Cylindroids or So-called Mu- 
cous Casts in the Urine. 
/ 
BY 
MORRIS MANGES, A. M., M. D., 
PHYSICIAN TO OUTDOOR DEPARTMENT, MOUNT SINAI 
HOSPITAL, NEW YORK. 
REPRINTED FROM TUB 
Weto ¥orft .Journal 
for February 18, 1898. Reprinted from, the New York Medical Journal 
for February 18, 1893. 
CYLINDROIDS OR SO-CALLED MUCOUS CASTS 
IN THE URINE* 
By MORRIS MANGES, A. M., M. D., 
PHYSICIAN TO OUTDOOR DEPARTMENT, MOUNT SINAI HOSPITAL, NEW YORK. 
Although earlier writers had not infrequently called 
attention to bodies in the urine whose form resembled that 
of renal casts, yet it was not till 1870 that Thomas (1), 
while observing the urine in scarlet fever, carefully studied 
the forms to which he gave the name cylindroids. This 
name he applied not alone on account of their resemblance 
to true casts, but because they so frequently occurred with 
the latter, and also reacted in a similar manner toward 
acetic acid, llovida (2) carefully analyzed them chemically 
and showed the identity of their composition writh that of 
renal casts. They were mentioned by Bartels (3) and 
Wagner (4). Bizzozero (5), Eichhorst (6), Neubauer and 
Vogel (7), von Jaksch (8), Ftirbringer (9), Leube (10), and 
Rosenstein (11) also described them. The most exhaust- 
ive study on this subject was made by von Torok and Pol- 
* Read before the Section in Genito-urinary Surgery of the New 
York Academy of Medicine, December 8, 1892. 
Copyright, 1893, by D. Appleton and Company. 2 
CYLINDROIDS IN THE URINE. 
lak (12) in a prize essay entitled Ueber die Entstehung der 
homogenen Harncylinder und Cylindroide. 
Most of these writers agree, in some measure at least, 
in recognizing cylindroids as renal products bearing a 
more or less close resemblance to hyaline casts. Other 
authors regard them only as forms of mucin. Thus 
Baginsky (13) spoke of them as hyaline mucous shreds, 
which may be found in the urine of scarlet-fever patients. 
Tyson (14) states that occasionally casts may be found 
which are apparently “ pure mucus-molds of the urinifer- 
ous tubules.” These forms, in his opinion, undoubtedly 
come from the kidney and must be distinguished from the 
bands of mucin which are found in hyperacid urines. 
Millard (15), in his treatise on Bright’s disease, in 
which he has so carefully and thoroughly distinguished 
the relations of mucin to albuminuria, speaks of mucous 
casts, but denies that they have any significance except 
that they are often mistaken for hyaline casts. The mucous 
cast, as distinguished from true casts, he maintains, is not 
an inflammatory product. Vierordt (16), while describing 
mucin, says: “ Several forms are characteristic; among 
these are cylindroids, or microscopic shreds of mucus 
which careless observers may mistake for casts. Their 
origin and diagnostic significance are uncertain; they may 
be found (accompanying casts) in nephritis, in cystitis, and 
even in healthy individuals.” 
Peyer (17) also considers them products of mucus. He 
gives excellent plates (see Plates 6, 32, and 64) showing- 
various varieties, including prostatic and spermatic cylin- 
ders. Saundby (18) coincides with the above views and 
simply speaks of them as mucous cylinders. 
Yon Hosslin (19), in 1889, described an unusual form 
of casts which he found in the urine of an epileptic after a 
very severe renal colic which lasted eighteen hours. The CYLINDROIDS IN THE URINE. 
3 
urine passed after the attack had a specific gravity of 
1-035 and was laden with urates. With the naked eye 
numerous flakes could be seen floating in the urine. Under 
the microscope these were found to consist of sharply con- 
toured hyaline casts, branching dichotomously, and be- 
tween which were finely granular uratic deposits. As the 
urine was free from albumin, von Ilosslin believed that 
these casts coidd not consist of any albuminoid substance. 
Inasmuch as mucin is increased in quantity in renal colic, 
he therefore asserted that in this case the secretion of mu- 
cin was so great that mucin casts were formed in the kid- 
ney. The fact that he could never find casts after any of 
the epileptic attacks which the patient subsequently had, 
excludes the possibility of including them under this lat- 
ter group. 
