CHEMICAL . 
MICROSCOPICAL 
ANALYSIS 
OF 
THE URINE. 
F 0 W LK Ro CHEMICAL AND MICROSCOPICAL 
ANALYSIS OF THE URINE 
IN HEALTH AND DISEASE 
DESIGNED FOR PHYSICIANS AND STUDENTS 
BY 
GEO. B. FOWLER, M.D. 
« < • 
INSTRUCTOR IN PHYSIOLOGY, COLLEGE OP PHYSICIANS AND SURGEONS, NEW 
YORK, FELLOW OF THE NEW YORK ACADEMY OF MEDICINE, 
MEMBER OF THE NEW YORK COUNTY MEDICAL 
SOCIETY, ETC. 
Third Ed it io n 
REVISED AND ENLARGED, WITH EIGHTEEN ILLUSTRATIONS 
NEW YORK 
Gr. P. PUTNAM'S SONS 
182 FIFTH AVENUE 
1879. Copybight. 
G. P. PUTNAM'S SONS. 
1876. PREFACE TO THIRD EDITION. 
The alterations in this edition consist in the correc- 
tion of a few typographical errors, the substitution of 
several new cuts, and the introduction of a Supplement 
containing additional matter, which, the author trusts, 
will enable the little book to maintain the favor hith- 
erto so kindly bestowed. 
1 West Forty-Fifth Street, Oct., 1879. PREFACE TO SECOND EDITION. 
In this, as in the first edition, the object has been 
to present the most practical and important features 
of the subject. The book has been carefully revised, 
and somewhat enlarged by the introduction of new 
matter, but the same general arrangement is preserved. 
The decimal system of weights and measures has 
been adopted, also the new chemical nomenclature 
and notation. To meet the requirements of those not 
familiar with the decimal system, equivalents in 
grains or ounces are usually given in brackets, and a 
table of comparative valuer is inserted on the last 
page. 
October, 1876. PART I. 
1. Characters of Normal Urine. 
2. Effects of Reagents upon Normal Urine. 
PART II. 
Characters of Abnormal Urine. 
PART III. 
Urinary Deposits. 
1. Those which are Natural Constituents of 
the Urine, either Separately or in Combination. 
2. Those which are Foreign to its Composition 
UNDER ANY FoRM. 
PART IV. 
Accidental Ingredients which do not Form 
Deposits. 
PART V. 
Quantitative Analysis. 
PART VI. 
Calculi and Gravel. ANALYSIS OF THE URINE. 
PART I. 
Characters of Normal Urine. 
The Composition of the urine per thousand 
parts is as follows : 
Water ....... 950.00 
Urea ....... 26.20 
Creatinine 0.87 
Sodium and potassium urates . . 1.45 
Sodium and potassium hippurates . . 0.70 
Mucus and coloring matter . . 0.35 
ORGANIC. 
INORGANIC. 
'Sodium biphosphate .... 0.40 
Sodium and potassium phosphates . 3.35 
Lime and magnesium phosphates . . 0.83 
Sodium and potassium chlorides . 12.55 
Sodium and potassium sulphates . . 3.30 
1000.00 
These proportions are not invariable, but as in all 
animal fluids, greatly depend upon diet, age, sex, 
occupation, etc. 
A glance at the above table is sufficient to reveal 6 
ANALYSIS OF THE URINE. 
the fact that the urine is practically a watery solution 
of urea and inorganic salts, the chlorides being espe- 
cially abundant. 
UREA-CHAO. 
This is the most important, and next to water, the 
most abundant ingredient of the urine. It is present 
in the urine of all animals in large proportion, except 
that of birds and scaly amphibians, where it is almost 
wholly replaced by the urates. 
PHYSICAL AND CHEMICAL CHARACTERS. 
Urea is a crystallizable substance, and has the 
chemical composition given above. The crystals are 
white, delicate needle-shaped prisms, very soluble in 
water and alcohol, but sparingly so in ether. It is 
neutral to test-paper, has a cooling taste like saltpetre, 
and is without odor. It never appears as a sponta- 
neous deposit in urine. If kept protected from the 
atmosphere, or in a pure watery solution, urea does 
not decompose; if, however, it is boiled for a long 
time in pure water or a few moments with an alkali, 
or heated with water in a sealed tube above 100° C., 
a change is effected whereby ammonium carbonate is 
produced by the appropriation of the elements of two 
molecules of water, thus : 
Urea. Water. Ammonium Carbonate. 
OH4N2O + H4O2 = (NH4)2CO3. 
The same phenomenon occurs when a watery solu- 
tion of urea is brought in contact with decomposing 
organic matter. Hence the ammoniacal odor of 
stale urine. ANALYSIS OF THE UBINE. 
7 
A peculiar interest is attached to urea as being the 
first organic product which was artificially produced. 
It was obtained by Wohler by mixing the vapors of 
cyanic acid and ammonia : 
Cyanic Acid. Ammonia. Urea. 
CHNO + NH3 = CH4N2O. 
The first result of this process is the formation of 
a neutral cyanate; but on heating this is converted 
into urea. To-day urea is artificially obtained by 
several methods from cyanogen compounds, and by 
the action of oxydizing agents upon albuminous mat- 
ters and upon uric acid. A method which yields it in 
great abundance is the following: Equal quantities, 
by weight, of potassium cyanate and ammonium sul- 
phate are dissolved in a little water, and then evap- 
orated to dryness over the water-bath. The residue 
is boiled w'ith strong alcohol, which dissolves out the 
urea from the potassium sulphate and ammonium sul- 
phate. The alcoholic solution is now filtered, con- 
centrated, and allowed to cool, when the urea will 
show itself as a crystalline deposit. 
To obtain urea from urine involves a much less 
satisfactory process, in that it requires more manipula- 
tion, and necessitates the employment of an immense 
quantity of urine to commence with, in order to 
secure an appreciable amount of the substance sought. 
The process is as follows: Urine is evaporated to a 
syrupy consistency, the deposit of phosphates and 
urates being filtered away as they appear, and about 
one-quarter of its volume of strong nitric acid added. 
A crystalline deposit of urea nitrate is immediately 8 
ANALYSIS OF THE URINE. 
formed, which is made still more abundant by cool- 
ing. The whole is then to be thrown upon a filter 
and the crystals dried between folds of bibulous 
paper. They are then dissolved in a little warm water 
and the solution heated with an excess of barium 
carbonate.. 
The nitric acid quits the urea, setting it free, and 
unites with the barium to form barium nitrate; the 
liberated carbonic acid manifesting its escape by effer- 
vescence. A little concentration will cause the barium 
nitrate to crystallize, when we get rid of it by filtering. 
Now evaporate our watery solution of urea to dryness 
over the bath and extract with as small amount of alco- 
hol as will dissolve the residue. On cooling the urea 
will crystallize out. 
Urea behaves in some respects like an organic base. 
It unites readily with nitric and oxalic acids to form 
the nitrate and oxalate respectively. Both of these 
products may be obtained from the urine, it being 
only necessary to evaporate this fluid down to about 
one-fourth its volume, allow it to cool and add an excess 
of the acid. In the case of nitric acid there will be a 
very abundant precipitate of urea nitrate in the form 
of flat six-sided scales more or less colored by the urine 
pigment, and overlying each other to such an extent 
as to almost conceal their true form. 
Urea has a much greater affinity for oxalic than for 
nitric acid, and if we add a strong solution of the for- 
mer to the deposit already obtained the nitrate will be 
decomposed, and a copious fawn-colored mass of urea- 
oxalate crystals appear. The crystals of this latter for- 
mation are very similar to those of the nitrate, being ANALYSIS OF THE URINE. 
9 
rhombic plates and prisms. They may however be 
distinguished by their somewhat smaller size and the 
appearance among them of a few rather thick four- 
sided prisms. 
PHYSIOLOGICAL AND PATHOLOGICAL RELATIONS. 
Urea is the product of the retrograde metamorpho- 
sis of the nitrogenous constituents of the body. It is 
not formed in the kidneys, as once supposed, but ex- 
ists in the blood of the general circulation in the pro- 
portion of about 0.16 parts per thousand. It has also 
been discovered in the lymph and chyle, the humors 
of the eye, and in the perspiration. 
Whether urea is produced in the solid tissues or in 
the blood is not determined, but it is quite evident 
that the kidneys simply serve as eliminators of it; 
because it is found that the renal veins contain much 
less urea than do the renal arteries; and if the latter 
vessels be tied there is a very marked increase of urea 
in the blood. 
Urea is excreted at the rate of about 35 grammes 
(525 grains) per day. But this process depends very 
greatly upon several conditions which are never to 
be overlooked. The most important are age, sex, 
bodily weight, food and muscular activity. 
Women and children produce less urea than men, 
though in children there is more in proportion to 
the weight. (Harley. Scherer. Becquerel.) Large 
people excrete more urea than small ones. The pro- 
portion is about .5 per thousand parts of the weight. 
All observers agree that the excretion of urea is aug- 
mented under the influence of a nitrogenous diet, and 10 
ANALYSIS OF THE UBINE. 
diminished to a minimum by the use of food strictly 
non-nitrogenous. 
Five-sixths of all the nitrogen ingested has been 
found in the urinary solids; and the entire quantity 
is to be detected in the urine and feces.1 Practically 
urea represents all the nitrogen excreted. 
Whether muscular exercise affects the amount of 
urea discharged has been long a mooted question and 
the subject of numerous careful and laborious experi- 
ments. Liebig promulgated the doctrine that the 
tissues consume their own substance with the result 
to eliminate an amount of nitrogen proportionate to 
their activity. This view, however, has lately been 
assailed and in turn supported by many eminent 
observers. 
According to Parkes there is no increase of nitro- 
gen-i. e., urea-during unusual muscular exercise, 
but after such a period the increase is very striking.2 
Fick and Wislicinus,8 two German experimenters, 
estimated the amount of urea discharged by themselves 
before, during and after the ascent of a high mountain 
on foot, the diet consisting of non-nitrogenous food. 
The results obtained showed that there was less urea 
eliminated for a given time during the work than be- 
fore. At night, having arrived at the top, they par- 
took of a mixed meal which had the effect to augment 
1 Parkes. Proceedings of the Royal Society, June 20, 
1867, and Lehmann, Physiological Chemistry. Am. ed., vol. 1, 
p. 151. 
2 Proceedings of the Royal Society, Jan., 1867. Vol. xv. Id. 
vol. xvi. Id. March, 1871. 
8 " On the origin of muscular Power," Philosophical Mag. 
(Supplement) vol. xxxi., 1866. ANALYSIS OF THE URINE. 
11 
the nitrogenous discharge, but it did not with either 
individual equal that excreted before the work. Very- 
extensive and conclusive experiments on this subject, 
however, are those performed upon the pedestrian 
Weston, by Prof. A. Flint, Jr.1 In these observations 
the greatest care was taken in all the details. The 
amount of nitrogen in the food was calculated as well 
as that excreted, in order to avoid any error which 
might arise from the variation in the diet. Weston 
was under observation fifteen days-five days before, 
five days during and five days after the walk. The 
result was that the increase of urea discharged during 
the period of exertion was very marked. 
These results have very recently received additional 
support by experiments upon the same individual, dur- 
ing a trial of endurance in London, conducted by Dr. 
Pavy,2 who "concludes that the production of urea is 
due not alone to muscular exercise but to general func- 
tional activity. " It then appears settled that nitrogen- 
ous food and functional activity increase the discharge 
of urea. But whether in the case of food the result is 
due to an excess of nitrogenous material in the blood 
being directly transformed into the excretion, or whether 
the tissues are stimulated to more active metamorpho- 
sis by this excess, is a question as yet undecided. 
The excretion of urea varies with the different 
periods of the day, being less in the morning and 
greatest at night. Indeed we have seen specimens of 
urine passed late in the afternoon and evening which 
1 New York Medical Journal, June, 1871, p. 669. 
2 London Lancet, 1876. Vol. I., No. ix., et seq. See Supple- 
ment, 1. 12 
ANALYSIS OF THE URINE. 
gave an abundant precipitate with nitric acid (urea 
nitrate) without previous manipulation. 
As a general rule an excessive discharge of water 
by the kidneys is accompanied by an augmentation in 
the amount of urea, and a diminished flow by a de- 
crease. 
Urea is formed and excreted as long as the vital 
functions are performed, whatever be the diet, and 
even when all food is withheld. 
In disease the production of urea may be both in- 
creased and diminished. It is increased in most febrile 
and inflammatory diseases such as pneumonia, perito- 
nitis, etc., but during convalescence sinks below the 
normal average. In diabetes mellitus, where the 
patient .takes enormous quantities of food, the total 
daily quantity of urea may be 60 or 70 grammes, (900 
or 1050 grs). In diabetes insipidus it is also increased, 
evidently on account of the excessive amount of water 
ingested. 
The excretion of urea is diminished in renal dis- 
eases, cholera, phthisis and all other chronic affections 
accompanied by impaired nutrition. It is, however, 
evident that these deviations are not all due to the 
same cause. In diseases which interfere with the func- 
tions of the kidneys, the same amount of urea may be 
formed as in health, but the kidneys being impaired it 
accumulates in the circulation ; while in diseases char- 
acterized by a chronic torpidity of the vital forces the 
metamorphosis of the tissues and food is retarded-but 
the small amount produced is properly drained away 
from the blood by the kidneys. 
In Bright's disease the failure of the urea to be • ANALYSIS OF THE URINE. 
13 
separated from the blood causes it to collect there in 
great quantity, and also to appear in every tissue and 
fluid of the body. Thus confined it acts as a poison 
upon the nervous system inducing what is known as 
ur&wiia. Retained any length of time in the urinary 
organs urea is decomposed into ammonium carbonate, 
which is absorbed and gives rise to a diseased condition 
called ammonazmia. Whether urea is thus changed in 
the blood and uraemia and ammonaemia are identical is 
not known. The method of estimating the quantity 
of urea will be given in another place. 
CREATININE-C4H7N3O. 
This is another excretory product closely resem- 
bling urea in that it is crystallizable, contains nitrogen 
and has the properties of an organic base. Very 
little is known concerning it further than that it 
exists in small amount in muscle, and that it can be 
obtained from creatine of muscle, by the separation 
of the elements of water, as follows : 
Creatine. Water. Creatinine. 
c4h9n3o2 - h2o = c4h7n3o. 
Both creatine and creatinine exist in the urine to a 
very small extent. They are probably intermediate 
formations in the metamorphosis of nitrogenous mat- 
ters towards urea, uric acid, carbonic acid and water. 
The remaining ingredients of the urine which have 
a practical interest will be considered under " urinary 
deposits." 
Color.-The tint of healthy urine is liable to va- 14 
ANALYSIS OF THE HEINE. 
nation, though a yellow amber is about the standard 
color. 
The coloring matter of urine is a peculiar organic 
constituent which though diligently studied is not yet 
perfectly understood. Its proneness to decomposition 
renders it very difficult of separation in a pure state, 
and on this account a variety of substances have been 
described, differing somewhat in color and general 
characters, and christened accordingly. This is the 
reason we see so many names applied to the urine 
pigment. 
The most important results were obtained by Har- 
ley,1 and Thudichum.2 Harley succeeded in obtaining 
a "bright red, non-crystallizable compound " which 
when fresh closely resembles red sealing wax. After a 
while it gradually becomes darker and more brittle, but 
does not lose its general characters even after twelve 
years keeping. He describes it as being insoluble in 
water, soluble in alcohol, chloroform and ether with a 
rich port wine color, according to the amount dissolved, 
and soluble in fresh urine imparting the characteristic 
tint of normal high colored specimens of that fluid. 
To this substance he gave the name IJrohwmatlne; 
for he believed it to be but the altered and effete blood 
pigment, and its proportion in the urine to be directly 
connected with the metamorphosis of that substance. 
Urohsematine contains both nitrogen and iron. Ac- 
cording to its discoverer it is this material which is set 
free and manifests itself in the darkening of color when 
nitric or any strong mineral acid is added to urine. 
