Detrol (Tolterodine)
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ACTIVITY OF KIDNEYS
When physicians wish to increase urination in patients with dropsy due to heart or kidney disease, they resort to the use of mercury as a diuretic. Dr. Samuel Johnson in his last illness had dropsy. Perhaps the word is not used now so much as formerly and it may be necessary to explain that it means the swelling of the body tissues with fluid. Ten months before his death, when he was evidently badly water-logged, he received “sudden and unexpected relief” by voiding twenty pints of urine in one day. Mercuric diuretics were not known at that time, but people then as now were obsessed by worry about their bowels. So Johnson, who was no exception, took “mercury,” probably in the form of calomel, to stimulate these aforesaid viscera. As he had been extremely ill of asthma, he probably had been forced to complete rest. Recovery from some degree of decompensation, that is heart failure, plus the mercury, resulted in this tremendous voiding of urine.
Nervousness certainly increases the activity of the kidneys. Afternoon football practice becomes much of a routine, but the Saturday afternoon games are decidedly a different matter. For five days our rather inadequate toilet facilities in the old field house did very well. On the following afternoon with a gigantic and hostile group awaiting us outside there was always a waiting line within.
A healthy male adult usually secretes from one to two quarts of urine in twenty-four hours. Women, who as a whole seem to dislike drinking water, do not do so well as this. The amount may vary greatly; under special conditions even a good kidney may secrete anywhere from an ounce or two up to well over a quart an hour.
Other men as minutely skillful as Bowman have actually succeeded in passing microscopic pipettes into the different parts of the nephron, and have collected the fluids and analyzed them. It is known now that within a few hours the glomeruli pass out amounts of fluid equal to all there is in the blood. But as the fluid passes down the tubes some of it may be absorbed again into the blood; or again, the blood may give up even more fluid through the tubes.
It is evident from all this that the kidneys are not merely sewers carrying off the refuse of the body, as was formerly thought, but are most efficient laboratories. They are not machines doing a routine job. The demands upon them are constantly changing.
The adult needs to take in, daily, one seventh of the amount of the body’s extra-cellular fluid; that is, fluid in the blood vessels and between the tissue cells. The infant needs one half.
Dr. James L. Gamble, who is a pediatrician as well as an authority on body fluids, says: “The arithmetic of this is that water flows through the infant three times as fast as through the adult, which explains an unpopular item of the infant’s social behavior.”
It is an interesting fact that each blood vessel entering a glomerulus is larger than the vessel which leaves it. This means that the blood pressure is thereby increased locally. This pressure evidently helps in passing the fluid and waste from the blood into the urinary system. Ever since the blood-pressure machine was perfected, scientists have worried as to the cause of high blood pressure, and unfortunately this worry has been shared by the general public who, of course, has had no intelligent approach to the matter. There seems to be some fairly close connection between the kidney and high blood pressure. I do not think, however, that at the present time this relationship has been fully clarified. At the time of this writing, salt is highly suspect, low salt diets are the fad, and I am told that restaurants are not cooking enough salt into their food to make it palatable. Since all the live cells of the body are bathed in a salt solution, and since there is a definite dangerous condition known as a “low salt syndrome,” I think we should view this development with alarm.
*31/276/5*
