state of venous engorgement may probably exist for some time without any structural change in the glands themselves, but unless relieved, it is apparent that exudation will ultimately occur, and derange the whole action of these excernant organs. The actual progress of this hematuria into chronic albuminous nephritis has not been traced, the remedies used in the cases, of which this paper is a general history, having had the effect of checking, if not of curing the hemorrhage. Treatment.-The therapeutical indications are three in number First, to check the hemorrhage by relieving the congestion; secondly, to restore the general health; thirdly, to guard against relapse, and this is an important point, as there is a great tendency thereto upon the application of any exciting cause. The first indication may be effected by rest, daily use of the warm bath, with friction to the bodily surface, local depletion, abstinence from diuretic drinks, bland farinaceous diet, and the use of astringent remedies. To relieve the gastro-hepatic derangement, a small quantity of blue-pill, with a sedative saline draught, will be found useful at intervals during the exhibition of astringent remedies, the best of which is gallic acid. It has been given in the following form :—Gallic acid, a drachm; dilute hydrochloric acid, two drachms; solution of hydrochlorate of morphia, (E. P.,) one drachm; distilled water, five ounces and a half, as a mixture; a tablespoonful to be taken every fourth hour. The therapeutical effects of gallic acid are well described by Dr. Golding Bird:"Gallic acid acts as a direct astringent, reaching the renal capillaries, and finding its way into the urine, which becomes strongly charged with it, &c." To relieve the irritability of the bladder, five grains of soap-and-opium pill should be used every night as a suppository. These medicines should be continued until the hemorrhage ceases, and the vesical irritability which remains for some time after the cessation of the hemorrhage, is relieved by tincture of cantharides, in doses of from ten to twenty drops, combined with an anodyne. When the urine is free from blood-discs, the general hygienic rules for restoring tone to the system should be enforced; animal diet with a few glasses of sherry daily, may be allowed, and quinine with iron prescribed; As preventive measures, the warm bath with friction should be daily persisted in; flannel should be worn next the skin, and all exposure to exciting causes studiously avoided.-Lancet, Jan. 14, 1854, p. 40. 74.-ON SO-CALLED CHYLOUS URINE. By DR. H. BENCE JONES, F.R.S., &c. [Dr. Bence Jones has previously illustrated the effect of some acute diseases upon the renal secretion, as being causes and consequences of congestion of the kidney. He says,] In cholera, scarlet fever, delirium tremens, and injury of the spinal cord, the effect on the urine was produced by these diseases affecting in different ways the circulation of the blood in the kidney. To say that the congestion arises from an effort to throw out a poison by the kidneys, is not to me more satisfactory than it would be to assert that the inflamed eye or ear, after scarlet fever, is caused by scarlet fever poison passing off by these organs. I am more satisfied with the explanation, that a state of blood prone to congestion and inflammation (excess of fibrin and diminished blood-globules) exists, and that, whether the congestion begins here or there, is determined by the slightest causes; thus, even in injury of the spinal cord, in which any poison is out of the question, the congestion may begin in the kidneys, the bladder, the bowels, the lungs, or the skin, and it may pass into violent inflammation of this or that organ; while, in few cases, no congestion of any organ may occur. In chronic diseases, also, it appears to me certain that an altered condition of the capillaries of the kidney gives a better explanation of the phenomena observed in the urine than is obtained by the doctrine of the elimination of a hypothetical poison. The disease which gives rise to the phenomenon of so-called chylous urine, in its causes, effects, and treatment is, perhaps, the best example of the results of chronic congestion that can be brought before you; and, though it is but rarely met with, yet it will form, with the diseases which I have already brought before you, the best introduction to the causes and symptoms of Bright's disease. Here is a specimen of the so-called chylous urine, given to me by a patient yesterday, who for twenty-five years has passed this milky fluid, containing even more albumen than is ordinarily met with in Bright's disease, and yet she has long ceased from trying to obtain medical relief. The close examination of such cases clearly proves that, except in the presence of the minutely divided fatty matter, which appears only when the chyle passes into the blood, there is no connexion between this disease and chyle, but that it depends on congestion of the kidney, which causes albumen, fibrin, and blood-globules to pass out in the urine, and reduces considerably the specific gravity of the secretion, by preventing the elimination of other substances. Hitherto I have not been able to make any microscopic examination of the kidney in this disease, nor am I able to refer you to any published account of the exact state of the kidney; still the remarkable variations of the disease, the medicines which make it better, and the causes which make it worse, point to a slight but decided change in the capillaries of the kidney (perhaps in the capillaries of the mammary processes), whereby, as in a filter, when the weight of fluid is too great, some substances are allowed to pass through which would be retained if the filter were stronger. [Dr. Jones has seen four cases of this disease. In one case, all the peculiarities of the urine, during three years, will be found detailed in the Philosophical Transactions' for 1850, and in the 'Medico-Chirurgical Transactions' for the same year. Dr. Jones proceeds:] My object now is to show you 1st that Congestion takes place and causes albumen to pass off in the urine before any food has been eaten; 2ndly, that The effect of this congestion is also to diminish the specific gravity of the urine; and 3rdly, to dwell on The remedies for the disease. If you look at the following Table, you will find that the urine first passed each day is always the clearest, least like the specimen on the table. Very frequently, before getting up, no trace of albumen could be found by any chemical test, nor by the most minute microscopical examination could the urine be distinguished from perfectly healthy secretion. By causing the patient to get up before he had taken anything to eat, the urine became highly albuminous, and sometimes fibrinous to such a degree that the liquid gelatinized on standing, while, by the microscope, blood globules could be detected in considerable quantity. At the same time, the specific gravity was reduced eight or even twelve degrees. The amount of albumen was comparatively determined by precipitating the urine by alcohol. This does not give the albumen directly, because the sulphates are at the same time precipitated. The following examples of the state of the urine before food will show the increase of the albumen and the decrease of the specific gravity: Urine passed at 7.15 a.m., on getting up, gave scarcely a trace of albumen Precipitate with Alcohol. Per 1000 grs. urine. Specific Gravity. 0.8 gr. 1027. 1015.6 1013:4 9.50 a.m., just before breakfast, opalescent; coagulated to solid 141 11 a.m., after breakfast, perfectly milky 14:5 Another day 6 a.m., on getting up, urine clear; no trace of albumen 7.30 a.m., before breakfast, opalescent Another day 6:35 a.m., on getting up, yellow, milky 8.10 a.m., before breakfast, more milky, with large pinkish coagula وو وو 1.6 1026-4 11.9 3.6 1026'6 16:58 1016'4 وو دو I frequently determined beforehand whether the urine before breakfast should be albuminous or free from albumen, by directing the patient to get up and move about early, or to keep very quiet in bed; and by keeping him in bed all the day, the urine throughout the whole day was very slightly albuminous. The following conclusions are given in the 'Philosophical Transactions: 1. That so-called chylous urine may contain fat, albumen, fibrin, and healthy blood globules. 2. That, although the fat passes off in the urine after food is taken, yet the albumen, fibrin, and blood globules are thrown out before any food has been taken. During perfect rest the albumen ceases to be excreted; and it does not appear in quantity in the urine even after food is taken, provided there is perfect rest. A short time after rising early, the urine may coagulate spontaneously, although no fat is present in perceptible quantity, and this may happen previous to any food. 3. Though the urine made just before and a short time after bleed |