PLUMBUM.
URINARY ORGANS.
►
Kidneys and Bladder. ►
Three years previously, the patient had been in the hospital with
albuminuria and casts in the urine, but when discharged these symptoms
had disappeared; at that time he had no brain symptoms except headache;
on this occasion, the urine, which was retained in the bladder and had
to be drawn with a catheter, contained albumen and a large number of
casts; two days subsequently there was anuria, trismus, opisthotonos,
convulsions followed by loss of mind; during the attack the tongue was
badly bitten, the pupils contracted and indolent; on the following days
the amount of urine, in spite of treatment (an infusion of squills), 600
and 700 c.cm.; the urine for twenty-four hours contained 17 grams of
urea; the patient did not have another spasm, though
he suffered from most violent pains in the upper and lower extremities;
after this the amount of urine increased, the urea rose to 39 and 41
grams, the albumen diminished, the pus disappeared and the mind became
free, but after about two weeks he was seized with erysipelas, from
which he died, [548]. [The
post-mortem showed a very easy separation of the suprarenal capsules,
the upper surface of the kidney granular, the parenchyma very moist, the
cortical gray, somewhat reduced in size, the malpighian corpuscles not
distinct, the pyramids gray. Under the microscope the kidneys presented
an exquisite picture of interstitial nephritis in a rather early stage;
the cortical substances especially presented in both transverse and
vertical sections, great cellular hyperplasia
and increase of interstitial connective tissue, though the
process was not equally diffused; while frequently the whole field was
occupied by small cells of connective tissue with scarcely a trace of
uriniferous tubes, other sections exhibited the tubercles of normal size
and configuration, but separated by abnormally
broad septa of connective tissue; the glomeruli presented
varying characters, some normal, others
atrophied to fibrillar knots of connective tissue, and others in all
possible stages of degeneration. The substance of the
pyramids was less affected than the cortical; the growth of connective
tissue was here much less pronounced, and in many places was not noticed
at all; the tubes were for the most part denuded of epithelium. The
small arteries of the kidney showed no remarkable change; in the
transverse section was seen a very broad zone of connective tissue;
hyperplasia thickening of the walls and contraction of the calibre of
the vessels were not noticed. The intertubular capillaries in both the
cortical and tubular portions of the kidney were excessively filled; in
the latter there were numerous spots of hæmorrhages into the urinary
canals, and here and there the cativies of the urinary canals were found
stopped by old plugs, and by some calcareous concretions. The liver
showed analogous changes of hyperplasia of
connective tissue, in some places even tubercular nodes of connective
tissue growth. The heart showed inflammatory connective
tissue growth, with chronic myocarditis; in some places very broad septa
of small-celled connective tissue was formed between single muscular
fibrillæ. (Microscopic examination of other parts of the body cannot be
detailed here. -T. F. A.] ► Chronic
nephritis is a frequent affection in cases of lead poisoning; its
development never accompanied by acute symptoms, [329]. ► Acute
nephritis, with fever, [541]. ► Lacerating pain in the renal region,
aggravated at the same time with the abdominal sufferings, and, like
them, diminished by friction and pressure, [128]. ►
Severe pain in the vesical region, [182].
[1990.] ►
Bladder distended, [439]. ► Paralysis of the sphincter of the
bladder, which allowed the urine to pass guttatim, [290]. ►
Tenesmus of the neck of the bladder, [46].
► When the paroxysm of pain has
subsided, the sound is easily introduced (into the bladder), and without
pain; attempting to introduce the sound during the accession, causes
great increase of the pain, [305].
► Bladder inactive; difficult
urination, [523]. ► In one of the cases, the sphincter
vesicæ did not permit the urine to pass for more than thirty-six hours,
so much so, that the bladder extended up to the umbilicus; in the same
patient the whole of the genito-urinary apparatus was especially
affected. At times the testes were retracted into the inguinal canal,
occasioning most excruciating pains in the back, loins, scrotum, and
perineum, [266]. ► The patient had not passed water for
thirty-six hours, and the bladder felt bloated. I examined the region of
the bladder externally, but on account of the excessive tenderness,
could not positively ascertain whether it was full or not; on passing
the catheter I found it entirely empty, with the exception of a few
drops of bloody mucus; there was in this case complete
suppression of urine, [427].
► Painful sense of constriction
towards the neck of the bladder, difficulty of introducing a sound into
the bladder, [305]. ► Induration of the prostate, [55]. [From the injection of liquor
Goulardi, for gonorrhœa.] ► Urethra.