In a paper on Tube Casts and their Diagnostic Value, 
read before this year’s meeting of the Association of 
American Physicians, Danfortli (20) divides these bodies 
(i. e., casts) into two groups, of which one includes the 
ordinary forms, the other being the mucin casts. These, 
he states, are “ the characteristic morphologic products of 
catarrhal nephritis and establish its differential diagnosis.” 
Cylindroids have also been variously mentioned as pro- 
static cylinders or tubules, spermatic casts, etc. On the 
other hand, very many recognized standard text-books do 
not even mention them.* 
Description.—Cylindroids are ribbon-like forms, usually 
Qf great length and of about the same diameter as renal casts. 
* Da Costa’s paper in the American Journal of the Medical Sciences 
for January, 1893, is an excellent proof of this assertion. Although 
very careful chemical and microscopical examinations of the urine were 
made in all his cases, yet cylindroids are never referred to. This is all 
the more striking since nowhere else do these bodies occur more fre- 
quently. 4 
CYLINDROIDS IN THE URINE. 
They may assume various shapes, due to bends and twists 
which are usually in their longitudinal axis, giving them a 
corkscrew appearance. These axial twists are most fre- 
quently observed near the extremities. Folds and lateral 
indentations are very common. The diameter may be uni- 
form or varying ; the latter is by far more common. Hence, 
as a rule, the extremities are narrow and elongated, and 
often bifurcated. Subdivision into three or even four 
branches is by no means rare. They are frequently thicker 
at one end than at the other. Their outlines are delicate, 
although more highly refracting than hyaline casts. A 
very characteristic feature is the longi- 
tudinal situation of various grades of 
delicacy; these markings not alone as- 
sist us in finding them, but are also a 
very important diagnostic feature which 
distinguishes them from true cylinders. 
They may occur isolated or in 
groups of two or three, or even in large 
snarls; the latter may often he detected 
by following up one extremity of the 
cylindroid (Fig. l). Not infrequently a 
specimen is at once cast and cylindroid, 
as where one end of a cast terminates in a spiral, striated 
form (Fig. 2). I have observed both extremities assume 
this form. One example which I saw of this variety had a 
body like a granular cast (probably due to some extra- 
neous precipitation) ; in still another example this granu- 
lar appearance was present in two portions of the specimen, 
the intervening space being quite hyaline, while the ex- 
tremities were typically cylindroidal (Fig. 3). Finally, 
cylindroids may occur inclosed in hyaline casts, as is well 
shown in Fig. 4. 
Like true casts, cylindroids may bear various forms of 
Fig. 1.—Snarl of in- 
terlacing cylindroids. 
(Low power.) From 
Bizzozero. CYLINDROIDS IN THE URINE. 
5 
epithelium, red and white blood-cells, crystals, detritus, fat- 
droplets, and bacteria. These may be inclosed within or 
may simply be adherent. When covered with amorphous 
deposits they may strongly resemble granular casts. 
Fig. 2.—Combined casts and cylindroids. (x400.) The specimen to the left 
was found in an acid urine (drawn by catheter) containing much free uric 
acid. The specific gravity was 1 030. Albumin and mucin were present in 
traces, with sugar 0’4 per cent. It contained three renal epithelial cells and 
numerous small fat globules. Hyaline and fatty casts also were present. 
The other specimen also is from a gouty urine, very acid, of the specific 
gravity of 1'032, containing many crystals of uric acid and cxalate of cal- 
cium, together with hyaline and granular casts. 
Their length is characteristic. According to Bizzozero 
(5) (loc. cit., p. 281), they may even be one millimetre long. 
It is common to see them extend over two, three, or even 
five fields of the microscope. The diameter of the thin 
forms (Bizzozero) is 1 to 2 p,; the broader varieties measure 
between 5 and 10 p,. False cylindroids may be much 
broader than this. 
