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FORD EXCHANGE. 
 
 3 4 
 
EXAMINATION OF THE URINE, 
 
 / BY 
 
 GEOI; B. FOWLER, M.D., 
 
 EXAMINER IN PHYSIOLOGY, COLLEGE OP PHYSICIANS AND SURGEONS, 
 YORK, FELLOW OP THE NEW- YORK ACADEMY OP MEDICINE, 
 I, MEMBER N. Y. COUNTY MEDICAL SOCIETY, ETC. 
 
 New- York : 
 
 D. APPLETON & COMPANY, 
 
 549 and 551 Broadway. 
 
 1874, 
 

 
 46975 
 
+± V 
 
 PREFACE. \j> * 
 
 This book is intended simply as a " Guide." It lias been 
 my endeavor to render the subject and the manipulations as 
 plain as possible, hoping thereby to enable the reader to 
 acquire a thorough knowledge of the common and important 
 characters of the urine. 
 
 In teaching the subject. I have become convinced that a 
 few words regarding the conditions which produce the vari- 
 ous changes in the urine, normal and abnormal, have very 
 greatly assisted the student in mastering the subject, by at 
 once revealing its practical import. I have, therefore, intro- 
 duced here brief outlines of the physiological and patholo- 
 gical influences which bear upon the subject. 
 
 The general arrangement of a manual like this is impor- 
 tant ; that which I have adopted is as follows : 
 
 Part I. 
 
 1. Characters of Normal Urine. 
 
 2. Effects of Reagents upon Normal Urine. 
 
 Part II. — Characters of Abnormal Urine. 
 
 Part III. — Urinary Deposits. 
 
 1. Those which are Natural Constituents of the 
 
 Urine, either Separately or in Combination. 
 
 2. Those which are Foreign to its Composition 
 
 under any form. 
 
 Part IV. — Accidental Ingre'dients which do not F»rm 
 Deposits. 
 
 Part V. — Quantitative Analysis. • • 
 
 Part VI. — Calculi and Gravel. 
 
 April, 1874. 
 
EXAMINATION OF THE URINE. 
 
 PAET I. 
 
 
 1. CHARACTERS OF NORMAL URINE. 
 
 
 Composition. 
 
 
 Water, 
 
 938.00 
 
 Urea, . . . .... 
 
 30.00 
 
 Creatinine, ...... 
 
 1.50 
 
 Creatine, 
 
 1.25 
 
 Urate of Soda, j 
 
 
 " " Potassa, I 
 
 1.80 
 
 u u Ammonia, ) 
 
 
 Coloring Matter and Mucus, . 
 
 .30 
 
 Biphosphate of Soda, 
 
 
 
 Phosphate of Soda, 
 
 
 
 " " Potassa, 
 
 - 
 
 12.45 
 
 " "Magnesia, 
 
 
 x 
 
 " " Lime, 
 
 
 
 Chlorides of Sodium and Potassium, . 
 
 7.80 
 
 Sulphates of Soda and I 
 
 \>tassa, 
 
 6.90 
 
 1000.00 
 
 Odor. — The odor of normal urine has been de- 
 scribed as resembling that of violets. It is subject to 
 many changes, however, depending upon articles of 
 
6 EXAMINATION OF THE URINE. 
 
 food, and some medicines impart to it a peculiar odor. 
 But when this is the case, it is best considered under 
 the head of abnormal, which see. 
 
 Color. — The tint of healthy urine is liable to 
 variation, though a yellow amber is about the stand- 
 ard color.' The coloring matter of urine is a peculiar 
 organic constituent called urosacine. It is present in 
 definite proportion, and depends upon the amount of 
 water whether its presence in the urine be marked 
 by a deep or faint color. Excessive indulgence in 
 water, malt liquors and wine, and diminished activity 
 of the perspiratory apparatus, will cause an increase 
 of the watery element in the urine, and consequently 
 more or less dilution, when the urine will assume a 
 light color, and may even resemble pure water. The 
 converse of the above conditions will produce a 
 contrary re suit. 
 
 Transparency. — Normal urine is perfectly clear, 
 with the exception of a small collection of mucus 
 and epithelium which nearly always collect at the 
 bottom of the vessel. 
 
 Reaction. — Healthy urine has an acid reaction, 
 which is due not to the presence of any free acid, but 
 to an acid salt, the biphosphate of soda. This re- 
 action may be decided or faint. But it should not be 
 understood that unless the urine is acid it is abnormal. 
 Indeed, the reaction may vary within healthy limits, 
 between well-marked alkalinity and acidity. 
 
 The causes of this irregularity are found to be in 
 the diet. It has been ascertained that a vegetable 
 diet will lessen and sometimes cause the disappear- 
 
EXAMINATION OF THE URINE. 7 
 
 ance of the acidity ; and it has been found that after 
 a mixed meal, the urine is distinctly alkaline. This 
 reaction continues a little while, when the alkalinity 
 becomes less, and finally the acid state is restored. 
 The acid reaction thus increases during fasting, and 
 reaches its greatest degree of intensity after twelve 
 hours of abstinence from food. (Roberts.) 
 
 It is well to note that this variation is not due to 
 any diminution in the acid present, but simply to a 
 sudden accumulation of alkaline ingredients, the re- 
 sult of digestion. For during digestion, all the salts 
 of the organic acids, such as tartrates, malates, 
 citrates, and lactates are transformed into carbonates, 
 and as such appear in the urine. Substances con- 
 taining these organic compounds are in daily use, 
 either as food or medicine. All the fruits and vege- 
 tables offer familiar examples, and mineral waters are 
 a common cause of a temporary alkaline urine. 
 
 Specific Gravity. — The specific gravity of normal 
 urine varies from 1018 to 1025. These limits may be 
 extended in individual cases, and, in fact, depend 
 greatly upon the quantity of urine voided. In other 
 words, the specific gravity bears an inverse ratio to the 
 daily quantity. Should we have an increased flow of 
 urine from unusual indulgence in drink, or from the 
 action of any diuretic, we would not expect the density 
 to equal that where the same amount of solid mate- 
 rial was present in a less amount of water. For in 
 diuresis, except in a few instances of disease, we merely 
 have the water increased, and not the solid constitu- 
 ents. And, on the other hand, where the individual 
 
8 EXAMINATION OF THE URINE. 
 
 lias taken little or no fluid, or has perspired freely, or 
 is suffering with diarrhoea, the urine would be what 
 we call concentrated — that is, the normal amount of 
 solid ingredients, salts, urea, etc., would be there 
 dissolved in a small proportion of water. And under 
 these circumstances, the specific gravity would be ( 
 liiffh — even 1030 would not indicate disease. 
 
 Daily Quantity. — The total quantity of urine 
 voided by a healthy individual during twenty-four 
 hours is estimated to be from 35 to 50 fluid ounces. 
 This is subject to variation, depending upon the 
 quantity of fluids drunk, the activity of the perspira- 
 tory functions, etc. ; for it is evident that should 
 there be a small proportion of fluids taken into the 
 system, there will be less secreted by the kidneys, and 
 vice versa. And should perspiration prevail to an 
 unnatural degree, we should be getting rid of the 
 water by another channel, and would not expect to 
 find the same volume of urine ; and the same may 
 be said of watery discharges from the bowels. ' The 
 kidneys act as regulators of the water-supply of the 
 blood ; they take from it any excess, and when there 
 is an insufficiency, they demand only enough to dis- 
 solve the solid substances of the urine, and to facili- 
 tate their discharge from the body. 
 
 The estimation of the daily secretion of urine is 
 one of the most important points connected with its 
 study. It, however, depends greatly upon another 
 condition for its significance to the physician — 
 namely, specific gravity. 
 
 The most important and abundant solid ingredient 
 
EXAMINATION OF THE URINE. V 
 
 of the urine, urea, is present in increased quantities 
 as a result of muscular exercise and diet ; therefore ' 
 remember to consider these facts in instances where 
 a greater density than 1024: to 1025 is found. 
 
 These variations in specific gravity, ranging from 
 1006 to 1030, can not be [constant, and not excite 
 suspicion regarding the integrity of the kidneys, or 
 some pathological condition of the economy. To en- 
 title them to be considered under the head of normal, 
 they must be only temporary and easily referred to 
 some such cause as has been mentioned. 
 
 2. EFFECTS OF REAGENTS UPON NORMAL URINE. 
 
 Cold. — Cold has no visible effect upon urine of a 
 specific gravity at or below 1020. But in concentrated 
 specimens, after cooling, there will be a precipitate, 
 more or less colored, which consists of the amorphous 
 urates, they being only soluble in warm urine and in 
 an excess of water. This precipitate first appears as 
 a cloud throughout the whole volume of urine, but 
 will gradually collect at the bottom and adhere in 
 specks to the sides of the vessel as a fine powder. 
 
 Such a deposit or cloudiness will disappear upon 
 again raising the temperature to that of the body. 
 
 Heat. — Normal urine of a decided acid reaction is 
 unaffected by the application of heat. But should 
 the reaction be faintly acid, neutral, or alkaline, heat 
 will cause a cloudiness, due to the precipitation of the 
 earthy phosphates, lime and magnesia. 
 
 These two phosphates are insoluble in a neutral or 
 alkaline fluid, and are less soluble in warm than in a 
 
10 EXAMINATION OF THE URINE. 
 
 cold fluid, and therefore will be precipitated by heat 
 if the reaction of urine is even slightly acid. 
 
 Acid. — -The addition of an acid to urine has no 
 visible effect beyond deepening the color. But if 
 nitric acid be added, in the proportion of about one 
 third, after several hours minute but distinct dark 
 brown crystals will be seen clinging to the sides of the 
 test-tube or vessel, and collect at the bottom. These 
 are the crystals of uric acid which have resulted from 
 a decomposition of the urates by the nitric acid. 
 
 Alkalies. — When urine is rendered alkaline, the 
 earthy phosphates of lime and magnesia will be preci- 
 pitated. 
 
 The subaeetate of lead and nitrate of baryta preci- 
 pitate the alkaline sulphates, which are said to vary in 
 certain diseases. But this proportion in the urine is 
 itself variable, and is found to depend greatly upon 
 the kind of food taken. 
 
 The nitrate of silver precipitates the chlorides. It 
 is sometimes expedient to estimate the comparative 
 quantity of the chlorides, inasmuch as it is pretty 
 well established that they are subject to great fluc- 
 tuations in certain forms of disease. In all severe 
 inflammations/pneumonia, pleurisy, cholera, etc., the 
 chlorides almost disappear from the urine, and the 
 nitrate of silver produces little or no effect. But 
 when the attack begins to subside, this reagent will 
 detect the return of the chlorides. This precipitate 
 is a very copious w T hite cloud. 
 
 Subaeetate of lead and nitrate of silver also preci- 
 pitate the mucus and coloring matter of urine. 
 
EXAMINATION OF THE TJEINE. 11 
 
 Urea. — Urea represents the wornout nitrogenous 
 elements of the body. It is excreted at tlie rate of 
 about 500 grains per day. If, through any derange- 
 ment of the functions^ of the kidneys, urea is not 
 thrown off by the urine, it accumulates in the circu- 
 lation and acts as a poison upon the nervous system, 
 inducing what is called uremia. 
 
 A convenient way to ascertain whether urea is pre- 
 sent in the urine, in about the normal proportion, is 
 as follows : 
 
 Evaporate 5 f of urine over a water-bath to 1 \ ; 
 filter away the phosphates and urates which are depo- 
 sited, and allow the clear concentrated specimen to 
 cool. Now add about 1 3 of nitric acid, and a copi- 
 ous formation of crystals of nitrate of urea will re- 
 sult, if the urea is present in any thing like the normal 
 quantity. Or a few drops of the urine may be placed 
 upon a glass slide and a drop of nitric acid added, 
 and the whole allowed to evaporate, w T hen the crystals 
 will be distinctly seen, and under the microscope will 
 appear as delicate six-sided plates, superimposed one 
 upon another. 
 
 CHANGES WHICH TAKE PLACE IN TRINE AFTER BEING 
 DISCHARGED FROM THE BODY. 
 
 If a specimen of urine be kept for observation, the 
 following changes show themselves : 
 
 At first, after a period varying from two days to a 
 week, the acidity becomes more marked, the color is 
 darker, and crystals of uric acid and oxalate of lime 
 make their appearance. Even should the urine be 
 faintly alkaline, to commence with, and cloudiness 
 
12 
 
 EXAMINATION OF THE URINE. 
 
 exist from the precipitation of the earthy phospates, 
 it will become acid, and the cloudiness clear up, when 
 the process continues as in the other cases. The aci- 
 dity increases up to a certain point, and then begins 
 to grow less. It may continue two, four, or seven 
 days ; and Lehman states, he has observed the acid 
 Fi »- L reaction to increase for 
 
 two or three weeks, and 
 then not disappear al- 
 together until eight 
 weeks.* This is the 
 
 ACID FERMENTATION of 
 
 urine (Fig. 1). 
 
 The acidity gradually 
 becomes fainter and 
 fainter, and at length 
 the urine is neutral. 
 
