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

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.

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$urates, while an oi)acity seen al tirst may he due to oil-i;l()l)ules, as in chylous urine or fatly eiuboUis, to the efiecl of copaiba or cubehs taken internally, or, most frequently, to pus. When pus is detecteil, its source should be ascertained if possible. That from the urethra will be swept out with the first few ounces of urine, which should therefore be collected separately. If the remainder of the ui-ine comes away clear, the diagnosis is pretty certain, but if not an effort may be made to distinguisli between pus from the kidney and that from the bladder. By first washing out the bladder and then lying in a catheter, a suflicient sample may be obtained. If it be uniformly turbid, the source of pus will be above the bladder ; if clear, probably in that viscus ( Thomson). In an alkaline urine, turbidity generally indicates decomposition, with a ropy deposit of altered pus and mucus. (6) The Reaction of Urine in health is generally acid, due to acid phosphates and urates, and also to free acitls—such as lactic, oxalic, and acetic. After food has been absorbed, the reaction becomes more or less alkaline as it leaves the kidney, although after mingling with the acid urine in the bladder, it may never be actually alkaline when passed from the urethra. The secondary effect of a meal, especially of animal food, is to increase the acidity of the urine. It has been pointed out that the acidity of the urine varies inwardly with the secretion of the gastric juice. When there is much acid in the stomach, a less quantity is excreted by the kidneys, and vice versa—opium increases acidity of urine (Harrison). Urine may be per?nanently alkaline (i) from the presence of large quantities of alkaline phosphates, as occurs sometimes in patients when in an anaemic and depressed state. (2) From the internal use of alkalies (caustic and carbonated) and alkaline salts of acetic, tartaric, citric, malic, and lactic acids. (3) From cold bathing. (4) From ammoniacal decomposition v\'here, through the agency of micro-organisms, urea unites with water to form carbonate of ammonia. The reaction of urine often throws great light u]3on clinical symptoms. An unduly acid condition seems chiefly to e.xcite the nmcous membrane of the urinary tract, and over-stimulate its nervous and muscular activity, producing symptoms very like those of calculus in the kidney or bladder. In some cases it may be the cause of small quantities of blood and pus in the urine, which still further complicate the diagnosis. An alkaline condition from any of the above causes except the last (decomposition) seems to have no effect on the urinary passages, and is not liable to form any calculus. On the other hand, urine alkaline from ammoniacal decomposition is a strong irritant of the mucous lining of the whole urinary tract, sooner or later inflames it, and tends to deposit phosphalic salts. An important relation has been traced by Lister between the state of the mucous membrane and the action of micro-organisms. If the former be healthy, the urine seems able to withstand the action of micro-organisms even when implanted$