Classification.—The classification of these bodies into 
two great groups—the true and false cylindroids—is of im- 
portance, not alone in estimating their diagnostic signifi- 6 
CYLINDROIDS IN THE URINE. 
cance, but also in explaining the differences of opinions 
held by various writers on this subject. That some cylin- 
droids are renal in origin 
is positively shown by 
the fact that von Torok 
and Poliak (12) have ac- 
tually seen them in the 
uriniferous tubules in 
sections of a large white 
kidney, of a waxy kid- 
ney, and numerous cases 
of chronic parenchyma- 
tous nephritis. Further- 
more, they were also 
found in the kidneys of 
rabbits poisoned with 
cantharides and bichro- 
mate of potasssium; in 
experimental stenosis of 
the renal veins; in liga- 
tion of the renal arteries ; 
and also where the ure- 
ters were tied off (Fig. 5). 
Another very strong proof that cylindroids are formed in 
the kidneys is shown in the curious casts inclosing cylin- 
droids (Fig- 4). As von Torok and Poliak observe, un- 
less we accept the view that the cylindroid already existed 
in the tubule where it was subsequently inclosed in a 
mantle of albuminoid material, we must assume that the 
cylindroid forced its way into the already formed cast. 
For this, however, it is not rigid enough, as any pressure 
from behind would simply press the spirals of the cylin- 
droid closer together. The alternation of casts and cylin- 
droids, their occurrence in the same specimen in which 
Fig. 3.—False cylindroid with deposit of 
amorphous urates. From a case of 
oxaluria; urine was very acid, speci- 
fic gravity l-028; contained urethral 
shreds, hyaline casts, and a small num- 
ber of red and white hlood-cells. A 
large trace of albumin and mucin also 
present. (x400.) CYLINDROIDS IN THE URINE. 
7 
they both contain exactly the same varieties of epithelial 
cells, blood-cells, detritus, etc., the similarity of their re- 
actions to various chemical reagents—all these attest the 
Fig. 4.—A hyaline cast 
containing a cylin- 
droid. From a case 
of Bright’s disease. 
(Yon TOrflk and 
Poliak.) 
Fig. 5.— Sections of uriniferous tubules containing 
jcylindroids. The specimen at the left was from 
the kidney of a rabbit in which the renal veins 
had been narrowed. The one at the right is 
from the kidney of a rabbit poisoned with can- 
tharides. (Vm TOrok and Poliak.) 
correctness of this view. Finally, I have also seen them 
in urine drawn with the catheter in cases where there was 
absolutely no indication of pyelitis and cystitis (Fig. 6). 
On the other hand, it is just as certain that others are 
formed outside of the kidneys. They may be readily ob- 
served in the secretions of the prostate, Cowper’s and Lit- 
tre’s glands, the bladder, vagina, uterus, and urethra. They 
may also he seen in the urine voided post coitum, or after a 
hard passage, or after what Keyes has termed “ milking 8 
CYLINDROIDS IN THE URINE. 
the prostate.” If any of the above secretions be mingled 
with perfectly normal urine, cylindroids may then be ob- 
served in the specimen (Figs. 7, 8, and 9). 
Fig. 6.—Renal cylindroids from a case of typhus] fever. Urine contained small trace'of 
albumin, red blood-cells, hyaline and epithelial casts. Cylindroids were soluble in 
acetic acid. A few adherent red blood-cells in one of the specimens. Urine was high 
colored, acid ; specific gravity, l-028. (x400.) 
Renal cylindroids have been subdivided into three 
groups : (a) small, narrow threads ; (b) ribbon-like bodies 
(c) collapsed tubules. Von Torok and Poliak also mention 
another variety where the contours are very vague. This 
classification referring only to the shape has no practical 
significance. 
Composition.—The exact composition of casts being un- 
known, a corresponding degree of uncertainty must neces- CYLINDROIDS IN THE URINE. 
9 
sarily exist concerning the nature of the basement substance 
of cylindroids. Of casts, Knoll (21) says that their sub- 
stance is identical with none of the known forms of albu- 
min—as acid albumin, albumin, albumose, globulin, fibrin, 
Fig. 7.—False cylindroids from a case of gout and cystitis. Urine acid; spe- 
cific gravity, 1'019 ; faint trace of albumin, large trace of mucin ; free uric 
acid crystals very abundant. Epithelial cells of bladder and pus cells quite 
abundant. (x 400.) 
mucin, or peptone, liovida (2), who has paid more atten- 
tion to this subject than any one else, claimed that casts and 
cylindroids were identical in composition. This is true if 
pseudo-cylindroids are not included; for, as already shown 10 
CYLINDROIDS IN THE URINE. 
above, true and false cylindroids react differently to acetic 
acid, the former being rapidly dissolved, while of the latter 
some are unaffected, but others are swollen up and appar- 
ently disappear; however, they again become visible after 
staining. 