 Acid Fermentation : Uric acid and octa- -^r- i j i 
 
 nedra of oxalate of lime. JN ow, marked changes 
 
 will be noticeable. The urine is cloudy ; it will con- 
 tain conf ervoid vegetations and algae ; myriads of 
 infusorial animalcules are visible under the micro- 
 scope (vibriones). Neutrality gives place very soon 
 to alkalinity, which is advertised most emphati- 
 cally by a putrescent, ammoniacal odor. The uric 
 acid crystals will disappear, and others of the triple 
 2>hosphate of ammonia and magnesia are produced. 
 These crystals are large prisms, and can be seen 
 glistening on the surface of the urine where a layer 
 
 Dark, round 
 
 of brittle fatty matter has formed. 
 
 ' Physiol ogicaVChemistry, vol. 2, p. 121. 
 
EXAMINATION OF THE TJEINE. 13 
 
 crystals of the urate of ammonia may also be seen 
 with the microscope. 
 
 This state of things continues* until the decompo- 
 sition is complete. Then the ainmoniacal odor will 
 no longer be detected, and the urine will have lost 
 most of its color. 
 
 This constitutes the Fig - a - 
 
 ALKALINE FERMENTATION 
 
 (Fig. 2). 
 
 The chemistry of 
 these two fermentations 
 has been differently ex- 
 plained ; but that offered 
 by Scherer is generally 
 accepted as correct. 
 
 He says that the or- 
 ganic matters, the color- 
 
 -i Alkaline Fermentation : Crystals of triple 
 
 mg matter and mUCUS, phosphate] and urate of ammonia, 
 , , t .• * j. amorphous phosphate of lime. 
 
 act as catalytic bodies, 
 
 and induce the fermentation whereby lactic acid is pro- 
 duced. Just how lactic is formed is not well under- 
 stood, but it is certain that it makes its appearance in 
 urine when allowed to stand, in which it could not 
 be detected when fresh. The presence of lactic acid 
 then decomposes the urates, whereby uric acid is set 
 free and makes its appearance as crystals. At the 
 same time, oxalic acid must be produced, for crystals 
 of the oxalate of lime show themselves. This oxalate 
 of lime is very insoluble, and could not have existed 
 in the urine before without detection. Therefore the 
 supposition is that oxalic acid is formed and imme- 
 
14 EXAMINATION OF THE URINE. 
 
 diately unites with the lime already present. So 
 much for the acid fermentation. 
 
 Now, urea is decomposable into the carbonate of 
 ammonia by contact with a decomposing organic 
 substance, and the addition of two equivalents of 
 water. Here then we have the conditions of this 
 decomposition. The mucus gradually loses its power 
 of producing lactic and oxalic acids, and begins itself 
 to decompose ; and surrounded by water, the arrange- 
 ment for the transformation is complete. It accord- 
 ingly takes place, and the first effect of the presence 
 of carbonate of ammonia is to neutralize the acid 
 reaction, and then to induce the alkaline. Now, of 
 course, the earthy phosphates are no longer soluble, 
 and render the urine opalescent by this precipita- 
 tion ; the uric acid crystals are dissolved ; a scum of 
 animal matter intermixed with the amorphus phos- 
 phates now forms on the surface, and very soon 
 glistens with crystals of a new formation, the triple 
 phosphate or ammonio-magnesian phosphate. (It is 
 called triple because it consists of two equivalents of 
 magnesia and one of ammonia.) 
 
 At the same time, the carbonate of ammonia acts 
 upon the phosphate of soda of the urine, and an- 
 other double salt, the phosphate of soda and am- 
 monia, is formed. 
 
 The crystals of this last compound salt are very 
 similar to those of the preceding, and having the 
 same history, and being affected alike by different 
 substances, need not be studied apart. 
 
 The urea continues to be decomposed, and the car- 
 bonate of ammonia to unite and form these several 
 
EXAMINATION OF THE UKINE 15 
 
 new substances, until there is nothing more for it to 
 unite with. Now it escapes as gas, and the odor re- 
 minds us of that common to public urinals, where, 
 indeed, the same process as just described is going on. 
 At length, all the urea is decomposed, and the evolu- 
 tion of the ammonia ceases. The other substances 
 either remain unchanged or some pass off in the form 
 of other gases. 
 
 These are the important facts concerning normal 
 urine, and a knowledge of them is indispensable, in 
 that if we are not acquainted with them, we certainly 
 shall not be prepared to detect and appreciate the 
 variations which constantly present themselves, and 
 constitute an abnormal condition. 
 
PART II. 
 
 CHARACTERS OF ABNORMAL URINE. 
 
 Odor. — The odor of urine is frequently affected, 
 and is likely to attract the attention of both patient 
 and physician, and lead to its examination. Many 
 articles taken as food and medicine impart to it an 
 odor peculiar to themselves. Such are asparagus, 
 onions, turpentine, cnbebs, and copaiba. An am- 
 moniacal odor tells the story of decomposition. 
 
 Color. — The color of urine is subject to many 
 changes, depending on the degree of concentration, 
 where it will be more or less dark ; on dilution, where 
 the lighter shades will prevail,. In febrile diseases, 
 where we have a partial suppression of urine, the 
 secretion is high-colored. In diabetes miletus, a 
 disease characterized by an inordinate flow of urine 
 of a high specific gravity and the presence of sugar, 
 the tint is light ; also in diabetes insipitus, when there 
 is a great increase in the amount of urine of low 
 specific gravity. Some articles of food and medi- 
 cine also affect the color of the urine. Strong coffee 
 heightens the color, rhubarb imparts a deep yellow, 
 and logwood gives it a reddish hue. Santonine renders 
 it an orange red when alkaline ; when acid, a golden 
 yellow. Creosote and compounds of tar have been 
 
EXAMINATION OF THE UUINE. 17 
 
 known to cause the urine to become almost black ; 
 
 and, lastly, blood and bile may be present in such 
 quantities as to be readily recognized. 
 
 The presence of bile may be distinguished from 
 the effects of rhubarb by the addition of a little 
 liquor ammonia, when the deep yellow of the latter 
 will be converted into a crimson. 
 
 Transparency. — If a specimen of urine under 
 examination is not clear and transparent, it should be 
 first ascertained whether there was any turbidity 
 when first voided ; for we have seen that perfectly 
 healthy urine, when kept for any length of time, 
 will undergo changes and a marked opalescence 
 exist. And abnormal urine may be at first perfectly 
 clear, but on cooling or standing exhibit a cloudiness 
 or deposit. It is possible for urine to be abnormal, 
 and yet remain free from turbidity or deposit. For 
 example, albumen and sugar are perfectly soluble, and 
 can not be detected by simple ocular inspection. 
 
 Substances which interfere with the transparency 
 of recently discharged urine are, pus, blood, phos- 
 phates, urates (if the specimen is cool), chyle, 
 spermatozoa, and epithelium,. 
 
 The reader is referred to each of these under the 
 head of " Urinary Deposits." 
 
 Reaction. — After wdiat has been said concerning 
 the variability in the reaction of normal urine, it is 
 sufficient to J add now that when we meet with a 
 patient whose urine is habitually or most of the time 
 neutral or alkaline, we should regard him as a subject 
 for treatment. 
 
18 EXAMINATION OF THE URINE. 
 
 Remember that the alkalinity may be due to the 
 presence of the fixed salts (soda and potassa), or to a 
 volatile one (ammonia) ; that the former are derived 
 from the blood, and the latter is the result of the 
 decomposition of urea. These two conditions can 
 easily be distinguished apart by the ammoniacal odor 
 which betrays the presence of carbonate of ammonia, 
 and the fact that the blue color which it imparts to 
 reddened litmus-paper fades away. And also, if the 
 reaction be due to carbonate of ammonia, we shall 
 find crystals of the triple phosphate under the micro- 
 scope. (Fig. 6.) Where either the fixed salts or 
 the volatile one is present, of course the urine will 
 be turbid from a precipitation of the earthy phos- 
 phates. And this precipitation occurring in the 
 bladder is likely to give rise to a calculus ; yet it is 
 pretty w r ell established that the urine can remain 
 alkaline a long time from the carbonates of soda and 
 potassa (fixed salts), and a stone not form. It is 
 crystalline deposits which we have to fear in this re- 
 gard, and therefore, as the presence of carbonate of 
 ammonia results in crystalline formations, calculi or 
 concretions are apt to be induced by it. Therefore it 
 is very important to recognize these two alkaline con- 
 ditions, and to know that when the reaction is due to 
 one, the cause pre-existed in the blood ; when to the 
 other, the cause is the decomposition of nrea some- 
 where in the urinary passages. 
 
 Then, too, we may have the urine abnormally acid, 
 producing a scalding sensation during micturition. 
 Now, we know what the result is when an acid is 
 added to the urine outside thebodv : uric acid crystals 
 
EXAMINATION OF THE UEINE. 19 
 
 will be precipitated. So it is in. the bladder under the 
 same conditions. These crystals then accumulate 
 and form gravel, some of which is voided by painful 
 efforts by the urethra, but others soon grow by union 
 and very soon become a calculus, and by their pre- 
 sence irritate and inflame the bladder, which then 
 throws off a quantity of mucus and epithelium. These 
 products of inflammation supplied with the necessary 
 conditions for decomposition, warmth and moisture, 
 quickly begin to affect the urine as it comes down 
 from the kidneys. The result is, the decomposition 
 of urea, production of carbonate of ammonia,' and 
 growth of the original uric-acid stone by successive 
 layers of the earthy phosphates. 
 
 Daily Quantity and Specific Gravity. — We 
 
 have seen, in the case of healthy urine, how closely 
 the specific gravity and daily quantity are related, 
 and that as one increased, the other decreased ; or, in 
 other words, that they bore an inverse ratio to each 
 other. In certain diseased conditions, however, both 
 are increased and decreased together. The specific 
 gravity may be 1030, and [the daily quantity 60 1 . 
 Here we would recognize . the fact that there is a 
 double waste of both water and solids. And, again, 
 the specific gravity may be 1006 to 1012, and the 
 quantity not exceed 12 § . In this case, there is a 
 suppression of both elements, and from retention of 
 the chief solid constituent, :iirea, the most fatal re- 
 sults may follow. There is also a disease — diabetes 
 insipitus — where the daily quantity of urine is fifty 
 and sixty ounces, and the specific gravity much below 
 
20 EXAMINATION OF THE URINE. 
 
 the normal standard. This state of thing robs the 
 system of its proportion of water, occasioning great 
 thirst, whereby nature endeavors to counteract the 
 drain. 
 
 Here, then, in abnormal urine, the specific gravity 
 and the daily quantity are in direct ratio, except in 
 diabetes insipitus. When the amount of water is in- 
 creased, the solids will he also, and vice versa. 
 
 The specific gravity of urine may be increased by 
 accidental ingredients, such as pus, blood, mucus, 
 albumen, and sugar. 
 
 Great care is necessary in collecting urine for ex- 
 amination. The patient must be made to~pass the 
 entire secretion of twenty-four] hours in one clean 
 vessel, and from this total quantity a portion must 
 be selected for examination, especially as regards the 
 specific gravity. 
 
PAET III. 
 
 1. URINARY DEPOSITS. 
 
 The urine is subject to deposits, or collections of 
 solid and semi-solid substances, which, on account of 
 their weight, subside when undisturbed. These de- 
 posits consist of various materials, some of which are 
 normal constituents of the urine, either separately or 
 in combination, while others are foreign to its compo- 
 sition altogether. 
 
 Therefore, it will be convenient to study urinary 
 deposits by dividing them into these two classes. 
 
 To THE FIRST CLASS BELONG URIC ACID, THE URATES, 
 THE PHOSPHATES, OXALATE OF LIME, EPITHELIUM, MUCUS, 
 AND PIGMENTS. 
 
 Uric Acid. — Uric acid does not exist in a free 
 state in the urine, but is there in combination with the 
 alkaline bases, soda, potassa, and ammonia. It, how- 
 ever, presents itself independent of these, and forms a 
 deposit of dark brown crystals. We have seen that 
 this occurs during the acid fermentation of urine, 
 and that it is due to the development and action of 
 lactic acid, which decomposes the urates. We can 
 accomplish the same result by adding any strong acid 
 to a test-tube containing- urine, and allowing; it to re- 
 main quiet for several hours. Then the characteristic 
 uric-acid crystals will be seen attached to the sides 
 and collected at the bottom. 
 
 The dark brown color which almost invariably dis- 
 
22 
 
 EXAMINATION OF THE URINE. 
 
 tin<mislies these crystals is derived from the coloring 
 matter of the urine, for which they have a great 
 affinity. Yet we sometimes see almost colorless and 
 pure crystals of uric acid, and these are apt to be 
 small square plates or diamonds. 
 
 The formation of crys- 
 tals of uric acid may 
 take place in the uri- 
 nary passages, not only 
 as a result of fermen- 
 tation, but spontaneous- 
 ly, due to an excessive 
 acid condition of the 
 urine. In either case, 
 gravel and calculi are 
 likely to result. It is 
 therefore very impor- 
 tant to know whether a deposit took place previous 
 to the discharge or afterward. 
 
 Fig. 4. A deposit of uric acid 
 
 is of a dark brown co- 
 lor, or if pure, it is a 
 white, glistening pow- 
 der, and under the mi- 
 croscope presents the 
 greatest variety of crys- 
 talline forms. In fact, 
 so numerous are the 
 shapes and arrange- 
 ments of these crystals, 
 Uric acid. that it is very difficult to 
 
 give any description. Yet when familiar with urinary 
 crystals, they are not likely to confuse one. For it 
 
 Uric acid. 
 
