Dr. Willis informs us, in his preface, that his object has been to give a comprehensive and connected view of the Functional Derangements of the Organs which secrete and excrete the Urine, whether primary or secondary in their nature, and of the medical and dietetic Treatment adapted to their different Forms. As among the most frequent and formidable of the immediate consequences of certain disordered states of the renal secretion, he has also included a particular consideration of Stone in the Kidney and Bladder, and of its Remedy by Medical Means. He goes on to state:— "A few years have added largely to our knowledge both of the physiology and pathology of the kidney; and every step in advance, has made the necessity of studying the qualities of the urine in almost every one of the diseases with which the body of man is afflicted, more and more apparent. Under the guidance of science, too, and particularly of recent discoveries in animal chemistry, the examination of the urine, an art but lately held in merited contempt, has assumed a character of the highest importance to the practical physician. If it have been deemed of moment to ascertain the qualities of the alvine evacuations--the mere residue, the undigested and unavailable portions of the food,—it must surely at once be seen that it is of paramount importance to determine the condition of that secretion, which contains the recrementitious matter of the blood, and in its constitution presents an index, as it were, of the state of all the functions whose sum composes the Life. Urinary diseases are besides in themselves, and considered abstractedly, subjects of peculiar interest and importance. They are of very common occurrence, extremely rebellious in their nature, and most fatal in their effects. They are, farther, very far from being generally understood; of all the well-worn pathways of medical literature, there is probably no one less trodden than that which leads to a knowledge of the forms, tendencies, and medical treatment of urinary diseases. Much has undoubtedly been done in this department of late; but what exists lies widely scattered, is little accessible, and, without connexion, is even less available for practical purposes. I have gathered these fragments together, and striven to arrange them into a whole, under the lights afforded by physiology, reflection, and experience." viii. These remarks will afford a key to the character and complexion of the work. Like its author it displays the stamp of learning, and will be found to constitute a careful compilation. The work consists of an introduction and of two parts. The first part is occupied with the consideration of the Functional Derangements of the Kidneys, and their immediate consequences; the second part is devoted to the Functional Derangements of the Organs which excrete the Urine. The First Part comprises eight chapters. The first is on the morbid states in which the secreting faculty of the kidney is exalted, and the menstruum and readily soluble principles of healthy urine occur in altered absolute, or relative quantity; the second on the morbid states in which the secreting faculty of the kidneys is lessened or abolished; the third, on the morbid states in which the urine contains in excess and as precipitates, certain ingredients that occur normally in smaller quantity and in solution; the fourth, on the morbid states in which the urine contains in solution or as precipitates, certain principles which do not occur in the healthy secretion, but appear be derived immediately from one or other of these; the fifth, on the morbid states in which certain matters being constituents of the blood are contained in the urine; the sixth, on the morbid states in which the constitutents of secretions and altered elements of the blood are discharged with the urine; to 1 the seventh, on the morbid states in which principles foreign to the urine and the blood, and derived from none of the natural constituents of these fluids, are eliminated by the kidney; and the eighth, on the consequences of one or other of the morbid states described, particularly of those comprised in Chapters III. and IV.—Urolithiasis, the formation and growth of urinary calculi. The Second Part presents five chapters. The first is on impediments to the discharge of the urine; the second, on inability to retain the urine; the third, on irritability of the bladder-Cysterethismus; the fourth, on spasm of the bladder-Cystospasmus; the fifth, on catarrh of the bladder-Cystorrhoea. The Introduction, consisting of twenty-six pages, is occupied with the physiology of the kidney, and natural constitution of the urine. On these points it will not be necessary for us to dwell long. Animals, it is well known, are composed of oxygen, hydrogen, carbon, and nitrogen. Their food may or may not contain the latter, but carbon and nitrogen, which, form elements of composition, must be partially got rid of. There is an apparatus, therefore, for throwing off both. A lung, observes Dr. Willis, or something analogous to it, is the apparatus in reference to the carbon; a kidney, that in reference to the nitrogen. The lung and the kidney, consequently, taken together, constitute the apparatus of rejection among animals. It has long been known that no animal could survive continued abstraction from the access of air; that the elimination of carbon, effected by the contact of the atmosphere, was