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I']R "yr7 f 7 O _ ■■ ’' 7Q. Q A GUIDE 
TO THE 
EXAMINATION OF THE URINE. WORKS BY THE SAME AUTHOR. 
A Treatise on Hcemophilia sometimes called 
the Hereditary Haemorrhagic Diathesis. Fcap. 4to, ys. 6d. 
“ The book now lying before us contains an exhaustive examination and 
discussion of the literature relating to hemophilia. In one chapter several 
cases occurring under the author’s own observation are detailed. Dr. 
Legg is thoroughly acquainted with the German literature on this sub- 
ject, and the book may therefore be recommended to all persons specially 
interested in it. The get up of the book is such as has not yet been at- 
tained by German publishers.’’—Medicinish-chirurgische Rundschau. 
The author has enjoyed the opportunity of making numerous observa- 
tions upon bleeders ; and by a conscientious use of the literature of the 
subject, he has succeeded in producing a most excellent work, which not 
only supplies a deficiency amongst English books, but also contains many 
original observations and theories, new to German science.”—Schmidt’s 
Jahrbiicher. 
“ Dr. Legg deserves the thanks of the profession for this exceedingly 
painstaking and laborious compilation, which, containing as it does the 
opinions of 163 writers who have touched upon the disease, cannot fail to 
impart to its readers as much learning on the subject as it is possible to 
derive from mere book-reading We are deeply indebted to Dr. Legg 
for this painstaking monograph, which comes before the world in a most 
elegant form, and is a credit alike to the author and publisher.”—Lancet. 
A Guide to the Examination of the Urine; 
intended chiefly for Clinical Clerks and Students. Fourth 
edit. fcap. Bvo, cloth. 
Notices of the Press of Third Edition. 
“We are glad to see that the merits of this little book have been so fully 
appreciated as to have called for a third edition.”—Lancet. 
“We are glad to welcome this little work Just what was wanted.”— 
British Med. Journal. 
“ Dr. Wickham Legg’s little book is well calculated to assist the student 
in the acquisition of an exact and methodical manner of carrying on an 
examination of the urine. It has already reached a second edition, and we 
have no doubt will prove a popular and useful guide to students.”—Dublin 
Quarterly Journal. 
On Diseases of the Liver. 
Vol. I, Containing the Physiology of the Liver, Signs 
of Disease of the Liver, Ascites, Jaundice, and 
Diseases of the Hepatic Vessels. Preparing. A GUIDE 
TO THE 
EXAMINATION OF THE URINE 
DESIGNED CHIEFLY 
FOR THE USE OF CLINICAL CLERKS AND 
STUDENTS 
BY 
J. WICKHAM LEGG, M.D. 
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 
DEMONSTRATOR OF MORBID ANATOMY IN SAINT BARTHOLOMEW’S HOSPITAL. 
PHILADELPHIA: 
LINDSAY AND BLAKISTON, 
M.DCCC. LXXVI. 
[All rights reserved.} INTRODUCTION. 
This little work is intended to supply the 
clinical clerk and student of medicine with a 
concise guide to the recognition of the more 
important characters of the urine; and from its 
small size to serve as a companion at the bedside 
to the busy practitioner, who may be unable to 
consult the larger works on the subject. A plan 
for the examination of the urine, step by step, 
has been given, with an account of the method 
for ascertaining the nature of those alterations 
that most frequently occur in disease. An ap- 
pendix has been added in which the manner of 
estimating the urea, chlorides, phosphates, sugar, 
&c., by volumetric or other rapid analysis has 
been described. 
London, September, 1869, ADVERTISEMENT TO THE FOURTH 
EDITION. 
The fourth edition has been carefully revised. 
An account of Dr. Russell and Dr. Samuel 
West’s method of estimating urea has been 
added to the appendix. 
47 Green Street. 
June 17, 1876. A GUIDE 
TO THE 
EXAMINATION OF THE URINE. 
In order that the examination of the urine may- 
be made on a definite plan, the following- 
scheme, in which the most important clinical 
facts are directed to be ascertained, is recom- 
mended to the student. The order of examina- 
tion that is here given should be followed, the 
details of each operation being described on the 
page stated at the end of each paragraph. 
SCHEME FOR THE EXAMINATION OP 
THE URINE. 
I. Observe the colour of the urine, its appear- 
ance, if clear, smoky, turbid, &c. (page 3.) 
11, Ascertain the specific gravity, (page 6.) 
111. Examine the reaction, whether acid, neutral, 
or alkaline, by means of litmus or turmeric 
paper, (page 9.) 2 
SCHEME OF EXAMINATION. 
IV. Test the urine for albumen, (page n.) If 
albuminous, look with the microscope for— 
renal casts, (page 63.); pus corpuscles, (page 
56.) ; red blood corpuscles, (page 58.) 
V. Test the urine for sugar, (page 18.) 
VI. If there be no albumen or sugar present, 
and no deposit, the urine need not be further 
examined, unless some special indication exist. 
VII. But if any sediment (page 42.) be observed, 
it must be examined with the microscope : 
the following enumeration of the more com- 
mon deposits may help the student: 
Pink or reddish deposit, dissolved on heat- 
ing test-tube—urate of soda, (page 47.) 
White crystalline deposit, soluble in acetic 
acid—phosphates, (pag-e 50.) 
Hummocky white sharply defined cloud, 
insoluble in acetic acid—oxalate of lime, 
(page 49.) 
White amorphous flocculent deposit—ren- 
dered ropy by alkalies—pus, (page 56.) 
Brownish-red crystalline deposit—uri,c acid, 
(page 44.) 
Red amorphous deposit—blood, (page 58.) 3 
COLOUR OF URINE, 
PHYSICAL EXAMINATION. 
The physical examination of the urine is the 
application of the senses to its investigation with- 
out the employment of chemical or microscopical 
aids. The colour, translucency, odour, and con- 
sistence are the only characters which can be 
ascertained by this simple method of observation. 
Colour. Urine is ordinarily of a reddish yel- 
low colour; but it may be as colourless as 
water, or dark brown black like porter; a smoky 
tint is absolutely diagnostic of the presence of 
blood; a brownish green suggests the presence 
of the colouring matter of the bile. Many drugs, 
as rhubarb, saffron, and santonin, give a pecu- 
liar red colour to the urine. The carbolic acid 
treatment of wounds colours the urine black. 
Tannin given by the mouth renders the urine 
colourless. 
A pale urine is seen in health, as the urina 
potus; and in disease, in anaemia, diabetes, 
nervous disorders, and convalescence from 
acute diseases. A pale urine contains little 
colouring matter, and but a small proportion 
of solid constituents, always excepting, however, 
the urine of diabetes mellitus. A pale urine is a 4 
TURBIDITY OF URINE. 
sign that the patient is not suffering any high de- 
gree of pyrexia. A high coloured urine occurs, 
in health, after food as the urina cibi, and after 
strong exercise ; and in disease, in fevers, and 
most acute diseases, in which considerable meta- 
morphosis of the tissues takes place. It contains 
much colouring matter and urea in proportion to 
the water. A dark urine should be examined 
for pigment. (See the section on pigment, page 
30.) A dirty bluish coloured urine is sometimes 
seen in cholera and typhoid fever. 
Translucency. In health, the urine deposits, 
after remaining at rest for a short time, a slight 
cloud of mucus, derived from the bladder and 
urinary passages; but, in all other respects, 
healthy urine is perfectly clear. On cooling, 
however, it may sometimes become turbid from 
the presence of urates, which are distinguished 
from other deposits by their appearing upon the 
cooling of urine which was perfectly clear when 
first passed. Should the urine be turbid when 
first voided, it is a mark of disease; and pus is 
the most frequent cause of this appearance. 
Odour. It is not yet ascertained to what sub- 
stance the peculiar smell of the urine is due, nor 
is it of much importance to the clinical student. CONSISTENCE OF URINE. 
5 
When the urine loses its natural smell and be- 
comes foetid and ammoniacal, the change is due to 
the decomposition of urea into carbonate of am- 
monia, and the formation of sulphur compounds; 
in cases of cystitis and paraplegia the alteration 
begins very quickly after being voided. Various 
drugs, as cubebs, and articles of diet as aspa- 
ragus, give a characteristic smell to the urine; 
turpentine gives the odour of violets to the se- 
cretion. 
Consistence. The urine is a limpid fluid, flow- 
ing- freely from one vessel to another. But in 
catarrh of the bladder, and in retention of urine, 
the ammoniacal products of the decomposition of 
the urea render the pus present thick and viscid, 
thus causing- the secretion to be ropy, and poured 
with difficulty from one vessel to another. 
The froth on normal urine readily disappears: 
but if the froth be permanent, the presence of 
albumen, or of the constituents of the bile, may 
be suspected. 
Before passing to the mechanical and chemi- 
cal examination of the urine, it may be well to 
mention the apparatus and reagents which will 
be found necessary by the student for bedside 
investigation. They are: 6 
SPECIFIC GRAVITY. 
Cylindrical Urine Glasses, each containing 
about 6 fluid-ounces. 
A Urometer, the stem of which is graduated 
from 1000 to 1060. 
Blue and Red Litmus and Turmeric Paper, 
Test Tubes. 
A Spirit Lamp, or Bunsen’s Gas-Burner. 
Nitric Acid. 
Acetic Acid. 
Liquor Potassse or Liquor Sodse. 
Solution of Sulphate of Copper, 10 grains to 
the fluid-ounce, orFehling’s Test Solution 
for Sugar. 
Glass Funnel and Filtering Paper. 
With this apparatus and these reagents, the 
student will be able to perform all the more 
important reactions described below. 
SPECIFIC GRAVITY. 
The specific gravity of the urine varies in 
health between 1015 and 1025; the simplest 
way of estimating it is by means of the uro- 
meter. 
In order to use this instrument, a quantity of SPECIFIC GRAVITY. 
7 
the urine to be examined is poured into a cylin- 
drical glass, and care is taken to remove all the 
froth which may form, either by blotting paper, 
or by overfilling the vessel. The urometer must 
then be slowly introduced, and allowed to float 
freely in the urine, without touching either the 
side or bottom of the vessel. Since the fluid 
accumulates around the stem of the urome- 
ter from the physical force of attraction, the 
specific gravity appears to be higher than it 
really is, when read off while the eye is above 
the surface of the fluid; to obtain a correct 
reading, therefore, the eye must be lowered to 
the level of the surface of the fluid, and the 
number on the stem ascertained by looking at it 
through the urine: having noted this, the uro- 
meter should be depressed in the urine, and 
again allowed to come to rest, when the number 
may be again read off; the second estimation is 
made to correct any mistake that may have 
taken place in the first reading. The specific 
gravity thus ascertained should be noted down 
at once. The urine must be of the temperature 
of the surrounding air, otherwise great errors 
may creep in. 
The knowledge of the specific gravity of a 8 
CLINICAL IMPORT OF SPECIFIC GRAVITY. 
few ounces of urine is a matter of little value. 
To render the observation in any way service- 
able, the whole quantity passed in the 24 hours 
must be collected and mixed, and the specific 
gravity of a small amount of this taken. A 
rough estimation of the solid matters passed 
may be made from the specific gravity in the 
following way; the two last figures are multi- 
plied by 2 or 233 which gives the amount of 
solid matters in a 1000 parts of urine; if, for 
example the specific gravity of the urine be 1020, 
1000 grains of urine will contain 2 x 20, i.e. 
40 grains of solids, or multiplying by 2-33 =46-6. 
Clinical Import. Sugar in the urine is the most 
common cause of a high specific gravity ; if this 
body be not present, excess of urea will be the 
probable cause. 
A low specific gravity, below 1010, occurs 
after fluid has been taken in quantity. A low 
specific gravity is also noticed frequently in 
chronic Bright’s disease, immediately after the 
paroxysm of hysteria, in anaemic states, and in 
diuresis from any cause, such as mental emotion, 
or exposure to cold. 
A high specific gravity with a pale colour, and 
a low specific gravity with a deep tint, are 
equally signs of disease. REACTION OF URINE. 
9 
A new urometer should be carefully tested, 
.since those sold by the instrument makers give 
results varying as much as 10 or 12 degrees. 
The urometers in common use in Hospitals are 
very rarely correct. 
REACTION. 
The urine is almost always secreted acid, al- 
though it may become alkaline within a very 
short time of being passed. In the majority of 
the cases in which the urine is said to be alkaline, 
as in paraplegia and cystitis, the alkalinity is 
really due to decomposition after being passed. 
If the urine, then, be found to be alkaline, a fresh 
specimen should be tested immediately after it 
has been voided. In cases of retention, the 
urine sometimes becomes alkaline in the blad- 
der ; and, in health, can be made alkaline, by 
the administration of drugs, such as the carbon- 
ates, acetates, citrates or tartrates of the alka- 
lies. 
When the alkalinity of the urine is due to 
ammonia, the brown colour of the turmeric dis- 
appears when the paper is exposed for some 
time to the air, or gently heated; but the CLINICAL IMPORT OF REACTION. 
change from yellow to brown is permanent, if 
the alkalinity be owing to either potash or soda. 
The urine is rarely neutral to test paper; so 
that many observers have denied its occurrence. 
Occasionally the urine has an equivocal reaction, 
reddening blue litmus, and restoring the blue 
colour to reddened litmus paper. This amphi- 
genous or amphoterous reaction, as it has been 
called, has not yet been satisfactorily explained; 
it is, however, without any clinical import. 
