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Lamination of the uiune 
W.UJE.liAM LEGG. 
?BJBD EDITWt A GUIDE 
TO THE 
EXAMINATION OF THE URINE. A GUIDE 
TO THE 
EXAMINATION OF THE'URINE 
DESIGNED CHIEFLY 
FOR TUR USE OF CLINICAL CLERKS ANU STUDENTS 
BY 
J. WICKHAM LEGG, M.D. 
.«• ' 
CASUALTY PHYSICIAN TO SAINT BARTHOLOMEW'S HOSPITAL. 
Oirtr 
PHILADELPHIA: 
LINDSAY AND BLAKISTON. 
M DCCC LXXII 
[All rights reserved.} INTRODUCTION. 
This little work is intended to supply the clinical 
clerk and student of medicine with a concise 
guide to the recognition of the more important 
characters of the urine; and from its small size 
to serve as a companion at the bedside to the 
busy practitioner, who may be unable to consult 
the larger works on the subject. A plan for the 
examination of the urine, step by step, has been 
given, with an account of the method for ascer- 
taining the nature of those alterations that most 
frequently occur in disease. An appendix has 
been added in which the manner of estimating 
the urea, chlorides, phosphates, sugar, &c. by 
volumetric or other rapid analysis has been de- 
scribed. 
London, September 1869. ADVERTISEMENT TO THE THIRD 
EDITION. 
The third edition is, in nearly all important 
respects, the same as the second: greater detail 
has, however, been given to some of the para- 
graphs relating to the clinical value of the 
morbid changes which may be discovered in 
the urine. 
London, February 1st, 187'2, A GUIDE 
TO THE 
EXAMINATION OF THE URINE. 
In order that the examination of the urine may 
be made systematically, the following plan, in 
which the most important clinical facts are directed 
to be ascertained, is recommended to the student. 
The order of examination that is here given 
should be followed, the details of each operation 
being described on the page stated at the end of 
each paragraph. 
SCHEME FOR THE EXAMINATION OF 
THE URINE. 
I. Observe the colour of the urine, its appearance, 
if clear, smoky, turbid, &c. (page 3). 
II. Ascertain the specific gravity, (page 7). 
III. Examine the reaction, whether acid., neutral, 
or alkaline, by means of litmus or turmeric 
paper, (page 9). 2 
SCHEME OF EXAMINATION. 
IV. Test the urine for albumen, (page 12). If 
albuminous, examine microscopically for-renal 
casts, (page 61); pus corpuscles, (page 55); 
red blood corpuscles, (page 57). 
V. Test the urine for sugar, (page 19). 
VI. If there be no albumen or sugar present, and 
no deposit, the urine need not be further 
examined, unless some special indication exist. 
VII. But if any sediment (page 42) be observed, 
it must be examined microscopically: the 
following enumeration of the more common 
deposits will assist the student: 
Pink or reddish deposit, dissolved on heating 
test-tube-urate of soda, (page 47). 
White crystalline deposit, soluble in acetic 
acid-phosphates, (page 50). 
Hummocky white sharply defined cloud, 
insoluble in acetic acid-oxalate of lime, 
(page 49). 
White amorphous flocculent deposit, rendered 
ropy by alkalies-pus, (page 55). 
Brownish-red crystalline deposit-uric acid, 
(page 44). 
Red amorphous deposit-blood, (page 57). 3 
COLOUR OF URINE. 
PHYSICAL EXAMINATION. 
The physical examination of the urine is the 
application of the senses to its investigation with- 
out the employment of chemical or- microscopical 
aids. The colour, translucency, odour, and con- 
sistence are the only characters which can be 
ascertained by this simple method of observation. 
Colour. Urine is ordinarily of a reddish yellow 
colour; but it may be as colourless as water, or 
dark brown black like porter : a smoky tint is 
absolutely diagnostic of the presence of blood; a 
brownish green suggests the presence of the co- 
louring matter of the bile. Many drugs, as rhu- 
barb, saffron, and santonine, give a peculiar colour 
to the urine. The carbolic acid treatment of 
wounds colours the urine black. Tannin given by 
the mouth renders the urine colourless. 
A pale urine is seen in health, as the urina potus ; 
and in disease, in aneemia, diabetes, and conva- 
lescence from acute diseases. A pale urine contains 
little colouring matter, and but a small proportion 
of solid constituents, always excepting, however, 
the urine of diabetes mellitus. A pale urine is a 
sign that the patient is not suffering any high de- 4 
TURBIDITY OF URINE. 
gree of pyrexia. A high coloured urine occurs 
in healthy after food as the urina cibi, and after 
strong exercise; and in disease, in fevers, and 
most acute diseases, in which considerable meta- 
morphosis of the tissues takes place. It contains 
much colouring matter and urea in proportion to 
the water. A dark urine should be examined for 
pigment. (See the section on pigment, page 31). 
Translucency. In health, the urine deposits, 
after remaining at rest for a short time, a slight 
cloud of mucus, derived from the bladder and 
urinary passages; but, in all other respects, 
healthy ilriue is perfectly clear. On cooling, how- 
ever, it may sometimes become turbid from the 
presence of urates, which are distinguished from 
other deposits by their appearing upon the cooling 
of urine which was perfectly clear when first pass- 
ed. Should the urine be turbid when first voided, 
it is a mark of disease; and pus is the most fre- 
quent cause of this appearance. 
Odour. It is not yet ascertained to what sub- 
stance the peculiar smell of the urine is due, nor 
is it of much importance to the clinical student. 
When the urine loses its natural smell and be- 
comes foetid and ammoniacal, the change is due to CONSISTENCE OF URINE. 
5 
the decomposition of urea into carbonate of ammo- 
nia, and the formation of sulphur compounds; in 
cases of cystitis and paraplegia the alteration be- 
gins very rapidly after emission. Various drugs, 
as cubebs, and articles of diet, as asparagus, give 
a characteristic smell to the urine; turpentine 
gives the odour of violets to the secretion ; it is 
stated that in organic disease of the kidney, and 
in gout, these substances cannot be recognised in 
the urine by their smell, after they have been 
given by the mouth ; observations, contradictory 
to this statement, have, however, been recorded. 
Consistence. The urine is a limpid fluid, flow- 
ing freely from one vessel to another. But in 
catarrh of the bladder, and in retention of urine, 
the ammoniacal products of the decomposition of 
the urea render the pus present thick and viscid, 
thus causing the secretion to be ropy, and poured 
with difficulty from one vessel to another. 
The froth on normal urine readily disappears : 
but if the froth be permanent, the presence of 
albumen, or of the constituents of the bile, may be 
suspected. 
Before passing to the mechanical and chemical 6 
APPARATUS AND REAGENTS. 
examination of the urine, it may be well to men- 
tion the apparatus and reagents which will be 
found necessary by the student for bedside in- 
vestigation. They are: 
Cylindrical Urine Glasses, each containing 
about 6 fluid-ounces. 
A Urometer, the stem of which is graduated 
from 1000 to 1060. 
Blue and Red Litmus and Turmeric Paper. 
Test Tubes. 
A Spirit Lamp, or Bunsen's Gas-burner. 
Nitric Acid. 
Acetic Acid. 
Liquor Potassse or Liquor Sodas. 
Solution of Sulphate of Copper, 10 grains to 
the fluid-ounce, oi' Fehling's Test Solution 
for Sugar. 
Glass Funnel and Filtering Paper. 
With this apparatus and these reagents, the 
student will be able to perform all the more 
important reactions described below. 7 
SPECIFIC GRAVITY. 
The specific gravity of the urine varies in 
health between 1015 and 1025; the simplest way 
of estimating it is by means of the urometer. 
In order to use this instrument, a quantity of 
the urine to be examined is poured into a cylindri- 
cal glass, and care is taken to remove all the froth 
which may form, either by blotting paper, or by 
overfilling the vessel. The urometer must then 
be introduced, and allowed to float freely in the 
urine, without touching either the side or bottom 
of the vessel. Since the fluid accumulates around 
the stem of the urometer from the physical force 
of attraction, the specific gravity appears to be 
higher than it really is, when read off while the 
eye is above the surface of the fluid; to obtain a 
correct reading, therefore, the eye must be lowered 
to the level of the surface of the fluid, and the 
number on the stem ascertained by looking at it 
through the urine : having noted this, the uro- 
meter should be depressed in the urine, and again 
allowed to come to rest, when the number may 
be again read off; the second estimation is made 
to correct any mistake that may have occurred 8 
CLINICAL VALUE OF SPECIFIC GRAVITY. 
in the first reading. The specific gravity thus 
ascertained should be noted down at once. 
The knowledge of the specific gravity of a few 
ounces of urine is a matter of little value. To 
render the observation in any way serviceable, the 
whole quantity passed in the 24 hours must be 
collected and mixed, and the specific gravity of a 
small amount of this taken. A rough estimation 
of the solid matters passed may be made from the 
specific gravity in the following way; the two last 
figures are multiplied by 2 or 2'33 which gives 
the amount of solid matters in a 1000 parts of 
urine; if, for example the specific gravity of the 
urine be 1020, 1000 grains of urine will contain 
2 x 20 i.e. 40 grains of solids. 
Clinical Import. Sugar in the urine is the most 
common cause of a high specific gravity ; if this 
substance be not present, excess of urea will be 
the probable cause. 
A low specific gravity, below 1010, occurs after 
fluid has been taken in quantity. A low speci- 
fic gravity is also noticed frequently in chronic 
Bright's disease, in hysteria, immediately after the 
paroxysm, in anaemic conditions, and in diuresis 
from any cause, such as mental emotion, or expos- 
ure to cold. 9 
REACTION 01' URINE. 
A. high specific gravity with a pale colour, and 
a low specific gravity with a deep tint, are equally 
signs of disease. 
A new urometer should be carefully tested, 
since those sold by the instrument makers give 
results varying as much as 10 or 12 degrees. 
The urometers in common use in Hospitals are 
very rarely correct. 
REACTION. 
The urine is almost always secreted acid, al- 
thougdi it may become alkaline within a very 
short time of emission. In the majority of the 
cases in which the urine is said to be alkaline, as 
in paraplegia and cystitis, the alkalinity is really 
due to decomposition after being passed. If the 
urine, then, be found to be alkaline, a fresh speci- 
men should be tested immediately after it has 
been voided. In cases of retention, the urine 
sometimes becomes alkaline in the bladder; and, 
in health, can be made alkaline, by the adminis- 
tration of drugs. 
When the alkalinity of the urine is due to 
ammonia, the brown colour of the turmeric disap- 10 
AMPHIGENOUS REACTION OF URINE. 
pears when the paper is exposed for some time to 
the air, or gently heated; but the change from 
yellow to brown is permanent, if the alkalinity be 
owing to either potash or soda. 
The urine is rarely neutral to test paper; so 
that many observers have denied its occurrence. 
Occasionally the urine has an equivocal reaction, 
reddening blue litmus, and restoring the blue 
colour to reddened litmus paper. This amphi- 
genous or amphoterous reaction, as it has been 
called, may be explained in the following manner: 
by the decomposition of urea, ammonia is given 
off, which combines with the acid phosphate of 
soda in the urine; this compound, in its turn, 
when gently warmed gives off ammonia, leaving 
the acid phosphate behind; so that some parts 
of the same fluid may have an acid, others an 
alkaline reaction. 
