A GUIDE 
TO THE 
EXAMINATION OF THE HEINE. A GUIDE 
TO THE 
EXAMINATION OF THE URINE 
BY 
J. WICKHAM LEGG 
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON ; FORMERLY 
ASSISTANT PHYSICIAN TO ST. BARTHOLOMEW’S HOSPITAL AND LEC- 
TURER ON PATHOLOGICAL ANATOMY IN THE MEDICAL SCHOOL 
SEVENTH EDITION 
EDITED AND REVISED BY 
H. LEWIS JONES, M.A., M.D. 
member of the royal college of physicians; medical officer 
IN charge of the electrical D'epartm nT IN 
st. Bartholomew’s b iospital 
PHILADELPHIA 
P. BLAKISTON, SON & Co. 
No. 1012 Walnut Street 
1893 PREFACE TO THE SEVENTH 
EDITION. 
The present edition has been carefully re- 
vised throughout; the arrangement of the 
sections has been slightly modified, and 
some parts have been rewritten. About 
twenty pages of fresh matter, and twelve 
new illustrations have been added; the 
latter include several reproductions by pho- 
tography of actual specimens of urinary 
crystals. 
H. LEWIS JONES, M.D. 
9 Upper Wimpole St., W. 
Sept. sth, 1893. CONTENTS. 
Introduction ..... xi 
Table of the Composition of the 
Urine i 
Preliminary Scheme for the Exam- 
INATION OF THE URINE . . 2 
Physical Examination ... 4 
Specific Gravity .... 9 
Reaction 13 
Examination for Albumen . . 16 
Examination for Sugar ... 29 
Bile in the Urine .... 41 
Blood ....... 44 
The Pigments of the Urine . . 50 Contents. 
PAGE. 
Urea ....... 54 
Uric Acid 57 
Hippuric Acid ..... 60 
Chlorides 62 
Phosphates 64 
Sulphates 66 
Urinary Sediments .... 67 
Unorganised Sediments: 
Uric Acid 68 
Urates 72 
Oxalate of Lime 75 
Phosphates . . . . *7B 
Cystin 81 
Leucin and Tyrosin ... 83 
Organised Sediments : 
Blood 87 
Pus 88 Contents. 
PAGE. 
Mucus and Epithelium . . 90 
Renal Casts .... 94 
Micro-Organisms . . . 103 
Spermatozoa . . , .104 
Appendix ...... 106 
General Directions . . . 107 
Estimation of Urea . . . 109 
Estimation of Chlorides . . 123 
Estimation of Phosphates . 126 
Estimation of Albumen . . 128 
Estimation of Sugar . , . 130 
Index 137 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 com- 
panion at the bedside to the busy practi- 
tioner, 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 are most frequently seen in 
disease. An appendix has been added in 
which the manner of estimating the urea, 
chlorides, phosphates, sugar, &c., by volu- 
metric or other rapid analysis has been 
described. A GUIDE 
TO THE 
EXAMINATION OE THE URINE. 
TABLE OF THE COMPOSITION OF 
THE URINE. 
The following table gives the average daily 
quantity of the chief urinary constituents.0 
Water 1500 c.c. 52J ounces 
Solids 72-03 grms. 111079 grs. 
Urea 
33*i8 „ 
512*4 
yy 
Kreatinin 
O'QI „ 
14*0 
yy 
Uric Acid 
o-55 .> 
8'57 
yy 
Hippuric acid 
0-40 „ 
6*i6 
yy 
“ Pigment and ) 
Extractive ” ) 
10*00 „ 
i54-o 
yy 
Sulphuric Acid 
2’OI ,, 
30*98 
yy 
Phosphoric Acid 
3’i6 „ 
48*8 
yy 
Chlorine 
Too ,, 
107*8 
yy 
Ammonia 
°77 » 
n*8 
yy 
Potassium 
2-50 „ 
38-5 
yy 
Sodium 
11-09 „ 
170*78 
yy 
Calcium 
0*26 „ 
4*0 
yy 
Magnesium 
0*20 ,, 
3*0 
yy 
* Adapted from Kirkes’ Physiology. Thirteenth 
Edition. 2 
Scheme for Examination of Urine. 
In order that the examination of the urine 
may be made on a definite plan, the follow- 
ing scheme is recommended to the student. 
The order of examination that is here 
given should be followed always ; the details 
of each operation are described on the page 
referred to at the end of each paragraph. 
Notes should be taken of each observation. 
PRELIMINARY SCHEME FOR THE 
EXAMINATION OF THE URINE. 
I. Observe the colour of the urine and its 
appearance, noting whether it is clear or 
turbid (page 6). 
11. Ascertain the specific gravity (page 9). 
HI. Examine the reaction to litmus paper; 
and note whether acid, neutral, or alkaline 
(page 13). 
IV. Test the urine for albumen (page 16), 
If albumen is present look with the micro- 
scope for:— 
(a) Renal Casts (page 94). 
(/;) Pus Corpuscles (page 88). 
(c) Red Blood Corpuscles (page 45), Scheme for Examination of Urine. 
3 
V. Test the urine for sugar (page 29). 
VI. If the urine be dark coloured test for 
bile pigments (page 40). 
VII. If there be no albumen, nor sugar, nor 
bile pigment present, and if there be no 
sediment, the urine need not be further 
examined, except in special cases. 
VIII. If any sediment be observed it must 
be examined with the microscope (page 67). 
The following enumeration of the more 
common deposits may help the stu- 
dent. 
(a) Pink, or reddish amorphous deposit, 
dissolved when a portion of the urine, 
containing it, is heated in a test-tube. 
Urates (page 72). 
{b) Brownish-red crystalline deposit. 
Uric Acid (page 68). 
(c) White deposit, crystalline or amor- 
phous, soluble in acetic acid. Phos- 
phates (page 78). 
(d) Hummocky white sharply defined 
cloud, insoluble in acetic acid ; crys- 
talline. Oxalate of Lime (page 75). 
(e) White or yellowish flocculent deposit, 
rendered ropy by addition of liquor 
potassae. Pus (page 88). 4 
Colour of Urine. 
(/) White flocculi, amorphous, soluble 
in liq. potassse. Mucus. 
(g) Red non-crystalline deposit, con- 
taining red blood corpuscles. Blood 
(page 87). 
PHYSICAL EXAMINATION. 
The physical examination of the urine is 
the application of the senses to its investiga- 
tion, with or without the aid of the micro- 
scope or other physical instruments, and it 
is distinguished from the chemical examina- 
tion which is its investigation by the aid of 
chemical reactions. The quantity, colour, 
translucency, odour and consistence are the 
chief characters which can be ascertained by 
a simple physical examination. 
The quantity of urine passed daily is about 
52 ounces, or 1500 c.c., but it varies within 
rather wide limits. 
Colour.—Urine is ordinarily of a yellow or 
reddish-yellow colour, but it may be as 
colourless as water, or red, or dark brown 
like porter; the presence of a small quantity 
of blood gives it a colour which is well de- Colour of Urine, 
5 
scribed by the word smoky. If bile pigments 
are present it may have an orange, or brown, 
or dark greenish-brown tint. Many drugs 
give a peculiar colour to the urine; Rhubarb 
and Senna colour it reddish-brown, from the 
effect of the chrysophanic acid they contain ; 
Santonin gives the urine a bright yellow 
colour, which is reddened by alkalies. The 
absorption of carbolic acid gives it a dark 
hue. Tannin given by the mouth renders it 
almost colourless. 
The urine is pale (i) in health, when large 
quantities of fluid have been imbibed (urina 
potns), and (2) in disease, in anaemia, in dia- 
betes, in some nervous diseases [urina spastica) 
and during convalescence from severe illness. 
A pale urine contains little colouring matter 
and but a small proportion of solid consti- 
tuents, except in diabetes mellitus, when a 
pale urine may contain a large quantity of 
grape sugar (page 29). A pale urine is a 
sign that the patient is not suffering from 
any high degree of pyrexia. 
A high coloured urine occurs (1) in health, 
after food [urina cibi), after much exercise 
and after free perspiration, (2) in disease, in 
fevers and most acute disorders, for in these 6 
Odour of Urine. 
considerable metamorphosis 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 (page 50). 
Odour. It is not yet made out to what 
body the peculiar smell of the urine is due, 
nor is it of much importance to the clinical 
student. When the urine loses its natural 
smell and becomes foetid and ammoniacal, 
the change is due to the decomposition of 
urea into carbonate of ammonia, and to the 
formation of sulphur compounds ; in cases of 
cystitis and paraplegia the alteration begins 
either before or very quickly after the urine 
has been voided. Certain drugs, as copaiba, 
and oil of sandal wood, and certain articles 
of diet, as asparagus, give a characteristic 
smell to the urine; turpentine gives the 
odour of violets to the secretion. 
If the urine is turbid when first voided it 
should be carefully examined under the 
microscope. Pus is a common cause of this 
appearance, but a slight turbidity is often 
seen in freshly passed urine, if it be neutral 
or alkaline, and it is occasioned by the pre- Turbidity of Urine. 
7 
cipitation of phosphates which occurs under 
such circumstances. Urine which has been 
retained for some time in the bladder is 
likely to be slightly turbid from the presence 
of rather more than the usual quantity of 
mucus. 
Tmnslucency. 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 some- 
times become turbid from the presence of 
urates, which are distinguished from other 
deposits by their appearance, upon standing, 
in urine which was perfectly clear when first 
passed. 
Consistence. The urine is a limpid fluid, 
flowing freely from one vessel to another. 
But in catarrh of the bladder and in retention 
of urine, the ammoniacal products of the de- 
composition of the urea render the pus 
present thick and viscid, thus causing the 
secretion to be ropy, and when this condi- 
tion is well marked, the urine may be so 
viscid as to flow with difficulty when poured 
from one vessel to another. 8 
Apparatus and Reagents. 
The froth on normal urine readily dis- 
appears ; but if the froth be persistent, the 
presence of albumen, or of bile pigment, may 
be suspected. 
Before passing to the'chemical examina- 
tion of the urine, it may be well to speak of 
the apparatus and reagents which will be 
found necessary by the student for bedside 
investigation. They are : 
Cylindrical and Conical Urine Glasses, 
each containing about 6 fluid-ounces. 
A Urinometer, the stem of which is grad- 
uated from 1000 to 1060. 
Blue and Red Litmus Paper. 
Test Tubes. 
A Spirit Lamp, or Bunsen’s Gas Burner. 
Nitric Acid. 
Acetic Acid. 
Liquor Potassae or Liquor Sodae 
Solution of Sulphate of Copper, 10 grains 
to the fluid-ounce, or Fehling’s Test 
Solution for Sugar (p. 33). 
With this apparatus and these reagents 
the student will be able to perform the more 
important qualitative tests described below. 
Glass Funnels and Filtering Paper. Specific Gravity. 
9 
SPECIFIC GRAVITY. 
The specific gravity of a liquid is the 
number which expresses the relation of the 
weight of a given volume of the liquid to 
the weight of the same volume of distilled 
water. 
The specific gravity of the urine varies in 
health between 1010 and 1035, if the specific 
gravity of distilled water be taken as 1000. 
That is to say, a given volume of urine of a 
specific gravity of 1020 would be heavier 
than the same volume of distilled water in 
the proportion of 1020 to 1000. 
The simplest way of estimating the specific 
gravity of the urine is by means of the urino- 
meter (fig. 1). This instrument consists of 
a hollow glass vessel, weighted below, and 
terminating above in a slender stem. Its 
weight is so adjusted that it sinks deeply in 
distilled water. In denser liquids it sinks 
less deeply, and less of the stem is sub- 
merged ; and by means of a suitably grad- 
uated scale fixed in the stem, the specific 
gravity of the urine may be read off directly 
by observing the number on the scale which 10 
Specific Gravity. 
most nearly corresponds to the surface of 
the urine. 
In order to use this instrument, a quantity 
of the urine is poured into a cylindrical glass. 
Fig. i.—Urinometer, 
and care must be taken to remove any froth 
which may be present; this can be done 
with blotting paper, or by overfilling the 
vessel. The urinometer must then be care- Specific Gravity. 
fully introduced and allowed to float freely 
in the urine without touching the side or 
the bottom of the glass. Since the surface 
of the fluid rises by capillary attraction 
round the stem of the instrument, the 
specific gravity will be too low, if read off 
with the eye above the level of the liquid ; 
to obtain a correct reading the eye must be 
lowered to the level of the surface of the 
fluid, and the number on the stem ascer- 
tained by looking at it through the urine. 
Having noted this, depress the instru- 
ment in the urine, and allow it to come to 
rest once more, then repeat the reading to 
verify the first observation. The specific 
gravity thus ascertained should be noted 
down at once. 
The urine should be at the temperature 
of the surrounding air; if the specific gravity 
be taken while the urine is warm, the read- 
ings will be too low in about the proportion 
of one degree of the urinometer for every 
seven degrees Fahrenheit above the tem- 
perature for which the instrument was grad- 
uated. 
The knowledge of the specific gravity of a 
few ounces of urine is a matter of little value. 12 
Specific Gravity. 
To render the observation in any way ser- 
viceable, the whole quantity passed in the 
24 hours must be collected and mixed, and 
the specific gravity of this taken. A rough 
estimation of the solid matters passed may 
be made from the specific gravity in the fol- 
lowing way ; the two last figures are multi- 
plied by 2 or more correctly, 2-33, and the 
product gives the amount of solid matters in 
1000 parts of urine; if, for example, the 
specific gravity of the urine be 1020, 1000 
grains of urine will contain 20 x 2 = 40 
grains of solids, or multiplying by 2-33 = 
46-6 grains. 
If the quantity of urine is too small to 
float the urinometer, the specific gravity can 
be obtained in the following way. Add to 
the urine one, two, or three times its volume, 
carefully measured, of distilled water, take 
the specific gravity of the mixture, and 
multiply by the number of volumes em- 
ployed. If three volumes of water were used 
to dilute one volume of urine, and the 
specific gravity of this were found to be 
1005, then four volumes multiplied by 5 
would be 20, and 1020 would be the specific 
gravity of the urine. Clinical Import of Specific Gravity. 
13 
Clinical Import.—A high specific gravity- 
may be due to the presence of sugar; if 
this body is not present, then excess of urea 
will be the probable cause. 