Fig. 8.—Very long false cylindroid containing blood-cells. Both extremities 
bifurcated. From concentrated acid urine with traces of albumin and 
mucin. (x 400.) 
This effectually disposes of the belief of many who 
have regarded all cylindroids as being simply shreds of 
mucus. Even admitting that renal cylindroids could con- 
sist of mucin, from what part of the kidney could the 
necessary mucin be obtained ? The only rational source 
would he the pelvis; but in that case they would have a CYLINDROIDS IN THE URINE. 
11 
much less marked resemblance to true casts than they 
actually possess. Whatever cylindroids are formed there 
undoubtedly belong to the false variety. Mucus can not 
be secreted within the kidney, for it contains no muci- 
parous glands. Millard and Danforth still adhere to the 
possibility of a catarrhal nephritis. The latter writer as- 
sumes that the necessary mucin is furnished by the tubal 
Fig. 9.—False (spermatic) cylindroids found in urine after passage of hard 
faeces. (x300.) 
epithelium, most likely by that of the convoluted tubules. 
He maintains that, “ under certain circumstances, the epi- 
thelial cells seem to undergo a change which is equivalent 
to the ‘ mucoid degeneration ’ of Ziegler, the protoplasm 
of the cell being transformed into a mucoid substance, 
which is afterward cast into the lumen of the tubule, 
there to aggregate itself with the similar product of 
neighboring cells.” Such views of pathology may be 
dismissed as antiquated, for very few writers any longer 
speak of a catarrhal nephritis. The only other possible 
explanation would be that mucin, being now recognized 
as a nucleo-albumin, might arise from changes in the 
renal cells. However, if so marked a lesion were pres- 12 
CYLINDROIDS IN THE URINE. 
ent, we would have other manifestations of a well-marked 
nephritis. 
Thus we may assume that renal cylindroids consist of 
some as yet unknown albuminoid substance. On the other 
hand, pseudo-cylindroids are probably formed from some 
variety of mucin. 
Mode of Formation.—Of the three theories put forth to 
explain how casts are formed—viz., (a) by the liquefaction 
and metamorphosis of desquamated renal epithelium; (6) 
from secretory products of renal epithelial cells, the so- 
called vacuoles; (c) the coagulation of an albuminous tran- 
sudate into the tubules—only the latter comes into play 
when considering the origin of renal cylindroids. Their 
very form speaks for the correctness of this assumption, 
for according to the amount of the transudate will the cyl- 
indroid assume the shape either of a thin flat ribbon, or a 
hollow tube, or a solid cylinder. Originally the albuminous 
material is coagulated in straight lines; but the urine com- 
ing down from the glomerulus while they are still semi- 
solid, causes the various corkscrew twists, bends, and 
transverse folds. Their great length and the frequent oc- 
currence of dichotomous division would seem to indicate 
that they are usually formed in the straight tubules, al- 
though it is true that the branching of their extremities 
might also be explained by a subsequent splitting. 
This view will also readily explain the bodies which are 
cast and cylindroid combined,by assuming either that through 
some obstruction the transudate was forced to fill out the en- 
tire tubule at some point, or that, although its amount was 
enough to form a cast in some portions, it did not suffice at 
other parts. The occurrence of snarls of interlacing cyliu- 
droids does not weaken this assumption, for Thomas (23) 
asserts that they may be formed by the meeting in the 
calyces of the streams from the various collecting tubules. CYLINDROIDS IN THE URINE. 
13 
The occurrence of cylindroids in tubules with unaltered 
epithelium indicates either the coagulation of transuded 
albuminous fluids, or that the specimen was carried down 
from some point higher up. But to discuss this subject at 
greater lengths would only bring us back to the considera- 
tion of all the various theories on the formation of hyaline 
casts. 
Pseudo-cylindroids are simply bands of mucin precipi- 
tated in the excretory ducts of the various glands of the 
urinary tract by the acid reaction of the urine. 