The cause of the acid reaction of the urine is 
the presence of the acid phosphate of soda; and 
according to some observers, of free lactic and 
hippuric acids. Very shortly after being voided, 
the acidity increases, and lasts, in health, for 
days, free uric acid being often thrown down. 
Sooner or later, however, the alkaline fermen- 
tation sets in, and the urine becomes ammoniacaf 
and foetid from the conversion of urea into 
carbonate of ammonia, and the formation of sul- 
phide of ammonium, while the phosphates and 
the urate of ammonia are deposited as a white 
sediment. 
Clinical Import. The acidity of the urine is 
decreased during digestion, and increased by 
fasting or perspiration. A very acid, high- ALBUMEN IN THE URINE. 
coloured urine is associated with the “uric acid 
diathesis,” This condition favours the occur- 
rence of calculus and gravel. 
Alkalinity of the urine is always due, if the 
administration of alkalies can be excluded, to 
the decomposition of urea into carbonate of am- 
monia. It is present in some diseases of the 
spinal chord, and especially in chronic affections 
of the bladder and urinary organs, as a few 
drops of urine, which have undergone the alka- 
line fermentation, will rapidly beget the same 
change in perfectly fresh urine. 
When the alkalinity of the urine is due to fixed 
alkali, either potash or soda, it may be due to a 
catarrh of the urinary passages, the inghstion of 
alkaline salts, or some alteration in the meta- 
morphosis of the tissues. About this last con- 
dition, little is known with certainty. It is 
always best treated by meat diet and iron. 
EXAMINATION FOR ALBUMEN. 
This is the first and most important step in the 
chemical examination of the urine: the presence 
or absence of albumen must always be deter- 12 
ALBUMEN IN THE URINE. 
mined before proceeding- to test for any other 
substance, and the search must never be omitted 
in the examination of any urine. It is never 
present in natural urine. 
The best way of testing for albumen is to fill 
a test tube about two-thirds full of the urine to 
be examined, and to heat the upper layer of the 
fluid over the flame of a lamp, the lower end of 
the tube being held between the thumb and fore- 
finger of the observer, in the manner repre- 
sented in the accompanying wood cut. By 
employing this method, two strata of fluid are 
obtained for comparison. 
The heat is applied until the upper portion of 
the urine begins to boil, for although albumen. albumen in the urine. 
13 
when in large quantity, coagulates at a point 
many degrees below boiling, yet the presence of 
a small quantity gives no precipitate below 212° 
F. The boiled stratum of fluid should now be 
carefully compared with the cool layer in the 
lower part, by holding the test tube against the 
light; if any cloudiness or opacity be seen, it 
must not at once be concluded that albumen is 
present; but a drop or two of dilute nitric acid 
should be allowed to flow gently down the side 
into the urine; the cloud is permanent, if due to 
albumen; but disappears immediately if due to 
the earthy phosphates. This addition of acid 
after boiling should never be omitted, since the 
most practised eye cannot distinguish, by ap- 
pearance only, between the cloud produced by 
albumen, and the phosphate of lime. 
Cautions, i. The addition of the nitric acid 
not unfrequently carries down some of the co- 
agulated albumen into the unboiled layer of 
urine, and thus causes the cloud to be less thick 
than before; such an appearance is never pro- 
duced by phosphates; when they are the cause 
of the turbidity, the urine becomes absolutely 
clear, as before boiling; slight brown colora- 
tion only, occurring from the addition of the 
nitric acid. ALBUMEN IN THE URINE. 
ii. Should the urine be turbid from the pre- 
sence of urates, it quickly becomes clear on the 
application of slight heat; and as it is desirable 
before testing for albumen to have a clear solu- 
tion, the whole of the test tube should be passed 
two or three times through the flame of the lamp, 
until the urates be dissolved; the upper stratum 
of the urine should then be boiled, and compared 
with the lower, as above. 
iii. If the urine be neutral or alkaline at the 
time of testing, the albumen will not be precipi- 
tated by heat; the acid reaction must therefore 
be restored by a few drops of weak acetic acid, 
and the urine then boiled, and nitric acid added. 
If alkaline urine be boiled without previous 
acidulation, a deposit of phosphate of lime is 
almost sure to occur, which is immediately dis- 
solved on the addition of an acid. 
If nitric acid be added, before boiling, to an 
albuminous urine, the albumen will often not be 
precipitated on the application of heat. Care 
must therefore be taken that it is acetic acid 
which is used in the preparatory acidification of 
the urine. 
iv. If the urine be permanently turbid, from 
any cause, and it is desired to know accurately miixon’s test for albumen. 
whether albumen be present, the . urine must be 
filtered before boiling; in this way very minute 
quantities may be discovered. 
The method of testing for albumen, proposed 
by Heller, which consists in pouring nitric acid 
into a test tube, and allowing the urine to flow 
down upon the acid, so that the two fluids touch, 
but do not mix, and observing the layer of co- 
agulated albumen thus produced, is open to so 
many fallacies, that it cannot be recommended, 
save to experienced hands. Urea and urates are 
a common source of error, since they cause the 
appearance of a band very like that of albumen. 
It is sometimes desirable to examine the urine 
for traces of albumen, and also for the presence 
or absence of substances very closely allied to 
albumen, but which cannot be detected by the 
usual tests for albumen. In this case the method 
recommended by ■ Millon should be followed. 
An equal weight of mercury is digested in an 
equal weight of strong nitric acid, first in the 
cold, and then by a gentle heat, until the metal 
be completely dissolved. Two volumes of water 
are then added to one volume of the mercurial 
solution. The whole is set aside for some hours, 
a crystalline deposit takes place, and the clear ALBUMEN IN THE URINE. 
fluid is used for testing-. This fluid colours red 
all solutions which contain a trace of an albumin- 
ous compound; the reaction appears in the cold, 
but is increased by warming- up to near boiling- 
point. 
A rough way of estimating the amount of al- 
bumen present in the urine, is to pour some of 
the urine into a test tube, until it be about half 
full, and to boil the whole of the urine in the tube, 
till the albumen be completely coagulated. 
One or two drops of nitric acid are then added, 
and the test tube is set aside for 24 hours: at the 
1 ' 
end of that time, the proportion of the coagulated 
albumen, which has collected at the bottom of 
the tube, to the rest of the fluid, is noticed; if the 
albumen occupy one-third of the height of the 
fluid, there is said to be one-third of albumen in 
the urine; or one-sixth, or one-eighth, as may 
be. If, however, at the end of 24 hours scarcely 
any albumen have collected at the bottom, there is 
said to be a trace. If the urates have been de- 
posited, the urine must be filtered before boiling, 
or a considerable error will creep in, by their 
increasing the apparent amount of albumen. 
Clinical Import. The presence of albumen in 
urine is an important objective sign of disease. ITS CLINICAL IMPORT. 
17 
Any state, which brings about a mechanical 
impediment to the return of blood from the kid- 
neys, will be accompanied by albumen in the 
urine; and the albumen will be persistent so 
long as the congestion of the kidney continues; 
the longer the albumen remains in the urine, the 
greater danger is there of permanent textural 
injury to the kidney. In many acute febrile dis- 
eases, albumen is frequently present, which, as a 
rule, disappears with the termination of the ill- 
ness ; but, if persistent, it affords evidence of or- 
ganic disease of the kidney. In a chronic, non- 
febrile disorder, without obvious impediment to 
the return of blood from the kidneys to the heart, 
the discovery of albumen in a clear urine would 
indicate structural change in the kidney. 
The search for renal casts must always follow 
the detection of albumen in the urine. The dis- 
covery of these structures renders it certain that 
the albumen, or, at least, part of it, is derived 
from the kidney. 
A common cause of the presence of albumen 
is pus, according to its quantity; in the urine of 
women, a small quantity of albumen is frequently 
due to leucorrhoeal discharge, which is com- 
posed chiefly of pus. Gleet, and also, it is said. Moore's test for sugar. 
a great quantity of semen, cause albumen to be 
present in the urine. 
If blood be present in the urine, albumen must 
likewise be present, derived from the corpuscles 
and plasma. 
If the specific gravity rise above 1030, sugar 
may be suspected, and should be looked for. 
Many methods of testing- for sug-ar have been 
proposed; but only the most prominent and 
trustworthy will here be mentioned, although it 
must be confessed that a rapid, and yet trust- 
worthy, test, suited to practitioners, is still 
wanted. 
Moore's Test. Equal parts of urine, and liquor 
potassse or liquor sodse, are poured into a test- 
tube, and the upper layer of this mixture is 
heated to boiling, in the manner described in 
the section on examination for albumen. (See 
page 12.) The heated portion becomes brown- 
red, dark-brown, or black, according to the 
quantity of sugar present. The least change ot 
colour may be perceived by comparing the upper 
and the lower layers of the liquid. 
EXAMINATION FOR SUGAR. moore’s test for sugar. 
Cautions, i. High coloured urines, and urines 
containing excess of phosphates, darken very per- 
ceptibly on boiling with caustic alkalies, and, if the 
urine be albuminous, the colour will be greatly 
deepened, though no sugar be present. Before, 
therefore, applying Moore’s test to an albuminous 
urine; the albumen must be removed by filtra- 
tion after boiling with a drop or two of acetic 
acid. 
ii. It has been noticed that liquor potassse 
which has been kept for a few weeks only in 
white glass bottles, takes up lead from the glass, 
and that a black precipitate of sulphide of lead 
is formed, when the alkali is boiled with certain 
urines which contain much sulphur. Care must 
be therefore taken that the liquor potassse is 
free from lead. 
The value of Moore’s test is chiefly negative; 
if the urine on boiling with liquor potassse do 
not greatly darken, it may be assumed to be free 
from a hurtful quantity of sugar; if, however, 
much darkening occur, a further observation 
must be made with the copper or fermentation 
tests described below. 
The Copper Test depends on the property which 
grape sugar possesses, of reducing the higher 20 
trommer’s test for sugar. 
oxyde of copper to a suboxyde. There are two 
methods of conducting' this reaction, identical in 
principle, named respectively Trommer’s Test, 
and Fehling’s Test. 
Trommer’s Test. About a drachm of the sus- 
pected urine is poured into a test tube, and 
liquor potassae, or liquor sodse added in about 
the same quantity ; a weak solution of sulphate 
of copper (about 10 grains to the fluid ounce) is 
dropped into the mixture. The precipitate which 
first forms is redissolved on shaking- the test 
tube, and the copper solution should be carefully 
added, shaking the test tube after each drop 
has fallen into the mixture, so long as the 
precipitate is easily redissolved, when the solu- 
tion will have acquired a beautiful blue or green 
colour, but should be quite clear, and free from 
any precipitate ; the contents of the test tube 
must next be heated to boiling, when, if sugar 
be present, an orange-red precipitate is first 
thrown down, which, after some time, becomes 
reddish brown. This precipitate consists of the 
suboxyde of copper. 
Since uric acid and mucus will also reduce 
copper when they are boiled with its salts, a 
similar solution should be set aside in the cold; fehling’s test for sugar. 
21 
and if at the end of 24 hours the reddish precipi- 
tate have fallen, sugar is undoubtedly present. 
Cautions. Much trouble is often at first felt in 
arranging the proper proportion between the 
copper solution, and the liquor potassse. Much 
of this, no doubt, arises from the weak pharma- 
ceutical liquor potassse being used instead of the 
stronger solution of the chemical laboratory. 
The liquor potassse used in Trommer's test, 
should be from 20 to 30 per cent, of strength. 
This readily dissolves the precipitate formed on 
adding the copper ; a property which the phar- 
maceutical solution possesses in much smaller 
degree. Too much copper should not be added. 
It is a good rule always to have a slight excess 
of potash and never to operate save with a 
clear solution. 
Fehling’s Test. In consequence of the difficulty 
of properly adjusting the quantity of alkali and 
copper in Trommer's test, many practitioners 
prefer to use a solution in which the copper and 
alkali are present in the exact proportion neces- 
sary. This solution may be prepared in the 
following way: 6651 grains of crystallized 
potassio-tartrate of soda are dissolved in 5 
fluid ounces of a solution of caustic potash, sp. 22 
fehling’s test for sugar. 
gr. r 12. Into this alkaline solution is poured a 
fluid prepared by dissolving grains of sul- 
phate of copper in 10 fluid drachms of water. 
The solution is exceedingly apt to decompose, 
and must always be kept in stoppered bottles, 
and in a cool place. It is usually, therefore, 
more convenient not to mix the alkali and copper 
until the solution be wanted for use. In this 
case, a fluid drachm of the sulphate of copper 
solution may be added to half a fluid ounce of 
the alkaline solution prepared as above. 
About a couple of drachms of this test-solution 
are poured into an ordinary test-tube, and the 
fluid boiled over a lamp. If no deposit form, the 
solution may be used for analysis; but if a red 
precipitate be thrown down, the liquid has de- 
composed, and a fresh supply must be had. 
While the solution is boiling in the test-tube, 
the urine must be added to it drop by drop, and 
the effect watched. A few drops of urine which 
contain a large percentage of sugar will at once 
give a precipitate of yellow or red suboxyde; but 
if no precipitate occur, the urine should be added 
to the fluid, drop by drop, any deposit being 
carefully looked for, until a quantity equal to FERMENTATION TEST. 
23 
that of the Fehling's solution employed, have 
been added. If no precipitate be found after 
setting- the test-tube aside for an hour, the urine 
may be considered free from sugar. 
