{"1": {"fulltext": "", "height": "5328", "width": "3353", "jp2-path": "practicaluran00purd_0001.jp2"}, "2": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0002.jp2"}, "3": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0003.jp2"}, "4": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0004.jp2"}, "5": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0005.jp2"}, "6": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0006.jp2"}, "7": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0007.jp2"}, "8": {"fulltext": "PLATE I.\\nPale Yellow.\\nZ\\nLight Yellow.\\n3\\nYellow:\\n4\\nReddish Yello w.\\n5\\nYellowish Red.\\n6.\\nRed.\\n7.\\nBrownish Red.\\n8\\nBeddzsh Brown.\\n9.\\nBrownish Black.\\nFromUature ~by DrJ~.Vbpel\\nVDGEES SCALE OF URINE TINTS", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0008.jp2"}, "9": {"fulltext": "PRACTICAL URANALYSIS\\nAND\\nURINARY DIAGNOSIS\\nA Manual for the Use of Physicians, Surgeons,\\nand Students\\nBY\\nCHARLES W. PURDY, LL.D., M.D.\\nQUEEN S UNIVERSITY\\nFellow of the Royal College of Physicians and Surgeons, Kingston; Professor of Clinical\\nMedicine at the Chicago Post-Graduate Medical School. Author of Bright s\\nDisease and Allied Affections of the Kidneys also of Diabetes:\\nIts Causes, Symptoms, and Treatment\\nfifth Revised ana enlarged edition\\nWITH NUMEROUS ILLUSTRATIONS, INCLUDING PHOTO-\\nENGRAVINGS AND COLORED PLATES\\nPhiladelphia, New York, Chicago\\nF. A. DAVIS COMPANY, PUBLISHERS\\n1900", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0009.jp2"}, "10": {"fulltext": "649G0\\nLibrary af Cooupwk\\n**VO. toflU Ntt tltfED\\nOCT 23 1900\\nCopyright mtry\\nSECOND COPY.\\nQRDt\u00c2\u00ab DIVISION,\\nUOV 1719Q9\\nCOPYRIGHT, 1894, 1895, 1896, AND 1898,\\nBY\\nTHE F. A. DAVIS COMPANY.\\nCOPYRIGHT, 1900,\\nBY\\nF. A. DAVIS COMPANY.\\n[Registered at Stationers Hall, London, Eng.]\\nPhiladelphia, Pa., U. S. A.\\nThe Medical Bulletin Printing-House,\\n1916 Cherry Street.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0010.jp2"}, "11": {"fulltext": "o\\nTO THE\\nPROFESSORS, PAST AND PRESENT\\nTO THE\\nFELLOWS, ALUMNI, AND STUDENTS,\\nOF MY\\nALMA MATER,\\nTHE FOLLOWING PAGES ARE\\nAFFECTIONATELY INSCRIBBr\\nBY\\nTHE AUTHOR.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0011.jp2"}, "12": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0012.jp2"}, "13": {"fulltext": "PREFACE TO FIFTH EDITION.\\nThe present edition of this work consists of a careful and\\nthorough revision of the last one, with the addition of much\\noriginal and new matter, including a new chapter on the micro-\\nscope and its use in uranalysis. The author has much pleasure\\nin now fulfilling a promise made in the first edition, viz.: to\\nextend the range of centrifugal analysis so that it should include\\nmore complete as well as more practical data for urinary work.\\nAlthough requiring over five years labor for its perfection,\\ncentrifugal analysis has now been elevated to a scientific process,\\njustly entitled to rank among the so-called exact methods of anal-\\nysis. By means of the improved methods and new tables here-\\nwith introduced, the quantities of albumin and chlorine, of phos-\\nphoric and sulphuric acids in the urine may be simply and rapidly\\ndetermined, both relatively and absolutely, with a degree of\\naccuracy equal to that of an} other method.\\nThe physician is often led to purchase a microscope for the\\nchief or sole purpose of urinary examinations. In so doing the\\nnext step is to learn how to make satisfactory examinations of\\nurine therewith. In purchasing a work purporting to explain\\nthe use of the instrument, as a rule little or nothing will be\\nfound therein relative to microscopical examinations of the urine.\\nIn turning to systematic treatises on the urine, as a rule, an\\nequal lack of information on the subject is met with. The above\\nmentioned are some of the considerations for introducing in the\\npresent edition a separate section intended to furnish a general\\nidea of the microscope itself and its special use in urinary work.\\nWhile this section is hy no means claimed to be exhaustive, the\\nauthor hopes that the beginner will find therein some useful and\\npractical suggestions to aid him in his work.\\nThe chemical department of the work has been carefully\\nrevised, a few quantitative methods have been added where\\npreviously omitted, and nearly the whole subject of testing for\\n(v)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0013.jp2"}, "14": {"fulltext": "VI PREFACE TO FIFTH EDITION.\\nalbumin in the urine, both qualitative and quantitative, has been\\nrewritten. In short, an effort has been made to improve the\\nwork more especially in its practical bearings on clinical med-\\nicine, as well as to bring it thoroughly up to date. The labor\\nhas been no inconsiderable task, comprising over a hundred and\\ntwenty pages of manuscript, but this task has been greatly\\nlightened by the pleasant recollection of the very generous recep-\\ntion extended to former editions of the work by the profession\\nin general.\\nThe author makes acknowledgment with pleasure of the\\nvaluable aid of his assistant, Mr. Carl Irenseus, who has devoted\\nmuch time and pains in carefully working out the many details\\nof the tables on centrifugal analysis.\\n57 East Twentieth Street,\\nJune, 1900.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0014.jp2"}, "15": {"fulltext": "PREFACE.\\nOur present knowledge of the urine and of diseases of the\\nurinary organs may be said to be altogether abreast with other\\ndepartments of scientific and practical medicine. At present,\\nhowever, this knowledge is only accessible to the student\\nthrough somewhat extended search through general works on\\nMedicine, Surgery, Pathology, Physiological Chemistry, Mi-\\ncroscopy, etc., in addition to the various works devoted to this\\nspecial subject. European writers, especially those in our lan-\\nguage, following the sharp division between medical and sur-\\ngical diseases, have invariably considered the present subject,\\nboth in general and special works, either from an exclusively\\nmedical or surgical point of view, and American writers thus far,\\nwithout exception, have followed this example. But in America\\nthe whole profession is taught and qualified to practice both medi-\\ncine and surgery, and, therefore, the above-mentioned custom\\ncompels the student, in order to gain a complete knowledge of\\nthis subject, to study several authorities, entailing increased\\nexpense and time, if not, indeed, confusion. Believing, therefore,\\nthat American authors should, so far as is possible, deal with\\nthe whole subject comprised in the titles of special works, it has\\nbeen the aim of the author in the present work to furnish the\\nstudent, physician, and surgeon, in one moderate-sized volume,\\nthe essential features of our knowledge of the urine and urinary\\ndiagnosis, thoroughly up to date, and in the most systematic,\\npractical, and concise form. In carrying out this object an\\neffort has first been made to bring out prominently the relations\\nof the chemistry of the urine to physiological processes and\\n(vii)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0015.jp2"}, "16": {"fulltext": "Vlll PREFACE.\\npathological facts. Thus, in dealing with normal urine, each\\nconstituent has been considered, so far as at present is known,\\nin the following order Its chemical nature and composition\\nits source in the economy the significance of its increase\\nor decrease in the urine, with the relations of these to meta-\\nbolic processes, food-supply, physical surroundings, and tend-\\nency toward disease; and, finally, the most approved methods\\nof its detection and determination have been described. In\\ndealing with abnormal urine each morbid constituent has been\\nconsidered, so far as at present is known, in the following\\norder Its chemical nature and composition its source in\\nthe economy the clinical significance of its appearance in the\\nurine and, lastly, the most approved methods of its detection\\nand determination have been described. This method aims\\nat teaching not only how to detect, isolate, and determine the\\nconstituents of the urine, normal and abnormal, but also to de-\\ntermine the presence of disturbed physiological processes, to\\ndetect the presence of pathological changes, and to measure the\\ndegree of both.\\nThe second division of the work -Urinary Diagnosis aims\\nat a concise description of the special features of the urine that\\nindicate the presence of special pathological processes in prog-\\nress in the econom} r whether they be local or general, medical\\nor surgical, together with a brief enumeration of the leading-\\nclinical symptoms of each disease, and, in most cases, an\\nepitome of their nature and etiolog}^.\\nHaving compassed the whole text, it is designed that the in-\\nvestigator will next be in a position to utilize the information\\nthereby furnished to the best practical diagnostic purposes, and\\ngive him the mastery over the diseases considered, -/or, as a\\nrule, he who has accurately diagnosticated disease, has already\\nconstituted himself its conqueror.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0016.jp2"}, "17": {"fulltext": "PREFACE. IX\\nThe author has freely quoted the views of standard authori-\\nties, endeavoring in all cases to make due acknowledgment of\\nthe same throughout the text. Should, however, any of the\\nlatter have been overlooked, he desires here to express his obli-\\ngations for all knowledge derived from fellow-laborers in the\\nsame field of work.