1 The Urine and its Derangements. Phila., 1872, p. 96. 
2 British Med. Journal, Nov. 5, 1864. ANALYSIS OF THE HEINE. 
15 
Urochrome is the name by which Thudichum 
designates the pigment which he succeeded in extract- 
ing from the urine, and it is perhaps the best term to 
remember. When separated, it presents itself as a 
yellow, uncrystallizable mass; very soluble in water, 
to which it gives a yellow, urine-color. Whatever 
the pigment is, it is present in the urine in something 
like definite amount and depends upon the proportion 
of water whether it imparts a deep or faint color. 
Excessive indulgence in water, malt liquors and 
wine, and diminished activity of the perspiratory ap- 
paratus, will cause an increase of the watery element 
in the urine, and consequently more or less dilution. 
Under these circumstances we would find the color 
light; in some cases resembling pure water. The 
converse of these conditions will produce a contrary 
result. Urine voided by nervous and hysterical pa- 
tients is in large quantity and almost devoid of color. 
Transparency.-Normal urine is perfectly clear, 
with the exception of a small collection of mucus and 
epithelium which nearly always collect at the bottom 
of the vessel, but may entangle a number of air-bub- 
bles and float as a feathery ball just below the surface. 
Reaction.-Healthy urine has an acid reaction, 
which is due not to the presence of any free acid, but 
to an acid salt, sodium bi-phosphate. This reaction 
may be decided or faint. But it should not be under- 
stood that unless the urine is acid it is abnormal. 
• Indeed, the reaction may vary within healthy limits, 
between well-marked alkalinity and acidity; the 
irregularity being to a great extent due to diet. 
The urine of carnivorous animals is acid, that of 16 
ANALYSIS OF TIIE URINE. 
herbivora is alkaline, while in omnivora the reaction 
can be said to occupy a position between the two. It 
has been ascertained that a vegetable diet will cause 
the disappearance of the acidity in the carnivora, and 
a regimen of flesh induce an acid condition in the 
urine of herbivora. Consequently in omnivorous man 
we are not surprised at the unstable reaction presented 
by his urine, and can account for the changes by refer- 
ence to his food. 
According to most observers the urine is alkaline 
after a mixed meal, but soon begins to grow less so, 
until the acid state is restored. The acidity increases 
during fasting, and reaches its greatest degree of in- 
tensity after about twelve hours abstinence from food. 
(Roberts.) 
It is well to note that this variation is not due to 
any diminution in the acid salt present, but simply to 
a sudden accumulation of alkaline ingredients, the re- 
sult of digestion. For during this process, all the salts 
of the organic acids, such as tartrates, malates, citrates, 
and lactates are transformed into alkaline carbonates, 
and as such appear in the urine.1 Substances contain- 
ing these organic compounds are in daily use, either 
as food or medicine. Many fruits and vegetables offer 
familiar examples, and carbonated mineral waters are a 
common cause of a temporarily alkaline urine. 
Specific Gravity.-The specific gravity of nor- 
mal urine varies from 1018 to 1025. These limits may 
be extended in individual cases, and in fact, depend 
greatly upon the quantity of urine voided. In other 
words, the specific gravity bears an inverse ratio to the 
daily quantity. Should we have an increased flow of 
' See Supplement, 2. ANALYSIS OF THE HEINE. 
17 
urine from unusual indulgence in drink, or from the 
action of any diuretic, we would not expect the density 
to equal that where the same quantity of solid material 
is present in a less amount of water. For in diure- 
sis, except in a few instances of disease, we merely 
have the water increased, and not the solid constitu- 
ents. In such cases we should not be surprised to find 
the specific gravity as low as 1010 or even 1005. On 
the other hand, where the individual has taken little 
or no fluid, or has perspired freely, or is suffering from 
diarrhoea, the urine would be wdiat we call concentrated 
-that is, the normal amount of solid ingredients, salts, 
urea, etc., would be there dissolved in a small propor- 
tion of water. And under these circumstances, the 
specific gravity would be high-even 1030 would not 
indicate disease. 
Daily Quantity.-The total quantity of urine 
voided by a healthy individual during twenty-four 
hours is estimated to be about 1200 cubic centimetres. 
This is subject to variation, depending upon the quan- 
tity of fluids drunk, the activity of the perspiratory 
functions, etc.; for it is evident that should there be a 
small proportion of fluids taken into the system, there 
will be less secreted by the kidneys, and vice versa. 
And should perspiration prevail to an unnatural de- 
gree, we would be getting rid of the water by another 
channel, and would not expect to find the same volume 
of urine; the same may be said of watery discharges 
from the bowels. The kidneys act as regulators of the 
water-supply of the blood; they take from it any ex- 
cess, and when there is an insufficiency, they demand 
only enough to dissolve the solid constituents of 18 
ANALYSIS OF THE URINE. 
the urine, and to facilitate their discharge from 
the body. 
The estimation of the daily secretion of urine is one 
of the most important points connected with its study. 
But it will readily be seen, from what has been said, 
that it depends greatly upon the specific gravity wheth- 
er the quantity voided has a clinical significance. In 
fact the daily quantity and specific gravity of urine are 
so closely related that it is difficult to treat of them 
separately. 
The solids, urea especially, are increased under the 
influence of muscular exercise, and an animal diet; 
while the watery element is augmented by indulgence 
in drink, the action of diuretic medicines and by nerv- 
ous or hysterical conditions. Variations in specific 
gravity, ranging from 1005 to 1030, cannot be constant, 
and not excite suspicion regarding the integrity of the 
kidneys, or some pathological condition of the economy. 
To entitle them to be considered under the head of 
normal, they must be only temporary and easily re- 
ferred to some such cause as has been mentioned. 
2. EFFECTS OF REAGENTS UPON NORMAL URINE. 
Cold.-Cold has no visible effect upon urine of a 
specific gravity at or below about 1020. But in con- 
centrated specimens, after cooling, there will be a pre- 
cipitate, more or less colored, which consists of the 
amorphous urates, they being only soluble at an ele- 
vated temperature and in an excess of water. This 
precipitate first appears as a cloud throughout the 
whole volume of urine, but will gradually collect at ANALYSTS OF THE URINE. 
19 
the bottom and adhere in specks to the sides of the 
vessel as a fine powder. 
Such a deposit or cloudiness will disappear upon 
again raising the temperature to that of the body. 
Heat.-Normal urine of a decided acid reaction is 
unaffected by the application of heat. But should the 
reaction be faintly acid, neutral, or alkaline, heat will 
cause a cloudiness, due to the precipitation of the 
earthy phosphates of lime and magnesium. 
These two phosphates are insoluble in a neutral or 
alkaline fluid, and are less soluble in warm than in 
a cold medium, and therefore will be precipitated 
by heat if the reaction of urine is even slightly 
acid. 
Acid.-Vegetable acids have no immediate visible 
effect upon healthy urine; but strong mineral acids 
deepen the color. If nitric or hydrochloric acid be 
added, in the proportion of about one-fourth, after 
several hours minute but distinct dark browm crystals 
will be seen clinging to the sides of the test-tube or 
vessel, and collected at the bottom. These are the 
crystals of uric acid which have resulted from a decom- 
position of the urates by the acid. If the specimen be 
concentrated, voided after abstinence, a copious pre- 
cipitate of urea nitrate in the form of white shining 
scales will follow the addition of nitric acid.1 
Alkalies.-When urine is rendered alkaline, the 
earthy phosphates of lime and magnesium will be 
precipitated. 
Silver nitrate solution added to urine precipi- 
tates the chlorides. But it is necessary to previously 
acidify the urine with a few drops of nitric acid, other- 
1 See Supplement, 3. 20 
ANALYSIS OF THE URINE. 
wise silver phosphate will come down in addition to 
the chloride. 
It is sometimes expedient to estimate the compara- 
tive quantity of the chlorides, inasmuch as it is pretty 
well established that they are subject to great fluctua- 
tions in certain forms of disease. In pneumonia, 
pleurisy, and cholera, the chlorides almost disappear 
from the urine, and the silver salt produces little or no 
effect. But when the attack begins to subside, this 
reagent will detect the return of the chlorides. The 
precipitate is a very copious white cloud which turns 
black on exposure to the light. 
Barium chloride solution throws down the sul- 
phates from the urine. It is well first to add a 
little nitric or hydrochloric acid to the urine as some 
barium salts, other than the sulphates, are thereby dis- 
solved. 
The variations in the daily excretion of the sul- 
phates have little clinical significance as far as known. 
Basic acetate of lead and silver nitrate pre- 
cipitate the mucus and coloring matter. 
Many substances taken by the mouth or injected 
into the circulation subsequently make their appearance 
in the urine. Such are potassium ferrocyanide which 
can be detected a few minutes after administration by 
the blue color which it strikes with ferric nitrate; 
iodine given either in the free form or in combination 
is easily shown to be excreted by the kidneys. It, 
however, never appears free in the urine, and therefore 
will not give the characteristic reaction with starch 
until liberated by a drop or two of nitric acid. Quinine 
passes out by the urine, and many articles impart their ANALYSIS OF THE URINE. 
21 
peculiar odor, as ether, cubebs, copaiba, turpentine, 
peppermint, etc. See Supplement, 4. 
CHANGES WHICH TAKE PLACE IN URINE AFTER BEING 
DISCHARGED FROM THE BODY. 
If a specimen of urine be kept for observation, the 
following changes show themselves: 
At first, after a period varying from two days to a 
week, the acidity becomes more marked, the color is 
darker, and crystals of uric acid and lime oxalate 
make their appearance. Even should the urine be 
faintly alkaline, to commence with, and cloudiness 
exist from the precipitation of the earthy phosphates, 
it will become acid, and the cloudiness clear up, when 
the process continues as in the other case. The acid- 
ity increases up to a certain *point, and then begins 
to grow less. It may continue two, four, or seven 
days; and Lehman states, he has observed the acid 
reaction to increase for 
two or three weeks, and 
then not disappear al- 
together until eight 
weeks. This is the 
ACID FERMENTATION of 
urine (Fig. 1), which 
although not constant, 
will be observed in the 
majority of cases. 
The acidity gradually 
becomes fainter and 
fainter, and at length the urine is neutral. Now, 
marked changes will be noticeable. The urine is 
Fig. 1. 
Acid Fermentation : Uric acid, octahedra 
of lime oxalate, and amorphous urates. 22 
ANALYSIS OF THE URINE. 
cloudy; myriads of vegetable organisms in rapid 
motion are visible under the microscope (Bacteria). 
Neutrality gives place very soon to alkalinity, which 
is advertised most emphatically by a putrescent, am- 
moniacal odor. The uric acid crystals disappear, and 
others of the ammonio-magnesium 'phosphate are pro- 
duced. These crystals are large prisms, and can be 
seen glistening on the surface of the urine where a 
layer of brittle fatty matter has formed. Dark, round 
crystals of ammonium urate may also be seen with 
the microscope. 
This state of things continues until the decomposi- 
tion is complete. Then the ammoniacal odor will no 
longer be detected, and the urine will have lost most 
of its color. 
This constitutes the 
ALKALINE FERMENTATION 
which is constant (Fig. 2) 
The chemistry o f 
these two fermentations 
has been differently ex- 
plained ; but that offered 
by Scherer is generally 
accepted as correct. 
He says that the or- 
ganic matters,- the color- 
ing matter and mucus, 
act as catalytic bodies, 
and induce the fermenta- 
tion whereby lactic acid is produced. Just how lactic 
is formed is not well understood, but it is certain that 
it makes its appearance in urine when allowed to stand, 
Fig. 2. 
Alkaline Fermentation : Crystals of am- 
monio-magnesium phosphate, ammo- 
ninm urate and deposit of amorphous 
hme phosphate. ANALYSIS OF THE URINE. 
23 
in which it could not be detected when fresh. The 
presence of lactic acid then decomposes the urates, 
whereby uric acid is set free and makes its appear- 
ance as crystals. At the same time, oxalic acid must 
be produced, for crystals of the oxalate of lime show 
themselves. This oxalate of lime is very insoluble, 
and could not have existed in the urine before w'ithout 
detection. Therefore the supposition is that oxalic 
acid is formed and immediately unites with the lime 
already present, for which it has a great affinity. 
Theoretically we can account for the production of 
oxalic acid from uric acid. For when this is subjected 
to oxidizing agents it is decomposed, among other 
substances, into oxalic acid. So much for the acid 
fermentation. 
Now, we have seen (p. 6) that urea is converted 
into ammonium carbonate when in contact with a de- 
composing organic substance, by the addition of two 
equivalents of water. 
Here then in the urine we have the conditions of 
this decomposition. The mucus gradually loses its 
power of producing lactic and oxalic acids, and begins 
itself to decompose; and surrounded by water, the 
arrangement for the transformation is complete. It 
accordingly takes place, and the first effect of the pres- 
ence of ammonium carbonate is to neutralize the acid 
reaction, and then to induce the alkaline. Now', of 
course, the earthy phosphates are no longer soluble, and 
render the urine opalescent by their precipitation; the 
uric acid crystals are dissolved; a scum of animal 
matter intermixed with the amorphous phosphates 
forms on the surface, and very soon glistens with 24 
ANALYSIS OF THE UKINE. 
crystals of a new formation, ammonio-rriagnesium 
phosphate. 
The urea continues to be decomposed, and ammo- 
nium carbonate to unite and form these several new 
substances, until there is nothing more for it to com- 
bine with. Now it escapes as gas, and the odor re- 
minds us of that common to public urinals, where, 
indeed, the same process as just described is going on. 
At length, all the urea is decomposed, and the evolu- 
tion of ammonia ceases. The other substances either 
remain unchanged or pass off in the form of other 
gases. 
These are the important facts concerning normal 
urine, and a knowledge of them is indispensable, in 
that if we are not acquainted with them, we certainly 
shall not be prepared to detect and appreciate the 
variations which constantly present themselves, and 
constitute an abnormal condition. PART IL 
CHARACTERS OF ABNORMAL URINE. 
Odor.-The odor of urine is frequently affected, 
and is likely to attract the attention of both patient 
and physician, and lead to its examination. Many 
articles taken as food and medicine impart to it an 
odor peculiar to themselves. Such are asparagus, 
onions, turpentine, cubebs, and copaiba. An ara- 
moniacal odor tells the story of decomposition, and 
urine containing pus, blood or albumen very soon 
decomposes and emits a putrid odor. 
Color.-The color of urine is subject to many 
changes depending simply upon the degree of concen- 
tration. In febrile diseases, where we have a partial 
suppression of the watery element, the secretion is 
high-colored. In diabetes mellitus, a disease charac- 
terized by an inordinate flow of urine of high specific 
gravity, and containing sugar, the tint is light and of 
a peculiar straw color. In diabetes insipidus the urine 
sometimes resembles pure water. In albuminuria, es- 
pecially of long standing, there is a peculiar whitish, 
albuminous appearance which is highly characteristic. 
But we should never rely upon the color as indicating 
the presence or absence of albumen. 
Certain articles of food and medicine affect the 
color of the urine. Strong coffee heightens, rhubarb 26 
ANALYSIS OF THE URINE. 
imparts a deep yellow, and logwood gives it a reddish 
hue. Santonine renders it an orange red when alka- 
line ; when acid, a golden yellow. Creosote and com- 
pounds of tar have been known to cause the urine to 
become almost black ; and, lastly, blood and bile may 
be present in such quantities as to be readily recog- 
nized. 
The presence of bile may be distinguished from 
the effects of rhubarb by the addition of a little 
liquor ammonia, when the deep yellow of the latter 
will be converted into a crimson. 
Blue, green, and black urine is occasionally seen. 
These remarkable pigments occurring in this situation 
were long in being understood. But it is now gene- 
rally acceded that they are due to the presence of in- 
dican, a colorless substance, identical with the vegeta- 
ble product from which the indigo-blue and indigo-red 
of the arts are obtained; and that they represent but 
different stages of oxidation of this substance. These 
peculiar colors never appear in freshly voided urine, but 
are always observed in that which has been allowed to 
stand exposed to the air. It depends upon the amount 
of the coloring-matter whether the entire volume of 
the fluid will be affected. Sometimes its presence is 
only manifested by the affinity which it has for small 
solid particles, such as epithelium debris, crystals 
and extraneous matters, when these substances will 
be seen under the microscope deeply stained red, 
blue, etc. 
The addition of mineral acids will precipitate these 
pigments in urine in which indican exists. 