Cautions, i. The test solution should never 
be used without boiling beforehand for a few 
seconds; the tartrate being exceedingly apt to 
decompose, and the solution then reduces copper 
as effectually as would grape sugar. 
ii. The quantity of urine used in the test 
should never be greater than the quantity of 
test-solution employed. 
iii. After adding urine in volume equal to the 
Fehling’s solution, the boiling of the mixture 
must not be continued, as other bodies, besides 
sugar, present in the urine, will reduce copper 
at a high temperature. 
Fermentation Test. A few grains of German 
yeast are put into a test-tube, which must then 
be filled with urine, and inverted in a shallow 
dish already containing a little of the urine, or 
better still, quicksilver, and set aside in a warm 
place, as a mantel piece, or a hob. A glass bird 
fountain, if at hand, will be much more handy 
for this purpose than a test-tube. A similar test- 
tube or bird fountain must be filled with water, 24 
ESTIMATION OF SUGAR. 
a few grains of yeast added, and both vessels 
subjected to the same conditions. If sugar be 
present, the formation of carbonic acid will, at 
at the end of 24 hours, have driven nearly all the 
urine out of the test-tube or bird fountain, a few 
✓ 7 
bubbles only will have appeared in that contain- 
ing the water. To prove that this gas is car- 
bonic acid, some caustic potash or soda must 
be introduced into the test-tube, when the gas 
will be quickly absorbed, and the urine again 
rise in the tube. 
Estimation by loss of density after fermentation. 
Dr. Roberts has found that, after fermentation, 
“ the number of degrees of £ density lost' indi- 
cated as many grains of sugar per fluid ounce,” 
and he proposes to estimate by this means the 
amount of sugar present. 
About 4 fluid ounces of the urine are placed in 
a 12-ounce bottle with a piece of German yeast 
of the size of a chestnut. The bottle is then set 
aside, very lightly covered, in a warm place, such 
as the mantel-piece, or hob, and by its side, a 
bottle filled with the same urine, but without any 
yeast, and tightly corked. In 24 hours the fer- 
mentation is almost finished; the fermented urine 
is poured into a urine glass, and the specific CLINICAL IMPORT OF SUGAR. 
25 
gravity taken with the urometer; the specific 
gravity of the unfermented urine is also taken, 
and the specific gravity of the fermented is sub- 
tracted from the specific gravity of the unfer- 
mented, the remainder giving the number of 
grains of sugar contained in a fluid ounce: for 
example, if the specific gravity of the unferment- 
ed be 1040, and that of the fermented 1010, 
the number of grains of sugar in a fluid ounce 
will be 30. 
According to Briicke, healthy urine con- 
tains sugar in about -oi per cent. Conse- 
quently a healthy man excretes daily through 
the kidneys about 15 grains of sugar. Accord- 
ing to Leube, the excretion of sugar in diabetes 
is far greater during the night, than during the 
day : urea follows just the opposite rule. 
Clinical Import. If the foregoing tests an- 
nounce the presence of sugar, in considerable 
quantity, as often as the urine is examined, dia- 
betes mellitus may be inferred to exist. But 
should the presence of sugar in the urine be 
variable, and its amount small, the fact is not of 
any known great diagnostic, or therapeutic, im- 
portance. 
Sugar is said to be present in the urine of the 26 
gmelin’s test for bile pigments. 
foetus, of women when suckling, and of some 
old persons. It is seen in the urine during con- 
valescence from some acute disorders, especially 
cholera, in malarious diseases, and in carbuncle. 
Certain injuries of the nervous system also bring 
on glycosuria. 
BILE IN THE URINE. 
The presence of bile in the urine can seldom 
be overlooked, since it gives a dark greenish 
brown colour to the secretion. White filtering 
paper is coloured yellow by the urine; a per- 
manent froth is also formed by shaking the 
urine. 
Two bodies must be tested for, the bile pig- 
ments, and the bile acids, each of which must 
be looked for by itself. 
The bile pigments. Gindin's Test. Ordinary 
nitric acid, which nearly always contains some 
nitrous acid, is poured into a test-tube to the 
depth of half an inch. A portion of the urine to 
be examined is then gently poured down the side 
of the tube, held almost horizontally, on to the 
surface of the acid, so that the two fluids may 
touch but not mix; this operation is most con- petxenkofer's test for bile acids. 
27 
veniently performed by means of a pipette. At 
the line of contact, a zone of red appears in 
every urine; but if pigment be present, a zone 
above becomes first green, then violet, blue, and 
red, representing the various stages of oxydation 
of the colouring matters. The most characteristic 
is the green; without it the presence of bile pig- 
ments cannot be predicated. This reaction may 
also be performed by allowing a drop of nitric 
acid, and of the urine to be examined, to run to- 
gether on a porcelain dish, when the play of 
colours mentioned above will be observed at 
their line of contact. 
Caution. Any urine which contains a large 
amount of indican will give a blue or violet, and 
even green, colour with nitric acid. The green 
colour is, however, rarely seen with any other 
substance than bile pigment. 
The bile acids. Pettenkofer's Test. Some of 
the fluid containing the bile acids, is placed in 
a porcelain dish, and a drop of saturated solu- 
tion of cane sugar added ; strong sulphuric acid 
is then dropped into the mixture, taking care 
that this acid is clearly in excess of the amount 
• of bile acid present, that is, about the same vo- 
lume as the fluid containing the bile acids. On 28 
pettenkofer’s test for bile acids. 
applying- heat (which must only be moderate) a 
beautiful cherry-red colour is produced, passing 
into a deep purple. The purple colour is the 
only reaction characteristic of the presence of 
bile acids. 
Another, and perhaps a better, way of apply- 
ing Pettenkofer’s test is to pour the fluid contain- 
ing the bile acids, into a test tube; sulphuric 
acid being then added, at first in small quantity 
to precipitate the bile acids, but afterwards in 
amount sufficient to redissolve them, which 
renders the mixture perceptibly hot to the 
hand. A drop of syrup may now be let fall 
into the liquid, which then shows a play of co- 
lours passing from pink to cherry red, and from 
red to purple. 
Strassburg recommends that the test should 
be applied to urine in this fashion: a little cane 
sugar is added to the urine and dissolved; a 
a piece of filtering paper is dipped in the urine 
and then dried. When the paper is quite dry, 
a drop of concentrated sulphuric acid is let fall 
upon it by means of a glass rod, and after a quar- 
ter of a minute a beautiful violet colour ap- 
pears. I have used this test, but not very 
successfully. I feel unable to recommend it to 
the clinical student. SEPARATION OF BILE ACIDS. 
29 
Pettenkofer’s test should never be applied 
directly to urine: the bile acids are never pre- 
sent in sufficient quantity to give the reaction, 
however modified, and the urine in jaundice 
frequently contains a small quantity of albu- 
men which gives a reddish violet reaction with 
sugar and sulphuric acid, while the action 
of the acid upon the other constituents of the 
urine renders it impossible to be sure of the 
distinctive colours of Pettenkofer’s test. If, there- 
fore, it be very desirable to ascertain whether the 
bile acids be present in the urine, the method 
introduced by Hoppe must be employed for their 
separation; a long and somewhat complicated 
process, which can seldom be adopted by the 
clinical student. 
With this object, the urine must be rendered 
faintly ammoniacal with caustic ammonia, and 
then diacetate of lead added, so long as a preci- 
pitate occur. The precipitate must be collected 
on a filter, and washed with distilled water; then 
boiled with alcohol over a water bath, and filter- 
ed while hot; to the filtrate a few drops of pot- 
ash or soda are to be added, and the solution 
evaporated to dryness over a water bath. The 
residue is again to be boiled with absolute alco- 30 
COLOURING MATTERS IN THE URINE. 
hoi over a water bath until but a little be left. 
This must be then thrown into a great excess of 
aether in a stoppered bottle, and after some time, 
the alkaline salts of the bile acids will crystallize 
out. In order to prove that these crystals are 
salts of the bile acids, they must be dissolved in 
a little distilled water, and tested with Petten- 
kofer’s method, as directed above. 
Clinical Import. The bile pigments and the 
bile acids are present in the urine in most cases 
of jaundice. In hot weather, the bile pigments 
may sometimes be detected, by means of Gmelin's 
test, in the urine of persons who are not jaun- 
diced. Indeed some believe that the bile pig- 
ments are always present in small amount in 
health, and the same may be said of the bile 
acids. The quantity of bile acids present in 
jaundice is scarcely ever *O2 per cent., if the 
estimations on record may be trusted. 
OTHER COLOURING MATTERS IN THE 
URINE. 
The bile pigments are undoubtedly very near 
akin to the colouring matters of the blood. Hae- CLINICAL IMPORT OF HAEMOGLOBIN. 
31 
moglobin may be known to be present either by 
finding red corpuscles in the urine (see section 
on Blood, page 58.) or by the employment of the 
spectrum analysis. If this latter be out of the 
student's reach, Heller’s test, which does not, 
however, separate haemoglobin from haematin, 
may be used. Liquor potassae or liquor sodae 
is added to the urine in a test-tube, until a pro- 
nounced alkaline reaction be obtained, the mix- 
ture heated to the boiling point, and set aside 
for some time. The precipitate of phosphates 
has a greenish to a reddish colour, when the 
urine contains haemoglobin, methaemoglobin, or 
or haematin. The colour is due to the haematin, 
a product of the decomposition of haemoglobin. 
Another and very delicate reaction is the guaia- 
cum test. To the urine are added a few drops of 
tincture of guaiacum and next an aethereal solu- 
tion of peroxyde of hydrogen. If blood be 
present, a fine sapphire blue colour is deve- 
loped. 
Clinical Import. Haemoglobin appears in urine 
in which no red blood corpuscles can be detected, 
in most cases of jaundice, in poisoning by sulph- 
uric acid, phosphorus, and arseniuretted hydro- 
gen, Also in malignant cases of the acute 32 
UREA 
specific diseases, and in scurvy, haemoglobin 
may be found, without any corpuscles being 
detected. 
But little is known about the colouring- matters 
of the urine which have been named urohsema- 
tin, uroxanthin, hsemaphaein, &c. Indican is a 
constant constituent of the urine, and by boiling 
with mineral acids, is decomposed into sugar, 
indigo red and indigo blue. With nitric acid, 
it imitates the reactions of the bile pigment (see 
p, 26.) Heller pours a few drachms of fuming 
hydrochloric acid into a beaker glass and then 
adds about 30 or 40 drops of the urine. The 
fluid becomes red, violet, or blue if much indican 
have been present. Heller attributes the reac- 
tion to the presence of uroxanthin. 
Clinical Import. Much indican is said to be 
present in the urine in melanotic cancers: the 
presence of indican may be of help to the diag- 
nosis when the cancer is situated in an internal 
organ, for example, the liver. 
UREA. 
The clinical student may sometimes wish to 
know if the urine contain urea, or if a given SEPARATION OF UREA. 
33 
fluid be really urine, or some other secretion. 
The fluid is first to be tested for albumen, which, 
if present, must be removed by acidulation with 
two or three drops of acetic acid, raising the 
temperature of the fluid to the boiling point, 
and filtering. This filtrate is used for the sub- 
sequent operations of evaporation, &c. as stated 
below. 
If the urine be free from albumen, some quan- 
tity, 2 or 3 fluid ounces, must be evaporated in 
a Berlin dish over a water bath, until the fluid 
have the consistence of syrup. A water bath 
is essential, because an open flame would de- 
compose the urea. After the syrupy fluid has 
completely cooled, nitric acid, as free as possible 
from nitrous acid, is added drop by drop, so 
long as a precipitate is formed. An excess of 
nitric acid is desirable. Some of these crystals 
of nitrate of urea, removed with a glass rod and 
placed under the microscope, show flat rhom- 
bic or hexagonal plates closely united to one 
another. Sometimes only a few drops of the 
fluid can be had, and the student should then 
let a little fall on a glass slide, set it aside in a 
warm place such as a mantel piece, for the fluid 
to concentrate, then add some strong nitric acid, 34 
IMPORT OE UREA. 
and place the crystals under the microscope. 
If the fluid contain urea, rhombic or hexa- 
gonal plates will be seen. 
Clinical Import. Urea is the most important 
constituent of the urine ; a healthy man excretes 
from 300 to 500 grains in the 24 hours. Its 
amount is increased in health by a high meat 
diet, and decreased by purely vegetable food. 
In some acute diseases, as pneumonia, typhoid 
fever, and acute rheumatism, it is said to be 
greatly increased owing to the excessive tissue- 
metamorphosis ; it may be present in such 
quantity as to give a precipitate, without pre- 
vious concentration, when the urine is acidulated 
with nitric acid. Dr. Samuel West has, however, 
found in these diseases that though the percen- 
tage of urea be high, owing to the small amount 
of urine passed, yet the total amount of urea is 
in many cases below the standard of health. 
In chronic diseases, especially those attended by 
a cachexia, or in uraemia and chronic Bright's 
disease the amount of urea is below the aver- 
age. CLINICAL IMPORT OF URIC ACID. 
35 
URIC ACID. 
Uric acid is a less oxydised stage of urea. If 
an urate be injected into the veins of an animal, 
an equivalent amount of urea appears in the 
urine. Uric acid is found in the urine of all 
carnivorous animals. In that of reptiles it en- 
tirely replaces the urea in the urine. 