\\nSome repetitions of matter will be noted, both in the text\\nand foot-notes, the object being to save references to other parts\\nof the work and render it more convenient as an open hand-book\\nfor the laboratory table.\\nOver twenty-five years experience, coupled with a somewhat\\nliberal examination of the literature of this subject, as well as\\nconsiderable practical observation and experiment, have enabled\\nthe author to contribute some original matter and methods,\\nwhich, he trusts, will prove to be an advance in certain practical\\ndepartments of the subject.\\nFinally, an appendix has been added upon the subject of\\nurinary examinations for life-insurance. Believing, from some\\nexperience as a medical director, that on the one hand life-insur-\\nance associations are often unjustly called upon to pay insurance\\non uninsurable lives, and on the other hand that applicants are\\noften deprived of the privileges of life-insurance to which they\\nare justly entitled, especial pains have been taken with this de-\\npartment of the work, with the earnest hope of contributing, in\\nsome degree, to the amelioration of these two forms of injustice.\\n57 East Twentieth Street,\\nChicago, September- 1894.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0017.jp2"}, "18": {"fulltext": "CONTENTS.\\nPART I.\u00e2\u0080\u0094 ANALYSIS OF URINE.\\nSECTION I.\\nGeneral Considerations i-20\\nComposition of urine. Changes in the urine upon standing; alkaline\\nfermentation, acid fermentation. Collection of urine for analysis.\\nPhysical characters of the urine Color, variations of, in health\\npathologically. Vogel s scale of urine colors, application of scale\\nHalliburton s table of color variations. Odor of the urine, variations\\nof effects of drugs on clinical significance. Transparency of the\\nurine, changes on standing, in disease. Consistence of the urine,\\nnormal, pathological. Specific gravity of the urine, variations of, in\\nhealth pathological, prognostic significance determination of tem-\\nperature of the urine, effects of, upon specific gravity. Chemical\\nreaction of the urine, variations of conditions affecting. Quantity\\nof urine, average causes affecting, in health pathologically. Esti-\\nmation of solids table for estimating from specific gravity signifi-\\ncance of reduction of variations of, in disease rules in making\\ndeductions from estimation, average standard. Estimation of acidity\\nof the urine.\\nSECTION II.\\nComposition of Normal Urine 21-66\\nOrganic constituents Urea, chemical characters of origin in the\\neconomy variations in quantity clinical significance of, sepa-\\nration from the urine; detection. Determination, Liebig s method;\\nRautenburg s and Pfliiger s modifications. Hypobromite method.\\nFowler s method of differential density. Uric acid, chemical nature\\nof origin in the economy conditions affecting precipitation, daily\\naverage, detection. Determination, Heintz s method Haycraft s\\nmethod Hopkin s method. Xanthin, chemical characters of,\\ndetection. Allantoin, chemical characters of, detection and de-\\ntermination. Creatinin, chemical characters of. Creatin, conditions\\naffecting excretion, detection and determination of. Aromatic\\nsubstances in the urine Hippuric acid, chemical characters of, condi-\\ntions affecting its excretion, detection and determination. Ethereal\\nsulphates, origin of, circumstances causing excess of. Phenol-potas-\\nsium sulphate (carbolic acid), detection and determination. Indoxyl-\\npotassium sulphate (indican), clinical relations, detection, determi-\\nnation. Urinary pigments Normal urobilin, chemical characters\\nof; origin of, in the economy significance of variations detection.\\nUroerythryn, nature of. Urochrom, chemical characters of. Oxalic\\nacid. Succinic acid. Lactic acid. Fatty acids. Glycero-phosphoric\\nacid. Carbohydrates. Animal gum. Milk-sugar, detection of. In-\\nosite, detection of. Ferments\u00e2\u0080\u0094 pepsin, detection of diastase\\nrennet trypsin. Mucin, detection of. Inorganic constituents\\nChlorides, daily average, conditions affecting, clinical relations, de-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0018.jp2"}, "19": {"fulltext": "CONTENTS. Xi\\nPAGE\\ntection, determinations. Phosphates\u00e2\u0080\u0094 Total daily average, chemical\\ncharacters, clinical relations, detection, determination. Earthy\\nphosphates. Alkaline phosphates, quantitative determination of.\\nSulphates, amount, physiological relations, detection, determination.\\nCarbonates, detection and determination of. Iron. Ammonium.\\nHydrogen dioxide. Gases\u00e2\u0080\u0094 Carbonic acid, oxygen, nitrogen. Cen-\\ntrifugal analysis, advantages of process of. Method of estimating\\nchlorides, of phosphates, of sulphates.\\nSECTION III.\\nProteids 67-98\\nVarieties of proteids in urine. Albuminuria, causes of clinical signifi-\\ncance detection of albumin in the urine value of different tests\\nmethod of testing for albumin in urine determination of albumin in\\nurine. Proteoses, varieties of. Albumosuria\u00e2\u0080\u0094 classification of albu-\\nmoses, chemical characters of, clinical significance, detection of.\\nPeptonuria\u00e2\u0080\u0094 mode of production of peptones, chemical nature of,\\nclinical significance, detection, differentiation. Globulinuria\u00e2\u0080\u0094 nature\\nof globulin, clinical significance, detection and determination of. Dif-\\nferential testing for proteids. Halliburton s table of proteid reac-\\ntions. Haeinoglobinuria\u00e2\u0080\u0094 nature of haemoglobin, clinical significance,\\ndetection. Fibrinuria chemical nature of fibrin clinical signifi-\\ncance of fibrinuria, detection. Mucinuria (pathological)\u00e2\u0080\u0094 nature of\\nmucin, clinical significance, detection of.\\nSECTION IV.\\nCarbohydrates 99-122\\nGlycosuria chemical nature of dextrose clinical significance detec-\\ntion of sugar in the urine significance of sugar in the urine method\\nof testing for sugar in the urine determination of sugar in the urine.\\nLevulosuria chemical nature of levulose clinical significance, detec-\\ntion. Lactosuria\u00e2\u0080\u0094 chemical nature of lactose clinical significance,\\ndetection. Inosituria chemical characters of inosite clinical sig-\\nnificance of inosituria detection of inosite in urine. Glycuronic\\nacid, chemical characters and relations; significance of presence in\\nurine detection. Cane-sugar, detection. Glycogen, chemical char-\\nacters and relations.\\nSECTION V.\\nAbnormal Urine (continued 123-146\\nAce tonuri a\u00e2\u0080\u0094 chemical characters of acetone clinical significance of ace-\\ntonuria detection of acetone in urine. Diaceturia chemical char-\\nacters of diaceton clinical significance of diaceturia detection of\\nd-aceton. Choluria bile-acids, significance of, in the urine detec-\\ntion. Biliary pigments, significance of, in urine detection. Indoxyl-\\nsulphuric acid, derivation of, in the system; clinical significance of,\\nin urine detection. Diazo reaction in urine, clinical significance\\nof. Beta-oxybutyric acid, chemical charaters of detectiou in urine\\nclinical significance. Ptomaines and leucomaines in urine, nature\\nof. Putrescin. Cadaverin. Trimethylamin. Beatin. Jaksch s class-\\nification, detection, isolation, etc. Properties of animal bases. The\\nurine as a toxin toxic properties of normal urine. Bouchard s ex-\\nperiments and conclusions. Toxicity of pathological urines.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0019.jp2"}, "20": {"fulltext": "Xll CONTENTS.\\nSECTION VI. PAGE\\nUrinary Sediments 14*7\u00e2\u0080\u00941^7\\nClassification of urinary sediments. Sedimentation of urine, by gravity\\ncentrifugal method, advantages of; description of author s electric\\ncentrifuge. Deposits in urine upon long standing. Lithuria, nature\\nof sediment clinical significance of uric-acid deposits. Urates, varie-\\nties of clinical significance. Oxaluria, microscopical characters of\\nsediment differentiation, clinical significance. Beneke s conclusions\\nas to causes of oxaluria. Phosphaturia\u00e2\u0080\u0094 forms of phosphatic de-\\nposits conditions favoring deposit clinical significance. Cystin-\\nuria\u00e2\u0080\u0094 microscopical character of cystin differentiation clinical sig-\\nnificance. Leucinuria and tyrosinuria chemical characters of leucin\\nmicroscopical features. Tyrosin, chemical characters detection\\nclinical significance. Melanuria; chemical characters of melanin;\\ndetection clinical significance. Lipuria, nature of clinical signifi-\\ncance.\\nSECTION VII.\\nAnatomical Sediments 178-214\\nHaematuria, microscopical characters of blood clinical significance.\\nPyuria, character of urine in microscopical features of pus clinical\\nsignificance detection of pus determination of pus and blood in\\nurine. Epithelium, varieties found in urine microscopical features\\nclinical significance. Urinary casts, nature and origin classifica-\\ntion. Blood-casts, appearance of clinical significance. Epithelial\\ncasts, origin of appearance of clinical significance. Pus-casts. Bac-\\nterial casts, appearance and significance of. Granular casts, varieties\\nfound appearance and characters clinical significance. Fatty\\ncasts, origin of clinical significance. Hyaline casts, appearance of\\nvarieties, origin, clinical significance. Cylindroids, appearance of\\nclinical significance of. Method of searching for casts obstacles\\nformerly encountered overcome by centrifugal methods precautions\\nin microscopical examination. Spermatozoa, appearance, nature,\\nclinical significance of deposit. Fragments of tumors, diagnostic\\nvalue. Bacteriuria, classification. Non-pathogenic fungi, varieties\\nof microscopical features of significance of. Ammoniacal bacteri-\\nuria. Pathogenic fungi, varieties of, in urine,\u00e2\u0080\u0094 bacillus tuberculosis,\\ngonococci, etc. Vermes: Distoma haematobium, nature of result-\\ning lesions clinical symptoms. Filaria sanguinis hominis, appear-\\nance, nature, and habits of resulting lesions. Echinococci, features\\nof. Strongylus gigas, description of.