SOME NOTES UPON URINALYSIS. 
BY 
P. MAX FOSHAY, M.D., 
OP CLEVELAND, OHIO* 
FROM 
r H E MEDICAL NEWS, 
February 25, 1893, Reprinted from The Medical News, February 25, 1893.] 
SOME NOTES UPON IlfilNALYSIS. 
By P. MAX FOSHAY, M.D., 
OF CLEVELAND, OHIO. 
In the course of examining urines I have found 
that certain data, of which the analyst stands much 
in need, are not to be met with in any of the works 
upon urinalysis with which I am conversant, and I 
have examined, I think, all the manuals in general 
use. For instance, the average daily amount of total 
solids in the urine of healthy persons is given by all 
authors; but a statement as to what range of total 
solids is compatible with health is made by few, and 
then not in a satisfactory form. The average amount 
of solids is usually stated to be 70 grm. a day, but I 
am of the opinion that this is slightly too high for 
the average men and women in this country, and 
think 63 grm. would fall nearer the true average. 
The specific gravity in health may range from 1.015 
to 1.025, the average being 1.020. The quantity 
of urine passed daily by healthy persons is said to 
vary from 1300 to 1500 c.c. The Haeser and Neu- 
bauer formula for estimating total solids from the 
specific gravity is sufficiently accurate for clinical 
purposes. This is executed by multiplying the last 
two figures of the specific gravity by the factor 2.33, 
the product of which represents the number of grams 
of solids in 1000 c.c. of the urine, and must be mul- 
tiplied by the number of cubic centimeters of the 2 
urine under examination, and divided by 1000 
in order to obtain the correct amount of solids. 
Taking this factor and the averages of specific grav- 
ity and quantity, we readily arrive at the following 
results for the health-range of total solids. Employ- 
ing first the minimum specific gravity and maxi- 
mum quantity, we have: 
2.33 X is X 1300 e ., 
—— 222—2— =52.43 grm. f°r the minimum 
1000 
solids. 
Using next the maximum specific gravity and 
minimum quantity, we have : 
2.33 X 25 x 1200 , r .1 
—22. 2 =69.90 grm. for the maximum 
1000 
solids. 
In calculating the maximum and minimum of 
total solids, I took as a basis the most usual con- 
ditions of healthy urine, i. e., maximum quantity 
associated with minimum specific gravity and vice 
versa. But as there might be cases in which, along 
with apparent health, the maximum specific gravity 
is maintained simultaneously with maximum quan- 
tity, and vice versa, it seemed advisable to deter- 
mine these widest possible limits of the health-range 
of total solids, as follows : 
2.33 x 15 x 1200 
°222—222 — 41.94 grm. 
1000 
. 2-33 X 25 X 1500 = 8 g , 
IOOO 
1 Note the concordance between the average amounts of solids 
as determined from each of these limits: 
52.43 -f- 69.90 -j- 2 = 61.17 grm. 
41.94 -(- 87.38 2 = 64.66 grm. 
An average of these two amounts is 63.42 grm. 3 
In actual examination of urines it will be found 
that those whose total daily solids persistently ap- 
proximate to either of these extreme figures repre- 
sent some deviation from the normal standard of 
health. Whether a given case is pathologic or not 
must be determined by noting carefully all the con- 
ditions of the patient’s environment; whether his 
diet is liberal or scanty ; whether his habits are active 
or sedentary ; the climate and season of the year, 
and, in addition, sex and weight are important fac- 
tors in the problem. From my own experience I 
should say that the first determined limits, viz, irom 
52.43 to 69.90 grm., are much the safer ones to use 
in practice. 
The ratio which the amount of urea in a sample of 
urine bears to the amount of total solids has seemed 
to me to be of some interest and value. Little is 
said concerning it in the manuals; but I have ob- 
served it in an extended series of experiments. It 
should first be remarked that all my figures are upon 
the basis of the whole twenty-four hours’ urine, and 
all my examinations, with a few unavoidable excep- 
tions, are made upon the total daily quantity. In 
estimating urea I use the hypobromite method ex- 
clusively, as being, upon the whole, the most satis- 
factory, and I make a fresh solution of hypobromite 
of sodium for each and every determination. I use 
the ureometer devised by Dr. Charles Doremus as 
the cheapest (for they will get broken), simplest, 
most readily cleaned, and, in general, the instru- 
ment best adapted for use in the physician’s office ; 
while at the same time I am confident that the ureo- 
meter of Dr. John Marshall is more scientific, more 4 
accurate, and better fitted for the use of the chemist. 