► Retraction of the urethra, [46]. [2000.] ►
Pain in the urethra where it leaves the bladder (fifth day), [3]. ►
Great smarting along the urethra on commencing micturition, [213]. ►
Burning, during, and still more after micturition (second day), [4]. ►
Scalding on micturition, [336]. ► Micturition and Urine. ► Very frequent urging to urinate, with
burning along the urethra, but only a few drops are discharged at a
time, [182]. ►
Frequent ineffectual urging to urinate, [203].
► Desire to urinate, fruitless
efforts, or the urine passed drop by drop, [305]. ►
Frequent desire to pass urine, which was painful; urine often
high-colored, and depositing a lateritious sediment, [287]. ► *Quite
frequent vesical tenesmus; ineffectual urging to urinate; sometimes
after much effort, which increases the pains, urine passes guttatim.
He urinated twice in twenty-four hours, during remissions, to the amount
altogether of about a glassful. Bladder not distended. Catheter passed
with difficulty; the operation caused great uneasiness, and almost threw
him into convulsions, [224]. ► Sometimes urging to urinate, which either
was ineffectual, or the discharge required great effort, and much
increased the pains, [217]. [2010.] ►
Frequent vesical tenesmus, with much ineffectual urging to urinate; only
half a wineglassful was passed in two days, [201]. ►
Desire to urinate, with inability to pass urine immediately; it was
retained; in the forenoon, disappearing in the afternoon (second day), [4]. ►
Pain and difficulty in passing urine (after one year), [261]. ►
Frequent tenesmus, and ineffectual urging to urinate, [212]. ►
Frequent desire to urinate; micturition always scanty, [420]. ►
Micturition painful, [420]. ► Unconscious discharge of urine and fæces,
[177], [178], [181].
► Urine passed unconsciously, [174], [201].
► The patient passed urine
involuntarily during the epileptic spasms, [580]. ►
Frequent micturition of the usual amount, in the afternoon (first day), [4]. [2020.]
► Copious secretion from the kidneys,
[97]. ►
Greatly increased discharge of urine, [12].
► Awoke at 4 A.M. to urinate; more
than usual was passed; followed by pain in the abdomen as after taking
cold; it disappears after the emission of flatus, which is followed by
sticking in the abdomen (second day), [4].
► Frequent difficult micturition of
scanty urine, [46]. ► Some difficulty and pain in urinating, so
that he thought he had contracted gonorrhœa, [210]. ►
Difficult and sometimes painful micturition, [158]. ►
Micturition difficult, and only effected by a forcible contraction of
the abdominal muscles, which aggravates the pains, [214]. ►
Difficult, even somewhat painful, micturition, [212]. ►
*Difficult micturition, a little at a time, [126]. ►
Difficult urination, with much effort, [220].
[2030.] ►►
Difficult micturition, [25],
[80], [120], etc. ►
Great difficulty in urinating; there was great difficulty in passing the
catheter, but the subsequent history showed no permanent stricture, [499]. ►
Evacuation of urine difficult and hindered, also complete suppression, [23]. ►
Great difficulty in urinating, [498].
► *The urine is passed only by drops and
always with difficulty, [11].
► Urine voided seldom, and in small
quantities, [232]. ► Micturition less frequent than usual by
seven or eight times, [128]. ► Discharge of urine very much diminished, [50]. ►
At times she could not pass urine, [26].
► Urine could be passed only during
the remission of the abdominal pains, [16].
[2040.] ►
Paucity of secretion from the kidneys, and high-colored, [98]. ► For
some time there has been incontinence of urine at intervals between the
epileptic seizures, [521]. ► Incontinence of urine, [529]. ►
Micturition infrequent, [575]. ► Retention of urine, [89]. ►
Secretion of urine completely suppressed, [29].
[From large doses.] ► Suppression of
urine, [13], [34], [45],
[258], [534]. ►
Repeated attacks of strangury, [340].
► Retention of urine, with great
distension of the bladder, [533]. ► Retention of urine (in one case lasting
thirty-six hours, so that the bladder rose as far up as the navel), [326]. [2050.]
► Retention of urine during the
colic, [453]. ► Complete retention of urine; the catheter
could not be introduced for three days, [310].
► Dysuria, [288]. ►
Violent Dysuria, [55]. ► Ischuria, [43].
► Ischuria, with inflammatory fever, [55]. ►
Strangury, [109]; in five cases, [567]. ►
Hæmaturia, [109]. ► A large quantity of urine, of sp. gr.
1008, half of which became solid on boiling and adding nitric acid;
blood-discs were abundantly seen under the microscope, but no casts;
when he began to recover the albumen gradually
diminished in quantity (as I discovered less lead in the urine),
and at last totally disappeared, but has occasionally a little, perhaps
one-fiftieth part, albumen; later, albumen
rapidly increased, and there was not an atom of urea in it, its sp. gr.
being 1002, [491]. ► Voided a large quantity of urine, which
afforded a sensible quantity of lead, [229].