\\nSECTION VIII.\\nThe Microscope 215-240\\nSuggestions for the use of beginners. Different parts of the micro-\\nscope. Objectives. Illumination. Care of the instrument. Exami-\\nnation of the urinary sediment preparation of the sediment; micro-\\nscopical search of. Casts, diagnosis of. Epithelia. Crystals. Pus-\\nand blood- corpuscles. Micro-organisms. Mounting. Bacterial\\nexamination.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0020.jp2"}, "21": {"fulltext": "CONTENTS. XUl\\nSECTION IX. page\\nGravel and Calculus 241-256\\nClassification. Composition. Causes of urinary concretions. Uric-acid\\nconcretions, frequency of, recognition of, conditions favoring origin\\nand growth. Urate concretions, nature, frequency in infancy. Cal-\\ncium oxalate concretions, nature. Cystin calculus, nature, origin.\\nXanthin concretions, nature, origin, recognition. Calcium-phos-\\nphate concretions, nature. Ammonio-magnesium-phosphate concre-\\ntions, origin, significance. Mixed phosphatic concretions, nature,\\norigin. Calcium-carbonate concretions, nature. Fatty concretions.\\nIndigo concretions. Fibrin and blood concretions. Prostatic con-\\ncretions. Clinical differentiation. Analysis of calculi\u00e2\u0080\u0094 physical\\ncharacters, section, heat, chemical analysis, microscopical features,\\netc. Characteristics of uric acid, xanthin, cystin, protean concre-\\ntions, urostealith, urates of fixed alkalies, calcium oxalate, ammonio-\\nmagnesium phosphate. Heller s table for analysis of calculi.\\nPART II.\u00e2\u0080\u0094 URINARY DIAGNOSIS.\\nSECTION X\\nDiseases of the Urinary Organs and Urinary Disorders. 259-293\\nRegional anatomy of the kidneys and renal pelvis, the ureters, the\\nbladder. Physical examination of the kidneys. Palpation, percussion,\\netc., of the ureters, of the bladder. Cystoscopic exploration. Diag-\\nnosis. Acute renal hypersemia, nature of, the urine in clinical\\nfeatures of. Passive renal hypersemia, nature, causes, urine in\\nprominent clinical features of. Acute diffuse nephritis, nature,\\ncauses, urine in leading clinical features of. Chronic diffuse\\nnephritis, nature, causes, urine in leading clinical features of.\\nChronic interstitial nephritis, nature and causes of the urine in\\nleading clinical features. Amyloid disease of the kidneys, nature\\nand causes of the urine in differential features of urine leading\\nclinical features. Cystic disease of kidneys, urine in, etc.\\nSECTION XL\\nDiseases of the Urinary Organs and Urinary Disorders\\n{continued) 294-340\\nRenal tuberculosis, nature, causes, etc the urine in leading clinical\\nsymptoms. Renal cancer, the urine in prominent clinical symptoms\\nof. Renal calculus, the urine in clinical symptoms. Renal em-\\nbolism, nature, causes, frequency, etc. the urine in prominent\\nclinical symptoms of. Uraemia, nature, causes of the urine in\\nprominent clinical features of. Haemoglobinuria, nature and causes\\nthe urine in leading clinical symptoms. Chyluria, nature and\\ncauses the urine in leading clinical symptoms. Diabetes insipidus,\\nnature and causes urine in leading symptoms. Diabetes mellitus,\\nnature, causes the urine in leading clinical symptoms. Urinary\\nfever, nature and causes; the urine in: leading clinical symptoms.\\nHydronephrosis, nature and causes the urine in leading symptoms.\\nPyonephrosis, nature and causes the urine in prominent symptoms.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0021.jp2"}, "22": {"fulltext": "XIV CONTENTS.\\nAcute interstitial nephritis, nature and causes the urine in promi-\\nnent symptoms. Chronic pyelitis, nature and causes the urine in\\nclinical symptoms of. Movable kidney, nature and causes the urine\\nin prominent clinical features of. Cystitis, nature and causes the\\nurine in leading clinical symptoms. Stone in the bladder, causes\\nthe urine in; prominent clinical features. Tuberculosis of the\\nbladder, origin and nature the urine in leading clinical features.\\nCancer of the bladder, origin the urine leading clinical features.\\nBenign growths in the bladder, nature, causes the urine in; leading\\nclinical features.\\nSECTION XII.\\nThe Urine in Other Diseases 341-360\\nSimple pyrexia. Acute infectious diseases Typhoid fever scarlatina\\ncholera diphtheria variola yellow fever typhus fever. Diseases\\nof the liver Cirrhosis jaundice acute yellow atrophy. Articular\\ndiseases Rheumatism acute gout. Diseases of the nervous sys-\\ntem Epilepsy hysteria meningitis. Diseases of the respiratory\\norgans Pulmonary tuberculosis pneumonia acute pleurisy acute\\nbronchitis. Diseases of the digestive system Dyspepsia, etc.\\nAPPENDIX A.\\nExamination op Urine for Life-Insurance 361-377\\nPhysical examination of urine Color, transparency, specific gravity,\\nreaction, indications of variations. Chemical examination Albu-\\nmin, method of testing for differentiation significance dangers to\\nbe avoided in accepting albuminuric applicants. Sugar, testing for\\nsignificance of; dangers of accepting glycosuric applicants. Urea,\\nquantitative determination of. Microscopical examination of the\\nurine: Suggestions on searching for casts, morphological elements,\\netc., when difficult to find. Pyuria, dangerous features of. Hsema-\\nturia, relations of, to insurance. Calculi, relations of, to insurance.\\nRules as guides for medical examiners.\\nAPPENDIX B.\\nReagents and Apparatus for Qualitative and Determi-\\nnate Uranalysis 378-385\\nLiquid reagents. Solid reagents. Apparatus. Record blanks.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0022.jp2"}, "23": {"fulltext": "LIST OF ILLUSTRATIONS.\\nFIG. PAGE\\nPlate I. Vogel s scale of urine tints. (Colored.), Frontispiece.\\nPlate II. (Colored.), 6\\n1. Squibb s urinometer, 13\\n2. Westphal balance, 14\\n3. Crystals of urea, 21\\n4. Dr. Doremus s ureometer, 28\\nPlate III. (Colored.), 30\\n5. Uric-acid crystals. (After Kuhn.), 31\\n6. Creatinin crystals. (After Kuhn.), 38\\n7. Hippuric-acid crystals. (After Peyer.), 40\\n8. Esbach s albuminometer, 82\\nPlate IV. Crystals of phenylglucosazone. (After v. Jaksch. Colored.), 105\\n9. The author s apparatus for quantitative determination of sugar in\\nurine, Ill\\n10. Ultzrnann s polarizing saccharimeter adjusted to microscope-stand, 114\\n11. Sectional view of Ultzrnann s polarizing saccharimeter, 115\\n12. The author s electric centrifuge. (One-fourth actual size.), 149\\n12a. Speed-indicator, 150\\n12b. Author s percentage tube, 151\\n12c. Arm for sedimenting micro-organisms, 152\\n12d 153\\n12e 154\\n13 155\\nPlate V. Uric-acid crystals with amorphous urates. (After Peyer.\\nColored.), 156\\n14. Sodium-urate crystals. (After Peyer.), 160\\nPlate VI. Ammonium urate, showing spherules and thorn-apple-\\nshaped crystals. (After Peyer. Colored.), 161\\n15. Various forms of calcium-oxalate crystals. (After Peyer.), 163\\n16. Triple-phosphate crystals. (After Ultzmann.), 166\\n17. Calcium-phosphate crystals. (After Peyer.), 167\\n18. The more common form of cystin crystals. (After Peyer.), 171\\n19. Leuciu and tyrosin. (After Peyer.), 173\\n20. Normal blood-corpuscles. (After Peyer.), 178\\n21. Pus-corpuscles. (After Ultzmann.), 182\\n22. Epithelium from various parts of the urinary tract. (After v. Jaksch.), 187\\n23. Epithelial casts. (After Peyer.), 191\\n24. Granular casts. (After Peyer.), 193\\n25. Fatty casts. (After Peyer.), 194\\n(XV)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0023.jp2"}, "24": {"fulltext": "XVI LIST OF ILLUSTRATIONS.\\nFIG. PAGE\\n26. Narrow hyaline casts. (After Peyer.), 195\\n27. So-called waxy casts. (After Peyer.), 190\\n28. False casts. (After Peyer.), 19$\\n29. Spermatozoa in urinary sediment. (After Peyer.), 201\\n30. Yeast-fungus in urine. (After Harley.), 203\\n31. Micrococcus ureae. (After v. Jakscli.), 204\\nPlate VII. Tubercle bacilli in urinary sediment. (After v. Jaksch.), 206\\n32. Eggs of distoma from urinary sediment, 208\\n33. Distoma haematobium, male and female, with eggs, 209\\n34. Filaria in human blood. (After Mackenzie.), 210\\n35. Echinococcus, with twohooklets and section of cystic membrane greatly\\nmagnified. (After Peyer.), 212\\nA. Spencer s stand No. 0, showing objectives, eye-piece, and nose-piece.\\n(One-half full size.), 217\\nB 219\\nC. Zeiss s stand IVa. (One-half full size.), 225\\nD. Reichert s stand No. Illb, 227\\n36. Topographical relations of kidneys, anteriorly. (After Morris.), 261\\n37. Topographical relations of kidneys, posteriorly. (After Morris.), 262\\n38. Relations of the kidneys. (After Sappey.), 263\\n39. Urinary sediment in passive hypersemia of the kidneys. (After Peyer.) 273\\n40. Urinary sediment in acute nephritis. (After Peyer.), 278\\n41. Urinary sediment in chronic diffuse nephritis, showing results of fatty\\nchanges in progress. (After Peyer.), 281\\n42. Waxy casts in urine of amyloid disease of the kidney. (After Peyer.), 289\\n43. Urinary sediment in pyelitis. (After Peyer.), 325\\n44. Urinary sediment in cystitis. (After Peyer.), 331\\nLIST OF TABLES.\\nPAGE\\nAnalysis of urine, 10\\nTable for estimating total solids from specific gravity, 17\\nTable for chlorides in the urine, 64\\nTable for phosphates in the urine, 65\\nTable for sulphates in the urine, 65\\nPurdy s quantitative method for albumin in urine (centrifugal), 80\\nTable of reactions of proteids in the urine, 93\\nTable for estimating amount of sugar in the urine by Purdy s formula, 108\\nTable for chemical diagnosis of gravel and calculi, 255", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0024.jp2"}, "25": {"fulltext": "Part I.