The cause of the acid reaction of the urine is the 
presence of the acid phosphate of soda; and, 
according to some observers, of free lactic and 
hippuric acids. Very shortly after emission, the 
acidity increases, and lasts, in health, for days, 
free uric acid being often deposited. 
Sooner or later, however, the alkaline fermenta- CLINICAL IMPORT OF REACTION. 
11 
tion sets in, and the urine becomes ammoniacal 
and foetid from the conversion of urea into car- 
bonate of ammonia, and the formation of sul- 
phide of ammonium, while the phosphates and 
the urate of ammonia are deposited as a white 
sediment. 
Clinical Import. The acidity of the urine is 
decreased during digestion, and increased by fast- 
ing or perspiration. A very acid, high-coloured 
urine is associated with the " uric acid diathesis." 
This condition favours the occurrence of calculus 
and gravel. 
Alkalinity of the urine is nearly always due to 
decomposition of the urea into carbonate of ammo- 
nia. It is frequently present in some diseases of 
the spinal chord, and in chronic affections of the 
bladder and urinary organs, as a few drops of 
urine, which have undergone the alkaline fermen- 
tation, will rapidly produce the same change in 
perfectly fresh urine. 
When the alkalinity of the urine is due to fixed 
alkali, either potash or soda, it may be due to a 
catarrh of the urinary passages, the ingestion of 
alkaline salts, or some alteration in the metamor- 
phosis of the tissues. About this condition, little 12 
ALBUMEN IN THE URINE. 
is known with certainty. It is always best treated 
by meat diet and iron. 
EXAMINATION FOR ALBUMEN. 
This is the first and most important step in the 
chemical examination of the urine : the presence 
or absence of albumen must always be determined 
before proceeding to test for any other substance, 
and the search must never be omitted in the 
examination of any urine. 
The best way of testing for albumen is to fill 
a test tube about two-thirds full of the urine to be 
examined, and to heat the upper layer of the fluid 
over the flame of a lamp, the lower end of the 
tube being held between the thumb and fore- 
finger of the observer, in the manner represented 
in the accompanying wood cut. By employing 
this method, two strata of fluid are obtained for 
comparison. 13 
ALBUMEN IN THE URINE. 
The heat is applied until the upper portion of 
the urine begins to boil., for although albumen, 
when in large quantity, coagulates at a point 
many degrees below boiling, yet the presence of a 
small quantity gives no precipitate below 212° 
F. The boiled stratum of fluid should now be 
carefully compared with the cool layer in the 
lower part, by holding the test tube against the 
light; if any cloudiness or opacity be seen, it 
must not at once be concluded that albumen is 
present; but a drop or two of dilute nitric acid 
should be allowed to flow gently down the side 
into the urine; the cloud is permanent, if due to 
albumen; but disappears immediately if due to 
the earthy phosphates. This addition of acid 14 
ALBUMEN IN THE URINE. 
after boiling should never be omitted, since the 
most practised eye cannot distinguish, by appear- 
ance only, between the cloud produced by albu- 
men, and the phosphate of lime. 
Cautions, i. The addition of the nitric acid not 
unfrequently carries down some of the coagulated 
albumen into the unboiled layer of urine, and thus 
causes the cloud to be less thick than before; 
such an appearance is never produced by phos- 
phates : when they are the cause of the turbidity, 
the urine becomes absolutely clear, as before boil- 
ing ; slight brown coloration only, occurring from 
the addition of the nitric acid. 
ii. Should the urine be turbid from the pre- 
sence of urates, it quickly becomes clear on the 
application of slight heat; and as it is desirable 
before testing for albumen to have a clear solu- 
tion, the whole of the test tube should be passed 
two or three times through the flame of the lamp, 
until the urates are dissolved ; the upper stratum 
of the urine should then be boiled, and compared 
with the lower, as above. 
iii. If the urine be neutral or alkaline at the 
time of testing, the albumen will not be precipi- 
tated by heat; the acid reaction must therefore be ALBUMEN IN THE UKINE. 
15 
restored by a few drops of weak acetic acid, and 
the urine then boiled, and nitric acid added. If 
alkaline urine be boiled without previous acidula- 
tion, a deposit of phosphate of lime is almost sure 
to occur, which is immediately dissolved on the 
addition of an acid. 
If nitric acid be added, before boiling, to an 
albuminous urine, the albumen will often not be 
precipitated on the application of heat. Care 
must therefore be taken that it is acetic acid 
which is used in the preparatory acidification of 
the urine. 
iv. If the urine be permanently turbid, from 
any cause, and it is desired to know accurately 
whether albumen be present, the urine must be 
filtered before boiling; in this way very minute 
quantities may be discovered. 
The method of testing for albumen, proposed 
by Heller, which consists of pouring nitric acid 
into a test tube, and allowing the urine to flow 
down upon the acid, so that the two fluids touch, 
but do not mix, and observing the layer of coagu- 
lated albumen thus produced, is open to many 
notorious fallacies, and does not detect minute 
quantities; it cannot, therefore,, be recommended. 16 
MILLON;S TEST FOR ALBUMEN. 
The carbolic acid test is also exceedingly falla- 
cious. 
It is sometimes desirable to examine the urine 
for traces of albumen, and also for the presence or 
absence of substances very closely allied to albu- 
men, but which cannot be detected by the usual 
tests for albumen. In this case the method re- 
commended by Millon should be followed. An 
equal weight of mercury is digested in an equal 
weight of strong nitric acid, first in the cold, and 
then by a gentle heat, until the metal is completely 
dissolved. Two volumes of water are then added 
to one volume of the mercurial solution. The 
whole is set aside for some hours, a crystalline de- 
posit takes place, and the clear fluid is used for 
testing. This fluid colours red all solutions which 
contain a trace of an albuminous compound; the 
reaction appears in the cold, but is increased by 
warming up to near boiling point. 
A rough way of estimating the amount of albu- 
men 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, 
until the albumen be completely coagulated. One 
oi' two drops of nitric acid are then added, and the CLINICAL IMPORT OP ALBUMEN. 
17 
test tube is set aside for 24 hours ; at the end of 
that time, the proportion of the coagulated albu- 
men, which has collected at the bottom of the 
tube, to the rest of the fluid, is noticed; if the 
albumen occupy one-third of the height of the 
fluid, there is said to be one-third of albumen in 
the urine; oi' one-sixth, or one-eighth, as may be. 
If, however, at the end of 24 hours scarcely any 
albumen has collected at the bottom, there is said 
to be a trace. If the urates have been deposited, 
the urine must be filtered before boiling, or a 
considerable error will creep in, by their increas- 
ing the apparent amount of albumen.* 
Clinical Import. The presence of albumen in 
the urine is an important objective sign of disease. 
Any state, which produces a mechanical impedi- 
ment to the return of blood from the kidneys, 
will be accompanied by albumen in the urine; 
and the albumen will be persistent so long as 
the congestion of the kidney continues ; the long- 
er the albumen remains in the urine, the greater 
danger is there of permanent textural injury to 
* The plan for estimating the albumen, by the difference in the 
specific gravity, before and after coagulation, is stated by compe- 
tent observers to be quite untrustworthy. 18 
CLINICAL IMPORT OF ALBUMEN. 
the kidney. In many acute febrile diseases, albu- 
men is frequently present, which, as a rule, dis- 
appears with the termination of the illness; but, 
if persistent, it affords evidence of organic disease 
of the kidney. In a chronic, nou-febrile disorder, 
without obvious impediment to the return of blood 
from the kidneys to the heart, the discovery of 
albumen in a clear urine would indicate structural 
change in the kidney. 
The search for renal casts must always follow 
the detection of albumen in the urine. The dis- 
covery of these structures renders it certain that 
the albumen, or, at least, part of it, is derived from 
the kidney. 
A frequent cause of the presence of albumen is 
pus,in proportion to its quantity; in the urine of 
women, a small quantity of albumen is frequently 
due to leucorrhceal discharge, which is composed 
chiefly of pus. Gleet, and also, it is said, a great 
quantity of semen, cause albumen to be present in 
in the urine. 
The presence of blood in the urine necessitates 
the presence of albumen, derived from the corpus- 
cles and plasma. moore's test for sugar. 
19 
EXAMINATION FOR SUGAR. 
If the specific gravity rise above 1030, sugar' 
may be suspected, and should be looked for. 
Many methods of testing for sugar have been 
proposed ; but only the most prominent and trust- 
worthy will here be mentioned, although it must 
be confessed that a rapid, and yet trustworthy, 
test, suited to practitioners, is still a desideratum. 
Moore's Test. Equal parts of urine, and liquor 
potassae or liquor sodas, are poured into a test tube, 
and the upper layer of this mixture is heated to 
boiling, in the manner describedin the section on 
examination for albumen. (See page 12). The 
heated portion becomes brown-red, dark-brown, or 
black, according to the quantity of sugar present. 
The least alteration of colour may be perceived by 
comparing the upper and the lower' portions of 
the liquid. 
Cautions, i. High coloured urines, and urines 
containing excess of phosphates, darken percepti- 
bly on boiling with caustic alkalies, and, if the 
urine be albuminous, the colour will be greatly 
deepened, though no sugar be present. Before, 
therefore, applying Moore's test to an albuminous 20 
moore's test for sugar. 
urine, the albumen must be removed by filtration 
after boiling with a drop or two of acetic acid. 
ii. It has been noticed that liquor potassaa 
which has been kept for a few weeks only in white 
glass bottles, takes up lead from the glass, and 
that a black precipitate of sulphide of lead is 
formed, when the alkali is boiled with certain 
urines which contain much sulphur. Care must 
be therefore taken that the liquor potassaa is free 
from lead. 
The value of Moore's test is chiefly negative : 
if the urine on boiling with liquor potassaa do 
not perceptibly darken, it may be assumed to be 
free from a hurtful quantity of sugar; if, however, 
darkening occur, a further observation must be 
made with the copper or fermentation tests de- 
scribed below. 
The Copper Test depends on the property which 
grape sugar possesses, of reducing the higher ox- 
ide of copper to a suboxide. There are two me- 
thods of conducting this reaction, identical in 
principle, named respectively Trommer's Test, and 
Fehling's Test. 
Trommer's Test. About a drachm of the sus- 
pected urine is poured into a test tube, and liquor trommer's test foe sugar. 
21 
potassae, or liquor sodas added in about half the 
quantity : a weak solution of sulphate of copper 
(about 10 grs. to the fluid ounce) is dropped into 
the mixture. The precipitate which first forms is 
redissolved on shaking the test tube., and the cop- 
per solution should be carefully added, shaking 
the test tube after each drop has fallen into the 
mixture, so long as the precipitate is easily redis- 
solved, when the solution will have acquired a 
beautiful blue or green colour, but should be quite 
clear, and free from any precipitate; the contents 
of the test tube must next be heated to boiling1, 
when, if sugar be present, an orange-red precipi- 
tate is first thrown down, which, after some time, 
becomes reddish brown. This precipitate consists 
of the saboxide of copper. 
Since uric acid and mucus will also reduce 
copper when they are boiled with its salts, a simi- 
lar solution should be set aside in the cold; and 
if at the end of 24 hours the reddish precipitate 
have fallen, sugar is undoubtedly present. 
Cautions. Much difficulty is often at first ex- 
perienced in arranging the proper proportion be- 
tween the copper solution, and the liquor potassae. 
If too much copper be added, which is the most 22 
fehling's test foe sugab. 
common mistake, the potash cannot redissolve 
the precipitate first formed, which may then be 
mistaken foi' a precipitate of suboxide. The best 
rule to bear in mind is : always to have an excess 
of potash present, and never to operate except 
with a clear solution. 