EXAMINATION OF THE URINE. 23 
 
 is only necessary to be able to recognize the otlier crys- 
 talline deposits, which vary little or none ; and then 
 when a brown crystal of an unusual form is seen, 
 it is pretty safe to pronounce it uric acid. The 
 most common appearances are represented in Figs. 3 
 and 4. 
 
 Tests. — Uric acid is insoluble in water, alcohol, 
 and ether. It is soluble in an alkali, especially at a 
 high temperature. 
 
 There is a beautiful test for uric acid called the 
 murexid test. Place the uric acid in a clean white 
 porcelain capsule, and add a drop or two of nitric 
 acid ; then evaporate over the flame of a spirit-lamp. 
 When the nitric acid has been driven off, there will a 
 pink stain show itself, which, on the addition of a 
 little liquor ammonia, assumes a beautiful purple 
 color. 
 
 Urates. — The urates, of soda, potassa, and ammonia, 
 are present in the urine, in solution, but frequently 
 are precipitated, and appear as a dense cloud or 
 powder, which collects at the bottom of the urine- 
 glass, and at the same time dusts the sides over with 
 a powdery film. The color of the precipitate may 
 vary from a white to a red, according to the concen- 
 tration of the urine, these substances having a great 
 affinity for the coloring matter. As a class, the urates 
 have very much the same qualities. 
 
 They are soluble in an excess of water at a low 
 temperature, but at an elevated temperature, and 
 that of the body, they will dissolve in a less amount of 
 water. It is this reason that, however concentrated 
 
24 EXAMINATION OF THE URINE. 
 
 the urine may be when voided, it is never turbid with 
 the urates. But in a short time, the temperature falls, 
 and a cloudiness is visible, followed shortly by a copi- 
 ous deposit. 
 
 Knowing, then, that the urates are precipitated 
 when the urine is deficient in water, we can under- 
 stand how abstinence from drink, profuse perspira- 
 tion, a watery discharge from the bowels, or any 
 influence which lessens the normal quantity of water 
 in the system, or turns it away from the kidneys, will 
 have the effect of concentrating the urinary secretion, 
 and causing the urates to appear when the urine cools. 
 
 In fevers, the urates are deposited, and are high 
 colored. Irregularity in the digestive apparatus is 
 likely to be followed by an appearance of these sub- 
 stances. In children teething, we often encounter a 
 copious white deposit, which is mostly the urate of 
 ammonia. 
 
 As to the relative quantity of the three urates in 
 the urine, that of soda stands first, and ammonia last. 
 
 This deposit of the urates is almost always amor- 
 phous, though sometimes crystals of urate of soda and 
 urate of ammonia are seen under the microscope. 
 The amorphous granules sometimes arrange them- 
 selves in regular forms, resembling very much 
 granular casts, but the application of heat w T ill 
 quickly clear up any confusion. Crystals of the 
 urate of soda are met with in the urine of gouty 
 patients mostly, and have the appearances represented 
 in Fig. 5 5 — round masses of dark color, with radiating 
 lines from the centre, and irregular projections along 
 the circumference. 
 
EXAMINATION OF THE UKIJSTE. 
 
 25 
 
 The crystals of urate of ammonia appear as very 
 dark, spherical masses, and as delicate dumb-bells 
 (Fig. 5 a). These crys- Fi ^ 5 - 
 
 tals form during the am- 
 moniacal decomposition 
 of urine, and can be 
 seen under that condi- 
 tion (Fig. 1). 
 
 Tests. — The amor- 
 phous urates are dis- 
 solved by an alkali and 
 also by an excess of an 
 acid, but their presence 
 usually indicates an acid 
 urine. The application of heat is the most simple 
 test. They dissolve at a temperature of 50° Fahr. 
 The murexid test for uric acid is applicable to the 
 urates also. 
 
 a, Urate of ammonia. 
 
 b, Urate of soda. 
 
 Phosphates. — It is the earthy phosphates of lime 
 and magnesia with which we have to deal as precipi- 
 tates. 
 
 The earthy phosphates are precipitated in three 
 forms : the amorphous phosphate of lime, the stella 
 phosphate of lime, and the ammonio-magnesian phos- 
 phate, or triple phosphate. 
 
 The amorphous phosphate of lime is the common 
 deposit of urine, which is alkaline from the effects of 
 a meal from the carbonates, citrates, etc., taken by 
 the mouth, and frequently becomes abundant after 
 nervous exhaustion, as want of sleep, hard study, etc. 
 
 The stellar phosj?hate of lime is a crystalline form 
 
20 EXAMINATION OF THE URINE. 
 
 which sometimes appears in urine. Roberts considers 
 its presence indicative of some grave disorder, he 
 having encountered it in diabetes, cancer, and phthisis.* 
 It may, however, appear in urine where much lime 
 has been taken as food ; then if the urine is reduced 
 to a neutral or alkaline state, the stellar crystals may 
 form. These crystals are arranged in radiating stars 
 and bundles, and are perfectly colorless. 
 
 The ammonio-magnesian or triple phosphate is a 
 crystalline deposit, the result almost always of the 
 alkaline fermentation and the decomposition of 
 urea. (See " Fermentation of Urine.") This deposit 
 very seldom takes place inside the body, and when it 
 does, it is the result of paralysis of the bladder, stone, 
 or retention of urine from some other cause. Under 
 these circumstances, decomposition takes place, and 
 the ammonia, which is one of the results, unites with 
 the magnesia already present, and the deposit is 
 formed. The ammonia normally present in the urine 
 is seldom sufficient to constitute this deposit icithout 
 the decomposition of urea. 
 
 The earthy phosphates are only soluble in an acid 
 fluid. It is the acid salt, biphosphate of soda, which 
 holds them in solution in the urine. But we have 
 seen that the urine is frequently neutral and alkaline 
 (see u Reaction of formal Urine "), and should expect 
 to meet with the phosphates in those instances as a pre- 
 cipitate. It is true that we do. Even in urine which 
 is weakly acid, they will be thrown down when the 
 temperature is elevated, for it is a fact to remember 
 
 * Urinary and llenal Diseases. Am. Ed., 1871, p. 108. 
 
EXAMINATION OF THE URINE. 
 
 27 
 
 Fig. 6. 
 
 that the phosphates are less soluble in hot than in cold 
 solutions. 
 
 A deposit of amorphous phosphates has the appear- 
 ance of a white powder, but if the triple phosphate 
 be present, the crystals will be easily seen and quickly 
 recognized by their large 
 size and characteristic 
 glistening, prismatic 
 forms. (Fig. 6.) 
 
 Tests. — The earthy 
 phosphates are distin- 
 guished by their solubili- 
 ty in any acid solution. 
 Therefore if an opales- 
 cence or precipitate be 
 composed of these mat- 
 ters, a drop of any acid Triple phosphates. 
 
 will immediately cause it to disappear. 
 
 Oxalate of Lime. — Oxalate of lime is found in 
 urine as a result of the acid fermentation, and also in 
 perfectly fresh and undecomposed specimens of this 
 fluid. Indeed, the formation may take place before 
 the urine is discharged. The source of this forma- 
 tion is oxalic acid and lime. It is claimed by many 
 that oxalic acid is a normal constituent of the urine, 
 and that it, like the other ingredients, is subject to 
 variation, and when furnished in a little more than 
 the usual amount, it unites with the lime, and the 
 oxalate of lime is the result. 
 
 It appears as a whitish powder, and never is very 
 abundant. 
 
28 
 
 EXAMINATION OF THE URINE. 
 
 A great deal has been said concerning the clinical 
 significance of oxalate'of lime in the urine, under the 
 heads of u Oxaluria" and " Oxalic Diathesis." Some 
 writers have maintained that oxalic acid normally ex- 
 ists in the blood and urine, and others have declared 
 the contrary. 
 
 A long train of symptoms were attributable to its 
 presence in the urine, such as nervous prostration, 
 despondency, loss of sexual power in the male, etc. 
 But I believe these theories have all exploded, and 
 from the simple fact that oxalate of lime is very often 
 found in the urine of persons in blooming health. 
 Indeed, about the only clinical value which attaches 
 to this deposit is the possibility of the formation of a 
 calculus and gravel. And as these concretions are 
 very hard and rough, they are dreaded more than any 
 other. 
 
 Tests. — This deposit is always crystalline, and the 
 
 microscopic appearance 
 is sufficient in every 
 respect to distinguish 
 them from any thing 
 else. There are two 
 kinds of crystals: the 
 
 Fig. 7. 
 
 octahedra, which are the 
 most common, and the 
 dumb-bell. The first 
 consist of two pyramids 
 placed base to base. 
 (Fio;. 7.) Sometimes 
 only a single pyramid exists. Crystals of oxalate 
 of lime are usually very small and colorless. Oxalate 
 of lime is soluble in strong mineral acids. 
 
 Oxalate of lime : Octahedra and dumb 
 bells. 
 
EXAMINATION OF THE URINE. 
 
 29 
 
 Epithelium, — Every specimen of urine contains 
 some epithelium, which is augmented in certain dis- 
 eases of the kidneys and urinary passages. In the 
 healthy state, we find that from the bladder in the 
 greatest amount ; and in the female, vaginal epitheli- 
 um will be mingled with the urine, if great care is not 
 exercised. 
 
 As the genito-urinary apparatus is lined with epi- 
 thelium of different forms throughout its extent, it is 
 well to know what are the peculiarities which distin- 
 guish that of one region from that of another. 
 
 Vaginal epithelium is very common in the urine of 
 women, especially when there is any discharge from 
 the vagina or uterus. It is easily recognized by its 
 large size, thinness, wa- 
 vy outline, and disposi- 
 tion to fold upon itself. 
 (Fig. 8, h.) The female 
 urethra contains very 
 similar forms, but they 
 are somewhat smaller. 
 
 The tirethra is lined 
 by epithelium, which 
 differs in the spongy 
 and prostatic portions. 
 From the meatus to the 
 prostatic region, the cells are round and oval. About 
 the prostate, they are spindle-shaped, caudate, and 
 irregular. 
 
 In the Madder, the size is increased, and they are 
 often seen still united by their edges. (Fig. 8, a.) 
 Those from the ureters possess the same characters, 
 only are of smaller size. 
 
 Epithelium : 
 
 b, Vaginal ; 
 
30 EXAMINATION OF THE UPJNE. 
 
 The pelvis of the kidney contains small round and 
 oval cells, of the flat variety, which are a little larger 
 than tubular epithelium. 
 
 The epithelium of the 'kidney tubules is a very 
 complicated one, but it is sufficient for our purposes to 
 know that it is spherical, about twice as large as a 
 blood-globule, from which it may be distinguished, 
 should any doubt arise, by its nucleus. It usually 
 comes away from the kidney adhering to fibrinous 
 moulds of the tubes, but may often be seen floating 
 free in the urine. (Fig. 8, c.) 
 
 When epithelium is present in abundance, it will 
 be accompanied by an increase in the natural amount 
 of mucus, and the two substances settle to the bottom 
 of the urine-glass, intimately mingled. Under the 
 microscope, patches of epithelium-cells will be seen 
 held together by the adhesive mucus. 
 
 Epithelium appears in the urine as a result of any 
 inflammation or mechanical irritation of the mucous 
 membrane of the urinary tract. 
 
 Mucus. — There is always a small amount of mucus 
 in healthy urine, especially in the first passed in the 
 morning. It is to the presence of mucus, however 
 limited in quantity, that the decomposition of urine 
 is due. For if the urine be filtered, it may be kept 
 for an indefinite time without any change manifesting 
 itself.* 
 
 Mucus appears as a deposit at the bottom of the 
 glass, or may entangle air-bubbles and float as a fea- 
 
 * Sclierer. 
 
EXAMINATION OF THE URINE. 31 
 
 thery ball below tlie surface. It appears of the color 
 of the urine containing it, but when separated on a 
 filter, is perfectly transparent and glairy. All amor- 
 phous and crystalline deposits, blood, pus, casts, etc., 
 become mingled with it and interfere with its transpa- 
 rency, or may mask its presence. 
 
 Excessive secretion of mucus may be the result of 
 mechanical irritation, ammoniacal decomposition of 
 the urine in the bladder, or chronic inflammation. 
 Sometimes there is such an amount of mucus secreted, 
 that the whole volume of urine will be rendered semi- 
 solid, and will rope like the white of egg. 
 
 Tests. — Mucus is liable to be confounded with pus, 
 especially when colored by amorphous deposits. It 
 may be distinguished from pus by its ropy and viscid 
 nature, and, best of all, by its appearance under the 
 microscope, mucus having no corpuscular elements. 
 
 Pigments. — We frequently encounter peculiar 
 little bodies under the microscope, possessing indefi- 
 nite shapes and appearances, and attracting the atten- 
 tion of the observer by their high color, being either 
 red, dark brown, or yellow. 
 
 They sometimes resemble epithelium, but show no 
 nucleus ; again, they may be an irregular mass, unlike 
 any thing we are familiar with. What is their origin 
 and significance? This is an unsettled question, and 
 has not been much investigated. They are likely to 
 occur in any specimen [of urine, but Koberts states 
 that in several cases of chronic Bright's disease, he 
 has noticed a great increase of them. 
 
