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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$To distinguish between bile-pignients and those caused by rhubarb or santonin, an alkali may be added, when the former will be changed to a dirty brown, and the latter become a deeper red. It is well to remember that, although the presence of bile in the urine may point to temporary or permanent obstruction of the hepatic or common bile-ducts by gall-stones or otherwise, the absence of bile by no means excludes a blocking of the cystic duct, or a filling-up of the gall- bladder with gall-stones, or a former temporary tjbstruction of the other ducts. In all cases of doubt, the test for bile-pigments to be afterwards given nmst be applied. _ (3) Sugar in the urine may be teni|K)rarily present in .small quan- tities, or be found there in excess as a constant ingredient. In the latter case, it indicates diabetes mellilus, which sometimes has im- portant surgical aspects. In some cases an intractaljle eczema is caused by it on the parts near the meatus urinarius (in both se.xes); in other cases it is associated with numerous boils or carbuncles, and sometimes with gangrene. More recently sugar in urine has been found temporarily present in many acute inllammations, and may be considered an indication of com- mencing suppuration, so as to be a great helj) in the diagnosis of obscure cases. Temporary glycosuria has often lieen observed after inhalation of chloroform, and is of no importance. (4) Blood in the urine—hremaluria—often of the greatest im- portance in surgical diagnosis, may be due to lesions or inflanmiation at any part of the urinary tract, from the kidney to the orifice of the urethra. When blood gets immediate access to the urethra, it may be pa.ssed independently of any urine, or be mingled with the first few ounces of it only, the rest being clear. .Such a relation would be seen in a partial rujiture of the urethra (if complete, there would be no subsec]uenl ficjvv of urine); in rujJlure of the vas deferens through muscular strain (J/illon); or in the course of severe gonorrhoea. Vesical hajmorrhagc is mostly seen at the end of micturition ; while in renal hicmorrhage the blood, unless in very large (juantity, is uniformly mi.xed with the urine and darkened in colour. The acid of urine soon changes the bright-red hasmoglobin into a dark brown or black colour; hence the smoky tint considered characteristic of ha;maturia. From the colour, an idea may be gained as to the source of the blood; because the longer it has been mingled with the urine, the more will it be changed, and vice versa. Bright-coloured blood in an acid urine must, therefore, have come from the urethra, or from the bladder or kidneys just before it was passed ; while darkened blood pigment will have been shed from the kidneys or ureters, or from the bladder sometime before being passed. Clots from the ureter, urethra, or pelvis of the kidney, when floated out in a basin of clean water (Hil/o?i), will resemble casts of those parts, or of calculi which caused the bleeding (in the latter case particles from the calculus may adhere to the clot), while from the bladder they will be irregular. Blood in minutest quantity can be detected with the microscope by its corpuscles, when no change in the colour of the urine can be traced. Following an injur}' to the loin, or a strain, haematuria may indi- cate one or other of the following renal conditions {Morris):—$