Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

  • Hermann Senator
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    same origin and significance as urinary casts. According to the writer's experience, distinct cylindroids occur in cases of catarrh of the urinary passages, extending into the pelvis and possibly somewhat further into the papillse, and in themselves, therefore, in nowise indicate disease of the renal parenchyma. A certain resemblance to urinary casts is possessed by the so-called mucous coagula and collections of micrococci arranged in the form of cylinders; but with a little practice the confusion is readily avoided, and another point of differ- entiation is that these structures are insoluble in acetic acid. [Some of the salts of the urine—e. g., urates—may be arranged in the form of casts, and may, indeed, really be molded into that shape in the tubules of the kidney.—En.] The term hem/^iria ii? usecj to desigrl^^ the admixture of blood or red blood-cells vAth the'm4fiq^r*tire^eva»cu|Qtion of pure blood from the urinary passages.V ^n the latter case the^ature of the evacuated fluid can hardly remaiuNin^oiiH'^^n. ^eM^afeier case the color will difPer more or less from tmt>«£^|iu£fi-fekjm according to the quantity mixed with the urine, and may be a brownish red or the color of more or less diluted meat juice. If the admixture of blood is so slight that it does not affect the macroscopic appearance of the urine, it is not customary to employ the term hematuria. When the urine contains a very large percentage of blood-fibrin, clots are usually present at the same time. Hematuria may be simulated in various ways. Blood not derived from the urinary apparatus may become mixed with the urine, as often happens, for example, during menstruation, and not infrequently in cases of hemorrhage from structures contiguous to the orifice of the urethra, such as the anus or vagina; or the blood may be intentionally mixed with the urine for purposes of deception. It may also be simu- lated by the presence of other pigments, giving the urine an appearance more or less similar to that of bloody urine. The former group of fallacies is not difficult to avoid with a little care, and, if necessary, the urine may be withdrawn with the cath- eter. To distinguish blood from other pigments, various methods are available: 1. The most important of these is microscopic examination for the presence of red blood-cells of the fluid or of the sediment obtained by allowing the urine to stand or by centrifugation. In acid urine the cells are preserved intact for a considerable period of time; when the urine is highly concentrated they assume the shape of a mul- berry ; while in urine of a very low specific gravity they become paler by the washing out of the hemoglobin, but may still be recognized by their biconcave shape and reddish-yellow color. In certain cases they present the alteration known as fragmentation. In addition to red blood-cells, leukocytes are also present in numbers corresponding to the proportions of the two structures in the blood; they are, therefore, usually less numerous than the red cells. As the urine undergoes decomposition, the red blood-cells are broken up into reddish-brown or
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