 It has been thought that they might be epithelium- 
 
32 EXAMINATION OF THE URINE. 
 
 scales, stained by the coloring matter of the urine, 
 and this coloring matter itself is known to undergo 
 changes whereby other colors are produced capable of 
 tinting any foreign substance from the atmosphere, 
 which is exceedingly liable to get into a specimen. 
 
 One other source, and a common one, of these col- 
 ored specks under the microscope, it is important to 
 guard against : it is that they may exist in the glass 
 slides or covers ; for these articles are polished with 
 a red powder, particles of which become imbedded in 
 its minute irregularities. Dr. Edward Curtis was the 
 first to w r arn microscopists against this source of error. 
 
 II. 
 
 Second class of deposits : those which are foreign 
 to the composition of the urine, under any form. 
 
 This class differs from the preceding in that most of 
 the deposits have a pathological significance. 
 
 The following are included under this head : Hood, 
 casts, pus, oil, chyle, spermatozoa, cystine, keistine, 
 confervoid vegetations, and vibriones. 
 
 Blood. — Blood may be mingled with the urine 
 from either of the organs through which it has to pass. 
 Urine containing blood may or may not give evidence 
 of it when first passed. It depends upon the quanti- 
 ty of blood present whether there will be any distinc- 
 tion as regards color. 
 
 If the quantity is small, we probably will not sus- 
 pect its presence until the urine has stood some hours 
 in a urine-glass, when a red line or layer will be dis- 
 cernible at the bottom. (It must not be confounded 
 
EXAMINATION OF THE URINE. 33 
 
 witli uric acid, which is of a dark brown color, instead 
 of a blood-red.) The deposit consists of the red cor- 
 puscles. 
 
 We may have urine stained with blood, and yet con- 
 taining no, or very few, corpuscles. Thus the blood 
 may be represented in the urine under these two con- 
 ditions : hcematuria, where the elements of the blood 
 are present under their natural forms ; hcematinuria, 
 where the red corpuscles appear to have disintegrated 
 or dissolved, and only a few perfect ones can be found. 
 It is necessary to consider these apart. 
 
 Hematuria. — Hematuria is that condition where 
 red blood corpuscles are present in the urine, and im- 
 part to that fluid a more or less marked bloody color. 
 It is the result of ruptured blood-vessels. The rup- 
 ture may have taken place from direct violence, con- 
 gestion, ulcers, abscess, or the presence of a stone. 
 When the kidney is the seat of the lesion, the discol- 
 oration of the urine will be equally diffused, on ac- 
 count of the admixture beginning at the fountain-head, 
 so to speak. The urine will have a smoky hue ; and the 
 source of the hemorrhage in the kidney is rendered 
 still more conclusive by the finding of casts under the 
 microscope. When the blood has originated lower 
 down, in the bladder or urethra, it has an opportunity 
 to coagulate before the current of the urine diffuses it, 
 and consequently when voided, small clots will be seen, 
 and the volume of urine will be irregularly colored. 
 
 Tests. — A rupture permitting the escape of the blood 
 corpuscles will, of course, allow of the passage of al- 
 bumen, and consequently we always find this sub- 
 
34 EXAMINATION OF THE UHINE. 
 
 stance in hematuria. The corpiiscles themselves are 
 albuminoid, and were there no free albumen present, 
 would respond to the heat and nitric acid tests. (See 
 " Albumen.") But the most positive proof of the pres- 
 ence of blood is furnished by the appearances of the 
 sediment under the microscope. This instrument, 
 with a i-inch lens, will reveal the corpuscles. They 
 arebi-concave discs, about y^ of an inch in diameter. 
 By careful focusing, their form can be distinguished, 
 the outline and centre never being equally distinct 
 at the same time ; then if a current be excited in the 
 drop under the eye, by touching the side of the thin 
 glass cover with a bit of blotting-paper, the corpus- 
 cles will roll over and over and show their thin edges 
 jng.j)^ an( j concave surfaces. 
 
 All these points are il- 
 lustrated in Fig. 9, a. 
 
 There are changes, 
 however, which blood 
 corpuscles u n cl e r g o 
 when subjected to un- 
 natural influences. In 
 the blood serum, they 
 maintain their shape 
 Blood comnld^r^N^a; b. Swollen and size, but immersed 
 &™t£r? tipil; *' Shriveled from lack in a watery solution 
 like urine, they immediately begin to absorb wa- 
 ter, and very soon have swollen to twice their 
 natural size, lost their color and bi-concave character, 
 and are now r spherical. "When allowed to dry, they 
 shrivel and become so irregular that should one 
 
EXAMINATION OF TIIE URINE. 35 
 
 not be familiar with the change, lie will not suspect 
 their presence. 
 
 KsBmatinuria. — This curious affection is characte- 
 rized by a chocolate-colored urine due to the presence 
 of hsematine, which has transuded through the blood- 
 vessels, and appears independent of the blood corpus- 
 cles which are thought to have dissolved. A few cor- 
 puscles, however, are usually seen. Dark granular 
 and hyaline casts are frequently found, as well as 
 amorphous matter and octahedra of oxalate of lime. 
 
 Tests. — Heat will reveal the presence of albumen, 
 which must necessarily be present. When the albu- 
 men is coagulated, it is stained by the dark coloring 
 matter, and the specimen, when allowed to settle, will 
 present the appearance of the chocolate-colored coag- 
 ulum at the bottom, and the transparent urine above. 
 
 CASTS. 
 
 Casts are moulds of the uriniferous tubules. The 
 kidney is largely supplied with capillaries, which form 
 a complex network about the tubules, and any con- 
 gestion of the organ is very apt to result in an exuda- 
 tion from the blood-vessels into these little canals, of 
 a peculiar substance, the composition of which is not 
 well understood. This substance has the property of 
 spontaneous coagulation, and thus adapts itself to the 
 shape and size of the tube, and the urine collecting be- 
 hind, washes it out, and it appears as a cast of the 
 tubule. The pressure which induces this exudation 
 is also sufficient to cause a transudation of the liquid 
 portion of the blood ; and it results that albuminu- 
 ria always exists where casts are formed. 
 
36 
 
 EXAMINATION OF THE URINE. 
 
 Fig. 10. 
 
 We depend upon the microscope altogether for the 
 detection of casts, and considerable* skill is sometimes 
 necessary to distinguish between them and certain 
 extraneous matters. The most frequent sources of 
 confusion in this respect are cotton fibres and feathers. 
 Cotton fibres are striated, and are apt to be folded or 
 
 twisted. A particle of 
 feather or hair has de- 
 finite anatomical char- 
 acters, which should be 
 too well know^n to allow 
 of a mistake. The ap- 
 pearances of these acci- 
 dental substances are 
 shown in Figure 10. 
 
 As a guide, it may 
 be said of casts, that 
 
 a, Hairs ; b, Cotton fibres ; c, Starch ., n i 
 
 grains ; d s Air-bubbles ; e, Feathers. they are generally rOUnd- 
 
 ed at one extremity, and their sides are parallel. 
 They are not flexible enough to allow of folding or 
 twisting, which is so common to cotton fibres. 
 
 Casts are not all of the same diameter. One reason 
 for this is, that the tubules themselves vary in size in 
 different parts of their course. Another cause de- 
 pends upon the fact that in certain affections of the 
 kidney, the epithelium lining the tubules is detached 
 and voided with the urine. Now, a tubule thus de- 
 nuded is larger than it w T as previous to the shedding 
 of its lining, and consequently will afterward form a 
 larger cast. 
 
 Casts differ as regards appearance. The coagulable 
 matter which transudes into the tubules is perfectly 
 
EXAMINATION OF THE URINE. 37 
 
 transparent and structureless, so far as we have been 
 able to ascertain. The theory is, then, that this mate- 
 rial when collected in the tubules fills and distends 
 them. This distention causes pressure upon the epi- 
 thelium lining which adheres to and sinks into them 
 to a certain extent. Now, when the cast is washed 
 out by the pressure of urine from behind, it pulls 
 slightly upon its epithelial attachments, and if the 
 cells be detached or detachable, through degeneration, 
 they must come along with it. 
 
 Now, it follows, from the above theory, that if the 
 kidney is not diseased to such an extent as to allow of 
 desquamation of its epithelium, or, on the other hand, 
 if the epithelium has been previously shed, leaving 
 the tubule bare, the cast will come away and appear 
 in the urine unaltered as regards its structure, and 
 will appear as a transparent mould of a renal tubule. 
 These we call hyaline casts. 
 
 It is not necessary, after the above explanation, to 
 say more than that when the epithelium does show 
 itself adhering to the cast, we recognize another va- 
 riety — namely, epithelium casts. 
 
 And suppose these epithelium cells to have under- 
 gone a fatty degeneration, we should then Imve fatty 
 casts. Go a little further, and imagine the epithelium 
 to have suffered what is known as a granular degene- 
 ration, then we should find granular casts. 
 % [Besides these varieties, we meet with several others, 
 having nothing to do, however, with the] epithelium 
 element. These are blood, pits, and r tcaxy casts. 
 
 As it is my purpose to give a few hints respecting 
 the practical bearing of the subjects treated of in this 
 
38 
 
 EXAMINATION OF THE URINE. 
 
 manual, it will be necessary to glance at eacli one of 
 these casts separately. 
 
 Hyaline Casts? as tlieir name implies, are struc- 
 tureless and transparent. They vary in diameter from 
 the width of one blood corpuscle to that of three. 
 Their length is not definite. Being transparent, they 
 are difficult to find, and on this account are often 
 overlooked. 
 
 The mode of formation of these casts has been 
 stated above ; and therefore when they are small, it is 
 fair to suppose the kidney yet to be comparatively 
 sound, and the cause of the symptoms wliicli led to 
 the examination of the urine not of long standing. 
 At any rate, we meet with small hyaline casts in acute 
 Bright's disease. But what does a large hyaline cast 
 signify ? It tells the story of a more advanced dis- 
 ease, and its transparency is not due to a refusal of 
 Fig. 11. the epithelium to come 
 
 off with it, and thereby 
 asserting its healthiness ; 
 but, on the contrary, its 
 very size bears evidence 
 of the previous shed- 
 ding of the epithelium, 
 and of the present nu- 
 dity of the tubule 
 whence it came. 
 
 A cast of this last va- 
 
 a, Hyaline casts ; b, Epithelium casts, riety may be perfectly 
 
 transparent, or it may be dotted over with a few 
 
 specks of granular matter, and perhaps here and there 
 
 a broken-down epithelium cell. 
 
EXAMINATION OF THE URINE. 39 
 
 It is evident, that in chronic disease of the kidney, 
 both small and large hyaline casts will be found in 
 the urine, because the organ is not equally diseased in 
 all its parts. (Fig. 11, a.) 
 
 Epithelium Casts. — We have seen that the effu- 
 sion of fibrinous material into the uriniferous tubules 
 undergoes spontaneous coagulation, and is afterward 
 washed out by the urine which collects behind it ; and 
 that if the epithelium lining the tubules be detached 
 or detachable, it will adhere to the mould, and be af- 
 terward found in that situation in the urine. 
 
 The cells may be scattered upon the surface of the 
 cast or may present a regular arrangement, the same 
 which existed while they yet occupied their normal 
 place in the kidney. At the same time, there will be 
 found free epithelium in the urine. 
 
 Epithelium casts are found in the urine of persons 
 convalescing from scarlet fever, and in acute Bright's 
 disease. In pneumonia and severe inflammatory dis- 
 eases, they are the prevailing variety of cast. (Fig. 
 
 1M-) M 
 
 Fatty Casts are epithelium casts in which the epi- 
 thelium has undergone a fatty degeneration. The 
 cells appear to have beeu filled with fat and to have 
 burst, discharging their oily contents into the tubules, 
 where they have adhered to the fibrinous effusion. 
 The cast will be more or less covered with these mi- 
 nute oil-drops and epithelial cells, which are also full of 
 oil or fat. At the same time, fatty cells and free fat 
 will be seen floating in the urine. (Fig. 12, a.) jj 
 
40 
 
 EXAMINATION OF THE URINE. 
 
 Casts of tliis description are found in chronic affec- 
 tions of tlie kidney, and their presence in the urine is 
 a very grave sign. 
 
 Granular Casts represent the epithelial element in 
 a state of granular degeneration. What this granular 
 material is, is not very well understood, though sup- 
 posed to be fat in a state of fine subdivision. The 
 cell may have entirely disappeared or may remain, 
 filled with these granules. These casts, appearing in 
 abundance, are indicative of serious changes in the 
 kidneys, and their presence determines an unfavorable 
 prognosis. Fig. 12, £, Fig . i 2 . 
 
 illustrates the granular 
 cast. It will be noticed 
 that they are dark, and 
 have ragged extremi- 
 ties. 
 
 Blood Casts. — If 
 
 there is a hemorrhage in 
 the kidney when the 
 conditions are present 
 which induce the for- 
 mation Of CastS,« the «, Fatty casts ;&, Granular casts. 
 
 blood-globules will attach themselves to the mould, 
 sometimes very regularly, and form what is called a 
 blood cast. At the same time, they will be present in 
 a free state in the urine. 
 
 Blood casts are common in scarlet fever and any 
 form of acute Bright's disease. They do not gene- 
 rally present themselves for any length of time, being 
 
EXAMINATION OF THE TJEINE. 41 
 
 the result of a hemorrhage which is not apt to con- 
 tinue. 
 
