A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart.

  • Caird, Francis Mitchell, 1853-1926
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    224/290 (page 212)
    it l)e undertaken. As :i report of llm urine is a necessary com- plement to most surgical cases, a chajHer flevoled to the investigation of the urine from an especially surgical point of view seems to be called for in the present work. A. General Conditions to be Noted. The general questions involved in the examination of the urine will be briefly discussed before the melliods of investigation are given in detail. (i) Quantity of Urine.^This is estimated by collecting and measuring the urine passed in Iwenly-four hours, and is im])ortant— (a.) because deviations from the normal are alone often indications of disease; (/'.) because without a knowledge of the quantity, no relial)le conclusions can be drawn from a knf)wledge of the siiecific gravity. The normal amount of urine for an adult varies from about 35 to about 65 ounces in twenty-four hours- on an average, about 50 ounces. The c|uantity will vary with that of the fluid drunk and with the extent of its excretion by the skin, lungs, and iiowels. This latter factor, as well as the patient's usual (|uantity, must be taken into account before any conclusions as to abnormality can be arrived at, although, of course, an insatiable thirst and appetite are themselves symptoms of Diabetes Mellitus. Variations in the Normal Excretion.— An important matter is the varying rate at which urine is excreted during the twenty-four hours by the kidneys. Roberts has shown* that th(? solid and Muid constituents (jf urine are much increased after meals, and diminished during fasting and sleep. J'Yom this two deductions may Ix' drawn, which might be of service in surgical cases—(i) Tliat the urine, like the fiuces, maybe reduced by a sparing solid as well as li(|uid diet, in eases where it might be thought necessary; and (2) that where urine had to be repeatedly drawn off by the catheter, the meal-hours might be so planned to suit the surgeon's time, that his visits an hour or so later would relieve the bladder after the increased How had occurred. Urine is diminished in feverish conditions, especially those associated with sweating ; in cirrhosis of the liver ; in hearl-disease, when it results in backward venous congestion, or lowered arterial blood-pressure ; in acute Bright's disease, or in the acute interstitial nephritis reflexly caused by irritation to the urethra, or in the later stages of all forms of chronic Bright's disease ; in ra])id removal of fluid from the blood, as in severe hcemorrhage, extensive serous effusions, or violent diarrhoea; in peritonitis, and in severe irritation of the splanchnic nerves, as in strangulation of the bowel, and in * On Urinary ana' Renal Diseases.