Chapter 9 - Diseases of the Abdominal Cavity
Introduction to Diseases of the Abdominal Cavity
Acute Inflammation of the Liver
Chronic Inflammation of the Liver
Congestion of the Liver
Passive Congestion of the Liver
Cirrhosis of the Liver
Acute Inflammation of the Spleen
Chronic Inflammation of the Spleen
Jaundice
Gall Stones
Acute Inflammation of the Stomach
Chronic Inflammation of the Stomach
Indigestion/Dyspepsia
Heart Burn
Cramps in the stomach
Water Brash
Vomiting
Seasickness
Milk Sickness
Acute Inflammation of the Peritoneum
Chronic Inflammation of the Peritoneum
Acute Inflammation of the Bowels
Chronic Inflammation of the Bowels
Appendicitis
Cancer of the Intestine
Intestinal Obstruction
Colic
Air Swellings
Bilious Colic
Painters' Colic
Constistipation
Piles/Hemorrhoids
Diarrhea
Chronic Diarrhea
Cholera Morbus
Asiatic Cholera
Dysentery
Chronic Dysentery
Worms
Acute Inflamation of the Kidneys
Chronic Inflamation of the Kidneys
Acute Inflammation of the Bladder
Chronic Inflammation of the Bladder
Disease of the Supra Renal Capsules
Bright's Disease
Simple Home Tests for Urine - Diagram
Diabetes
Bleeding from the Kidneys
Suppresion of Urine
Retention of Urine
Inability to Hold Urine
Gravel
Uric Acid Gravel
Phosphatic Deposits
Oxalic Deposits
Urate of Ammonia Deposits
Hippuric Acid Deposits
Cystine Deposits
Bladder Stones
Dropsy of the Belly
General Dropsy
Uremia

9.52 Gravel

Urinary Deposits. Gravel. Stone.

UNNATURAL deposits in urine are to be regarded simply as evidences of changes which disease is making in the body. As such they are valuable, more valuable, in many cases, than any or all other symptoms we can study, and most valuable from the ease with which they may be investigated. Yet but very few physicians, comparatively, pay any special attention to them, or make any effort to acquire the small amount of knowledge needed for their detection.

Sources of the Urine. The urinary secretion has three sources. The largest bulk of it comes from the superabundance of drink taken into the stomach. This is shown from the free flow of pale urine after taking copious drafts of water or other fluids. Such quantities of water as are often drunk, would embarrass the functions of animal life, were it not pumped off by the kidneys.
A second source of supply for the urinary secretion is to be found in the elements of imperfectly digested food, and also some abnormal elements arising from incomplete assimilation. Oxalic acid is a specimen of the latter, being sometimes largely excreted, in dyspepsia, soon after a meal.
The third source of urine is found in those old and worn out atoms of the system, which can serve no further useful purpose in the animal economy, and which cannot be got rid of by the lungs or skin It is only, however, one portion of the dead tissue, namely, that which is rich in nitrogen, which goes out through the renal strainer; another portion, which has a preponderance of inflammable elements carbon, hydrogen, and perhaps sulphur takes the outward channel through the liver, as bile.

Characteristics of Urine. Healthy urine has alight amber color, is transparent, and has different degrees of density, its specific gravity varying from 1.003 to 1.030. It has an aromatic, violet like smell and a bitter, disagreeable taste, like salts.
That which is passed a little time after drinking largely, is pale, and has a low specific gravity, varying from 1.003 to 1.009, and is called urina potus. That passed soon after the digestion of a full meal, is called urina chyli, or urina eibi ; it has a specific gravity from 1.020tol.030. That which is secreted from the blood, and is passed before eating or drinking in the morning, is called urina sanguinis; and has a specific gravity of from 1.015 to 1.025. This is the best specimen of the average density and nature of healthy urine.
Healthy urine contains urea, uric acid, sulphuric acid, phosphoric acid, lime, magnesia, phosphate of soda, etc. It is only when these are discovered in excess, that they indicate disease.

Examination of Urine. Let a piece of blue litmus paper be first dipped in the urine; if it be acid, the color of the paper will be changed to red, or reddish brown. Should the blue color remain unchanged, then use yellow turmeric or reddened litmus paper; if the urine is alkaline, the turmeric will become brown, and the reddened litmus will be changed to blue. If the color in both cases remains unaltered, the urine is neutral; that is, neither acid nor alkaline.
This being done, let the specific gravity be taken. This is easily done by the urinometer (Fig. 115). This instrument is known also by the names hydrometer, and gravimeter. It is generally made of glass. When placed in distilled water, it will sink to a certain point; and as all bodies immersed in fluid displace a bulk equal to themselves, it follows that in a fluid denser than water, the instrument will not sink so deep. The space above the large bulb is marked off into degrees corresponding to different densities. When this instrument is immersed in urine, and has come to rest, the number on the graduated scale, which stands at the surface of the liquid, when added to 1.000, will represent the specific gravity of the fluid. If, for example, the surface of the liquid corresponds with 9 on the scale, the specific gravity of the urine will be 1.009; if at 25, it will be 1.025.

By attending to the specific gravity of the urine, the physician may often gain important information respecting his patient, as it may be made to show him how much solid matter is daily carried out of the body through the kidneys. This, at the bedside, may often give useful hints in regard to treatment.
The following table, constructed by Dr. Golding Bird, shows at a glance the amount of solid matter in 1000 grains of urine of different densities :

The mode of using the above table is this. Having learned the density of the urine passed in twenty four hours by means of the urinometer (Fig. 115), a glance at the table will show the proportion of solid matter and water in 1000 grains of the urine. Then, by weighing, the whole quantity of urine passed in twenty four hours, the weight of solids drained off by the kidneys may be determined by the simple rule of proportion.

Symptoms of Gravel. A sudden attack of pain in the region of the kidneys, so acute and severe, frequently, as to cause fainting and even convulsions. The pain runs down to the groin and thigh, causing a numbness on the affected side, and a drawing up of the testicle. The pain is excessive at times, and then remits. Finally it stops suddenly.
Leading from the kidneys to the bladder are two small tubes about the size of a goose quill, called ureters, being the appointed channels of the urine. The pain, of which I have spoken, is caused, generally, by the passage of a stone along one of these small tubes. If the stone happen to be a little too large for the tube, or uneven or ragged upon its surface so as to bruise and tear the delicate lining of the ureter, severe pain is the result. The pain is intense when the stone moves along; remits when it stops; and suddenly ceases altogether, when it gets through, and drops into the bladder.
Sometimes there is no pain, the gravel being so fine as to pass through the ureters very easily. It then passes through the urethra also, and is found as a sediment of the urine at the bottom of the, vessel.
These urinary deposits are various, and quite unlike each other in kind. They indicate different states of health, and require to be spoken of separately.

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