Thudichum A, man, æt. 28; 43.0 81-0 121-0 1 4 6-7 2 6 489 4 2 4.9

Ditto..

weight, 70 kilos.,

seventy-six days.

B, man, æt. 28; 43.0 71.0 1100 1 4 6.7 2 3 59-9 3 6 59

weight, 72 kilos.,

The values obtained by my observations, extending over larger than those of former observers. They may therefore urine secreted by adults, and of the lowest and highest amount

of

133 days of

two individuals, are throughout considerably be said to extend our knowledge of the average quantity of consistent with healthy function.

Among the influences which determine the quantity of urine, many are inherent in the mode of life, others are entirely independent of any act of the individual. Of the former are the quantity and quality of food and drink, and the amount of perspiration caused by activity.

The ingestion into the system of large quantities of water, tea, coffee, beer, (weak) wine, &c., may in a short time raise the hourly quantity of urine from 60 or 70 c.c. to 300, 600, 700 c.c. (from 2 to 10 or 20 fl. oz.) and more. I recollect that, when at College, I used to bet with one of my fellowyoungsters as to which of us could drink the largest quantity of water within the hour, from two to three in the afternoon, having taken dinner between twelve and one. At first I beat him, drinking four litres. The quantity of urine discharged was of course correspondingly great, and certainly not less than two litres per hour. After a week my opponent beat me hollow, drinking six litres during the appointed hour. I recollect a student who drank fifteen half litres of weak beer within the hours from eight to eleven at night, an entire half litre at a time, and felt nothing the worse for it. A patient at one of the German spas used to take sixteen half-pint glasses of weak saline water between the hours from six to eight in the morning. In both cases the quantity of urine discharged within the next hour amounted to about one half of the quantity of fluid consumed during that hour, and in all cases the excess of fluid seemed to be discharged within two hours and a half after the last ingestion.

The quantities of water consumed by patients in some hydropathic establishments are something extraordinary. It is the same in many English and Continental spas, where patients make it their avocation to drink warm and cold water. A discharge of urine up to 1000 c.c. (35 fl. oz.) per hour is there of common occurrence after drinking.

Abstinence from drink, on the other hand, diminishes the secretion of urine; but this diminution is not exactly in inverse proportion to the increase by drink. The urine does not sink below a certain quantity, even in cases of total abstinence from food and drink. With a dry diet the urine may, as observed by Mosler on four males of from twenty to twenty-five years of age, sink from the medium of 860 c.c. (3 fl. oz.) per hour under their ordinary diet to 37·0 c.c. (10 fl. oz.) dr.

The temperature of the atmosphere, the amount of moisture diffused in it, and its tension as expressed by the barometer, are influences over which the individual has only partial conThe amount of moisture, therefore, which is exhaled

by the lungs and skin-though of course dependent in part on the amount of water present in the blood, on the relative excretory activity of the organs, and on the bodily state of the individual, such as exercise, rest, sleep, and so on-is partly determined by atmospheric influences.

Certain regular variations in the hourly quantity of urine are produced by the cosmic influences of day and night. During the sleep of night only 580 c.c. (15 fl. dr.) of urine per hour are excreted; in the morning the medium is 690 c.c. (18 fl. dr.); after dinner, if taken early, or after luncheon, the amount of urine becomes largest-770 c.c. (2§ fl. oz.), and sinks again in the evening to 730 c.c. (19 fl. dr.), when even a late dinner will not influence it so much as might be supposed from the observations after an early dinner. Nothing could better demonstrate the influences of activity and rest upon the quantity of urine than these facts. Not only is there a greater production of effete matter, during waking and exercise, requiring to be discharged from the blood than during sleep, but also the excretory activity of the kidney is higher, in consequence of the transference of the nervous stimulus, and from the stimulant action of certain substances of aliment, such as coffee, porter, onions, and a host of other articles of diuretic property. This transferred nervous and direct stimulus may be brought to bear upon the kidneys at any hour of the day or night, and it is therefore that persons working with either mind or body during the night, discharge as much urine as during the same activity in the daytime. On the other hand, sleep and inactivity in the daytime will diminish the quantity of

urine.

To recapitulate: the physiological quantity of urine is dependent, on the one hand, upon the amount of water introduced into the blood, or abstracted from it by other excretory organs; and, on the other hand, upon the excretory activity of the kidneys in its widest sense, as we have already stated.

QUANTITY OF URINE DISCHARGED IN DISEASE.

Though in patients all the influences which determine the quantity of urine in health may combine with the influences of the disease, yet as a general rule the consideration of the total quantity of urine in a great number of diseases will convince us that its variation, or a certain mode of variation, forms one of their essential symptoms. In the long run the character of the disease will determine the character of the

urine, however the satisfaction of an accidental thirst of the patient may increase it for a time, or however much it may have been diminished by vomiting, diarrhoea, perspiration, or increased pulmonic exhalation.

In the previous remarks we have seen the maximum, medium, and minimum quantities of urine discharged in given times by given weights of individual. This must form the basis of any attempt at judging whether the quantity of urine in a given case of disease is less or more than the same individual would be likely to discharge during health. The only caution necessary is to allow a sufficient margin for accidental variations. If we do so, the practical conclusions arrived at from a consideration of this point are as valuable as any of the most pathognomonic objective symptoms. As an example, we will assume the case of an average adult individual. We know he does not drink a great deal when well, and may therefore put down his medium quantity of urine for twentyfour hours as 1300 c.c. (42 fl. oz.) This individual has become ill, and we now ascertain that his urine for twenty-four hours only amounts to 400 c.c. (13 fl. oz.) We are at once justified in the conclusion that the disease has brought about a diminution of the bulk of the urine to less than one third its ordinary medium. Experience teaches us the consequences likely to follow the condition of the system, of which this lessened quantity of urine is a symptom. The symptom therefore has a high diagnostic and prognostic value, as we shall presently more particularly show. An increased amount of urine, on the other hand, to about 2500 or 3000 c.c. (80 or 96 fl. oz.), in a patient who in health would discharge from 1600 to 1700 c.c. (514 to 55 fl. oz.), is an evident excess, which, if not traceable to any special accidental cause, and if permanent, as in diabetes, is the main and principal symptom of the disorder, and therefore the almost exclusive means of its diagnosis.

We will presently show to the reader the use of observing these variations in every case; but science requires that we should observe everything offered to our senses by a case, even should we not see the immediate use of it.

It is a fact, derived from general experience, and which may be verified any and every day, that the quantity of the urine is diminished in all acute febrile diseases, viz., in exanthemata and zymotic diseases, in low gastric fevers and typhus, in rheumatic fevers, in all inflammatory diseases, such as pneumonia, pleuritis, and bronchitis, and in the inflammatory fevers of tropical climates or miasmatic regions. In all these discases, and in many more, a constant dimi