Fehling's Test. In consequence of the difficulty 
of properly adjusting the quantity of alkali and 
copper in Trommer's test, many practitioners pre- 
fer to use a solution in which the copper and alkali 
are present in the exact proportion necessary. 
This solution may be prepared in the following 
way : grains of crystallized potassio-tartrate 
of soda are dissolved in 5 fluid-ounces of a solution 
of caustic potash, sp. gr. 1T2. Into this alkaline 
solution is poured a fluid prepared by dissolving 
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 be wanted for 
use. In this case, a fluid-dracbm of the sulphate 
of copper solution may be added to half a fluid- 
ounce of the alkaline solution prepared as above. fehling's test. 
23 
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 occur, the solu- 
tion may be used for analysis j but if a red preci- 
pitate be thrown down, the liquid has decomposed, 
and a fresh supply must be obtained. While the 
solution is boiling in the test-tube, the urine must 
be added to it drop by drop, and the effect 
watched. A few drops of urine which contain 
a large percentage of sugar will at once give a 
precipitate of yellow oi1 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, have been added. If 
no precipitate be found after allowing the test- 
tube to remain at rest for an hour, the urine may 
be considered free from sugar. 
Cautions, i. The test solution should never 
be employed without previous boiling for a few 
.seconds; the tartrate being exceedingly apt to 
decompose, and the solution then reduces copper 
as effectually as would grape sugar. 
ii. The quantity of urine used in the test 
should never be greater than the quantity of test 
solution employed. 24 
FERMENTATION TEST. 
iii. After adding urine in volume equal to the 
Fehling's solution, the boiling of the mixture must 
not be continued, as other substances, besides 
sugar, present in the urine, will reduce copper at 
a high temperature. 
Fermentation Test. A few grains of German 
yeast are put into a test tube, which must then be 
filled with urine, and inverted in a shallow dish 
already containing a little of the urine, or better 
still, quicksilver, and set aside in a warm place, as a 
mantel-piece, or a hob. A glass bird fountain, if 
at hand, will be much more handy for this pur- 
pose than a test tube. A similar test tube or bird 
fountain must be filled with water, a few grains of 
yeast added, and both vessels subjected to the 
same conditions. If sugar be present, the forma- 
tion of carbonic acid will, at the end of 24 hours, 
have driven nearly all the urine out of the test 
tube or bird fountain, a few bubbles only will have 
appeared in that containing the water. To prove 
that this gas is carbonic acid, some caustic potash 
or soda must be introduced into the test tube, 
when the gas will be quickly absorbed, and the 
urine again rise in the tube. 
Estimation by loss of density after fermentation. ESTIMATION OF SUGAR. 
25 
Dr. Roberts has found that, after 
"the number of degrees of ' density lost' indi- 
cated as many grains of sugar per fluid ounce/' 
and he proposes to estimate by this means the 
amount of sugar present. 
About 4 fluid-ounces of the urine are placed in 
a 12-ounce bottle with a piece of German yeast 
of the size of a chestnut. The bottle is then set 
aside, very lightly covered, in a warm place, such 
as the mantel piece, or hob, and by its side, a 
bottle filled with the same urine, but without any 
yeast, and tightly corked. In 24 hours the 
mentation is almost finished; the fermented urine 
is poured into a urine glass, and the specific 
gravity taken with the urometer; the specific 
gravity of the unfermented urine is also taken, 
and the specific gravity of the fermented is sub- 
tracted from the specific gravity of the unfer- 
mented, the remainder giving the number of 
grains of sugar contained in a fluid-ounce: for 
example, if the specific gravity of the unferment-- 
ed be 1040, and that of the fermented 1010, 
the number of grains of sugar in a fluid-ounce 
will be 30. 
The researches of Bruecke have proved that 26 
IMPORT OF SUGAR. 
healthy urine contains sugar in about '01 per 
cent. Consequently a healthy man excretes daily 
through the kidneys about 15 grains of sugar. 
According to Leube, the excretion of sugar in 
diabetes is far greater during the night, than dur- 
ing the day. 
Clinical Import. If the foregoing tests an- 
nounce the presence of sugar, in considerable 
quantity, as often as the urine is examined, dia- 
betes mellitus may be inferred to exist. But 
should the presence of sugar in the urine be 
variable, and its amount small, the fact is not of 
any known great diagnostic, or therapeutic, im- 
portance. 
Sugar is said to be present in the urine of the 
foetus, of women during lactation, and of some 
old persons. It occurs in the urine during con- 
valescence from some acute disorders, especially 
cholera, in malarious diseases, and in carbuncle. 
Certain injuries of the nervous system also pro- 
duce glycosuria. GMELIX'S TEST FOE BILE PIGMENTS. 
27 
BILE IN THE URINE. 
The presence of bile in the urine can seldom be 
overlooked, since it gives a dark greenish brown 
colour to the secretion. White filtering paper is 
coloured green or yellow by the urine; a perma- 
nent froth is also produced by shaking the urine. 
Two substances must be tested for, the bile 
pigments, and the bile acids, each of which must 
be looked for separately. 
The bile pigments. Gmelin's Test. Ordinary 
nitric acid, which nearly always contains some 
nitrous acid, is poured into a test tube to the 
depth of half an inch, A portion of the urine to 
be examined is then gently poured down the side 
of the tube, held almost horizontally, on to the 
surface of the acid, so that the two fluids may 
touch but not mix; this operation is most con- 
veniently performed by means of a pipette. At 
the line of contact, a zone of red appears in every 
urine ■ but if pigment be present, a zone above 
becomes first green, then violet, blue, and red, 
representing the various stages of oxidation of 28 
pettenkofer's test for bile acids. 
the colouring matters; the most characteristic 
are green and violet. This reaction may also 
be performed by allowing a drop of nitric acid., 
and of the urine to be examined., to run together 
on a porcelain dish, when the play of colours 
mentioned above will be observed at their line of 
contact. 
Caution. Any urine which contains a large 
amount of indican will give a blue or violet, and 
even green, colour with nitric acid. The green 
colour is, however, rarely seen with any other sub- 
stance than bile pigment. 
The bile acids. Pettenkofer's Test. Some of 
the fluid containing the bile acids, is placed in 
a porcelain dish, and a drop of saturated solu- 
tion of cane sugar added; strong sulphuric acid 
is then dropped into the mixture, taking care 
that this acid is clearly in excess of the amount 
of bile acid present, that is, about the same vo- 
lume as the fluid containing the bile acids. On 
applying heat (which must only be moderate) 
a beautiful cherry-red colour is produced, pass- 
ing into a deep purple. The purple colour is 
the only reaction characteristic of the presence of 
bile acids. pettenkofer's test for bile acids. 
29 
Another, and perhaps a better, way of per- 
forming Pettenkofer's test is to pour the fluid 
containing the bile acids into a test tube; sul- 
phuric acid being then added, at first in small 
quantity to precipitate the bile acids, but after- 
wards in amount sufficient to redissolve them, 
which renders the mixture perceptibly hot to the 
hand. A drop of syrup may now be let fall 
into the fluid, which then shows a play of co- 
lours passing from pink to cherry red, and from 
red to purple.* 
This test should never be applied directly to 
urine: setting aside the fact that the bile acids 
are never present in sufficient quantity to give 
the reaction, the urine in jaundice frequently 
* Bogomoloff has lately proposed a test for the bile acids which he 
regards as easier of performance and more delicate than Petten- 
kofer's. The bile acids having been separated by Hoppe's method 
from other substances, especially colouring matters, the alcoholic 
solution is evaporated to dryness, taking care during the last mo- 
ments of evaporation to spread the solution as much as possible 
over the bottom of the dish: a drop of sulphuric acid is then let 
fall upon some part of the dried layer of acids, and also with the 
acid a drop of alcohol. In the centre of the drop, a yellow colour 
is developed, around, an orange red, then red, rose red, and violet. 
In a few hours, the colours have all become blue. (Centrdlb. f. d. 
m. W. 1869, pp. 484 and 489.) 30 
SEPARATION OF BILE ACIDS. 
contains a small quantity of albumen which gives 
a reddish violet reaction with sugar aud sul- 
phuric acid, while the action of the acid upon 
the other constituents of the urine renders it 
impossible to be sure of the distinctive colours 
of Pettenkofer's test. If, therefore, it be very 
desirable to ascertain whether the bile acids be 
present in the urine, the method introduced by 
Hoppe must be employed for their separation : 
a long and somewhat complicated process, which 
can seldom be adopted by the clinical student. 
With this object, the urine must be rendered 
faintly ammoniacal with caustic ammonia, and 
then diacetate of lead added, so long as a precipi- 
tate occurs. The precipitate must be collected on 
a filter and washed with distilled water; then 
boiled with alcohol over a water bath, and filtered 
while hot; to the filtrate a few drops of potash or 
soda are to be added, and the solution evaporated 
to dryness over a water bath. The residue is 
again to be boiled with absolute alcohol over a 
water bath until but a small quantity is left. This 
must be then shaken with ether in a stoppered 
bottle, and after some time, the alkaline salts 
of the bile acids will crystallize out. In order to COLOURING MATTERS IN THE URINE. 
31 
prove that these crystals are salts of the bile acids, 
they must be dissolved in a little distilled water, 
and tested with Pettenkofer's method, as directed 
above. 
Clinical Import. The bile pigments and the 
bile acids are present in the urine in most cases 
of jaundice. In hot weather, the bile pigments 
may sometimes be detected, by means of Gmelin's 
test, in the urine of persons who are not jaun- 
diced. The quantity of bile acids present is 
usually not more than -02 per cent.; the small- 
ness of the amount in the urine being probably 
due to them oxidation after entering the blood. 
COLOURING MATTERS IN THE URINE. 
The bile pigments have a very close chemical re- 
lation to the colouring matters of the blood. Haa- 
moglobin may be known to be present either by 
finding red corpuscles in the urine (see section on 
Blood, page 57.) or by the employment of the spec- 
trum analysis. If this latter be out of the stu- 
dent's reach, Heller's test, which does not, however, 
separate haemoglobin from haematin, may be used. 32 
CLINICAL IMPORT OF HEMOGLOBIN. 
Liquor potass® or liquor sod® is added to the urine 
in a test tube, until a pronounced alkaline re- 
action is obtained, the mixture heated to the boil- 
ing point, and set aside for some time. The pre- 
cipitate of phosphates has a greenish to a reddish 
colour, when the urine contains h®moglobin, me- 
themoglobin, or b®matin. The colour is due to 
the h®matin, a product of the decomposition of 
haemoglobin. 
Clinical Import. H®moglobin appears in 
in which no red blood corpuscles can be detected, 
in most cases of jaundice, in poisoning by sulph- 
uric acid, phosphorus, and arseniuretted hydro- 
gen. Also in malignant cases of the acute specific 
diseases, and in scurvy, hmmoglobin may be 
found, without any corpuscles being detected. 
But little is known about the colouring matters 
of the urine which have been named uroh®matin, 
uroxanthin, h®maph®in, &c. Indican is a con- 
stant constituent of the urine, and by boiling with 
mineral acids, is decomposed into sugar, indigo 
red, and indigo blue. With nitric acid, it imi- 
tates the reactions of the bile pigment (see p. 28.) 
Heller pours a few drachms of fuming hydro- 
chloric acid into a beaker glass and then adds SEPARATION OF UREA. 
