Lumbar pain is an accompaniment of all derangements of the pelvic viscera. The lay mind associates backache with kidney disease; but backache may mean rheumatism, constipation, piles, fissure, prolapsus of the womb, endometritis or endocervicitis, enlarged prostate, stricture of the urethra, etc. Too much attention is given to lumbar pain or backache in connection with kidney affections. Indeed, severe kidney disease may be developed without much discomfort in the back.

In nervous diseases, pain in the bladder is felt in urinating, especially at the expulsion of the last few drops. In urethral irritation it is the first urine that causes discomfort. Hysterical women are very prone to have urethral irritation. Hysterio-cysto-neurotics are usually subjected to so many operations that they are ruined, but never cured.

In this connection I wish to chronicle an observation that I have made: In all cases of tabes dorsalis I have found granular inflammation and great sensitiveness of the urethral mucous membrane, and almost invariably stricture. I have made a practice of using the olive-tipped sound and rubbing away the granulations, and at the same time dilating any stricture that may be present. I have found this treatment a valuable adjunct to the general treatment.

Of all influences leading to the development of tabes, venery stands first. Hence a successful treatment of tabes dorsalis must keep in view the need of remedying the sexual neurosis.

In locomotor ataxia, and in some cases of arteriosclerosis, desire for urinating is lost. The subject must use his reason and attend to this function at stated interval. The urine is sometimes voided without consciousness, and unless the subject sees it pass he will not know it.

Frequent desire to urinate may be wholly due to nervousness; or it may be due to stricture, granular inflammation of the urethra, irritation and inflammation of the bladder, gravel or stone in the bladder, polyuria (hypersecretion of urine) due to drinking overmuch, or eating sloppy foods--soups.

In urethral stricture the stream is often divided, the length and volume of the stream is diminished, and a few drops will be passed after leaving the urinal. This is also true of prostatic enlargement. When the urine stops suddenly, it indicates stone in the bladder. Pain at the end of the penis is another sign of stone in the bladder.

Retention of urine is where the urine is held in the bladder without power to empty it. This demands catheterization. Partial retention is the habit of carrying residual urine--a small or large amount may be retained after all is passed that can be passed. This in time causes a filthy bladder, and consequently bladder disease. Catheterization and washing out the bladder with tepid water will give great relief. Enlarged prostate, stone, and partial paralysis are the causes of this affection.

Anuria is suppression of secretion, and the bladder is found empty.

Examination of Urine (see tests in medical dictionary). Urine varies in quantity. When below 1,200 grams (38 ounces), oliguria (scanty urine) is said to exist; when above 1,500 grams (46 ounces), polyuria exists.

It is necessary to note the amount of urine voided in twenty-four hours. Make a note of the time of urinating, and throw the first urine away. Then save all voided, including that which is passed at the close of the last hour in twenty-four. If there are about thirty-eight to forty ounces, with no symptoms of kidney derangement, such as sugar or albumin, all is well.

Note the color, transparency, consistency, odor, filaments (threadlike appearances), substances in suspension, sediments, and always the reaction and density.

When the urine is turbid, its cause must be known. This condition is due to the presence in it of mucous, pus, uric acid, urates, phosphates, etc. Mucous precipitates by adding acid; pus forms a curdle by adding ammonia. Uric acid and urates are dissolved by heat; phosphates become soluble by adding acetic acid.

The cause for change in color should be determined. A reddish or brown appearance is caused by the presence of blood. However, certain drugs cause this appearance (coal-tar remedies in certain subjects). The microscope reveals the red corpuscles. Hemoglobinuria, requires the spectroscope; also urobilinuria. An intense color indicates bile pigment. (See test table in medical dictionary.)

The most important tests are for albumin and sugar. A simple test for laymen to determine the presence of albumin is to boil urine in a test tube, or a spoon if a tube cannot be procured. If the urine becomes milky or cloudy, add a few drops of lemon juice. If the urine clears up at once, there is no albumin. When suspicious of albumin, the patient should consult his physician and have the urine thoroughly examined.