Whether these extraordinary appearances have any ANALYSIS OF THE URINE. 
27 
clinical significance is not decided. Indican has been 
detected in many specimens of healthy urines.1 
Transparency.-If a specimen of urine under 
examination is not clear and transparent, it should be 
first ascertained whether there was any turbidity 
when first voided; for we have seen that perfectly 
healthy urine, when kept for any length of time, will 
undergo changes and a marked opalescence exist. 
And abnormal urine may be at first perfectly clear, 
but on cooling or standing exhibit a cloudiness or de- 
posit. It is possible for urine to be abnormal, and yet 
remain free from turbidity or deposit. For example, 
albumen and sugar are perfectly soluble, and can not 
be detected by simple ocular inspection. 
Substances which interfere with the transparency 
of recently discharged urine are, pus, blood, phos- 
phates, urates (if the specimen is cool), chyle, sper- 
matozoa, and epithelium. 
The reader is referred to each of these under the 
head of " Urinary Deposits." 
Reaction.-After what has been said concerning 
the variability in the reaction of normal urine, it is 
sufficient to add now that when we meet with a 
patient wdiose urine is habitually or most of the time 
neutral or alkaline, we should regard him as a subject 
for treatment. 
Remember that the alkalinity may be due to the 
presence of the fixed salts of sodium and potassium, or 
1 Literature: Hassall, Philosophical Transactions-1864, p. 
297. Harley. " Urine and its Derangements." Phila., 1872, p. 
107. In Thudichum, " On the Pathology of the Urine," Lon- 
don, 1853, p. 328, a very full account is given. See Supplement, 5. 28 
ANALYSIS OF THE URINE. 
to the volatile one of ammonium; that the former are 
derived from the blood and the latter is the result 
of the decomposition of urea. These two conditions 
can easily be distinguished apart by the ammoniacal 
odor which betrays the presence of ammonium car- 
bonate, and the fact that the blue color which it 
imparts to reddened litmus-paper fades away. And 
also, if the reaction be due to this alkali, we shall find 
crystals of the ammonio-magnesian phosphate under 
the microscope. (Fig. 6.) Where either the fixed 
salts or the volatile one is present, of course the urine 
will be turbid from a precipitation of the earthy phos- 
phates. And this precipitation occurring in the blad- 
der is likely to give rise to a calculus; yet it is pretty 
well established that the urine can remain alkaline a 
long time from sodium and potassium carbonates, and 
a stone not form. It is crystalline deposits which we 
have to fear in this regard, and as the volatile alkali 
induces crystalline formations, calculi or concretions 
are apt to accompany it. 
Then, too, we may have the urine abnormally acid, 
producing a scalding sensation during micturition. 
Now, we know what the result is when an acid is 
added to the urine outside the body: uric acid crystals 
will be precipitated. So it is in the bladder under the 
same conditions. These crystals then accumulate and 
form gravel, which may lodge in the kidney, ureter or 
bladder. In either situation it is easy to comprehend 
how their presence and increase in size will cause re- 
tention and decomposition of the urine and growth of 
the original uric acid concretion by successive layers 
of earthy phosphates. ANALYSIS OF THE UKINE. 
29 
Daily Quantity and Specific Gravity.-We 
have seen, in the case of healthy urine, how closely 
the specific gravity and daily quantity are related, 
and that as one increased, the other decreased ; or, in 
other words, that they bore an inverse ratio to each 
other. In certain diseased conditions, however, both 
are increased and decreased together. The specific 
gravity may be 1030, and the daily quantity 2 litres 
(70 oz). Here we would recognize the fact that there 
is a double waste of both water and solids. And, 
again, the specific gravity may be 1006 to 1012, and the 
quantity not exceed 400 cubic centimetres (12 oz). In 
this case, there is a suppression of both elements, and 
from retention of the'chief solid constituent, urea, the 
most fatal results may follow. There is also a disease 
-diabetes insipidus-where the daily quantity of 
urine is enormous, and the specific gravity much loelow 
the normal standard. This state of things robs the sys- 
tem of its proportion of water, occasioning great thirst, 
whereby nature endeavors to counteract the drain. 
Here, then, as a general rule in abnormal urine, the 
specific gravity and the daily quantity are in direct 
ratio. When the amount of water is increased, the 
solids will l)e also, and vice versa. 
The specific gravity of urine will be increased by 
abnormal ingredients, such as pus, blood, mucus, albu- 
men, and sugar. 
Great care is necessary in collecting urine for ex- 
amination. The patient must be made to pass the 
entire secretion of twenty-four hours in one clean 
vessel, and from this total quantity a portion must 
be selected for examination, especially as regards the 
specific gravity. PART III. 
1. URINARY DEPOSITS. 
The urine is subject to deposits, or collections of 
solid and semi-solid substances, which, on account of 
their weight, subside when undisturbed. These de- 
posits consist of various materials, some of which are 
normal constituents of the urine, either separately or 
in combination, while others are foreign to its compo- 
sition altogether. 
It will be convenient to study urinary deposits by 
dividing them into these two classes. 
To THE FIRST CLASS BELONG URIC ACID, THE URATES, 
HIPPURIC ACID, THE PHOSPHATES, LIME OXALATE, EPITHE- 
LIUM, MUCUS, AND PIGMENTS. 
Uric Acid.-C5H4N4O3. This is another nitro- 
genous excrementitious substance very closely resem- 
bling urea; its chief difference being that it is not so 
prone to decomposition, and does not exist in the 
body in a free state, under normal conditions. 
Uric acid as soon as formed unites with a portion 
of the alkaline bases of the phosphates in the blood, 
and appears in the urine as sodium and potassium urates. 
It appropriates the sodium base in greater propor- 
tion and thus results the formation of sodium bi- 
phosphate and the acid reaction of the urine : 
Sodium phosphate. Uric acid. Sodium urate. Sodium biphosphate. 
NaaHPO4 + C5II4N4O3 = NaC5H3N4O3 + NaH2PO4. ANALYSIS OF THE URINE. 
31 
By oxidation uric acid is converted into urea and 
oxalic acid. 
There are various pathological conditions, not well 
understood, which give rise to free uric acid in the 
urine. Slight derangements in the digestive process, 
an excess of nitrogenous food or a want of alkalies will 
cause it to appear. When free it invariably presents 
itself as crystals, in most instances of a brown color. 
We have seen that uric acid is set free during the acid 
fermentation of urine, and that it is caused by the 
development and action of lactic acid, which decom- 
poses the urates. We can accomplish the same result 
by adding any strong acid to a test-tube containing 
urine, and allowing it to remain quiet for several 
hours. Then the characteristic uric-acid crystals will be 
seen attached to the sides and collected at the bottom. 
The dark brown color which almost invariably dis- 
tinguishes these crystals is derived from the coloring 
matter of the urine, for which they have a great 
affinity. Yet we some- 
times see almost colorless 
and pure crystals of uric 
acid; and these are apt 
to be small square plates 
and diamonds. 
The formation of crys- 
tals of uric acid may 
take place in the uri- 
nary passages, not only 
as a result of fermen- 
tation, but spontaneous- 
ly, as just indicated. In either case, gravel and calculi 
Fig. 3. 
Uric Acid. 32 
ANALYSIS OF THE URINE. 
are likely to result. It is very important to know 
whether a deposit in a specimen under observation 
has taken place previous or subsequent to its discharge. 
A deposit of uric acicU 
is of a dark brown co- 
lor, or if pure, it is a 
white, glistening sedi- 
ment, and under the 
microscope presents the 
greatest variety of crys- 
talline forms. In fact, 
so numerous are the 
shapes and arrangements 
of these crystals, that it 
is very difficult to de- 
scribe them. Yet when familiar with urinary crys- 
tals, they are not likely to confuse one. For it is only 
necessary to be able to recognize the other crystalline 
deposits, which vary little or none; and then when a 
brown crystal of an unusual form is seen, it is pretty 
safe to pronounce it uric acid.1 The most common mi- 
croscopic appearances are represented in Figs. 3 and 4. 
Tests.-Uric acid is insoluble in water, alcohol, 
and ether. It is soluble in an alkali, especially at a 
high temperature, and in sulphuric acid without de- 
composition, for it can be reprecipitated simply by the 
addition of water. 
There is a beautiful test for uric acid called the 
Fig. 4. 
Uric Acid. 
1 Where any doubt exists as to the identity of a colored crys- 
tal it should be dissolved in a little warm alkali and then treated 
with hydrochloric acid ; when if it be uric acid minute colorless 
plates will be detected after some hours, under the micro- 
scope. ANALYSIS OF THE URINE. 
33 
murexid test. Place the uric acid in a clean white 
porcelain capsule, and add a drop or two of nitric 
acid ; then evaporate over the flame of a spirit-lamp. 
When the nitric acid has been driven off, there will a 
pink stain show itself, which on the addition of a 
little liquor ammonia, assumes a beautiful purple color. 
Urates.-We have just seen that uric acid, simul- 
taneously with its formation, unites with a part of the 
loosely combined sodium and potassium of the phos- 
phates, and forms sodium and potassium urates. (It is 
a question whether the urine contains lime and ammo- 
nium urates.) The urates constitute the most frequent 
deposit met with in the urine. They appear as a dense 
cloud, which collects at the bottom of the urine-glass, 
and at the same time dusts the sides over with a 
powdery film. The color of the precipitate varies 
from a white to a red, according to the concentration 
of the urine, these substances having a great affinity 
for the coloring matter. 
The urates have very much the same characters, 
being soluble in an excess of water at a low temper- 
ature, and soluble in very small proportion of this 
medium under the influence of heat. It is this reason 
that, however concentrated the urine may be when 
voided, it is never turbid with the urates : but in a 
short time, the temperature falling, a cloudiness is visi- 
ble, followed shortly by a copious deposit. 
Knowing, then, that the urates are precipitated 
when the urine is deficient in water, we can under- 
stand how abstinence from drink, profuse perspira- 
tion, a watery discharge from the bowels, or any 
influence which lessens the normal quantity of water 34 
ANALYSIS OF THE URINE. 
in the system, or turns it away from the kidneys, will 
have the effect of concentrating the urinary secretion, 
and causing the urates to appear when the urine cools. 
Yet, a deposit of the urates is not on all occasions 
due to a suppression of the watery element; there are 
various disturbances of the system wherein their pro- 
duction and excretion is enhanced. 
In fevers, heart and liver diseases, the urates are 
deposited and are high colored. Irregularity in the 
digestive apparatus often induces their precipitation, 
and we often encounter a copious white deposit of 
them in the urine of teething children. 
A deposit of urates is almost always amorphous, 
though sometimes crystals of sodium urate are formed, 
and in the alkaline fermentation, ammonium urate. 
Crystals of sodium urate are met with in the chalky 
concretion common in the bodies of gouty persons, 
and also in the urine of such. In the concretions they 
are needle-shaped, arranged in rosettes of various 
degrees of perfection; 
while in the urine they 
assume a globular form, 
with irregular projec- 
tions along the surface. 
(Fig. 5, 5.) 
Ammonium urate 
crystals appear as very 
dark, spherical masses, 
and as dumb-bells. They 
form during the alka- 
line decomposition, and 
can only be seen under that condition. (Fig- 5, a.) The 
Fig. 5. 
a. Ammonium urate. 
b. Sodium urate. ANALYSIS OF THE URINE. 
35 
pathological indications of the crystalline urates are 
much more important than those attaching to the 
amorphous deposit, in that the former are deposited in 
the urinary tract, while the latter seldom are. 
A urine showing a precipitation of urates is always 
acid. 
Tests.-The urates disappear at a temperature of 
100 F. They are soluble in an alkali. The addition 
of an acid decomposes them, with the liberation of 
uric acid which very soon crystallizes. This pro- 
cess is very interesting to observe under the micro- 
scope. 
The murexid test for uric acid is applicable to the 
urates. 
Hippuric Acid.-C9H9NO3. Hippnric acid was 
formerly believed to exist only in the urine of her- 
bivora; but it is now generally conceded that it is 
quite constant, in small proportion, in the renal excre- 
tion of man. It increases under the influence of a 
vegetable diet, and can be made to appear in large 
amount by taking benzoic acid by the mouth-this 
substance being transformed into hippuric acid. Hip- 
puric has very similar characters to uric acid, and their 
compounds possess no important distinctions. 
The hippurates owing to their solubility never 
appear as deposits in urine. But they are readily de- 
composed by acids, when the hippuric acid will form 
a crystalline deposit in very concentrated solutions. 
Crystals of hippuric acid may then be encountered 
during the acid fermentation of urine or as a result 
of the addition of an acid in our manipulations. 
The acid is easily obtained from the urine pf the 36 
ANALYSIS OF THE URINE. 
horse, or by administering a quantity of benzoic acid 
to a man or dog. Then upon evaporating and adding 
hydrochloric acid, a visible deposit of hippuric acid is 
obtained, which under the microscope is seen to con- 
sist of long transparent prisms and needles. 
Tests.-These crystals may be mistaken for those 
of the phosphates. In such a case a drop of Hy- 
drochloric acid will decide the question; the phos- 
phates being thereby dissolved and hippuric acid un- 
affected. 
To the taste they are bitter. The watery solution 
reddens litmus paper, showing it to be a stronger acid 
than uric. 
Phosphates.-The alkaline phosphates of sodium 
and potassium, owing to their solubility, are never 
met with as deposits in urine. 
It is the earthy phosphates of lime and magnesium 
with which we have to deal as precipitates, and which 
are so frequently encountered. They present them- 
selves in three forms : the amorphous lime phosphate, 
the crystalline lime phosphate, and the ammonio-mag- 
nesium phosphate. 
Amorphous lime phosphate, with a small amount 
of magnesium phosphate,.is the common deposit of 
urine rendered alkaline by a vegetable diet or the 
administration of vegetable acids and their salts. It 
frequently becomes abundant after nervous exhaustion, 
as loss of sleep, mental application, etc. 
This deposit renders the urine milky when voided, 
and subsequently subsides as a not very abundant 
white collection at the bottom of the vessel. 
Crystalline lime phosphate is sometimes met with. ANALYSIS OF THE URINE. 
37 
The crystals are perfectly colorless needles arranged 
in radiating bundles. They are sometimes called the 
stellar phosphate. 
Roberts considers their presence indicative of some 
grave disorder, having discovered them in diabetes, 
cancer, and phthisis. It may, however, appear in 
normal urine when much lime has been introduced 
into the system. 
The ammonio-magnesian phosphate is a crystalline 
deposit, the result almost always of the alkaline fer- 
mentation and the decomposition of urea. This de- 
posit very seldom takes place inside the body, and 
wdien it does, it is the result of retention of urine. 
Under these circumstances, decomposition takes place, 
and the ammonium, which is one of the results, unites 
with the magnesium already present, and the deposit 
is formed. The ammonium normally present in the 
urine is seldom sufficient to constitute this deposit 
without the decomposition of urea. 
The earthy phosphates are only soluble in an acid 
fluid, the acid salt sodium biphosphate holding them 
in solution in the urine. Whenever the urine becomes 
neutral or alkaline from a diminution in the quantity 
of uric acid or from an excess of alkaline ingredients 
in the blood, or from retention and consequent de- 
composition, the earthy phosphates will be thrown 
down. 
Notwithstanding the great amount of literature on 
the subject, " phosphaturia," with the exception of 
that induced by the alkaline decomposition, has 
not much clinical significance. Under the micro- 
scope the phosphates appear as amorphous gran- 38 
ANALYSIS OF THE URINE. 
ules and, in the case of the ammonio-magnesian, 
large glistening prismatic crystals. When crystallization 
takes place rapidly we of- 
ten see beautiful feathery 
forms like those represent- 
ed in the lower portion of 
the accompanying figure. 
Tests. - The earthy 
phosphates are soluble in 
an acid solution; and 
are less soluble in hot 
than cold media. A drop 
or two of any acid will 
cause them to disappear. 
Lime Oxalate.-Lime oxalate is found in urine 
as a result of the acid fermentation, and also in per- 
fectly fresh and undecomposed specimens. Indeed, 
the formation may take place in the body. It is 
claimed by many that oxalic acid is a normal constitu- 
ent of the urine, and that it, like the other ingredients, 
is subject to variation, and when furnished in a little 
more than the usual amount, it unites with the lime 
already present, and the oxalate is the result. It is 
probably derived from uric acid by oxidation. 