 Pus Casts. — These are rare. They are met with 
 where the kidney is the seat of abscess. Yet cases 
 where abscess was found at post-mortem examina- 
 tions, and furnished no pus casts during life, are re- 
 corded. "When present, they have the appearance of 
 pus corpuscles adhering to the fibrinous cast. The 
 urine will at the same time contain more or less pure 
 pus. To prevent confounding pus corpuscles and 
 epithelium, it is well to note that they are smaller, 
 and the addition of acetic acid will render the cell- 
 wall of the pus corpuscle transparent, and reveal a 
 distinct granular nucleus. 
 
 Amyloid or Waxy Casts are the large, transpa- 
 rent, and waxy-looking objects which are occasionally 
 seen, and are thought by some to denote a correspond- 
 ing condition of the kidney. But nothing definite is 
 yet known concerning them. They sometimes present 
 a few transverse markings and fissures, as though they 
 were very brittle and had been broken. 
 
 This completes the list of casts, and it may be use- 
 ful to sum up their clinical significance. 
 
 The appearance of a few small hyaline casts may 
 be, and probably is, the result of a congestion in the 
 kidney of recent origin. 
 
 Epithelial and hyaline casts are very frequently 
 found in the urine of patients recovering from scarlet 
 fever, pneumonia, bronchitis, and congestive diseases 
 generally. 
 
42 EXAMINATION OF THE URINE. 
 
 Fatty, granular, and waxy casts have a grave signi- 
 ficance ; yet the appearance of one or two of them 
 should not induce us to pronounce too certainly the 
 fatal termination of the case. 
 
 It is the continuance of a prevailing kind of cast 
 which is most to he relied tcpon in the way of diagno- 
 sis and prognosis. 
 
 Casts are liable to disintegrate, and may become so 
 changed as to escape detection if allowed to remain 
 in decomposing urine. Therefore it is important to 
 look for them before decomposition begins. The 
 lightest cast will have fallen to the bottom of the 
 urine-glass in ten or twelve hours. Then gently pour 
 away all the urine except about two drachms, and from 
 this, with the aid of a glass tube, take up, from the 
 bottom, a drop or two for microscopic examination. 
 (See last page for detailed directions for microscopic 
 manipulations.) 
 
 Pus. — There are various causes giving rise to pus 
 in the urine. Cystitis, pyelitis, gonorrhoea — in fact, an 
 abscess or ulceration comumnicating with the urinary 
 tract at any point. In women, purulent discharges 
 from the vagina are likely to confuse us as to the ori- 
 gin of the pus. 
 
 Urine containing pus is turbid when voided, and, on 
 standing, deposits a whitish cloud of a ropy consisten- 
 cy, which distinguishes it from an inorganic deposit. 
 
 Tests, — Pus consists of a fluid and a corpuscular 
 element. The fluid is albuminous, and will be acted 
 on accordingly by heat and nitric acid, although puru- 
 lent urine never gives a marked coagulum ; and this 
 
EXAMINATION OF THE URINE. 
 
 43 
 
 fact serves as a good test, the turbidity not disappear- 
 ing with heat and nitric acid, and at the same time 
 scarcely becoming more marked. 
 
 Liquor potassa causes a semi-solid, gelatinous pre- 
 cipitate. 
 
 The microscope will reveal the pus corpuscles, and 
 this is conclusive evidence. Pus corpuscles are a lit- 
 tle larger than the blood corpuscles, colorless and 
 spheroidal. They are made up of cell-wall, granular 
 contents, and nuclei. By the addition of a drop of 
 acetic acid, the cell-wall 
 is rendered transpa- 
 rent, and the nucleus is 
 brought sharply into 
 view. (Fig. 13.) . 
 
 Oil. — It has been as- 
 serted that oil is a con- 
 stituent of normal urine 
 in very small propor- 
 tion, and only detected 
 after a careful analysis. 
 It, however, sometimes 
 makes its appearance in quantities sufficient not only 
 to be recognized under the microscope, but visible to 
 the unassisted eye. 
 
 It may present itself either as distinct oil-drops, as 
 granules, or as a very fine emulsion, each particle of 
 which appears as a mere point under the microscope 
 (this latter condition we have in chylous urine). If 
 either of these forms of fat are in the urine, we shall 
 have a layer of it on the surface when allowed to rest. 
 In the case of granular fat, the layer will appear 
 
 a. Pus corpuscles ; &, 
 acid. 
 
 Effect of acetic 
 
44 EXAMINATION OF THE URINE. 
 
 creamy ; where the globules are of any size, a yellow, 
 oily layer will be seen. 
 
 Oil globules were detected in the urine of a man 
 who was taking cod-liver oil by Roberts. Fatty de- 
 generation of the kidneys is accompanied by oil in 
 the urine. Much speculation has been indulged in 
 concerning the source of oil where there is no recog- 
 nizable affection of any organ. It is known that 
 during digestion, the blood is loaded with chyle, and 
 may, under circumstances not understood, permit it 
 to escape into the urine. (See " Chylous Urine.") 
 
 A frequent source of oil-drops in the urine is the 
 vessel in which it is collected, or the bottle in which 
 it is brought to the physician, and, in many instances, 
 the passage of catheters and sounds, which are always 
 oiled before introducing. 
 
 Tests. — Oil is soluble in ether. But if it be in 
 small quantity, it often becomes necessary to first 
 extract it with ether, and afterward evaporate almost 
 to dryness before any traces of it can be seen. 
 
 Under the microscope, oil-drops are distinguished 
 by their perfectly circular outline, difference in size, 
 and solubility in ether. As seen in urine, the glo- 
 bules are never very large, and might be mistaken for 
 blood corpuscles. But their sharp-cut, bright outline, 
 absence of color, and peculiar properties mentioned 
 above, can scarcely fail to identify them. 
 
 Chylous Urine. — Chylous urine has ever been one 
 of the most interesting and at the same time puzzling 
 conditions with which we have to deal. In appearance, 
 it is milky, and on standing collects in a creamy layer 
 
EXAMINATION OF THE UHINE. 45 
 
 on the surface. There is always more or less blood, 
 fibrine, and albumen present. Sometimes it coagu- 
 lates spontaneously when passed, and very closely 
 resembles blanc mange. Cases are related where it 
 coagulated in the bladder and completely blocked up 
 the urethra, from which it was extracted in long 
 flakes. It is a rare affection, and but few cases are 
 reported. Writers disagree widely concerning its 
 pathology and symptoms ; but without going over the 
 history at length, the following are the main points 
 regarding this peculiar disease : 
 
 It is most common in warm climates; makes its 
 appearance suddenly, and as suddenly ceases, to re- 
 appear again after months or even years. Sometimes 
 it coagulates spontaneously, like lymph, and again 
 does not undergo this change. Themilkiness is more 
 marked after meals. The older authors considered 
 the kidneys and the assimilative functions of the 
 system to be at fault and diseased. But casts have 
 been searched for in vain, and several post-mortem 
 examinations of individuals who were affected with 
 this disease have failed to afford evidence of altera- 
 tions in any organ. So that now it begins to be 
 stated that the chyle and lymph are discharged directly 
 into the urinary passages from the lymphatic vessels 
 themselves ; and Roberts especially advances this 
 opinion, having noticed, in patients voiding chylous 
 urine, appearances which indicated disease of the 
 lymphatics. 
 
 I had an opportunity recently of examining a 
 specimen of chylous urine, the history of which it 
 may be well to relate. It occurred in the practice of 
 
46 EXAMINATION OF THE URINE. 
 
 Professor Alonzo Clark. The patient had resided in 
 the South most of his life. About ten weeks before 
 he consulted Professor Clark, he had attempted to 
 pass his urine five times within an hour. This neces- 
 sitated great straining, and he was suddenly alarmed 
 by a severe pain and a discharge of blood and milky 
 urine. (The pain was located in the prostatic ure- 
 thra, and as he had undergone an operation for stone 
 a few years before, it and the hemorrhage were refer- 
 red to that cause.) This condition came and dis- 
 appeared several times until I saw the urine. The 
 patient stated that the milky fluid sometimes was per- 
 fectly free from any urine. He w T as able to know 
 this from the fact that the uriniferous odor was 
 entirely absent, and, moreover, the bladder had just 
 been emptied only a few minutes before. 
 
 This urine did not coagulate spontaneously. It 
 contained blood, and had an alkaline reaction. 
 
 Tests. — Besides the characters above stated, other 
 tests are scarcely necessary. Chyle is oil in a state 
 of emulsion. 
 
 Under the microscope, the granules appear very 
 minute. 
 
 Spermatozoa. — The spermatic elements some- 
 times become mingled with the urine in sufficient 
 numbers to form a deposit. As a deposit, they re- 
 semble mucus and pus, though never so abundant. 
 Their presence may be accounted for as a result of 
 coition or an involuntary discharge of semen. This 
 latter may be continuous and constitute spermator- 
 rhoea. With the exception of this last-named condi- 
 
EXAMINATION OF THE UHINE. 
 
 47 
 
 tion, the presence of spermatozoa in the urine is 
 without significance. 
 
 Tests. — The semen is albuminous, and will be ren- 
 dered cloudy, to a more or less degree, by heat and 
 nitric acid. But the microscope will reveal whether 
 the albuminous reaction is due to the presence of 
 semen, in that the characteristic filaments or sperma- 
 tozoa will be seen. If the specimen be recent, they 
 will be in active motion. Spermatozoa are possessed 
 of a head and tail-like extremity, the former being 
 slightly flattened from Fig. 14. 
 
 before backward. Their 
 
 length is about 
 
 t 
 
 "6" oo 
 
 of 
 
 Spermatozoa; b, Vibriones. 
 
 an inch. (Fig. 14, a.) 
 
 Cystine.— This is a 
 substance but rarely met 
 with, compared with 
 other deposits. Its 
 source is not positively 
 known, though supposed 
 to be the liver. A 
 remarkable fact concerning it is its liability to run 
 in families. The most important clinical significance 
 attached to it is its liability to form a calculus ; 
 otherwise cystine may appear in the urine of an indi- 
 vidual for years and not depreciate the health. 
 
 Urine containing cystine has usually an oily ap- 
 pearance, and deposits a light, rose-colored powder. 
 Decomposition takes place very soon, and, according 
 to Dr. Bird, the color changes to a green. Cystine 
 
48 EXAMINATION OF THE URINE. 
 
 contains sulphur, which is decomposed and evolved 
 as sulphuretted hydrogen. 
 
 Tests.— Acetic acid will cause a further precipitate 
 to take place. It is insoluble in the vegetable acids, 
 and is not dissolved by heat. It is soluble in 
 ammonia and mineral acids. 
 
 The crystals are six-sided plates, and colorless. If 
 a solution of cystine be placed in a shallow dish with 
 Fi s- 15 - a little ammonia, evapo- 
 
 ration w T ill cause a de- 
 posit of the pure crys- 
 tals. (Fig. 15.) 
 
 Keistine. — It was at 
 
 one time thought that 
 the urine of pregnant 
 women offered peculia- 
 rities by which the preg- 
 nant state could be diag- 
 Cystine * nosed. It was stated 
 
 that there would form upon the surface of such urine 
 a layer of cheesy matter unlike any appearance pre- 
 sented when the subject was not pregnant. . The 
 name keistine (cheesy) was given to this formation. 
 The results of observation, however, have been so 
 conflicting that the profession, to-day, reject the 
 matter, and attribute the phenomenon as one and 
 the same thing as the alkaline fermentation, which is 
 hastened in pregnancy by the presence of an increas- 
 ed amount of animal matter, such as epithelium and 
 mucus from the vagina and bladder. 
 
EXAMINATION OF THE URINE. 49 
 
 VEGETABLE FUNGI. 
 
 There are several microscopic vegetable growths 
 which invade the urine. The most important are the 
 Penicilium glaucum, or common mould ; the To- 
 rula cerevisiw, and Saccharomyces cerevisice, or sugar 
 fungus. 
 
 Penicilium Glaucum — This fungus will appear 
 in any urine kept any length of time at an elevated 
 temperature. In warm weather, it sometimes makes 
 its appearance at the end of twenty -four or forty-eight 
 hours. 
 
 There may or may not be any very visible deposit ; 
 this depends upon the growth of the, fungus. But it is 
 often encountered under the microscope, when not 
 seen in the urine by the unassisted eye. 
 
 There is a vegetable part, the mycelium, and a 
 fructifying part, the Fig. 16. 
 
 spores. The mycelium 
 is nothing but an irregu- 
 lar ramification and in- 
 terlacement of fibres, 
 some of which shoot up- 
 ward toward the surface 
 of the fluid, and on 
 reaching it, develop 
 upon their extremities 
 the spores. And it is 
 simply by the arrange- Penicilium glaucum, 
 
 ment of these spores that we are able to distinguish 
 most of the different varieties of mould. In the 
 
50 EXAMINATION OF THE URINE. 
 
 penicilium glaucum, the spores are arranged in 
 projecting rows upon the stem. (Fig. 16.) They 
 ripen and fall, or are blown away to other quar- 
 ters ; but in either case, they immediately begin to 
 elongate, and then to branch, until a mycilium of 
 new growth is formed. We must see the spores while 
 yet on the stem, in order tp judge of the variety of 
 the fungus, for they so closely resemble other spores, 
 that it would be a difficult matter to recognize them 
 when once dislodged and separated. 
 