A low specific gravity, below 1010, occurs 
after fluid has been taken in quantity, and in 
diuresis from any cause, such as exposure to- 
cold, or mental emotion, or after a paroxysm 
of hysteria. A low specific gravity is also- 
noticed frequently in anaemic states, and it 
is a common symptom in chronic interstitial 
nephritis. 
A new urinometer should be carefully 
tested, as they are sometimes carelessly 
graduated. As a rule the smaller instru- 
ments are less correct than the larger ones. 
A large urinometer and a large amount of 
urine give the truest results. 
REACTION. 
If all the urine passed in twenty-four 
hours by a healthy person be collected and 
mixed, the reaction of the whole quantity 
will be acid. The degree of acidity, however, 
is not uniform, but varies throughout the: 14 
Reaction. 
twenty-four hours, and after a meal the 
urine may be neutral or alkaline for a time; 
This has been called the time of “ the alka- 
line tide” by Sir William Roberts; and it is 
supposed to be associated with the large 
secretion of acid gastric juice at that time. 
To neutralize the acidity of the urine passed 
in twenty-four hours requires about fourteen 
grains of sodium carbonate. 
The acidity of the urine is due to the pre- 
sence of an acid salt, acid sodium phos- 
phate, NaH2P04, and not to the presence of 
free acids. It is probable that the organic 
acids of urine (uric acid, hippuric acid, &c.), 
are present only in combination with alka- 
line bases; and therefore they are without 
influence upon the reaction of normal urine. 
The acidity of the urine is said to increase 
a little during the first few hours after being 
voided, but sooner or later decomposition 
sets in, with conversion of the urea into am- 
monium carbonate and water by the agency 
of a special ferment, (the micrococcus urea); the 
urine then becomes alkaline, and ammonia- 
cal, and foetid from the presence of ammo- 
nium sulphides, while the earthy phosphates, 
and ammonium urate are deposited as a 
white sediment. Reaction. 
15 
In many of the cases in which the urine is 
found to be alkaline, the alkalinity is due to 
decomposition, taking place after the urine 
has been passed; therefore if a patient’s 
urine is found to be alkaline, a fresh speci- 
men should be obtained and tested immedi- 
ately. It is also important to know whether 
the alkalinity is due to ammonium carbonate 
or to fixed alkali. When the alkalinity is 
due to ammonium carbonate, red litmus 
paper which has been turned blue by the 
urine will lose its blue colour if gently 
warmed and dried, but it will remain blue if 
the alkalinity is due to potash of soda. 
When urine owes its alkalinity to am- 
monium carbonate, it is almost certainly due 
to decomposition of the urea ; this decom- 
position takes place in the bladder itself in 
cases of cystitis, in paraplegia, and in reten- 
tion of urine, if by any means the micrococcus 
uvece has gained an entry into the bladder, as 
frequently happens after the use of sounds or 
catheters which have previously been in 
contact with urine undergoing the ammon- 
iacal fermentation. In health the urine can 
be made alkaline by medicines which contain 
the fixed alkalies either in the form of Examination for A Ibumen. 
hydrates, carbonates, or alkaline phosphates, 
or in combination with most organic acids 
such as acetates, citrates, tartrates, in which 
cases the alkali is excreted as an alkaline 
carbonate. The administration of ammonia 
either free or combined does not make the 
urine alkaline. A diet consisting largely of 
meat tends to increase the acidity of the 
urine, and a vegetarian diet tends to make 
the urine alkaline. It is not so easy to make 
the urine acid by the administration of drugs 
as it is to make it alkaline, but the mineral 
acids do increase the acidity of the urine to 
a certain extent ; and there are certain 
organic acids which are excreted as acids, 
and tend to increase the acidity of the urine. 
Benzoic acid, which is excreted as Hippuric 
acid, is one of the best known instances. 
The acidity of urine is increased by fast- 
ing, and is apparently increased when the 
urinary water is diminished, and the urine 
thereby rendered more concentrated. 
This is the first and most important step 
in the chemical examination of the urine; 
EXAMINATION FOR ALBUMEN. Examination for A lb amen. 
17 
the presence or absence of albumen must 
always be determined before proceeding to 
test for any other substance, and the search 
must never be omitted in the examination of 
any urine. 
A very large number of reagents have 
been proposed as tests for albumen in the 
urine. They all act by coagulation and pre- 
cipitation of the albumen, which is thus 
rendered visible. It will be sufficient to 
describe three methods of testing for albu- 
men, viz : 
(1) Coagulation by heat and acid. 
(2) Coagulation by concentrated nitric acid 
in the cold. (Heller’s test). 
(3) Coagulation by picric acid. 
(1) By heat and acid.—The best way of 
performing this test is to fill a test tube 
about two-thirds full of the urine to be ex- 
amined, and to heat the upper layers of the 
fluid over the flame of a lamp, the lower part 
of the tube being held between the thumb 
and forefinger of the observer, in the manner 
represented in the following woodcut (fig. 2). 
By employing this method of procedure, the 
boiled upper part of the urine can be com- 
pared with the unboiled portion in the lower Examination for A Ihumen. 
part of the tube, and any slight degree 
of turbidity produced by the boiling can 
be readily perceived. It is a very useful 
precaution to filter the urine before boiling 
it; this step is too commonly neglected, but 
when the urine is a all turbid it should 
always be filtered before testing for albumen, 
for it is very much easier to see any faint 
Fig. 2. 
cloud of turbidity produced by the test if the 
urine under examination is first rendered 
perfectly bright and clear. The heat must be 
applied until the upper portion of the urine 
boils, and it is as well to keep it boiling for a 
full minute, otherwise, in certain cases, seme 
of the albumen may escape coagulation. The Examination for A Ibumen. 
boiled layer of fluid should now be carefully 
compared with the cool layer in the lower 
part of the tube, by holding the test tube in 
a good light, and looking through it at a dark 
background, for example, the sleeve of one’s 
coat. If any cloudiness or turbidity be seen, 
it must not at once be concluded that albu- 
men is present ; a drop or two of acetic acid 
or nitric acid should first be added. The 
cloud is permanent if due to albumen, but 
disappears quickly if due to phosphates. 
This addition of acid after boiling should 
never be omitted, since the most practised 
eye cannot distinguish, by appearance only, 
between the cloud of albumen, and the cloud 
of phosphate of lime. 
Cautions. The nitric acid must be added 
carefully, and not more than two drops used, 
otherwise the coagulated albumen if present 
only in small quantity may be redissolved, 
and the urine may be wrongly thought to be 
free from albumen. It is much better to 
acidify with strong acetic acid, and not to 
use nitric acid for this test at all. 
The effervescence which is often noticed, 
when nitric acid is added to the urine, is due 
to the decomposition of the urea by the 20 
Examination for Albumen. 
nitrous acid which is so commonly present 
as an impurity. The gases evolved are 
carbon dioxide and nitrogen. * Should the 
urine be turbid from the presence of urates, 
it may be made clear by gently warming the 
contents of the test tube before boiling the 
upper layers. It is often more convenient to 
clear such urines by gentle heat rather than 
by filtration. 
If the urine be neutral or alkaline at the 
time of testing, it may be carefully acidified 
by a few drops of dilute acetic acid before 
boiling; but it is better not to do so, lest the 
albumen be converted into acid albumen, 
and give no precipitate on boiling. If the 
preliminary acidification be done with nitric 
or hydrochloric acids this change into acid 
albumen is almost certain to be the result. 
If the urine be alkaline the albumen may 
be present as alkali-albumen; and this body 
also gives no precipitate on boiling alone but 
this is not likely to mislead because the pre- 
cipitate will appear as soon as the drop or 
two of strong acid is added after the boiling. 
The precipitate of phosphate of lime 
which is produced when certain urines are 
boiled always disappears when the acid is Examination for A Ihumen. 
21 
added. This precipitate is not a sign that 
the urine under examination is rich in phos- 
phates, but signifies rather that the speci- 
men is deficient in acidity. 
(2) Precipitation by concentrated nitric acid 
without heat. Heller's test. 
The addition of strong nitric acid to albu- 
minous urine will usually coagulate the 
albumen; the most delicate mode of ap- 
plying the test is by the method proposed by 
Heller, which consists in pouring some 
strong nitric acid into a test-tube, and 
afterwards adding the urine to be tested, in 
such a way as to avoid mixing the two 
fluids; this is done by holding the test-tube 
in a very much inclined position and allow- 
ing the urine to flow in very gently along 
the side of the tube. When this operation is 
carefully carried out the two fluids touch 
but do not mix, the nitric acid, owing to 
its greater density, remaining in the lower 
stratum. If albumen be present a whitish 
ring or disc of coagulated albumen gradually 
forms at the line of contact of the two liquids. 
Unless the urine is quite clear and bright, 
the test is not very delicate ; but it is easy to 
filter the urine and indeed the neatest way of 22 
Examination for Albumen. 
bringing the two liquids into contact, un- 
mixed, is to let the urine flow down the side 
of the test-tube from the filter itself. 
Heller’s test is thought highly of by many 
people, but it is not so good a test as the 
one by heat and acetic acid. Urea nitrate 
may form in concentrated urines, and mis- 
lead, and uric acid may do the same. 
Copaiba taken internally causes a pre- 
cipitate to appear in the urine with nitric 
acid in the cold, and so imitates the coagu- 
lation of albumen. It does not give any 
reaction with heat and acetic acid. 
(3) The picric acid test. A saturated solu- 
tion of picric acid coagulates albumen in 
neutral or acid urine ; it is usually recom- 
mended to acidify the urine with citric acid 
before applying the test, but this is rarely 
necessary, the picric acid itself will gerierally 
be sufficient to ensure that the mixture shall 
not be alkaline. 
To carry out the test, fill a test-tube half 
full of the urine, filtered if necessary, and 
then pour upon it picric acid solution to the 
depth of about an inch, if albumen is present 
a white cloud will be formed at the junction 
of the two fluids, and may be increased by Examination for Albumen. 
23 
gently shaking the tube so that the fluids 
mix near their point of junction. 
The compound of picric acid and albumen 
is soluble in excess of albumen, but this is 
not a serious objection to its use in testing 
urines, as it can easily be guarded against 
by a little care and attention. 
(4) Potassio-mercuric iodide (Tanrefs test)0 
is also recommended as a good test for albu- 
men. It is extremely delicate, indeed, per- 
haps too much so, for it is said to produce a 
slight opalescence in al urines. 
Among other suggested tests for albumen 
in the urine may be mentioned tungstate of 
soda and ferrocyanide of potassium (both of 
these must be applied to urines which have 
previously been acidified with acetic or citric 
acid) and Sir William Roberts’ acidulated 
brine test (saturated solution of sodium 
chloride 19 parts, strong hydrochloric acid 
1 part). A paper by Dr. Vincent Harris, in 
vol. xix. of the St. Bartholomew’s Hospital 
Reports should be consulted for full inform- 
ation on these reagents. 
To make the testing of urines more con- 
* Mercuric chloride 1*35 grammes, potassium iodide 
3'32 grammes, acetic acid 20 c.c., water 64 c.c. 24 
Examination for Albumen. 
venient for practitioners Dr. Oliver" of 
Harrogate has contrived a series of test 
papers charged with the proper reagents by 
means of which albumen may be readily 
discovered in the urine, and he has extended 
the same methods to the testing for sugar, 
bile pigment and bile salts. 
The ordinary preteids occurring in the 
urine are (i) serum-albumen, (2) paraglobulin; 
both of these bodies are present in ordinary 
cases of albuminuria, though their relative 
proportions may vary a good deal (3) acid al- 
bumen, and alkali albumen may also occur, but 
their presence is due to changes in the urine 
after its secretion by the kidney, (4) alhumoses 
and peptone may also be found; perhaps most 
of the cases reported as peptonuria should be 
regarded as cases of urine containing albu- 
rn ose. 
The presence of these bodies may be 
ascertained by the biuret test; the urine is 
first made alkaline with liquor potassae, and 
then a drop of a dilute solution of sulphate 
of copper is added and the mixture is well 
shaken. A rose colour appears if albumose 
or peptone be present. 
* On Bed-side Urine Testing. By Dr. Geo. Oliver. 
H. K. Lewis. Estimation of Albumen. 
25 
This test can, however, but seldom be 
applied directly to the urine ; if other albu- 
minous bodies be present it is absolutely 
necessary that they be removed ; and if the 
urine be high coloured, it will be necessary to 
decolorise it with carbonate of lead. These 
more elaborate processes can seldom be 
employed by the clinical clerk.* 
Albumoses have been found in the urine 
in such conditions as scurvy, purpura, and 
other acute haemorrhagic diseases; also in 
those cases where a large number of white 
corpuscles are being destroyed, as in the ab- 
sorption of large pleuritic effusions, in pneu- 
monia, inflammation of the joints, meningitis, 
fractures, boils, &c. 
A rough way of estimating the amount of 
albumen 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 
* See Textbook of Chemical Physiology and Patho- 
logy, Dr. Halliburton. Longmans &= Co. “ The detec- 
tion of proteid bodies in the urine,” Dr. Sydney 
Martin. Brit. Med. Jour., April, 1888. 26 
Estimation of Albumen. 
for twenty-four hours; at the 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 albu- 
men in the urine, and so for one-sixth, or one- 
eighth, as may be. If, however, at the end 
of 24 hours scarcely any albumen have col- 
lected at the bottom, there is said to be a 
trace. If any urates have been deposited, the 
urine must be filtered before boiling, or a 
considerable error will creep in, by their 
increasing the apparent amount of albu- 
men. 
This method of estimating the albumen 
quantitatively has been elaborated by the 
use of graduated test-tubes. Esbach’s “albu- 
minometer” (fig. 3) is such a tube ; to use it, 
urine is poured in to reach the graduation U. 
and saturated picric acid solution is added 
to the mark R, the tube is shaken and the 
fluids mixed, the coagulated albumen is then 
left to settle for twenty-four hours and the 
number opposite to its upper level at the end 
of that time is read off directly as grammes 
per litre of dry albumen. To express the Clinical Import of Albumen. 
27 
result as a percentage divide by 10 because 
a litre of water weighs 1000 grammes. 