necessary to its existence, and that an organ or means of some kind for effecting this object was as universal as organisation itself. Recent researches have also shown that we descend very low in the scale of creation before we lose traces of a kidney or apparatus for freeing the system of nitrogen. The long, and from their magnitude alone, evidently important Malpighian canals in Insects, have been found to secrete, and even to contain calculi of, uric acid. The same substance has also been discovered in the matter elaborated by the saccus calcareus, the organe de la viscosité of Cuvier, of Mollusca; and, as in the case of the lung, when we have lost traces of a concentrated and special organ that might be called a kidney, we find evidences of a means diffused through the system for accomplishing the important end of azotic purgatiou. The principles excreted by the lung and the kidney represent very nearly the sum of those introduced as aliment, which may be regarded as finally decomposed into carbonic acid and urea. "The experiments of M. Chossat upon this matter are of the highest interest. He showed that the quantity of solid urinous excrement was in harmony directly with the quantity combined with the quality of the food taken. Each ounce of farinaceous aliment, bread, yielded regularly 9.9 grains, each ounce of albuminous food 13.6 grains, and each ounce of fibrinous food 17.3 grains of solid urinous excrement. They therefore stood to each other in the power to produce solid urine, in the ratio of 5.7.9. When like weights of these different kinds of food deprived of water were taken, the differences in the proportion of urinous excrement yielded by each were still more striking; each ounce of dry bread, for instance, then produced from sixteen to nineteen grains, each ounce of dry albumen seventy-three grains, and each ounce of dry fibrine seventy-six grains of solid urine. Whence it follows that the quantity of azote contained in the food is a principal element determining the amount of solid excrementitious urinary matter. M. Chossat found, in fact, that ten-elevenths of all the azote ingested with the food were discharged by the kidney." xviii. As Dr. Willis observes, these experiments of M. Chossat's go to place the kidney in the same rank as the lung, and sufficiently explain the serious disturbance of the health that results from impairments of its function. We need not, at present, examine the anatomical structure of the kidney, and it is scarcely necessary to observe that the performance of its functions depends in a great measure on its nerves. This might have been anticipated à priori, and has received experimental confirmation from Müller and Peipers. When the renal nerves were destroyed or divided, the secretion of urine was entirely suspended. The azotic compounds in the urine present themselves under the two principal forms of urea and uric acid. The former has been discovered in the blood; the latter, hitherto, has not. One, or both, with water, are probably the essential constituents of the urine. The specific gravity of the urine varies with the quantity and quality of the food. It varies from 1.005, after a sparing meal with considerable quantities of diluents, to 1.033 or even 1.038, after a hearty meal, with chylification going on. "Writers differ very much in their estimates of the average density of the urine. Prout believed that from 1.010 to 1.015 might be about the average density; any such estimate from 1.015 to 1.025 is certainly much too high for the latitude of London. My observations would lead me to say that the average specific gravity of the urine among grown individuals generally, could not be estimated more closely than 1.015. If children be included, an estimate somewhere about 1.012 will, I believe, be found very near the truth. Densities below 1.012, I should incline to speak of as low densities above 1.020 I should certainly regard as high. But it is next to impossible to come to any conclusion on this point. The density of the urine in fact is influenced by so many varying circumstances-temperature, kind of food, quantity of drink, state of the alvine evacuations, &c. that we are only in a condition to judge of the point in each different individual instance. M. Chossat found the mean density under a vegeto-albuminous regimen in his own person to be 1.012; under an albuminous regimen it was 1.015; under a vegeto-fibrinous and a wholly fibrinous regimen 1.023 and 1.024." xxvii. Solid Matters of the Urine.-The qualitative analysis of the urine is not difficult-the quantitative is. The analysis of the urine generally quoted is that of Berzelius, as old as the year 1809. It is as follows: Dr. Christison has given a qualitative analysis of the urine of a healthy individual, of specific gravity 1.029, which was voided to the extent of about thirty-five ounces daily. Of this urine the solid contents amounted to 67.7 per 1000. Of these 55-2 were urea, extractive matters, and animalized acetates, soluble in alcohol; 11.1 alkaline muriates, sulphates and phosphates; 1.0 earthy phosphates, and 0.4 mucus. But Dr. Willis judiciously remarks, that this must be regarded as a specimen of urine of unusually high specific gravity. He observes: "I have found such differences in the relative quantities of the matters soluble in alcohol and in water, that I believe it to be no more possible to fix on any absolute standard, in