Occurrence.—It is surprising how frequently these forms 
may be observed in the urine after we have once learned to 
recognize them. AVhere the urine has been mixed with va- 
rious discharges—as in cystitis, leucorrhoea, or gonorrhoea, 
after coitus, after a hard passage, etc.—they may be readily 
discovered, as they are then quite abundant. They are 
also present in pyelitis, the various forms of nephritis, 
and congestion of the kidneys ; consequently they are pres- 
ent in diphtheria, scarlet fever, and other exanthemata. I 
have even recently observed them in a case of typhus fever 
(see Fig. 6). They may occur alone or with casts, fre- 
quently alternating with the latter as the renal lesion abates 
in severity. These are least abundant in the chronic forms 
of nephritis. In normal urines they are by no means rare. 
Jaksch (8) (loc,. cit., p. 236) found cylindroids very fre- 
quently in the urine of children, with and without albu- 
min, where renal disease could otherwise not be demon- 
strated. Among the non-albuminous urines they are espe- 
cially liable to occur in jaundice, in concentrated and 
hyperacid specimens, and, finally, in subjects suffering 
from gouty manifestations and imperfect metabolism. It 
is just these cases which give us so much trouble in de- 
termining whether or no a trace of albumin might be pres- 
ent. These specimens are usually of a very high specific 14 
CYLINDROIDS IN THE URINE. 
gravity (over 1‘030), hyperacid, and contain a large quantity 
of urates ; free crystals of uric acid and oxalate of lime are 
present when the urine is voided, or appear soon on stand- 
ing. In these cases mucin is always present, often in con- 
siderable amounts. Hyaline casts, a moderate number of 
pus-cells, and at times even red blood-cells (where the pel- 
vis of the kidney or other parts of the urinary tract have 
been irritated by sharp pointed crystals), are by no means 
rare in such specimens. Many of these cases are put back 
and often rejected by life-insurance companies. 
False cylindroids have absolutely no relation to albu- 
minaria, but appear to accompany mucinuria. The renal 
varieties may be present with or without albumin. The 
trace of albumin which is so frequently present in these cases 
is often probably due to the excess of mucin which is so com- 
mon in these patients. However, Le Nobel (22) has always 
found globulin in urines containing cylindroids. 
The youngest age at which I have observed them was 
five years—in a little girl with psoriasis ; her family history 
was decidedly gouty. 
Diagnosis.—For the purpose of studying the general 
characteristics of cylindroids, the urine of any patients suf- 
fering from gonorrhoea offers a good field, since the forms 
here present are very easily recognized on account of the 
distinctness of the longitudinal striation, their greater re- 
fracting power, and their length. Moderate powers (300 to 
400 diameters) are ample. The delicacy of the contours 
of these bodies requires that the illumination be not too 
strong ; they may be very easily overlooked when gaslight 
is used. Staining with Lugol’s iodine solution, picric acid, 
etc., is always of assistance. 
Cylindroids are most readily found in freshly voided 
urine, especially if the minute Hakes which are often in- 
closed in the mucus be examined. These flakes are very CYLINDROIDS IN THE URINE. 
15 
hard to find if the urine has been shaken up. Another 
means of detecting them is to look for the snarls already 
referred to. 
The differential diagnosis is important. The greatest 
difficulty will be encountered in distinguishing the true 
from the false forms. The only absolute test is the solu- 
bility of the former in acetic acid and the insolubility of 
the latter in the same reagent. However, the accuracy of 
this test is vitiated by the fact that some pseudo-cylindroids 
will swell up on the addition of this reagent and apparently 
disappear. Staining with Lugol’s solution will, however, 
show that the specimen can still be rendered visible. How- 
ever, to carry out this test successfully requires not a little 
skill in microscopic technique to constantly keep the par- 
ticular specimen in the field of the microscope. 
The presence of albumin, casts, and renal epithelial 
cells would lead us to expect the renal forms, while an ex- 
cess of mucin, the admixture with products from the blad- 
der, prostate, urethra, vagina, and uterus, would indicate 
pseudo-cylindroids. In the latter, also, the striations are 
coarser, the refractive power is greater, the diameter varies 
more, the extremities are more frequently divided into 
more than two branches—in a word, the less the resem- 
blance to true casts, the greater the probability that we are 
dealing with pseudo-cylindroids. Naturally, the differen- 
tiation is materially aided by the presence of adventitious 
products—viz., spermatozoa, epithelium of the lower uri- 
nary tract, etc. 