Clinical import.—The presence of albumen 
in the urine is an important objective sign of 
Fig. 3.—Esbach’s Albuminometer. 
disease. The causes of albuminuria may be 
grouped under the following heads : 
(i) Obstruction to the flow of blood 
through the kidneys. 28 
Clinical Import of Albumen. 
Any state which brings about a mechani- 
cal impediment to the return of blood from 
the kidneys, will be accompanied by albu- 
men in the urine, and the albumen will be 
persistent so long as the congestion of the 
kidney continues ; the longer the state of 
congestion remains, the greater danger is 
there of permanent textural injury to the 
kidney. Any general impediment to the 
circulation, such as valvular disease of the 
heart, or emphysema of the lungs, or any 
local impediment to the renal circulation, 
as from a tumour pressing upon the renal 
veins or inferior vena cava, will produce albu- 
minuria. 
(2) Any acute febrile disease may be ac- 
companied by albuminuria, which, as a rule, 
disappears with the disappearance of the 
febrile state, unless there be some permanent 
structural change set up thereby in the 
kidney. 
(3) Diseases of the kidney itself are usually 
accompanied by albuminuria. 
It must not be forgotten that albumen may 
find its way with the urine from any part of 
the urinary tract, from the ureters, as when 
they are lacerated by the passage of a cal- Sugar in the Urine. 
29 
cuius; from the bladder, in many diseased 
conditions of that viscus ; from the urethra 
in gonorrhoea, or from the vagina. In the 
urine of women, a small quantity of albumen 
is often due to leucorrhoeal discharge, which 
is composed partly of pus. 
If blood be present in the urine, albumen 
must likewise be present, derived from the 
corpuscles and plasma. 
The search for renal casts (p. 94) must 
always follow the detection of albumen in 
the urine. The discovery of these structures 
renders it certain that the albumen, or at 
least part of it, is derived from the kidney. 
EXAMINATION FOR SUGAR. 
If the specific gravity rise above 1030, 
sugar may be suspected, and should be 
looked for. Sugar may also occur in urines 
of low specific gravity. 
The sugar in the urine is grape sugar. 
Many methods of testing for sugar have 
been proposed; but only the most prominent 
and trustworthy will here be mentioned. 
Before testing urine for sugar, it should be 30 
Moore's Test for Sugar. 
tested for albumen; and if this body be 
present, it should be removed by boiling 
and acidulating some of the urine with one 
or two drops of acetic acid, and filtering. In 
the same way if the urine be high coloured, 
it may be well to get rid of the colouring 
matters by throwing them down with a solu- 
tion of acetate of lead and filtering. And if 
the urine be turbid from urates, it is very 
desirable to free the urine from these by fil- 
tration before applying the tests for sugar. 
Moore's test.—Equal parts of urine, and 
liquor potassae or liquor sodae, 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. (Seep. 17). The heated portion 
becomes brown or dark brown, according to 
the quantity of sugar present. The least 
change of colour may be perceived by com- 
paring the upper and lower layers of the 
liquid. 
Caution. High-coloured urines and indeed 
almost all urines darken very perceptibly on 
boiling with caustic alkalies, and if the urine 
be albuminous, the colour will be greatly 
deepened, though no sugar be present. This Trammer’s Test for Sugar. 
test, therefore, is not worthy of the attention 
of a careful student. 
The Copper test depends on the property 
which grape sugar possesses, of reducing the 
higher oxide of copper (CuO) to a suboxide 
(Cu3o). There are two methods of con- 
ducting this reaction, identical in principle, 
named respectively Trommer’s Test and 
Fehling’s Test. 
Trammer's test.—About a drachm of the 
suspected urine is poured into a test tube, 
and liquor potassae or liquor sodas 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. If 
sugar is present 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 
solution will have acquired a beautiful blue 
colour, but should be quite clear, and free 
from any blue 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 32 
Trammers Test for Sugar. 
some time, becomes reddish brown. This 
precipitate consists of the suboxide of copper 
or cuprous oxide. 
On applying Trommer’s test to urine, a 
change of colour is seen in every case; but 
this is no proof of the presence of sugar ; the 
reaction is only known to be complete when 
a red or orange precipitate is thrown down. 
If the test be carefully done with urine 
which contains no sugar, or other reducing 
substances, the following points will be 
noticed:—i. The mixture is of a pale blue or 
green colour, and not of the deep blue which 
is seen when sugar is present, 2. The floc- 
culent precipitate of cupric hydrate is not 
redissolved, even though it may seem to be, 
and if the mixture be filtered it will come 
through without any blue tinge. 3. Boiling 
produces a yellowish colouration of the mix- 
ture from the action of the excess of alkali 
upon the colouring matters of the urine, (see 
Moore’s test above), and floating in the mix- 
ture may be seen flakes of phosphate of lime, 
thrown down by the potash, and black parti- 
cles of cupric oxide the result of the decom- 
position of the cupric hydrate by the heat 
employed. Fehling’s Test for Sugar. 
33 
When sugar is present, the cupric hydrate 
redissolves to form a rich deep blue solution, 
which will pass through the filter, and boil- 
ing throws down an opaque precipitate of 
the red cuprous oxide. 
Since uric acid and mucus will also reduce 
copper when they are boiled with its salts in 
an alkaline solution the test should be tried 
also in the cold, and if at the end of the 
twenty-four hours the reddish precipitate 
have fallen, sugar is undoubtedly present. 
Cautions.—Much trouble is often at first 
felt in arranging the proper proportion be- 
tween the copper solution, and the liquor 
potassse. The mixture must be alkaline, too 
much copper must not be added ; and it is 
wise, in every doubtful case, to filter, and 
operate with a clear solution. 
Fehling's solution. (Dr. Pavy’s solution is 
identical in principle with Fehling’s solution). 
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 necessary. 
This solution may be prepared in the fol- 
lowing way : grains of crystallized 34 
Fehling's Test for Sugar. 
potassio-tartrate of soda are dissolved in 5 
fluid ounces of a solution of caustic potash, sp. 
gr. 1 -i2. Into this alkaline solution is poured 
a fluid prepared by dissolving 133-I grains of 
sulphate 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 
is 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 of potassio-tartrate of soda 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 decomposed, 
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 yel- Fermentation Test for Sugar. 
35 
low or red suboxide; 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 that of 
the Fehling’s solution employed has been 
added. If no precipitate be found after set- 
ting the test-tube aside for an hour, the urine 
may be considered free from sugar. 
Cautions.—x. The test solution should never 
be used without boiling beforehand for a few 
seconds; for the tartrate is exceedingly apt 
to decompose, and the solution then reduces 
itself as effectually as if grape sugar were 
present. 
2. The quantity of urine used in the test 
should never be greater than the quantity of 
test solution employed. 
3. After adding urine in volume equal to 
the Fehling’s solution, the boiling of the 
mixture must not be continued, as other 
bodies present in the urine, besides sugar, 
may reduce copper at a prolonged high tem- 
perature. 
Fermentation test.—Two portions of the urine 
are taken, and put into two flasks; to one 
a few grains of German yeast is added ; both 
are then set aside in a warm place. Fer- 36 
Indigo-Carmine Test for Sugar. 
mentation sets in in that flask to which the 
yeast has been added, and the sugar is thereby 
split up into alcohol and carbon dioxide, and 
from the loss of weight which results, the 
quantity of sugar present can be calculated. 
Estimation by loss of density after fermentation. 
Sir William Roberts has shown, that, after 
fermentation, “ the number of degrees of 
‘ density lost ’ indicated as many grains of 
sugar per fluid ounce,” and he proposes to 
estimate by this means the amount of sugar 
present. 
In twenty-four hours the fermentation is 
almost finished; the fermented urine is 
poured into a urine glass, and the specific 
gravity taken with the urinometer; the 
specific gravity of the unfermented urine is 
also taken, and the specific gravity of the 
fermented is subtracted from the specific 
gravity of the unfermented, the remainder 
giving the number of grains of sugar con- 
tained in a fluid ounce ; for example, if the 
specific gravity of the unfermented be 1040, 
and that of the fermented 1010, the number 
of grains of sugar in a fluid ounce will be 30. 
Indigo-carmine test.—When indigo-blue or 
indigo-carmine (sulphindigotate or soda) is Picric Acid Test for Sugar. 
37 
heated with an alkali in the presence of 
glucose, it loses its colour and becomes 
indigo-white, which when oxidised becomes 
indigo-blue again. Dr. Oliver has taken ad- 
vantage of this reaction to contrive a test for 
sugar, and has prepared a test paper upon 
which indigo-carmine has been deposited : 
the paper is introduced with some carbonate 
of soda into a test-tube ; enough distilled 
or common water is poured into the tube to 
cover the papers and heat applied; the solu- 
tion thus prepared should be of a fine blue 
colour. To the blue solution a drop or two 
of the suspected urine may now be added, 
and the contents of the test-tube again 
warmed, but not boiled or shaken ; if sugar 
be present, the blue colour of the indigo is 
quickly discharged, and the solution becomes 
yellow ; if the solution be now cooled and 
shaken, blue streaks pass down into the fluid 
from the surface, and if the shaking be con- 
tinued, the fluid becomes of its original blue 
colour, and may again be decolourised by 
again warming it. 
The picric acid test.—Equal parts of liquor 
potassae and saturated solution of picric acid 
are mixed, and boiled in a test-tube. The 3 8 
Phenyl-hydrazine test for Sugar. 
mixture is then divided into two equal parts, 
in two similar test-tubes. A little of the sus- 
pected urine is added to one of them, and 
both are again boiled for a few moments. If 
sugar is present a deep brown colour will be 
developed in the one tube. The other is 
needed for purposes of comparison, because 
some darkening of colour is always produced 
when the mixture is boiled, whether sugar be 
present or not. 
Phenyl-hydrazine test.—Add to the urine a 
little acetate of soda, and some phenyl-hydra- 
zine hydrochlorate solution. Heat in a water 
bath to ioo° C. for half an hour. If sugar 
be present a yellow crystalline precipitate is 
thrown down. 
It has been thought that the coma so often 
seen at the end of diabetes, is due to the 
presence of acetone in the blood, and the 
state has been named acetonaemia. The 
urine will then often give a deep red reaction 
with perchloride of iron, a reaction which is 
thought to be due to the presence of acetone, 
acetonuria. Dr. Ralfe tests for the presence 
of acetone in the urine in the following way:— 
a drachm of liquor potassae in which about 
twenty grains of iodide of potassium have Clinical Import of Sugar. 
39 
been dissolved is boiled in a test-tube : while 
still hot, a drachm of the urine to be tested is 
poured on to the surface of the fluid, as in 
Heller’s test (see p. 21) and at the line of 
contact, a ring of phosphate appears ; and 
if acetone be present, the colour of the ring 
becomes in a few minutes yellow, and 
numerous yellow points of iodoform appear, 
which later on sink to the bottom of the test- 
tube. 
It is still disputed whether the urine in 
health contain sugar. Briicke holds that a 
healthy man excretes daily through the kid- 
neys about fifteen grains of sugar. Accord- 
ing to Leube, the excretion of sugar in dia- 
betes is far greater during the night, than 
during the day: urea follows just the opposite 
rule. 
Clinical Import.—lf the foregoing tests an- 
nounce the presence of sugar, in considerable 
quantity, as often as the urine is examined, 
diabetes mellitus may be inferred to exist. 
But should the presence of sugar in the urine 
be variable, and amount small, the fact is not 
of any known great diagnostic or therapeutic 
importance. 
Sugar is said to be present in the urine of 40 
Bile in the Urine. 
the foetus; of women when suckling, and of 
some old persons. It is seen in the urine 
during convalescence from some acute dis- 
orders, especially cholera, in malarious dis- 
eases, and in carbuncle. Certain injuries 
of the nervous system also bring on glyco- 
suria. 
BILE IN THE URINE. 
The presence of bile in the urine can sel- 
dom be overlooked, since it gives a dark 
orange or greenish brown colour to the secre- 
tion. White filtering paper is coloured yellow 
by the urine; a permanent froth is also 
formed by shaking the urine. The colour 
given to the urine by drugs such as rhubarb 
and santonin is distinguished from that given 
by the bile pigments by the reaction of alka- 
lies. Alkalies deepen the red of vegetable 
pigments, but turn bilious urine to a dirty 
brown. 
Two bodies must be tested for, the bile 
pigments and the bile acids, each of which 
must be looked for by itself. 
The bile pigments.—Gindin's test.—Or- 
dinary nitric acid, which is slightly yellow Guidin's Test for Bile. 
and 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 conveniently 
performed by means of a pipette. The test- 
tube may then be nearly filled with urine. 
At the line of contact, a zone of red appears 
in every urine; but if bile pigment be present, 
the layer of urine above becomes green. 
This is the characteristic colour ; without 
the green colour the presence of bile pigments 
cannot be predicated. This reaction may 
also be performed by allowing a drop of nitric 
acid and one of the urine to run together on 
a porcelain dish, when a play of colours with 
green will be observed at the line of contact. 
But this is not so good as the first method, 
as the green colour is less perfectly seen. By 
waiting a few minutes, the green colour will 
sometimes develop in a fluid which at first 
gave no reaction. 
Caution.—Any urine which contains a large 
amount of colouring matter will give a red- 
dish or purple colour with nitric acid. The 42 
Pettenkofer's Test for Bile Salts. 
green colour, however, is not seen with any 
other body than bile pigment. 
lodine test.—Some solution of iodine, not 
more than a drop or two, should be added to 
the urine in a test-tube, and if bile pigment 
be present, the whole becomes of a fine green 
colour. The green colour is perhaps due to 
the formation of the same body, biliverdin, 
which causes the green reaction in Gmelin’s 
test. 
The bile salts.—Pettenkofer's test.—This 
test depends upon the reaction given by the 
bile acids with sulphuric acid and cane sugar, 
to produce a purple colour. 
Pettenkofer’s test should never be applied 
directly to urine : the bile acids are never 
present in sufficient quantity to give the re- 
action, however modified, and the urine in 
jaundice frequently contains a small quantity 
of albumen which gives a reddish violet re- 
action with sugar and sulphuric acid, while 
the action of the acid upon the other coloured 
constituents of the urine renders it impos- 
sible to be sure of the distinctive colours of 
Pettenkofer’s test. If, therefore, it be very 
desirable to ascertain whether the bile acids 
be present in the urine, the following method Hay's Test for Bile Salts. 