It appears as a whitish powder, and never is very 
abundant. 
A great deal has been said concerning the signifi- 
cance of oxalate of lime in the urine, under the heads 
of " Oxaluria " and " Oxalic Diathesis." 
A long train of symptoms were attributed to its 
presence in the urine, such as nervous prostration, 
despondency, loss of sexual power in the male, etc. 
Fig. 6. 
Ammonio-magnesian phosphate. ANALYSIS OF THE URINE. 
39 
And although there is not as much interest in the sub- 
ject now as formerly, I have reason to believe that the 
doctrine is not altogether false. 
But the chief significance which attaches to this 
deposit is the possibility of the formation of a stone; 
and as this variety is very hard and rough, it is espe- 
cially dreaded. 
Tests.-A deposit of lime oxalate is always crys- 
talline, and the microscopic appearances are sufficient 
to distinguish it. The crystals are of two kinds, 
octahedra and dumb-bells, each being colorless and 
transparent. 
The octahedra, which are by far the most common, 
consist of two pyramids placed base to base and vary- 
ing in size from about of an inch to that which 
may bo seen by the un- 
aided eye. 
The dumb-bells are 
h i g h 1 y characteristic. 
Occasionally an oval 
mass is seen which ap- 
pears to be a dumb- 
bell in process of forma- 
tion. 
Lime oxalate is solu- 
ble in strong mineral 
acids. 
Epithelium.-Every specimen of urine contains 
some epithelium, which in certain diseases of the kid- 
neys and urinary passages is greatly increased. In the 
healthy state, we find that from the bladder in the 
greatest amount; and in the female, vaginal epitheli- 
Fig. 7. 
Lime oxalate : Octahedra and dumb- 
bells. 40 
ANALYSIS OF THE URINE. 
um will be mingled with the urine, if great care is not 
exercised. 
As the genito-urinary apparatus is lined with epi- 
thelium of different forms throughout its extent, it is 
well to know what are the peculiarities which distin- 
guish that of one region from that of another. 
Vaginal epithelium is very common in the urine of 
women, especially when there is any discharge from 
the vagina or uterus. It is easily recognized by its 
large size, thinness, wa- 
vy outline, and disposi- 
tion to fold upon itself. 
(Fig. 8, Z>.) The female 
urethra contains very 
similar forms, but they 
are somewhat smaller. 
The urethra is lined 
by epithelium, which 
differs in the spongy 
and prostatic portions. 
From the meatus to the 
prostatic region, the cells are round and oval. About 
the prostate, they are spindle-shaped, caudate, and 
irregular. 
In the bladder, the size is increased, and they are 
often seen still united by their edges. (Fig. 8, ai) 
Those from the ureters possess the same characters, 
only are of smaller size. 
The pelvis of the kidney contains small round and 
oval cells, of the flat variety, which are a little larger 
than tubular epithelium. 
The epithelium of the kidney tubules is a very 
Fig. 8. 
Epithelium : a, Bladder: 5, Vaginal : 
c, Renal. ' ANALYSIS OF THE URINE. 
41 
complicated one, but it is sufficient for our purposes to 
know that it is spherical, about twice as large as a 
blood-globule, from which it may be distinguished, 
should any doubt arise, by its nucleus. It usually 
comes away from the kidney adhering to fibrinous 
moulds of the tubes, but may often be seen floating 
free in the urine. (Fig. 8, c.) 
When epithelium is present in abundance, it will 
be accompanied by an increase in the natural amount 
of mucus, and the two substances settle to the bottom 
of the urine-glass, intimately mingled. Under the 
microscope, patches of epithelium-cells will be seen 
held together by the adhesive mucus. 
Epithelium appears in the urine as a result of any 
inflammation or mechanical irritation of the mucous 
membrane of the urinary tract. 
Mucus.-There is always a small amount of mucus 
in healthy urine, especially in that first passed in the 
morning. It is to the presence of mucus, however 
limited in quantity, that the decomposition of urine 
is due. For if the urine be filtered, it may be kept 
for an indefinite time without any change manifesting 
itself. (Scherer.) 
Mucus appears as a deposit at the bottom of the 
glass, or may entangle air-bubbles and float just below 
the surface. It has the color of the urine contain- 
ing it, and when separated on a filter, is perfectly 
transparent and glairy. AH amorphous and crystal- 
line deposits, blood, pus, casts, etc., -become mingled 
with it and interfere with the transparency, or may 
mask its presence. 
Excessive secretion of mucus may be the result of 42 
ANALYSIS OF THE HEINE. 
mechanical irritation, ammoniacal decomposition of 
the urine in the bladder, or chronic inflammation. 
Sometimes there is such an amount produced that the 
whole volume of urine will be rendered semi-solid, 
and will rope like the white of egg. 
Tests.-Mucus is liable to be confounded with pus, 
especially when colored by amorphous deposits. It 
may be distinguished from pus by its ropy and viscid 
nature, and, best of all, by its appearance under 
the microscope, mucus having no corpuscular ele- 
ments. 
Pigments. - We frequently encounter peculiar 
little bodies under the microscope, possessing indefi- 
nite shapes and appearances, and attracting the atten- 
tion of the observer by their high color, being either 
red, dark brown, or yellow. 
They sometimes resemble epithelium, but show no 
nucleus; again, they may be an irregular mass, unlike 
any thing we are familiar with. What their origin 
and significance is, is an unsettled question. They are 
likely to occur in any specimen of urine, but Roberts 
states that in several cases of chronic Bright's disease, 
he has noticed a great increase of them. 
It has been thought that they might be epithelium- 
scales, stained by the coloring matter of the urine, as 
this is known to undergo changes whereby other colors 
are produced. The oxidation of indican probably has 
something to do with the matter. 
One other source, and a common one, of these col- 
ored specks under the microscope, it is important to 
guard against: it is that they may exist in the glass 
slides or covers; for these articles are polished with ANALYSIS OF THE URINE. 
43 
a red powder, particles of which become imbedded in 
its minute irregularities. 
II. 
Second class of deposits : those which are foreign 
to the composition of the urine under any form. 
This class differs from the preceding in that most 
of the deposits have a pathological significance. ' 
The following are included under this head : blood, 
CASTS, PUS, OIL, CHYLE, SPERMATOZOA, CYSTINE, KEISTINE, 
CONFERVOID VEGETATIONS, and BACTERIA. 
Blood.-Blood may be mingled with the urine 
from either of the organs through which it has to pass. 
Urine containing blood may or may not give evidence 
of it when first passed. It depends upon the quanti- 
ty of blood present whether there will be any distinc- 
tion as regards color. 
If the quantity is small, we probably will not sus- 
pect its presence until the urine has remained undis- 
turbed some hours in a urine-glass, when a red line or 
layer will be discernible at the bottom. (It must not 
be confounded with uric acid, which is of a dark brown 
color, instead of a blood-red.) The deposit consists of 
the red corpuscles. 
We may have urine stained with blood, and yet 
containing no corpuscles, or at least a very few. Thus 
the blood may be represented in the urine under these 
two conditions: hwmaturia, where the elements of 
the blood are present under their natural forms; 
liamaglobinuria, where the red corpuscles appear to 
have disintegrated or dissolved, and only a few per- 44 
ANALYSIS OF THE UKINE. 
feet ones can be found. It is necessary to consider 
these apart. 
IlmmaturuL.-In hsematuria the red corpuscles 
are present, and impart to the urine a more or less 
red or smoky hue. The corpuscles have escaped from 
the circulation as a result of ruptured vessels some- 
where in the urinary tract, which may be due to vio- 
lence, as falls or blows, Bright's disease, temporary 
congestion, ulcers, abscess, and the lacerations attend- 
ing the presence of stone and gravel. Haematuria is 
common in some irruptive fevers, notably scarlet; it 
is very frequently induced by the administration of 
turpentine and cantharides, and it may occur vica- 
riously for menstruation and a hemorrhoidal flux. 
The urine of women is extremely liable to contain 
blood during the menstrual period, from admixture 
outside the body. 
H&maglobinuria.-This curious affection is charac- 
terized by a chocolate-colored urine, due to the pres- 
ence of haemoglobin, which has transuded through the 
blood-vessels, and appears independent of the blood 
corpuscles which are thought to have dissolved. Dark 
granular and hyaline casts are frequently found, as 
well as amorphous matter and octahedra of lime 
oxalate. 
The occurrence of the blood-coloring matter in the 
urine independent of the corpuscles characterizes a 
disease which has recently received considerable atten- 
tion. The chief features of hsemaglobinuria are, first 
of all, its intermittent character ; and second, the total 
absence, in the majority of cases, of symptoms attrib- 
utable to disorders of the urinary apparatus. ANALYSIS OF THE URINE. 
45 
In short, the general opinion is that it is a form 
of malarial poisoning, and it is consequently fre- 
quently spoken of as malarial or paroxysmal hsema- 
turia. 
Whether there is a marked absence of the red 
corpuscles in this disease is a question upon which 
authors disagree. In a case under my own observa- 
tion there was never any scarcity of them during the 
attacks. Dr. Legg1 attributes the failure of some to 
find them to their rapid disappearance in urine when 
kept for some hours. The urine contains albumen 
during the paroxysms, but is generally entirely free 
from it in the intervals. 
Tests.-A rupture permitting the escape of the 
blood corpuscles will, of course, allow of the passage 
of albumen, and consequently we always find this sub- 
stance in haematuria. The corpuscles themselves are 
albuminoid, and were there no free albumen present, 
would respond to the heat and nitric acid tests. But 
the most positive proof of the presence of blood is 
furnished by the appearance of the sediment under 
the microscope. This instrument, with a J-inch lens, 
will reveal the corpuscles. They are bi-concave discs, 
about -g-oVu °f an inch in diameter. By careful focus- 
ing, their form can be distinguished, the outline and 
centre never being equally distinct at the same time; 
then if a current be excited in the drop under the eye, 
by touching the side of the thin glass cover with a bit 
1 On Paroxysmal Haematuria: St. Bartholomew's Hospital 
Reports. London. 1874. Here a full resume of the subject is 
given. 46 
ANALYSIS OF THE HEINE. 
of blotting-paper, the corpuscles will roll over and 
over and show their thin 
edges and concave sur- 
faces. All these points 
are illustrated in Fig. 
9, a. 
There are changes, 
however, which blood 
corpuscles undergo when 
subjected to unnatural 
influences. In the blood 
serum, they maintain 
their shape and size, but 
immersed in a watery 
solution like urine, they immediately begin to absorb 
water, and very soon have swollen to twice their 
natural size, lost their color and bi-concave character, 
and have become spherical. When allowed to dry, 
they shrivel and become so irregular that should one 
not be familiar with the fact, he might not suspect 
their presence. When in this condition, the addition 
of a drop of water containing a little common salt will 
cause them to assume something of their original shape. 
In the event that we should fail to detect any 
corpuscles when blood is suspected, they having dis-ft 
solved or never having been present, it is only neces- 
sary to apply heat and nitric acid. Then if there be 
haemoglobin present, it will assume a very dark color, 
become entangled with the coagulated albumen, and 
if allowed to rest, will collect at the bottom of the 
test-tube as a chocolate-colored mass, with the trans- 
parent urine above. 
Fig. 9. 
Blood Corpuscles: a, Normal; b Swol- 
len by absorption ; c, Shriveled from 
lack of water. 47 
ANALYSIS OF THE HEINE. 
The spectroscope will detect exceedingly small 
quantities of haemoglobin in solution, and should any 
doubt exist as to whether blood is present in a speci- 
men of urine, this instrument will very readily 
determine.1 
Casts.-Casts are moulds of the uriniferous tubules. 
The kidney is largely supplied with capillaries, which 
form a complex network about the tubules, and any 
congestion of the organ is very apt to result in an exu- 
dation from the blood-vessels into these little canals, of 
a peculiar substance, the composition of which is not 
w'ell understood. This substance has the property of 
spontaneous coagulation, and thus adapts itself to the 
shape and size of the tube, and the urine collecting be- 
hind, washes it out, and it subsequently appears in the 
urine as a cast. The pressure which induces this exu- 
dation is also sufficient to cause a transudation of the 
liquid portion of the blood; and it results that albu- 
minuria always exists where casts are formed. 
Casts are not all of the same diameter. One reason 
for this is, that the tubules themselves vary in size in 
different parts of their course. Another cause de- 
pends upon the fact that in certain affections of the 
kidney, the epithelium lining the tubules is detached 
and voided with the urine. Now, a tubule thus de- 
nuded is larger than it was previous to the shedding 
of its lining, and consequently wTill afterward form a 
larger cast. 
Casts differ as regards appearance. The coagulable 
1 See Dalton's Physiology. Pliila. 1875. P. 248. And a 
paper by the author, The Spectroscope ; its Value in Medical 
Science. Trans. N. Y. Academy of Medicine. 1876. 48 
ANALYSIS OF THE URINE. 
matter which transudes into the tubules is perfectly 
transparent and structureless, so far as has been ascer- 
tained. The theory is, that this material when col- 
lected in the tubules fills and distends them; this dis- 
tention causes pressure upon the epithelium lining 
which adheres to and sinks into it to a certain extent. 
Now, when the cast is washed out by the pressure of 
urine from behind, it pulls slightly upon its epithelial 
attachments, and if the cells be detached or detachable, 
through degeneration, they must come along with it. 
It follows, then from the above description that if 
the kidney is not diseased to such an extent as to allow 
of desquamation of its epithelium, or, on the other 
hand, if the epithelium has been previously shed, 
leaving the tubule bare, the cast will come away and 
appear in the urine unaltered as regards its structure, 
and will appear as a transparent mould of a renal 
tubule. These we call hyaline casts. 
It is not necessary, after the above explanation, to 
say more than that when the epithelium does show 
itself adhering to the cast, we recognize another va- 
riety-namely, epithelium casts. 
And suppose these epithelium cells to have under- 
gone a fatty degeneration, we should then have fatty 
casts. Go a little further, and imagine the epithelium 
to have suffered what is known as a granular degene- 
ration, then we should find granular casts. 
Besides these varieties, we meet with several others, 
having nothing to do, however, with the epithelium 
element. These are Wood, pus, and waxy casts. 
As it is my purpose to give a few hints respecting 
the practical bearing of the subjects treated of in this ANALYSIS OF THE URINE. 
49 
manual, it will be necessary to glance at each one of 
these casts separately. 
Hyaline Casts, as their name implies, are struc- 
tureless and transparent. They vary in diameter from 
the width of one blood corpuscle to that of three. 
Their length is not definite. Being transparent, they 
are difficult to find, and on this account are often 
overlooked. 
The mode of formation of these casts has been 
stated above; and therefore when they are small, it is 
fair to suppose the kidney yet to be comparatively 
sound, and the cause of the symptoms which led to 
the examination of the urine, not of long standing. 
At any rate, we meet with small hyaline casts in acute 
Bright's disease. But what does a large hyaline cast 
signify ? It tells the story of a more advanced dis- 
ease, and its transparency is not due to a refusal of 
the epithelium to come 
off with it, and thereby 
asserting its healthiness; 
but, on the contrary, its 
very size bears evidence 
of the previous shed- 
ding of the epithelium, 
and of the present nudity 
of the tubule whence it 
came. 
A cast of this last va- 
riety may be perfectly 
transparent, or it may be dotted over with a few 
specks of granular matter, and perhaps here and there 
a broken-down epithelium cell. 
Fig. 11. 
a, Hyaline casts ; 5, Epithelium casts. 50 
ANALYSIS OF THE URINE. 
It is evident that in chronic disease of the kidney, 
both small and large hyaline casts will be fonnd in the 
urine, because the organ is not equally diseased in all 
its parts. (Fig. 11, a.) 
Epithelium Casts.-We have seen that the effu- 
sion of fibrinous material into the uriniferous tubules 
undergoes spontaneous coagulation, and is afterward 
washed out by the urine which collects behind it; and 
that if the epithelium lining the tubules be detached 
or detachable, it will adhere to the mould, and be 
afterward found in that situation in the urine. 