To ascertain if the urine contain uric acid, it 
is necesary to acidulate about a fluid ounce of 
the urine with a fluid drachm of hydrochloric 
acid, or strong acetic acid, in a suitable glass 
vessel, an ordinary beaker being best, and to 
set it aside, covered with a glass plate, for 24 or 
48 hours. At the end of that time, if uric acid 
be present, reddish brown crystals will be seen 
attached to the sides and bottom of the glass, or 
floating on the surface of the fluid. These crys- 
tals have the flat rhombic, oval, or hexagonal 
shape of uric acid; they are soluble in alkalies, 
and give with nitric acid and ammonia the 
murexid test. (See page 46,) 
A healthy man excretes, on an average, about 
7 or 8 grains of uric acid in the 24 hours. 
Clinical Import. The excretion of uric acid is 
usually increased pari passu with the urea in py- 36 
HIPPURIC ACID. 
rexia, or acute rheumatism, and in chronic liver 
diseases. It is increased out of proportion to 
the urea in leucaemia. An excess of uric acid 
is observed after an attack of gout; it is often 
entirely absent from the urine immediately be- 
fore the paroxysm, and may disappear for days 
when this disease has become chronic. 
HIPPURIC ACID. 
The method of preparing hippuric acid from 
human urine is troublesome, and will rarely be 
required to be used by the clinical student. Two 
or more pints of perfectly fresh urine are evapor- 
ated to a syrup in a water bath and then extract- 
ed with alcohol. The solution is filtered, the 
filtrate evaporated over a water bath until a 
small quantity be left; and to this, when quite 
cold, hydrochloric acid is added so long as crys- 
tals are formed. 
The crystals of hippuric acid obtained in this 
manner, seen under a microscope, are long and 
needle-shaped prisms; they are distinguished 
from those of benzoic acid by their difficult solu- 
bility in aether. CHLORIDES. 
37 
Hippuric acid, when evaporated to dryness 
with nitric acid, in a porcelain crucible, over a 
lamp, and then further heated to redness, gives 
off a gas smelling like oil of bitter almonds. 
This reaction is common to benzoic and hippuric 
acids. 
Clinical Import. Hippuric acid exists in small 
quantity in the urine in health: its amount is 
greatly increased by the eating of much fruit, 
and also by the ingestion of benzoic acid. The 
hippuric acid appears in the urine in quantity 
equivalent to the benzoic acid taken. Excluding 
these circumstances, hippuric acid is also found 
in quantity in the urine of fever patients, and 
may even be the cause of the acid reaction; the 
amount is also increased in diabetes and cholera. 
Nothing is known of the importance of this 
acid in therapeutics or diagnosis. In health the 
amount varies from 7 to 15 grains in the 24 
hours. 
CHLORIDES. 
Chlorides may be known to be present by the 
following test. To a fluid drachm of urine in a 38 
CLINICAL IMPORT OF CHLORIDES. 
test-tube, a drop of nitric acid is added, and then 
a few drops of a solution of nitrate of silver ; if 
a trace of chloride be present, a cloudiness only 
will be given; but if any quantity, a white pre- 
cipitate is thrown down, soluble in caustic am- 
monia, and reprecipitated thence by the addition 
of nitric acid in excess. 
The nitric acid is added at first to prevent the 
precipitation of the phosphates with the chlor- 
ides. 
A rough comparative idea of the quantity of 
chloride present may be made from day to day, 
by always taking the same quantity of urine, 
acidulating it in a test-tube with nitric acid, and 
adding a solution of nitrate of silver until no 
further precipitate is formed. The test-tube 
must then be set aside for 24 hours, and a 
note then taken of the proportion of the chlor- 
ide of silver deposit, for comparison with other 
observations. 
On an average, a healthy man secretes 250 
grains of chloride of sodium in the 24 hours. 
Clinical Import. During acute pneumonia acute 
rheumatism, and most other pyrexial diseases 
the chlorides diminish in quantity, or even disap- 
pear from the urine. Their reappearance in PHOSPHATES. 
39 
daily increasing- quantity is a sign of the dimi- 
nution of the intensity of the disease. The 
amount of chlorides apparently depends upon 
the dig-estive powers of the patient, even in 
chronic diseases. 
PHOSPHATES. 
The presence of phosphates in the urine may 
be ascertained by the following test. A fluid is 
prepared by adding a drop or two of caustic 
ammonia to a fluid drachm of a solution of sul- 
phate of magnesia in a test-tube ; hydrochloric 
acid is added until the precipitate caused by the 
ammonia be redissolved. Caustic ammonia is 
again added in excess, until the fluid be strongly 
ammoniacal. A fluid drachm of urine is now 
poured into another test-tube, and rendered am- 
moniacal with caustic ammonia; to this urine 
some of the prepared solution is added, and a 
precipitate of the ammoniaco-magnesian phos- 
phate occurs at once, if the urine contain the 
ordinary amount of phosphates; but the preci- 
pitate forms slowly, if the phosphates are present 
in very small amount. 40 
SULPHATES. 
The quantity of phosphoric acid excreted by a 
healthy man in the 24 hours is about 50 grains. 
Clinical Import. The amount of phosphoric 
acid in the urine is increased in diseases of the 
nervous centres, and of the bones, and after 
great mental application. Acute febrile dis- 
eases cause increase of the phosphoric acid 
from increased tissue-metamorphosis, while in 
Bright’s disease and some forms of dyspepsia 
the quantity of the phosphates is diminished. 
Dr. Gee has pointed out that the phosphates 
diminish or disappear after the acme of the 
paroxysm in ague. 
SULPHATES. 
The sulphates are at once recognised by the 
addition to some of the urine, in a test tube, of 
a drop of hydrochloric acid, and afterwards of a 
few drops of a solution of chloride of barium; 
a white precipitate, insoluble in nitric acid, is 
thrown down. 
The quantity of sulphuric acid excreted by a 
healthy man in the 24 hours is about 30 grains. 
Clinical Import. The quantity of the sulphates AMOUNT OF URINARY CONSTITUENTS. 
41 
is increased by a full animal diet; very little 
is known for certain of their amount in disease, 
and that little is at present of not much inport- 
ance. 
The following- table of the amount of urinary 
constituents excreted by a grown up man in the 
24 hours is compiled from Dr. Parkes’ book on 
the urine: 
Quantity 40 to 50 fluid ounces. 
Total Solids .... 800 to 1000 grains. 
Urea 350 to 600 grains. 
Uric Acid 5 to 15 grains. 
Chlorine 50 to 150 grains. 
Phosphoric Acid . . 30 to 60 grains. 
Sulphuric Acid . . . 20 to 60 grains. 
In a healthy man, the hourly excretion of urine 
may vary from 20 to 200 C.C. In general, it is 
from 50 to 70 C.C. when much drink is taken, and 
40 to 60 C.C. when little is taken. I kilogramme 
of body-weight, therefore, excretes about I C.C. 
of urine every hour. 
The urine is always diminished in quantity 
during the height of a pyrexial disease ; a sign 42 
URINARY SEDIMENTS. 
of improvement is the increase in the quantity 
of urine. When a disease is about to prove 
fatal, the quantity often sinks. In diabetes and 
interstitial nephritis, the quantity is increased; 
and this is often the case when collections of fluid 
in serous cavities are being- absorbed. 
URINARY SEDIMENTS. 
When a urinary deposit is to be examined, 
about 4 or 5 fluid ounces of the urine should be 
collected in a tall narrow cylindrical glass, and 
set aside for a few hours. Cylindrical glasses 
have,' in my own experience, succeeded better 
than conical vessels, since the sloping sides 
of the latter tend to cause the sediment to 
collect on them, without falling to the bottom. 
This is particularly the case with uric acid and 
renal casts, especially if they be present in but 
small quantity. 
When the sediment has collected at the bottom, 
the supernatant urine may be poured off, and a DIRECTIONS FOR MICROSCOPE. 
43 
drop of the sediment placed on a glass slide, for 
examination under the microscope. 
In looking for renal casts, it is better to use 
only the very last drops which fall from the 
vessel, after the rest of the urine is poured 
away. 
Directions for the Microscope. A drop of the 
fluid containing the deposit is placed in the 
centre of the glass slide, which must be ab- 
solutely clean, and the drop very gradually 
covered with a piece of thin glass, (seven- 
eighths of an inch square is the best size), so 
.as to drive all the air before it, and to prevent 
any air bubbles being present under the glass. 
This is best accomplished by the aid of a needle, 
placing one edge of the thin glass upon the 
slide, and resting the other upon the needle, 
then inclining the needle gradually, until it be 
horizontal. All superfluous moisture around 
■the glass cover must be carefully removed with 
a cloth, or with blotting paper. The slide is 
then ready to be placed under the microscope. 
A quarter-inch object glass will be sufficient 
for the recognition of nearly all the sediments 
that the student will have to deal with. The 
tube of the microscope must be moved down 44 
UNORGANISED SEDIMENTS. 
until the object glass is about a quarter of an 
inch distant from the slide; the light from the 
mirror is now thrown upon the slide at a point 
immediately under the object glass; the obser- 
ver should then look through the microscope, 
placing the instrument with the coarse adjuster 
in the focus which suits his own eyesight. 
Sediments are either organised or unorgan- 
ised. To the latter belong uric acid, urates, 
oxalate of lime, phosphates, cystin, &c. To the 
former, pus, blood, mucus and epithelium, renal 
casts, fungi, and spermatozoa. 
UNORGANISED SEDIMENTS. 
URIC ACID. 
Uric Acid is only met with as a deposit in 
very acid urine, and is usually accompanied by 
a considerable sediment of urates. Owing to its 
peculiar appearance, like cayenne pepper, it can 
at once be recognised by the naked eye, never URIC ACID. 
45 
being- deposited from the urine in colourless 
crystals. 
When the sediment is examined under the mi- 
croscope, the crystals are at once known to be 
uric acid by their reddish brown colour, all 
other crystalline deposits being transparent and 
colourless. If indeed, the student be in doubt as 
to the nature of a crystal, he will never be very 
wrong, if he judge it to be uric acid when there 
is a slight tinge of brown visible. The crystals, 
themselves, have numerous forms: they occur 
very commonly in rhomboidal, or long oval, 
plates with acute angles; these crystals are 
often united so as to form rosettes, or they may 
be rectangular, barrel shaped, or in hexagonal 
plates, with two parallel sides longer than the 
other four. 
Uric Acid. 46 
MUREXID TEST FOR URIC ACID 
If the student be not quite sure of their nature,, 
he should add to the specimen under the micro- 
scope, a little liquor potassae or liquor sodse, 
which will dissolve uric acid, if present; when 
dissolved by the alkali, it can be reprecipitated 
in hexagonal plates by the addition of hydroch- 
loric or acetic acid. 
Traces may also be detected by means of the 
murexid test; a small portion of the suspected 
sediment is placed in a porcelain dish, and a 
drop of nitric acid let fall upon it; the dish is 
then gently heated over a lamp until all the nitric 
acid be driven off, when, if uric acid be present, 
a beautiful red staining is seen; after cooling, 
a drop of caustic ammonia should be allowed to 
roll over the reddened spot, which then becomes 
purple; if liquor potassae be used instead of 
ammonia, the colour will be violet. The test 
does not, however, distinguish uric acid from its 
salts. 
Usually the uric acid is not free when the urine 
is voided, but it is precipitated by the increase of 
acidity which always occurs shortly after emis- 
sion, This is especially the case in the urine of 
diabetes, where the whole of the uric acid pre- 
sent may be set free from this cause. URATES. 
47 
Clinical Import. The presence of free uric 
acid is no proof that uric acid is being excreted 
in excess; the only inference that can be made, 
is that the urine is extremely acid. But if free 
uric acid shews itself immediately after the urine 
has been passed, it is not improbable that a 
deposit may be taking place in the pelvis of the 
kidney, or the bladder; a state of considerable 
danger, since it may lay the foundation of a cal- 
culus; uric acid, and urate, calculi being the 
most common of all urinary concretions. 
This deposit is the most common and least 
important of all the urinary sediments. Any 
febrile state will lead to this deposit; even a 
greater amount of perspiration than usual, will 
be followed by urine that becomes turbid on 
cooling, merely as a result of a diminished secre- 
tion of water. Urine containing an excess of 
urates is never turbid when fresh passed; it is 
only when the urine has cooled, that the peculiar 
muddiness is observed. If the urine be gently 
warmed, the turbidity immediately disappears. 
URATES. 48 
URATES. 
The urates differ in colour considerably, accord- 
ing- to the amount of colouring matter in the 
urine, varying from white to pink or red. In 
young children the ‘ milky’ urine, which alarms 
mothers, is due to a deposit of peculiarly white 
urates. 
In the urine, uric acid is found combined with 
three bases: with soda, with ammonia, and with 
lime. The urate of soda is the most frequent of 
the three, and is usually seen under the micro- 
scope as an amorphous deposit; sometimes it 
forms round dark bodies with short spikes pro- 
jecting from them. The urate of ammonia is 
rarer, and occurs in beautiful globular forms 
with spikes closely resembling the urate of soda, 
but of greater length. The urate of lime is very 
rare, and forms only an amorphous sediment. 
If any doubt be entertained as to the nature of 
these salts, it is necessary to add a drop of hy- 
drochloric or strong acetic acid to the specimen, 
when crystals of uric acid will immediately be 
formed. These crystals are again dissolved by 
caustic soda or potash. If further evidence be 
required, the murexid test with nitric acid and 
ammonia (page 46) may be applied. OXALATES. 
49 
OXALATE OF LIME. 
Oxalate of lime is sometimes deposited from 
the urine during- the acid fermentation, or even 
later. 