[2060.] ►
Secretion of a large quantity of watery urine, on the surface of which a
pellicle had been observed after standing (the same had been noticed
about a year previous and occasionally since then); the pellicle was of
pearly whiteness (it looked exactly like spermaceti), with a distinct metallic lustre; it left a greasy
mark on the paper in which it had been wrapped; i.
e., fatty matter mixed with lead in some form; the color was
natural; reaction acid, but not strongly so; sp. gr. 1022; no albumen;
on standing for an hour, deposits a light flaky sediment (one fourth),
showing under the microscope only a few granules (mucous), and a
solitary cell of renal epithelium, containing several fatty globules, [59]. ►
Urine scanty, yellowish-brown, turbid, sp. gr. 1019, albuminous,
sediment consisting of a large number of tubular crystals of uric acid,
perfectly hyaline cylinders, to some of which adhered cells similar to
white blood-corpuscles, to others fat-drops; this was associated with
epileptiform spasms, with complete loss of consciousness, during which
the temperature was 40°, pulse 140, [541].
[It was possible that the epileptic attacks were not dependent upon the
disease of the kidneys, since the patient inherited epilepsy from father
and mother, and had suffered from it for many years.] ► In the first stage, when the poisoning is
of recent date, and there are colics and vomiting, there is generally a
very notable diminution of the urinary secretion; it falls sometimes to
as little as 1/4 or 1/5 of the normal quantity; the density is
augmented, but not proportionally to the diminution in quantity, as is
the case in simple oliguria; there is, therefore, a diminution of the
extractive matters contained in the urine; the urea is from six to seven
times less in quantity; the phosphoric acid, uric acid, and chlorides
are less, but the coloring matters are ten to twenty times more abundant
than normal. In the second period, the vomiting and colic have
disappeared, and the lead is introduced into the various organs, and
acts upon their functions; the quantity of urine still remains a little
below the normal point; the extractive matters are still less in
quantity, the urea being only half the normal quantity; the same may be
said of phosphoric and uric acids; the quantity of coloring matter is
still very great. In the third stage there is anæmia, and the
intoxication is confirmed; there is a permanent alteration of the urine,
characterized by a less quantity and density, and notable diminution of
the urea and phosphoric and uric acids; whether this diminution is
dependent upon some disturbance of assimilation, or is connected with a
certain degree of impermeability, is still a doubtful point;
nevertheless, as we find double the quantity of normal excrementitious
matter present in the blood, we may rather ascribe their diminution in
the urine to impermeability. Lastly, to anæmia, is coupled albuminuria;
the quantity of urine secreted is very variable, sometimes approaching
the normal; but the density is very low; the extractive matters are
considerably diminished; and whether albuminuria exists or not, we do
not observe any increase of the quantity of uric acid in the blood; nor
is uric acid found in the serum of a blister, [436]. ►
Diminished urine, [210]. ► Urine scanty, and easily discharged, [175]. ►
Urine very scanty, and passed only once during the last twenty-four
hours (tenth day), [240]. ► Urine passed a little at a time; frequent
ineffectual desire to urinate, [120].
► Urine scanty, [188], [212],
[291], [327]. ► Urine
scanty, often retained for nineteen hours, [339]. ►
Cerebral affections and amaurosis, with albuminuria; the amaurosis is
supposed to depend upon the chronic nephritis, which is produced by
lead; this view is supported by the circumstance, that in several cases,
the amaurosis and the cerebral
(usually epileptic) symptoms appeared and
ceased coincidentally with the appearance and cessation of the
albuminuria, [493]. [2070.] ►
Large quantity of albumen in her urine, the sp. gr. being only 1010;
when she began to recover the albumen gradually
diminished in quantity, as I discovered less lead in the urine, and at last totally
disappeared, [492]. ► Albumen was present in the urine; the
albuminuria was either merely temporary, ceasing by the tenth day, or it
was continued up to and after the patient’s dismissal from the hospital.
Lead was discovered several times in the urine, [495]. ► Four
cases in which albuminuria existed during life, and nephritis was found
after death; three of them were chronic, one comparatively recent, [494]. ►
Urine heavily albuminous, without any œdema
(in several cases), [348].
[Autopsy showed the kidneys smaller, the surface granulated, the
cortical substance dark-yellow, and atrophied.] ►
Urine very heavily loaded with albumen, containing epithelial casts (and
traces of lead), [347]. ► Urine albuminous, containing numerous
cells from the kidney, [344]. ► The urine contained a trace of albumen, [418], [569].