The cells may be scattered upon the surface of the 
cast or may present a regular arrangement, the same 
which existed while they yet occupied their normal 
place in the kidney. At the same time, there will be 
found free epithelium in the urine. 
Epithelium casts are found in the urine of persons 
convalescing from scarlet fever, and in acute Bright's 
disease. In pneumonia and severe inflammatory dis- 
eases, they are the prevailing variety of cast. (Fig. 11, Z».) 
Fatty Casts are epithelium casts in which the 
epithelium has undergone a fatty degeneration. The 
cells appear to have been filled with fat and to have 
burst, discharging their oily contents into the tubules, 
where they have adhered to the fibrinous effusion. 
The cast will be more or less covered with these 
minute oil-drops and epithelial cells, which are also 
full of oil or fat. At the same time, fatty cells and 
free fat will be seen floating in the urine. (Fig. 12, «.) 
Casts of this description are found in chronic affec- 
tions of the kidney, and their presence in the urine is 
a very grave sign. ANALYSIS OF THE UBINE. 
51 
Granular Casts represent the epithelial element 
in a state of granular degeneration. What this granu- 
lar material is, is not very well understood, though 
supposed to be fat in a state of fine subdivision. The 
cell may have entirely disappeared, or may remain, 
filled with these granules. These casts, appearing in 
abundance, are indicative of serious changes in the 
kidneys, and their presence determines an unfavorable 
prognosis. Fig. 12, 5, 
illustrates the granular 
cast. It will be noticed 
that they are dark, and 
have ragged extremities. 
Blood Casts. - If 
there is a hemorrhage in 
the kidney when the 
conditions are present 
which induce the for- 
mation of casts, the 
blood-globules will attach 
themselves to the mould, sometimes very regularly, 
and form what is called a blood cast. At the same 
time, they will be present in a free state in the urine. 
Blood casts are common in scarlet fever and any 
form of acute Bright's disease. They do not gen- 
erally present themselves for any length of time, 
being the result of a hemorrhage which is not apt to 
continue. 
Pus Casts.-These are rare. They are met with 
where the kidney is the seat of abscess. Yet cases 
where abscess was found at post-mortem examina- 
tions, and furnished no pus casts during life, are re- 
Fig. 12. 
a, Fatty casts ; b, Granular casts. 52 
ANALYSIS OF THE URINE. 
corded. When present, they have the appearance of 
pus corpuscles adhering to the fibrinous cast. The 
urine will at the same time contain more or less pure 
pus. To prevent confounding pus corpuscles and 
epithelium, it is well to note that they are smaller, 
and the addition of acetic acid will render the cell- 
wall of the pus corpuscle transparent, and reveal a 
distinct granular nucleus. 
Amyloid or Waxy Casts are the large, transpa- 
rent, and waxy-looking objects which are occasionally 
seen, and are thought by some to denote a correspond- 
ing condition of the kidney. But nothing definite is 
yet known concerning them. They sometimes present 
a few transverse markings and fissures, as though they 
were very brittle and had been broken. 
This completes the list of casts, and it may be use- 
ful to sum up their clinical significance. 
The appearance of a few small hyaline casts may 
be, and probably is, the result of a congestion in the 
kidney of recent origin. 
Epithelial and hyaline casts are very frequently 
found in the urine of patients recovering from scarlet 
fever, pneumonia, bronchitis, and congestive diseases 
generally. 
Fatty, granular, and waxy casts have a grave signif- 
icance ; yet the appearance of one or two of them 
should not induce us to pronounce too certainly the 
fatal termination of the case. 
It is the continuance of a prevailing hind of cast 
which is most to l)e relied upon in the way of diagno- 
sis and prognosis. 
Detection.-We depend upon the microscope al- ANALYSIS OF THE URINE. 
53 
together for the detection of casts, and considerable 
skill is sometimes necessary to distinguish between 
them and certain extraneous matters. The most fre- 
quent sources of confusion in this respect are cotton 
fibres and feathers. Cotton fibres are striated, and 
are apt to be folded or 
twisted. A particle of 
feather or hair has de- 
finite anatomical char- 
acters, which should be 
too well known to allow 
of a mistake. The ap- 
pearances of these acci- 
dental substances are 
shown in Figure 10. 
As a guide, it may be 
said of casts, that they 
are generally rounded at one extremity, have parallel 
sides, and are not flexible enough to allow of folding 
or twisting. 
Casts are liable to disintegrate, and may become so 
changed as to escape detection if allowed to remain 
in decomposing urine. Therefore it is important to 
look for them before decomposition begins. The 
lightest cast will have fallen to the bottom of the 
urine-glass in ten or twelve hours. Then gently pour 
away all the urine except about two drachms, and from 
this, with the aid of a glass tube, take up, from the 
bottom, a drop or two for microscopic examination. 
(See last page for detailed directions for microscopic 
manipulations.) 
Pus.-There are various causes giving rise to pus 
Fie. 10. 
a, Hairs ; b, Cotton fibres; c, Starch 
grains ; Air-bubbles ; e, Feathers. 54 
ANALYSIS OF THE URINE. 
in the urine. Cystitis, pyelitis, gonorrhoea-in fact, an 
abscess or ulceration communicating with the urinary 
tract at any point. In women, purulent discharges 
from the vagina are likely to confuse us as to the ori- 
gin of the pus found in their urine. 
Urine containing pus is turbid when voided, and, on 
standing, deposits a whitish cloud of a ropy consisten- 
cy, which distinguishes it from an inorganic deposit. 
It decomposes very readily and emits a nauseous odor. 
Tests.-Pus consists of a fluid and a corpuscular 
element. The fluid is albuminous, and will be acted 
on accordingly by heat and nitric acid, although puru- 
lent urine never gives a marked coagulum; and this 
fact serves as a good test, the turbidity not disappear- 
ing with heat and nitric acid, and at the same time 
scarcely becoming more marked. 
Liquor potassa causes a semi-solid, gelatinous pre- 
cipitate. 
The microscope will reveal the pus corpuscles, and 
this is conclusive evi- 
dence. These bodies are 
a little larger than the 
blood corpuscles, color- 
less and spheroidal. 
They are made up of 
cell-wall, granular con- 
tents, and nuclei. By the 
addition of a drop of 
acetic acid, the cell-wall 
is rendered transpa- 
rent, and the nucleus is 
brought sharply into view. (Fig. 13.) 
Fig. 13. 
a, Pus corpuscles; d, Effect of acetic 
acid. ALALYSIS OF THE URINE. 
55 
Oil.-It has been asserted that oil is a constituent 
of normal urine in very small proportion, and only 
detected after a careful analysis. It, however, sometimes 
makes its appearance in quantities sufficient not only 
to be recognized under the microscope, but visible to 
the unassisted eye. 
It may present itself either as distinct oil-drops, as 
granules, or as a very fine emulsion, each particle of 
which appears as a mere point under the microscope 
(this latter condition we have in chylous urine). If 
either of these forms of fat are in the urine, we shall 
have a layer of it on the surface when allowed to rest. 
In the case of granular fat, the layer will appear 
creamy; where the globules are of any size, a yellow, 
oily layer will be seen. 
Oil globules were detected in the urine of a man 
who was taking cod-liver oil by Roberts. Fatty de- 
generation of the kidneys is accompanied by oil in 
the urine. Much speculation has been indulged in 
concerning the source of oil where there is no recog- 
nizable affection of any organ. It is known that 
during digestion, the blood is loaded with chyle, and 
may, under circumstances not understood, permit it to 
escape into the urine. (See " Chylous Urine.") 
A frequent source of oil-drops in the urine is the 
vessel in which it is collected, or the bottle in which 
it is brought to the physician, and, in many instances, 
the passage of catheters and sounds, which are always 
oiled before being introduced. 
Tests.-Oil is soluble in ether. But if it be in 
small quantity, it often becomes necessary to first 56 
ANALYSIS OF THE URINE. 
extract it with ether, and afterward evaporate almost 
to dryness before any traces of it can be seen. 
Under the microscope, oil-drops are distinguished 
by their perfectly circular outline, difference in size, 
and solubility in ether. As seen in urine, the glo- 
bules are never very large, and might be mistaken for 
blood corpuscles. But their sharp-cut, bright outline, 
absence of color, and peculiar properties mentioned 
above, can scarcely fail to identify them. 
Chylous Urine.-Chylous urine has ever been 
one of the most interesting, and at the same time puz- 
zling conditions with which we have to deal. In appear- 
ance, it is milky, and on standing collects in a creamy 
layer on the surface. There is always more or less 
blood, ffbrine, and albumen present. Sometimes it 
coagulates spontaneously when passed, and very closely 
resembles blanc mange. Cases are related where it 
coagulated in the bladder and completely blocked up 
the urethra, from which it was extracted in long flakes. 
It is a rare affection, and but few cases are reported. 
Writers disagree widely concerning its pathology and 
symptoms; but without going over the history at 
length, the following are the main points regarding 
this peculiar disease : 
It is most common in warm climates; makes its 
appearance suddenly, and as suddenly ceases, to re- 
appear again after months or even years. Sometimes 
it coagulates spontaneously, like lymph, and again 
does not undergo this change. The milkiness is more 
marked after meals. The older authors considered 
the kidneys and the assimilative functions of the 
system to be at fault and diseased. But casts have ANALYSIS OF THE URINE. 
57 
been searched for in vain, and several post-mortem 
examinations of individuals who were affected with 
this disease have failed to afford evidence of altera- 
tions in any organ. So that now it begins to be 
stated that the chyle and lymph are discharged directly 
into the urinary passage from the lymphatic vessels 
themselves; and Roberts especially advances this 
opinion, having noticed, in patients voiding chylous 
urine, appearances which indicated disease of the 
lymphatics. 
We had an opportunity recently of examining a 
specimen of chylous urine, the history of which it 
may be well to relate. The patient had resided in 
the South most of his life. About ten weeks before, 
he had attempted to pass his urine five times within 
an hour. This necessitated great straining, and he 
was suddenly alarmed by a severe pain and a discharge 
of blood and milky urine. (The pain was located in 
the, prostatic urethra, and as he had undergone an op- 
eration for stone a few years before, it and the hem- 
orrhage were referred to that cause.) This condition 
came and disappeared several times until we saw the 
urine. The patient stated that the milky fluid some- 
times was perfectly free from any urine. He was able 
to know this from the fact that the uriniferous odor 
was entirely absent, and, moreover, the bladder had 
just been emptied only a few minutes before. 
This urine did not coagulate spontaneously. It 
contained blood, and had an alkaline reaction. 
Tests.-Besides the characters above stated, other 
tests are scarcely necessary. Chyle is oil in a state of 
emulsion. 58 
ANALYSIS OF THE URINE. 
Under the microscope, the granules appear very- 
minute. 
Spermatozoa.-The spermatic elements some- 
times become mingled with the urine in sufficient 
numbers to form a deposit. As a deposit, they re- 
semble mucus and pus, though never so abundant. 
Their presence may be accounted for as a result of 
coition or an involuntary discharge of semen. This 
latter may be continuous and constitute spermator- 
rhoea. With the exception of this last-named condi- 
tion, the presence of spermatozoa in the urine is 
without significance. 
Tests.-The semen is albuminous, and will be ren- 
dered cloudy, to a more or less degree, by heat and 
nitric acid. But the microscope will decide whether 
the albuminous reaction is due to the presence of 
semen, in that it will reveal the characteristic fila- 
ments or spermatozoa. If the specimen be recent, they 
will be in active motion. Spermatozoa are possessed 
of a head and tail-like extremity, the former being 
slightly flattened from 
before backward. Their 
length is about of 
an inch. Fig. 14, a.) 
Cystine.-This is a 
substance but rarely met 
with, compared with 
other deposits. Its 
source is not positively 
known, though supposed 
to be the liver. A re- 
markable fact concerning it is its liability to run in 
Fig. 14. 
a, Spermatozoa ; b, Bacteria. ANALYSIS OF THE URINE. 
59 
families. The most important clinical significance 
attaching to it is its liability to form a calculus ; other 
wise cystine may appear in the urine of an indi- 
vidual for years and not depreciate the health. 
Urine containing cystine has usually an oily ap- 
pearance, and deposits a light, rose-colored powder. 
Decomposition takes place very soon, and according 
to Dr. Bird, the color changes to a green. Cystine 
contains sulphur, which in the process of decomposi- 
tion is evolved as sulphuretted hydrogen. 
Tests.-Acetic acid will cause a further precipitate 
to take place. It is insoluble in the vegetable acids, 
and is not dissolved by heat. It is soluble in am- 
monia and mineral acids. 
The crystals are six-sided plates, and colorless. If 
a solution of cystine be placed in a shallow dish with 
a little ammonia, evapo- 
ration will cause a de- 
posit of the pure crys- 
tals. Cystine crystals 
are easily distinguished 
from uric acid by their 
solubility in nitric acid. 
(Fig. 15.) 
Keistine.-It was at 
one time thought that 
the urine of pregnant 
women offered peculiari- 
ties by which the pregnant state could be diagnosed. 
It was stated that there would form upon the surface 
of such urine a layer of cheesy matter unlike any ap- 
pearance presented when the subject was not pregnant. 
Fig. 15. 
Cystine. 60 
ANALYSIS OF THE URINE. 
The name keistine (cheesy) was given to this forma- 
tion. The results of observation, however, have been 
so conflicting that the profession, to-day, do not regard 
the formation as a distinct one, but attribute the phe- 
nomenon as one and the same thing as the alkaline 
fermentation, which is hastened in pregnancy by the 
presence of an increased amount of animal matter, such 
as epithelium and mucus from the vagina and bladder. 
VEGETABLE FUNGI. 
There are several microscopic vegetable growths 
which invade the urine. The most important are the 
PeniciUlum glaucum, or common mould, and Sac- 
char omyces, or sugar fungus. 
Penicillium G1 au- 
cum.-This is the com- 
mon mould so frequently 
seen on old leather and 
articles kept in d a m p 
places. It is apt to ap- 
pear in urine wdien left 
exposed at ordinary tem- 
perature, but whether 
there will be a visible 
deposit depends upon 
the extent of the growth. 
This fungus as seen under the microscope con- 
sists of two distinct parts: the mycelium and the 
spores. 
The mycelium or vegetative portion is an irregular 
interlacement of fibres which are immersed in the 
Fig. 16. 
Penicillium Glaucum. ANALYSIS OF THE URINE. 
61 
urine. From these arise slender stalks which shoot 
upwards towards the surface, and on reaching it de- 
velop the spores upon their extremities. 
It is chiefly by the arrangement of the spores upon 
the stalk that we are able to distinguish the different 
fungi having a mycelium. In the variety under con- 
sideration they are disposed in diverging rows and 
have a peculiar whitish-green color; hence its name. 
{Penicillus,brush-like, and yAawcof, sea-green.) 
The spores ripen and fall into the urine or are 
blown away to other quarters. In either case, if the 
locality be a favorable one, they immediately begin to 
elongate and then to branch, until very soon a myce- 
lium of new growth is formed. 
There are other varieties of vegetable fungi very 
similar to penicillium liable to be encountered in a 
microscopic inspection of urine, but none of them have 
any special interest, their presence being due to the 
ubiquitous nature of their spores. 
Saccharomyces.-This is the term applied to 
the variety of fungus found in solutions undergoing the 
vinous fermentation-conversion of sugar into alcohol 
and carbonic acid. It will make its appearance in any 
saccharine mixture containing albuminous matter and 
subjected to a temperature of about 70° F. Saccha- 
romyces is therefore especially interesting to the phy- 
sician in that its appearance in urine is a certain indi- 
cation of the presence of sugar. 
This plant consists simply of cells of about 10 
micro-millimetres an inch) in diameter, of an 
oval or spheroidal shape, generally colorless and hav- 
ing a granular appearance, with one or more germinal ANALYSIS OF THE URINE. 
62 
bodies in their interior. There are several species, 
differing chiefly in the size and shape of the cells; 
that of beer-yeast is known as " Saccharomyces Cere- 
visiae." Saccharomyces multiplies by budding, and 
during the active state 
the cells present appear- 
ances indicative of the 
process; from the young 
bud just beginning to 
emerge from the parent 
cell, on through the vari- 
ous stages of its growth 
until it has attained an 
equal size, and finally 
separates. Occasionally 
the new cell puts forth 
buds before it becomes independent and gives rise in 
this wray to a chain or irregular collection of cells, as 
seen in the figure? 