The daily amount of urea excreted in health may 
range from 20 to 40 grm., according to diet, the 
average of these figures being 30 grm. I am, how- 
ever, very much inclined to think that 27 grm. daily 
is as high an average as the analyst will make in this 
country. Using our previously-calculated average 
limits for total solids, we find the limits of the ratio 
between urea and solids to be as follows: 
='2.6, or a ratio of urea to solids as 1 : 2.6. 
20 
**9’9° = 1.7, or a ratio of urea to solids as 1: 1.7. 
40 
Here I have employed minimum figures of 
solids and urea, and vice versa, as, of course, we 
almost invariably find them associated in nature. 
Taking minimum urea with maximum solids, and 
vice versa, as rarely occurs in health, and never per- 
sistently, the ratios will be as follows :l 
= 3.5, or a ratio of urea to solids as 1 : 3.5. 
20 
5M3__ j or a ratiQ 0f urea t0 solids as 1 : 1.3. 
40 
From these two groups the average ratios will be 
calculated, as follows: 
1 Upon the basis of extreme limits of variation of solids the 
ratios might be figured as follows : 
= 2.1, or a ratio of urea to solids as i : 2.1. 
20 
87.38 , 
■ = 2.2, or a ratio of urea to solids, as 1: 2.2. 
40 
(41.94 87.38 \ 
= 1.05 and =4-4) is impossible. 5 
2.6 + 1.7 = 4.3-4- 2 = 2.2 or a ratio as 1 : 2.2 
3-5 + i-3 = 4.8-7-2 = 2.4 or a ratio as 1 : 2.4 
Hence we may conclude that the average ratio of 
urea to solids in healthy urine is as 1 : 2.3, but that 
there may be a range, dependent wholly upon diet, 
of from 1 : 1.5 to 1 : 3.0. And I should say from 
somewhat extended observation upon this point, 
both in normal and pathologic urines, that a urine 
in which the ratio of urea to solids remains persist- 
ently at either the maximum or minimum figure is 
not excreted by a person in thoroughly good health. 
As far as my experiments have gone, the most nota- 
ble fact to be observed concerning this ratio in the 
urine of persons suffering from various diseased con- 
ditions is its extreme variability from day to day, 
in this respect differing markedly from the ratios in 
healthy urines. I should not at present attribute 
great diagnostic value to this ratio, but in every 
case I meet it furnishes valuable collateral evidence.1 
The ordinary volumetric methods of estimating 
1 For normal urine the following averages are those given in 
the books for the twenty-four hours’ quantity: 
Average specific gravity . . . 1.020 
“ quantity 1350 c.c. 
“ total solids .... 70 grm. 
“ urea . . . . . 30 “ 
From this we find an average ratio of urea to solids of 1 : 2.33 
As 63 grm. seems a better figure for average solids, 
and 27 grm. a more correct average for urea, the corrected ratio 
will be 1 : 2.3 . 
And note that the average amount of total solids calculated 6 
phosphates and chlorids, while they are accurate 
and not difficult of execution for one who has plenty 
of time at his disposal, are yet out of reach of the 
average practitioner of medicine. Yet he would 
many times profit by the knowledge of the approxi- 
mate amount of these substances in his patient’s 
urine; so that I have endeavored to improve upon the 
rough methods of estimation given by most authors. 
I have not yet proceeded far enough in my experi- 
ments to be certain of the value of the method I 
propose, but, every time that I have checked it by 
the volumetric methods, it has furnished results suf- 
ficiently accurate for the physician’s purpose. It is 
to be borne in mind that the knowledge of the exact 
amount of chlorids and phosphates in a urine is of 
no practical value to the physician. If he knows 
whether these substances are present in increased or 
decreased quantity, he possesses all the knowledge 
that he can apply in the present state of our science. 
The method I use is not new, but I am not aware 
of its application to the estimation of these salts in 
urine, though I doubt not it may have been so 
employed. I venture a hope that some physicians 
may find the method serviceable. 