43 
must be employed for their separation ; a 
long and somewhat complicated process, 
which can seldom be adopted by the clinical 
student. 
Mix several ounces of the urine with ani- 
mal charcoal to form a soft paste, and eva- 
porate to dryness over a water bath, stirring 
the mixture from time to time; when quite 
dry, extract with hot absolute alcohol; con- 
centrate, and apply Pettenkofer’s test as 
follows:—To a portion of the concentrated 
alcoholic extract in a porcelain dish add a 
drop of cane sugar syrup, mix well with a 
glass rod, add one drop of strong sulphuric 
acid, mix again, and warm very gently and 
gradually, A purple colour develops if bile 
salts are present. 
Hay's test.—Urine containing bile salts has 
a lower surface tension than that of urine in 
which no bile salts are present, and for that 
reason finely powdered sulphur, which will 
float on the surface of water, will sink rapidly 
in urine to which a trace of bile salt has 
been added. 
If this test be applied to urine it will be 
found that the sulphur falls more readily 
through the surface of any urine than 44 
Blood. 
through distilled water, and through the 
surface of urine containing bile salts more 
readily still. 
A solution of commercial peptone has also 
been made use of by Dr. Oliver for the 
detection of bile salts in the urine ; and con- 
versely, a solution of bile salts may be used 
for the detection of peptonuria. The pre- 
cipitation is, according to Dr. Halliburton, 
a reaction between the bile salts and albu- 
mose ; true peptone not being precipitated 
by bile salts. 
BLOOD. 
Blood is not at all infrequently found 
in the urine,' and it may be derived from 
any part of the urinary tract. If derived 
from the kidneys, the blood will be com- 
pletely diffused through the urine, and give it 
a peculiar smoky appearance, quite dia- 
gnostic. If the haemorrhage from the kidney 
be great the urine will have a bright red 
colour, like blood; and there may be a dis- 
tinct sediment of red blood corpuscles at the 
bottom of the urine glass. 
The microscopic test.—In any case where the Microscopic Test for Blood. 
45 
presence of blood is suspected the urine 
must be examined under the microscope for 
red blood corpuscles ; as these tend to settle 
to the bottom, a drop of the fluid should be 
taken up with a pipette from the lowest part 
of the vessel, the corpuscles if present will 
then be readily seen, unless the sample of 
urine be a stale one. 
Their peculiar shape and colour will pre- 
Fig. 4.—Blood corpuscles in the urine. 
vent the student mistaking them for any 
other deposit; they may, however, in a 
urine of low specific gravity, become swollen, 
pale,, and at last burst from endosmosis ; in 
those of high specific 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 pre- 
sent, which may be so great that the urine 46 
Guaiacum Test for Blood. 
will solidify on the application of heat. The 
urine readily becomes alkaline, and steps 
may be taken to restore the acid reaction 
with acetic acid, before testing for albumen. 
The spectroscope test.—As part of the hsemo- 
globin passes from the corpuscles and is 
held in solution in the urine, it is as well also 
to examine this with the spectroscope, when 
the characteristic absorption bands of haemo- 
globin will be seen, usually in the form of 
oxyhaemoglobin. 
In some cases the haemoglobin may be 
partly or wholly converted into methaemo- 
globin, especially when the urine has become 
stale before it is examined. And also in 
cases of poisoning by chlorate of potassium 
the same body has been found in the urine. 
The gmiacum test.—A few drops of the 
tincture of guaiacam are added to the urine 
in a test tube, and then an excess of ozonic 
ether, that is a mixture of peroxide of hydro- 
gen and ether. The mixture is shaken to- 
gether, and on standing, the ether separates; 
of a fine sapphire blue colour, if blood be 
present. 
The reaction depends upon the oxidation 
of the guaiacum by the ozonic ether; this Clinical Import of Blood. 
47 
however, it is unable to do save in the pres- 
ence of a body like haemoglobin; so that it 
is the presence of the haemoglobin which de- 
termines the reaction. 
The results of this test must always be 
received with caution, and can hardly be 
accepted unless confirmed by other evidence. 
Many other bodies besides haemoglobin seem 
able to determine the oxidation of the 
guaiacum. 
The hcemin test.—The formation of haemin 
crystals can also be applied as a test for 
blood in the urine, but it is more adapted to 
the detection of blood in urinary sediment, 
and will be considered under that heading 
(p. 87). Haematoporphyrin also occurs in 
urine and will be dealt with in the next 
section on urinary pigments. 
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 or Chronic Nephritis. 
Congestion of kidney. 
Cancer of kidney. 
External injury. 48 
Clinical Import of Blood. 
2. Disease of Renal Pelvis and Ureter. 
Calculus. 
Parasite, as Bilharzia haematobia. 
Cancer. 
3. Disease of the Bladder. 
Calculus. 
Cancerous or villous growths. 
Congestion or ulceration of mucous 
membrane. 
4. Disease of the Urethra. 
Congestion, as in gonorrhoea. 
Tearing of the mucous membrane 
5. In women, uterine discharges, as 
from mechanical injury. 
menstruation, &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 therefore be made for renal casts. If 
the amount of blood be large, it probably 
comes from the pelvis of the kidney, ureter, 
or bladder; if from the pelvis or ureter, there 
may be pus, and possibly also gravel in the 
urine, with pains in 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 Uric Acid. 
49 
said, that if the blood be completely 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 haemor- 
rhage is from the urethra. These rules will, 
however, often be found to fail. 
In certain other diseases it is said that 
haemoglobin may be detected by chemical 
tests, but yet no blood corpuscles seen with 
the microscope; such as poisoning by arsen- 
iuretted hydrogen, phosphorus, and sulphuric 
acid; in jaundice, malignant cases of the acute 
specific diseases, and scurvy. Also in the 
disease called paroxysmal haematuria, it is 
said that no corpuscles can be found. 
One of the chief dangers of haematuria is 
the formation of clots in the passages, and 
consequent ischuria. Small clots may some- 
times form the nucleus of a calculus. 50 
Pigments of the Urine. 
THE PIGMENTS OF THE URINE. 
Our knowledge of the colouring matters of 
urine is still very imperfect ; the following 
statement of what is known will suffice for 
the purposes oI this book. 
(1) Urochrome.— This name has been given 
to a yellow body, which is the cause of the 
yellow colour of normal urine ; it is an un- 
stable, nomcrystalline body, insoluble in 
chloroform, and has no special spectroscopic 
absorption band. It is always present, 
(2) Urobilin.—This is a red body, soluble 
in chloroform, which is found in febrile 
urines, and is in part the cause of their hav- 
ing a red tinge ; it is fluorescent, and gives 
even in very dilute solutions a dark absorp- 
tion band near the junction of green and 
blue of the spectrum. 
(3) Uvoevythnn.—This is the- name given 
to a body which is carried down from cer- 
tain urines in combination with the urates, 
and gives them the pink colour which they 
sometimes present. Urines holding it in solu- 
tion have an orange-red colour, and usually 
contain urobilin as well. Its composition is Hmnatoporphyrin in the Urine. 
unknown; in strong alcoholic solution it 
presents two faint absorption bands in the 
green part of the spectrum. 
Hcßmatopoyphyrin. Occasionally one meets 
with urines of a deep wine-red colour, which 
give very strongly the spectra of haematopor- 
phyrin. Dr. Archibald Garrod has lately 
shown that traces of hgematoporphyrin are 
extremely common in the urine both in 
health and in disease, and that it is very 
frequently present in fair amount without 
producing any special coloration in the urine. 
In a paper in the Journal of Physiology, 1892, 
p. 598, et seq., he describes methods for ex- 
tracting the haematoporphyrin in a pure 
form, by means of the process employed by 
Heller for the precipitation of blood pig- 
ments from urine. Liq. potassae is added 
to the urine to throw down the earthy phos- 
phates ; these carry down the haematopor- 
phyrin. After washing with distilled water 
on a filter the haematoporphyrin can be dis- 
solved out of the phosphates by alcohol 
acidulated with dilute sulphuric acid. In 
certain febrile states this body is often pre- 
sent in considerable amount, although but 
seldom in such large quantities as to give 52 
Indigo in the Urine. 
the urine a dark red colour. It is identical 
with hsematoporphyrin prepared artificially 
from the blood. 
Indigo.—In rare cases an urine of a green 
colour containing free indigo blue has been 
passed, and it is possible by chemical me- 
thods to obtain indigo from many urines. 
The name of Indican has been applied to 
the urinary body whose decomposition yields 
indigo, and urines are said to give the 
indican reaction when they yield purple 
colours on treatment with strong acids ; a 
better name for the indigo producing body is 
indoxyl-sulphuric acid, which exists, com- 
bined with bases (potash or soda) in most 
urines. To test for this body the urine must 
be mixed with half its bulk of hydrochloric 
acid, and left exposed to the air for twelve 
hours, at the end of that time a pellicle of 
blue indigo may be found floating on its 
surface. This can be filtered off and the 
filter dried and treated with warm chloro- 
form, which dissolves the indigo and acquires 
a blue colour ; other methods for obtaining 
the indigo are to be found in the textbooks 
of physiological chemistry. Another body 
closely allied to indoxyl-sulphuric acid, Clinical Import of Urinary Pigments. 
53 
namely skatoxyl-sulphuric acid (skatol is 
methyl-indol) also occurs in the urine, its 
presence is the cause of a peculiar pink 
colour which is sometimes noticed when 
strong nitric acid is added to certain pale 
coloured urines. 
Melanin.—The urine of patients with mela- 
notic cancer is sometimes of a dark brown 
colour from the presence of a pigment called 
melanin. Its history is unknown. 
Clinical Import.—Our knowledge of the 
urinary pigments in health is in so imperfect 
a state that nothing is known of the changes 
which they undergo in disease. 
In obstruction, catarrh, and other diseases 
of the small intestines, it is said that there is 
an increase of indican in the urine. 
Cautions.—lt is necessary to be on one’s 
guard against certain colour appearances 
due to drugs. The addition of nitric acid 
to the urine of a patient taking iodides or 
bromides causes the development of a brown 
colour from the liberated iodine or bromine. 
Fuchsine and certain other of the aniline 
colours are excreted by the urine, to which 
they communicate their colour, as also do 
rhubarb, senna, and santonin. 54 
Urea 
UREA. 
Urea is the body characteristic of the 
urine; unless a fluid contain urea, it cannot 
be said to be urine. 
The clinical student may sometimes wish 
to know if the urine contain urea, or if a 
given fluid be really urine, or some other 
secretion. The fluid is first to be tested for 
albumen, which, if present, must be removed 
by boiling and acidifying with a few drops of 
acetic acid, and filtering. The filtrate is to 
be used for the subsequent operation as 
stated below. 
If the urine be free from albumen, some 
quantity, two or three fluid ounces, must be 
evaporated in a porcelain dish over a water 
bath, until the fluid have the consistence of 
syrup. A water bath is essential, because 
an open flame would decompose the urea. 
After the fluid is completely cooled, a drop 
may be let fall on a slide, and a drop of 
strong pure nitric acid may be added with a 
glass rod. 
If the nitric acid be yellow from the pre- 
sence of nitrous acid, it is unsuitable, as it Urea 
55 
will oxidise and destroy the urea, but if it be 
pure then crystals of nitrate of urea will 
form in flat rhombic or hexagonal plates 
which may be recognised under the micro- 
scope (fig. 5, b). 
By adding a drop of saturated solution of 
oxalic acid instead of the nitric acid, crystals 
Fig. 5. 
a. Oxalate of Urea. b. Nitrate of Urea. 
of oxalate of urea of somewhat similar shapes 
will be obtained (fig. 5, a). 
Sometimes only a few drops of the fluid 
can be had, and the student should then let 
a little fall on the glass slide, set it aside in 
a warm place, protected from dust, for the 
fluid to concentrate, then add the strong 56 
Clinical Import of Urea. 
nitric acid, and place the slide under the 
microscope. 
Another simple method of determining the 
presence of urea in a liquid is to add a little 
sodium hypobromite or hypochlorite solution. 
If urea be present, a brisk effervescence is 
produced. As the reagent gives an efferves- 
cence with ammonia it must first be ascer- 
tained that ammonia is not present in the 
liquid. 
Clinical Import.—Healthy urine may be 
looked upon as being for the most part a 
solution of urea and chloride of sodium; one 
half of the solids being made up of urea, and 
one quarter of chloride of sodium. Urea is 
the most important constituent of the urine; 
a healthy man excretes from 300 to 500 
grains in twenty-four hours. Its amount is 
increased in health by a free meat diet, and 
decreased by purely vegetable food. In some 
acute diseases, as pneumonia, typhoid fever, 
and acute rheumatism, the urea is greatly 
increased owing to the excessive tissue- 
metamorphosis ; it may be present in such 
quantity as to give a mass of crystals, with 
out previous concentration, when the urine 
is acidulated with nitric acid. In chronic Uric Acid. 
57 
diseases, especially those attended by a ca- 
chexia, or in uraemia and chronic Bright’s 
disease, the amount of urea is below the 
average. In diabetes, the amount of urea 
secreted in twenty-four hours is increased; 
although the amount per cent, in the urine is 
much decreased by the excessive flow of 
water which passes out through the kidneys. 
URIC ACID. 
Uric acid exists in the urine chiefly in the 
form of urates of the alkaline metals, potas- 
sium and sodium. The average daily quan- 
tity excreted is from 7 to 9 grains. 
Uric acid is very insoluble in water, re- 
quiring 15,000 times its weight of cold water, 
and 1,900 times its weight of hot water to 
dissolve it. The urates are much less in- 
soluble, but they too are frequently precipi- 
tated from solution as the urine becomes cold 
on standing. 
On this account uric acid, and urates both 
form common urinary sediments, and will be 
considered under that section. 
Usually the uric acid is not free when the 58 
Uric Acid. 
urine is voided, but it is thrown down by the 
increase of acidity which always occurs 
shortly after emission. This is especially the 
case in the urine of diabetes, where the 
whole of the uric acid present may be set 
free from this cause. 