Bacteria (little rods).-This is the general term 
given to the minute vegetable organisms invariably 
present in putrefying animal and vegetable matter. 
They consist of simple cells filled with a colorless fluid 
and presenting several varieties of form: spheroidal 
(micrococcus), curved (vibrio), twisted (spirillum), and 
oblong, (bacterium). 
The varieties most common to decomposing urine 
are bacterium termo, vibrio, and micrococcus; but 
unless we employ very high powers of the microscope 
Fig. 17. 
Saccharomyces cerivisiae. 
1 For an elaborate description of these and similar fungi, see 
Botanische untersuchungen uber die Alkoholgarungspilze. By 
Max. Reess, Leipsic. 1870. ANALYSIS OF THE HEINE. 
63 
these last will not be detected, on account of their 
very minute size. 
Bacterium termo measures about -g4-0- mm. (-hot 
of an inch) in length by about t 0\-q- mm. °1 an 
inch) in breadth. Vibriones are of about the same 
width, but three or four times longer. 
The most remarkable feature connected with these 
bodies is their active motion, which is seen to consist 
of rapid vibrations with the effect to propel the cell 
with considerable velocity through the fluid. 
The appearances presented by bacteria of two cells 
connected together is due to their mode of multiplica- 
tion being by division; if closely watched the sepa- 
ration will very soon be seen to be complete. PART IV. 
ACCIDENTAL INGREDIENTS WHICH DO NOT FORM 
DEPOSITS. 
There are certain abnormal substances frequently 
present in urine, but which are in such perfect solu- 
tion as to afford no evidence of their presence by 
way of a deposit, and with the exception of bile may 
have little or no effect upon the natural color. 
Such are albumen, sugar, and bile. 
Albuminuria.-We have seen that urine con- 
taining pus, blood, or semen will necessarily be albu- 
minous, but we come now to consider albuminuria 
which is not due to the presence of either of the above 
but which is occasioned by the escape of the albumin- 
ous constituents of the blood through the kidneys. 
This phenomenon may result from 
1. Mal-assimilation of albuminous food. 
2. Mechanical obstruction to the renal circulation. 
3. Chronic degeneration of the kidneys. 
We know that in order to be assimilated albumin- 
ous substances must first be converted into albumin- 
ose, and subsequently into blood-albumen. Now it is 
a well established fact that if this process is not carried 
out and albumen enters the circulation imperfectly 
digested, it is immediately eliminated by the kidneys. 
It is therefore easy to understand how deranged diges- ALALYSIS OF THE URINE. 
65 
tion or excessive indulgence in albuminous food will 
be sometimes followed by albuminuria. 
Mechanical obstruction will include all of those 
conditions which interfere with the normal circulation 
of the kidneys and induce congestion. The cause may 
be an inflammation of the kidney itself as in nephritis 
(Bright's disease); it may be due to passive congestion 
from hepatic or cardiac disease or the pressure of a tu- 
mor, and it is induced by the specific poisons of many 
general affections, as rheumatism, gout, scarlet, yellow, 
typhus and typhoid fevers, and malaria. Increased 
blood-pressure is also brought about in the kidneys by 
lesions of the central nervous system. In these the 
vaso-motor filaments are paralyzed. 
Chronic degenerations of the kidneys are, as a rule, 
the result of prolonged congestions ; and the albumen 
which escapes them is principally due to a continuance 
of this condition and the frequent attacks of inflamma- 
tion to which they are especially liable. 
Albuminous urine has certain characteristics appre- 
ciable by simple ocular inspection. In the first place 
it froths more than normal urine, when violently agi- 
tated ; and if the disease be of long standing the color 
will be light and the specimen present a peculiar hazy 
appearance due to the presence of casts, fat granules 
and epithelium. In nephritis there will be more or 
less blood present. 
The specific gravity of albuminous urine is low- 
100T-1015-on account of the deficiency in solids, 
especially urea. See Supplement, 6. 
It is of the highest importance to subject urine in 
which albumen has been detected, to a microscopic ex- 66 
ANALYSIS OF THE URINE. 
amination; for it is by the presence or absence of casts 
and certain other debris that we are able to judge of 
the morbid conditions which prevail. (See "Casts.") 
Albumen always exists in urine where casts are 
found, but casts are not necessarily present in every 
instance with albumen. 
Tests.-Albumen is coagulated by heat, alcohol, 
the mineral acids and by a solution of acetic acid and 
potassium ferrocyanide. Other methods do not con- 
cern us. 
A test-tube is one-third filled with the suspected 
urine, and held in the flame of a spirit-lamp until boil- 
ing is fairly going on. If any perceptible opacity has 
ensued it can be due to two things-albumen or the 
earthy phosphates. The question is determined by 
the addition of one or two drops of nitric acid; if it 
be albumen the opacity is slightly increased, if the 
phosphates it entirely disappears. 
When the amount of albumen present is very 
small it is necessary to proceed very carefully and 
have an equal quantity of the same specimen, which 
has not been manipulated, in another test-tube for 
comparison. Nitric acid alone is a delicate test for 
albumen. The test-tube should be inclined and the 
acid allowed to run down the side and gain the bottom, 
where it will be seen as a clear layer. If albumen be 
present there will appear an opaque stratum where the 
urine and acid come in contact. 
There are two fallacious results which are likely to 
follow the addition of nitric acid to urine containing 
an excess of either urea or the urates, which might 
mislead a novice. With the first there may be a crys- ANALYSIS OF THE URINE. 
67 
talline precipitate of urea nitrate; with the second 
an amorphous deposit of uric acid. Neither of these, 
however, should be taken for albumen, for they both 
disappear when heated; and besides the urea salt pre- 
sents definite crystals as will the uric acid if allowed 
to stand a few hours. 
The most delicate test for albumen is with acetic 
acid and potassium ferrocyanide. Render the fluid to 
be tested distinctly acid with acetic acid and add a 
few drops of a solution of potassium ferrocyanide; the 
presence of albumen will be indicated by an increased 
opacity. 
There is one fact to be borne in mind in testing 
with heat alone where no evident effect follows its ap- 
plication. It is that a strongly alkaline condition will 
hold albumen in solution against heat; hence the im- 
portance of always employing nitric acid after boiling. 
A convenient, and for general purposes a sufficiently 
accurate, method for estimating the quantity of albu- 
men from day to day, is simply to coagulate with heat 
and nitric acid and allow the coagulum to collect at 
the bottom of the test-tube and compare its mass with 
the amount of urine used, as J, etc. For greater 
accuracy a graduated tube may be used. 
Sugar.-There is a grave disorder chiefly charac- 
terized by the excretion of enormous quantities of 
saccharine urine of high specific gravity, 1030-1060, 
known as diabetes mellitus. The pathology is obscure. 
We know that one of the functions of the liver is to 
produce sugar, and that this process is carried on in- 
dependent of saccharine and starchy food. But what 
is the particular lesion or class of lesions which causes 68 
ANALYSIS OF THE UKTNE. 
the fluids of the body to be saturated with sugar is 
not determined. 
It has been suggested that diabetes mellitus may 
be due to two distinct conditions :-Am excessive pro- 
duction of sugar by the liver, and a failure of the sys- 
tem to assimilate that normally produced. 
Experimentally sugar can be made to appear in the 
urine by various operations upon the nervous system and 
by any means which accelerates the portal circulation. 
The ingestion of large quantities of sugar or food 
containing it, especially after fasting, will induce a 
saccharine condition of the urine. Disease of the 
liver is not, then, necessarily the primary cause of 
diabetes. 
Sugar appears in the urine, temporarily, during 
the course of various affections, as,-disease and injury 
of the nervous system, mental shock, amputation, 
pregnancy, etc. 
Saccharine urine presents a peculiar bright straw 
color. Albumen is frequently present. A drop placed 
upon the fingers and allowed to evaporate leaves a 
sticky molasses-like residue. 
Tests.-If saccharine urine be boiled with liquor 
potassse, it will assume a dark brown or molasses color. 
This is known as Moore's Test. It is unreliable in 
that any urine of high specific gravity will give the 
same result. 
If a little yeast be added to urine containing sugar, 
fermentation will ensue, whereby carbonic acid gas 
and alcohol are produced. The gas escaping in bub- 
bles can be collected and tested. This is a good test, 
but not a very convenient one. It is not necessary to 69 
ANALYSIS OF THE URINE. 
add yeast except to hasten the result, for if sugar is 
present in urine the yeast fungus, saccharomyces cere- 
visiae, will be spontaneously developed and the decom- 
position proceed as in the former case. A convenient 
apparatus with which to apply the fermentation test to 
urine is constructed as follows: Procure a glass jar or 
test-tube capable of standing upright, and provide it 
with a tight-fitting stopper. Through the stopper let 
a glass tube descend almost to the bottom of the jar. 
Half an inch of the lower extremity of this tube 
should be bent upwards, and that portion which is 
outside the jar curved so as to have its extremity di- 
rected downwards. Fill the jar with the suspected 
urine, add a small lump of German yeast, and adjust 
the cork and tube. The whole is now to be kept in a 
moderately warm place, 70° F., for about 48 hours; 
and if sugar be present, except in very minute amount, 
the decomposition into alcohol and carbonic acid gas 
will take place. The gas accumulating at the top of 
the jar and unable to escape, presses upon the urine 
below, and drives it out of the long glass tube. Hav- 
ing collected a quantity of gas, the cork is carefully 
removed and the usual tests for carbonic acid applied. 
Trammer's Test.-This method of determining 
the presence of sugar in a solution is based upon the 
fact that sngar possesses the property of immediately 
reducing the salts of copper in an alkaline solution at 
the boiling-point. 
The usual mode of applying this test is to add two 
or three drops of a solution of copper sulphate to a 
quantity of the suspected fluid in a test-tube, and then 
pour in an excess of liquor potassae. If sngar be pres- 70 
ANALYSIS OF THE URINE. 
ent, the whole now assumes a deep, transparent blue 
color.1 Upon boiling, copper oxide will be thrown 
down as a bright yellow precipitate (in some cases an 
orange red). When this change occurs, the blue color 
disappears entirely, and the mixture becomes perfectly 
opaque. 
Unfortunately when applied to the urine after the 
above manner, these phenomena do not present them- 
selves. Having added the copper and potassa, there 
will appear the usual transparent blue color, but when 
boiled we almost invariably fail to see anything like a 
yellow or red precipitate. Either the blue color is 
entirely destroyed, and a dark, transparent, molasses 
color appears, or there is a dirty green precipitate. 
Considerable has been written concerning the in- 
applicability of Trommer's test to the urine, the expla- 
nation being that the organic constituents, urea, color- 
ing matter, etc., interfere with the reduction of the 
suboxide of copper. Directions have therefore been 
given to get rid of these matters by filtration through 
finely-powdered animal charcoal. This process is an 
efficient, but as a general rule, not a convenient one 
for the practicing physician. 
1 If a solution of copper sulphate be treated with potassium 
hydrate there will be a pale blue precipitate of copper hydrate 
formed ; but if we add a small quantity of tartaric acid previous 
to the potassium the precipitate will be redissolved on the addi- 
tion of an excess of the latter. 
Sugar has a property similar to tartaric acid in this respect, 
and the very fact that on the addition of the reagents of Trom- 
mer's test to a fluid results in the production of a perfectly clear 
blue color, is in favor of the presence of sugar. We should never 
be satisfied however with this evidence alone, especially in deal- 
ing with the urine. ANALYSIS OF THE URINE. 
71 
Therefore, because I believe this method to be the 
most simple and reliable one, I submit the follow- 
ing hints and rules for the application of Trommer's 
test to the urine; they being the result of a series of 
investigations on the subject.1 
In the first place, it is necessary to have a great 
excess of the test, because if the urine l>e in too great 
quantity, the precipitate is dissolved ; and on this fact 
depends my method. 
Proceed as follows: Place about 2 c.c. (2 3 .) of the 
urine in a test-tube, and to it add about 4 drops of a 
copper sulphate solution made in the proportion of 1 
part of copper sulphate to 3 parts of water. To this 
mixture add liquor potassge until the milky precipitate 
first formed is dissolved and the whole assumes a per- 
fectly transparent blue color. 
The conditions now are such that the precipitate of 
copper oxide will be in such amount as not to be to- 
tally dissolved by the small quantity of urine employed. 
Therefore when this blue mixture is boiled the reaction 
is as satisfactory as with a watery solution of sugar. 
If there is no immediate reaction set the test-tube 
aside and wait ten or twenty minutes. There is no 
change if the urine is free from sugar. 
If albumen is present the color resulting from the 
mixture of the test fluids will assume a purplish hue, 
and may interfere with the process. It can be removed 
by coagulating and filtering. 
Do not mistake the flocculi of the phosphates, 
thrown down by the alkaline test fluid, for a precipi- 
tate of the suboxide of copper. This latter is dark 
1 New York Medical Journal. June, 1874, p. 632. 72 
ANALYSIS OF THE HEINE. 
red or yellow, and soon subsides to the bottom of 
the test-tube, and is seen there as a compact little 
mass. 
The test with Fehling's Solution (for composition, 
see p. 75) is based upon the same principle as the 
foregoing, and if we have the solution, it is a very 
easy and reliable test. But it has to be prepared, and 
when kept for any length of time, is liable to undergo 
changes which unfit it for further use. 
The way to use it is to take a test-tube a quarter 
full and boil it. To this add a drop of the suspected 
urine if much sugar is present; if little, add ten or 
fifteen drops. 
Here we have the same principle as advised with 
Trommer's test-namely, a small quantity of urine 
and a great excess of the test fluid. 
If any change occurs in the Fehling liquor when 
boiled alone, it is unfit for use. 
Bile.-The coloring matter of the bile is frequently 
excreted with the urine, imparting to it a more or less 
greenish-brown color. 
It occurs in jaundice even before the skin has be- 
come perceptibly colored, and continues a little while 
after the natural color is restored. 
The biliary salts, glykocholate and taurocholate of 
soda, sometimes are present also, and it is frequently 
important to know whether the bile is represented in 
the urine solely by its coloring matter, or whether 
these more important ingredients are there too. 
Tests.-The coloring matter of bile can be detected 
by pouring a little of the urine into a white plate, 
and allowing it to come in contact with a few drops ANALYSIS OF THE URINE. 
73 
of nitric acid. As the two mingle, a play of colors 
will be observed, varying from a violet to a green. 
Any oxidizing agent, tincture of iodine, or the atmo- 
sphere, will produce a grass-green color. 
Instances may occur when the bile pigment is present 
in such small amount as to render its detection difficult. 
In such cases the urine should be allowed to remain at 
rest several hours at a low temperature to favor the 
deposition of the urates. If these constituents are 
precipitated they will appropriate the bile color and 
by separating them and dissolving in a small amount 
of water with heat, we can then apply the nitric acid 
test as above. 
To detect the biliary salts we must resort to "Pet- 
tenkofer's test" as follows: If the color of the urine 
be very marked it should be mixed with animal char- 
coal and filtered ; then take about 10 c.c. ( 3 ii) of the 
clear liquid thus obtained and to it add a few drops of 
cane-sugar (one part to four of water). Sulphuric acid 
is now to be added very cautiously, the test-tube being 
occasionally dipped in cold water to keep the tempera- 
ture thus developed at about 60°. When the acid is 
first added if the biliary salts are present there will be 
a whitish precipitate of cholic acid, which subsequently 
disappears on the continued addition of the reagent 
The next change consists in a cherry-red color which 
appears at the bottom of the tube. Cease, now, to add 
the acid and observe that the red gradually changes to 
a deep purple. 
It is this play of colors which constitutes the most 
characteristic feature of the test. 
If the urine contains albumen it should be coagu- 74 
ANALYSIS OF THE URINE. 
lated and removed, as this substance will imitate in 
some degree the behavior of the biliary matters with 
Pettenkofer's test.1 
1 See Dalton's Physiology, 1875, p. 212, for other precautions 
to be observed with Pettenkofer's test. PART V. 
