THE

HOMEOPATHIC

THEORY AND
AND PRACTICE

OF

MEDICINE.

GENUS VIL-INFLAMMATORY DISEASES OF THE KIDNEYS AND URINARY ORGANS.

1. NORMAL ANATOMY OF THE KIDNEYS.

WHILE the subject of Renal Diseases is under consideration, it may be interesting to present a brief anatomical and physiological description of the healthy kidney, with the ordinary physical and chemical character of normal urine. By such a course we enable the medical man to compare, with facility, morbid with healthy conditions of the organ. The great advantages of this mode of procedure, in placing concisely before the reader every thing pertaining to these organs, both normal and abnormal, and the amount of time and labor thus saved in looking up reliable authorities, will be apparent to every one.

Among the writers who have distinguished themselves in extending our knowledge respecting the anatomy and physiology of the diseases of the kidneys, we cite the following: Todd and Bowman, Phys., Anat. and Phys. of Man; George Johnson, On the Diseases of the Kidney, &c.; Hassall, The Urine in Health and Disease; Thudicum, A Treatise on the Pathology of the Urine; Basham, On Dropsy, connected with Disease of the Kidneys; Beale, Illustrations of the Constituents of Urine, &c.; Rayer, Traité des Maladies des Reins; Lehmann, Physiological Chemistry; Becquerel, Semeiotique des Urines, &c.; Frerichs, Die Bright'sche Nierenkrankheit und deren Behandl.; Prout, On the Nature and Treatment of Stomach and Renal Diseases; Scherer, Annal. der Chemie und Pharmacie; Christison, On Granular Degeneration of the Kidneys; Bird, Urinary Deposits, &c.; Bence Jones, An. Chem. in relation to Stomach and Renal Diseases; Solon, On Albuminuria.

The researches of these authors have been so extensive, and their observations and illustrations are so minute and accurate with regard to everything pertaining to the kidneys, in their healthy and diseased states, that we shall not hesitate to avail ourselves largely of their valuable experience.

THE ANATOMY AND PHYSIOLOGY OF THE KIDNEYS.-Location.-The kidneys are located deeply in the lumbar region, on each side of the spine, and "directly beneath the ribs of the lumbar region."

Form.-Symmetrical glands, in form much like a French bean, with their convex margins directed outwards, and their concave borders or hilums, towards the spine.

Size. From four to four and a half inches in length, about two inches in breadth, and from one to one-eighth inches in thickness.

Weight. From four and a half to five and a half ounces.

Anatomical Relations.-The ascending colon lies in front of the right, and the descending colon in front of the left kidney. A small portion of the duodenum touches the anterior surface of the right kidney. The spleen, and the lower part of the stomach, when distended, are directly over the upper portion of the anterior surface of the left kidney, the former organ being in actual contact with it. The posterior portions of the kidneys are in close proximity to the lumbar and psoas muscles, and in contact with the diaphragm.

Renal Capsule.-A strong, fibrous membrane enveloping the kidneys, attached externally to a bed of adipose tissues, and internally to the gland itself; giving out here and there fibrous attachments to the cortical substance and receiving in return a number of small vessels; connected above with the fibrous layer of the pelvis, and at the hilum with the ureter.

Renal Surface. On the surface of the kidneys are eight to ten imperfect fissures, indicating the original lobular divisions of the organ during intra-uterine life. Other lobular demarcations are perceptible, arising from a peculiar arrangement of the stellate veins upon the renal surface. These veins enter the cortex vertically from its surface, and during their passage to the hilum are recipients of blood from the venous plexuses of the tubuli uriniferi.

Renal Matrix.-A tissue composed of a firm, transparent, fibro-cellular net-work, in which the entire substance of the kidney is embedded. The tubes and blood-vessels of the gland traverse the matrix in all directions, and, in a section of the kidney, may be recognized as deepred oval spots, surrounded and supported by the intervening meshes of the matrix. Todd and Bowman suppose that its only office is to serve as a support for the tubes and capillary vessels.

Substance of the Kidney.-Anatomists have divided the kidney into two separate portions, termed cortical and medullary.

Cortical portion.-The external and cortical portion is from two to six lines in thickness, of a reddish color, soft consistence, and dotted throughout its structure with a number of minute, deep-red granular spots-the Malphighian corpuscles. It is composed chiefly of the convoluted uriniferous tubes, and the Malphighian bodies.

Tubuli Uriniferi.-These convoluted tubes consist of a delicate basement membrane, attached to the matrix, and lined with epithelial cells, whose office it is to separate from the blood, the urea, uric acid, the sulphates, the phosphates, and the other solid constituents of the urine. These tubes terminate at, and are continuous with the Malphighian corpuscles, and are connected below with the straight tubes of the medullary portion, which receive the urine as it is secreted by the Malphighian bodies and the cells of the convoluted tubes.

Malphighian Bodies.- Are made up of small round tufts of capillaries from the afferent, and terminating in the efferent vessels, and enclosed by capsules lined at their lower thirds with epithelium. Their function is to separate from the blood the aqueous portion of the urine.

Medullary Portion.-The internal medullary portion constitutes the remaining part of the gland, is less soft than the cortical substance, of a deeper red than the cortical portions, although Todd and Bowman describe it as paler, and its substance is arranged in the form of cones, named from their discoverer, pyramids of Malphighi. These cones or pyramids are made up of the straight tubes, which are continuations of the convoluted secreting cortical tubes, and appear to be simply channels for conveying the urine from the secreting cells to the pelvis of the kidney. They are lined by a thin squamous epithelium which serves to shield the basement membrane from the irritation of the passing urine. As the tubes proceed from the apices of the cones to the cortical substance, they throw off numerous anastomosing branches, which become more numerous, and of smaller diameter as they approach the bases of the pyramids. The number of pyramids is usually placed at from ten to fifteen, and their apices float freely in the pelves of the kidneys. No Malphighian bodies have been observed in this portion of the organ.