Uric acid is sometimes deposited from its 
salts before the urine leaves the body, in this 
case it may be passed in the form of small 
red crystalline masses like grains of cayenne 
pepper, or these may collect in the kidney or 
bladder to form uric acid gravel or calculi. 
To ascertain if the urine contain uric acid, 
it is necessary to acidulate three or four fluid 
ounces 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 
crystals have the flat rhombic, oval, or hexa- 
gonal shape of uric acid ; they are soluble in 
alkalies, and give with nitric acid and am- 
monia the murexide test. (See below). Clinical Import of Uric Acid. 
59 
It has lately been shown that all the urates 
can be precipitated from urine by saturation 
with ammonium chloride. Under certain 
circumstances this method is very conveni- 
ent ; the urates thrown down in this way can 
readily be submitted to the rnurexide test, or 
they may be weighed, if it is required to esti- 
mate the quantity of uric acid present in a 
specimen of urine. 
The Murexide 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 warmed 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 am- 
monia should be allowed to flow over the 
reddened spot, which then becomes purple ; 
if liquor potassae be used instead of am- 
monia, the colour will be violet. The test 
does not, however, distinguish uric acid from 
its salts. 
Clinical Import.—The excretion of uric acid 
or of urates is usually increased pari passu 
with the urea in pyrexia, in acute rheu- 
matism, and in chronic liver diseases, and 
in constipation. It is increased out of pro- Hippuric Acid. 
portion to the urea in leucaemia. Any cause 
tending to diminish the urinary water, such 
as free perspiration, will cause a separation 
of urates from the urine on cooling, and so 
produce an apparent increase in their amount. 
An excess of uric acid is observed after an 
attack of gout; it is often entirely absent 
from the urine immediately before the par- 
oxysm, and may disappear for days when 
this disease has become chronic. 
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 shew 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 con- 
siderable danger, since it may lay the found- 
ation of a calculus ; uric acid calculi being 
the most common of all urinary concretions. 
HIPPURIC ACID. 
The method of preparing hippuric acid 
from human urine is troublesome, and will Clinical Import of Hippuric Acid. 
rarely be required to be used by the clinical 
student. 
Take 250 c.c. or ten fluid ounces of urine, 
evaporate on a water bath to one-fifth of its 
bulk, acidify strongly with acetic acid, then 
stir in enough plaster of paris to make the 
mixture set dry and firm. When set, pow- 
der the mass and exhaust with ether. On 
evaporation of the ether, the hippuric acid 
will be left. 
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 al- 
monds. This reaction is common to benzoic 
and hippuric acids. The crystals of hip- 
puric acid, seen under a microscope, are 
long and needle-shaped prisms. 
Clinical Import.—Hippuric acid exists in 
small quantity in the urine in health; its 
amount is greatly increased by the eating of 
much fruit, especially cranberries and green- 
gages, 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 62 
Chlorides. 
urine of fever patients, and may even be the 
cause of the acid reaction ; but it exists for 
the most part in the form of hippurates of 
potash and soda. 
The amount is also increased in diabetes 
and chorea. 
Nothing is known of the importance of 
this acid for therapeutics or diagnosis. In 
health the amount varies from 7 to 15 grains 
in the twenty-four hours. 
CHLORIDES. 
Chlorides may be shown to be present by 
the following test. To a fluid drachm of 
urine in a 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 precipitate is thrown 
down, soluble in caustic ammonia, and re- 
precipitated 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 
chlorides. Clinical Import of Chlorides. 
63 
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 be 
formed. The test tube must then be set 
aside for twenty-four hours, and a note then 
taken of the proportion of the chloride of 
silver deposit, for comparison with other ob- 
servations. 
On an average, a healthy man secretes 
250 grains of chloride of sodium in the 
twenty-four hours. 
Clinical Import.—During acute pneumonia, 
acute rheumatism, and most other pyrexial 
diseases, the chlorides diminish in quantity, 
or even disappear from the urine. Their 
reappearance in daily increasing quantity is 
a sign of the diminution of the intensity of 
the disease. The amount of chlorides ap- 
parently depends upon the digestive powers 
of the patient even in chronic diseases. 64 
Phosphates. 
PHOSPHATES. 
The phosphates of the urine consist chiefly 
of acid sodium phosphate NaH2P04 and acid 
calcium phosphate Ca2H2P04. The corre- 
sponding salts of potassium and of mag- 
nesium are also present, though in smaller 
quantities. All these bodies are readily 
soluble in acid urine. When the urine is 
alkaline the phosphates of lime and mag- 
nesia are no longer in the form of the acid 
salts, and being insoluble are precipitated, 
usually in an amorphous state, though the 
calcium phosphate may occur in crystals as 
well. 
If the alkalinity of the urine be due to 
ammonia, a crystalline compound of am- 
monio-magnesian phosphate is formed, 
NH4MgP04+6H20. 
The precipitate of phosphates which is 
produced when a neutral urine is boiled 
(p. 19) is phosphate of lime ; and it is pro- 
bably due to a temporary conversion of the 
acid calcium phosphate into the insoluble 
neutral salt. When the urine is set aside to Clinical Import of Phosphates. 
65 
cool, the precipitate may redissolve, by a 
reconversion to its original state. 
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 sulphate of magnesia in a test 
tube; hydrochloric acid is added until the 
precipitate caused by the ammonia be re- 
dissolved. Caustic ammonia is again added 
in excess until the fluid be strongly am- 
moniacal. A fluid ounce of urine is now 
poured into another test tube, and rendered 
ammoniacal with caustic ammonia ; to this 
urine some of the prepared solution is added, 
and a crystalline precipitate of the ammonio- 
magnesian phosphate occurs at once, if the 
urine contain the ordinary amount of phos- 
phates ; but the precipitate forms slowly, if 
the phosphates are present in very small 
amount. 
The quantity of phosphoric acid excreted 
by a healthy man in the twenty-four 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 66 
Clinical Import of Sulphates. 
after great mental application. Acute febrile 
diseases cause increase of the phosphoric 
acid from increased tissue-metamorphosis, 
while in Bright’s disease and some other 
forms of dyspepsia, the quantity of the phos- 
phates is diminished. Dr. Gee and Dr. 
Zuelzer have pointed out that the phos- 
phates diminish or disappear after the acme 
of the paroxysm in ague, and after some 
other febrile disorders. 
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, in- 
soluble in nitric acid, is thrown down. 
The quantity of sulphuric acid excreted 
by a healthy man in the twenty-four hours is 
about 30 grains. 
Clinical Import.—The quantity of the sul- 
phates is increased by a full animal diet or 
by the ingestion of any foods which contain 
sulphur. Very little is known for certain of Urinary Sediments. 
67 
their amount in disease, and that little is at 
present of not much importance. 
URINARY SEDIMENTS. 
When a urinary deposit is to be examined, 
about four or five fluid ounces of the urine 
should be collected in a tall glass, and set 
aside for a few hours. If conical vessels are 
used, some of the sediment may cling to the 
sides, and this is an objection ; but on the 
other hand their shape is advantageous be- 
cause the sediment which does fall to the 
bottom is concentrated into a very small 
compass. Conical glasses are therefore pre- 
ferred by some, and cylindrical glasses are 
more in favour with others. 
If crystals form and adhere to the sides of 
the glass, they may very conveniently be 
dislodged by a glass rod with half an inch of 
soft rubber tubing stretched over the end, 
with this they can be rubbed off under the 
surface of the fluid, and collected at the 
bottom. 
The sediment is to be taken up in a glass 
pipette, and this operation is easier if the 68 
Uric Acid. 
bulk of the supernatant fluid be first poured 
off. A drop of the fluid containing the sedi- 
ment is then to be placed on a glass slide, 
and covered with a cover glass. All super- 
fluous moisture around the edge of the cover 
glass must be removed with a piece of blot- 
ting paper. 
The sediment must be examined with a 
low power of the microscope first, and after- 
wards with a high power. 
Sediments may conveniently be divided 
into two groups, organised and unorgan- 
ised. To the latter belong uric acid, urates, 
oxalate of lime, phosphates, cystin, &c. ; to 
the former, pus, blood, mucus and epithe- 
lium, renal casts, fungi and spermatozoa. 
UNORGANISED SEDIMENTS. 
URIC ACID. 
Uric acid is only met with as a depositUn 
very acid urine, and is often accompanied Uric Acid. 
69 
by a considerable sediment of urates. Owing 
to its peculiar colour and appearance, like 
cayenne pepper, it can at once be recognised 
by the naked eye. It is never deposited 
from the urine in colourless crystals. 
Fig. 6.—Uric Acid. 
When the sediment is examined under the 
microscope, the crystals are at once known 
to be uric acid by their reddish-brown colour, 
all other crystalline deposits being transpa- 
rent and colourless. If, indeed, the student 
be in doubt as to the nature of a crystal, he 70 
Uric Acid. 
will never be very wrong, if he judge it to be 
uric acid when there is any tinge of brown 
visible. The crystals, themselves, have nu- 
merous shapes. The most typical is that of 
a lozenge or ace of diamonds, but there are 
many varieties, the most common modifica- 
Fig. 7.—Uric Acid. 
tion is for the crystals to have curved surfaces, 
as a consequence of their formation in a fluid 
containing uncrystallisable organic matter. 
Again the lozenge shape may be a long and 
slender one, or may be short and broad. 
When several crystals are united together, Uric Acid. 
rosettes are formed, dumb-bells and comb- 
shaped masses are also sometimes found. A 
barrel-shaped crystal is not uncommonly 
met with, having two curved optical lines 
crossing it (see figs. 6, 7, 8). 
Fig. 8.—Uric Acid. 
When a sediment is suspected from its 
appearance under the microscope to be uric 
acid, a chemical test can easily be applied 72 
Urates. 
by running in a few drops of liquor potassae 
under the cover-glass. This will dissolve 
the crystals of uric acid, which can again be 
reprecipitated by adding a drop of hydro- 
chloric or acetic acid. 
The murexide test can also be applied to 
the sediment, see above (p. 59). 
URATES. 
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 
secretion of water. Urine containing an 
excess of urates is rarely turbid when passed; 
it is only when the urine is cooled, that the 
peculiar muddiness is observed. If the urine 
be gently warmed, the turbidity immediately 
disappears. The urates differ in colour con- 
siderably, according to the amount of colour- 
ing matter in the urine, varying from white 
to pink, yellow or red. In young children 
the “milky” urine which alarms mothers, is 
due to a deposit of peculiar white urates. Urates. 
73 
In the urine uric acid is found combined 
with potash, with soda, with ammonia, and 
with lime. The urate of soda is the most 
common of the three, and is usually seen 
under the microscope as an amorphous de- 
posit ; sometimes it forms small spheres with 
short spikes projecting from them (fig. 9). The 
urate of ammonia is rarer and occurs in 
globular forms grouped together (fig. 10). Itisa 
Fig. 9.—Hedgehog Crystals of Urate of Soda. 
common constituent of the precipitate formed 
in ammoniacal urine. 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 hydrochloric or strong acetic 
acid to the specimen, when crystals of uric 
acid will immediately be formed. These 74 
Urates. 
crystals are again dissolved by caustic soda 
or potash. If further evidence be required, 
the murexide test with nitric acid and am- 
monia (page 59) may be applied to them. 
Sir William Roberts has shown that the 
urates which occur as a sediment in the 
urine are acid urates and contain a large 
percentage of very loosely combined uric 
acid. The combination can be readily split 
up, by the addition of distilled water to the 
sediment after it has been partly freed from 
urine by means of blotting paper. To carry 
out the experiment, let some of the sediment 
fall from a pipette on to thick white blotting 
paper. When the moisture has been ab- 
Fig. io.—Urate of Ammonia. Oxalate of Lime. 
75 
sorbed, transfer the residue to a glass slide, 
cover it with a cover-slip, and examine it 
with a microscope, then run in a drop or two 
of distilled water, and the formation of crys- 
tals of uric acid from the amorphous urates 
can be observed ; this reaction may be used 
as a simple test for urates. 
OXALATE OF LIME. 
Oxalate of lime occurs as a urinary sedi- 
ment in the form of minute colourless octa- 
hedral crystals. It is usually associated with 
the presence of an increased amount of 
mucus in the urine; its presence is often 
indicated by the unusually dense white ap- 
pearance of the cloud of mucus which com- 
monly settles from urine after standing, 
therefore, when the mucus forms a white 
conspicuous cloud in the urine glass the 
presence of oxalate of lime should be sus- 
pected. 
The shape of the crystals is a very definite 
one, they consist of two four-sided pyramids 
springing from one base. In certain posi- 
tions of the crystals the contours of the two 76 
Oxalate of Lime. 
pyramids seem almost to coincide, produc- 
ing an appearance which has been compared 
to that of a square envelope, with its dia- 
gonal folds (fig. n). 
Sometimes colourless dumb-bell-shaped 
crystals are found associated with the octahe- 
dra of oxalate of lime. These are commonly 
considered to be oxalate of lime too, but 
Fig. 11.—Oxalate of Lime. 
they may be crystals of an allied salt, the 
oxalurate of lime (fig. 12), 
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 hydrochloric acid. 
Clinical Import.—After urates, oxalate of Clinical Import of Oxalate of Lime. 
77 
lime is the most common unorganised urinary 
sediment; 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 oxidation, 
as in bronchitis. The occasional presence of 
a few crystals of oxalate of lime is not of 
Fig. 12-—Dumb-bells of Oxalate of Lime. (From a photography 
highly magnified). 
much importance. They are frequently seen 
in the urine after the eating of fresh fruit 
and vegetables. The ingestion of foods or 
drugs containing either oxalic acid or lime 
salts may cause them to appear in the urine- 
When the deposit is constant, and in large 
quantity, the formation of the mulberry cal- 78 
Phosphates. 
cuius may be feared. This sediment is said 
to be associated with a dyspeptic and hypo- 
chondriacal condition, sometimes termed the 
“ oxalic acid diathesis.” 
PHOSPHATES. 
The phosphates are only separated from 
alkaline, or very feebly acid, urine; and 
they are always deposited when the urine 
undergoes the alkaline fermentation. They 
■consist of the ammoniaco-magnesian phos- 
phate, and the phosphate of lime. Both are 
usually found together. 