 Torula Carevisise. — This fungus was formerly 
 supposed to be the true sugar-mould, and its growth 
 in a solution considered a pretty sure evidence of the 
 presence of sugar. 
 
 But it is now known that it will show itself in 
 fluids where the most delicate chemical tests fail to 
 detect sugar. 
 
 It is very similar in appearance to the penicilium 
 just described, but can be distinguished by the arrange- 
 ments of its spores, they being arranged in spheres, 
 upon the end of the stem. 
 
 Saccharomyces Cerevisise — This is the growth 
 which we will find in saccharine solutions, and more 
 particularly concerns us, as its presence may deter- 
 mine whether a specimen of urine contains sugar in 
 those instances where chemical tests are not very 
 definite. 
 
 In order to become perfectly familiar with the 
 appearances of this fungus, I advise every one to do 
 the simple thing of making a solution of a little egg 
 
EXAMINATION OF THE URINE. 
 
 5L 
 
 albumen, honey, and water, and keep at a temperature 
 of about 100° F. for twelve hours, and examine the 
 sediment under a microscope. 
 
 We shall discover numerous round or ovoid bodies 
 of a brown color. Some will contain distinct nuclei. 
 Some will have budded, and appear as two or three 
 cells fused together. By careful examination, every 
 stage of this growth or budding will be seen, instances 
 where the new shoot is just appearing, and again a 
 distinct row of full- 
 grown cells. (Fig. 17.) 
 
 Vibriones. — These 
 are microscopic objects, 
 and are almost the low- 
 est order of the infuso- 
 rial animalcules. They 
 appear in decomposing 
 animal infusions, and are 
 common to urine during 
 the alkaline fermenta- 
 tion. They are about 
 go^o of an inch in length, and are in constant 
 motion. (Fig. 14, b.) They are propelled by a spiral 
 or corkscrew-like movement. 
 
 Saccharomyces cerivisiae. 
 
PART IV. 
 
 ACCIDENTAL INGREDIENTS WHICH DO NOT FORM 
 DEPOSITS. 
 
 There are certain abnormal substances which are 
 frequently present in urine, but are in such perfect 
 solution as to afford no evidence of their presence by 
 way of a deposit, and may have little or no effect 
 upon the natural color (with the exception of bile). 
 
 Such are albumen, sugar, and bile. (I shall not 
 consider those matters which, taken by the mouth, as 
 food or medicine, subsequently appear in the urine.) 
 
 Albumen. — Albumen frequently constitutes an 
 ingredient of the urine. As such, it is derived from 
 the blood, and, in fact, is a portion of it. It may be 
 the fluid albumen of the blood plasma which has 
 exuded through the renal circulation from congestion 
 or over-distention of the vessels; or it may be the 
 albuminoid corpuscles themselves which have been 
 mino-led with the urine as a result of a hemorrhage 
 somewhere in the tract. 
 
 Almost all the congestive diseases are accompanied 
 by albuminuria, and any interference in the return 
 flow of blood from the kidneys for any length of time 
 will almost surely be followed by albuminous urine. 
 Diseases affording this interference are pneumonia, 
 scarlet fever, and inflammatory affections generally. 
 The pressure of the pregnant uterus or any tumor 
 
EXAMINATION OF THE URINE. 53 
 
 upon the renal veins is a common cause of albumen 
 in the urine. And most important of all are the 
 affections of the kidneys themselves, whereby they 
 lose the power of eliminating the urine alone, but 
 allow constituents of the blood to escape at the same 
 time. We judge of the condition which produces 
 albuminuria very much by the presence or absence 
 of casts, and by the kind of cast which accompanies 
 the condition (see " Casts"), for casts and albumen 
 almost always exist together. Urine containing albu- 
 men is apt to be of less specific gravity than normal. 
 Albuminous urine froths on pouring from one vessel 
 to another, and this fact is the first, oftentimes, to 
 attract the attention of a patient. 
 
 Tests. — Albumen is precipitated by heat, the 
 mineral acids and their salts. But two of these are 
 necessary — heat and nitric acid. If heat is to be 
 applied, first see that the urine is acid ; if it is not, 
 add a drop or two of acetic acid. Now boil, and if a 
 precipitate come down, it can be nothing else but 
 albumen. On the other hand, if an alkaline urine is 
 subjected to boiling, the earthy phosphates are preci- 
 pitated and might lead to error. However, a drop 
 of any acid added to such a precipitate would quickly 
 decide the point. If it be phosphates, the acid will 
 dissolve them ; if albumen, it will not. (See " Phos- 
 phates.") It is best to have another test tube of 
 the same size filled with the unboiled urine for com- 
 parison, when any delicacy is necessary. Nitric acid 
 is the most delicate test. Incline the test-tube con- 
 taining the suspected urine, and allow a drop of ni- 
 tric acid to run down the side and gain the bottom. 
 
54 EXAMINATION OF THE URINE. 
 
 It will appear there as a perfectly clear layer, and if 
 albumen be present, a white stratum will be seen just 
 above it where the urine conies in contact with it. 
 
 An easy method to estimate the amount of albu- 
 men is to coagulate it by heat or nitric acid, and 
 allow the coagulum to settle to the bottom of the test- 
 tube. The amount compared with the quantity of 
 urine present, as J, i, etc., will enable us to detect any 
 change from day to clay. 
 
 Sugar. — There is a pathological condition marked 
 by the excretion of an enormous quantity of urine of 
 high specific gravity — 1030-1060, and containing 
 sugar. The disease is diabetes melitus. 
 
 It is an established physiological fact that the liver 
 produces sugar entirely independent of any starchy 
 or saccharine substances used as food ; but it is by ho 
 means established that the liver is the origin of the 
 sugar found in the urine. 
 
 The color of diabetic urine is most always light, 
 the specific gravity high. Albumen is frequently 
 present. 
 
 Tests. — If saccharine urine be boiled with liquor 
 potassse, it wall assume a dark brown or molasses 
 color. This is known as Moore's Test. It is unreli- 
 able in that any urine of high specific gravity will give 
 the same result. 
 
 If a little yeast be added to urine containing sugar, 
 
 fermentation will ensue, whereby carbonic acid gas 
 
 and alcohol will be produced. The gas escaping in 
 
 bubbles can be collected and tested. This is a good 
 
 test, but not very convenient. It is rarely resorted to, 
 
EXAMINATION OF THE URINE. 55 
 
 because we possess another, easier and entirely satis- 
 factory, namely : 
 
 Trommer's Test, — This method of determining 
 the presence of sugar in a solution is based upon the 
 fact that sugar possesses the property of reducing the 
 salts of copper in an alkaline solution at the boiling- 
 point. 
 
 The usual mode of applying this test is to add two 
 or three drops of a solution of sulphate of copper to 
 a quantity of the suspected fluid in a test-tube, and then 
 pour in an excess of liquor potassse. The whole 
 now assumes a deep, transparent blue color. Now boil, 
 and if sugar be present, the suboxide of copper will be 
 thrown down as a bright yellow precipitate (in some 
 cases an orange red). When this change occurs, the 
 blue color disappears entirely, and the mixture be- 
 comes perfectly opaque. 
 
 Unfortunately, when applied to the urine after the 
 above manner, these phenomena do not present them- 
 selves. Having added the copper and potassae, there 
 will appear the usual transparent blue color. Now 
 boil the solution, and almost invariably we fail to see 
 any thing like a yellow or red precipitate. Either 
 the blue color is entirely destroyed, and a dark, trans- 
 parent, molasses color appears, or there is a dirty green 
 precipitate. 
 
 Considerable lias been written concerning the in- 
 applicability of Trommer's test to the urine, the expla- 
 nation being that the organic constituents, urea, color- 
 ing matter, etc., interfere with the reduction of the 
 suboxide of copper. Directions have therefore been 
 
56 EXAMINATION OF THE URINE. 
 
 given to get rid of these matters by filtration through 
 finely-powdered animal charcoal. 
 
 This process is an efficient, but, as a general rule, 
 not a convenient one to the practicing physician. 
 Therefore, as a result of some recent investigations on 
 the subject, I submit the following hints and rules for 
 the application of Trommer's test to the urine as being 
 a perfectly simple and reliable method : 
 
 In the first place, it is necessary to have a great 
 excess of the test, because if the urine he in too great 
 quantity, the precipitate i$ dissolved, and on this fact 
 depends my method. 
 
 Judge by the specific gravity of the urine and the 
 history of the case whether there is much sugar present. 
 
 If the evidence is in favor of a considerable amount, 
 take about ten drops of the urine in a test-tube, and 
 add two drops of a solution of sulphate of copper 
 (strength, 13-1). If very little sugar is suspected, 
 take about ten drops and one drop of copper solution. 
 Now, add liquor potassee until the mixture assumes a 
 perfectly clear blue color. If the addition of the 
 potassse in excess induces a permanent milkiness 
 instead of a transparent blue, it is apt to be due to 
 too much copper having been added. Now, subject 
 the solution to boiling, and 
 
 If no sugar bepresent, a flocculent green precipitate 
 comes down, leaving the liquid colorless. 
 
 If sugar be present, an orange red or yellow pre- 
 cipitate will appear. 
 
 (When the sugar is in excess, the color of the pre- 
 cipitate is yellow. When the copper is in about 
 
EXAMINATION OF THE URINE. 57 
 
 proper proportion, the color of the precipitate is orange 
 or red.) 
 
 When the copper is in excess, the precipitate is 
 greenish yellow, but soon changes to orange. If no 
 change occur immediately, set the test-tube aside and 
 wait. 
 
 If a dark, molasses, transparent color manifest 
 itself, there is very probably sugar present, but too 
 much urine was used, and has dissolved the copper 
 precipitate ; therefore take the same quantity of 
 urine as before, and add four or five drops of the 
 copper solution. 
 
 Do not mistake the flocculi of the phosphates, 
 thrown down by the alkaline test fluid, for a precipi- 
 tate of the suboxide of copper. This latter is dark 
 red or yellow, and soon subsides to the bottom of the 
 test-tube, and is seen there as a compact little mass. 
 
 The main points of the foregoing method for the 
 application of Trommer's test to the urine are that, 
 1st. I have found the urine capable of dissolving the 
 copper precipitate. 2d. A certain quantity can only 
 dissolve a certain quantity of said precipitate. 3d. 
 Therefore take a very little urine to begin with, for 
 if ice use much xirine, we have to put in copper enough 
 to allow for the dissolving power of that amount of 
 urine and some over for the sugar to attack. Now, 
 before ice could produce a clear blue color by the 
 addition of potash solution, the test-tube would over- 
 flow. 
 
 The test with Feeling's Solution (for composition, 
 see p. 60) is based upon the same principle as the 
 foregoing, and if we have the solution, it is a very 
 
58 EXAMINATION OF THE URINE. 
 
 easy and reliable test. But it has to be made, and 
 when kept for any length of time, is liable to undergo 
 changes which unfit it for further use. 
 
 The way to use it is to take a test-tube a quarter full 
 and boil it. To this add a drop of the suspected 
 urine if much sugar is present ; if little, add ten or 
 fifteen drops. 
 
 Here we have the same principle as advised with 
 Trommer's test — namely, a small quantity of urine 
 and a great excess of the test fluid. 
 
 If any change occurs in the Fehling liquor when 
 boiled alone, it is unfit for use. 
 
 Bile. — The coloring matter of the bile is frequently 
 excreted with the urine, imparting to it a more or 
 less greenish-brown color. 
 
 It occurs in jaundice even before the skin has be- 
 come perceptibly colored, and continues a little while 
 after the natural color is restored. 
 
 The biliary salts, glykocholate and taurocholate of 
 soda, sometimes are present also, and it is frequently 
 important to know whether the bile is represented in 
 the urine solely by its coloring matter, or whether 
 these more important ingredients are there too. 
 
 Tests. — The coloring matter of bile can be detected 
 by pouring a little of the urine into a white plate, 
 and allowing it to come in contact with a few drops 
 of nitric acid. As the two mingle, a play of colors 
 will be observed, varying from a violet to a green. 
 Any oxidizing agent, tincture of iodine, or the 
 atmosphere, will produce a grass-green color. 
 
 To detect the biliary salts,~we must resort to Pet- 
 
EXAMINATION OF THE URINE. 59 
 
 tenkofer's test, as follows : Make a watery solution of 
 the urine, if the color be very marked, and pour about 
 3 ii of it into a test-tube. To this add a few drops of 
 a solution of cane-sugar (one part to four of water). 
 Then very gradually drop in sulphuric acid. The 
 mixture becomes heated by the action of the acid, 
 but must be kept below 50° F. Vqry soon, if the 
 biliary salts are present, and care is taken not to 
 agitate the mixture, a red color will appear at the 
 bottom of the test-tube. Xow, cease adding the acid. 
 The red gradually changes to a crimson, and finally 
 a beautiful claret pervades the whole. # 
 
 It is this play of colors which constitutes the most 
 characteristic feature of the test. 
 
PAKT V. 
 QUANTITATIVE ANALYSIS. 
 
 SUGAR — UREA, 
 
 There are only two substances of which the medi- 
 cal man will be often called upon to estimate the 
 quantity in the urine — they are sugar and urea. 
 
 Sugar. — The quantitative analysis of sugar in the 
 urine is performed with Fehling's solution, which has 
 the following composition : 
 
 Sulphate of copper, . . 90 £ grains. 
 Neutral tartrate of potash, . 364 
 Solution of caustic soda (sp. gr. 1.12), 4 fluid 
 ounces. 
 Add water to make exactly six fluid ounces. 
 
