the testicle. The urine is discharged in small quantity, high coloured, and often mixed with blood, or with mucus tinged with blood. Dr. Pemberton has noticed, as occasionally accompanying this state of disease, a sympathetic pain in the parietes of the abdomen midway between the os ilium and navel, increased by pressure, and in some cases so acute as to arrest the whole attention of the patient.

The distressing symptoms now enumerated are of very variable duration. They usually terminate as suddenly as they began, marking the moment at which the calculus escapes from the ureter into the bladder. There it remains for a longer or shorter time, when it either enters the urethra, and is ultimately discharged from the body, or begins to occasion some of the symptoms of stone in the bladder. In a few unfortunate cases the calculus becomes permanently retained in the contracted portion of the ureter, producing that train of symptoms which usually attends disease of the urinary system, and terminating in disorganization of the kidney, and eventually the death of the patient.

A fit of the gravel has been mistaken for lumbago. It is to be distinguished by the nausea which attends it, by the changes observable in the secretion of the kidney, the affection of the testicle, and the pain continuing unaltered by any variations in the posture of the body. Attention to the same symptoms will serve to distinguish nephralgia from a fit of the colic, with which also it is liable to be confounded.

In the treatment of nephralgia the principles laid down in the last chapter for the relief of the lithic diathesis may be applied; recollecting, that here high irritation and feverish action are superadded to great excess in the formation of uric acid. An active purgative is often of essential service. When the pain is very acute, blood may be taken from the loins by cupping, or even from the arm. The patient should be placed in a warm bath, and a full dose of opium given every second or third hour, according to the urgency of the symptoms. Starch glysters, with laudanum, contribute materially to the patient's relief, but opium should not be employed until the lower bowels have been freely emptied by the extr. colocynth. comp. aided by a brisk purgative enema, which, of itself, will generally afford considerable ease. Stimulating diuretics are to be carefully avoided.

NEPHRITIS.

Nephritis, or inflammation of the kidney, may have its seat either in the substance of that organ, or in its capsule and surrounding cellular membrane. The former occurs only as a consequence of calculi retained in the kidney, and wherever met with, has, I believe, always a chronic character. The latter has been observed, in a few instances, as an acute idiopathic affection, arising from exposure to cold, or severe horse exercise.* The symptoms in no respect differ from those of nephralgia, except that the pulse is here frequent and hard, and the tongue loaded, with other marks of inflammatory fever. In severe cases, the secretion of urine is, for a time, almost entirely suspended. The treatment of inflamed kidney must be conducted upon the usual principles. General and local bloodletting, mild purgatives, frequent emollient glysters, and demulcent drinks, are our principal resources. Blisters should of course be avoided. Opiates may be administered where we have reason to suspect the presence of calculus. The warm bath is not to be recommended until free blood-letting has diminished the volume of the circulating fluids. Otherwise the sensations of pain and distension in the lower belly, and back, will be augmented by it, with a corresponding increase of fever.

RENAL ABSCESS.

Inflammation of the kidney, duly treated, may subside without any serious consequences; but in most instances, in spite of every care, it terminates in abscess, a lamentable and not uncommon state of disease. Dr. Baillie observes,† that no considerable gland of the body is so liable to form abscesses as the kidney. In some cases which he has seen, they appeared to be of a common kind, but the greater number partook of the nature of scrophula. He considers it probable, that calculi in the kidney are the immediate cause of the inflammation, which, however, receives its character from the constitution of the patient. The existence of abscess of the kidney may be known by the voiding of pus with the urine, subsequent to, or accompanied by, the usual symptoms of diseased kidney. We further

* See particularly a case by Dr. Turner in the College Transactions, vol. iv. page 226. + Morbid Anatomy, page 288.

learn from the same experience, that renal abscess is sometimes complicated with enlargement of the kidney. Patients may continue to live with this complaint for a very long time. The formation of matter will sometimes be suspended for several months, but very trifling circumstances will renew the symptoms. Permanent recovery from renal abscess is rarely witnessed. Medicine produces little or no effect upon it. A seton in the loins with the uva ursi have occasionally proved serviceable. Great quiet of body and uniform temperate living are useful in mitigating urgent symptoms, and retarding the progress of the disease.

Causes. A predisposition to ulcerated kidney, and generally to disease of the urinary system, is given by the decline of life. A very large proportion of old people suffer under some morbid affection of these organs. In one it takes the form of calculus, in another of diseased prostate, in a third, of irritable bladder, in a fourth, of chronic inflammation and abscess of the kidney.