33 
about 30 or 40 drops of the urine. The fluid be- 
comes red, violet, or blue if much indican have 
been present. Heller attributes the reaction to 
the presence of uroxanthin. 
Clinical Import. Much indican is said to be 
present in the urine in melanotic cancers : the 
presence of indican may be of help to the dia- 
gnosis when the cancer is situated in an internal 
organ, for example, the liver. 
UREA. 
The clinical student may sometimes wish to 
know if the urine contain urea, or if a given fluid 
be really urine, or some other secretion. The 
fluid is first to be tested for albumen, which, if 
present, must be removed by acidulation with 
two or three drops of acetic acid, raising the 
temperature of the fluid to the boiling point, 
and filtering. This filtrate is used for the sub- 
sequent operations of evaporation, &c. as stated 
below. 
If the urine be free from albumen, some quan- 
tity, 2 or 3 fluid-ounces, must be evaporated in 34 
IMPORT OF UREA. 
a Berlin dish over a water bath, until the fluid 
have the consistence of syrup. A water bath 
is essential, because an open flame would de- 
compose the urea. After the syrupy fluid has 
completely cooled, nitric acid, as free as possi- 
ble from nitrous acid, is added drop by drop, 
so long as a precipitate is formed. An excess 
of nitric acid is desirable. Some of these crys- 
tals of nitrate of urea, removed with a glass 
rod and placed under the microscope, show flat 
rhombic or hexagonal plates closely united to one- 
another. 
Clinical Import. Urea is the most important 
constituent of the urine; a healthy man ex- 
cretes from 300 to 500 grains in the 24 hours. 
In some acute diseases, as pneumonia, typhoid 
fever, and acute rheumatism, it is greatly in- 
creased owing to the excessive tissue-metam- 
orphosis, and may be present in such quantity 
as to give a precipitate, without previous con- 
centration, when the urine is acidulated with 
nitric acid. In other diseases,, as uraemia and 
Bright's disease, the quantity of urea is below the- 
average. IMPORT OF URIC ACJD. 
35 
URIC ACID. 
To ascertain, if the urine contain uric acid, it is 
necessary to acidulate about a fluid-ounce of the 
urine with a fluid-drachm of hydrochloric acid, 
or strong acetic acid, in a suitable glass vessel, an 
ordinary beaker being best, and to set it aside, 
covered with a glass plate, for 24 or 48 hours. 
At the end of that time, if uric acid be present, 
reddish brown crystals will be seen attached to 
the sides and bottom of the glass, or floating on 
the surface of the fluid. These crystals have the 
flat rhombic, oval, or' hexagonal shape of uric- 
acid ; they are soluble in alkalies, and give with 
nitric acid and ammonia the murexid test. (See 
page 4G.) 
A healthy man excretes, on an average, about 
7 or 8 grains of uric acid in the 24 hours.* 
Clinical Import. The excretion of uric acid is 
usually increased pari passu with the urea in 
* It lias been proposed by Berenger-Feraud to estimate the 
uric acid by means of a funnel with a lengthened graduated stem- 
For details see his paper "Note sur un instrument destine a 
doser 1'acide urique de 1'urine" in the Bull. gen. de Therap., 1867, 
t. Ixxii. p. 213- 36 
HIPPURIC ACID. 
pyrexia, or acute rheumatism, and in chronic liver 
diseases. An excess of uric acid is observed after 
an attack of gout; it is often entirely absent from 
the urine immediately before the paroxysm, and 
may disappear for days when tips disease has 
become chronic. 
HIPPURIC ACID. 
The method of preparing hippuric acid from 
human urine is troublesome, and will rarely be 
required to be used by the clinical student. Two 
or more pints of perfectly fresh urine are evapor- 
ated to a syrup in a water bath and then extract- 
ed with alcohol. The solution is filtered, the 
filtrate evaporated over a water bath until a small 
quantity be left; and to this, when quite cold, hy- 
drochloric acid is added so long as crystals are 
formed. 
The crystals of hippuric acid obtained in this 
manner, seen under a microscope, are long and 
needle-shaped prisms; they are distinguished 
from those of benzoic acid by their difficult solu- 
bility in ether. CHLORIDES. 
37 
Hippuric acid, when evaporated to dryness with 
nitric acid, in a porcelain crucible, over a lamp, 
and then further heated to redness, gives off a 
gas smelling like oil of bitter almonds. This 
reaction is common to benzoic and hippuric 
acids. 
Clinical Import.. Hippuric acid exists in small 
quantity in the urine in health : its amount is 
greatly increased by the eating of much fruit, and 
also by the ingestion of benzoic acid. The hip- 
puric acid appears in the urine in quantity equiva- 
lent to the benzoic acid taken. Excluding these 
circumstances, hippuric acid is also found in quan- 
tity in the urine of fever patients, and may even 
be the cause of the acid reaction : the amount is 
also increased in diabetes and chorea. Accord- 
ing to Kiihne, the hippuric acid disappears from 
the urine of jaundice. 
Nothing is known of the importance of this acid 
in therapeutics or diagnosis. 
CHLORIDES. 
Chlorides may be known to be present by the 
following test. To a fluid drachm of urine in a 38 
IMPORT OF CHLORIDES. 
test tube, a drop of nitric acid is added, and then 
a few drops of a solution of nitrate of silver; if a 
trace of chloride be present, a cloudiness only will 
be given ; but if any quantity, a white precipitate 
is thrown down, soluble in caustic ammonia, and 
reprecipitated thence by the addition of nitric acid 
in excess. 
The nitric acid is added at first to prevent 
the precipitation of the phosphates with the chlo- 
rides. 
A rough comparative idea of the quantity of 
chloride present may be made from day to day, 
by always taking the same quantity of urine, 
acidulating it in a test tube with nitric acid, and 
adding a solution of nitrate of silver until no 
further precipitate is formed. The test tube must 
then be set aside for 24 hours, and a note then 
taken of the proportion of the chloride of silver 
deposit, for comparison with other observations. 
On an average, a healthy male adult excretes 
250 grains of chloride of sodium in the 24 hours. 
Clinical Import. During acute pneumonia, 
acute rheumatism, and most other pyrexial dis- 
eases the chlorides diminish in quantity, or even 
disappear from the urine. Their reappearance in PHOSPHATES. 
39 
daily increasing quantity is a sign of the diminu- 
tion of the intensity of the disease. The amount 
of chlorides apparently depends upon the diges- 
tive powers of the patient, even in chronic dis- 
eases. 
PHOSPHATES. 
The presence of phosphates in the urine may 
be ascertained by the following test. A fluid is 
prepared by adding a drop or two of caustic 
ammonia to a fluid-drachm of a solution of sul- 
phate of magnesia in a test tube; hydrochloric 
acid is added until the precipitate caused by the 
ammonia is redissolved. Caustic ammonia is 
again added in excess, until the fluid is strongly 
ammoniacal. A fluid-drachm of urine is now 
poured into another test tube, and rendered am- 
moniacal with caustic ammonia; to this urine 
some of the prepared solution is added, and a pre- 
cipitate of the ammoniaco-magnesian phosphate 
occurs at once, if the urine contain the ordinary 
amount of phosphates ; but the precipitate forms 
slowly, if the phosphates are present in very small 
amount. 40 
SULPHATES. 
The normal quantity of phosphoric acid excret- 
ed by a male adult in the 24 hours is about 50' 
grains. 
Clinical Import. The amount of phosphoric 
acid in the urine is increased in diseases of the 
nervous centres, and after great mental applica- 
tion. Acute febrile diseases cause increase of the 
phosphoric acid from increased tissue-metamor- 
phosis, while in Bright's disease and some forms 
of dyspepsia the quantity of the phosphates is 
diminished. 
SULPHATES. 
The sulphates are at once recognised by the 
addition to some of the urine, in a test tube, of a 
drop of hydrochloric acid, and afterwards of a few 
drops of a solution of chloride of barium; a white 
precipitate, insoluble in nitric acid, is thrown 
down. 
The quantity of sulphuric acid excreted by a 
healthy male adult in the 24 hours is about 30 
grains. 
Clinical Import. The quantity of the sulphates 
is increased by a full animal diet■ very little AMOUNT OF URINARY CONSTITUENTS. 
41 
is known for certain of their amount in disease, 
and that little is at present of not much import- 
ance. 
The following table of the amount of urinary 
constituents excreted by a male adult in the 24 
hours is compiled from Dr. Parkes' book on the 
urine : 
Quantity40 to 50 fluid ounces. 
Total Solids .... 800 to 1000 grains. 
Urea- 350 to 600 grains. 
Uric Acid5 to 15 grains. 
Chlorine50 to 150 grains. 
Phosphoric Acid . . 30 to 60 grains. 
Sulphuric Acid ... 20 to 60 grains. 
Iii the adult, the hourly excretion of urine may 
vary from 20 to 200 C.C. In general, it is from 
50 to 70 C.C. when much drink is taken, and 
40 to 60 C.C., when little is drunk. 1 kilogramme 
of body-weight, therefore, excretes about 1 C.C. 
of urine every hour. 
The urine is always diminished in quantity 
during the height of a pyrexial disease : a sign 
of improvement is the increase in the quantity of 42 
URINARY SEDIMENTS. 
urine. When a disease is about to prove fatal, 
the quantity often sinks. In diabetes and inter- 
stitial nephritis, the quantity is increased; and 
this is often the case when collections of fluid in 
serous cavities are being absorbed. 
URINARY SEDIMENTS. 
When a urinary deposit is to be examined, 
about 4 or 5 fluid-ounces of the urine should be 
collected in a tall narrow cylindrical glass, and set 
aside for a few hours. Cylindrical glasses have, 
in the writer's experience, succeeded better than 
conical vessels, since the sloping sides of the 
latter tend to cause the sediment to collect on 
them, without falling to the bottom. This is 
particularly the case with uric acid and renal 
casts, especially if they be present in but small 
quantity. 
When the sediment has collected at the bottom, 
the supernatant urine may be poured off, and a DIRECTIONS FOR MICROSCOPE. 
43 
drop of the sediment placed on a glass slide, for 
examination under the microscope. 
In looking for renal casts, it is better to use 
only the very last drops which fall from the ves- 
sel, after the rest of the urine is poured away. 
Directions for the Microscope. A drop of the 
fluid containing the deposit is placed in the centre 
of the glass slide, which must be absolutely clean, 
and the drop very gradually covered with a piece 
of thin glass, (seven-eighths of an inch square is 
the best size), so as to drive all the air before it, 
and to prevent any air bubbles being present 
under the glass. This is best accomplished by 
the aid of a needle, placing one edge of the thin 
glass upon the slide, and resting the other upon 
the needle, then inclining the needle gradually, 
until it be horizontal. All superfluous moisture 
around the glass cover must be carefully removed 
with a cloth, or with blotting paper. The slide is 
then ready to be placed under the microscope. 
A quarter-inch object glass will be sufficient 
for the recognition of nearly all the sediments that 
occur. The tube of the microscope must be 
moved down until the object glass is about a 
quarter of an inch distant from the slide; the 44 
UNORGANISED SEDIMENTS. 
light from the mirror is now thrown upon the 
slide at a point immediately under the object 
glass; the observer should then look through the 
microscope, placing the instrument with the 
coarse adjuster in the focus which suits his own 
eyesight. 
Sediments are either organised or unorganised. 
To the latter belong uric acid, urates, oxalate of 
lime, phosphates, cystin, &c. To the former, pus, 
blood, mucus and epithelium, renal casts, fungi, 
and spermatozoa. 