 The following apparatus is necessary : 200 grain 
 measure ; burette graduated to grains ; 8 1 flask ; spi- 
 rit-lamp and stand upon which to place the flask to 
 boil its contents. 
 
 Fehling's solution contains a definite amount of 
 sulphate of copper in an alkaline solution. The gra- 
 duation in the above formula is such that 200 grains 
 of the solution correspond, or are decomposed by 1 
 grain of sugar ; and when this decomposition has 
 taken place, of course the blue color of the sulphate 
 of copper is gone. 
 
EXAMINATION OF THE URINE. 61 
 
 So, proceed as follows: Diabetic urine usually con- 
 tains so much sugar that it is best to dilute it in this 
 analysis : as much as one in ten, if sugar be very 
 abundant ; one in five or pure urine, if in small pro- 
 portion. Suppose we wish to dilute it as much as 
 one in ten : take 4 J ounces of water and -J- ounce of 
 the urine and mix well. Now, measure out 200 grains 
 of the copper solution and pour it into the flask. 
 This had also better be diluted with twice its bulk of 
 water, then set it to boil. Then, if you have a bu- 
 rette, fill it up w r ith the diluted urine to the O mark. If 
 a burette is not at hand, measure out a certain quan- 
 tity, and remember it, for you will wish to know how 
 much of the diluted urine has been used. By this 
 time, the blue liquid in the flask is boiling. Now, very 
 carefully add drop by drop the urine from the burette 
 or what you have measured, and watch the result. 
 As the saccharine urine comes in contact with the cop- 
 per solution, some of the latter is decomposed, and 
 appears as a red powder. Let it boil after each addi- 
 tion of the urine. 
 
 A time will at length arrive when all the blue color 
 will have disappeared, and a red, insoluble powder 
 taken its place. 
 
 Cease the whole operation every little while, and 
 let this red oxide of copper settle, when it will be 
 easier to determine whether any blue color yet remains 
 in the supernatent liquid. During the last part of the 
 operation, proceed very, carefully, for there is great 
 danger of adding too much sugar, and then immedi- 
 ately the whole experiment is spoiled. The mixture, 
 under these circumstances, will turn suddenly of a 
 
G2 EXAMINATION OF THE URINE. 
 
 molasses color, the result of the action of a boiling 
 alkali upon the sugar. 
 
 Having been cautious then, suppose you have added 
 diluted urine until the blue color has entirely dis- 
 appeared. Now, then, refer to your burette or mea- 
 sured quantity which you poured out to commence 
 with. How much of the diluted urine has been used ? 
 Say 250 grains. But this is only one tenth urine ; we 
 have therefore only used 25.0 grains pure urine. 
 These 25.0 grains of the pure urine contain one grain 
 of sugar, because it has reduced the copper in 200 
 grains of the standard Fehling's solution. Divide 25 
 into 100, and we have the percentage of sugar in the 
 specimen of urine, or 4 per cent. 
 
 Fehling's solution is liable to undergo spontaneous 
 decomposition, as has been before mentioned, and it 
 should always be boiled thoroughly before using ; if 
 perfect, no change in color is induced by boiling. 
 
 In order to obviate this disadvantage of the decom- 
 position of Fehling's solution, Professor Chandler re- 
 commends the following method, and to those familiar 
 with the French system of weights and measures, it is 
 superior to any other : 
 
 Take 34.639 grammes of copper sulphate, and dis- 
 solve in 1 litre of water ; 10 cubic centimetres of this 
 correspond to .05 grammes of sugar ; 10 c.c. of this 
 copper solution, therefore, are placed in a flask and di- 
 luted with about four times as much water. Now, put 
 in a pinch of tartaric acid (to prevent the precipitation 
 of the hydrate of copper when the potash is added). 
 Shake the mixture, and then pour in a solution of 
 potassic hydrate until the whole assumes a clear blue 
 
EXAMINATION* OF TriE URINE. 63 
 
 color. Now, proceed exactly as directed in tlie other 
 case, except that instead of grains of urine, we mea- 
 sure out cubic centimetres. That is, take 2 c.c. of 
 urine, if the sugar present be in large proportion, and 
 dilute it with 18 c.c. of water. Now, the mixture 
 consists of one tenth urine. (This dilution is resorted 
 to in order that we may add the sugar more gradually, 
 and not overadd it.) 
 
 Suppose, then, we have used 20 c.c. of the diluted 
 urine ; but this only contains one tenth, or 2 c.c. of 
 pure urine. Therefore : 2 c.c. : .05 grammes of sugar:: 
 100 : quantity of sugar = 2.5 per cent. 
 
 The advantage of this method depends upon the 
 fact that the copper, tartaric acid, and potash are not 
 mixed until we wish to perform the analysis, and 
 therefore do not deteriorate by keeping. 
 
 Urea. — The daily quantity of urea excreted fre- 
 quently becomes of importance, and various methods 
 of estimating it have been advised. None are so 
 simple as the one proposed by Dr. Davy, of England.* 
 Doubts having arisen as to its accuracy, I undertook a 
 series of experiments in order to ascertain if they 
 were well founded.f The results of these experiments 
 led me to the conclusion that the method was in every 
 respect sufficiently accurate for practical purposes, and 
 I therefore introduce it here as the one best adapted 
 to the physician who wishes to perform the analysis 
 himself. 
 
 The analysis depends upon the decomposition 
 
 * Philosophical Mag. 1854. \ New-York Med. Jour., Sept. 1872. 
 
G4 EXAMINATION OF THE URINE. 
 
 which ensues when urea is brought in contact with 
 the hypochlorite of soda, potash, or lime. 
 
 Nitrogen gas is evolved, and being collected and 
 measured, the amount of urea originally present is 
 estimated. The following are Dr. Davy's directions: 
 
 U A strong glass tube, about twelve or fourteen 
 inches long, closed at one end, and its open extremity 
 ground smooth, and having the bore not larger than 
 the thumb can conveniently cover, holding from two 
 to three cubic inches, each divided into tenths and 
 hundredths by graduation on the glass, is tilled more 
 than a third full of mercury, to which afterward a 
 measured quantity of urine to be examined is poured, 
 which may be from a quarter of a drachm to a drachm 
 or upward, according to the capacity of the tube. 
 Then, holding the tube in one hand, near its open ex- 
 tremity, and having the thumb in readiness to cover 
 the aperture, the operator fills it completely full with 
 a solution of the hypochlorite of soda (taking care 
 not to overflow the tube), and then instantly covers 
 the opening tightly with the thumb, and having rapid- 
 ly inverted the tube once or twice, to mix the urine 
 with the hypochlorite, he finally opens the tube under 
 a saturated solution of common salt and water, con- 
 tained in a steady cup or mortar. The mercury 
 then flows out, and the solution of salt takes its 
 place, and the mixture of urine and hypochlorite 
 being lighter than the solution of salt, will remain in 
 the upper part of the tube, and will therefore be pre- 
 vented from descending and mixing with the fluid in 
 the cup. A rapid disengagement of minute bubbles 
 of gas soon takes place in the mixture in the upper 
 
EXAMINATION OF THE URINE. 65 
 
 part of the tube, and tlie gas is there retained and 
 collected. The tube is then left in the upright posi- 
 tion till there is no further appearance of minute glo- 
 bules of gas being formed, the time being dependent 
 upon the strength of the hypochlorite and the quan- 
 tity of urea present. But the decomposition is usually 
 completed in from three to four hours ; it may, how- 
 ever, be left much longer, even for a day if convenient, 
 and having set the experiment going, it requires no 
 further attention ; and when the decomposition is 
 completed, it is only necessary to read the quantity of 
 gas produced off the scale on the tube. In cases 
 where great accuracy is required, due attention must 
 be paid to the temperature and atmospheric pressure, 
 and certain corrections made if these should deviate 
 from the usual standards of comparison, at the time 
 of reading off the volume of gas ; but in most cases, 
 sufficiently near approximation to accuracy may be 
 obtained without reference to those particulars." 
 
 It has been found by calculation that one cubic inch 
 of gas corresponds to .64 of a grain of urea. There- 
 fore, multiply the amount of gas by .64, and the pro- 
 duct will be the amount of urea in the mixture. Ac- 
 cording to the volume of urine employed, it is an easy 
 matter to determine how much an ounce of the urine 
 would contain, and from this, the total excretion of 
 urea per day. 
 
 There are one or two sources of error to be avoid- 
 ed. Ammonia and uric acid will give rise to nitrogen 
 gas, and thereby increase the apparent amount of urea. 
 It is the ammonia which is most likely to exist in 
 quantities sufficient to cause confusion, and we must 
 
GO 
 
 EXAMINATION OF THE URINE. 
 
 get rid of it by " gently heating the urine with a cer- 
 tain quantity of baryta-water as long as the odor of 
 ammonia is disengaged, and then filter the solution." 
 The apparatus necessary to perform 
 this analysis is shown in Fig. 18. The 
 graduated tube can be procured of 
 Benjamin & Co., No. 10 Barclay 
 street. 
 
 The hypochlorite of soda is pre- 
 ferable to either that of lime or pot- 
 ash, because it is easily procured, be- 
 ing an article in general use under the 
 name "Liquor Sodee Chlorinate," or Labarraque's 
 Solution. But there are various preparations of this 
 solution, both foreign and domestic, which do not 
 correspond in strength, and are not universally kept 
 on sale. Therefore, I used in my .experiments, a pre- 
 paration of reliable manufacture, and the one most 
 generally sold in the United States, namely, 
 " Squibb's Liquor Sodae Chlorinate," and I advise 
 its use in connection with this analysis. 
 
 Fig. 18. 
 
PART VI. 
 
 CALCULI AND GRAVEL. 
 
 We have seen that the urine is' subject to a variety 
 of deposits. Now, some of these are precipitated 
 within the urinary passages under certain conditions, 
 in a manner to form solid masses of considerable size. 
 
 When the masses are small enough to be voided by 
 the urethra, or pass from the kidney to the bladder, 
 they are called gravel. During their passage, they fre- 
 quently cause excessive pain, and by the irritation to 
 the urethra or ureter, induce spasmodic contractions 
 of those canals, and subsequent severe inflammation. 
 
 It is important to be aware that the conditions 
 which give rise to these small concretions are the 
 same which favor the formation of larger ones, or 
 calculi. 
 
 Also gravel is in most cases the cause of larger con- 
 cretions, as we will presently see. 
 
 Calculi. — By a urinary calculus or stone, we mean 
 those solid concretions found in the bladder and kid- 
 ney, and which vary in size from that of a pea to a 
 hen's egg. They differ in composition as well as in 
 general form and texture. 
 
 As regards composition, the most common are as 
 follows : uric acid, oxalate of lime, urates^phospliatic^ 
 and cystine. 
 
68 EXAMINATION OF THE URINE. 
 
 There are several other extremely rare varieties, as 
 ii r osteal it h, xanthine, and carbonate of lime. 
 
 A stone is very rarely composed of one substance alone ; 
 but is made up of alternating and varying concentric 
 layers of different deposits. This happens as follows: 
 A few crystals of uric acid, of oxalate of lime, or a 
 mass of mucus, a clot of blood, or some foreign sub- 
 stance accidentally introduced into the bladder, serves 
 as a nucleus. Then the necessary conditions prevail- 
 ing, we get a deposit of a layer, either of uric acid cr 
 something else ; and thus the stone grows until finally 
 its presence is irritating, and it begins to act as a foreign 
 body ; and if it be removed at this stage, we shall 
 have a pretty pure stone of uric acid, or whatever the 
 predominating deposit up to this time has been. In- 
 flammation follows, whereby the mucous membrane 
 throws oif an extra quantity of mucus, which, min- 
 gling with the urine, induces fermentation. As a 
 result of this, the urea is decomposed, and carbonate 
 of ammonia appears, to render the urine alkaline ; 
 and then, of course, the earthy phosphates are preci- 
 tated and add another layer to the stone. And so 
 the very presence of the calculus conduces to its own 
 growth. 
 
 As before stated, w x e are not likely to have a stone 
 made up of one material ; yet this may be the case, or, 
 at any rate, one particular substance may predomi- 
 nate and thereby impart its characters to a stone. 
 
 Uric Acid. — Uric acid is the most common of all 
 deposits going to form calculi. The nucleus of almost 
 every stone is composed -of crystals of this substance, 
 
EXAMINATION OF THE URINE. 69 
 
 and not unfrequently we see it constituting a stone 
 almost entirely, especially if it be removed before the 
 alkaline fermentation ensues. 
 
 When this is the case, the size rarely exceeds that of 
 a pigeon's egg. The color ranges from a brick-dust 
 red to a fawn, and the surface is generally covered 
 with little tubercles. If, however, there were more 
 than one stone in the bladder, friction of their sur- 
 faces would tend to make them smooth. 
 
 They are usually spherical, and slightly flattened. 
 When sawed in half, their concentric laminae are very 
 distinctly seen. 
 
 When a stone of this composition exists in the 
 bladder, the urine is acid. 
 
 Tests. — The murexid test is the most direct and 
 characteristic. Place a fragment of the stone in a 
 clean porcelain capsule, and add one or two drops of 
 nitric acid ; now evaporate k the acid by gentle heat 
 over the flame of a spirit-lamp, and a pink color will 
 appear, which changes to a purple when a little am- 
 monia is dropped in. 
 