Oxalate of lime occurs as a urinary sediment 
in colourless octahedral crystals, having the so- 
called ‘ envelope’ appearance which, when once 
seen, can hardly be mistaken for anything else. 
This deposit also occurs in colourless dumb 
bells. 
Oxalate of lime is insoluble in acetic acid; by 
this it is distinguished from the phosphates : it 
is colourless and insoluble in alkalies, and thus 
differs from uric acid. It is, however, soluble 
in the mineral acids, as, for example, in hydro- 
chloric acid. 
Clinical Import. After urates, oxalate of lime 
is the most common unorganised urinary sedi- 
ment ; it is often seen in the urine of patients 
convalescent from acute diseases; and many 
writers state that it may always be found when 
there is lessened oxydation, as in bronchitis. 
The occasional presence of a few crystals of 
oxalate of lime is not of much importance. 
They are frequently seen in the urine after the 50 
PHOSPHATES. 
eating of fresh fruit and vegetables. When the 
deposit is constant, and in large quantity, the 
formation of the mulberry calculus may be 
feared. This sediment is said to be associated 
with a dyspeptic and hypochondriacal condition, 
sometimes termed the “oxalic acid diathesis.” 
A 
B 
Ammoniaco-Magnesian 
Phosphate. 
Oxalate of Lime. 
a. Dumb Bells. 
b. Octahedra. 
PHOSPHATES. 
The phosphates are only separated from very 
feebly acid, or alkaline urine; aud they are 
always deposited when the urine undergoes the MICRO-CHEMICAL TESTS. 
51 
alkaline fermentation. They consist of the am- 
moniaco-magnesian phosphate, and the phos- 
phate of lime. Both are usually found together. 
Under the microscope, the ammoniaco-mag- 
nesian phosphate appears in beautiful right 
rhombic prisms, which disappear immediately 
on the addition of acetic acid, and are thus 
distinguished from the oxalate of lime, with 
which an inexperienced observer might, per- 
haps, confound them. 
The phosphate of lime chiefly occurs as an 
amorphous deposit; it is insoluble in water, but 
soluble in acetic acid ; in feebly acid urines, it 
appears to be held in solution by the carbonic 
acid, so that it is precipitated by heat in flakes 
resembling albumen, which are at once, how- 
ever, dissolved by a drop of acid. 
Clinical Import. The deposit of phosphates 
indicates an alkaline reaction of the urine, a 
condition favourable to the formation of phos- 
phatic calculi. 
If the least doubt be left upon the observer’s 
mind after the microscopical examination of a 
sediment, he must use the aid of reagents in 
determining its nature. The following scheme 52 
MICRO-CHEMICAL TESTS. 
will be found useful: a drop of strong- acetic 
acid should be placed on the glass slide, near 
the thin covering glass, so that the acid may 
run in between the two pieces of glass, but it 
should be carefully prevented from wetting the 
upper surface of the cover, as this will produce 
an obscurity over the object. Or after having 
placed a drop of the fluid containing the sedi- 
ment upon the glass slide, the end of a thread 
should be placed in the drop, and then the 
covering- glass laid upon it, so that the other 
end remains free: the acid or other reagent 
may then be placed upon the free end of the 
thread, and is thus conducted along the thread 
to the sediment under the cover. Should the 
deposit be phosphatic, the acid quickly dissolves 
the crystals, or amorphous sediment; but if the 
sediment consists of urates, crystals possessing 
the well-known shape of uric acid are formed. 
If no effect upon the sediment is produced by 
acetic acid, it consists of either uric acid, or 
oxalate of lime. Liquor potassse, added with 
the same precautions as acetic acid, brings 
about a solution of the crystals of uric acid, 
but the alkali has no effect upon the oxalate of 
lime, which will be dissolved by the action of 
hydrochloric acid. CYSTIN. 
CYSTIN. 
Cystin is a rare deposit in the urine ; it occurs 
in regular colourless hexagonal plates, united by 
their flat surfaces, and overlapping one another. 
When dissolved in the urine, cystin may be 
thrown down by the addition of acetic acid, and 
the precipitate examined under the microscope. 
It may be distinguished from uric acid, which 
sometimes crystallizes in hexagonal plates, by 
the absence of colour in the crystals. 
Urine which contains cystin is usually feebly 
acid, of a yellowish green colour, and of a pecu- 
liar odour, compared to sweet briar, but which 
sometimes resembles that of putrid cabbage. 
The urea and uric acid are diminished in most 
cases. The ammoniaco-magnesian phosphate 
often accompanies the crystals of cystin. 
Cystin contains a large quantity of sulphur, 
and Liebig* proposed a test which is founded 
on this fact. A solution is made by adding to a 
small quantity of solution of acetate of lead liquor 
potassse or liquor sodae until the precipitate 
first formed be redissolved; about equal parts 
of this solution and of urine are boiled, when 
black sulphide of lead is formed from the com- 54 
LEUCIN AND TYROSIN. 
bination of the sulphur with the lead. This 
test is, however, by no means a good one, since 
many bodies frequently present in the urine, for 
example, albumen, contain enough sulphur to 
give the reaction. 
Of the Clinical Import, nothing is known. 
The appearance of cystin in the urine is be- 
lieved by some to be hereditary and to be con- 
nected with calculous disorders. Other observers 
have found it in the urine of chlorosis. 
LEUCIN AND TYROSIN. 
Leucin and Tyrosin are very rare deposits in 
the urine. Under the microscope, leucin appears 
in dark giobular forms, which have been com- 
pared to masses of fat cells; tyrosin, however, 
crystallizes in beautiful bundles of delicate nee- 
dles, sometimes arranged in a stellate form. 
These bodies have been detected in the urine 
in cases of acute yellow atrophy of the liver, of 
small pox, of typhoid fever, and acute tubercu- 
losis. 
If these bodies do not occur as a sediment 
they may be looked for by the following method ; LEUCIN AND TYROSIN, 
55 
a large quantity of the urine must have a solu- 
tion of acetate of lead added to it so long as a 
precipitate forms. Through the filtrate sulphur- 
etted hydrogen is passed to remove the excess 
of lead; and the fluid is filtered again, evapor- 
ated over a water bath to a syrup and then 
extracted with spirit. The leucin is dissolved in 
the spirit while the tyrosin for the greater part 
remains undissolved. The part insoluble in 
spirit may now be dissolved in water and boiled 
with a few drops of nitrate of mercury ; if tyro- 
sin be present, the fluid becomes rose red and 
soon after a red precipitate is thrown down. 
This test for tyrosin is called Hoffmann’s test 
and is said to be very delicate. 
The solution in spirit contains the impure 
leucin and requires further preparation. It 
must again be filtered, evaporated to dryness 
and dissolved in ammonia, and then acetate of 
lead added so long' as a precipitate forms, then 
filtered and washed with a little water. The 
precipitate on the filter, which is a combination 
of leucin with lead, is suspended in water and sul- 
phuretted hydrogen passed through, the liquid 
again filtered, evaporated and set aside to crys- 
tallize. The crystals that form must be tested PUS IN THE URINE. 
in the following' manner. They are carefully 
heated with nitric acid in a platinum crucible: if 
leucin be present a colourless almost invisible resi- 
due is left which, warmed with a few drops of soda 
solution, becomes of a yellow colour passing into 
brown. Another test is this; if leucin be heated 
in a dry test-tube, oily drops are formed which 
give off the smell of amylamin. 
This preparation is undoubtedly very long and 
troublesome; but without it, it is impossible to 
speak with confidence of the presence of leucin 
and tyrosin : of course, if a sediment suspected 
to be leucin or tyrosin be found in the urine 
it may be tested at once by the tests given 
above. But the recognition of crystals under the 
microscope having the same form as leucin and 
tyrosin, is of no value, as in many cases, whether 
in health or disease, urine will give crystals 
identical in form with leucin and tyrosin but in 
which the chemical tests altogether fail. 
ORGANISED SEDIMENTS. 
Pus is often present in the urine, and forms a 
PUS. PUS IN THE URINE. 
57 
thick sediment at the bottom of the urine glass. 
The urine readily becomes alkaline, and rapidly 
decomposes after being passed. It is perma- 
nently turbid ; that is, the turbidity is unaffected 
by heat. 
Under the microscope, the deposit shows nu- 
merous pus corpuscles, round colourless bodies, 
not varying much in size,, having granular con- 
tents, and nuclei varying from I to 4 in number; 
if acted on by acetic acid, the nuclei become 
much more distinct. If the urine have been long 
passed, the pus corpuscles undergo changes 
which render them incapable of being recog- 
nised. 
The urine of course contains albumen, and in 
proportion to the amount of pus present. If the 
quantity of albumen exceed that which should be 
given by the pus present in the urine, evidence 
of kidney disease, as casts of tubes, should at 
once be looked for. 
The deposit from urine containing pus is ren- 
dered viscid and gelatinous by the addition of 
about half its quantity of liquor potassse: it be- 
comes ropy and cannot be dropped from one 
vessel to the other; urine containing mucus on 
the other hand, becomes more fluid and limpid 
by the addition of caustic alkali. BLOOD IN THE URINE. 
Pus occurs in the urine in the following dis- 
eases : 
Leucorrhoea in women. 
Gonorrhoea or Gleet in men. 
Pyelitis, from any cause. 
Cystitis. 
Any abscess bursting into any part of the 
urinary tract. 
Leucorrhoea is an exceedingly frequent cause 
of the presence of a slight amount of albumen in 
the urine of women; if it be necessary to ex- 
clude this origin, the urine must be obtained by 
means of the catheter. 
BLOOD. 
Blood is not at all unfrequently found in the 
urine, and it may be derived from any part of 
the urinary-renal tract. If derived from the kid- 
neys, the blood will be completely diffused 
through the urine, and give it a peculiar smoky 
appearance, quite diagnostic. If the haemorr- 
hage from the kidney be great, however, the 
urine will have a bright red colour, like blood. 
But when the urine contains a great deal of BLOOD IN THE URINE. 
59 
blood, the blood is usually derived, not from the 
kidneys, but from some other part of the urinary 
tract. 
The deposit at the bottom of the urine glass 
shows under the microscope the circular discs, 
familiar to every one as the red corpuscles of 
the blood. Their peculiar colour will prevent 
the student mistaking them for any other de- 
posit ; they may, however, in a urine of low 
specific gravity, become swollen, pale, and at 
last burst from endosmosis ; in those of high spe- 
cific gravity, they will often become contracted, 
shrivelled, and distorted, from exosmosis. 
The urine will, of course, contain albumen in 
proportion to the quantity of blood present, 
which may be so great that the urine will 
solidify on the application of heat. The urine 
very readily becomes alkaline, and care must 
be taken to restore the acid reaction with acetic 
acid, before testing for albumen. 
Clinical Import. The presence of blood or of 
blood corpuscles, in the urine is a sign of 
haemorrhage from the kidney or the urinary 
passages. It may result from: 
i. Disease of the Kidney. 
Acute Bright’s disease. BLOOD IN THE URINE. 
Congestion of kidney. 
Cancer of kidney. 
External injury. 
ii. Disease of Pelvis and Ureter. 
Calculus in pelvis or ureter. 
Parasite, as Bilharzia hsemotobia. 
Cancer. 
iii. Disease of the Bladder. 
Calculus. 
Cancerous or villous growths. 
Congestion or ulceration of mucous mem- 
brane. 
iv. Disease of Urethra. 
Congestion, as in gonorrhoea. 
Tearing of the mucous membrane from 
mechanical injury. 
v. In women, uterine discharges, as men- 
struation, &c. 
If the amount of blood in the urine be small, 
the chances favour the belief that the blood is 
derived from the kidneys; search must there- 
fore be made for renal casts. If the amount of 
blood be large, it probably comes from the 
pelvis of kidney, ureter, or bladder; if from the 
pelvis or ureter there will also be pus and 
probably also gravel in the urine, with pains in MUCUS AND EPITHELIUM. 
61 
the loins, passing- down into the thighs and 
testicles. If there be none of these indications, 
the blood probably comes from the bladder. 
It is commonly said, that if the blood be com- 
pletely mixed with the urine, the haemorrhage 
is from the kidneys; if the urine first passed be 
clear, and that at the end of micturition, become 
bloody, or if even pure blood be passed, the 
haemorrhage is from the bladder or prostate; 
while, if the first portion of the urine be bloody, 
and the last drops clear, the haemorrhage is from 
the urethra. These rules will, however, often be 
found to fail. 
The chief danger of haematuria is the forma- 
tion of clots in the- passages and consequent 
ischuria. Small clots may sometimes form the 
nucleus of a calculus. 
MUCUS AND EPITHELIUM. 
Mucus is a constant constituent of every urine, 
and if healthy urine be allowed to remain at 
rest for an hour, a light cloud will be found to 
have settled at the bottom of the urine glass; on 
examination with the microscope, it will be found 62 
MUCUS AND EPITHELIUM. 
to consist of mucus corpuscles, and epithelium 
scales detached from the surfaces over which the 
urine has passed. 
The urethra and bladder give up a roundish 
or oval epithelium cell to the urine. In the urine 
of women, especially in cases of leucorrhoea, the 
epithelium cells of the vagina are very nume- 
rous ; they exactly resemble the squamous 
epithelium of the mouth. Under irritation, the 
mucous membrane of the pelvis and ureter 
will produce cells, caudate, spindle-shaped, and 
irregular, very like to those formerly looked 
upon as diagnostic of cancer. From this cir- 
cumstance it is impossible to speak positively of 
the existence of cancer cells in the urine. 