UNORGANISED SEDIMENTS. 
URIC ACID. 
Uric Acid is only met with, as a deposit in very 
acid urine, and is usually accompanied by a con- 
siderable sediment of urates. Owing to its pecu- 
liar colour, varying from a yellow to a brownish 
red, it can at once be recognised by the naked eye, 
never being deposited from the urine in colourless, 
crystals. URIC ACID. 
45 
When the sediment is examined under the mi- 
croscope, the crystals are at once known to be 
uric acid by their reddish brown colour, all other 
crystalline deposits being transparent and colour- 
less. If indeed, the student be in doubt as to the 
nature of a crystal, lie will never be very wrong, 
if he judge it to be uric acid when there is a slight 
tinge of brown visible. The crystals, themselves, 
have numerous forms : they occur very commonly 
in rhomboidal, or long oval, plates with acute 
angles; these crystals are often united so as to 
form rosettes, or they may be rectangular, barrel 
shaped, or in hexagonal plates, with two parallel 
sides longer than the other four. 
Uric Acid. 
If the student be not quite sure of their nature, 46 
MUREXID TEST FOR URIC ACID. 
he should add to the specimen under the micro- 
scope, a little liquor potassee or liquor sodse, which 
will dissolve uric acid, if present; when dissolved 
by the alkali, it can be reprecipitated in hexagonal 
plates by the addition of hydrochloric or acetic 
acid. 
Very small traces may also be detected by- 
means of the murexid test; a small portion of the 
suspected sediment is placed in a porcelain dish, 
and a drop of nitric acid let fall upon it; the dish 
is then gently heated over a lamp until all the 
nitric acid is driven off, when, if uric acid be pre- 
sent, a beautiful red staining is seen ; after cool- 
ing, a drop of caustic ammonia should be allowed 
to roll over the reddened spot, which then be- 
comes purple; if liquor potassae be used instead 
of ammonia, the colour will be violet. The test 
does not, however, distinguish uric acid from its 
salts. 
Usually the uric acid is not free when the urine 
is voided, but it is precipitated by the increase of 
acidity which always occurs shortly after 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. 47 
URATES. 
Clinical Import. The presence of free uric acid 
is no proof that uric acid is being excreted in 
excess; the only inference that can be made, is 
that the urine is extremely acid. But if free uric- 
acid 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, 
oi' the bladder : a condition of considerable dan- 
ger, since it may lay the foundation of a calculus 
uric acid, and urate, calculi being the most fre- 
quent of all urinary concretions. 
URATES. 
This deposit is the most frequent and least 
important of all the urinary sediments. Any 
febrile condition 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 never turbid when fresh passed; it 
is only when the urine has cooled, that the pe- 
culiar muddiness is observed. If the urine be 48 
URATES. 
gently warmed, the turbidity immediately dis- 
appears. The urates differ in colour considera- 
bly, according to the amount of colouring matter 
in the urine, varying from white to pink or red. 
In young children the ' milky' urine, which 
alarms mothers, is due to a deposit of peculiarly 
white urates. 
In the urine, uric acid is found combined with 
three bases : with soda, with ammonia, and with 
lime. The urate of soda is the most frequent of 
the three, and is usually seen under the micro- 
scope as an amorphous deposit; sometimes it 
forms round dark bodies with short spikes pro- 
jecting from them. The urate of ammonia is 
rarer, and occurs in beautiful globular forms with 
spikes closely resembling the urate of soda, but 
of greater length. The urate of lime is very rare, 
and forms only an amorphous sediment. If any 
doubt be entertained as to the nature of these 
salts, it is necessary to add a drop of hydrochloric 
or strong acetic acid to the specimen, when crys- 
tals of uric acid will immediately be formed. 
These crystals are again dissolved by caustic soda 
or potash. If further evidence be required, the 
murexid test with nitric acid and ammonia (page 
46) may be applied. 49 
OXALATES. 
OXALATE OF LIME. 
Oxalate of lime is sometimes deposited from the 
urine during the acid fermentation, or even later. 
Oxalate of lime occurs as a urinary sediment 
in colourless octahedral crystals, having the so- 
called c envelope' appearance which, when once 
seen, can hardly be mistaken for anything else. 
This deposit also occurs in colourless dumb 
bells. 
Oxalate of lime is insoluble in acetic acid ; by 
this it is distinguished from the phosphates : it is 
colourless and insoluble in alkalies, and thus 
differs from uric acid. It is, however, soluble in 
the mineral acids, as, for example, in hydrochloric 
acid. 
Clinical Import. After urates, oxalate of lime 
is the most common unorganised urinary sedi- 
ment; it is often seen in the urine of patients 
convalescent from acute diseases ; and many writ- 
ers state that it may always be found when there 
is lessened oxidation, as in bronchitis. The occa- 
sional presence of a few crystals of oxalate of lime 
is not of much importance. They are frequently 
seen in the urine after the the eating of fresh fruit 50 
PHOSPHATES. 
and vegetables. When the deposit is constant, 
and in large quantity, the formation of the mul- 
berry calculus may be feared. This sediment is 
said to be associated with a dyspeptic and hypo- 
chondriacal condition, sometimes termed the "ox- 
alic acid diathesis?' 
A B 
Oxalate of Lime. 
a. Dumb Bells. 
b. Octahedra. 
Ammoniaco- Magnes- 
ian Phosphate. 
PHOSPHATES. 
The phosphates are only separated from very 
feebly acid, or alkaline urine; and they are 
always deposited when the urine undergoes the 51 
MICRO-CHEMICAL TESTS. 
alkaline fermentation. They consist of the am- 
moniaco-magnesian phosphate, and the phos- 
phate of lime. Both are usually found together. 
Undei' the microscope, the ammoniaco-magnes- 
ian phosphate appears in beautiful right rhomb- 
ic prisms, which disappear immediately on the 
addition of acetic acid, and are thus disting- 
uished from the oxalate of lime, with which an 
inexperienced observer might, perhaps, confound 
them. 
The phosphate of lime chiefly occurs as an 
amorphous deposit; it is insoluble in water, but 
soluble in acetic acid ; in feebly acid urines, it ap- 
pears to be held in solution by the carbonic acid, so 
that it is precipitated by heat in flakes resembling 
albumen, which are at once, however, dissolved by 
a drop of acid. 
Clinical Import. 'The deposit of phosphates in- 
dicates an alkaline reaction of the urine, a con- 
dition favourable to the formation of phosphatic 
calculi. 
If the least doubt be left upon the observer's 
mind after the microscopical examination of a 
sediment, he must use the assistance of reagents 52 
MICRO-CHEMICAL TESTS. 
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 be- 
tween the two pieces of glass, but it should be 
carefully prevented from wetting the upper 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 dis- 
solves the crystals, or amorphous sediment; but 
if the sediment consists of urates, crystals pos- 
sessing the well-known shape of uric acid are 
formed. If no effect upon the sediment is pro- 
duced by acetic acid, it consists of either uric 
acid, or oxalate of lime. Liquor potassae, added 
with the same precautions as acetic acid, brings 
about a solution of the crystals of uric acid, but 
the alkali has no effect upon oxalate of lime, which 53 
CYSTIN. 
will be dissolved by the action of hydrochloric 
acid. 
CYSTIN. 
Cystin is a rare deposit in the urine: it occurs 
in regular colourless hexagonal plates, united by 
their flat surfaces, and overlapping one another. 
When dissolved in the urine, cystin may be thrown 
down by the addition of acetic acid, and the pre- 
cipitate examined under the microscope. It may 
be distinguished from uric acid, which sometimes 
crystallizes in hexagonal plates, by the absence of 
colour in the crystals. 
Urine which contains cystin is usually feebly 
acid, of a yellowish green colour, and of a pecu- 
liar odour, compared to sweet briar, but which 
sometimes resembles that of putrid cabbage. The 
urea and uric acid are diminished in most cases. 
The ammoniaco-magnesian phosphate often ac- 
companies the crystals of cystin. 
Cystin contains a large quantity of sulphur, 
and Liebig has proposed a test which is found- 
ed on this fact. A solution is made by adding, 
to a small quantity of solution of acetate of 
lead, liquor potassae or' liquor sodte until the 54 
LEUCIN AND TYEOSIN. 
precipitate first formed is redissolved: about 
equal parts of this solution and of urine are 
boiled, when black sulphide of lead is formed 
from the combination of the sulphur with the lead. 
This test is, however, by no means a good one, 
since many bodies frequently present in the urine, 
e.g. albumen, contain enough sulphur to give the 
reaction. 
Of the Clinical Import, nothing is known. 
The appearance of cystin in the urine is be- 
lieved by some to be hereditary and to be con- 
nected with calculous disorders. Other observers 
have found it in the urine of chlorosis. 
LEUCIN AND TYROSIN. 
Leucin and Tyrosin are very rare deposits in 
the urine. Under the microscope, leucin appears 
in dark globular forms, which have been com- 
pared to masses of fat cells; tyrosin, however, 
crystallizes in beautiful bundles of delicate nee- 
dles, sometimes arranged in a stellate form. 
These bodies have been detected in the urine in 
cases of acute yellow atrophy of the liver, of small PUS IN THE URINE. 
55 
pox, of typhoid fever, and acute tuberculosis. 
The clinical value of their presence is, however, 
unknown. 
ORGANISED SEDIMENTS. 
PUS. 
Pus is frequently present in the urine, and pro- 
duces a thick sediment at the bottom of the urine 
glass. The urine readily becomes alkaline, and 
rapidly decomposes after being passed. It is per- 
manently turbid; that is, the turbidity is un- 
affected by heat. 
Under the microscope, the deposit shows nu- 
merous pus corpuscles, round colourless bodies, 
not varying much in size, having granular con- 
tents, and nuclei varying form 1 to 4 in number; 
if acted on by acetic acid, the nuclei become much 
more distinct. If the urine have been long passed, 
the pus corpuscles undergo changes which render 
them incapable of being recognised. 56 
PUS IN THE URINE. 
The urine of course contains albumen, and in 
proportion to the amount of pus present. If the 
quantity of albumen exceed that which should be 
given by the pus present in the urine, evidence of 
kidney disease, as casts of tubes, should at once 
be looked for. 
The deposit from urine containing pus is ren- 
dered viscid and gelatinous by the addition of 
about half its quantity of liquor potassee ; it be- 
comes ropy and cannot be dropped from one ves- 
sel to the other • urine containing mucus, on the 
other hand, becomes more fluid and limpid by the 
addition of caustic alkali. 
Pus occurs in the urine in the following dis- 
eases : 
Leucorrhoea in the female. 
Gonorrhoea or Gleet in the male. 
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. BLOOD IN THE URINE. 
57 
BLOOD. 
Blood is not at all unfrequently found in the 
urine, and it may be derived from any part of the 
urinary-renal tract. If derived from the kidneys, 
the blood will be completely diffused through the 
urine, and give it a peculiar smoky appearance, 
absolutely diagnostic. If the haemorrhage from 
the kidney be great, however, the urine will have 
a bright red colour, like blood. But when the 
urine contains a great deal of blood, the blood is 
usually derived, not from the kidneys, but from 
some other part of the urinary tract. 