QUANTITATIVE ANALYSIS. 
SUGAR-UREA. 
Sugar and urea are the only substances of which it 
is frequently of practical importance to estimate the 
amount in urine. 
Sugar.-There are two methods by which the phy- 
sician can readily determine the quantity of sugar in a 
given solution; one necessitating considerable skill in 
chemical manipulation, and the other remarkable for 
its simplicity. 
The first of these is based upon the reactions with 
Trommer's test, the only conditions being that we 
must use a graduated solution, it having been found 
that a certain amount of sugar will reduce a definite 
quantity of copper sulphate. 
The solution commonly employed is known as 
" Fehling's liquor." This investigator, having dis- 
covered that 5 parts of sugar decompose 34.64 parts 
of copper sulphate, advised the following solution: 
Pure crystallized copper sulphate . . 34.64 grammes. 
Neutral potassium tartrate . . . 150 " 
Solution of sodium hydrate (sp. gr. 1.12) 650 " 
The potassium tartrate is dissolved in the solution 76 
ANALYSIS OF THE URINE. 
of caustic soda, and the copper sulphate in a little pure 
water. The two solutions are now mixed and the 
whole diluted with water until the volume amounts 
to 1 litre. 10 c.c. of this solution will be decolorized 
by .05 grammes of sugar. The objection to Fehling's 
solution thus prepared is its liability to spontaneous 
decomposition when kept for any length of time, some 
of the copper being reduced by the tartaric acid which 
is set free. The following method is therefore gener- 
ally employed and is much preferable: 
1st. Pure dry crystallized copper sulphate, 34.64 
grammes. Distilled water, 1000 grammes. 10 c.c. of 
this solution correspond to .05 gramme of sugar. 
2d. Solution of potassium hydrate (sp. gr. about 
1050. 
3d. A saturated solution of potassium bitartrate. 
These three solutions are to be kept in separate 
glass-stoppered bottles, and are not mixed until used. 
They therefore do not deteriorate by keeping. The 
apparatus necessary for this analysis consists of a glass 
chemical flask of 250 c.c. (8 oz.) capacity; burette 
graduated to cubic centimetres and tenths; spirit lamp 
and stand upon which to place the flask to boil its 
contents. 
The process is as follows: 10 c.c. of the copper sul- 
phate solution are first put into the flask and diluted 
with about four times as much water. About 10 c.c. 
of the potassium tartrate solution are now added and 
well mixed, after which pour in the solution of potas- 
sium hydrate until the whole assumes a clear blue color. ALALYSIS OF THE URINE. 
77 
Our test-fluid is now ready. Set it to boil. Then take 
2 c.c. of urine and dilute it with 18 c.c. of waterthe 
mixture now consists of TV urine. By this time ebul- 
lition has commenced in the flask and we proceed to 
add, drop by drop, the mixture of urine and water 
and closely watch the result. As the saccharine urine 
comes in contact with the boiling copper solution some 
of the latter is decomposed and appears as a red pre- 
cipitate. A time will at length arrive when the whole 
mixture changes to a brick-dust red, and no blue color 
remains. The entire operation should cease every little 
while to allow the red copper oxide to settle, when it 
will be easy to determine whether any blue color 
remains in the supernatent liquid. 
During the last part of the process great care is 
necessary in order not to add any more urine after the 
blue color has disappeared; if we do not stop at the 
right time, the mixture will suddenly assume a mo- 
lasses color, the result of the action of the boiling 
alkali upon the sugar, and our analysis is worthless. 
By a little practice proper skill is readily acquired. 
Suppose then the blue color has entirely disappeared 
from the mixture and we find that 10 c.c. of the di- 
luted urine have been used; but this only contains -fa or 
2 c.c. of urine. Therefore 2 c.c. of the urine contain 
.05 gramme of sugar. The percentage is easily cal- 
culated with this system of weights and measures : 
2 : .05 ;; 100 : a? = 2.5 per cent. 
Perhaps the best method to determine the quantity 
1 This is in order to add the saccharine urine more gradually. 
If the sugar is not abundant this dilution is not necessary. 78 
ANALYSIS OF THE UIIINE. 
of sugar in urine, adapted to the busy physician, is that 
recommended by Roberts,1 which is based upon the dif- 
ference in specific gravity before and after fermentation. 
The specific gravity of the specimen is taken and 
written down; a bottle provided with a perforated 
cork is then about half-filled, and a lump of German 
yeast added, about the size of a walnut, and the whole 
placed where it will remain at about 80° F. for eighteen 
hours. At the end of this time the decomposition into 
alcohol and carbonic gas will be complete; and now 
every degree of density lost indicates 2.188 milli- 
grammes of sugar per cubic centimetre before fermen- 
tation, (one grain for every fluid ounce). 
Urea.-The daily quantity of urea excreted fre- 
quently becomes of importance, and various methods 
of estimating it have been advised. None are so 
simple as the one proposed by Dr. Davy, of England.' 
Doubts having arisen as to its accuracy, we undertook 
a series of experiments in order to ascertain if they 
were well-founded. The results of these experiments3 
seemed to show that the method is in every respect 
sufficiently accurate for practical purposes, and it is 
therefore introduced here as the one best adapted to 
the physician who wishes to perform the analysis for 
himself. 
This method depends upon the decomposition 
which ensues when urea is brought into contact with 
sodium, potassium, or calcium hypochlorite. 
Nitrogen gas is evolved, and being collected and 
1 Urinary and. Renal Diseases, p. 198. Philadelphia, 1872. 
2 Philosophical Mag. 1854. 
3 New York Med. Jour., Sept. 1872. ANALYSIS OF THE URINE. 
79 
measured, the amount of urea originally present is 
estimated. The following are Dr. Davy's directions: 
"A strong glass tube, about twelve or fourteen 
inches long, closed at one end, and its open extremity 
ground smooth, and having the bore not larger than 
the thumb can conveniently cover, holding from two 
to three cubic inches (50 c.c.), each divided into tenths 
and hundredths by graduation on the glass, is filled 
more than a third full of mercury, to which afterward 
a measured quantity of urine to be examined is poured, 
which may be from a quarter of a drachm to a drachm 
or upward, according to the capacity of the tube. 
Then, holding the tube in one hand, near its open ex- 
tremity, and having the thumb in readiness to cover 
the aperture, the operator fills it completely full with 
a solution of sodium-hypochlorite (taking care not to 
overflow the tube), and then instantly covers the open- 
ing tightly with the thumb, and having rapidly inverted 
the tube once or twice, to mix the urine with the hy- 
pochlorite, he finally opens the tube under a saturated 
solution of common salt and water, contained in a 
steady cup or mortar. The mercury then flows out, 
and the solution of salt takes its place, and the mixture 
of urine and hypochlorite being lighter than the solu- 
tion of salt, will remain in the upper part of the tube, 
and will therefore be prevented from descending and 
mixing with the fluid in the cup. A rapid disengage- 
ment of minute bubbles of gas soon takes place in the 
mixture in the upper part of the tube, and the gas is 
there retained and collected. The tube is then left in 
the upright position till there is no further appearance 
of minute globules of gas being formed, the time being 80 
ANALYSIS OF THE UKINE. 
dependent upon the strength of the hypochlorite and 
the quantity of urea present. But the decomposition 
is usually completed in from three to four hours; it 
may, however, be left much longer, even for a day if 
convenient, and having set the experiment going, it 
requires no further attention; and when the decom- 
position is completed, it is only necessary to read the 
quantity of gas produced off the scale on the tube. In 
cases where great accuracy is required, due attention 
must be paid to the temperature and atmospheric pres- 
sure, and certain corrections made if these should de- 
viate from the usual standards of comparison, at the 
time of reading off the volume of gas; but in most 
cases, sufficiently near approximation to accuracy may 
be obtained without reference to those particulars." 
It has been found by calculation that 1 cubic centi- 
metre of gas corresponds to 2.5 milligrammes of urea 
-(1 cubic inch to .64 grains). 
There are one or two sources of error to be avoided. 
Ammonia and uric acid will give rise 
to nitrogen and thereby increase the 
apparent amount of urea. It is the 
former which is most likely to exist in 
quantities sufficient to cause confu- 
sion ; but as it only occurs in appre- 
ciable amount during the alkaline de- 
composition we can always avoid its 
effect by using fresh urine. 
The apparatus necessary to perform this analysis is 
shown in Fig. 18. The graduated tube can be pro- 
cured of Benjamin & Co., No. 10 Barclay street. 
Sodium hypochlorite is preferable, to either that 
fig. is. ANALYSIS OF THE URINE. 
81 
of calcium or potassium because it is easily pro- 
cured, being an article in general use under the 
name "Liquor Sodas Chlorinates," or Labarraque's 
Solution. But there are various preparations of this 
solution, both foreign and domestic, which do not cor- 
respond in strength, and are not universally kept on 
sale. We are in the habit of employing a preparation 
of reliable manufacture, and one most generally sold 
in the United States, namely, " Squibb's Liquor Sodee 
Chlorinates," and advise its use in connection with this 
analysis.1 
1 See Supplement, 7, for the author's method by differential 
density. PART VI. 
CALCULI AND GRAVEL. 
We have seen that the urine is subject to a variety 
of deposits. Now, under certain conditions some of 
them are precipitated within the urinary passages in a 
manner to form solid masses of considerable size. 
When the masses are sufficiently small to pass 
through the ureters or urethra they are called gravel 
and sand; when too large to admit of this passage they 
are designated as calculi. 
It is important to be aware that the predisposing 
causes of the small concretions conduce alike to the 
formation of the larger. 
Calculi.-By a urinary calculus or stone, we mean 
those solid concretions found in the bladder and kid- 
ney, and which vary in size from that of a pea to a 
hen's egg. They differ in composition as well as in 
general form and texture. 
As regards composition, the most common are uric 
acid, lime oxalate, urates, phosphates, and cystine. 
A stone is rarely composed of one substance alone ; 
but is made up of alternating and varying concentric 
layers of different deposits. 
In the first place the center of almost every urin- 
ary concretion consists of either uric acid or lime oxa- 
late with a little mass of mucus ; and the rest is com- ANALYSIS OF THE URINE. 
83 
posed of layers of the same, alternating occasionally 
with the earthy phosphates. And if the process is 
uninterrupted the stone will finally become encrusted 
with successive deposits of this last named ma- 
terial. 
Calculi originate in various ways. A little mass of 
retained mucus or blood will induce the acid decompo- 
sition, and determine the formation of uric acid and 
lime oxalate crystals in the substance of the mass, and 
thus constitute the nucleus of a stone. Foreign sub- 
stances as hair pins and pieces of slate pencil are not 
infrequently found to have originated a phosphatic 
stone. Finally, as already mentioned when studying 
deposits, we may have a spontaneous precipitation of 
crystaline or amorphous matter taking place within the 
body as a result of retention, and consequent decom- 
position, or on account of a derangement in the natural 
proportions of the urinary constituents. 
Whatever be the origin, the subsequent history of 
calculi is soon told. There are alternating layers of 
various materials until the mass begins to act as an 
irritating foreign body. The bladder now becomes 
inflamed; retention and decomposition ensue, and thus 
the very presence of the stone conduces to its own rapid 
growth. Although we are not likely to meet with a 
stone composed entirely of one material, yet this may 
happen, or at any rate, one particular substance may 
predominate and impart its own characters to the mass, 
This is especially true wdien removal is effected early, 
prior to the alkaline decomposition. 
Uric Acid.-Uric acid is the most common of all 
deposits going to form calculi, The nucleus of almost 84 
ANALYSIS OF THE URINE. 
every stone is composed of crystals of this substance, 
and not unfrequently we see it constituting a stone 
almost entirely, especially if it be removed before the 
alkaline fermentation ensues. 
When this is the case, the size rarely exceeds that of 
a pigeon's egg. The color ranges from a brick-dust 
red to a fawn, and the surface is generally covered 
with little tubercles; if, however, there were more 
than one stone in the bladder, their surfaces would be 
worn smooth by attrition. 
They are usually spherical, and slightly flattened. 
When sawed in half, their concentric laminae are very 
distinctly seen. 
When a stone of this composition exists in the 
bladder, the urine is acid. 
Tests.-The murexid test is the most direct and 
characteristic. Place a fragment of the stone in a 
clean porcelain capsule, and add one or two drops of 
nitric acid ; now evaporate the acid by gentle heat 
over the flame of a spirit-lamp, and a pink color will 
appear, which changes to a purple when a little am- 
monia is dropped in. 
Uric acid is soluble in an alkali from which it may 
be precipitated by hydrochloric acid and its character- 
istic crystals seen under the microscope. 
Under the blow-pipe it is converted into a black or 
very dark-brown coal. 
Urates.-Stones composed wholly of the urates are 
rare, though this deposit frequently alternates with 
others. 
When pure, they are small, and are apt to originate 
in the kidneys. Most frequently these calculi are met ANALYSIS OF THE HEINE. 
85 
with in children. These formations are of a red or 
brick-dust color. The urine will be acid. 
Tests.-The fact of their solubility in warm water 
will prove the presence of the urates. 
Lime Oxalate.-Like most other deposits, the 
lime oxalate more frequently forms a stone by alter- 
nation than alone. When this substance exists alone 
or predominates, the stone is exceedingly hard and 
rough; in fact, it has been called the mulberry cal- 
culus, from its warty and irregular surface. 
When the concretions of this formation are small 
enough to be classed as gravel, and are voided with the 
urine, they may be smooth. Here, however, there is 
a mixture of the urates, and the formation has proba- 
bly taken place in the kidneys, and by their number 
the surfaces are worn. 
In color, these stones are sometimes dark brown or 
even black, and again almost white. 
Most mixed calculi contain layers of oxalate of 
lime. 
The urine will be strongly acid. 
Tests.-Oxalate of lime is soluble in the mineral 
acids. Under the blow-pipe, it is reduced to a dark 
ash which turns moistened red litmus-paper blue,- 
caustic lime being the residue of the combustion. 
PHOSPHATES. 
We have seen that an alkaline condition of the 
urine will precipitate the earthy phosphates, and that 
the alkalinity may be due to two causes, only one of 
which is concerned in the formation of phosphatic cal- 
culi. We have said that the alkalinity of the fixed 86 
ANALYSIS OF THE URINE. 
salts may continue for a length of time without a stone 
being found; because the phosphatic precipitate will 
then be amorphous, and has little tendency to form 
concretions. But when putrefaction occurs from re- 
tention of urine, or the action of inflammatory pro- 
ducts anywhere in the urinary passages, then we have 
ammonium carbonate developed, and now crystals of 
the ammonio-magnesian or triple phosphate are thrown 
down, as well as the amorphous phosphate of lime. 
It is the ammoniacal decomposition, then, which 
most influences the formation of phosphatic calculi. 
Sometimes, however, after prolonged administration 
of alkaline medicines, and as a result of high living (in- 
dulgence in wine) where the urine is kept alkaline by 
the fixed salts, concretions of Amorphous Lime Phos- 
phate may form. 
These stones are light colored, easily broken, and 
present an earthy fracture. They rarely alternate with 
other forms. 
Tests.-Lime phosphate is insoluble in water; 
soluble in a weak acid, and is practically infusible un- 
der the blow-pipe. 
Mixed Phosphates.-Deposits of this nature are 
the result of the ammoniacal decomposition of urine, 
and consist of the crystalline ammonio-magnesian 
phosphate wfith the amorphous lime phosphate. They 
rarely constitute the whole or interior of a stone, but 
are generally added as the result of the presence of a 
pre-existing calculus, the irritation of which has in- 
duced the decomposition just mentioned. And it is 
a fact, that almost every stone, if it remains long 
enough in the bladder, will be encrusted with several ANALYSIS OF THE URINE. 
87 
layers of the mixed phosphates. These calculi some- 
times attain to enormous dimensions. 
They are chalk-colored, and have a glistening ap- 
pearance on account of the presence of the crystals of 
the phosphates on their surface. 
Tests.-Under the blow-pipe, the mixed phosphates 
readily fuse into a white enamel (and they have there- 
fore been sometimes called the fusible and 
give off ammonia and water. They are soluble in 
weak acids. 