Desquamation of the tubular epithelium of the 
kidney occurs only in disease ; the cells as seen 
in the urine, are slightly swollen, and acquire a 
more spheroidal, and less distinctly polygonal 
shape, apparently from the imbibition of fluid, 
and the removal of pressure. The cells are 
frequently granular, and contain fat drops, or 
are contracted, withered up, and shrivelled. 
Clinical Import. See Section on Renal Casts, 
page 68. RENAL CASTS. 
63 
RENAL CASTS. 
In Brighbs disease, and in congestion of the 
kidney, there are formed, in the uriniferous tu- 
bules, lengthened cylinders which are discharg- 
ed with the urine, and form the deposit known 
as “casts.” Those found in the urine are 
probably chiefly formed in the straight urinifer- 
ous tubes; and the view of their origin, which 
has found most favour in this country, is that the 
casts are formed by the escape of blood or 
plasma into the tubes of the kidney, and coagu- 
lation of the fibrin, which thus becomes moulded 
to the shape of the tube into which it has been 
extravasated. It is probable that many of the 
hyaline casts are formed in this way; but the 
balance of evidence at the present day is in fa- 
vour of the epithelial and granular casts being 
produced by a desquamation and degeneration 
of the renal epithelium. 
When the urine contains casts in great quan- 
tity, they can scarcely be overlooked, if the 
urine be allowed to settle for a few hours in a 
tall cylindrical glass the whole of the super- 
natant fluid poured off, and the last drops which 64 
METHOD OF SEARCHING 
flow from the lip of the glass put under the mi- 
croscope and examined. If there be but few 
casts present, the whole of the urine of the 24 
hours should be collected in a tall glass and 
allowed to settle for about 12 hours. The urine 
must then be all poured away, save the four or 
five ounces which have collected at the bottom. 
This residue must then be allowed to settle again 
for a few hours, when if casts be present, they 
will be found at the bottom of the glass, the last 
drops poured away being put under the micro- 
scope, Casts may oftentimes be missed if the 
urine given for examination be only the upper 
layer of a specimen which has settled for some 
time and of which all the casts have fallen to the 
bottom. It thus sometimes becomes of import- 
ance to collect all the urine passed. 
With a little experience, the student will soon 
become familiar with the appearance of casts, and 
will at once be able to distinguish them from 
foreign bodies in the urine. They are never 
broader than 6, or less than 2, red blood corpus- 
cles in diameter; but they vary considerably in 
length, never, however, exceeding the of an 
inch. The same cast does not vary greatly in FOR RENAL CASTS. 
its diameter, and never becomes twisted on it- 
self, as a cotton fibre does. 
The foreign bodies, most liable to be mistaken 
for renal casts, are cotton fibres, hair, and pieces 
of deal. 
Cotion fibres have a very irregular outline, and 
are much broader at one point than at another; 
they are often twisted, and of great length, 
which will distinguish them from casts. Their 
structure is often striped in a longitudinal direc- 
tion. 
Hair can often be distinguished from renal 
casts by its colour alone ; and if this be not very 
apparent, by its possessing a cortical and medul- 
lary structure; and by its length being greater 
than that of any cast. 
Fibres of Deal, which have their source in 
furniture, flooring, &c., may perhaps be mis- 
taken for renal casts. They are at once recog- 
nised by the presence of the large round wood- 
cells which characterise the order of Coniferse. 
Casts may be conveniently divided, according 
to their appearance under the microscope, into 
three kinds, the epithelial cast, the granular cast. 
\ 
and the hyaline cast. 66 
RENAL CASTS, 
Casts—A. Epithelial, B. Granular, c. Fatty. D. Hyaline, 
The epiihelial cast. This cylinder consists of 
a mass of epithelium cells derived from the tu- 
bules of the kidney; the cells may become granu- 
lar and acquire a dark appearance by transmit- 
ted light. The cast is usually wide, never very 
narrow. 
The granular cast. This is a solid cylinder 
having a granular appearance, which may be 
limited to a few dark points in the substance 
of the cast, or be so intense as to give the cast 
an almost black appearance. In this kind of 
cast may often be found epithelial cells, blood 
corpuscles, red or white, pus corpuscles, crystals 
of uric acid, urates, and especially oxalate of THEIR VARIETIES. 
67 
lime. The fatty cast is a variety of the granu- 
lar, produced by the running together into glob- 
ules of the granules of fat. 
The hyaline cast. This cast is usually very 
transparent, and the outline is often so indistinct 
that a little iodine or magenta must be added to 
the urine before it can be detected, or a dia- 
phragm with a narrow opening must be used. 
They show indistinct markings on their surface, 
or a few granules and nuclei. There are two 
kinds, the wide and the narrow ; the latter are 
sometimes of great length. 
In observing casts, notice must be taken of 
the action of acids upon them, or their contents. 
It is thought that when the cylinders resist the 
solvent action of hydrochloric acid to any great 
degree, that the inflammation of the kidney is 
correspondingly intense. The granules on the 
cast, if albuminous, will disappear, when acted 
on by acetic acid ; but if oily, they are rendered 
more distinct. The width of the cylinder is of 
some importance, as it is supposed that very 
broad casts are formed in tubules completely 
stripped of their epithelium, and that the prog- 
nosis is more grave when these wide casts show 
on their sides no nuclei, or attempt at re-formation 68 
CLINICAL IMPORT OF 
of epithelium. From the recent observations on 
the varying- diameters of the uriniferous tubes, 
the importance of the breadth of the cast be- 
comes less. 
Clinical Import. The presence of casts in the 
urine is a sure sign of disease of the kidney, 
but not, however, necessarily of permanent 
disease of the kidney. They are present in 
many acute diseases, accompanied by albumen 
in the urine ; but if they are found for several 
weeks together, after all fever have left the 
patient, then permanent disease of the kidney 
may be inferred. Casts are constantly present 
in the urine in all cases of congestion of the 
kidney, and of acute or chronic Bright’s disease. 
But no certain information as to the nature of 
the disease existing in the kidney, for ex- 
ample, whether lardaceous or otherwise, can be 
had from the characters of the casts, since all 
forms of Bright’s disease end in fatty changes. 
Some help may, however, be derived from the 
appearance of the casts in forming a judgment 
of the acute or chronic character, or a prognosis, 
of the disease. If, for example, there be found 
in the urine epithelial casts which have under- 
gone little, or no, granular change, and casts RENAL CASTS. 
studded with red blood-corpuscles, together with 
a large quantity of epithelium from the tubules 
of the kidney, having a natural or only slightly 
clouded appearance, there can be little doubt 
that the patient is suffering from an acute attack 
of Bright’s disease : while if the casts be chiefly 
fatty, or intensely granular, and the epithelium 
be small in amount, and the cells withered and 
contracted, or containing globules of oil, it will 
be more than probable that the case is one of 
chronic Bright’s disease. 
Since little trust can be put in the characters 
of the casts as an aid to special diagnosis, some 
of the leading characters of the renal derivatives 
in the chief forms of kidney affection will now 
be spoken of more at length. 
Congestion of the Kidney. The casts are chiefly 
hyaline, seldom showing any marks of fatty 
•change. Very rarely may blood or epithelial 
oasts be discovered. 
Acute Bright's disease. At the beginning, the 
urine deposits a sediment which consists of 
blood-corpuscles, narrow hyaline casts, and casts 
covered with blood-corpuscles, the 1 blood cast’ 
of some authors. In the next stage, the amount 
of blood present is not so great, but, a great 70 
CLINICAL VALUE OF RENAL CASTS. 
desquamation of the renal tubules taking- place, 
renal epithelium and epithelial casts are found in 
great numbers ; the epithelium has undergone 
little, if any, granular change; hyaline casts are 
observed together with epithelial. In the next 
stage, the changes in the epithelium may be 
almost daily observed; at first they become 
granular, cloudy in appearance, which change 
often goes on to fatty degeneration, and the epi- 
theial cells then contain large fat drops, while 
the epithelial casts undergo a like change, and 
become distinctly granular and even fatty. 
If the patient recover, the casts and epithelium 
slowly disappear from the urine, but if the case 
become chronic, the renal derivatives show the 
characters described in the next paragraph. 
Chronic Bright1 s Disease. Numerous forms of 
casts are met with; the hyaline, both narrow and 
wide forms; the larger are often beset with 
granules dissolved on the addition of acetic acid ; 
the granular, whose surface is often covered with 
fatty or shrivelled-up epithelium cells; fat drops 
may stud the cylinder. Epithelial casts are 
rare, except in febrile exacerbations, when the 
renal derivatives found in acute Bright’s disease 
are present, together with granular and fatty FUNGI 
casts, evidence of the previous alteration of the 
kidney. 
Lardaceous or Amyloid Kidney. The urinary 
deposit contains hyaline casts, which are often 
accompanied by pus corpuscles. Atrophied epi- 
thelial cells, becoming- fatty in the latter stag-es 
of the disease, are almost invariably present. 
FUNGI. 
Many kinds of fungi grow in the urine after it 
has been voided for some time, and when the am- 
moniacal decomposition has begun, or is about 
to begin. The most important are (a) bac- 
teria, also known as vibriones, monas crepusculum, 
inicrozyma and the like. Their origin is now 
warmly contested, but it cannot yet be said that 
any source save that of omne ovu77i ex ovo has been 
proved. They will be often known by their in- 
cessant motion ; but care must be taken not to 
confound with bacteria inorganic particles show- 
ing the molecular movement. They show vari- 
ous forms, chiefly linear, and need a high power 
of the microscope to recognise them ; (b) thepeni~ 
ciliumglaucum, the fungus which forms ‘mildew,’ 72 
SPERMATOZOA. 
and which often appears when the acid fermen- 
tation has begun; (c) the yeast fungus, iorula 
cerevista, or saccharomyces urinal, oval cells about 
the size of a blood-corpuscle joined together in 
a row, considered by Dr. Hassall to be diag- 
nostic of diabetes; (d) sarcina are apparently 
formed in the urine before it be voided ; they are 
square bodies, divided into secondary squares, 
which number 4, 16, 64, &c., and are like the 
sarcinae found in the vomited matters of per- 
sons suffering' from stenosis of the pylorus. 
Kiestein is a whitish pellicle formed on the 
surface of the urine of pregnant women, when 
allowed to remain at rest for a few days. It 
appears to consist chiefly of the mould fungus, 
globules of fat, and crystals of phosphates. For- 
merly it was thought to be a sign of pregnancy ; 
but it is seen in the urine of men and it is not 
always present in pregnancy. 
SPERMATOZOA. 
These little bodies are present in the urine of 
men first passed after an emission of semen. A 
few pass away in the urine, probably, without 
venereal excitement, especially when the person SPERMATOZOA. 
73 
is continent. In the urine of women, they are 
almost positive proof of sexual intercourse. 
The seminal secretion forms a glairy white de- 
posit at the bottom of the urine glass. When 
examined with the microscope, (for which a high 
power, magnifying 400 or 500 diameters, is best, 
although a power of 250 will identify them), sper- 
matozoa show the characteristic oval head or 
body, often somewhat pear-shaped, and long de- 
licate tail, two or three times the length of the 
head. In the urine no movement is ever shewn 
by these bodies. APPENDIX. 
It has been thought desirable to add a short 
account of the method of estimating the chief 
substances found in the urine, since the clinical 
clerk may often be desired to make an analysis 
of the urea, chlorides, phosphates, &c. No 
account of the method of making standard 
solutions will be given, as this preparation re- 
quires a greater knowledge of chemistry than is 
usually possessed by the clinical student. For 
the same reason, no details have been introduced 
which require the use of a balance. 
The metric weights and measures only will be 
employed: they are 
The litre, the unit for measures of 
I ’76 pints. 
The cubic centimeter, (C.C.) the Part 
of a litre. 
The gramme, (grm.) the unit of weight, the 
weight of a cubic centimeter of distilled 
water, at 4°C. at normal barometer pres- 
sure, =l5 -43 English grains. 76 
APPARATUS AND DIRECTIONS. 
The milligramme, the Part °* a 
gramme. 
The apparatus required will be : 
A measure of litre capacity, divided into parts 
containing io C.C. at least. 
Burettes, divided into quarters of a C.C. 
Pipettes, which deliver 5, 10, 15, 20, 30 and 
50 C.C. 
Beakers, Berlin dishes, stirring- rods, &c. 
GENERAL DIRECTIONS. 
The whole of the urine passed in the 24 hours 
must be obtained: it will be found most con- 
venient to collect it from 9 a.m. on one day to 
9 a.m, on the following day, making the patient 
micturate precisely at this hour. 
The urine must be kept, as it is passed, in a 
covered glass vessel. When the analysis is to 
be made, the urine must be measured in a vessel 
graduated to a 1000 C.C., and divided into parts 
containing at least 10 C.C. each. After measur- 
ing, the whole of the urine must be mixed 
together, and a portion of this used in the esti- 
mation of the urea, chlorides, &c. SEPARATION OF ALBUMEN. 