\\nAnalysis of Urine.\\nGENERAL CONSIDERATIONS\\nTHEORIES OF SECRETION AND EXCRETION OF URINE.\\n\u00e2\u0080\u00a2MPOSITION OF NORMAL URINE.\\nABNORMAL URINE. PRuTEIDs.\\nCARBOHYDRATES.\\nURINARY SEDIMENTS.\\nCHEMICAL SEDIMENTS.\\nANATOMICAL SEDIMENTS.\\nTHE MICROSCOPE AND ITS USE.\\nGRAVEL AND CALCULUS.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0025.jp2"}, "26": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0026.jp2"}, "27": {"fulltext": "SECTION I.\\nGENERAL CONSIDERATIONS.\\nThe recent advances in our knowledge of physiological chem-\\nistry, with the more extended and refined use of the microscope,\\nhave lent great precision to the study of the composition of the\\nurine, and thereby furnished us with a keener insight into the\\nrelationship of the urine to the organism, both in health and in\\ndisease. The variations in nutrition and waste are accurately\\nrecorded in the urine hour by hour, and by an intelligent inter-\\npretation of modern methods of uranalysis these physiological\\ntides may now be read as accurately as we can number the pulsa-\\ntions of the heart. T y the same methods we are now enabled to\\nmeasure the hourly inroads upon the organism made by disease\\nwith a precision often greater than is afforded hy the pulse or\\nthe clinical thermometer. Wherever in the econom}^ pathogenic\\nprocesses seriously disturb nutrition or normal metabolism, the\\nresults are recorded in the urine, because the urine, more emi-\\nnently than any other excretion, represents the equation of these\\nchanges.\\nThe accurate study of the urine, therefore, has become one\\nof the essential features in advanced clinical medicine. Indeed,\\nthrough uranalysis alone can an almost daily increasing number\\nof diseases be determined, their intensity be gauged, and their\\nprogress toward recoveiy, or their tendenc}^ toward a fatal ter-\\nmination, be predicted. While it is impossible to diagnosticate\\nall diseases from the urine, it is, nevertheless, true that no seri-\\nous disease can be in progress in the economy without giving\\nrise to more or less marked changes in the character of the urine,\\nand therefore we can no longer afford to exclude urinary analysis\\nfrom the scientific investigation of any serious form of disease.\\nIn order to fully comprehend the relations of the urine to\\nthe organism under the influence of the various pathological\\nconditions, it is first necessary to become acquainted with the\\n(i)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0027.jp2"}, "28": {"fulltext": "2 ANALYSIS OF URINE.\\nphysiolog} r of secretion and excretion of the urine, as well as\\nthe normal composition of the latter, together with those fluct-\\nuations which are included within the range of health.\\nWhile a number of points in the physiology of the secretion\\nand excretion of the urine still remain undetermined, it may be\\nstated that our present knowledge of the subject indicates that\\nthe process is partly a physical and partly a vital one. The\\nolder theory of Bowman, based on the anatomical construction\\nof the kidneys, taught that the epithelial cells of the urinary\\ntubules constitute the true secretory structure of the kidneys,\\nwhile the glomeruli act as mere filters for the escape of the\\nwatery elements from the blood. According to Bowman, there-\\nfore, the filtrate from the glomeruli consists almost solely of\\nwater, which aids in extracting the other constituents of the\\nurine from the epithelium of the tubules in its passage along\\nthe latter.\\nLudwig, on the other hand, explains the process on purely\\nphysical grounds, basing his theory on the varying degrees of\\nblood-pressure in the glomerular circulation and the interchange\\nof constituents by diffusion or osmosis in the urinary tubules.\\nAssuming that the relative blood-pressure in the kidney is great-\\nest in the glomerular tufts in consequence of the resistance to\\nthe efferent circulation, Ludwig holds that, consequently, a free\\nexudation of water takes place from the tufts, with, perhaps,\\nsome dissolved salts. This renders the blood much concentrated\\nthickened when it reaches the capillary plexus surrounding\\nthe* convoluted tubes, while within the latter is now the thin,\\naqueous filtrate from the tufts. It will be noted that such con-\\nditions form all the essential elements for active osmosis, within\\nthe tubules thin, watery fluid, and in the surrounding capillaries\\nthickened blood, while between them is interposed a thin mem-\\nbrane, the tubular wall. An interchange of elements conse-\\nquently occurs, by means of which water from the urinary tubules\\npasses into the blood w T hile, on the other hand, the products of\\nretrograde tissue changes urea and salts pass from the blood\\ninto the tubules, mingling there with the thin fluid and consti-\\ntuting the urine.\\nUnfortunately for the theory of Ludwig, he leaves out of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0028.jp2"}, "29": {"fulltext": "GENERAL CONSIDERATIONS. 3\\nconsideration any function on the part of the renal epithelium,\\nwhich violates analogical reasoning, because the renal epithelium\\npossesses the anatomical peculiarities of glandular epithelium,\\nthe function of which is secretory or selective wherever else met\\nwith throughout the economy. Moreover, both clinical and\\npathological experiences teach that the renal epithelium pos-\\nsesses a distinct and important function in the elaborating proc-\\nesses of the kidney for, in diseases which destroy or remove\\nthis epithelium from the urinary tubules, urea and allied prod-\\nucts are retained in the system, and the phenomena of uraemia\\nis evoked. Finally, the interesting experiments of Heidenhain\\nhave conclusively proved that the renal epithelium possesses a\\ndistinct selective power, as follows If a slightly-concentrated\\nsolution of indigo-sulphate of sodium be injected into the blood\\nof an animal, a blue color will soon after be communicated to the\\nurine and the epithelium of the convoluted tubules and ascending\\nlimbs of Henle s tubes, while the Malpighian structures do not\\npresent the slightest trace of blue. If the spinal cord of an\\nanimal be first divided and the indigo injection be subsequently\\nmade, the following phenomena may be observed: No urine\\nwhatever reaches the bladder, but the blue color passes into the\\nkidne} r and may be seen in the convoluted tubes and ascending\\nlimbs of Henle s tubes as before. Ten minutes after the injec-\\ntion the coloring matter is found solely in the epithelial cells in\\nthe locations above noted. An hour after the injection the epi-\\nthelial cells are found colorless, the blue matter having passed\\ninto the lumens of the tubes, where, in the absence of water from\\nthe glomeruli, it concentrates into crystals. This establishes a\\ndistinct eliminative power on the part of the renal epithelium\\naltogether independent of the glomeruli, because the latter were\\nparalyzed by section of the spinal cord.\\nIt seems altogether likely, therefore, that the chief specific\\nprinciples of the urine are eliminated by the renal epithelium,\\nprecisely as are the coloring matters in Heidenhain s experi-\\nments. This seems the more probable now, since it has been\\nestablished that the chief urinary constituents urea, uric acid,\\netc. exist preformed in the blood. Our present knowledge\\non this subject warrants the conclusion that the production of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0029.jp2"}, "30": {"fulltext": "4 ANALYSIS OF URINE.\\nthe urine is chiefly an elaborating or secreting process, regulated\\nin its fluidity by the glomerular system. In other words, that\\nthe water and some of the salts are secreted by the glomeruli,\\nthe peculiar anatomical construction of which permits a varying\\ndegree of activity corresponding chiefly with the varying degrees\\nof blood-pressure and blood-fluidity while, in the main, the solid\\nexcretory products of the urine are eliminated by the epithelium\\nof the renal tubules, through their vital, selective, or secretory\\npower, as in all other glandular structures of similar anatomical\\nconstruction.\\nComposition of the Urine. The constituents of normal urine\\nare derived from the elements of retrograde tissue metamorphosis\\nin the healthy state of the organism, together with certain waste\\nAmounts of Urinary Constituents Passed in Twenty-Four Hours.\\nConstituents.\\nWeight, 66 Kilo-\\ngrammes.\\nPer Kilogramme op\\nBody-Weight.\\nWater\\n1500.00 grammes.\\n72.00\\n33.18\\n0.55\\n0.40\\n0.91\\n10.00\\n2.01\\n3.16\\n7-8.00\\n0.77\\n2.50\\n11.09\\n0.26\\n0.21\\n23.000 gr\\n1.100\\n0.500\\n0.008\\n0.006\\n0.014\\n0.151\\n0.030\\n0.048\\n0.126\\nammes.\\nTotal solids\\na\\nUrea\\na\\nUric acid\\na\\nHippuric acid\\na\\nCreatinin\\nu\\nPigment and other\\nSulphuric acid.\\norganic matters\\nn\\nPhosphoric acid\\nu\\nChlorine\\n11\\nAmmonia\\nPotassium\\nSodium\\nCalcium\\nMagnesium\\nproducts of substances introduced into the system in the form of\\nfood and beverages. The normal constituents of the urine, ac-\\ncording to the basis of classification adopted by Hoppe-Seyler,\\nare as follow 1. Urea and related substances, uric acid, allan-\\ntoin, oxaluric acid, xauthin, guanin, creatinin, thio- (sulpho-)\\ncyanic acid. 2. Fatty and other non-nitrogenous substances,\\nfatty acids of the series C n H211 O2 oxalic, lactic, glycero-phos-\\nphoric acids very small quantities of certain carbohydrates\\nsugar (Brucke). 