In spite of all these distinctions, the differentiation be- 
tween these two groups will not infrequently be attended 
with the greatest difficulties; and in some cases it is even 
impossible, especially where both forms are present. 
From casts cylindroids may readily be distinguished by 
their length, irregular contours, twists, and, above all, the 16 
CYLINDROIDS IN THE URINE 
longitudinal striations already referred to. Casts resemble 
a cylinder, while cylindroids are more band-like. Granular 
casts may be closely simulated where many of these charac- 
teristics have been obliterated by the presence of amorphous 
deposits. I have even seen true blood casts simulated by 
cylindroids bearing- a large number of closely packed red 
blood-cells. In this connection it might be well for super- 
ficial observers to bear in mind how much renal casts differ 
from the usual typical drawings in most text-books, show- 
ing a cylinder with parallel sides and rounded extremities. 
Hyaline casts are quite frequently irregular in their con- 
tours, their sides often taper toward one extremity, bends 
are common, and Neubauer and Vogel even state (loc. cit., ii. 
Theil, S. 155) that some may have bifurcated extremities.* 
I have already spoken of the forms which are at once 
cast and cylindroid—i. e., either the casts with spiral and 
tapering extremities, which are quite common, or the very 
rare forms in which cylindroids are inclosed in casts. 
Significance.—Having thus shown the necessity of re- 
garding these bodies as something more than mucous casts, 
and having also proved the existence of both true and false 
cylindroids, the question naturally arises, What is their sig- 
nificance and what prognostic conclusions may be drawn 
from them ? 
The pseudo-cylindroids, as such, may be dismissed with- 
out another word, as their significance is limited to simply 
recognizing them as such. Whatever bearings these forms 
have in diagnosis is merely due to the difficulty which may 
be encountered in absolutely distinguishing them from the 
true renal varieties. 
* Examples of the very irregular outlines of casts may be seen in 
Basham, On Dropsy connected with Diseases of the Kidney, London, 
1858, Plate IX; Salkowski and Leube, loc. cit., p. 444, Fig. 36; von 
Jaksch, loc. cit., Figs. *78 and 81, CYLINDROIDS IN THE URINE. 
17 
Leube (10) (loc. cit., p. 447) asserts that in his opinion 
there is no reason for specially distinguishing cylindroids 
from ordinary casts, especially as the latter so frequently 
have lateral indentations and axial twists. Rosenstein (11) 
(loc. cit., p. 45) denies the right of attributing to cylindroids 
a special importance which renders their distinction from 
casts necessary. Fiirbringer (9) (loc. cit., p. 36) coincides 
with the latter. 
Thomas (23) believes that where cylindroids are replaced 
by casts an exacerbation of the nephritis may be inferred ; 
and, vice versa, cylindroids take the place of casts when the 
renal process abates. He also assumes that cylindroids are 
present where the quantity of albumin is very minute, and 
that they may even be the only signs of a mild nephritis. 
The latter may frequently be due to the excretion of infec- 
tious elements; in some cases the process resolves; in 
others it goes on to a nephritis. He suggests that bacte- 
rial influences may be discovered in many other cases where 
cylindroids occur. 
Tbe views of von Torok and Poliak, Tyson, and others 
have already been stated. 
Danforth, in addition to what has already been quoted 
of his contention that “ mucin casts ” establish the diagnosis 
of catarrhal nephritis, also maintains that these bodies are 
of great importance in the early recognition of interstitial 
nephritis. 
My own belief is that if we can be absolutely sure that 
we are dealing with true renal cylindroids, their significance 
would be about the same as that of hyaline casts. But the 
value of such inferences is materially lessened by the great 
difficulties which often attend this differentiation. Not in- 
frequently I have found it impossible. So experienced an 
observer as Peyer admits the same. Therefore, to attribute 
any absolutely diagnostic significance to cylindroids is not 18 
CYLINDROIDS IN THE URINE. 
justified, as these doubtful cases usually occur where our 
other means of diagnosticating nephritis also leave us in the 
lurch. Such a conclusion once more reminds us that a di- 
agnosis of nephritis ought not to be made from an exami- 
nation of the urine alone ; but that all the other organs 
should be interrogated before making absolute statements 
as to the existence of renal disease. 
Literature. 