77 
A complication arises if the urine contain 
albumen ; and, in this case, the albumen must 
be removed before proceeding- to the analysis of 
the urea, &c.; a measured quantity of urine, too 
or 200 C.C. is heated in a Berlin dish, the bottom 
of which is protected by a piece of iron wire 
gauze, over a small, naked flame, to nearly the 
boiling- point. If the albumen do not separate 
in flakes, dilute acetic acid is very carefully added 
until the acid reaction be marked. If too much 
acetic acid be added, part of the albumen may 
be redissolved. The heat must be moderate, and 
only just rise to boiling point, or the urea will 
be decomposed. The urine, after cooling, is 
then to be filtered into the same measure that 
was used at the beginning to ascertain the 
volume (too or 200 C.C.), the dish and filter 
washed with small quantities of distilled water, 
which are added to the filtrate, until the urine 
stand at exactly 100 or 200 C.C. according to 
the initial quantity. This fluid is then used in 
the estimation of the urea, chlorides, phosphates, 
sugar, &c. 78 
ESTIMATION OP UREA. 
There are two methods now commonly in 
use for the estimation of urea: one, lately 
introduced by Dr. Russell and Dr, Samuel 
West; the other, a method first employed by 
Liebig- and known by his name. 
In both of these it is necessary to ascertain 
beforehand the presence or absence of albumen. 
If albumen be present, it must be separated by 
the method given on the page above. If the 
urine be free from albumen, both the methods 
may be used without further preparation of the 
urine. 
The first process, a modification of Hiifnet’s, 
is based upon the fact that when urea is acted 
on by an alkaline hypobromite, nitrogen is 
given off, and this nitrogen, when collected 
and measured, gives an estimation of the urea 
decomposed. 
The hypobromite solution used in this process 
is made by dissolving 100 grammes of common 
solid caustic soda in 250 C.C. of water and 
then gradually adding 25 C.C. of bromine. 
The solution may be had of any manufacturing 
chemist but it is must be quite freshly prepared. ESTIMATION OF UREA. 
79 
The apparatus5”5 necessary is figured in the ad- 
joining woodcut. It consists of the tube, A, which 
is about 9 inches long, narrowed somewhat be- 
fore the closed end be reached, which end is 
blown out into a bulb, B. The free end is 
fitted by means of an india rubber cork into the 
hole G at the bottom of the trough C D which 
* It may be had of Cetti, Brooke Street, Holborn, price 
ss. 6d. ESTIMATION OF UREA. 
stands on three legs. When an estimation is to 
be made, 5 C.C. of urine are measured off with 
a pipette and allowed to run down the side of 
the tube A, into the bulb B. Distilled water is 
then added by means of a wash bottle, to wash 
away the urine adhering to the sides of the tube, 
but in quantity enough only to fill up the bulb as 
high as the constriction, or a very little above 
it. A glass rod tipped with india rubber is then 
introduced into the tube, A, so that the india 
rubber fills up the constriction and acts as a 
cork. Care must be taken that no air bubbles 
are present below the constriction. The hypo- 
bromite solution is then poured into the tube 
until it be quite full: and the trough filled with 
common water. The graduated tube F, is then 
filled with water, the thumb slipped over it, so 
that it contains no air bubbles, and then inverted 
in the trough. The glass rod tipped with india 
rubber is withdrawn, and the graduated tube, 
F, immediately slipped over the mouth of the 
tube A. The mouth of this should project well 
up into the tube F, so as to prevent the escape 
of any of the gas. The reaction begins imme- 
diately, but in order to bring it to an end as 
quickly as possible, the bulb should be heated ESTIMATION OF UREA. 
by a spirit lamp or Bunsen s burner till the bulb 
be hot to the hand. In five minutes the amount 
of gas may be read off. After some hours the 
gas is lessened in quantity; it is thus important 
to read it off as soon as the reaction is over. 
The amount of gas measured by the divisions 
on the tube gives the percentage of the urea in 
the specimen of urine examined. 
The estimation of the total amount of urea 
excreted in the 24 hours is now easy. All that 
is to be done is to multiply the total number of 
cubic centimeters of urine passed by the figures 
read off on the measured tube. Thus, if the 
amount of urine passed in the 24 hours be 1770 
C.C. and the percentage of the urine i“B., it is 
only necessary to multiply 1770 by rB. to get 
the amount of urea in milligammes. 
This will be 31860 milligrammes, and since 
1000 milligrammes equal one gramme, the 
total amount of urea passed will be 3r86 
grammes. 
If the urine contain more than 2 per cent, 
of urea, the urine must be diluted with an 
equal bulk of distilled water, and the results 
doubled. 
This method seems likely to be of great value 82 
ESTIMATION OF UREA. 
in clinical research, as it may readily be used in 
the wards of a hospital. 
The following- method is that described by 
Liebig-. 
The solutions required are : 
A standard solution of nitrate of mercury, 
of which i C.C, corresponds exactly to 
io milligrammes of urea. 
A solution of baryta, made by mixing 2 
volumes of cold saturated solution of 
caustic baryta, with I volume of cold 
saturated solution of nitrate of baryta. 
A saturated solution of carbonate of soda. 
If the urine be free from albumen, a measured 
pipette, containing 10 or 15 C.C., is filled with 
urine, twice, and the urine allowed to run into a 
urine glass or beaker. The same pipette is 
next filled with the baryta solution, which is 
then added to the urine previously measured off. 
There are thus two volumes of urea to one of 
baryta solution. The mixture of urine and 
baryta is then passed through filtering paper; 
a drop or two of the filtrate is to be tested with 
the baryta solution to see if any precipitate 
occur, and if any precipitate do occur, it is best 
to take a fresh quantity of urine and to add an 83 
ESTIMATION OF UREA. 
equal volume of baryta solution; after filtration, 
this must again be tested. The object of the 
addition of the baryta is to remove the phos- 
phates from the urine. 
The next step is to measure off a definite 
quantity of the filtrate, so that in any case it 
may contain 10 C.C. of urine. Thus, if one 
volume of baryta solution were used with two 
volumes of urine, 15 C.C. of the filtrate would 
be measured off with a pipette. If equal 
volumes of urine and baryta solution were em- 
ployed, 20 C.C. must be measured off. A bur- 
ette divided into quarters of a cubic centimeter 
is then to be filled with the standard solution of 
nitrate of mercury. The burette must be filled 
to the brim, and allowed to remain at rest for 
some time, so that all bubbles may rise to the 
surface and burst. The solution must then be 
let off by the pinch-cock at the bottom of the 
burette, until the lower of the two black lines, 
seen by means of transmitted light on the sur- 
face of the fluid, be exactly on a level with the 
first division of the burette. Care must be 
taken that the solution fills the whole of the ap- 
paratus below the pinch-cock, and that no air 
bubbles are there contained; for if the latter 84 
ESTIMATION OF UREA. 
rise to the surface during- the analysis, the esti- 
mation is, of course, worthless. 
The measured quantity of the filtrate of the 
urine and baryta is then to be placed in a small 
glass vessel, a beaker holding about 100 C.C. 
being best; a few drops of dilute nitric acid are 
to be added, and the vessel placed under the 
burette.* The work of estimating the urea now 
begins. The solution of nitrate of mercury is 
allowed to run, drop by drop, into the fluid 
below, stirring the latter well with a glass rod, 
until a permanent precipitate be produced : the 
absence, at first, of a permanent precipitate is 
caused by the chlorides present; the amount of 
nitrate of mercury used is then read off and 
* A great saving of time may be effected by making two se- 
parate estimations; in the first estimation, at once adding 15 
C.C. of the mercury solution to the fluid in the beaker, testing 
this with the soda, and then adding the mercury solution in 5 
C.C. at a time, and testing with soda after each addition, until 
a yellow colour is produced. The exact point for the estima- 
tion of the urea is found to be between 15 and 20 C.0., or 20 
and 25 C.C., as the case may be. A second estimation is then 
made, and mercury solution to the amount of the smallest 
number of C.C. before the yellow colour was produced, is at 
once allowed to flow into the beaker, and then added more 
carefully by quarters or halves of a C.C, as described in the 
text. ESTIMATION OF UREA. 
85 
noted down; the nitrate of mercury is then 
added by quarters or halves of a C.C., the mix- 
ture being* well stirred after every addition, 
until a drop of the mixture give a yellow colour 
when brought into contact with solution of car- 
bonate of soda. 
The most convenient method of ascertaining 
the first appearance of the yellow colour is to 
place a small glass disc on a piece of black 
paper, with a few drops of saturated solution of 
carbonate of soda spread over it; and to let fall 
as small a drop as possible of the fluid from the 
beaker into the margin of the soda solution. If 
no yellow colour be seen, another half C.C. of 
the mercury solution must be added, and the fluid 
from the beaker again tested with the soda, and 
the mercury solution must be added until the 
least appearance of yellow occur, when one 
drop more of the mercury solution must be 
added to the beaker, the fluid well stirred about, 
and another small drop taken from the mixture 
and tested with the soda, when, if the process 
have been rightly performed, an increase in the 
yellow colour will be perceived. Great car® 
must be taken, during the whole of these opera-, 
tions, not to lose one single drop of the fluid 86 
ESTIMATION OF UREA. 
from either the beaker or burette. Then the 
whole of the carbonate of soda solution con- 
tained on the glass plate is to be poured into the 
beaker, and a drop from this mixture tested 
with fresh soda; if the yellow colour now 
appear, the number of C.C. used must be read 
off; but if not, more of the mercury solution 
must be dropped into the beaker until the yellow 
colour appear in the soda, and the number of 
C.C. used then read off. From the total num- 
ber of C.C. used, there must be subtracted the 
number of C.C. used in the first part of the 
process before a permanent precipitate were 
produced, and the remainder multiplied by 10 
gives the number of milligrammes of urea con- 
tained in io C.C of urine, because i C.C. of the 
mercury solution corresponds to to milligrammes 
of urea. 
Thus far the amount of urea contained in io 
C.C. of urine has been ascertained; by simple 
proportion it is easy to find the quantity passed 
in the 24 hours. For example, suppose that 1 
C.C. of the mercury solution were used before a 
permanent precipitate were produced; and that 
19 C.C. were used before the yellow colour were 
distinctly seen, then 1 C.C. subtracted from 19 ESTIMATION OF CHLORIDES. 
87 
C.C. leaves 18, which multiplied by 10 gives 180 
milligrammes of urea in 10 C.C. of urine. Sup- 
pose that the patient had passed 1770 C.C. of 
urine in the 24 hours, then the calculation would 
be as follows: 
10: 1770; ; 31860 
180 
10) 318600 
31860 milligrammes 
As 1000 milligrammes equal 1 gramme, 33860 
milligrammes equal 31-860 grammes. 
ESTIMATION OP CHLORIDES. 
The solutions required are: 
A standard solution of nitrate of silver, of 
which 1 C.C. corresponds exactly to 10 
milligrammes of chloride of sodium. 
A saturated solution of neutral chromate of 
potash. 
The urine should be as fresh as possible, and, 
if albuminous, submitted to the preparation de- 
scribed at page 77. 10 C.C. of urine are then 
measured off into a glass vessel or beaker, and 88 
ESTIMATION OF CHLORIDES. 
two or three drops of the solution of chromate 
of potash added, A burette divided into quar- 
ters of a C.C. is then filled with the standard 
solution of nitrate of silver, and the precautions 
as to filling- burettes, described in speaking of 
the estimation of urea (page 82) must be ob- 
served. The silver solution must then be 
allowed to fall into the beaker, and each drop 
well mixed with the urine by means of a glass 
rod. As each drop falls into the urine, it must 
be carefully watched for the least tinge of red 
surrounding the precipitate of chloride of silver. 
This reddish colour announces the approaching 
termination of the process, and is at first not 
permanent, but disappears when the fluid in the 
beaker is well stirred. The first drop, however, 
which produces a reddish tinge, not disappear- 
ing by agitation, indicates that the whole of the 
chloride present has been precipitated, and that 
chromate of silver is beginning to be formed. 
The quantity of silver solution used is now read 
off, and another drop let fall into the beaker 
from the burette, when the reddish colour ought 
to be heightened. From the number of C.C. 
used, the quantity of chloride is calculated; for, 
since 1 C.C. of the silver solution corresponds to- ESTIMATION OF CHLORIDES. 
89 
10 milligrammes of chloride of sodium, the 
number of C.C. of the silver solution used, 
multiplied by 10, will give the amount in milli- 
grammes of the chloride of sodium present in 
10 C.C. of urine. Thus if 6 C.C. of silver solu- 
tion were used before a permanent reddish 
precipitate was produced, 10 C.C. of urine will 
contain 60 milligrammes of chloride of sodium : 
and if the patient passed 1200 C.C. of urine in 
the 24 hours, the amount of chloride passed can 
be easily calculated in the following way: 
10 : 1200 : : 60 : 7200. 
7200 milligrammes equal 7-2 grammes, which 
will be the total quantity passed in the 24 hours. 
This process, as applied to urine, nearly all- 
ways gives results a little above the real amount 
present. 
For greater accuracy, therefore, 10 C.C. of the 
urine are measured off into a porcelain crucible, 
lor 2 grammes of nitrate of potash, free from 
chlorides, are dissolved in it, and the whole 
slowly evaporated to dryness, and exposed to a 
low red heat, until the carbon be completely 
oxydised, and the contents of the crucible white. 
After cooling, these are dissolved in distilled 
water, a few drops of nitric acid added until a ESTIMATION OF PHOSPHATES. 
faintly acid reaction be produced, a small quan- 
tity of carbonate of lime being then added in 
order to make the solution again neutral, the 
solution filtered, and the chlorides then estimat- 
ed in the manner described above. 
ESTIMATION OF PHOSPHATES. 
The solutions required are ; 
A standard solution of acetate of uranium, 
of which i C.C, corresponds exactly to 5 
milligrammes of phosphoric acid. 