► *Urine very albuminous, [429], [504],
[509], [523]. ► *Urine
albuminous, sp. gr. 1024, scanty, dark brown, [420]. ► The
urine contained a large amount of albumen; 150, 000 grams of urine
contained 12 grams of urea, [581].
[2080.] ►
Urine very albuminous, diminished in quantity to 1/2 litre in
twenty-four hours, sp. gr. fell to 1009, [429].
► Urine yellowish-brown, acid, clear,
sp. gr. 1030, albuminous, containing numerous granular cylinders; after
treatment, principally with Croton oil, the albumen gradually
disappeared from the urine, though the sp. gr. remained high (no sugar),
[449]. ►
Later, the excretion of albumen in her urine has been gradually
increasing, the sp. gr. being always under 1010, and often as low as
1002, with a very minute quantity of urea, [492]. ► Urine
albuminous, containing numerous isolated cells from the kidney, [345]. ►
Urine albuminous; sp. gr. 1010, [429].
►► Urine albuminous, [346], [385],
[484], [534], [535].
► Urine slightly alkaline, containing
traces of albumen (and of lead, 1.95 grams to the litre), [580]. ►
Secretion of kidneys scanty, and of a deep-red color, [267]. ► Urine
red, soon decomposing, and becoming thick with flaky clouds, [485]. ►
Urine (drawn by catheter), red and acid, [120].
[2090.] ►
Scanty red urine, easily discharged, [125a].
► Urine red and acid, [224], [217].
► Urine reddish, fiery, [49]. ►
Urine looking like Malaga wine, and of neutral reaction; slight film of
uric acid, [502]. ► Only one-third or one-quarter of the
normal amount of urine passed, [203].
► Scanty and high-colored urine,
[82], [103], [125],
[322]. ►
Urine dark-colored, brownish-red, turbid, with flocculent sediment, sp.
gr. 1017, acid, albuminous; sediment consisting of a number of red
blood-corpuscles, and a large number of short, rather thick, turbid
cylinders, beset with red blood-corpuscles; the patient presented all
the symptoms of acute, diffuse nephritis, [450]. ► Urine
“hémaphéique,” mahogany-colored; yielding, by M. Gubler’s
process, a thin pellicle of uric acid, [501].
► Urine high-colored, depositing much
lithates on cooling, [445]. ► Urine very scanty, 4 to 6 ounces in a
day, and high-colored, [290]. [2100.] ► Urine scanty, high-colored, and sometimes
voided with difficulty, [331]. ► Urine usually of a deep yellow color, but
clear. Now, not very turbid, but of a reddish-amber color, containing
much albumen, and a large proportion of uric acid, [503]. ► Urine
dark, brownish-red, [35d]. ► The urine was rather more colored than
natural, but did not present that peculiar play of colors with nitric
acid, said to be indicative of the presence of bile, [282]. ► Urine
transparent, high-colored, not at all yellow, [183]. ► Urine
brown-yellow, [184]. ► The urine becomes dull yellow, [117]. ►
Urine orange-colored, [119], [160]. ►
High-colored urine, [73]. ► Urine dark-colored, [126]. [2110.]
►► *Urine dark-colored and scanty,
evacuated by drops, [576].
► Urine scanty and dark-colored, [273]. ►
Urine dark-colored and turbid, [245].
► Yellow, acid urine, [172]. ► Urine
clear, of a pale lemon-color, and without sediment; alkaline, although
heat and nitric acid showed no abdomen. It turned red litmus-paper blue
at once, but had no effect on tournesol-paper, [203]. ► Urine
“hémaphéique” in the first degree, i.
e., merely amber-colored; copious deposit of minium, [505]. ►
Urine acid, [212]. ► Yellow, acid urine, [182]. ► Urine
plentiful and limpid, [275], [276]. ►
Urine pale, bright, specific gravity 1015, [341]. [2120.]
► Urine pale, [357]. ► Urine
scanty and limpid, [190]. ► Urine alkaline but not albuminous, [439]. ►
Urine plentiful, pale, [277]. ► Urine usually acid, contained much
lithates during the first few days under observation; the specific
gravity ranged from 1015 to 1025; no albumen was ever detected. In two
cases the urine was alkaline, and contained phosphates in considerable
quantity; becoming, however, faintly acid in a day or two, and remaining
so throughout, [446]. ► Lead in the urine, [440], [448].
► Urine alkaline, not albuminous, [440]. ►
Urine contains a little sugar and mucus, no albumen, [488]. ► Urine
free from albumen, sugar, or lead, and is generally natural, but
occasionally loaded with a dark-brown sediment, [499]. ► Urine
natural, but watery in color, [46].® 2000
Article