The researches of pathologists, and particularly of Dr. Cheston,* have proved the dependence, in many cases, of abscess of the kidney upon the presence of a stone in the bladder. Dr. Cheston adds, that the sympathy is mutual, and that abscess in the kidney leads, in its turn, to diseased and irritable bladder.

The complete destruction of one kidney is not necessarily fatal. Where the constitution is sound, the other kidney has sometimes enlarged so as to do the office of both, and life has been preserved, and even rendered comfortable, under such circumstances. Occasionally a true scirrhous enlargement of the kidney takes place; and though instances are not wanting of such a disease remaining unsuspected during life,† yet, in most cases, it is attended with the voiding of bloody urine, a constant pain in the loins, aggravated by the slightest motion, and a lingering death.

HEMATURIA.

Hæmorrhage from the urethra sometimes occurs along with hæmatemesis, and other marks of a general hæmorrhagic tendency. But in the majority of cases it is symptomatic of local disease in some part of the urinary system. I have seen it

Cheston's "Pathological Inquiries," chap. ii.

+ See Medical Observations and Inquiries, vol. vi. page 236.

occur with fever, pain about the region of the bladder, constant desire of micturition, and other unequivocal evidences of inflammation of the bladder. It is seldom, however, of sufficient violence to prove hurtful by the mere quantity of blood lost. The prognosis, therefore, and treatment of this hæmorrhage, merge in those of the primary affection, and hardly merit a more specific notice.

ISCHURIA RENALIS.

If the importance of any disease could be estimated by the survey of a system of nosology, ischuria would stand foremost among the disorders of the human race. Subdivisions of this disease have been made with tedious minuteness, but they are altogether useless in practice. The only species with which the physician is concerned, is the ischuria renalis; a few observations on the history of which will conclude what I have to offer on the chronic diseases of the urinary system.

Ischuria renalis is a very rare form of disease, in which the functions of the kidneys are suspended, and the urine is retained in the blood. The accompanying symptoms are, a dull pain, or sense of weight in the iliac regions, with great anxiety; nausea, vomiting, hiccup, cramps, general irritability and restlessness, or sometimes delirium, lethargy, and coma. It is occasionally attended with a constant desire to void the urine, though the catheter proves that none is in the bladder. The taste of the urine has been discerned in the mouth, and in many instances a remarkably strong urinous smell has been perceptible in the perspiration.

The causes of this affection are various. It seldom occurs except in advanced life. It has been traced to cold in habits of body liable to gravellish complaints. A more common cause of the disease may be found in local irritations in one kidney, operating by sympathy on the other; such as calculi, hydatids, and schirrhus. Lastly, it would appear from the progress of the disease, that it has originated, in a variety of cases, from some affection of the brain and nervous system. It is an important pathological fact, that this paralytic state of the kidney is almost always succeeded about the second or third day by marks of fatal oppression on the brain.* Dr. Heberden

See a paper by Sir Henry Halford on "The Necessity of Cautious Prognosis;" College Transactions, vol. vi. page 398.

indeed relates a case where the retention existed seven days, and the patient recovered; but it has been well remarked by Sir H. Halford, that a very small measure of urine is sufficient for the exigencies of the constitution, and that it is the total cessation of the secretion which is so uniformly fatal.

The treatment of ischuria renalis consists in the employment of the warm bath, of the stimulating diuretics, and terebinthinate injections. Opium has been advised, on the supposition of some spasmodic stricture existing in the vessels of the kidney. Cupping from the back of the neck, and a brisk purgative, appear more consonant to the suggestions of general pathology.

CHAP. III.

AMENORRHEA AND CHLOROSIS.

Remarks on the general influence of disturbed uterine Functions. Amenorrhea. Division of the Disease into Retention and Suppression of the Menses. Accompanying Symptoms. Plethora and irregular determinations of Blood. Debility. Characters of Chlorosis. Causes of retained and obstructed Menstruation. Treatment. Agency of Emmenagogues. Of Dysmenorrhea. Of the Turn of Life.

THE high importance of the uterine functions in the animal economy cannot be doubted; and from the earliest ages ingenuity has been taxed to explain them, and to ascertain the extent of their influence both in health and disease. The menstrual flux, the most obvious of the uterine phenomena, has afforded a wide field for pathological discussion; and being a constant object of attention to females, has thus acquired a consequence which fixes it upon the notice of the medical practitioner. Its overflow or suppression are continually adduced as the causes of disease; and in different ways it has become interwoven with the opinions entertained of almost every complaint to which the female sex is exposed. Before entering on the consideration of the discases of the uterine system, a