A solution containing- acetic acid and ace- 
tate of soda: too grammes of acetate of 
soda are dissolved in water, too C.C. of 
acetic acid added, and the mixture dilut- 
ed until it equal 1000 C.C. 
A weak yellowish solution of ferrocyanide 
of potassium. 
50 C.C. of the filtered urine are mixed in a 
beaker with 5 C.C. of the solution of acetic acid 
and acetate of soda. The beaker is placed over 
a water bath, and when the mixture is well 
warmed, the standard uranium solution is drop- ESTIMATION OF PHOSPHATES. 
91 
ped into the beaker until precipitation cease; 
this can easily be ascertained by allowing the 
solution to trickle down the side of the beaker, 
A small drop from the beaker is then to be 
placed on a porcelain dish by means of a glass 
rod, and a drop of the solution of ferrocyanide 
of potassium placed close to it by means of 
another glass rod, and the two drops allowed to 
run together. If no alteration of the colour be 
produced at their line of meeting, more of the 
uranium solution must be added to the urine, 
until a drop, tested with the solution of ferrocy- 
anide of potassium, produce a light brown col- 
our where the two fluids meet. The number of 
C.C. of the uranium solution that have been 
used is read off; and if, after a second warming 
of the urine contained in the beaker, and a 
second trial of the fluid with the solution of the 
ferrocyanide, no increase in the intensity of the 
colour be produced, the process may be regard- 
ed as completed; but if a dark brown colour be 
produced by this second trial, too much uranium 
solution has been added, and the estimation 
must be begun again with another 50 C.C. of 
urine. 
The calculation for the amount of phosphoric 
acid passed in 24 hours is now easy. 92 
ESTIMATION OF ALBUMEN, 
i C.C. of uranium solution equals 5 milli- 
grammes of phosphoric acid. So that, if 15 
C.C. of the uranium solution have been used, 50 
C.C. of the urine will contain 75 milligrammes 
of phosphoric acid, and if the patient have passed 
1500 C.C. in the 24 hours, the calculation will 
be 
50 : 1500 : : 75 ; 2250 
75 
50)112500 
2250 milligrammes. 
2250 milligrammes equal 2’25 grammes, which 
will be the quantity of phosphoric acid passed 
in the 24 hours. 
ESTIMATION OP ALBUMEN. 
No easy, rapid, and trustworthy method of 
estimating the albumen, has yet been suggested. 
The ordinary way of coagulating the albumen 
by heat and acetic acid, throwing the precipi- 
tate on a weighed filter, washing, drying, and 
reweighing, is so long and troublesome that it is 
never employed in clinical observations. 
A fairly good method for clinical observation ESTIMATION OF SUGAR. 
93 
is the estimation by means of the polariscope. 
It is necessary to have the urine moderately 
transparent, and free from blood-corpuscles, 
sugar, and bile acids, to obtain results which 
are tolerably accurate. If the turbidity be per- 
sistent after filtration, a few drops of acetic acid, 
or a little carbonate of soda or milk of lime 
added to the urine before filtration, may remove 
the turbidity. For the method of using the 
polariscope, see page 95. 
The quantity of albumen in the urine is usually 
not more than 1 per cent.; it very rarely rises 
to 4 per cent, or more. A patient may pass 2 
to 20 grms. of albumen in the 24 hours. This 
latter amount is extreme. 
ESTIMATION OP SUGAR. 
There are two methods of estimating the a- 
mount of sugar present in diabetic urine, either 
by volumetric analysis, or by means of the po- 
lariscope. 
Volumetric Method. A standard copper solu- 
tion is required, containing sulphate of copper, 
neutral tartrate of soda or potash, and caustic 94 
ESTIMATION OF SUGAR 
solution of soda, 20 C.C. of which correspond to 
100 milligrammes of grape sugar. This solu- 
tion is exceedingly apt to decompose, and must 
therefore be preserved in well stoppered, com- 
pletely filled, glass vessels, and in a cool dark 
place. 
In estimating the sugar, the first step is to 
ascertain if the copper solution remain unde- 
composed : it may be used in the analysis, if, 
after boiling some portion in a test-tube, and 
setting it aside for an hour, no precipitate of 
copper oxyde have fallen. 20 C.C, of the 
copper solution are then measured off with a 
pipette, allowed to flow into a glass flask, and 
diluted with about 4 times their volume of dis- 
tilled water. 10 C.C. of the urine are then mea- 
sured off, and distilled water added until the 
mixture exactly measure 100 C.C. If, however, 
the urine contain sugar in but small quantity, 
it may be diluted with its volume of water only, 
or indeed with none at all. A burette is filled 
with the diluted urine, and the flask containing 
the copper solution is heated over a small flame, 
wire gauze intervening, until boiling begin: 
2 C.C. of the urine are then allowed to flow into 
the boiling copper solution. After a few se- BY FEHLING'S PROCESS. 
95 
conds, it must be carefully noticed if the copper 
solution have lost its colour, or be still blue. If 
it still appear blue when the flask is held be- 
tween the light and the eye of the observer, 
another C.C. of the urine must be added to the 
boiling copper solution; then the colour must 
be noticed, and if it be still blue, the operation 
should be repeated until the colour of the fluid 
have become yellow. The analysis is not yet, 
however, completed. The fluid in the flask 
must be filtered into three test tubes, and to the 
first test tube a few drops of the copper solution 
must be added, and the whole boiled to see if an 
orange-red precipitate of suboxyde of copper be 
produced; to the second test tube a small quan- 
tity of hydrochloric acid is added, and sul- 
phuretted hydrogen passed through; to the 
third, acetic acid and ferrocyanide of potassium 
are added. None of these reagents ought to 
produce a precipitate. 
If, on boiling with the copper solution, a pre- 
cipitate occur, too much urine has been added; 
if, in either of the two last mentioned test tubes a 
precipitate occur, not enough of the urine has 
been added to decompose all the copper; in 
either case, the estimation must be repeated. 96 
ESTIMATION OF SUGAR 
Since 20 C.C. of the copper solution corres- 
pond exactly to 100 milligrammes of sugar, the 
complete decoloration of the copper solution will 
be accomplished by exactly 100 milligrammes of 
sugar. If, therefore, for the 20 C.C. of copper, 
15 *5 C.C. of the dilute urine were required for 
complete removal of colour, and if the dilute 
urine contained only 10 per cent, of urine, i‘ss 
C.C. of urine will contain 100 milligrammes of 
sugar, and 100 C.C. of urine will contain 6‘45 
grm. of sugar ; as by proportion : 
If the urine contain albumen as well as sugar, 
the former must be removed as directed, page 
77- 
1-55 : ioo: : 100: 6450. 
Estimation by means of the Polariscope. By 
means of this instrument an estimation of the 
sugar present can be made, provided that the 
urine be moderately transparent. If it be 
passed through animal charcoal, the accuracy 
is greater of course, but not so great as to be of 
much consequence in purely clinical research. 
If the urine contain albumen, it must be re- 
moved by the method given above, page 77* 
The bile acids, when present, can scarcely affect 
the result, since they are found in such very 
small amount in the urine. BY THE POLARISCOPE. 
97 
The polariscope consists of a tube, supported 
upon a foot, and divided into three parts, one of 
which, the middle, is moveable, but the other 
two, which are at the ends of the instrument, are 
fixed. One of the fixed tubes is furnished with a 
small screw, attached to its lower surface; this 
may be called the eye-piece. The other fixed 
tube has no screw attached to it; it may be 
called the object-glass. 
A good argand burner, or a gas lamp, pro- 
tected by a neutral tinted glass cylinder, is ne- 
cessary, When the polariscope is to be used, 
the lamp is placed an inch or so in front of the 
object-glass. The hollow glass tube in the 
middle of the instrument must now be removed, 
and filled with distilled water; the small glass 
disc being slid over the end of the tube com- 
pletely filled with water, in such a manner that 
no air-bubbles are included in the tubes; the 
metal cover to keep the glass disc in its place is 
then attached to the tube, and the tube freed 
carefully from all moisture. The tube is now 
set in its place in the middle of the instrument ; 
and the observer, looking through the eye-piece, 
draws out, or pushes in, the moveable tube close 
to the eye, until he see at the end of the eye- 98 
ESTIMATION OF SUGAR 
piece, nearer to the lamp, a circular field di- 
vided into two equal parts by a black line, 
which ought to be sufficiently well defined. He 
next turns the screw attached to the under sur- 
face of the eye-piece to the right or left, as may 
be required, until the colour of the two halves of 
the field be exactly the same. The observer 
then notices whether the zeroes on the scale 
above the eye-piece be exactly opposite to each 
other. If they be not, the little button at the 
end of the scale should be gently turned, until 
they quite coincide. 
Before adjusting the instrument, the urine may 
be set aside to filter, or to pass through animal 
charcoal, if that be at hand. If the fluid be as 
free from colour as ordinary diabetic urine, it 
may be observed in the longer tube, 20 centi- 
meters in length, since the accuracy of the esti- 
mation is increased with the length of the tube. 
But if the fluid be dark, the shorter tube, 10 cen- 
timeters long must be used. 
The tube is now filled with the urine, in the 
same manner as it was previously filled with dis- 
tilled water, and again placed in the middle of 
the instrument. The observer then notices if 
any alteration in colour of the two halves of the BY THE POLARISCOPE. 
99 
field have taken place. If the uniformity of 
colour no longer exist, he should turn the screw 
below the eye-piece until the two halves of the 
field appear of precisely the same tint. The 
eyes are best rested occasionally during this 
part of the operation by looking on some white 
surface, as the ceiling of the room, or a sheet of 
paper. When the two semi-circles become ex- 
actly the same in colour, the number of degrees 
which the moveable zero is distant from the 
fixed zero is read off; and if the fluid observed 
contain sugar, the moveable scale will be found 
to the right: but if the albumen only, to the left. 
The number of degrees that the zero has moved 
gives, when divided by 2, the percentage amount 
of either sugar or albumen, if the longer tube 
were used; but the percentage is at once known, 
if the shorter tube were employed, as it is the 
same in amount with the number of degrees by 
which two zeroes are separated from each other. INDEX. 
Albumen: n. 
estimation of: 16, 92. 
Heller’s test for: 15. 
Millon’s test for: 15. 
removing from urine: 77. 
Alkaline Urine: 9. 
Amphigenous Reaction: 10. 
Apparatus: 6, 76. 
Bacteria; 71. 
Bile Acids, test for: 27, 
Hoppe’s method of separat- 
ing : 29. 
Strassburg’s test for : 28. 
Bile Pigments: 26. 
Blood: 58. 
Heller’s test for: 31. 
Guaiacum test for : 31. 
smoky appearance of urine 
containing: 3. 
as source of albumen: 18. 
in acute Bright’s Disease: 
69. 
Bright’s disease, acute : 69. 
chronic: 70. 
Cancer Cells in urine : 62. 
Carbolic Acid, cause of black 
urine: 3. 
Casts, renal: 63. 
Chlorides; 37. 
amount daily excreted: 
38- 
estimation : 38, 87. 
Colour of urine: 3. 
Colouring matters in urine 
30. 
Consistence: 5. 
Cystin: 53. 
Epithelium : 61. 
clinical import of: 68. 
Fehling’s test: 21. 
Fermentation: 23. 
Froth on urine: 5. 
Fungi: 71. 
Gmelin’s test: 26. 
Haemoglobin : 31. 
Heller’s test for: 31. 
Hsemaphasin, 32. 
Heller’s test for albumen 
IS- 
Hippuric acid: 36. 
Hoffmann’s test for tyrosin 
55- 
Indican : 32. 
Kiestein: 72. 
Leucin: 54. 
Microscope, directions for 
43- 
Microzyma: 71. 
Millon’s test for albumen 102 
INDEX 
Monas crepusculum : 71, 
Moore’s test for sugar : 18. 
Murexid test for uric acid : 
46. 
Odour of urine : 4. 
Oxalate of lime: 49. 
Penicilium glaucum: 71. 
Pettenkofer’s test for bile 
acids : 27 
Phosphates : 39. 
amount daily excreted: 40. 
distinction from albumen: 
13- 
estimation of: 90. 
urinary sediment : 50 
Physical examination : 3. 
Pigment in urine: 30. 
Polariscope : 96. 
Pus: 56. 
as cause of turbidity: 4. 
as source of albumen ; 17. 
Reaction of urine : 9. 
Reagents: 6. 
Renal casts: 63. 
Saccharomyces urinse; 72. 
Santonin: 3. 
Sarcinae; 72. 
Sediments: 42. 
micro-chemical examina- 
tion of: 51. 
Solids, total daily excretion 
of: 41. 
estimation of: 8. 
Specific gravity: 6. 
Spermatozoa: 72. 
Sugar: 18. 
amount daily excreted in 
health: 25. 
cause of high specific gra- 
vity: 8. 
estimation of: 24, 93. 
Fehling’s test for : 21. 
Fermentation test for: 23. 
Moore’s test for : 18. 
Trommer’s test for: 20. 
Sulphates: 40. 
amount daily excreted: 40. 
Tannin: 3. 
Translucency of urine : 4. 
Trommer’s test for sugar: 
20. 
Turbidity of urine : 4. 
Tyrosin: 54. 
Urates: 47^ 
Urea: 32. 
amount daily excreted : 34. 
estimation of: 78. 
Uric acid; 35. 
amount daily excreted: 35. 
Urinary sediment: 42. 
Urohsematin : 32. 
Urometer: 9. 
Uroxanthin: 32* 
Heller’s test for: 32. NEW BOOKS 
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