Under the microscope, the ammoniaco- 
magnesian phosphate appears in beautiful 
right rhombic prisms, which disappear im- 
mediately on the addition of acetic acid, and 
are thus distinguished from the oxalate of 
lime with which an inexperienced observer 
might, perhaps, confound them. 
When the ammonio-magnesian phosphate 
is precipitated artificially from urine by 
the addition of the “magnesia mixture” 
(p. 65) the crystals are usually branched 
.and feathery; these “feathery phosphates” Clinical Import of Phosphates. 
79 
may rarely occur in urine which has be- 
come ammoniacal through fermentation of 
its urea. 
Phosphate of lime usually occurs as an 
amorphous precipitate, but occasionally crys- 
tals of hydrated phosphate of urine may be 
seen, they form stellate groups of colourless 
prisms; and are known as “ stellar phos- 
phates.” 
(a) Stellar phosphates, 
Fig. 13. 
(b) Triple phosphates. 
Clinical Import.—The deposit of phosphates 
indicates an alkaline reaction of the urine, a 
condition favourable to the formation of 
phosphatic calculi. 
If the least doubt be left upon the observer’s 
mind after the examination of a sediment 
with the microscope, he must use the aid of Clinical Import of Phosphates. 
reagents in determining its nature. The 
following scheme 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 care- 
fully prevented from wetting the under sur- 
face of the cover, as this will produce an 
obscurity over the object. Or after having 
placed a drop of the fluid containing the 
sediment 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 
consist 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,. Cy stin. 
81 
but the alkali has no effect upon the oxalate 
of lime, which will be dissolved by the action 
of hydrochloric acid. 
These tests can also be applied to frag- 
ments of calculi. 
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, 
Fig. 14.—Cystin. 82 
Cystin. 
cystin may be thrown down by the addition 
of acetic acid, and the precipitate examined 
under the microscope. It may be distin- 
guished from uric acid, which sometimes 
crystallizes in hexagonal plates, by the 
absence of colour in the crystals. 
Cystin is soluble in strong ammonia. If 
certain urinary crystals are suspected to be 
cystin the sediment containing them may be 
treated with a ten per cent, solution of liquor 
ammoniae and the mixture filtered and set 
aside in a wratch glass. When the ammonia 
has evaporated the six-sided crystals of 
cystin will be left behind, if cystin were 
present. A trace of sodium nitro-prusside 
gives a violet colour if added to an alkaline 
solution 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 
liquor potassse or liquor sodae to a small 
quantity of solution of acetate of lead 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 combination of the sul- 
phur with the lead. This test is, however, by Leucin and Tyrosin. 
83 
no means a good one, since many bodies fre- 
quently present in the urine, for example albu- 
men, contain enough sulphur to give the 
reaction. 
Clinical import.—Nothing certain is known. 
Sometimes cystin is found in several mem- 
bers of a family ; and persons apparently 
healthy may excrete cystin for years. There 
is always a risk that such cases may develop 
cystin calculi. 
LEUCIN AND TYROSIN. 
Leucin and Tyrosin are very rare deposits 
in the urine. Under the microscope, leucin 
appears in dark globular crystals, which have 
been compared to oil drops ; tyrosin, how- 
ever, crystallizes in beautiful bundles of 
delicate needles, sometimes arranged in a 
sheaf-like or stellate form. 
These bodies have been occasionally de- 
tected in the urine as a sediment, in cases 
of acute yellow atrophy of the liver. 
If these bodies do not occur as a sediment, 
they may be looked for by the following 
method: a large quantity of the urine must 
have a solution of acetate of lead added to it 84 
Leucin and Tyrosin. 
so long as a precipitate forms. Through the 
filtrate, sulphuretted hydrogen is passed to 
remove the excess of lead; and the fluid is 
filtered again, evaporated over a water bath 
to a syrup, and set aside to cool; crystals of 
Fig 15.—(a) Leucin. (b) Tyrosin 
leucin and tyrosin will form in the viscid 
mass, and can be recognised under the 
microscope. To separate them, the residue 
must be treated with hot alcohol, this dis- 
solves the leucin, leaving the tyrosin behind. 
The part insoluble in spirit may now be Leucin and Tyrosin. 
85 
dissolved in water and boiled with a few 
drops of mercuric nitrate solution ; if tyrosin 
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 com- 
bination of leucin with lead, is suspended in 
water, and sulphuretted hydrogen passed 
through, the liquid again filtered, evaporated, 
and set aside to crystallize. The crystals 
that form must be tested in the following 
manner: They are carefully heated with 
nitric acid in a platinum crucible : if leucin 
be present, a colourless, almost invisible, 
residue 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. 86 
Clinical Import of Leucin and Tyrosin. 
This preparation is undoubtedly 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 
reactions given above. But the recognition 
of crystals under the microscope, having the 
same form as leucin and tyrosin, is of small 
value, as in many cases, whether in health 
or disease, the urine may give crystals iden- 
tical in form with leucin and tyrosin, but in 
which chemical tests altogether fail, or give 
the well-known reactions of other bodies. 
Clinical import.—Leucin and tyrosin occur 
in the urine of acute yellow atrophy of the 
liver, and of phosphorus poisoning. They 
have been said to occur in acute tuberculosis, 
in typhus fever and in small-pox. Blood 
8 7 
ORGANISED SEDIMENTS. 
BLOOD. 
If blood be present in the urine in abun- 
dance, there may be a brown or reddish 
sediment of blood corpuscles mixed with 
fibrin to form a clot. In such a case the 
sediment will give the reactions and tests for 
blood which have been already described, 
and a microscopic examination of the sedi- 
ment will show abundance of red-blood cor- 
puscles. The Haemin test may also be 
applied as follows. Transfer a small portion 
of the sediment to a slide, and dry it by 
gentle heat, add a crystal or two of chloride 
of sodium, and two drops of glacial acetic 
acid, cover with a cover glass and heat to 
ebullition over a small spirit lamp flame; 
when cold, examine under the microscope 
for the small reddish-brown rhomboidal crys- 
tals of hsemin. 88 
Pus. 
Another method of detecting blood in a 
sediment is to treat it with alcohol to which 
a few minims of liquor ammoniae have been 
added; it should be boiled for two or three 
minutes and filtered; to the filtrate add a 
few drops of ammonium sulphide, and exa- 
mine with a spectroscope for the two bands 
of reduced haematin. 
These tests are seldom needed for the de- 
tection of blood in urine, for if there be 
enough blood present to produce a sediment 
the ordinary tests for blood will readily prove 
its presence in the supernatant fluid. 
PUS. 
Pus is often present in the urine, and forms 
a thick sediment at the bottom of the urine 
glass. The urine readily becomes alkaline, 
and rapidly decomposes after being passed. 
It is permanently turbid ; that is, the tur- 
bidity is unaffected by heat. 
Under the microscope, the deposit shows 
numerous pus corpuscles, round colourless 
bodies, not varying much in size, having 
granular contents, and nuclei varying from 89 
one to four 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 recognised. 
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 
Fig. 16.—Pus corpuscles in urine, unaltered, and affected by 
acetic acid. 
urine, evidence of kidney disease, as casts of 
tubes, should at once be looked for. 
The deposit from urine containing pus is 
rendered viscid and gelatinous by the ad- 
dition of about half its quantity of liquor 
potassse ; it becomes ropy and falls in a 
mass when 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. Mucus and Epithelium. 
Pus occurs in the urine in the following 
diseases:— 
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 exclude this origin, the urine 
must be obtained by means of the catheter. 
MUCUS AND EPITHELIUM. 
Mucus is a constant constituent of every 
urine, and if healthy urine be allowed to re- 
main at rest for an hour, a light cloud will be 
found floating in the fluid or settled at the 
bottom of the urine glass; on examination 
with the microscope, it will be found to con- 
sist of amorphous particles mixed with 
corpuscles and epithelium scales detached 
from the surfaces over which the urine has 
passed. The mucus is increased in quantity Mucus and Epithelium. 
91 
in catarrhal conditions of the urinary tract. 
It is dissolved by dilute alkalies and precipi- 
tated from its solutions by acetic or other 
dilute acids; on this account it forms a 
cloud in acid urines; in alkaline urines it 
may be present in solution, and if abundant, 
it may be thrown down on acidification, and 
so simulate albumen. 
Dr. George Oliver has examined the re- 
actions of mucin in the urine, and finds that 
both potassio-mercuric iodide and picric acid 
will give a turbidity with mucin. In acid 
urines the mucin is in suspension, and can 
be removed by filtration before the tests for 
albumen are applied, but in alkaline urines 
the mucin is in solution, and cannot be got 
rid of in this way. Moreover the urines 
which contain an excess of mucin are often 
alkaline in reaction. In these cases it is 
best to acidify the urine very slightly with 
dilute acetic acid to precipitate the mucin, 
which can then be separated by filtra- 
tion. 
Dr. Oliver recommends the following test 
with his prepared papers : to a drachm of 
urine add a citric acid paper and a potassio- 
mercuric iodide paper. A slight milkiness 92 
Mucus and Epithelium. 
which disappears on warming and returns on 
cooling signifies the presence of mucin. 
The urethra and bladder give up a round- 
ish or oval epithelium cell to the urine. In 
the urine of women, especially in cases of 
Fig. 17.—Vaginal epithelium 
leucorrhoea, the epithelium cells of the vagina 
are very numerous; they exactly resemble 
the squamous epithelium of the mouth. 
Under irritation, the mucous membrane of 
the renal pelvis and ureter will produce 
cells, caudate, spindle-shaped, and irregular, 
very like those formerly looked upon as 
diagnostic of cancer. From this circum- 
stance 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, Mucus and Epithelium. 
93 
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 gran- 
Fi«. 18.—Epithelium from the bladder, ureter and pelvis of 
the kidney. 
Fig. 19.—Renal epithelium, healthy and fatty. 
ular and contain fat drops, or are contracted,, 
withered up, and shrivelled. 
Clinical import.—See Section on Renal 
Casts below. 94 
Renal Casts. 
RENAL CASTS 
In Bright’s disease and in congestion of 
the kidney, there are formed in the urini- 
ferous tubules lengthened cylinders which 
are discharged with the urine, and form the 
deposit known as “ casts.” Those found in 
the urine are probably chiefly formed in 
the straight uriniferous tubes; and there 
are two views of the origin of renal casts : 
one is that casts are formed by the escape 
of blood or plasma into the tubes of the 
kidney, and coagulation of the fibrin, which 
thus becomes moulded to the shape of the 
tube into which it has been extravasated. 
It is possible that many of the hyaline casts 
are formed in this way. The other view 
is that the epithelial and granular casts 
are produced by a desquamation and de- 
generation of the renal epithelium. 
When the urine contains casts in great 
■quantity, 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 
supernatant fluid poured off, and the last 
■drops which flow from the lip of the glass Renal Casts. 
95 
put under the microscope and examined. If 
there be but few casts present, the whole of 
the urine of the twenty-four hours should be 
collected in a tall glass and allowed to settle 
for about twelve ours. 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 pre- 
sent, they will be ound at the bottom of the 
glass, the last drops poured away being put 
under the microscope. Casts may oftentimes 
be missed if the urine given for examination 
be only the upper layer of a specimen which 
has settled for some hours and of which all 
the casts have fallen to the bottom. It thus 
sometimes becomes of importance to collect 
all the urine passed. 
The detection of casts is very much facili- 
tated by staining them. This may be readily 
carried out by adding a few drops of solution 
of fuchsine, or of methylene blue to the urine, 
and allowing it to stand for a few hours until 
the casts settle to the bottom, or a drop of 
the same dyes may be added to the drop of 
urine on the slide just before it is to be 
examined ; the dye must be very dilute, so 96 
Renal Casts. 
as not to give more than a faint tinge of 
colour to the urine itself. 
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 six, or less than 
two, red blood corpuscles in diameter ; but 
they vary considerably in length, never, 
however, exceeding the of an inch. 
The same cast does not vary greatly in its 
diameter, and never becomes twisted on 
itself, as a cotton fibre does. 
The foreign bodies, most likely to be mis- 
taken for renal casts, are cotton fibres, hair, 
and pieces of deal. 
Cotton fibres have a very irregular outline 
and are much broader at one point than 
another ; they are often twisted, and of great 
length, which will distinguish them from 
casts. Their structure is often striped in a 
longitudinal direction. 
Hair can often be distinguished from renal 
casts by its colour alone ; and if this be not 
very apparent,I*by its possessing a cortical 
and medullary structure ; and by its length 
being greater than that of any cast. Renal Casts. 
97 
Fibres of deal, which have their source in 
furniture, flooring, &c., may perhaps be mis- 
taken for renal casts. They are at once 
recognised by the presence of the large 
round wood cells which characterise the tribe 
of Coniferae. 
In the urine of female patients in the wards 
of a hospital a curious sedimentary deposit of 
round or oval bodies may sometimes prove 
perplexing. These bodies are starch grains 
derived from some form of starch powder or 
dusting powder applied for toilet purposes to 
the patients by the nurses. 
Casts may be conveniently divided, ac- 
cording to their appearance under the mi- 
croscope, into three kinds, the epithelial 
cast, the granular cast, and the hyaline cast. 
The epithelial cast. The cylinder consists 
of a mass of epithelium cells derived from 
the tubules of the kidney ; the cells may be- 
come granular and acquire a dark appear- 
ance by transmitted 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 sub- 
stance of the casts, or be so intense as to 98 
Renal Casts. 
give the casts 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 lime. The 
fatty cast is a variety of the granular, pro- 
duced by the running together, into globules, 
of the granules of fat. 
The hyaline cast. This cast is usually very 
transparent, and the outline is often so indis- 
tinct that a little iodine or magenta must be 
added to the urine before it can be detected, 
or a diaphragm 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. The granules on the cast, if albu- 
minous, will disappear when acted on by 
acetic acid ; but if fatty, 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 Renal Casts. 
99 
that the prognosis is more grave when these 
wide casts show on their sides no nuclei, 
or attempt at re-formation of epithelium. 
From later observations on the varying 
Fig. 20.—a. Blood casts, b. Epithelial casts, c. Granular 
casts, d. Fatty casts, e. Hyaline casts. 
diameters of the uriniferous tubes, the im- 
portance of the breadth of the cast becomes 
less. 