1. Thomas. Archiv fur Beilkunde, 1870, Bd. xi, S. 130. 
2. Rovida. J. Moleschott’s Untersuchungen, Bd. xi, S. 1-29. 
3. Bartels. Yon Ziemssen’s Cyclopaedia, 1875, Bd. ix. 
4. Wagner. Der Morbus Bdghtii, 1882. 
5. Bizzozero. Klinische Mikroskapie. German Translation, 
1887, S. 211. 
6. Fichhorst. Physikalische Untersuchungsmethoden in- 
neren Krankheiten. 
7. Neubauer und Yogel. Analyse des Harm, 9te Auflage, 
2t,e Theil, S. 151. 
8. Yon Jaksch. Klinisdie Diagnostik, 2te Auflage, S. 236. 
9. Fiirbringer. Krankheiten der Ham- und Geschlechts- 
organe, 1890, S. 36. 
10. Salkowski und Leube. Die Lehre vom Ham, 1882, S. 
447. 
11. Rosenstein. Pathologie und Therapie der Nierenkrank- 
heiten, 3te Auflage, 1886, S. 45. 
12. Yon Torok und Poliak. Archiv fur experiment. Pa- 
thologie und Pharmakologie, 1888, Bd. xxv, S. 87. 
13. Baginsky. Lehrbuch der Kinderkrankheiten, 1883. 
14. Tyson. Examination of Urine, 1886, p. 214. 
15. Millard. Bright's Disease. Third Edition, chap. x. 
16. Yierordt. Diagnostik der inneren Krankheiten, 1888, 
S. 355. 
17. Peyer. Atlas of Clinical Microscopy, 1885, Plates 6, 
32, 64. 
18. Saundby. Bright's Disease, 1889, p. 40. 
19. You Hosslin. Ueber eine ungewohulicbe Form von CYLINDROIDS IN THE URINE. 
19 
Harncylindern in eiweissfreiem Brin. Munchener vied. Woch- 
ensclirift, 1889, Bd. xxxvi, S. 771. 
20. Dnnforth. Medical Aews, vol. Ixi, No. 4, p. 85. 
21. Knoll. Zeitsclirift fur Heilkunde, 1882, Bd. iii, S. 148 ; 
quoted by von Jaksch, loc. cit., S. 238. 
22. Le Nobel. Centralblatt far vied. Wissensckaft, 1887, 
Bd. xxxiv, S. 625. 
23. Thomas in Gerhardt’s Tlandbuch der KinderheiIkunde, 
1878, iv, 3te Abtheilung, S. 294. 
941 Madison Avenue. seasons war 
Pisysicmiis slionli Mask 
-FOR- 
The New York Medical Journal, 
Edited by FRANK P, FOSTER, M.D., 
Published by D. APPLETON & CO,. 1, 3, & 5 Bond St. 
1. BECAUSE: It is the LEADING JOURNAL of America, and 
contains more reading-matter than any other journal of its class. 
2. BECAUSE : It is the exponent of the most advanced scientific 
medical thought, 
3. BECAUSE : Its contributors are among the most learned medi- 
cal men of this country. 
4. BECAUSE: Its “Original Articles” are the results of sci- 
entific observation and research, and are of infinite practical 
value to the general practitioner. 
5. BECAUSE: The “.Reports on the Progress of Medicine,” 
which are published from time to time, contain the most recent 
discoveries in the various departments of medicine, and are 
written by practitioners especially qualified for the purpose, 
6. BECAUSE : The column devoted in each number to “Thera- 
peutical Notes ” contains a rfaume of the practical application 
of the most recent therapeutic novelties, 
y„ BECAUSE : The Society Proceedings, of which each number 
contains one or more, are reports of the practical experience of 
prominent physicians who thus give to the profession the results 
of certain modes of treatment in given cases. 
8- BECAUSE : The Editorial Columns are controlled only by the 
desire to promote the welfare, honor, and advancement of tho 
science of medicine, as viewed from a standpoint looking to the 
best interests of the profession, 
9. BECAUSE : Nothing is admitted to its columns that has not 
some bearing on medicine, or is not possessed of some practical 
value. 
£0. BECAUSE : If is published solely in the interests of medicine, 
and for the upholding of the elevated position occupied by the 
profession of America. 
Subscription Price, $5.00 per Annum. Voiumes begin in January 
and July,