Cystine.-This substance sometimes forms calculi 
and gravel. The number of cases is very limited, 
and very few specimens of the concretion exist. The 
stone is quite small, not larger than an almond, and of 
a dirty brown or greenish color. There appear to be 
no distinct laminae, but rather a radiating structure. 
The pathology is obscure. 
Tests.-Cystine is soluble in the mineral acids, 
and in caustic ammonia; insoluble in water, acetic 
acid, and ammonium carbonate. If a piece of the 
calculus is dissolved in a little caustic ammonia, con- 
tained in a shallow dish, upon evaporation the char- 
acteristic hexagonal crystals already described, can be 
detected under the microscope. 
Cystine burns with a bluish flame, emitting a pe- 
culiar, unpleasant, acid odor. SCHEME EOR EXAMINATION OF URINE. 
Proceed in the following order : 
1. Odor. 
2. Color. 
3. Transparency. 
4. Reaction to test-paper. 
5. Specific gravity. 
6. Daily quantity. 
7. Any deposit ? Character of. 
8. Apply reagents. 
PRECIPITATES. 
DISSOLVES. 
Heat. 
j Albumen. 
1 Phosphates. 
Urates. 
Nitric Acid. 
\ Albumen. 
) Urea. 
/ Uric acid. 
Phosphates. 
Liq. Potassae. 
Phosphates. 
Albumen. 
Acetic acid. 
Cystine. 
Albumen. 
Silver nitrate. 
Chlorides. 
Barium Chloride. 
Sulphates. 
There are certain precautions to be observed with 
these reactions, for which reference must be made to 
the text. GENERAL DIRECTIONS. 
Urine intended for examination should be placed in 
a conical-shaped glass vessel, such as an ordinary ale- 
glass, in order that any deposit which may appear 
shall be concentrated in a comparatively small space • 
for if there is a very minute quantity, we otherwise 
might not be able to secure a specimen for the micro- 
scope, or detect its presence by ordinary inspection. 
After the specimen has stood for six or eight hours, 
very gently pour off all but about half an ounce. 
This is done in order to prevent the deposited crys- 
tals, casts, or whatever is there, from becoming again 
mingled with a great quantity of urine when it is 
agitated by our subsequent manipulations. 
Now', having provided yourself with a drop-tube, 
which be sure is clean, place the finger over the large 
end, and direct the other end to the bottom of the 
glass; raise the finger, and the urine ascends in the 
tube; replace the finger, and we have it confined there. 
Touch the point of the tube thus supplied upon a 
clean glass slide, and a drop will escape, which is all- 
sufficient. A thin glass cover is placed over this drop 
on the slide in a manner to exclude air-bubbles, as 
follows: place one side of the cover on the slide and 
allow it to come gradually down. If the cover floats, 
there is too much urine, which will overflow it, and 
obscure the lens. Under such circumstances, just 
absorb the surplus urine with a little blotting-paper. 
We need a good lens for the examination of 
urinary deposits, and sometimes a -J-inch in order to 
distinctly discern small hyaline casts. LIST OF APPARATUS AND REAGENTS 
REQUIRED. 
APPARATUS. 
doz. 4-in ch test-tubes. 
Test tube rack. 
Alcohol lamp. 
Small glass funnel. 
Filter-paper to fit funnel. 
Red and blue litmus paper. 
Urinometer. 82.00. 
Absolutely necessary. 
' Glass flask 200.c.c. (8 5 )• 
Cubic centimetre meas- 
ure. 
Quantitative an- 
alysis of sugar. 
Special ap- 
paratus. 
Glass tube graduated to 
cubic centimetres. 
Quantitative an- 
alysis of urea. 
82.00. 
REAGENTS, IN GLASS-STOPPERED BOTTLES. 
Nitric acid, 4 3 . 
Acetic acid, 4 3 . 
Sulphuric acid (pure), 4 3 . 
Solution caustic potassa (20 gr.-l § ), 8 §. 
Sol. copper sulphate (1 3 -15 ), 4 §. 
Sol. silver nitrate (10 gr.-l § ), 4 §. 
Sol. barium chloride (10 gr.-l §), 4 §. 
83.50. COMPARATIVE VALUES OF FRENCH AND ENGLISH 
MEASURES USED IN THIS BOOK. 
1 gramme = 15.434 grains. 
1 cubic centimetre = 0.061 cubic inch =0.273 
1 litre = 61 cubic inches = 33.8 §. 
1 millimetre = inch. 
1 micromillimetre = inch. SUPPLEMENT. 
1. Dr. Pavy concludes that the increase of urea, in 
the experiments upon the pedestrian, was due, not 
alone to muscular oxidation, but to general bodily exer- 
tion. And the present view is that the production of 
urea is the result of functional activity, and the amount 
of production has reference to the degree of activity, 
bodily or mental. 
2. This chemical change by which the urine is ren- 
dered alkaline after the ingestion of organic acids or 
their salts is due to oxidation, and may be thus ex- 
pressed : 
Potassium Citrate. Carbon Dioxide. Water. Potassium. 
C6H6K2O7 + O8 = + UsOa + -K* 
The carbon dioxide (carbonic acid gas) then unites 
with water-without water it cannot combine to form 
salts-and carbonic acid is the result: 
Carbon Dioxide. Water. Carbonic Acid, 
G(CO2) + 6(H2O) = 6(II2CO3). 
Finally the free potassium combines with this acid 
by substituting K2 for H2, and we have the alkaline 
salt, potassium carbonate, 6(K2CO3). 
3. Nitric acid added to the urine of persons taking 
cubebs or copaiba, and perhaps other oleo-resins, gives a 
slight turbidity, which does not subside for several 
days. 94 
4. The presence of alcohol in the urine can be 
demonstrated by the striking reaction displayed when 
a small quantity of the following solution is added 
thereto : Potassium bichromate, one part, strong sul- 
phuric acid three hundred parts (by weight). 
The result is a beautiful green color. 
This test is valuable in that it may enable us to dis- 
tinguish alcoholic from apoplectic coma, and from in- 
sensibility induced by other narcotics or by injury. 
It may be stated in general terms that those sub- 
stances which, when taken into the circulation, are apt 
to reappear in the urine under their own form, are 
such as have either little affinity for the constituents 
of the body, are soluble in water, or are already com- 
pletely oxidized. 
5. It is now claimed that indican is increased in all 
serious affections of the digestive apparatus, such as 
incarceration and invagination of the intestine, cancer 
and inflammatory diseases of the accessory glands 
(liver, pancreas). 
6. The amount of albumen in the urine from a dis- 
eased kidney is rarely sufficient to offset the deficiency 
of urea, and thus maintain a normal specific gravity. 
7. Differential Density Diethod for estimating Urea. 
This method is one devised by myself.1 The experi- 
mental details upon which it is founded are published 
in the New York Medical Journal for June, 1877. 
The estimation is based upon the difference in spe- 
cific gravity of a solution of urea before and after the 
decomposition by sodium, hypochlorite, or " Labar- 
raque's Solution." 
ANALYSIS OP THE URINE. 
1 Prize Essay of the Alumni Association Col. Phys, and 
Surg., New York, 1877. SUPPLEMENT. 
95 
My preliminary experiments were performed with 
solutions of pure urea of known strength, and it was 
found that, after decomposition, every degree of density 
lost indicates 7.791 milligrammes of urea per cubic cen- 
timetre of the solution (3.55 grains per ounce}. Or 
every degree lost corresponds to .77 per cent. 
The first important step is to procure a suitable 
hydrometer. The requirements are a stem which will 
indicate the gravity of the hypochlorite, and also that 
of the urine, that is, an index ranging from 1000 to 
1050, and that each graduation should indicate one 
degree, and be about two millimetres (one-twelfth of an 
inch) apart, in order to allow of accuracy in the read- 
ing. To be able to work with smaller quantities of 
fluids, the instrument should be divided into two of 
equal size, one reading from 1000 to 1025, the other 
from 1025 to 1050.1 
The reagent most convenient for this analysis is 
Squibb's " Liquor Soda Chlorinatse," because it has a 
uniform sp. gr. of about 1048. However, if this prepa- 
ration is not at hand, and if the one we have possesses 
a density beyond the range of our hydrometer, it can 
be reduced to 1050 by the addition of water. 
In order to use this method, proceed as follows: Pro- 
cure two glass cylinder jars, one about nine inches in 
height by one and a half in diameter, the othei' about 
seven inches by one inch. Into the smaller pom* a 
quantity of the urine, and ascertain its specific gravity. 
Take about fifteen cubic centimetres (one half ounce) 
of it and pour it into the large jar. Now wash out the 
smallei- jar thoroughly, and in it take the specific 
1 Such, hydrometers will be made by John Tagliabue, 66 Ful- 
ton Street. 96 
ANALYSIS OF THE URINE. 
gravity of the hypochlorite solution. Then add to the 
urine in the large cylinder exactly seven times as much 
hypochlorite as there was urine taken. 
When the two fluids mingle there will be a brisk 
effervescence, and care must be taken that none of the 
mixture be lost. After several minutes the disengage- 
ment of gas is less rapid ; and now, by vigorously shak- 
ing the jar at short intervals, I have found the process 
to be hastened, so that at the expiration of an hour the 
decomposition is complete. It then only remains to 
take the gravity of the quiescent solution, deduct from 
what it was before decomposition, and estimate the 
amount of urea on the basis already given, after' this 
manner: 
Suppose the specific gravity of the urine to be 1020, 
and that of the hypochlorite 1045. But it is impracti- 
cable to take the specific gravity of the mixture of 
these two on account of their immediate reaction; we 
therefore resort to the law of proportion, and estimate 
it as follows : 
1 part at 1020 = 1020 
7 parts at 1045 = 7315 
8 )8335 
1041| sp. gr. of mixture before decomposition. 
From the gravity of the eight parts we subtract that 
which is obtained after decomposition, which, we will 
say, is 1038J. There is then a loss of 3°. Every de- 
gree of loss equals 7.791 milligrammes per cubic centi- 
metre of urine used. Therefore the urine contained 
23.373 milligrammes of urea per cubic centimetre, or 
2.3 per cent. 
It is, of course, highly important that the tempera- SUPPLEMENT. 
97 
ture of the fluids should all agree when their specific 
gravity is taken. This may be regulated by the use of 
a plain thermometer, or by the combination hydrome- 
ter and thermometer now so generally employed. But 
the simplest method is to mix the urine and reagent, 
and set the mixture aside with the pure urine and 
hypochlorite in the same locality, when the specific 
gravity of the three can be taken at a uniform temper- 
ature. 
The presence of neither albumen nor sugar inter- 
feres with the accuracy of this method. 
But it may be urged as an objection that other 
nitrogenous ingredients of the urine, such as uric acid 
and creatinine, suffer the same decomposition as urea, 
and therefore constitute elements of error. Yet, when 
we take into consideration the facts regarding these 
substances, namely, that of the nitrogen contained in 
uric acid, thirty-five per cent., in hippuric acid, eighty- 
two and a half per cent., and in creatinine, twenty-five 
per cent., is not disengaged by solutions of the hypo- 
chlorites, and when we remember how insignificant are 
the quantities of these substances in the urine com- 
pared to urea-the excretion per day being respect- 
ively about 0.7, 0.35, and one gramme, a total of 2.05 
grammes-it is obvious that their presence does not 
establish a serious fallacy. Ammonia, however, would 
interfere and give an erroneous result. 
When the urine contains a great excess of urea, 
more than would be decomposed by seven parts of hy- 
pochlorite, it is simply necessary to dilute it with an 
equal volume of water, use one part of the dilution to 
seven of the reagent, and multiply the result obtained 
by two. 
It is evident that with this method we must be able 98 
ANALYSIS OF THE URINE. 
to fix the point at which the hydrometer floats in the 
several liquids with nicety. When these liquids are 
perfectly transparent there is no difficulty, the proper 
way being to read from the under surface of the fluid, 
bringing the eye on a level with that surface. But, 
when the urine from any cause is opaque, this process 
is not practicable, and, under these circumstances, I 
resort to the following simple device : 
Take a piece of soft pine, and shape.it into a circu- 
lar disk somewhat smaller than the calibre of the small- 
est jar to be used. Make it exceedingly thin and uni- 
form, and perforate it in the centre with a round hole 
which will freely accommodate the stem of the hydrom- 
eter. Having put the stem of the instrument through 
this opening and immersed it in the fluid, the bit of wood 
will float on the surface, and the specific gravity can be 
readily taken by noting the point at which the float 
comes in contact with the stem. The weight of the 
wood will cause a slight increase in density, but, when 
used, in every case the error will be the same, and 
therefore corrects itself. INDEX. 
A. 
PAG« 
Acid, Effect of, upon Normal Urine 19 
Acid Fermentation21 
Albumen,45,64 
Abnormal Urine 25 
Alkalies, Effect of, upon Normal Urine19 
Alkaline Fermentation22 
Apparatus and Reagents required 90 
B. 
Bacteria 62 
Barium Chloride, as Reagent20 
Bile 72 
Blood 43 
Black Urine26 
Blue " 26 
C. 
Calculi 82 
" Cystine 87 
" Phosphates85 
" Lime Oxalate85 
" Urates... 84 
" Uric Acid 83 
Casts.47 
" Blood51 
" Epithelium50 100 
INDEX. 
PAGB 
Casta Fatty 50 
" Granular 51 
" Hyaline 49 
" Pus 51 
" Waxy 52 
Changes in Urine on Standing21 
Chlorides 19 
Chylous Urine 56 
Color of Normal Urine 13 
Color of Abnormal Urine 25 
Cold, Effect of, upon Urine 18 
Composition of Urine 5 
Creatinine 13 
Cystine 58, 87 
D. 
Daily Quantity of Normal Urine 17 
" " " Abnormal Urine 29 
Deposits30, 43 
Directions for examining Urine 89 
E. 
Effects of Reagents upon Normal Urine 18 
Epithelium 39 
" Bladder 40 
" Renal 40 
" Urethral 40 
" Vaginal 40 
Extraneous Matters in Urine53 
F. 
Fehling's Solution, Composition of 75 
" " Used as Qualitative Test 72 
Fermentation Test for Sugar68 
Fungi, vegetable60 INDEX. 
101 
G- PAGX 
Gravel 82 
Green Urine 26 
H. 
Hsematuria 44 
Haematinuria 44 
Heat, Effect of, upon Normal Urine 19 
Hippuric Acid 35 
K. 
Keistine 59 
L. 
Lead, Basic acetate of, as Reagent 20 
Lime Oxalate21, 38 
" " Calculus 85 
M. 
Medicines, Reappearance of in Urine 20 
Moore's Test for Sugar 68 
Mould Fungus 60 
Mucus 41 
N. 
Normal Urine, Characters of 5 
O. 
Odor of Abnormal Urine 25 
Oil in Urine 55 
P. 
Penicilium Glaucum 60 
Pigments 42 102 
INDEX. 
PAGE 
Phosphates 19, 22, 28, 36 
" Ammonio-magnesian 22, 37, 86 
" Earthy, Precipitated by Alkalies 19 
" Stella36 
" Calculi. 85 
Pus 53 
Q. 
Quantitative Analysis'.75 
" " of Sugar 75 
" " of Urea78 
R. 
Reaction of Normal Urine 15 
" " Abnormal Urine27 
Reagents, Effects of, upon Normal Urine 18 
" Required 90 
S. 
Saccharomyces Cerevisiae 61 
Scheme for examining Urine 88 
Silver Nitrate, as Reagent 19 
Specific Gravity of Normal Urine 16 
" " " Abnormal Urine 29 
Spermatozoa 58 
Sugar, Tests for 67, 68 
" Quantitative Analysis of 75 
" Fungus 61 
Sulphates, Precipitation of 20 
T. 
Transparency of Normal Urine15 
" " Abnormal Urine 27 
Trommer's Test for Sugar. 69 
" adapted to Urine 71 IKDEX. 
103 
U. PAG! 
Urates 18, 33 
" Calculi 84 
Urea 6 
" Nitrate 7, 8 
" Physiological and Pathological Relations of 9 
" Quantitative Analysis of 78 
Uric Acid 19, 21, 30 
" " Calculi83 
Urinary Deposits30 
V. 
Values, Comparative of French and English Measures91 
Vegetable Fungi 60 
Vibriones 62