Normal urine has a peculiar, well-known odor. When urine gives out an ammoniacal odor (smells of ammonia), it indicates bladder derangement, retention of urine, or possibly it may come from eating raw vegetables. Fecal odor indicates a vesico-rectal fistula--an opening from the bladder into the bowels.

In diabetes the urine, like the breath, may have a sharp, pungent, metallic, or ether smell. This odor is an unfavorable prognostic sign. It indicates a threatening diacetemic coma (diacetic acid in the blood). When this odor is present, the urine should be tested with ferric chloride, which gives off a burgundy-red color.

In dyspeptic coma, related to diaceturia (diabetes), diacetic poisoning, the principal symptoms are: a sharp epigastric plain (stomach pain); an increasing wandering or beclouded state of the mind, which gradually terminates in coma; then comes the final state, which is marked by a characteristic breathing, described by Kussmaul as follows: "The breathing is divided into four stages; namely, a brisk inspiration, a pause, a brisk expiration, and a pause," This syndrome (aggregate symptoms) is liable to be precipitated by anything that will produce fatigue. A journey is liable to precipitate the symptoms. I have noted that diabetic subjects, on coming to Denver from low altitudes, are liable to do themselves harm through their desire for sight-seeing--they are inclined to walk overmuch and overdo in many ways.

Before the ending referred to develops, there may be detected a peculiar odor of the breath and urine; namely, a strong ether odor, in some cases very pungent. This odor from the breath of diabetics is not characteristic; for I have met with it in children suffering an attack of gastritis, also in fasting to overcome various morbid affections. This peculiar breath develops in those suffering great anger, and from other excessive emotions.

It is said this odor is caused by the development of acetone in the blood. Rheumatism--the arthritis-deformans type--is especially marked by the development of acetone (vinegar) in the blood.

It is thought that diabetes is more probably caused by the development in the blood of a ptomain. I have found that gastro-intestinal decomposition is invariably a precursor of diabetes. When digestion is reduced by dietetic abuse, and the nerve energy is broken because of enervating habits, power to digest the carbohydrate foods is lost, when they are ingested, acetous fermentation must take place. Just what syndrome is set up will depend upon the physical state and the personality of the patient. A diabetes may develop; some form of rheumatism may be the manifestation; insanity or crime may be the ultimate result of the morbid process.

Where this state of the blood or urine is suspected, the following test should be made: Place urine in a test tube. Allow a drop or two of perchloride of iron to trickle down one side of the test tube. The iron, being heavier than the urine, falls to the bottom of the tube. If there is sugar present--if there is ethyl-diacetic acid present--the perchlorid turns the urine brownish. This coloring is not characteristic, for the same color can be obtained if the patient has taken antipyrin. The use of the drug should be suspended until the sugar test is made, and then the drug should be abandoned by those who would like to get well. Anything that depresses the body will prevent recovery.

Turpentine, onions, and asparagus impart a disagreeable odor to normal urine.

The consistency of urine varies. Sometimes it is thick, and viscid. It may froth easily. This should lead to examination for albumin. If a spot of urine on the clothes attracts flies, sugar should be suspected--which, of course, suggests diabetes.

The color of urine varies. It may be very light-colored in diabetes, inflammation of the kidneys (interstitial nephritis), nervous polyuria, and at crises--which latter means at the time when symptoms of disease decline.

The color is deep when disease is intense; for the excretions are scanty. The urine then is a reddish or brown color, due to bile. When the urine is very red, blood should be suspected. If in women, menstrual discharge may account for it. If the blood is from the urethra, it will pass when not voiding urine. When from the kidneys, the blood is more uniformly mixed with the urine. Carbolic acid imparts to urine a blackish-brown color; rhubarb, logwood, and senna color the urine red; santonin gives it a greenish yellow appearance.