Occasionally casts may be seen which are Clinical Import of Renal Casts. 
composed of masses of micrococci. They 
are of serious import, and generally signify 
that some infective process is taking place 
in the renal tubules. 
Clinical import. The presence of casts in 
the urine is a sure sign of disease of the kid- 
ney, but not, however, necessarily of per- 
manent 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 in- 
formation as to the nature of the disease 
existing in the kidney, for example, 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 ex- 
ample, there be found in the urine epithelial 
casts which have undergone little, or no, Renal Casts. 
granular change, and 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 dis- 
ease. 
Since little trust can be put in the char- 
acters 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 casts 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 102 
Renal Casts. 
“ blood cast ”of some authors. In the next 
stage, the amount of blood present is not so 
great, but a great 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, hvhich change often 
goes on to fatty degeneration, and the epi- 
thelial 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 epi- 
thelium slowly disappear from the urine, but 
if the case become chronic, the renal deriva- 
tives show the characters described in the 
next paragraph. 
Chronic Bright'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 Micro-Organisms. 
103 
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 
casts, evidence of this previous alteration of 
the kidney. 
Lavdaceous or amyloid kidney.—The urinary 
deposit contains hyaline casts, which some- 
times give the amyloid reaction, and which 
are often accompanied by pus corpuscles. 
Atrophied epithelial cells, becoming fatty in 
the latter stages of the disease, are almost 
invariably present. 
MICRO-ORGANISMS. 
Many kinds of organisms appear in the 
urine after it has been voided for some time, 
and when the ammoniacal decomposition has 
begun, or is about to begin. The most im- 
portant are micrococci and bacteria. When 
found in freshly passed urine, they are often 
due to the introduction into the bladder of 
catheters imperfectly cleansed. It is prob- Spermatozoa. 
able that catheters are seldom properly 
cleansed (sterilised) after use. 
When there is any fistulous communica- 
tion between the rectum and bladder micro- 
organisms may occur in the urine. 
In the various forms of general infection as 
by the specific fevers, erysipelas, tuberculosis, 
etc., the specific micro-organisms have been 
detected in the urine. 
SavcincE have been seen a few times in the 
urine. They are characterised by their 
peculiar arrangement into square packets. 
Penicillium glaucum or mould fungi, and 
Tonila cerevisia; or yeast fungi may develop 
in urine after it has been passed, especially 
in diabetic urine. 
SPERMATOZOA. 
These 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 is continent. In the urine of 
women, they are almost positive proof of 
sexual intercourse. Spermatozoa. 
105 
The seminal secretion forms a glairy white 
deposit 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), spermatozoa show the 
characteristic oval head or body often some- 
what pear-shaped, and long delicate tail, two 
or three times the length of the head. In the 
urine no movement is ever shewn by these 
bodies. Appendix. 
APPENDIX. 
It has been thought desirable to add a 
short account of the method of estimating 
quantitatively 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 requires 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 capa- 
city =l*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 dis- General Directions. 
107 
tilled water, at 4°C. at normal baro- 
meter pressure, = 15-43 English grains. 
The milligramme, the xotjo Par* °f a 
gramme. 
The apparatus will be : 
A measure of litre capacity, divided into 
parts containing 10 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 convenient to collect it from g a.m. on 
one day to g a-m. on the following day, 
making the patient micturate just before 
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 1000 C.C. and 
marked into divisions of 10 C.C. After General Directions. 
measuring, the whole of the urine must be 
mixed together, and a portion of this used 
in the estimation of the urea, chlorides, &c. 
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 quan- 
tity of urine, 100 or 200 C.C., is heated to 
the boiling point in a Berlin dish, the 
bottom of which is protected from the 
flame by a piece of iron wire gauze. 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 in the beginning 
to ascertain the volume (100 or 200 C.C.) 
the dish and filter washed with small quan- 
tities of distilled water, which are added 
to the filtrate, until the urine stand at ex- 
actly 100 or 200 C.C. according to the initial 
quantity. This fluid is then used in the esti- 
mation of the urea, chlorides, phosphates, 
sugar, &c. Estimation of Urea. 
ESTIMATION OF UREA. 
There are two methods now commonly in 
use for the estimation of urea: 
The first process, a modification of Hiif- 
ner’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 quantity of urea decomposed. 
The second process, first employed by 
Liebig, and known by his name, depends 
upon a reaction of urea with mercuric nitrate 
in which these two bodies combine to form 
a white precipitate. This reaction is used as 
the basis of a volumetric estimation of urea, 
which will be described below. 
In both of these processes it is necessary 
to ascertain beforehand the presence or ab- 
sence 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. 
i. The Hypobromite Method.—Many forms 
of apparatus have been contrived for sim- Estimation of Urea. 
plifying the carrying out of this test; one, 
introduced by Dr. Russell and Dr. Samuel 
West, has been largely used for clinical work, 
and will be described; a more recent, and 
Fig. 2i.—Southall’s apparatus for estimation of urea, 
better form of apparatus for the same pur- 
pose, commonly known as Southall’s appar- 
atus, will be described lirst. It consists of a 
bent graduated tube closed at one end, and 
expanded into a funnel at the other. It is Estimation of Urea. 
supported upon a wooden stand in an in- 
verted position, so that the gas evolved 
during the reaction may be collected in the 
graduated limb, while the liquid displaced 
by the gas is retained in the expanded lower 
portion ; the hypobromite solution is made by 
adding bromine to a solution of caustic soda ; 
it must be freshly made, as it will not keep 
long. 
The composition of the hypobromite solu- 
tion is as follows : 
Sodium hydrate, 5 parts; distilled water 
20 parts ; bromine 2 fluid parts. This solu- 
tion keeps well for about a month, and may 
be easily prepared in a moment, fresh and 
fresh as wanted, by keeping a quantity of 
sodium solution ready, and then adding the 
needful proportion of bromine to a measured 
amount of the caustic soda solution. The bro- 
mine should be kept in sealed glass capsules, 
which may be dropped into the solution and 
broken with a shake. In this way the dis- 
agreeable odour and inconvenience of hand- 
ling the bromine are avoided. 
The exact strength of the solution is only 
important in so far as this, that there must 
be enough hypobromite present to decompose 112 
Estimation of Urea. 
the whole of the urea, and enough free caustic 
soda to absorb all the C02 produced by the 
reaction which may be written as follows : 
CON2H4 + 3NaBrO = C02 +N2 + 2H20 + 3Naßr. 
The directions for the use of Southall’s 
apparatus are as follows : 
Fill the vertical tube with a solution of 
hypobromite of sodium by pouring the solu- 
tion into the bulb until it is about half full; 
the apparatus should then be inclined hori- 
zontally until the entire tube is filled and 
just a little left in the bulb (say or there- 
abouts) ; then restore the apparatus to the 
vertical position. 
Having drawn into the pipette i cubic 
centimeter of the urine to be tested, which 
should be taken from the collected and 
measured excretion of 24 hours, the pipette 
is passed into the apparatus, the point being 
placed immediately under the long arm ; the 
india-rubber cap is now slowly compressed, 
so that the urine which is liberated all passes 
up the long tube ; as the urine passes through 
the solution the urea becomes decomposed 
and the nitrogen is set free. This gas now 
collects at the upper part of the tube, and its 
volume being measured, indicates the amount Estimation of Urea. 
of the urea from which it is evolved. In 
cases where there is much urea, it is advis- 
able to mix the urine with an equal amount 
of water before testing, the proportion of 
urea will then be equal to double of that 
indicated on the scale. 
The graduations are arranged so as to save 
the necessity of calculation, and give either 
of two readings. 
(1) Metrical Scale.—Each division indicates 
•ooi gramme of urea in i C.C. of urine. The 
percentage of urea is obtained by multiplying 
the result of the test by 100. To ascertain the 
total amount of urea voided in 24 hours, 
multiply the result of the test by the number 
of C.C. of urine passed during that period. 
(2) English Scale.—Each division indicates 
one grain of urea per fluid ounce of urine. 
The result of the test, when multiplied by the 
number of ounces of urine passed in 24 hours 
will give the total amount of urea voided 
during that period.* 
The apparatus! contrived by Russell and 
West is figured in the adjoining woodcut 
* The apparatus may be obtained from Down Bros., 
5 & 7 St. Thomas’s Street, London, S.E. 
f It may be had of Cetti, Brooke Street, Holborn. Estimation of Urea. 
(fig. 22). It consists of the tube A, which is 
about nine inches long, narrowed somewhat 
before the closed end is reached, which end 
is blown out into a bulb, B. The free end is 
ZO'/t- INCHES 
Fig. 22, 
fitted by means of an india-rubber cork into 
the hole G at the bottom of the trough C D 
which stands on three legs. When an esti- 
mation is to be made, 5 C.C. of urine are Estimation of Urea, 
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 hypobromite solution is then poured into 
the tube until it is quite full, and the trough 
is 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 it is then inverted in the trough. 
The glass rod tipped with india-rubber is 
withdrawn, and the graduated tube, F, im- 
mediately 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 immediately, but in order to bring 
it to an end as quickly as possible, the bulb 
should be warmed by a spirit lamp or Bun- 116 
Estimation of Urea. 
sen’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 les- 
sened 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 twenty-four hours is now easy. 
All that is to be done is to multiply the total 
number of cubic centimeters of urine passed 
in the twenty-four hours by the figures read 
off on the measured tube. Thus if the 
amount of urine passed in twenty-four hours 
be 1770 C.C. and the number of the tube 
read off r8 it is only necessary to multiply 
1770 by 18 to get the amount of urea in 
milligrammes. In this case it will be 31860 
milligrammes, and since 1000 milligrammes 
equal one gramme, the total amount of urea 
passed will be 31 -86 grammes or about i-8 
per cent. 
If the urine contain more than two per cent. 
of urea, the urine must be diluted with an 
equal bulk of distilled water, the test then 
carried out, and the results doubled. Estimation of Urea. 
The hypobromite methods give fair results 
for clinical purposes, but they are not to be 
regarded as more than rough approximations. 
Liebig’s method admits of far higher accu- 
racy, and, as a matter of fact, it is not at all 
difficult to carry out, when once the burette 
has been set up and the standard solution 
provided. 
The following method is that described by 
Liebig:— 
The solutions required are;— 
A standard solution of mercuric nitrate 
of which i C.C. corresponds exactly to 
10 milligrammes of urea. 
A solution of baryta, made by mixing 
two volumes of cold saturated solution 
of barium hydrate, with one volume 
of cold saturated solution of barium 
nitrate. 
A saturated solution of carbonate of 
soda to be used- as the indicator. 
If the urine be free from albumen, a mea- 
sured 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 Estimation of Urea. 
previously measured off. There are thus 
two volumes of urine mixed with one of 
baryta solution. The mixture is then passed 
through filtering paper ; a drop or two of the 
filtrate is to be tested with the baryta solu- 
tion to see if any further precipitate occur, 
and if any precipitate do occur, it is best to 
take a fresh quantity of urine and to add to 
it an equal volume of baryta solution; after 
filtration, this must again be tested. The 
object of the addition of the baryta is to re- 
move the phosphates 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 fil- 
trate would be measured off with the pipette. 
If equal volumes of urine and baryta solution 
were employed, 20 C.C. must be measured 
off. A burette divided into quarters of a 
cubic centimeter is then to be filled with the 
standard solution of mercuric nitrate. 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 
escape. The solution must then be let off by Estimation of Urea. 
the pinch-cock at the bottom of the burette, 
until the upper surface be exactly on a level 
with the first division of the burette. Care 
must be taken that the solution fills the 
whole of the apparatus below the pinch-cock, 
and that no air bubbles are there contained : 
for if the latter rise to the surface during 
the analysis, the estimation is, of course, 
vitiated. 
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 
* A great saving of time may be effected by making 
two separate estimations; in the first estimation, 15 
C.C. of the mercury solution may at once be added to 
the fluid in the beaker and a drop of the mixture, after 
thorough stirring, is to be added to a drop of the soda 
solution on a white tile; if no yellow colour appear in 
the soda solution, continue adding the mercury solu- 
tion 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 estimation of the urea is found to be 
between 15 and 20 C.C. or 20 and 25 C.C., as the case 
may be. A second estimation is then made, and mer- 
cury solution to the amount of the smallest number of Estimation of Urea. 
120 
estimating the urea now begins. The solu- 
tion 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 per- 
manent 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 
noted down ; the nitrate of mercury is then 
added by quarters or halves of a C.C. the 
mixture being well stirred after every addi- 
tion, until a drop of the mixture give a 
yellow colour when brought into contact with 
the solution of carbonate of soda. 
A convenient method of recognising the 
first appearance of the yellow colour is 
to place a glass plate 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 
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. 
121 
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 per- 
ceived. Great care must be taken during 
the whole of these operations, not to lose 
one single drop of the fluid from either the 
beaker or burette. The number of C.C. used 
is then read off. 
From the total number of C.C. used, there 
must be subtracted the number of C.C. used 
in the first part of the process before a per- 
manent precipitate was produced, and the 
remainder multiplied by 10 gives the number 
of milligrammes of urea contained in 10 C.C. 
of urine, because i C.C. of the mercury solu- 
tion corresponds to 10 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 quan- 
tity passed in the twenty-four hours. For Estimation of Urea. 
122 
example, suppose that i C.C. of the mercury 
solution were used before a permanent pre- 
cipitate was produced; and that 19 C.C. 
were used before the yellow colour was dis- 
tinctly seen, then 1 C.C. subtracted from 19 
C.C. leaves 18, which multiplied by 10 gives 
180 milligrammes of urea in 10 C.C. of urine. 
Suppose that the patient had passed 1770 
C.C. of urine in the twenty-four hours, then 
the calculation would be as follows; 
io ; 1770 : : 180 : 31860 
180 
10) 318600 
31860 milligrammes. 
As 1000 milligrammes equal 1 gramme, 
31860 milligrammes equal 31-860 grammes. 
To obtain the percentage of urea proceed as 
follows : 
1 per cent, in 1770 C.C. is 17-7 grm. 
x being the percentage required. 
17-7 : 31-86 as 1 : x Estimation of Chlorides. 
123 
ESTIMATION OF 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 so- 
dium. 
A saturated solution of neutral chromate 
of potash. 