3. Aromatic substances, the ethereal sulphates\\nof phenol, cresol, pyrocatechin, indoxyl,and skatoxyl hippuric", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0030.jp2"}, "31": {"fulltext": "GENERAL CONSIDERATIONS. 5\\nacid, aromatic oxyacids. 4. Other organic substances, pig-\\nments; ferments, especially pepsin; mucus, and humous sub-\\nstances. 5. Inorganic salts, chlorides of sodium and potassium,\\npotassium sulphate; sodium, calcium, and magnesium phos-\\nphates; silicic acid, ammonium compounds, and calcium carbo-\\nnate. 6. Gases, nitrogen and carbonic acid.\\nThe quantitative composition of the human urine is best ex-\\npressed in the classical table of Parkes, as on preceding page.\\nThe proportion between the solids of the urine and the water,\\naccording to Becquerel, is as follows Water 967 grains, solids\\n33 grains in each 1000 grains. Of the solid matters the organic\\nelements amount to about 24.865 grains, w r hile the inorganic con-\\nstituents are about 8.135 grains in each 1000 grains.\\nChanges in the Urine upon Standing. Considering the some-\\nwhat complex composition of the urine, holding as it does in so-\\nlution both organic and inorganic compounds which are subject\\nto organic as well as chemical alterations, as might be expected,\\nthe urine is subject to more or less rapid changes after it has\\nbeen voided. The rapidity of these changes depends chiefly upon\\nthe reaction and concentration of the urine, the temperature of\\nthe room in which it is kept, and the degree of access to micro-\\norganisms. A normal acid urine usually first precipitates the\\namorphous urates, then uric acid, and frequently oxalate of cal-\\ncium. Under ordinary circumstances these changes take place\\nwithin three days after the urine is voided. At ordinary tem-\\nperatures (70\u00c2\u00b0 to 74\u00c2\u00b0 F.\u00e2\u0080\u0094 21.1\u00c2\u00b0 to 23.3\u00c2\u00b0 C), after twenty-four\\nto forty-eight hours standing, and much sooner under high tem-\\nperatures (say, 100\u00c2\u00b0 F. 37.8\u00c2\u00b0 C), the urine begins to become\\ndull and opaque from the presence of micro-organisms, fission\\nfungi. These multiply, and at the end of four or five days, as a\\nconsequence, ammoniacal decomposition sets in; that is to say,\\nthrough the activity of the fungi the urea is gradually trans-\\nformed into carbonate of ammonium. The urine becomes more\\nand more alkaline from the liberation of ammonium carbonate.\\nThe amorphous urate deposit now becomes transformed into\\nurate of ammonium, uric-acid crystals are substituted by char-\\nacteristic prismatic crystals of ammonio-magnesian phosphate\\n(triple phosphate), and amorphous granules of calcium phosphate", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0031.jp2"}, "32": {"fulltext": "6 ANALYSIS OF URINE.\\nare deposited in quantity at the bottom and sides of the vessel.\\nFinally, the bacterial activity diminishes as the urine becomes\\nstrongly alkaline, and the micro-organisms ultimately perish.\\nUrines of low density and feeble acidity undergo the above-de-\\nscribed changes more rapidly, and, moreover, as a rule, do not\\ndeposit urates.\\nA change sometimes occurs in acid urine, consisting of pro-\\ngressive acidity, in which the urine darkens in color and deposits\\nuric acid and urates and sometimes calcium-oxalate crystals, with\\nthe frequent presence of yeast-fungus and bacteria. This was\\nformerly termed the acid fermentation but, according to\\nScherer, it is caused b}^ the mucus, which acts as an enzyme, or\\nferment, producing an acetic-acid or lactic-acid fermentation, with\\nprecipitation of uric acid and acid urates.\\nCollection of Urine for Analysis. For the purpose of quanti-\\ntative determination of the urinary constituents it is essential\\nto have a sample of a mixture of the whole product of the kid-\\nneys for twenty-four hours. The varying degrees of solid and\\nfluid contents of the urine at different hours of the day render\\nthe observance of the above rule strictly essential if we desire a\\nsample of urine that will represent the average product of the\\nkidneys. In order to guard against the early changes in the\\nurine which have just been described, the urine should be col-\\nlected in a perfectly -clean vessel, preferably a half-gallon bottle,\\nwhich should stand in a cool but dry room during the collec-\\ntion, and the bottle should be corked after each addition of urine.\\nFor qualitative determination of the morbid products of the\\nurine as sugar, albumin, etc. it is preferable to collect a freshly-\\nvoided sample of the urine about three hours after a meal, not the\\nurine voided in the morning on rising. Of all urines, that voided\\nin the morning on rising is the least likely to contain albumin\\nor sugar. When these substances are only occasionally present\\nin the urine, they are most likely to be found after food and ex-\\nercise. Finally, in collecting a sample of urine for purely micro-\\nscopical examination, it should be perfectly fresh and as con-\\ncentrated as possible. It has been shown that the urine soon\\nundergoes ammoniacal changes upon standing, the result of which\\nis to render it more or less strongly alkaline. Now, morphological", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0032.jp2"}, "33": {"fulltext": "PLATE II.\\nSediment of Alkaline Feementatiox. (After Hoffman\\nand Ultzmann.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0033.jp2"}, "34": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0034.jp2"}, "35": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE. 7\\nelements, as epithelium and casts, are soluble in alkaline solu-\\ntions so that the} may, if present when the urine is voided, be-\\ncome unrecognizably altered, or even disappear, if the foregoing\\nprecautions be not observed. Concentration of the urine may be\\nobtained by directing the patient to abstain, as much as consistent\\nwith comfort, from the use of fluids for twenty-four hours.\\nPHYSICAL CHARACTERS OF THE URINE.\\nColor. The average color of normal urine of specific gravity\\n1.020 and 1500 cubic centimetres volume for twenty-four hours\\nis straw or wine yellow, amber-colored. This, however, is sub-\\nject to considerable variations at different times of the day, and\\nunder varying circumstances included within the range of perfect\\nhealth. Thus, from an almost colorless (watery J appearance the\\nurine may range through the yellows and reach reddish brown.\\nThe pale, watery urine in health contains relatively small amounts\\nof coloring matter, as well as urea and salts. It is seldom very\\nacid, often neutral or feebly alkaline, and it is most often brought\\nabout by copious drinking. Highly-colored urine, on the con-\\ntrary, is usually concentrated, containing relatively large quan-\\ntities of solids and coloring matters. Its specific gravity is high,\\nand its reaction is usually sharply acid. It results from dimin-\\nished excretion of water by the kidneys, while the solids and\\ncoloring matters are normal or increased. In health it may\\noccur after hearty meals, vigorous exercise, or when the skin\\nhas been unduly active and little fluids imbibed.\\nPathologically the urine is subject to much wider variations\\nin color than in health. This may be due either to increase or\\ndiminution of the normal coloring matters, on the one hand, or,\\non the other, to the addition of abnormal pigments. Abnor-\\nmally light-colored urine is often due to polyuria, as in diabetes,\\nlisteria, and convulsions or it is often observed in diseases of\\nthe kidney which not only increase the normal amount of water\\nin the urine, but which also reduce the solids and coloring mat-\\nters, notably, interstitial nephritis and anrvloid degeneration\\nof the kidneys. Highly-colored urine, approaching red, is most\\noften induced by acute p} i*exia and inflammations. This is due\\nin part to concentration of the urine, though largely also to the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0035.jp2"}, "36": {"fulltext": "8 ANALYSIS OF URINE.\\npresence of uro-erythrine. The distinctly red tints of the urine\\nare always due to the presence of foreign coloring matters, most\\noften blood. The dark-brown tints m y be due to the presence\\nof methsemoglobin in diseases of the kidney attended by haem-\\norrhage. The urine in cases of melanotic cancer sometimes be-\\ncomes almost black, especially after standing for some time.\\nGreen urine, of dull hue, is common in jaundice, the color being\\ndue to the presence of biliverdin. The urine is frequently of a\\ngreenish hue in diabetes, notabty when the urine contains a high\\npercentage of sugar. Blue urine, of dull tint, is not uncommon\\nin cholera and typhus, owing to the presence of indigo. Finally,\\ncertain drugs, when swallowed, affect the color of the urine to\\na more or less marked degree thus, rhubarb and senna cause\\nbrown or reddish tints carbolic acid sometimes causes a black\\ncolor in the urine, notably after the urine has stood some time\\nthe same results follow the ingestion of naphthalin, hydrochinon,\\nresorcin, and pyrocatechin. Lastly, santonin, when swallowed,\\nalways causes a yellow color in the urine, of decided hue.\\nJ. Yogel has, at considerable labor, constructed a scale of\\ncolors of the urine from nature, which has, in a manner, become\\nstandard for comparative purposes. These colors he expresses\\nI\\nII\\nIII\\nIV\\nV\\nVI\\nVII\\nVIII\\nIX\\n1\\n2\\n4\\n8\\n16\\n32\\n64\\n128\\n256\\nPale yellow\\n1\\n1\\n2\\n4\\n8\\n16\\n32\\n64\\n128\\nLisrht yellow.