The necessary reagents are: The same solution 
of silver nitrate that is used in the volumetric 
estimation of chlorids (though any dilute solution 
will answer); a solution of a chlorid (preferably 
NaCl) of such strength as to represent the average 
proportion of chlorids in normal urine; and a simi- 
from these very figures (quantity 1350 cc. and specific gravity 
1.020) differs from that stated in the table, as follows : 
2-33XjOO350= 63 
IOOO 7 
lar solution of a phosphate (preferably Na^HPOJ.1 
One-half dozen ordinary stand test-tubes and a 
graduated pipette constitute the necessary appara- 
tus. The principle of the method is the compari- 
son of the relative bulk of the precipitates formed 
by adding the silver solution to the normal solu- 
tions, with similar precipitates formed by adding the 
silver solution to the urine. In estimating the 
chlorids I at present employ 1 c.c. of the sodium 
chlorid solution diluted to 5 c.c. in a stand-tube with 
distilled water, and 1 c.c. of the urine to be exam- 
ined similarly diluted, to which is added one drop 
of nitric acid to prevent precipitation of the phos- 
phates. Then 1 c.c. of the silver nitrate solution 
will completely precipitate the chlorid in the stand- 
ard solution. Add silver solution to the diluted 
urine until the precipitate no longer forms, and 
shake both tubes thoroughly. In two or three min- 
utes the comparison of the relative bulk of the pre- 
cipitates may be made, and will give a fair estima- 
tion of the deviation from normal, if there is any, 
of the chlorids in the urine. This method is very 
easy of execution, the required solutions keep well, 
and it furnishes, so far as tested, fairly approximate 
results. 
In roughly determining the phosphates I add 1 c.c. 
of the sodium phosphate solution to 1 c.c. of the 
1 Formulas 
1. Silver nitrate 
solution. 
AgN03 7-265 grm. 
Water 250 c.c. 
2. Chlorid 
solution. 
NaCl 3.25 grm, 
Water 337.5 c.c. 
3. Phosphate 
solution. 
Na2HP04 0.95 grin. 
Water 337.5 c.c. 8 
sodium chlorid solution (as the chlorids and phos- 
phates in the urine are necessarily precipitated 
together) and dilute to 5 c.c. with distilled water. 
As before, dilute 1 c.c. of urine to 5 c.c., and then 
add excess of silver solution to each tube, and shake. 
A mixed precipitate of silver chlorid and silver phos- 
phate falls in each tube, and, as we already know the 
relative amount of chlorids in the urine, any change 
from that relation will denote the deviation in 
amount of phosphates from the normal. I am free 
to confess that the application of this method to the 
phosphates is not yet nearly so satisfactory as it is 
in the case of the chlorids. 
Sometimes the analyst receives a sample of urine 
which is twenty-four hours old, or more, and it 
would be of great value to know approximately what 
changes, if any, had taken place in the urine since 
it was voided, either in specific gravity or amounts 
of urea and phosphates. The manuals furnish no 
information upon the point. I have only been able 
so far to try the effects of time upon the specific 
gravity and amount of urea, and then not in a suf- 
ficiently extended series of experiments to give 
authoritative results. Taking them for what they 
are worth, I note the following, and I select one 
case of each, rather than make an average. On a 
Sunday the specific gravity of a sample of fresh, 
warm urine (50 c.c.) was taken and found to be 
1.018. When cold it read 1.022, and four days 
later it was 1.023. The evaporating surface was 
only three-fourths of an inch in diameter. 
In a beaker, three inches in diameter, were placed 
200 c.c. of fresh urine. An estimation of urea was 9 
made at once, and upon every succeeding day, for 
seven days. When fresh, the urea amounted to 
0.020 grm. in i c.c., or 24 grm. in 1200 c.c. On the 
fourth day it was 0.022 grm. urea to 1 c.c., or 26.40 
grm. in 1200 c.c.; and upon the seventh day, 0.0234 
grm. in 1 c.c., or 28.08 in the 1200. On the last 
day the urine was brought to the original bulk by 
adding distilled water, and then the urea read 0.018 
grm. in 1 c.c., or 21.6 grm. in 1200 c.c. The result 
shows an apparent gain due to evaporation of 4.08 
grm. of urea, but areal loss of 2.4 grm. due to decom- 
position of the urea. It is worthy of note that I 
find little actual change, except by evaporation, if 
that is not prevented, in most urines during the first 
forty-eight hours. 
These facts are not sufficiently borne in mind, for 
I have seen an insurance examiner many times take 
the specific gravity of a warm, freshly-voided sam- 
ple of urine and report the result as representative, 
which it certainly was not. The Medical News. 
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