 Uric acid is soluble in an alkali. 
 
 Under the blow-pipe, it is consumed, being of organ- 
 ic origin, and a black ash remains. 
 
 Urates. — Stones composed wholly of the urates are 
 rare, though this deposit frequently alternates with 
 others. 
 
 When pure, they are small, and are apt to originate 
 in the kidneys. Most frequently these calculi are 
 met with in children. 
 
70 EXAMINATION OF THE URINE. 
 
 The urine will have an acid reaction where these 
 concretions exist. 
 
 They are more or less of a red or brick-dust color. 
 
 Tests. — The fact of their solubility in warm water 
 will prove the presence of the urates. 
 
 Oxalate of Lime. — Like other deposits, the oxalate 
 of lime more frequently forms a stone by alternation, 
 especially with uric acid. The nucleus may be uric 
 acid or oxalate of lime. When the latter exists alone 
 or predominates, the stone is exceedingly hard and 
 rough ; in fact, it has been called the mulberry calcu- 
 lus, from its warty and irregular surface. 
 
 When the concretions of this formation are small 
 enough to be classed as gravel, and arc voided with the 
 urine, they may be smooth. Here, however, there is 
 a mixture of the urates, and the formation has proba- 
 bly taken place in the kidneys, and by their number 
 the surfaces are worn. 
 
 In color, these stones are sometimes dark brown or 
 even black, and again almost white. 
 
 Most mixed calculi contain layers of oxalate of 
 lime. 
 
 The urine will be strongly acid. 
 
 Tests. — Oxalate of lime is soluble in the mineral 
 acids. Under the blow-pipe, it is reduced to a dark 
 ash, and when this ash is touched with moistened red 
 litmus-paper, it turns it blue — caustic lime being the 
 residue of the combustion. 
 
 PHOSPHATES. 
 
 AVe have seen that an alkaline condition of the 
 urine would precipitate the earthy phosphates, and 
 
EXAMINATION OF THE URINE. 71 
 
 that the alkalinity may be due to two causes, only 
 one of which is concerned in the formation of phos- 
 phatic calculi. We have said that the alkalinity of 
 the fixed salts may continue for a length of time with- 
 out a stone being found ; because the phosphatic pre- 
 cipitate will then be amorphous, and has little ten- 
 dency to form concretions. But when putrefaction 
 occurs from retention of urine, or the action of in- 
 flammatory products anywhere in the urinary pas- 
 sages, then we have carbonate of ammonia developed, 
 and now crystals of the ammonio-magnesian or triple 
 phosphate are thrown down, as well as the amorphous 
 phosphate of lime. 
 
 It is the aramoniacal decomposition, then, which 
 most influences the formation of phosphatic calculi. 
 
 Sometimes, after prolonged administration of alka- 
 line medicines, and as a result of high living where 
 the urine is kept alkaline by the fixed salts, we have a 
 jphosjj/iate of lime calculus formed. 
 
 These stones are light colored, easily broken, and 
 present an earthy fracture. They rarely alternate with 
 other forms. 
 
 Tests. — Phosphate of lime is insoluble in water ; 
 soluble in a weak acid, and is practically infusible un- 
 der the blow-pipe. 
 
 Mixed or Triple Phosphates.— Deposits of this 
 nature axe the result of the ammoniacal decomposition 
 of urine, and consist of the crystalline ammonio-mag- 
 nesian phosphate with the amorphous phosphate of 
 lime. They rarely constitute the whole or interior of 
 a stone, but are generally added as the result of the 
 
72 EXAMINATION OF THE URINE. 
 
 presence of a pre-existing calculus, the irritation of 
 which has induced the decomposition just mentioned. 
 And it is a fact, that almost every stone, if it remains 
 long enough in the bladder, will be encrusted with 
 several layers of the mixed phosphates. 
 
 So long as the ammoniacal decomposition continues, 
 there will be no more layers of uric acid, urates, or of 
 oxalate of lime; so that the interior of a stone may 
 present a variety of deposits, while the crust is com- 
 posed entirely of the phosphates. 
 
 Accordingly, stones of this description sometimes 
 attain to enormous dimensions. 
 
 These calculi are chalk-colored, and have a glisten- 
 ing appearance on account of the presence of the 
 crystals of the triple phosphates on their surface. 
 
 Tests. — Under the blow-pipe, the mixed phosphates 
 readily fuse into a white enamel (and they have there- 
 fore been sometimes called the fusible calculi), and 
 give off ammonia and water. They are soluble in 
 weak acids. 
 
 Cystine. — This substance sometimes forms calculi 
 and gravel. The number of cases is very limited, 
 and very few specimens of the concretion exist. 
 The stone is quite small, not larger than an almond, 
 and of a dirty brown or greenish color. There appear 
 to be no distinct laminee, but rather a radiating struc- 
 ture. The pathology is obscure. 
 
 Tests. — Cystine is soluble in the mineral acids ; in- 
 soluble in water, organic acids, and carbonate of am- 
 monia. Place a piece of the stone in contact with 
 caustic ammonia, and allow the latter to evaporate, 
 when the characteristic six-sided crystals of cystine 
 will be visible under the microscope, 
 
SCHEME FOR EXAMINATION OF URINE. 
 
 Proceed in the following manner : 
 
 1. Odor. 
 
 2. Color. 
 
 3. Transparency. 
 
 4. Reaction to test-paper. 
 
 5. Specific gravity. 
 
 6. Daily quantity. 
 
 7. Any deposit. 
 
 8. Apply reagents. 
 
 Heat. 
 
 PRECIPITATES. 
 
 DISSOLVES. 
 
 \ Albumen. 
 j Phosphates. 
 
 Urates. 
 
 Nitric Acid. 
 
 Albumen. 
 
 Phosphates. 
 
 Liq. Potassae. 
 
 Phosphates. 
 
 
 This table will be all that is necessary in the ma- 
 jority of cases, and for the sake of simplicity, I omit 
 the various complications, such as cystine, pus, bile, 
 chyle, etc., for which see the text. 
 
SCHEME NO. 2. 
 
 NORMAL. 
 
 Urine, acid -f- heat gives no result. 
 
 " alkaline -f- lie at gives earthy phosphates. 
 
 " -f- nitric acid gives no result except darkening 
 
 the color. 
 u -f- potassa gives earthy phosphates. 
 " -f- nitrate baryta gives alkaline sulphates. 
 " -f~ nitrate silver gives chlorides. 
 
 ABNORMAL. 
 
 Urine (slightly acid) -\- heat gives albumen. 
 
 " -f- n itric acid gives albumen. 
 Other reactions same as normal urine. 
 The other abnormal ingredients, blood, pus, cystine, 
 
 spermatozoa, etc., are readily recognized under the 
 
 microscope. 
 
GENERAL DIRECTIONS. 
 
 Urine intended for examination should be placed in 
 a conical-shaped glass vessel, such as an ordinary ale- 
 glass, in order that any deposit which may appear 
 shall be concentrated in a comparatively small space ; 
 for if there is a very minute quantity, we otherwise 
 might not be able to secure a specimen for the micro- 
 scope. 
 
 After the specimen has stood for six or eight hours, 
 very gently pour off all but about half an ounce. 
 This is done in order to prevent the deposited crys- 
 tals, casts, or whatever is there, from becoming again 
 mingled with a great quantity of urine when it is 
 agitated by our subsequent manipulations. 
 
 Now, having provided yourself with a drop-tube, 
 which be sure is clean, place the finger over the large 
 end, and direct the other end to the bottom of the 
 glass ; raise the finger, and the urine ascends in the tube ; 
 replace the finger, and we have it confined there. 
 Touch the point of the tube thus supplied upon a 
 clean glass slide, and a drop will escape, which is all- 
 sufficient. A thin glass cover is placed over this drop 
 on the slide in a manner to exclude air-bubbles, as 
 follows : place one side of the cover on the slide and 
 allow it to come gradually down. If the cover floats, 
 there is too much urine, which will overflow^ it, and 
 obscure the lens. Under such circumstances, just 
 absorb the surplus urine with a little blotting-paper. 
 
 We need a good J-inch lens for the examination of 
 urinary deposits, and sometimes a -J-inch in order to 
 distinctly discern small hyaline casts. 
 
LIST OF APPARATUS AND REAGENTS RE- 
 QUIRED. 
 
 Absolutely necessary. 
 
 Special ap- 
 paratus. 
 
 APPARATUS. 
 
 \ doz. 4-inch test-tubes. 
 Test-tube rack. 
 Alcohol lamp. 
 Small glass funnel. 
 Filter -paper to fit funnel. 
 Red and blue litmus paper. 
 $2.60. 
 
 ' Glass flask, 81. ) ^ ,., \. 
 
 r* i . '. . f (Quantitative an- 
 
 (Jubic centimetre or V ^ -, . r 
 
 ( alysis oi sugar, 
 gram measure. ) J 
 
 ni > . r -, , ) Quantitative an- 
 
 GJass tube graduat- f -i • * 
 
 ed to cubic inches. 
 
 alysis of urea. 
 
 $2. 
 
 Nitric acid, 41. 
 Acetic acid, 41. 
 Sulphuric acid (pure), 41 . 
 Solution caustic potassse (20 gr.-l ■ 
 Sol. copper sulphate (1 3 -1 1 ), 4 1 , 
 Sol. silver nitrate (10 gr.-l 1 ), 4 1 
 Sol. barium nitrate (10 gr.-l 1), 4: 
 
 $4. 
 
INDEX 
 
 Acid, Effect of, upon Normal Urine 10 
 
 Acid Fermentation 12 
 
 Albumen 52 
 
 Abnormal Urine 16 
 
 Alkalies, Effect of, upon Normal Urine. . . . , 10 
 
 Alkaline Fermentation 13 
 
 B 
 
 Baryta, Nitrate of, as Reagent 10 
 
 Bile 58 
 
 Blood 32 
 
 Calculi, 67 
 
 Cystine 72 
 
 " Phosphates 70 
 
 ' ' Oxalate of Lime 70 
 
 " Urates 69 
 
 " Uric Acid 68 
 
 Casts 35 
 
 " Blood 40 
 
 " Epithelium 39 
 
 k ' Fatty 39 
 
 ' ' Granular 40 
 
 ■" Hyaline 38 
 
 " Pus 41 
 
 " Waxy 41 
 
 Changes in Urine on standing 11 
 
78 INDEX. 
 
 Chlorides \ 10 
 
 Chylous Urine 44 
 
 Color of Normal Urine 6 
 
 Color of Abnormal Urine 16 
 
 Cold, Effect of, upon Urine 9 
 
 Composition of Urine 5 
 
 Cystine . 47 
 
 D 
 
 Daily Quantity of Normal Urine 8 
 
 " " " Abnormal Urine 19 
 
 Deposits 21-51 
 
 E 
 
 Epithelium 29 
 
 Bladder 29 
 
 Renal 30 
 
 Urethral 29 
 
 Vaginal 29 
 
 Extraneous Matters in Urine 36 
 
 F 
 
 Fehling's Solution, Composition of 60 
 
 G 
 
 Gravel , 67 
 
 H 
 
 Hematuria 33 
 
 HcTematinuria 35 
 
 Heat, Effect of, upon Normal Urine 9 
 
 K 
 
 Keistine 48 
 
 L 
 
 Lead, Subacetate of, as Reagent 10 
 
INDEX. 79 
 
 M 
 
 Moore's Test for Sugar 54 
 
 Mould Fungus 49 
 
 Mucus 30 
 
 N 
 
 Normal Urine, Characters of 5 
 
 O 
 
 Odor of Normal Urine 5 
 
 1 ' " Abnormal Urine 16 
 
 Oil in Urine 43 
 
 Oxalate of Lime 11 
 
 " " Calculus 70 
 
 P 
 
 Penicilium Glaucum 49 
 
 Pigments 31 
 
 Phosphates 12, 14, 25, 70 
 
 Earthy 25 
 
 Stella 25 
 
 Calculi 70 
 
 Pus * 42 
 
 Q 
 
 Quantitative Analysis 60 
 
 of Sugar 60 
 
 of Urea 63 
 
 R 
 
 Reaction of Normal Urine 6 
 
 " " Abnormal Urine 17 
 
 Reagents, Effects of, upon Normal Urine 9 
 
 S 
 
 Saccharomyces Cere visise 50 
 
 Silver Nitrate, as Reagent 10 
 
80 INDEX. 
 
 Specific Gravity of Normal Urine 7 
 
 " " " Abnormal Urine 19 
 
 Spermatozoa 4G 
 
 Sugar, Tests for 54, 57 
 
 " Quantitative Analysis of 60 
 
 " Mould 50 
 
 Sulphates, Alkaline •. 10 
 
 T 
 
 Transparency of Normal Urine 6 
 
 " " Abnormal Urine 17 
 
 Torula Cerevisia? 50 
 
 Triple Phosphates 12, 26, 70 
 
 Trommer's Test for Sugar 55 
 
 U 
 
 Urates. 23 
 
 " Calculi 69 
 
 Urea 11 
 
 " Quantitative Analysis of. 63 
 
 Uric Acid 11, 21,68 
 
 " " Calculi 68 
 
 Urinary Deposits 9 21 
 
 V 
 
 Vegetable Fungi 49 
 
 Vibriones 51 
 
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