Renal Blood Vessels. The following is Todd and Bowman's description of the vessels of the kidney: "The renal arteries divide into four or five branches, which enter the kidney at the hilum between the vein and the ureter. These vessels are surrounded with a quantity of fat. They pass between the papillæ to the bases of the cones, over which they spread. From these arteries smaller branches are given off, which ascend in the cortical substances nearly to the surface, and, in so doing, give off on all sides, a number of small terminal twigs, the afferent vessels of the Malphighian bodies. Arrived within the capsule,

the small afferent vessel at once divides into four or five branches, each of which again divides dichotomously. The small capillary vessels form loops, which project towards the opening of the uriniferous tube. The blood is received from these vessels, which lie towards the outside of the tuft, by branches of the efferent vessels which converge towards the more central part of the tuft to form one trunk, which leaves the Malphighian body, and soon breaks up into a plexus of capillary vessels, in the meshes of which the tubes lie. The terminal arterial twigs with their appended tufts, when injected with vermillion, have been compared not inaptly to a branch of currants."

EXAMINATION OF URINE. - General Principles.-The first urine voided in the morning or at the period of longest fasting from food and drink, is the truest expression of the kidney secretion, and contains the largest proportion of solids. This the urine of the blood, as distinguished from that of the food and drink.

As an average, in relation to the general habit of body, or with a view to the influence of paroxysmal diseases, &c., Chossat adopted the method, afterwards approved by Lecanu, Becquerel, Lehmann, Thudicum, and other authorities, of collecting the whole of the urine during several days and nights consecutively, and mixing in one mass what had been voided during twenty-four hours, before proceeding to the analysis of this average urine. Finally, an average is taken of the variations during several successive periods. Lehmann insists upon the necessity of this method, and advises, whenever it is impracticable, to confine the analysis to the solids of the urine.

For practical convenience, Thudicum advises the use of a flat-bodied glass, with a narrow, turned-up neck, and a mouth fitted to the requirements of the sex, either funnel-shaped or elipsoid. The neck should fit into a gap in the front border and wall of the bed-pan so that the penis shall lie easily in the neck of the urinal, and no urine be lost. These urinals should be graduated upon a scale of fluid ounces up to fifty or sixty, or centimetres two thousand, with forty divisions.

For the quantitative analysis of healthy urine, see the "Practical Handbook of Medical Chemistry," by John E. Bowman, Am. ed., p. 41; or, "Thudicum's Pathology of the Urine," Chap. 2; or "Becquerel, Semeiotique des Urines," Chap. X; or "Lehmann's Physiological Chemistry," Am. ed., Vol. 2, p. 149; or "Carpenter's Human Physiology," Am. ed. of 1858, p. 389. Other physical properties of urine are treated of in the same connection.

For estimates of the solids of the urine, based on its specific gravity, &c., see also, Johnson, On Diseases of the Kidneys, p. 43; or Golding Bird, On Urinary Leposits, p. 46; or Christison, Table, lib. 7, of Prac. Med., Lond. 1840, vol. iv.; or Berzelius, Lehrbuch der Ch., 3d ed., vol. x., p. 285.

For a practical approximation to the specific gravity of the whole urine, test, by the urinometer, that which is passed first in the morning and last in the evening, and then strike an average. Lehmann prefers the direct weighing of equal volumes in glass flasks,-thermometric and barometric relations being taken into account. The specific gravity of the glass, and the co-efficients of expansion of the air and water for a vacuum, by means of logarithms or a couple of algebraic equations. See Schmidt's Entwurf einer Untersuchens-Methode thierischer Säfte; or Thudicum's work pre-cited, p. 33. The Pycnometer, made to facilitate this operation, contains a thermometer in its stopper. Becquerel measures the density of urine with Baumé's areometer. (See p. 13.)

NORMAL URINE-PHYSICAL CHARACTERS.-Quantity in Health. This varies chiefly with the proportions of water, but averaging, under ordinary circumstances, about thirty ounces in summer and forty ounces in winter. The lungs and skin normally, the intestinal canal and serous membranes abnormally, may supply the function of the kidneys in evacuating the water of the urine, but as the secretion of water is merely accessory, not essential to their function, so our chief attention must be paid to the relative proportions of the different solid constituents.

These may normally vary from 0-20 to 0-80, or from forty to fifty grammes (Becquerel), or 1000 grains (Todd and Bowman), in twenty-four hours, for a man who lives freely; but less for the aged, and for women and children, whose urine is more watery.

Specific Gravity.-Making a fair average, it may be placed at 1020. But, in conditions of health, its density varies from 1010 to 1025. Normal urines of 1017 have 28.5 solid parts. (Lehmann.)

Aqueous urines, when not accounted for by the quantity of fluids imbibed, or by the chill and moist state of the atmosphere, are sometimes symptomatic of emotional agitation,-of joy, fright, anxiety, or of nervous disorders; hence they are oftenest remarked in the female. Polydypsia, anæmia, diabetes, and hysteria are cited by Becquerel as the states in which the urine is most aqueous.

A healthy adult passes from thirty to forty ounces of urine in twentyfour hours--the quantity in summer varying from thirty to thirty-five ounces, and in winter from thirty-five to forty ounces.

Of the solid constituents of healthy urine more than one-half is urea. This is derived in part from the metamorphoses of the tissues (probably the gelatinous tissues), and in part from innutritious and unassimilated food. The proportion of urea is increased by the use of animal food and active exercise, and diminished by vegetable and other non-nitrogenous articles. In or out of the body, it is readily converted into Carbonate of Ammonia; as one atom of urea and two atoms of water