regard to the ratio of the animal matters to the salts, in the urine, than to fix on any term as a measure of its specific gravity. This must be apparent when it is seen that in Dr. Christison's analysis, the animal matters are to the salts nearly in the proportion of five to one; in Berzelius's they stand to each other nearly in that of three to one; whilst Dr. Bostock has, if I remember rightly, estimated them as existing in the ratio of about five to four. The result depends greatly on the strength of the alcohol employed." xxviii. Perhaps some of our readers are not aware that urea, with one or two other proximate animal principles, may be formed artificially. The mode of obtaining urea is as follows:-When a quantity of cyanate of silver is treated with a solution of hydrochlorate of ammonia in water, a double decomposition takes place; chloride of silver, which is perfectly insoluble, falls to the bottom, a quantity of cyanate of ammonia remains in solution; this is readily obtained in the solid crystalline form by careful evaporation, and in elementary composition agrees exactly with the urea obtained from urine. At the termination of his account of lithic acid, our author observes: "There is one circumstance, which may probably influence the solution of this substance, which has received less attention than it deserves; and which I now find I have myself overlooked in the proper place; it is this: that the combination between the lithic acid and the water must take place at the moment of nascence. It is familiarly known that several chemical combinations can only be effected by presenting the combining elements to one another in the nascent state. When the urine contains any lithic acid dissolved, the deposit of this substance from the menstruum is a mere question of time: sooner or later it always happens. The recent researches of Leibig and Woehler have rendered it probable that lithic acid is a compound of urea and a substance itself composed of cyanogen and carbonic oxide, a substance, which, by the action of certain reagents, (superoxide of lead,) and probably also by the deranged operation of the kidney, is converted into oxalic acid, and the peculiar matter found in the allantois of the calf, allantoin." xxxiii. Dr. Willis's work, for that of a librarian, is carelessly written and got up. 0.03 933.. + It is on this point that the inverted pyramid of Pantheism, has been poised by some of that metaphysical school. After a brief survey of the names and labours of those who have contributed to render our information on the morbid states of the urine what it actually is, our author concludes by quoting and recommending for general adoption, Dr. Bostock's plan for noting the characters and qualities of that fluid in disease. We adverted to it in our last number, but it would be well to reintroduce the suggestions of Dr. Bostock here. With some slight modifications and additions, his formula, or proposal includes,-1. The designation of the circumstances under, and the time at which, the specimen of urine considered was voided; 2. Its quantity, and the quantity voided during the preceding twenty-four hours; 3. Its external characters,-colour, odour, transparency, or turbidity; 4. Its specific gravity, and the average specific gravity of the whole of the urine discharged during the previous twenty-four hours; 5. Its state in regard to acidity, neutrality, or alkalescence; 6. The amount of solid contents per cent.; the respective quantities of the extract soluble in strong alcohol, and in water being distinguished; 7. The effects of heat, of nitric acid, before and after the application of heat, of corrosive sublimate, and ferrocyanate of potash; 8. The amount of precipitate thrown down by ammonia, and by oxalate of ammonia; 9. The nature of the deposites, when any; 10. The nature of the spontaneous changes undergone within twelve hours, and of those that take place in the course of two or three days. With this we terminate our notice of the Introduction, and proceed to the first part of the work, on— I.-FUNCTIONAL DERANGEMENTS OF THE KIDNEYS, AND THEIR IMMEDIATE CONSEQUENCES. 1. MORBID STATES IN WHICH THE SECRETING FACULTY OF THE KIDNEYS IS EXALTED, AND THE MENSTRUUM AND READILY SOLUBLE PRINCIPLES OF HEALTHY URINE OCCUR IN ALTERED ABSOLUTE OR RELATIVE QUANTITY. This chapter is sub-divided into three sections:-the first, on the discharge of urine which is characterized by deficiency of solid matters generally-Hydruria. The second, on the discharge of urine which is characterized by a deficiency of urea-Anazoturia. The third, on the discharge of urine which is characterized by a superabundance of ureaAzoturia. The reader is already introduced to three of many new names; new, at all events, most probably to him. Whether the advantage of uniformity in nomenclature counterbalances the inconveniences of change of name, is a point which we shall not now pause to discuss. But we are sure that authors ought to be chary how they dabble in the Lexicon for novel terms. What trouble his nomenclature must have cost Mason Good! Yet who knows or cares to know his learned designations for familiar maladies? SECTION I. Of the discharge of Urine which is characterized by deficiency of solid matters generally,-HYDRURIA. If an individual drinks a great deal, he voids a proportionate quantity of urine. But this is not disease. Yet occasionally there seems an insatiable |