\\n11\\n1\\n2\\n4\\n8\\n16\\n32\\n64\\nYellow\\n111\\n1\\n2\\n4\\n8\\n16\\n32\\nReddish yellow\\nIV\\n1\\n2\\n4\\n8\\n16\\nYellowish red..\\n..=v\\n1\\n2\\n1\\n4\\n2\\n1\\n8\\n4\\n2\\n1\\nRed\\nBrownish red\\nReddish brown\\nBrownish black.\\nVI\\nVII\\nVIII\\nIX\\nas (1) pale yellow, (2) light yellow, (3) yellow, (4) reddish yel-\\nlow, (5) yellowish red, (6) red, (7) brownish red, (8) reddish\\nbrown, and (9) brownish black. (See Frontispiece.) He divides\\nthese into three groups, the first three being yellow urines, the\\nsecond three reddish urines, and the last three brown or dark\\nurines. In comparing the color of the urine with the scale the\\nurine should first be filtered if not perfectly clear, and it should", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0036.jp2"}, "37": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE. 9\\nbe examined by transmitted light in a glass vessel at least three\\nor four inches in diameter. It is claimed that the shades of\\ncolor in Yogel s scale correspond to certain relative amounts of\\ncoloring matter in the urine, and the test-table on preceding page\\nhas been constructed for the purpose of color analysis.\\nApplication. The table indicates how much coloring matter\\nequal parts of urine of different colors contain relatively. Thus,\\nif a certain volume of pale-yellow urine contain 1 part of coloring\\nmatter, the same volume of yellowish red contains 16 parts; of\\nred, 32 parts of brownish black, 256 parts. It further indi-\\ncates that 1 volume of yellow urine contains as much coloring-\\nmatter as 4 volumes of pale yellow; 1 of red 32 of pale yel-\\nlow, etc. If, therefore, one person pass 1000 cubic centimetres\\nof yellow urine in twenty-four hours, and another 4000 cubic\\ncentimetres of pale-yellow urine in the same time, both secrete\\nan equal amount of coloring matter. In order to make an ap-\\nproximate comparison by figures, Yogel places the quantity of\\ncoloring matter which 1000 cubic centimetres of pale-yellow\\nurine contain 1.\\nExample. 1800 cubic centimetres of urine of yellow color\\nare passed. 1000 cubic centimetres of pale-yellow urine equal\\none part of coloring matter.\\nBut yellow, according to the table, contains four times as\\nmuch therefore the following proportions 1000 4 1800 :X\\nT.2 as the amount of coloring matter in 1800 cubic centimetres\\nof yellow urine, the coloring matter in 1000 cubic centimetres of\\npale-yellow urine being considered as the unit.\\nHalliburton gives the following concise table of color vari-\\nations of the urine, with their causes. (See next page.)\\nOdor. The odor of normal freshly-voided urine is peculiar,\\n\u00e2\u0080\u0094of slightly aromatic nature, due, it is believed, to phei^lic,\\ntanrylic, damoluric, and damolic acids in minute quantities.\\nThere is considerable difference in the intensit}^ of the uric odor\\nin health, always being most pronounced in concentrated urine.\\nIf the urine become alkaline from standing, it acquires a pecu-\\nliar, repulsive, putrescent odor, in which ammonia is plainly\\ndistinguishable. The former is due to the decomposition of\\nmucus and other organic matters, while the ammonia is in the\\nN", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0037.jp2"}, "38": {"fulltext": "10\\nANALYSIS OF UKINE.\\nColor.\\nCause of Coloration.\\nPathological Condition.\\nNearly colorless.\\nDilution, or diminution\\nof normal pigments.\\nNervous conditions\\nhydruria, diabetes insipi-\\ndus, granular kidney.\\nDark yellow to\\nbrown-red.\\nIncrease of normal, or occur-\\nrence of pathological,\\npigments.\\nAcute febrile diseases.\\nMilky.\\nFat-globules.\\nChyluria.\\nPus-corpuscles.\\nPurulent diseases of the\\nurinary tract.\\nOrange.\\nExcreted drugs..\\nSantonin, chrysophanic acid.\\nRed or reddish.\\nUnchanged haemoglobin.\\nHaemorrhages,\\nor haemoglobinuria.\\nPigments in food (logwood,\\nmadda, bilberries, fuchsin).\\nHsematin.\\nSmall haemorrhages.\\nBrown to\\nMethaemoglobin.\\nMethaemoglobinuria.\\nbrown-blaek.\\nMelanin.\\nMelanotic sarcoma.\\nHydrochinon and catechol.\\nCarbolic-acid poisoning.\\nGreenish yellow,\\nsrreenish brown, ap-\\nproaching black.\\nBile-pigments.\\nJaundice.\\nDirty green\\nor blue.\\nA dark-blue scum on sur-\\nface, with a blue deposit,\\ndue to an excess of indigo-\\nforming substances.\\nCholera, typhus; seen es-\\npecially when the urine is\\nputrefying.\\nBrown -yellow to\\nred-brown, becom\\nine; blood-red upon\\nadding alkalies.\\nSubstances which are in-\\ntroduced into the system\\nwith senna, rhubarb, and\\nchelidonium.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0038.jp2"}, "39": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE. 11\\nform of carbonate, resulting from bacterial decomposition of a\\npart of the contained urea,\u00e2\u0080\u0094 CON 2 H 4 +2H 2 (XH 4 )2C0 3\\nCertain substances, when ingested, impart to the urine pecu-\\nliar and unnatural odors. Thus, a characteristic odor is acquired\\nafter eating asparagus, and an odor not unlike violets is produced\\nby the administration of turpentine-oil. The odor of cubebs,\\ncopaiba, sandal wood-oil, garlic, tolu, etc., are more or less com-\\nmunicated to the urine when taken internally. These odors may\\nbe serviceable by indicating that the patient has taken certain\\nmedicines or foods. Beau vis and others have claimed that the\\npeculiar odors after asparagus and turpentine-oil do not appear\\nin the urine in organic diseases of the kidney. This, if true,\\nmight be valuable for diagnostic purposes, but more extended\\nobservation has not confirmed the assertion.\\nPathologically the odor of the urine renders some informa-\\ntion. Thus, if the urine be ammoniacal when voided, it is strong\\nevidence of the existence of cystitis. In suppurating conditions\\nof the upper urinary tract the urine is often peculiarly offensive\\n(putrid), in consequence of its contained decomposing pus, blood,\\nand organic elements. In diabetes the urine often has the odor\\nof acetone. Urine containing cystin possesses an odor, at first,\\nlike sweet briar, but subsequently becomes very offensive.\\nTransparency. The normal freshly-voided urine may be said\\nto be always macroscopically clear after standing, a mucous\\ncloud, more or less pronounced, usually appears, which is un-\\nchanged by alkalies, heat, or mineral acids. Pathologically the\\nurine may become cloudy from various causes, as the precipita-\\ntion of urates, carbonates, phosphates, or organic products, as\\nblood, chyle, excess of mucus, pus, bacteria, etc. If the cloudi-\\nness of the urine disappear upon the application of gentle heat.\\nit ma} 7 be concluded that the turbidity was due to the presence\\nof precipitated urates. If, on the contrary, the turbidity increase\\nupon the application of heat, it is due either to precipitation of\\nthe earthy phosphates or to albuminous cell-elements, as pus or\\nblood. If the phosphates be the cause of the cloudiness, the\\nlatter rapidly clears up by the addition of an acid. If, on the\\nother hand, it become more turbid upon the addition of the acid,\\nit may be concluded that pus, blood, or albuminous cell-elements", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0039.jp2"}, "40": {"fulltext": "12 ANALYSIS OF URINE.\\nare the cause of the opacity. If the urine remain unchanged by\\nthe acetic acid, or if the turbidity be very slightly increased\\nthereby, it may be concluded that mucus or micro-organisms are\\nthe cause of the turbidity.\\nConsistence. Normal urine is always of aqueous consist-\\nence that is to say, it drops and flows as does water. Patho-\\nlogically the urine may become thick and viscid, so that it flows\\nfrom the vessel slowly and with difficulty, not separating into\\ndrops. Such is usually the case when the urine contains a large\\namount of mucus or pus, and especially if, in addition, the urine\\nbe alkaline. Diabetic urine, if heavily laden with sugar, is of\\ndiminished consistence, as is evidenced by its tendencj^ to froth\\nwhen agitated and the same may be said of highly-albuminous\\nurine. In chylous urine, owing to the contained molecular fat,\\nthe fluid often becomes much thickened. In fibrinuria the urine,\\nafter standing, sometimes becomes thickened into a jelly-like\\nconsistence so that it may stick to the vessel when the latter is\\ninverted.\\nSpecific Gravity. The average specific gravitjr of normal\\nurine of 1500 cubic centimetres (50 ounces) in volume for\\ntwenty-four hours is about 1.020, By this is meant taking dis-\\ntilled water at 15\u00c2\u00b0 C. (60\u00c2\u00b0 P.) as 1. the normal standard for\\nurine is about 1.020. Slight variations from this standard are\\nconsistent with perfect health, and depend chiefly upon the\\ncharacter of the food taken, as well as the quantity thereof, and\\nthe rapidity of tissue metamorphosis. If the diet consist largely\\nof nitrogenous foods, they furnish a higher relative amount of\\nsolids than fluids to be excreted by the kidneys, and, conse-\\nquent^, the specific gravity of the urine will be somewhat in-\\ncreased. Active muscular exertion also tends to raise the\\nspecific gravity of the urine. Copious diaphoresis may bring\\nabout a concentrated condition of the urine, with an accom-\\npanying increase of specific gravity. The specific gravity of\\nthe urine may be lowered by fasting or by imbibing large\\nquantities of fluids. Very marked departures from the normal\\nspecific gravity of the urine often constitute pathological factors\\nof great importance. In nearly all forms of organic albuminu-\\nria (Bright s disease) the tendency is toward a lowered specific\\ngravity of the urine. An important fact to be noted in this\\nconnection is that, in most cases of so-called functional albumi*", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0040.jp2"}, "41": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE.\\n13\\nnuria, the specific gravity of the urine is above the normal\\nstandard. Prognostically, in cases of nephritis, a marked re-\\nduction of the specific gravity of the urine should always be\\nregarded as of serious import. If the specific gravity of the\\nurine be markedly increased, it is strongly indicative of meli-\\nturia. Should it reach as high as 1.030, or above, search should\\nalways be made for sugar.\\nThe specific gravity of the urine ma}^ be taken with the\\nurinometer, but more accurately by the Westphal Mohr or Sar-\\ntorius balance. Only approximately correct results are possible\\nwith the urinometer but considerations of convenience have\\ninduced most (formerly including the author) to sanction its\\nuse. The best of urinometers are\\noften far from correct, and therefore\\nthe Westphal or Mohr balance is\\nstrongty advised where practicable.\\nThe urinometers made by Squibb\\nare among the best of such instru-\\nments. They are standardized at\\n25\u00c2\u00b0 C. (77\u00c2\u00b0 F.) and a thermometer\\nis furnished with each instrument\\nfor temperature corrections (see\\nFig. 1). In taking the specific\\ngravity of the urine with the uri-\\nnometer the jar is filled about three-\\nfourths full of urine, and any froth\\nappearing at the top is removed by\\nfiltering-paper or a pipette. The urinometer is next introduced\\ninto the urine and touched gently with the finger-tip, so that\\nit sinks and rises a few seconds until it finds the correct level.\\nWhen it comes to a rest the scale is read off on a level with the\\neye, and the figure on a level with the surface is marked.\\nThe Westphal balance (Fig. 2) is extremely accurate, carry-\\ning out the specific gravity to the fifth figure (fourth decimal)\\nTo take the specific gravity of the urine by this instrument\\nproceed as follows\\nAfter the instrument is mounted, and the beam rests in equilibrium, the\\nglass plummet which contains the thermometer is suspended from the hook on\\nthe right-hand end of the beam together with one of the large riders (A). This\\nbalances with distilled water at 15\u00c2\u00b0 C. and represents 1, Next pour the urine\\nI\\nFig. 1.\u00e2\u0080\u0094 Squibb s Uki^03ieter.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0041.jp2"}, "42": {"fulltext": "14\\nANALYSTS OF URINE.\\ninto the jar until the twist in the platinum wire is below the surface, then begin\\nthe weighing. Place the second rider (B) in the first notch on the left of the\\nscale on the beam, and, if the plummet rises, remove the rider to the second\\nnotch. If now the beam balances, and the temperature of the urine is 15\u00c2\u00b0 C\\nthe specific gravity of the urine is exactly 1.020. If the plummet still rises,\\nhowever, take the third-size rider (C) and find the notch on the beam where it\\nrests in equilibrium, or very nearly so. If the beam balances with the third\\nrider (C),\u00e2\u0080\u0094 say, in the fourth notch,\u00e2\u0080\u0094 the specific gravity is exactly 1.024\\nShould, however, the plummet still rise slightly, take the fourth rider (D,\\nsmallest one) and find the exact balance and, if in the sixth notch, the specific\\ngravity will be 1.0246. In other words, the second rider (B) gives the third\\nfigure (second decimal) of the specific gravity; the third rider (C) finds the\\nfourth figure (third decimal) of the specific gravity and the fourth rider (Z\\ngives the fifth figure, or fourth decimal. With a little practice, determinations\\nof the specific gravity of the urine by\\nmeans of the Westphal balance will be\\nfound rapid, simple, and absolutely cor-\\nrect. 1 Care should be exercised that no\\nair-bubbles become attached to the plum-\\nmet, and the proper temperature correc-\\ntions should be made as directed below.\\nFig. 2.\u00e2\u0080\u0094 Westphal Balance.\\nThe temperature of the urine\\nimmediately after being voided\\nranges from 85\u00c2\u00b0 to 95\u00c2\u00b0 P. (29.5\u00c2\u00b0\\nto 35\u00c2\u00b0 C.) therefore, in taking\\nthe specific gravity of freshly-\\nvoided urine, before cooling, its\\ntemperature should be observed,\\nand for every 7 degrees of tem-\\nperature the thermometer indi-\\ncates above that upon which the instrument is standardized 1\\ndegree should be added to the specific gravity of the urine in\\naddition to that indicated b}^ the instrument.\\nChemical Reaction. Normal mixed urine that is to say, the\\nwhole twenty-four hours product is always acid. The acidity\\nis due to acid sodium phosphate, and not, as formerly supposed,\\nto free acid. This sodium phosphate is derived from the basic\\nsodium phosphate of the blood the uric, hippuric, sulphuric,\\nand carbonic acids of the urine take up part of the sodium,\\nleaving an acid salt.\\nThe degree of acidity of the urine varies at different times of\\nthe day, especially with regard to food. Soon after a meal the\\n1 All determinations of specific gravity of the urine in the author s labo-\\nratory are made with the Westphal balance.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0042.jp2"}, "43": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE. 15\\nacidity begins to diminish, and in from three to four hours the\\nalkaline tide usually reaches its height occasionally, though\\nrarely, the acidity may become so diminished at such times that\\nthe urine gives an alkaline reaction with test-paper. Freshly-\\nvoided urine may be alkaline either from fixed alkali (potassium\\nor sodium) or from volatile alkali (ammonia). It is important\\nto distinguish between these two conditions, as in the first case\\nit merely reflects a condition of the blood, while in the second\\ncase it is nearly always associated with chronic inflammatory\\nconditions of the lower urinary tract, notably the bladder. If\\nred or violet litmus-paper turn blue in contact with urine just\\nvoided, and remain blue upon drying, the reaction is due to fixed\\nalkali. If, on the other hand, the paper return to the original color\\nupon drying, the reaction is due to volatile alkali (ammonia).\\nThe urine is rendered alkaline by the administration of alka-\\nline carbonates or the salts of vegetable acids. The urine may\\nbe rendered alkaline, usually to a less extent, by the following\\ncircumstances Soon after a full meal after the discharge of\\ngastric juice in abnormal waj s, through fistula or by copious\\nvomiting after hot baths and free perspiration upon a vegetable\\ndiet. With vegetarians, as with herbivorous animals, the food\\ncontains an excess of alkaline salts or vegetable acids. These\\nacids are converted into carbonates in the blood, which, passing\\ninto the urine, cause an alkaline reaction.\\nThe acidity of urine is increased by the ingestion of acids,\\nsaccharin, a purely meat diet, and prolonged muscular exercise.\\nIt may be developed, as already shown, by acid fermentation,\\nand in certain pathological conditions free fatty acids may ap-\\npear and render the urine sharpl}^ acid (lipaciduria).\\nOccasionally it happens that the urine is amphoteric, i.e.,\\nthe same urine turns red litmus-paper blue and blue litmus red.\\nThis seemingly paradoxical reaction, according to Huppert,\\ndepends upon the presence of acid and neutral phosphates in\\nvariable proportions.\\nQuantity. The average quantity of urine of a healthy indi-\\nvidual who eats and drinks in moderation, and lives in a temper-\\nate atmosphere, is about 1500 cubic centimetres (50 ounces) in\\ntwenty-four hours. The relative quantity varies considerably\\n2", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0043.jp2"}, "44": {"fulltext": "16 ANALYSIS OF URINE.\\nwith the time of day, most being passed in the afternoon, less\\nin the morning, and least at night. The volume of urine for\\ntwenty-four hours varies much in conditions of health, according\\nto certain circumstances. It is decreased by unusual activity\\nof the skin and bowels, as well as by rest and abstaining from\\nfluids. It is decidedly increased by imbibing large quantities of\\nfluids, the use of diuretic drugs, to a less extent by cold, atmos-\\npheric moisture, exercise, and liberal eating.\\nPathologically the urine is increased in diabetes, cirrhosis of\\nthe kidne}^, amyloid or waxy kidnejr, pure cardiac hypertrophy,\\nP3 r elitis, Irysteria, and convulsions. The quantity of urine is\\ndecreased in acute nephritis, cyanotic induration from cardiac\\ndefect, acute fevers, and inflammations. The urine may be more\\nor less completely suppressed in the acute forms of nephritis, in\\nthe algid stage of cholera and yellow fever, by violent fevers and\\ninflammations, by shock or collapse from internal injuries, as\\nrupture of the liver, spleen, bowels, or other viscera, by the\\nreflex shock or the congestion following catheterization (urinary\\nfever), and by obstructive diseases of the urinary passages, no-\\ntably the ureters. Finally, it is important to observe that in\\nnephritis more or less complete suppression of the urine, often\\nfollowed by uraemia and death, may result from the administration\\nof anaesthetics such as chloroform and ether, notably the latter.\\nIn estimating the quantity of urine it should be carefully\\ncollected for twenty-four hours, in an accurately-covered vessel,\\nin order to exclude dust and prevent evaporation, the patient\\nbeing directed to void and collect the urine previous to each\\nmovement of the bowels.