The deposit at the bottom of the urine glass 
shows under the microscope the circular discs, 
familial' to every one as the red corpuscles of the 
blood. Their peculiar colour will prevent the 
student mistaking them for any other deposit; 
they may, however, in a urine of low specific 
gravity, become swollen, 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 present, which 58 
BLOOD IN THE UKINE. 
may be so great that the urine will solidify on 
the application of heat. The urine very readily 
becomes alkaline, and care must be taken to re- 
store the acid reaction with acetic acid, before 
testing for albumen. 
CfomcaZ Import. The presence of blood, or of 
blood corpuscles, in the urine is a sign of the 
existence of haemorrhage from the kidney or the 
urinary passages. It may result from : 
1. Disease of the Kidney. 
Acute Bright's disease. 
Congestion of kidney. 
Cancer of kidney. 
External injury. 
2. Disease of Pelvis and Ureter. 
Calculus in pelvis or ureter. 
Parasite, as Bilharzia haemotobia. 
Cancer. 
3. Disease of the Bladder. 
Calculus. 
Cancerous or villous growths. 
Congestion oi' ulceration of mucous mem- 
brane. 
4. Disease of Urethra. 
Congestion, as in gonorrhoea. BLOOD IN THE HEINE. 
59 
Tearing of the mucous membrane from 
mechanical injury. 
5. In women, uterine discharges, as men- 
struation, &c. 
If the amount of blood in the urine be small, 
the chances favour the belief that the blood is 
derived from the kidneys ; search must therefore 
be made for renal casts. If the amount of blood 
be large, it probably comes from the pelvis of 
kidney, ureter, or bladder : if from the pelvis or 
ureter there will also be pus and probably also 
gravel in the urine, with pains in the loins, pass- 
ing down into the thighs and testicles. If there 
be none of these indications, the blood probably 
comes from the bladder. It is commonly said, 
that if the blood be 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 haemorrhage 
is from the urethra. These rules will, however, 
often be found to fail. 
The chief danger of haematuria is the formation 60 
MUCUS AND EPITHELIUM. 
of clots in the passages and consequent ischuria. 
Small clots may sometimes form the nucleus of a 
calculus. 
MUCUS AND EPITHELIUM. 
Mucus is a constant constituent of every urine, 
and if healthy urine be allowed to remain at rest 
for an hour, a light cloud will be found to have 
settled at the bottom of the urine glass; on mi- 
croscopical examination, it will be found to con- 
sist of mucus corpuscles, and epithelium scales 
detached from the surfaces over which the urine 
has passed. 
The urethra and bladder give up a roundish or 
oval epithelium cell to the urine. In the urine 
of the female, especially in cases of leucorrhoea, 
the epithelium cells of the vagina are very nume- 
rous, and they exactly resemble the squamous 
epithelium of the mouth. Under irritation, the 
mucous membrane of the pelvis and ureter will 
produce cells, caudate, spindle-shaped, and irreg- 
ular, exactly similar to those formerly regarded 
as diagnostic of cancer. From this circumstance 61 
RENAL CASTS. 
it is impossible to speak positively of the existence 
of cancer cells in the urine. 
Desquamation of the tubular epithelium of the 
kidney occurs only in disease; the cells, as seen 
in the urine, are slightly swollen, and acquire a 
more spheroidal, and less distinctly polygonal, 
shape, apparently from the imbibition of fluid, 
and the removal of pressure. The cells are fre- 
quently granular, and contain fat drops, or are 
contracted, withered up, and shrivelled. 
Clinical Import. See Section on Renal Casts, 
page 66. 
RENAL CASTS. 
In Blight's disease, and in congestion of the 
kidney, there are formed, in the uriniferous tu- 
bules, 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 the view of their origin which has found most 
favour in this country, is that the casts are 
ormed by the escape of blood into the tubes of 
the kidney, and coagulation of the fibrin, which 62 
RENAL CASTS. 
thus becomes moulded to the shape of the tube 
into which it has been extravasated. It is pro- 
bable that many of the hyaline casts are formed 
in this way; but the balance of evidence at the 
present day is in favour of the 'epithelial and 
granular casts being produced by a desquamation 
and degeneration 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 cylindri- 
cal glass, the whole of the supernatant fluid 
poured off, and the last drops which flow from 
the lip of the glass put under the microscope and 
examined.. If there be but few casts present, 
other plans may be adopted; the urine may be 
acidulated with a little acetic acid, and thus the 
uric acid precipitated, with which the casts will 
be carried down as well; or the urine may be 
filtered, and the casts searched for on the filter 
paper; or if the specific gravity be high, the urine 
may be diluted with distilled water, set aside for 
an hour, and the deposit then examined. 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 METHOD OF SEARCHING. 
63 
bodies in the urine. They are never broader than 
6, or less than 2, red blood corpuscles in dia- 
meter; but they vary considerably in length, 
never, however, exceeding the -th of an inch. 
The same cast does not vary greatly in its diame- 
ter, and never becomes twisted on itself, as a cot- 
ton fibre does. 
The foreign bodies, most liable to be mistaken 
for renal casts, are cotton fibres, hair, and pieces 
of deal. 
Cotton fibres have a very irregular outline, and 
are much broader at one part than at another; 
they are often twisted, and of great length, 
which will distinguish them from casts. Their 
structure is often striped in a longitudinal di- 
rection. 
Hair can often be distinguished from renal casts 
by its colour alone; and if this be not very appar- 
ent, by its possessing a cortical and medullary 
structure; and by its length being greater than 
that of any cast. 
Fibres- of Deal, which have their origin in the 
furniture, &c., of the apartment, may perhaps be 
mistaken for renal casts. They are at once 
recognised by the presence of the large round 64 
RENAL CASTS. 
wood-cells which characterise the order Coni- 
ferae. 
Casts may be conveniently divided, according 
to their appearance under the microscope, into 
three kinds, the epithelial cast, the granular cast, 
and the hyaline cast. 
Casts-a. Epithelial, b. Granular, c. Fatty, d. Hyaline. 
The epithelial cast. This cylinder consists of 
a mass of epithelial cells derived from the tubules 
of the kidney; the cells may become granular 
and acquire a dark appearance by transmitted 
light. The cast is usually wide, never very nar- 
row. THEIR VARIETIES. 
65 
The granular cast. This is a solid cylinder 
having a granular appearance, which may be 
limited to a few dark points in the substance 
of the cast, or be so intense as to give the cast an 
almost black appearance. In this kind of cast 
may often be found epithelial cells, blood corpus- 
cles, red or white, pus corpuscles, crystals of uric 
acid, urates, and especially oxalate of lime. The 
fatty cast is a variety of the granular, produced by 
the running together into globules of fat of tho 
granules of olein. 
The hyaline cast. This cast is usually very 
transparent, and the outline is often so indistinct 
that a little iodine or magenta must be added to 
the urine before it can be detected, or a dia- 
phragm with a narrow opening must be used. 
They show indistinct markings on their surface, 
or a few granules and nuclei. There are two 
kinds, the wide and the narrow; the latter are 
sometimes of great length. 
In observing casts, notice must be taken of 
the action of acids upon them, or them contents. 
It is thought that when the cylinders resist the 
solvent action of hydrochloric acid to any great 
degree, that the inflammation of the kidney is 66 
BEN AL CASTS. 
correspondingly intense. The granules on the 
cast, if formed of protein, will disappear, when 
acted on by acetic acid; but if of olein, they are 
rendered more distinct. The width of the cy- 
linder is of some importance, as it is supposed 
that very broad casts are formed in tubules com- 
pletely stripped of their epithelium, and that the 
prognosis is more grave when these wide casts 
show on their sides no nuclei, or attempt at re- 
formation of epithelium. From the recent obser- 
vations on the varying diameters of the uriniferous 
tubes, the importance of the breadth of the cast 
becomes less. 
Clinical Import. The presence of casts in the 
urine is a sure sign of disease of the kidney, but 
not, however, necessarily of permanent disease 
of the kidney. They are present in many acute 
diseases, accompanied by albumen in the urine; 
but if they are found for several weeks together, 
after all pyrexia has subsided, permanent disease 
of the kidney may be inferred. Casts are con- 
stantly present in the urine in all cases of con- 
gestion of the kidney, and of acute or chronic 
Bright's disease. But no certain information as 
to the nature of the disease existing in the kid- THEIR CLINICAL VALUE. 
67 
ney,* e.g. whether lardaceous or inflammatory, can 
be obtained from the characters of the casts, since 
all forms of Bright's disease terminate in fatty 
changes. Some assistance may however be de- 
rived from the appearance of the casts in forming 
a judgment of the acute or chronic character, or a 
prognosis, of the disease. If, for example, there 
be found in the urine epithelial casts which have 
undergone little, or no, 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 cloudy 
appearance, there can be little doubt that the pa- 
tient is suffering from an acute attack of Bright's 
disease : while if the casts be chiefly fatty, or in- 
tensely granular, and the epithelium be small in 
amount, and the cells withered and contracted, or 
containing globules of olein, it will be more than 
probable that the case is one of chronic Bright's 
disease. 
Since little reliance can be placed on the char- 
acters of the casts as an aid to special diagnosis, 
some of the leading characters of the renal de- 
rivatives in the chief forms of kidney affection 
have been subjoined. 68 
CLINICAL VALUE 
Congestion of the Kidney. The casts are chiefly 
hyaline, seldom showing any marks of fatty 
change. Very rarely axe blood or epithelial casts 
discovered. 
Acute Bright's disease. At the commencement, 
the urine deposits a sediment which consists of 
blood-corpuscles, narrow hyaline casts, and casts 
covered with blood-corpuscles, the ' blood casts' of 
some authors. In the next stage, the amount of 
blood present is not so great, but, a great des- 
quamation of the renal tubules taking place, renal 
epithelium and epithelial casts are found in great 
numbers; the epithelium has undergone very 
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 gran- 
ular, cloudy in appearance, which alteration, the 
sequel of the catarrh, often proceeds to fatty de- 
generation, and the epithelial cells then contain 
large fat drops, while the epithelial casts undergo 
similar change, and become distinctly granular 
and even fatty. 
If the patient recover, the casts and epithe- 
lium gradually disappear from the urine, but if OF RENAL CASTS. 
69 
the case become chronic, the renal derivatives 
show the characters described in the next para- 
graph. 
Chronic Bright's Disease. Numerous forms of 
casts are met with; the hyaline, both narrow and 
wide forms; the larger are often beset with gran- 
ules dissolved on addition of acetic acid; the 
granular, whose surface is often covered with 
fatty or shrivelled-up epithelium cells; fat drops 
may stud the cylinder. Epithelial casts are rare, 
except in febrile exacerbations, when the renal 
derivatives found in acute Bright's disease are 
present, together with granular and fatty casts, 
evidence of the previous alteration of the kid- 
ney. 
Lardaceous or Amyloid Kidney. The urinary 
deposit contains hyaline casts, which are often ac- 
companied by pus corpuscles. Atrophied epithe- 
lial cells, becoming fatty in the later stages of the 
disease, are almost invariably present. 70 
FUNGI. 
Many kinds of fungi grow in the urine after it 
has been voided for some time, and when the am- 
moniacal decomposition has begun, or is about to 
begin. The most important are (a) vibriones, 
which may be seen in almost every albuminous 
urine which has been passed some time; they 
are known by their linear form and incessant 
motion ; (b~) the peniciliwn glaucurn, the fungus 
which forms ' mildew/ and which often appears 
when the acid fermentation has begun; and (e) 
the yeast fungus, torula cerevisice, which was con- 
sidered by Dr. Hassall to be diagnostic of dia- 
betes. 