The urine should be as fresh as possible, 
and, if albuminous, submitted to the prepara- 
tion described at page 108. 10 C.C. of urine 
are then measured off into a glass vessel or 
beaker, and two or three drops of the solu- 
tion of chromate of potash added. A burette 
divided into quarters 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 (p. 118) must be observed. 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 124 
Estimation of Chlorides. 
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 
disappearing by agitation, indicates that the 
whole of the chloride present has been pre- 
cipitated, 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 i C.C. of the silver solution corresponds 
to 10 milligrammes of chloride of sodium, 
the number of C.C. of the silver solution 
used, multiplied by 10, will give the amount 
in milligrammes of the chloride of sodium 
present in 10 C.C. of urine. Thus if 6 C.C. 
of silver solution were used before a per- 
manent 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 twenty-four Estimation of Chlorides. 
125 
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 
twenty-four hours. 
This process, as applied to urine, nearly 
always gives a result a little above the real 
amount present. 
For greater accuracy, therefore 10 C.C. of 
the urine are measured off into a porcelain 
crucible, 1 or 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 faintly acid reaction 
be produced, a small quantity of carbonate 
of lime being then added in order to make 
the solution again neutral, the solution fil- 
tered, and the chlorides then estimated in 
the manner described above. 
The reaction referred to in the estimation 
of urea by mercuric nitrate, namely, that 
chlorides prevent the white precipitate of 126 
Estimation of Phosphates. 
mercuric nitrate with urea, can also be used 
as a method of estimating the chlorides in 
urine. See Harris and Power, Handbook for 
the Physiological Laboratory, sth edit., 1892. 
ESTIMATION OF PHOSPHATES. 
The solutions required are ; 
A standard solution of acetate of uran- 
ium, of which 1 C.C. corresponds 
exactly to 5 milligrammes of phos- 
phoric acid. 
A solution containing acetic acid and 
acetate of soda : 100 grammes of ace- 
tate of soda are dissolved in water, 
100 C.C. of acetic acid added, and the 
mixture diluted until it equal 1000 C.C. 
A weak solution of ferrocyanide of po- 
tassium. 
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 uran- 
ium solution is dropped into the beaker until Estimation of Phosphates. 
127 
precipitation cease ; this can easily be ascer- 
tained 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 ferrocyanide of potassium, pro- 
duce a light brown colour 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 
regarded 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 phos- 128 
Estimation of Albumen. 
phoric acid passed in twenty-four hours is 
now easy. 
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 milli- 
grammes of phosphoric acid, and if the 
patient have passed 1500 C.C. in the twenty- 
four hours, the calculation will be : 
50 ; 1500 ; : 75 : 2250 
75 
50)112500 
2250 milligrammes. 
2250 milligrammes equal grammes, 
which will be the quantity of phosphoric 
acid passed in the twenty-four hours. 
ESTIMATION OF ALBUMEN. 
No easy, rapid, and trustworthy method of 
estimating albumen has yet been suggested. 
The ordinary way of coagulating the albu- 
men by heat and acetic acid, throwing the 
precipitate on a weighed filter, washing, 
drying, and reweighing, is so long and Estimation of Sugar. 
129 
troublesome that it is never employed in 
clinical observations. 
A fairly good method for clinical observa- 
tion is the estimation by means of the polari- 
scope. 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 persistent after filtration, a few 
drops of acetic acid, or a little carbonate of 
soda or milk of lime added to the urine be- 
fore filtration may remove the turbidity. 
For the method of using the polariscope, 
see p. 132. See also (p. 26) on the use of 
Esbach’s tubes for clinical determinations. 
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 
twenty-four hours. The latter amount is 
extreme. 
ESTIMATION OF SUGAR. 
There are two methods of estimating the 
amount of sugar present in diabetic urine, 130 
Estimation of Sugar. 
one by volumetric analysis, the other by 
means of the polariscope. 
Volumetric Method.—A standard copper so- 
lution is required, containing sulphate of 
copper, neutral tartrate of soda or potash, 
and solution of caustic soda, 20 C.C. of 
which correspond to 100 milligrammes of 
grape sugar. This solution is exceedingly 
apt to decompose, and must therefore be 
preserved in well-stoppered, completely filled, 
glass vessels, and in a cool dark place. 
In estimating the sugar, the first step is to 
ascertain if the copper solution remain un- 
decomposed : 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 oxide 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 distilled water. 10 C.C. of the urine are 
then measured 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, Estimation of Sugar. 
131 
and the flask containing the copper solution 
is heated over a small flame, wire gauze in- 
tervening, until boiling begins; 2 C.C. of the 
urine are then allowed to flow into the boil- 
ing copper solution. After a few seconds, 
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 
between the light and the eye of the obser- 
ver, 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 has become yellow. 
Where extreme accuracy is required 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 sub-oxide of copper be pro- 
duced; to the second test-tube a small quan- 
tity of hydrochloric acid is then added, and, 
sulphuretted hydrogen passed through; to 
the third, acetic acid and ferrocyanide of 
potassium are added. None of these re- 
agents ought to produce a precipitate. 
If, on boiling with the copper solution, a 132 
Estimation of Sugar. 
precipitate 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. 
Since 20 C.C. of the copper solution corre- 
spond exactly to 100 milligrammes of sugar, 
the complete decoloration of the copper solu- 
tion 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, oi urine, 1-55 C.C. of urine will 
contain 100 milligrammes of sugar, and 100 
C.C. of urine will contain 6-45 grammes of 
sugar; as by proportion : 
1-55 : 100 : : 100 : 6450. 
If the urine contain albumen as well as 
sugar, the former must be removed as di- 
rected at page 108. 
Estimation hy 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 accur- Estimation of Sugar. 
133 
acy 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 removed by the method given above, 
page 108. The bile acids when present, can 
scarcely affect the result, since they are 
found in such very small amount in the urine. 
The polariscope consists of a tube, sup- 
ported upon a foot, and divided into three 
parts, one of which, the middle, is movable, 
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, at- 
tached 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, sodium flame, or a 
gas lamp, protected by a neutral tinted glass 
cylinder, is necessary. When the polari- 
scope is to be used the lamp is placed an inch 
or so in front of the object glass. The hol- 
low glass tube in the middle of the instru- 
ment must now be removed, and filled with 
distilled water ; the small glass disc being 
slid over the end of the tube completely filled 
with water, in such a manner that no air- 134 
Estimation of Sugar. 
bubble is included in the tube ; 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 instru- 
ment ; and the observer, looking through the 
eye-piece, draws out, or pushes in, the move- 
able tube close to the eye, until he see at the 
end of the eye-piece, nearer to the lamp, a 
circular field divided into two equal parts by 
a black line, which ought to be sufficiently 
well defined. He next turns the screw at- 
tached to the under surface 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 dia- 
betic urine, it may be observed in the longer 
tube, 20 centimeters in length, since the ac- Estimation of Sugar. 
135 
curacy of the estimation is increased with the 
length of the tube. But if the fluid be dark, 
the shorter tube, 10 centimeters long, must 
be used. 
The tube is now filled with the urine, in 
the same manner as it was previously filled 
with distilled 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 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 
exactly the same in colour, the number of 
degrees which the movable zero is distant 
from the fixed zero is read off; and if the 
fluid observed contain sugar, the movable 
scale will be found to the right; but if 
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 136 
Estimation of Sugar. 
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. 
Acetonasmia, 38 
Acid-albumin, 20, 24 
Acid urine, 13 
-— essential in testing 
for albumen, 20 
Acute diseases, urine in (see 
Pyrexial 
Ague, phosphates in, 66 
Albumen in the urine, 16 
cause of fallacy in test 
for sugar, 30 
cause of froth, 8 
clinical import of, 27 
separation of, 30, 108 
estimation of, 25, 128 
Albumose, 24 
Alkali-albumin, 20 ' 
Alkaline urine, 13 
in testing for albu- 
men, 20 
Ammonia in decomposing urine, 
14 
cause of alkaline reaction, 
15 
Ammoniaco- magnesian phos- 
phate, 78 
Amyloid kidney, casts in, 103 
Anaemia, low specific gravity 
in, 13 
Apparatus for qualitative ex- 
amination, 8 
Arseniuretted hydrogen, urine, 
Bile salts, Hay’s test, 43 
Biliverdin, formation of, 42 
Blood corpuscles in urine, 45, 
87 
■ cause of albu- 
men, 45 
smoky colour, 5 
clinical import 
of, 47 
Bright’s disease, low specific 
gravity in, 13 
urea in, 57 
phosphates in, 66 
casts in, 94 
Briicke on sugar in normal 
urine, 39 
Carbolic acid in urine, 5 
Carbuncle, sugar in urine of, 40 
Casts (see Renal Casts) 
Catarrh of bladder (see Cystitis) 
Chlorides, 62 
estimation of, 123 
clinical import, 63 
Colour of urine. 4 
Congestion of kidney, casts in, 
iox 
Consistence of urine, 7 
Convalescence, sugar in the 
urine in, 40 
Copper test for sugar, 31 
Cotton fibres, 96 
Cystin, 81 
Cystitis, decomposition and 
viscidity of urine in, 7 
alkaline urine in, 15 
cause of pus in urine, 89 
Bacteria, 103 
Benzoic acid, relation to hip- 
puric, 61 
Bile acids, 42 
in the urine, 40 
——- pigments, 40 
Deal fibres, 97 138 
Index 
Diabetes, sugar in, 39 
urea in, 57 
• quantity in, 54 
uric acid in, 58 
Diabetic coma, 38 
Jaffe, test for indican, 52 
Jaundice, urine in, 40 
Epithelial cast, 97 
Epithelium, 90 
Lardaceous kidney, 103 
Leube, urea and sugar in dia- 
betes, 39 
Leucaemia, uric acid in, 59 
Leucin, 83 
Leucorrhcea, cause of albumen 
in urine, 29 
cause of pus, 90 
Liebig’s test for cystin, 82 
estimation of urea, 47 
Lime, oxalate of, 75 
phosphate of, 78 
Liver diseases, uric acid in, 59 
Fehling’s test for sugar, 33 
Fermentation test for sugar, 35 
Ferrocyanide of potassium, test 
for albumen, 23 
Froth on urine, 8 
Fungi in urine, 103 
Gleet, cause of albumen in 
urine, 29 
of pus, go 
Glycosuria, 39 
Gmelin’s lest for bile pigments, 
4° 
Gonorrhoea, cause of pus, 90 
Gout, uric acid in, 60 
Granular cast, 97 
Guaiacum test for blood, 46 
Malarious diseases, sugar in 
urine of, 40 
Melanotic cancer, 53 
Methaemoglobin, 46 
Micro-organisms, 103 
Moore’s test for sugar, 30 
Mucus in urine, 90 
Murexide test for uric acid, 59 
Haematoporphyrin, 51 
Hasmaturia, 47 
Ha?min test, 47 
Haemoglobin in the urine, 49 
Heat test for albumen, 17 
Heller’s test for albumen, 21 
Hippuric acid, section on, 60 
Hoffmann’s test for tyrosin, 85 
Hiifner’s plan for estimating 
urea, tog 
Hyaline cast, g8 
Hypobromite process for urea, 
109 
Hysteria, low specific gravity 
in, 13 
Odour of urine, 6 
Oliver, Dr., test papers, 24, 37 
Oxalate of lime, 75 
Paraglobulin in urine, 24 
Paraplegia, decomposition and 
viscid urine in, 6 
Paroxysmal hasmaturia, 49 
Pavy’s test for sugar, 33 
Penicillium glaucum, 104 
Peptones in urine, 24 
Pettenkofer’s test for bile-acids, 
42 
Phosphates, 64 
as sediment, 78 
acid, cause of acid reaction, 
14 
confounded with albumen, 
19 
estimation of, 126 
Phosphorus poison, urine, 86 
Indican, 52 
Indigo-carmine test for sugar, 
36 
lodine test for bile pigments, Index 
139 
Picric acid test for albumen, 22 
for sugar, 37 
Pigments of urine, 50 
Potassio-mercuric iodide test 
for albumen, 23 
Pus in urine, as sediment, 88 
cause of albumen, 29 
of turbidity, 3 
Pyrexia, urine in, 5 
urea, 56 
chlorides, 63 
phosphates, 66 
casts in, 100 
Sulphur compounds, in decom- 
posing urine, 6 
in cystin, 82 
Sulphuric acid poisoning, 49 
Tanret’s test for albumen, 23 
Torula cerevisias, 104 
Translucency of urine, 7 
Trommer’s test for sugar, 31 
Tungstate of soda test for albu- 
men, 23 
Turbidity of urine, 7 
Turpentine, 6 
Tyrosin, 83 
Quantity of constituents, table 
of, 1 
Urates, as sediment, 72 
cause of fallacy in test for 
sugar, 33 
of turbidity, 7 
deposited in decomposing 
urine, 73 
—— interfere with test for albu- 
men, 22 
Urea, section on, 54 
in acute diseases, 56 
decomposition in urine, 14 
cause of high specific gra- 
vity, 13 
estimation of, 109 
by Southall’s appara- 
tus, no 
Uric acid, as sediment, 68 
section on, 57 
Urina cibi, 5 
potus, 5 
spastica, 5 
Urinometer, 7 
Urobilin, 50 
Ralfe, Dr., test for acetone, 38 
Reaction of urine, 13 
Renal casts, 94 
Retention, alkaline urine in, 15 
Rhubarb, colour of urine after, 
5 . 
Roberts estimation of sugar, 
36 
Russell’s process for estimat- 
ing urea, 113 
Saffron in urine, 5 
Santonin in urine, 5 
Sarcinaj, 104 
Scurvy, urine in, 49 
Sediments, urinary, 67 
Semen (see Spermatozoa) 
Serum albumen, 24 
Smoky tint of urine, 5 
Solids of urine, 1 
Specific gravity of urine, 9 
Spectrum of blood, 46 
Spermatozoa, 104 
Suckling women, sugar in urine 
of, 40 
Sugar in the urine, 29 
clinical import of, 39 
cause of high specific 
gravity, 13 
estimation of, 129 
Sulphates, section on, 66 
Violets, turpentine causes smell 
of, 6 
West, Samuel, estimation of 
urea, 113 
Yeast, test for sugar, 35 
fungus in urine, 104