We do not class the albuminous urine which accompanies the presence of pus•globules under the head of albnminuria, because we presume that, in the examination of the deposit, this fact has been observed, and it serves to cha racterize distinct conditions of the kidneys or urinary passages. It mast, however, be remembered that one of the features by which we are enabled to distinguish pus coming from the substance of the kidney, is that the urine contains an excess of albumen beyond that which is accounted for by the admixture of liquor puris. In this respect it is very analogous to htematuria. and the question of whether the kidney be directly involved is to be determined simply by ascertaining whether it do or do not secrete albumen ; the great difference between the two is that the blood is poured out in cases of chronic disease as an accidental admixture, while pus indicates a special condition ; and the albumen is only present because the kidney is altered in function and structure by the suppuration.
In both cases it is possible that the abnormal ingredients may have separate sources ; the albumen coming from the kidney, and the blood or the pas from the bladder or urinary passages. Against such coincidences it is almost im possible to guard, and it would be vain to attempt to lay down rules for diag nosis; but they are in practice not of very frequent occurrence; the accidental hemorrhage would not very greatly modify the treatment of the prominent disease of the kidney, and the presence of pus would lead to the adoption of similar measures, whether its source were the kidney or not, when it was found in a patient with albuminuria. The absolute diagnosis is therefore not very essential ; and probably some other symptom would suggest the bladder as the seat of suppuration or hemorrhage when they did not proceed from the kidney.
In its results to the economy at large, permanent disorganization of these glands is a disease of the greatest importance ; the constant drain of albumen, which at times passes off in enormous quantity, establishes a state of anemia which is more or less the cause of many of the secondary ailments which spring from it ; and, at the same time, the retention of effete matters, which are usually evacuated by this channel, seems to produce a sort of blood-poi soning which increases the anaemia, and is the more immediate exciting cause of the diarrhea, and the plastic exudations which so often appear during its progress.
§ 6. Diuresis.—As a temporary effect of direct stimulation of the kidney, an excessive secretion of urine is sufficiently common; its persistence is very unusual, except as a sign of diabetes. I diagnosis, as in pathology, the indications are wholly negative: it has to be ascertained that there is no sugar and no albumen ; the urine is of low specific gravity, and there cannot be any very un usual metamorphosis of tissue : but yet, when the quantity of urine isgreat, no doubt more solid matter passes out of the body than in health, and hence there is commonly some emaciation.
At present it does not appear that any logical view of its cause has been suggested.
The secretion of pale, limpid urine, as an effect of the hysteric paroxysm, has been already mentioned ; but sometimes a spurious diuresis is kept up for a long time in hysterical persons by what might be termed a dypsomania, in which enormous quantities of fluid are drunk during the day, and of course find an outlet by the kidney.
§ 6. Cystitia.—Inflammation of the bladder is a frequent source of pus in the urine; the urgency to frequent evacuation which retention of urine in the first instance, as, for example, an una voidable delay in emptying the bladder, followed by over disten sion and subsequent spasm, with fruitless efforts at micturition ; perhaps the presence of stricture in males, or in females the pres sure of an enlarged uterus renders it impossible thoroughly to empty it. It is immaterial whether the first distension be the cause of the inflammatory action which ensues, or whether it is produced by the retention of a small portion of urine on each occasion, which by its decomposition acts as a ferment on what is subsequently secreted; the whole contents of the bladder becom ing ammoniacal, irritating the mucous membrane, and giving rise to purulent secretion. latter is evidently the mode in which cystitis is developed in paraplegia, accompanied by paralysis of the bladder, because, by carefully washing it out daily with warm water the inflammation may be averted.
In other cases cystitis occurs as the consequence of stone in the bladder, the symptoms of which form no part of medical diagnosis; it is only worthy of remark that the irritability of the bladder connected with calculus, while causing its frequent evacua tion is specially accompanied by pain over the arch of the pubis, at the glans penis, or in the perimeum ; and that for a long time the urine continues to be clear and transparent after the irritation has been excited, not thick and opaque as when mixed with pus, because the purulent secretion is only a later event in the pro gress of the case. In inquiring into the origin of symptoms, a distinction must be made between the difficulty in passing the urine, when it is voided in a small stream in stricture, and the sudden stoppage of a full stream which occurs in cases of stone.