Sarcince are apparently formed in the urine be- 
fore it is voided; they are square bodies, divided 
into secondary squares, which number 4, 16, 64, 
&c., and are similar to the sarcinae found in the 
vomited matters of persons suffering from stenosis 
of the pylorus. 
Kiestein is a whitish pellicle formed on the 
surface of the urine of pregnant women, when 
allowed to remain at rest for a few days. It 
appears to consist chiefly of the mould fun- SPERMATOZOA. 
71 
gus, globules of fat, and crystals of phosphates. 
It was formerly regarded as a sign of preg- 
nancy j but it occurs in the urine of persons 
who are not pregnant, and is not always present 
in pregnancy. 
SPERMATOZOA. 
These little bodies are present in the urine 
of males first passed after an emission of semen. 
A few pass away in the urine, probably, with- 
out venereal excitement, especially when the 
person is continent. In the urine of women, 
they are almost positive proof of sexual inter- 
course. 
The seminal secretion forms a glairy white de- 
posit at the bottom of the urine glass. When 
examined with the microscope, (for which a high 
power, magnifying 400 or 500 diameters, is best, 
although a power* of 250 will identify them), sper- 
matozoa show the characteristic oval head or body, 
often somewhat pear-shaped, and long delicate 
tail, two or three times the length of the head. 
In the urine no movement is ever shewn by these 
bodies. APPENDIX. 
It lias been thought desirable to add a succinct 
account of the method of estimating the principal 
substances found in the urine, since the clinical 
clerk is often desired to make an analysis of the 
urea, chlorides, phosphates, &c. No account of 
the method of standardising the solutions will be 
given, as this preparation requires a greater know- 
ledge 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 capacity= 
1'76 pints. 
The cubic centimeter (C.C.), the - th part of 
a litre. 
The gramme (grm.), the unit of weight, the 
weight of a cubic centimeter of distilled 
water, at 4°C., at normal barometer pres- 
sure,=15'43 English grains. 
The milligramme, the ~ th part of a gramme. 74 
APPARATUS AND DIRECTIONS. 
The apparatus required 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 conveni- 
ent to collect it from 9 a.m. on one day to 9 a.m. 
on the following day, making the patient micturate 
precisely at this hour. 
The urine must be kept, as it is passed, in 
a covered glass vessel. When the analysis is to 
be made, the urine must be measured in a vessel 
graduated to a 1000 C.C., and divided into parts 
containing at least 10 C.C. each. After measur- 
ing, the whole of the urine must be mixed to- 
gether, 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 SEPARATION OF ALBUMEN. 
75 
removed before proceeding to the analysis of the 
urea, &c.; a measured quantity of urine, 100 or 
200 C.C. is heated in a Berlin dish, the bottom of 
which is protected by a piece of iron wire gauze, 
over a small, naked flame, to nearly the boiling 
point. If the albumen do not separate in flakes, 
dilute acetic acid is very carefully added until the 
acid reaction is marked. If too much acetic acid 
be added, part of the albumen may be redissolved. 
The heat must be moderate, and only just rise to 
boiling point, or the urea will be decomposed. The 
urine, after cooling, is then to be filtered into the 
same measure that was used at the beginning to as- 
certain the volume (100 or 200 C.C.), the dish and 
filtei' washed with small quantities of distilled 
water, which are added to the filtrate, until the 
urine stand at exactly 100 or 200 C.C. according 
to the initial quantity. This fluid is then used in 
the estimation of the urea, chlorides, phosphates, 
sugar, &c. 76 
ESTIMATION OF UREA. 
The solutions required are : 
A standardised solution of nitrate of mercury, 
of which 1 C.C. corresponds exactly to 10 
milligrammes of urea. 
A solution of baryta, made by mixing 2 vol- 
umes of cold] saturated solution of caustic 
baryta, with 1 volume of cold saturated 
solution of nitrate of baryta. 
A saturated solution of carbonate of soda. 
The first step is to ascertain the presence or 
absence of albumen. If albumen be present, 
it must be separated by the method described 
above at page 74; but if the urine be free from 
albumen, a measured pipette, containing 10 or 15 
C.C., is filled with urine, twice, and the urine al- 
lowed to run into a urine glass or beaker. The 
same pipette is next filled with the baryta solu- 
tion, which is then added to the urine previously 
measured off. The mixture of urine and baryta 
is then passed through filtering paper; a drop or 
two of the filtrate is to be tested with the baryta 
solution to see if any precipitate occur, and if any ESTIMATION OF UREA. 
77 
precipitate do occur, it is best to take a fresh 
quantity of urine and to add an equal volume of 
baryta solution; after filtration, this must again 
be tested. The object of the addition of the 
baryta is to remove the phosphates from the 
urine. 
The next step is to measure off a definite quan- 
tity of the filtrate, so that in any case it may con- 
tain 10 C.C. of urine. Thus, if one volume of 
baryta solution were used with two volumes of 
urine, 15 C.C. of the filtrate would be measured 
off with a pipette. If equal volumes of urine and 
baryta solution were employed, 20 C.C. must be 
measured off. A burette divided into quarters of 
a cubic centimeter is then to be filled with the 
standardised solution of nitrate of mercury. The 
burette must be filled to the brim, and allowed to 
remain at rest for some time, so that all bubbles 
may rise to the surface and burst. The solution 
must then be let off by the pinch-cock at the bot- 
tom of the burette, until the lower of the two 
black lines, seen by means of transmitted light on 
the surface of the fluid, is exactly on a level with 
the first division of the burette. Care must be 
taken that the solution fills the whole of the ap- 78 
ESTIMATION OF UREA. 
paratus 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, worthless. 
The measured quantity of the filtrate of the 
urine and baryta is then to be placed in a small 
glass vessel, a beaker holding about 100 C.C. 
being best ; a few drops of dilute nitric acid are 
to be added, and the vessel placed under the bu- 
rette.* The work of estimating the urea now be- 
gins. The solution of nitrate of mercury is al- 
lowed to run, drop by drop, into the fluid below, 
stirring the latter well with a glass rod, until a 
permanent precipitate is produced; the absence, 
at first, of a permanent precipitate is caused by 
* A great saving of time may be effected by making two se- 
parate estimations; in the first estimation, at once adding 15 
C.C. of the mercury solution to the fluid in the beaker, testing 
this with soda, and then adding the mercury solution in 5 C.C. at 
a time, and testing with soda after each addition, until a yellow 
colour is produced. The exact point for the 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 mercury 
solution to the amount of the smallest number of C.C. before the 
yellow colour was produced, is at once allowed to flow into the 
beaker, and then added more carefully by quarters or halves of a 
C.C. as described in the text. ESTIMATION OF UREA. 
79 
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 
aftei' every addition, until a drop of the mixture 
gives a yellow colour when brought into contact 
with solution of carbonate of soda. 
The most convenient method of ascertaining 
the first appearance of the yellow colour is to 
place a small glass disc on a piece of black paper, 
with a few drops of saturated solution of carbonate 
of soda spread over it; and to let fall as small a 
drop as possible of the fluid from the beaker into 
the margin of the soda solution. If no yellow 
colour be seen, another half C.C. of the mercury 
solution must be added, and the fluid from the 
beakei- 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 mer- 
cury solution must be added to the beaker, the 
fluid well stirred about, and another small drop 
taken from the mixture and tested with the soda, 
when, if the process have been rightly performed, 
an increase in the yellow colour will be perceived. 
Great care must be taken, during the whole of 80 
ESTIMATION OF UREA. 
these operations, not to lose one single drop of 
the fluid from either the beaker or burette. Then 
the whole of the carbonate of soda solution con- 
tained on the glass plate is to be poured into the 
beaker, and a drop from this mixture tested with 
fresh soda; if the yellow colour now appear, 
the number of C.C. used must be read off; but 
if not, more of the mercury solution must be 
dropped into the beaker until the yellow colour 
appear in the soda, and the number of C.C. used 
then read off. From the total number of C.C. 
used, there must be subtracted the number of C.C. 
used in the first part of the process before a 
permanent precipitate was produced, and the 
remainder multiplied by 10 gives the number of 
milligrammes of urea contained in 10 C.C. of 
urine, because 1 C.C. of the mercury solution 
corresponds to 10 milligrammes of urea. 
Thus far the amount of urea contained in 10 
C.C. of urine has been ascertained ; by simple pro- 
portion it is easy to find the quantity passed in 
the 24 hours. For example, suppose that 1 C.C. 
of the mercury solution were used before a 
permanent precipitate was produced; and that 
19 C.C. were used before the yellow colour was ESTIMATION OF CHLORIDES. 
81 
distinctly 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. Sup- 
pose that the patient had passed 1770 C.C. of 
urine in the 24 hours, then the calculation would 
be as follows : 
10: 1770: :180 : 31860 
180 
10) 318600 
31860 milligrammes 
As 1000 milligrammes equal 1 gramme, 31860 
milligrammes equal 31'860 grammes. 
ESTIMATION OF CHLORIDES. 
The solutions required are : 
A standardised solution of nitrate of silver, 
of which 1 C.C. corresponds exactly to 10 
milligrammes of chloride of sodium. 
A saturated solution of neutral chromate of 
potash. 
The urine should be as fresh as possible, and, 
if albuminous, submitted to the preparation de- 
scribed at page 74. 10 C.C. of urine are then 82 
ESTIMATION OF CHLORIDES. 
measured off into a glass vessel or beaker, and 
two or three drops of the solution of chromate of 
potash added. A burette divided into quarters of 
a C.C. is then filled with the standardised solution 
of nitrate of silver, and the precautions as to fill- 
ing burettes, described in speaking of the estima- 
tion of urea, (page 77) 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 watched for 
the least tinge of red surrounding the precipitate 
of chloride of silver. This reddish colour an- 
nounces the approaching termination of the pro- 
cess, 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 
precipitated, and that chromate of silver is be- 
ginning 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 coloui' ought to be heightened. From the 
number of C.C. used, the quantity of chloride is 83 
ESTIMATION OF CHLORIDES, 
x 
calculated; for, since 1 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 permanent reddish precipitate 
was produced, 10 C.C. of urine will contain 60 
milligrammes of chloride of sodium; and if the 
patient passed 1200 C.C. of urine in the 24 hours, 
the amount of chloride passed can be easily calcu- 
lated in the following way : 
7200 milligrammes equal 7'2 grammes, which will 
be the total quantity passed in the 24 hours. 
This process, as applied to urine, nearly al- 
ways gives results a little above the real amount 
present. 
For greater accuracy, therefore, 10 C.C. of the 
urine are measured off into a platinum 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 oxidised, 
and the contents of the crucible white. After 
10: 1200 : : 60: 7200. 84 
ESTIMATION OK PHOSPHATES. 
cooling, these are dissolved in distilled water, 
a few drops of nitric acid added until a faintly 
acid reaction is produced, a small quantity of 
carbonate of lime being then introduced in order 
to make the solution again neutral, and the 
chlorides then estimated in the manner described 
above. 
ESTIMATION OF PHOSPHATES. 
The solutions required are : 
A standardised solution of acetate of uranium, 
of which 1 C.C. corresponds exactly to 5 
milligrammes of phosphoric acid. 
A solution containing acetic acid and acetate 
of soda: 100 grammes of acetate 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 yellowish solution of ferrocyanide of 
potassium. 
