DISEASES OF THE URINARY ORGANS - proceeding to apply the inferences deducible from the con dition of the urine to the diagnosis of diseases of the urinary organs, reference must also be made to those changes which are due to disturbing influences acting through the general circulation, and are in no way connected with actual lesion of the kidney. It is almost impossible to get at the early history of the diseases of these organs, because it is only when some very remarkable change in the character of the secretion takes place, or when some secondary affection is developed, that the patient seeks for advice, or is even conscious that anything is wrong. This is not less true of the acute than of the chronic affections ; but as the pro gress of the former is more rapid, we are commonly able to trace the history backwards to what may be justly considered its starting-point.
§ 1. Nephritis and Nephralgia.—The secretion of urine is more or less suppressed in nephritis, and as a consequence anasarca rapidly ensues; but the patient thinks nothing of the diminished flow of urine, and is perhaps greatly astonished when dropsy comes on. Frequently and very justly ascribed to having caught cold, it is very evidently associated with disturbed cutaneous action : it sometimes occurs in a perfectly healthy person after very severe exposure : more commonly, however, there is pre existing disease of the kidney, or it follows as a specific action, at a pretty definite interval, upon an attack of scarlatina; in the latter case we may generally trace some slight exposure, but it is alleged by some observers that it may be the direct effect of the scarlatinal poison without any such exciting cause.
It commences with febrile disturbance, and there is often deep aching pain in the back: the urine is scanty, loaded, deep-colored, of high specific gravity, and albuminous : blood is sometimes mixed with it, as a consequence of congestion ; but this does not appear early when the kidneys are previously healthy. Total suppression of urine is not commonly the result of nephritis in a healthy kidney, and when that event occurs, we may generally conclude that disease of long standing is present, however acute the attack may otherwise appear. A common impression pre
vails that an attack of nephritis lays the foundation for subsequent chronic disease ; but there is no evidence to prove this relation, and it ought not to be assumed until we know that among a given number of patients who have had scarlatinal dropsy, subsequent disease is more common than among a similar number who have never had scarlatina at all : the hypothesis, however, is not with out probability.
Another form of nephritis is excited by local causes, whether in consequence of external injury or the presence of a calculus in. the kidney, when it is preceded by nephralgia. These two causes of nephritis have this effect in common, that the attack sometimes terminates in abscess. Nephralgia, in so far as it may be distin guished from nephritis, expresses the pain attending the affection in its early stage; and in proportion as the pain is severe, we may conclude that it is due to irritation rather than to inflammation. We cannot go back to the date of the formation of a calculus, but we can sometimes discover in a strain or a sudden jerk of the body the time when it was displaced. Very soon after, severe pain is felt on one side of the loins, shooting down to the groin and inside of the thigh, exciting sympathetic pain and retraction of the testicle, or encircling the abdomen, and passing round as far as the umbilicus ; the severity of the pain is sometimes so great as to produce nausea and vomiting : the urine may be blood-stained, and is always passed with unusual frequency. After a time the calculus traverses the ureter, and passes into the bladder, or falls back again into its former position, and the pain ceases. The patient may suffer only from the irritation, and no febrile disturbance ensue ; or inflammatory action may supervene in the affected kidney, when the pain persists and assumes the character of a dull aching sensation.