50 C.C. of the filtered urine are mixed in a 
beaker with 5 C.C. of the solution of acetic acid 
and acetate of soda. The beaker is placed over 
a water bath, and when the mixture is well ESTIMATION OF 
85 
warmed, the standardised uranium solution is 
dropped into the beaker until precipitation 
this can easily be ascertained by allow- 
ing 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 ferrocy- 
anide of potassium placed close to it by means 
of another glass rod, and the two drops allowed 
to run together. If no alteration of the colour 
be produced at their line of meeting, more of 
the uranium solution must be added to the urine, 
until a drop, tested with the solution of ferrocy- 
anide of potassium, produce a light brown col- 
our where the two fluids meet. The number, 
of C.C. of the uranium solution that have been 
used is read off; and if, after a second warm- 
ing 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 re- 
garded as completed ; but if a dark brown col- 
our be produced by this second trial, too much 
uranium solution has been added, and the estima- 
tion must be recommenced with another 50 C.C. 
of urine. 86 
ESTIMATION OF ALBUMEN. 
The calculation for the amount of phosphoric 
acid passed in 24 hours is now easy. 
1 C.C. of uranium solution equals 5 milligrammes 
of phosphoric acid. So that, if 15 C.C. of the ura- 
nium solution have been used, 50 C.C. of the urine 
will contain 75 milligrammes of phosphoric acid, 
and if the patient have passed 1500 C.C. in the 24 
hours, the calculation will be 
50 : 1500 : : 75 : 2250 
75 
50)112500 
2250 milligrammes. 
2250 milligrammes equal 2'25 grammes, which 
will be the quantity of phosphoric acid passed in 
the 24 hours. 
ESTIMATION OF ALBUMEN. 
No easy, rapid, and trustworthy method of 
estimating the albumen has yet been suggested. 
The ordinary way of coagulating the albumen by 
heat and acetic acid, throwing the precipitate on 
a weighed filter, washing, drying, and reweighing, 
is so long and troublesome that it is never em- 
ployed in clinical observation. ESTIMATION OF SUGAR. 
87 
By far the best method for clinical observation 
is the estimation by means of the polariscope.* It 
is only necessary to have the urine moderately 
transparent, and free from blood-corpuscles, sugar, 
and bile acids, to obtain results which are more 
than sufficiently accurate for ah clinical purposes. 
If the turbidity be persistent after filtration, a few 
drops of acetic acid, or a little carbonate of soda 
oi* milk of lime added to the urine before filtration, 
may remove the turbidity. For the method of 
using the polariscope, see page 90. 
The quantity of albumen in the urine is usually 
not more than 1 per cent.; it very rarely rises to 
4 per cent, or more. A patient may pass 2 to 
20 grms. of albumen in the 24 hours. This latter 
amount is extreme. 
ESTIMATION OF SUGAR. 
There are two methods of estimating the a- 
mount of sugar present in diabetic urine, either by 
* Another method, on the principle of the lactometer has been 
introduced by Vogel {Deutsches Archiv f. klin. Medicin, Bd. iii. 
Heft. i. S. 143). It is recommended by many German physiolo- 
gical chemists, but the author has had no experience in its em- 
ployment. 88 
ESTIMATION OF SUGAR 
volumetric analysis, or by means of the polari- 
scope. 
KoZiMneZnc Method. A standardised copper so- 
lution is required, containing sulphate of copper, 
neutral tartrate of soda or potash, and caustic 
solution of soda, and 20 C.C. of which correspond 
to 100 milligrammes of grape sugar. This solu- 
tion is exceedingly apt to decompose, and must 
therefore be preserved in well stoppered, com- 
pletely-filled, glass vessels, and in a cool dark 
place. 
In estimating the sugar, the first step is to 
ascertain if the copper solution remain undecom- 
posed : 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 wa- 
ter only, or indeed with none at all. A burette by fehling's process. 
89 
is filled with the diluted urine, and the flask 
containing the copper solution is heated over a 
small flame, wire gauze intervening, until boil- 
ing begin : 2 C.C. of the urine are then allowed 
to flow into the boiling 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 be- 
tween the light and the eye of the observer, 
another C.C. of the urine must be added to the 
boiling copper solution • then the colour must be 
noticed, and if it be still blue, the operation 
should be repeated until the colour of the fluid 
have become yellow. The analysis is not yet, how- 
ever, completed. The fluid in the flask must be 
filtered into three test tubes, and to the first test 
tube a few drops of the copper solution must be 
added, and the whole boiled to see if an orange- 
red precipitate of suboxide of copper be produced; 
to the second test tube a small quantity of hydro- 
chloric acid is added, and sulphuretted hydrogen 
passed through; to the third, acetic acid and 
ferrocyanide of potassium are added. None of 
these reagents ought to produce a precipitate. 
If, on boiling with the copper solution, a preci- 90 
ESTIMATION OF SUGAR 
pitate occur, too much urine has been added ; if, 
in eithei' of the two last mentioned test tubes a 
precipitate occur, not enough of the urine has 
been added to decompose all the copper 5 in either 
case, the estimation must be repeated. 
Since 20 C.C. of the copper solution correspond 
exactly to 100 milligrammes of sugar, the com- 
plete decoloration of the copper solution will be 
accomplished by exactly 100 milligrammes of 
sugar. If, therefore, for the 20 C.C. of copper, 
15'5 C.C. of the dilute urine were required for 
complete removal of colour, and if the dilute urine 
contained only 10 per cent of urine, 1'55 C.C. of 
urine will contain J 00 milligrammes of sugar, and 
100 C.C. of urine will contain 6'45 grm. of sugar; 
as by proportion: 
If the urine contain albumen as well as sugar, 
the former must be removed as directed, page 
74. 
Estimation by means of the Polariscope. By 
means of this instrument an estimation of the 
sugar present can be made, provided that the 
urine be moderately transparent. If it be passed 
through animal charcoal, the accuracy is greater, 
1-55: 100: : 100: 6450. BY THE POLARISCOPE. 
91 
of course, but not so great as to be of much con- 
sequence in purely clinical research. If the urine 
contain albumen, it must be removed by the 
method given above, page 74. 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 essentially of a tube,, 
supported upon a foot, and divided into three- 
parts, one of which, the middle, is moveable, but 
the other two, which are at the ends of the instru- 
ment are fixed. One of the fixed tubes is fur- 
nished with a small screw, attached to its lower- 
surface ; this may be called the eye-piece. The- 
other fixed tube has no screw attached to it; it 
may be called the object-glass. 
A good argand burner, or a gas lamp, pro- 
tected by a neutral tinted glass cylinder, is neces- 
sary. When the polariscope is to be used, the 
lamp is placed an inch or so in front of the object- 
glass. The hollow glass tube in the middle of the 
instrument must now be removed, and filled with 
distilled water; the small glass disc being slid 
over the end of the tube completely filled with 
water, in such a manner that no air bubbles are 92 
ESTIMATION OF SUGAR 
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 moist- 
ure. The tube is now set in its place in the 
middle of the instrument; and the observer, look- 
ing through the eye-piece, draws out, or pushes 
in, the moveable tube close to the eye, until he 
.see at the end of the eye-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 attached 
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 are exactly opposite to 
each other. If they are not, the little button at 
the end of the scale should be gently turned, until 
they quite coincide. 
Before adjusting the instrument, the urine may 
be set aside to filter, or to pass through animal 
charcoal, if that be at hand. If the fluid be as 
free from colour as ordinary diabetic urine, it may 
be observed in the longer tube, 20 centimeters in 
length, since the accuracy of the estimation is in- BY THE POLARISCOPE. 
93 
creased 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 in- 
strument. The observer then notices if any alter- 
ation in colour of the two halves of the field have 
taken place. If the uniformity of colour no longer 
exist, he turns the screw below the eye-piece until 
the two halves of the field appear of precisely 
the same tint. The eyes are best rested occa- 
sionally during this part of the operation by look- 
ing on some white surface, as the ceiling of the 
room, or a sheet of paper. When the two semi-cir- 
cles become exactly the same in colour, the num- 
ber of degrees which the moveable zero is distant 
from the fixed zero is read off; and if the fluid 
observed contain sugar, the moveable scale will be 
found to the right: but if albumen only, to the 
left. The number of degrees that the zero has 
moved gives, when divided by 2, the percentage 
amount of either sugar or albumen, if the longer 
tube were used; but'the percentage is at once 
known, if the shorter tube were employed, as it is 94 
ESTIMATION OF SUGAR BY THE POLARISCOPE. 
itlie same in amount with the number of degrees 
iby which the two zeroes are separated from each 
.other. INDEX. 
Albumen, 12. 
estimation of, 16, 86. 
Heller's test for, 15. 
Millon's test for, 16. 
removing from urine, 74. 
Alkaline urine, 9. 
Amphigenous reaction, 10. 
Apparatus, 6, 74. 
Bile Acids, test for, 28. 
Hoppe's method of separa- 
tion, 30. 
Bile pigments, 27. 
Blood, 57. 
smoky appearance of urine 
containing, 3. 
source of albumen, 18. 
in acute Bright's disease, 68. 
Bogomoloff's test for bile, 29. 
Bright's disease, acute. 68. 
chronic, 69. 
Cancer cells in urine, 60. 
Carbolic acid, cause of black 
urine, 3. 
test for albumen, 16. 
Casts, renal, 61. 
Chlorides, 37. 
amount daily excreted, 38. 
estimation, 38, 81. 
Colour of urine, 3. 
Consistence of urine. 5. 
Cystin, 50. 
Epithelium, 60. 
clinical import of, 66. 
Fehling's test, 22. 
F ermentation test, 24. 
Froth on urine, 5. 
Fungi, 70. • 
Gmelin's test, 27. 
Haemoglobin, 31. 
Heller's test for, 31. 
Haemophein, 32. 
Heller's test for albumen, 15. 
Hippuric Acid, 36. 
Indican, 32. 
Kiestein, 70. 
Leucin, 54. 
Microscope, directions for, 43. 
Moore's test, 19. 
Mucus, 60. 
natural deposit from urine, 4. 
Murexid test, 46. 
Odour of urine, 4. 
Oxalate of Lime, 49. 
Pettenkofer's test, 28. 
Phosphates, 39. 
amount daily excreted, 40. 
distinction from albumen, 13, 
estimation of, 84. 
urinary sediment, 50. 
Physical examination, 3. 
Pigment in urine, 31. 
Polariscope, 87. 
Pus, 55. 
cause of turbidity, 4. 
source of albumen, 18. 
Reaction of urine, 9. 
Reagents, 6. 
Renal casts, 18. 
Sarcinse, 70. 96 
INDEX. 
Sediments, 42. 
micro-chemical examination 
of, 51. 
Solids, total daily excretion of, 
41. 
estimation of, 8. 
Specific gravity, 7. 
Spermatozoa, 71. 
Sugar, 19. 
amount daily excreted, 25. 
cause of high specific gra- 
vity, 8. 
estimation of, 24, 87- 
Fehling's test, 22. 
Fermentation test, 24. 
Moore's test, 19. 
Trommer's test, 20. 
Sulphates, 40. 
amount daily excreted, 40. 
Tannin, 3. 
Translucency of urine, 4. 
Trommer's test, 20. 
Turbidity of urine, 4. 
Tyrosin, 54. 
Urates, 47. 
Urea, 33. 
amount daily excreted, 34. 
estimation of, 76. 
Uric Acid, 35. 
amount daily excreted, 35. 
urinary sediment, 44. 
Urohsematin, 32. 
Urometer, 7- 
Uroxanthein, 32. 
Heller's test for, 32. 
London: Printed by H. K. Lewis, Gower Street.