\\nSolids. In determining the solids of the urine observations\\nshould be made upon a sample of the mixed product of the kid-\\nneys for the whole twenty-four hours. The most accurate results\\nare obtained by taking a given quantity of urine, say, 20 cubic\\ncentimetres, in a previously-weighed porcelain dish, and evapo-\\nrating it over a water-bath. It should then be dried in a warm\\nchamber for an hour or so, and then allowed to cool, when it\\nshould be weighed. This should be repeated a number of times\\nuntil there is no further loss of weight from drying then the\\ndifference in weight between the empty dish and that containing", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0044.jp2"}, "45": {"fulltext": "PHYSICAL CHARACTERS OF THE URINE.\\nIT\\nthe dried solids constitutes the weight of the solids in 20 cubic\\ncentimetres of the urine. From this the solids of the whole\\nvolume of urine may be readily reckoned.\\nThe foregoing method being somewhat tedious, and, besides,\\nconsuming too much time for practical work, approximate results\\nmay be more readily obtained by multiplying the last two figures\\nof the specific gravity of the urine by the co-efficient of Haser.\\nwhich is 2.33. This gives, approximately, the number of grammes\\nof solids in each 1000 cubic centimetres of the urine.\\nExample. If the twenty-four hours urine be 1500 cubic\\ncentimetres, and the specific gravity be 1.020 with Haser s co-\\nefficient, then we have as follows\\n20 X 2.33 46.60 grammes in 1000 cubic centimetres of urine;\\nA 46.60 X 1500 _ QO\\ntherefore, 69.9 grammes of solids.\\n1000\\nTable for Estimating Total Solids from Specific Gravity.\\nSpecific Gravity.\\nSolids Found by Weighing.\\nSolids Found by Multi-\\nplying by 0.233.\\nPer Thousand:\\nPer Thousand:\\n1.0160\\n37.4\\n37.28\\n1.0260\\n62.0\\n60.58\\n1.0154\\n35.1\\n35.88\\n1.0261\\n60.2\\n60.81\\n1.0213\\n48.6\\n49.63\\n1.0230\\n56.4\\n53.59\\n1.0225\\n49.3\\n52.42\\n1.0240\\n54.1\\n55.92\\n1.0257\\n60.4\\n59.88\\n1.0275\\n63.9\\n64.07\\n1.0217\\n48.5\\n50.56\\n1.0223\\n52.15\\n51.96\\n1.0140\\n31.08\\n32.62\\n1.0236\\n56.64\\n54.98\\n1.0133\\n30.87\\n30.99\\n1.0134\\n31.06\\n31.22\\n1.0238\\n57.09\\n55.45\\n1.0250\\n60.47\\n58.25\\n1.0164\\n37.26\\n38.21\\n1.0135\\n33.35\\n31.45\\n1.0210\\n48.54\\n48.93\\n1.0137\\n32.55\\n31.92\\n1.0085\\n19.16\\n19.80\\n1.0110\\n24.96\\n25.63\\nAverage\\n1.0200\\n46.59\\n46.52", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0045.jp2"}, "46": {"fulltext": "18 ANALYSIS OF URINE.\\nFrom these determinations it will be found that, by dividing\\nthe mean quantit} r of solid constituents found in 1000 grammes\\nof urine by the last three decimals of the mean specific gravity,\\nwe obtain the quotient 0.23295, for which we may conveniently\\nsubstitute the number 0.233, as Haser suggests. By multiplying\\nwith this quotient the three last decimals of the specific gravity\\ncarried out to four places of decimals, we obtain the figures in\\nthe third column of the table. The variations from the results\\nobtained by actual weighing may be seen by a glance at the\\ntable. If, however, as is usual, the specific gravity of the urine\\nbe determined only to three decimals, the second and third fig-\\nures multiplied by 2.33, as suggested by Haser, give approxi-\\nmately the amount of solid matters in 1000 parts of urine.\\nA material reduction of the solids of the urine in cases of\\nrenal disease indicates a tendency to uraemia, and therefore puts\\nthe physician on his guard against this dangerous complication.\\nThe diagnosis between diabetes insipidus and hydruria may be\\ndetermined by the amount of solids in the urine. The so-called\\nrenal inadequacy an -obscure term introduced by Sir An-\\ndrew Clark, which usually means unrecognized interstitial ne-\\nphritis and the anazoturia of Willis are both indicated by a\\nreduction of the solids of the urine.\\nDuring the course of acute fevers and inflammations the\\nquantity of solids in the urine furnishes very valuable information\\nas a guide both for prognosis and treatment. The amount of\\ntissue metamorphosis, as evidenced by the quantity of solids\\nin the urine, is a good indication of the severitj^ of the disease.\\nIf these changes be too active, measures are indicated for re-\\nstraining them. If exudations are to be removed, a copious ex-\\ncretion may indicate to us that the chemico-vital changes ending\\nin elimination are progressing sufficiently without artificial aid.\\nAgain, by insufficiency of the urinary solids defective elimination\\nmay be detected when the thermometer indicates a high ratio of\\ntissue metamorphosis in progress, and we are thereby admon-\\nished to employ measures to re-establish elimination.\\nNo definite deductions are to be drawn, from the quantity of\\nsolids present, as to the relative amount of any special product,\\nespecially that of urea. Since the amount of urea normally con-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0046.jp2"}, "47": {"fulltext": "PHYSICAL CHARACTERS OP THE URINE. 19\\nstitutes about one-half of the solids excreted by the kidneys, it\\nhas been suggested that an approximate knowledge of the amount\\nof urea is to be gained by merely dividing the whole quantity of\\nsolids by 2. Such a rule should never be suggested as a guide\\nin pathological conditions, because, under such circumstances,\\nthe various solids of the urine are often present in widely dif-\\nferent proportions, as well as quantities. In addition to this,\\nthe special solid constituents of the urine possess widely different\\nspecific gravities, notably that of urea from sodium chloride,\\nwhich is as 2 to 3. For these reasons, even when the total solids\\nare determined with accuracy, the amount of urea, nitrogen, or\\nother constituent, if sought, can only be determined by special\\nquantitative methods, which will be described in the succeeding\\nsection of this work.\\nHaving ascertained the actual quantity of solids in the urine,\\nin order to make deductions therefrom of any definite value in\\nhealth or disease, careful regard must be had to certain con-\\nditions and features connected with each individual case before\\nwe can determine the degree in which the quantity of solids is\\nexcreted above or below the average or normal standard for\\nsuch individual case. Those that chiefly influence the normal\\nbalance of excretion can be reduced to a ratio that will afford\\napproximate results of definite and practical value. The most\\nprominent of these conditions are the weight of the individual,\\nthe age, the diet, and the amount of exercise taken. We may\\nplace the average weight at 66 kilogrammes (145 pounds) avoir-\\ndupois, the age being from 20 to 40, the diet that of ordinary\\nmixed foods, and the exercise being that of the usual healthy\\nman about ordinary labor. To the above standard the following\\ngeneral rules may be applied\\n1. The average excretion of solids per weight of 145 pounds\\nbeing 61.14 grammes (945 grains), a proportional reduction or\\naddition should be allowed, according to the weight of the sub-\\nject examined.\\n2. Deduct 10 per cent, from the average solids in persons be-\\ntween 40 and 50 years of age, 20 per cent, if between 50 and 60,\\n30 per cent, if between 60 and TO, and 50 per cent, above 70.\\n3. For Diet. In persons who have fasted for two or more", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0047.jp2"}, "48": {"fulltext": "20 ANALYSIS OF URINE.\\ndays, as in some fevers and other diseases, deduct one-third from\\nthe average solids. If the diet be spare, deduct one-eighth to\\none-sixth if rather plentiful, but still below that of health, de-\\nduct one-tenth.\\n4. For Exercise. If there be total rest, deduct one-tenth\\nfrom the average solids but if merely quietude, deduct one-\\ntwentieth.\\nThe average standard of excretion of solids by the kidneys\\n(61.14 grammes 945 grains for weight of 66 kilogrammes\\n145 pounds avoirdupois) represents the mean of the combined\\nobservations by Becquerel, Parkes, Bocker, J. Vogel, Lehman,\\nGorup Besanez, Ranke, and Rummel, obtained by evaporating\\nthe urine and determining the solids by actual weighing. The\\nrules for correction are based on the proportions laid down by\\nParkes.\\nEstimation of Acidity of the Urine. Since the acidity of the\\nurine is due to acid sodium phosphate, it cannot be quite cor-\\nrectly estimated by the ordinary acidimetric method, owing to\\nthe action of the alkali employed upon the acid sodium phos-\\nphate, a mixture of neutral and acid sodium phosphate resulting\\nat first, producing the so-called amphoteric reaction and render-\\ning the recognition of the exact end-reaction impossible. A\\nslight excess of NaOH must therefore be added and the reading\\ntaken when the reaction has become faintly alkaline, the degree\\nof acidity found being a trifle too high.\\nMethod. Take 100 cubic centimetres of urine in a flask from\\nthe twenty-four hour specimen and titrate with a one-tenth\\nnormal solution of sodium hydrate, using a sensitive litmus-paper\\nas an indicator until a faintly-alkaline reaction is produced. The\\nnumber of cubic centimetres of the one-tenth normal solution\\nemployed multiplied by 0.0063 will give the percentage of acidity\\nin terms of oxalic acid. The total acidity thus found corresponds\\nto from 2 to 4 grammes of oxalic acid per day.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0048.jp2"}, "49": {"fulltext": "SECTION II.\\nCOMPOSITION OF NORMAL URINE.\\nORGANIC CONSTITUENTS.\\nUrea\u00e2\u0080\u0094 CO(NH 2 2\\nUrea, or carbamide, was first prepared synthetically from\\nammonium cyanate (NH 4 )CN0 by Woliler (1828). From\\nthe urine it was first prepared in an impure state by Rouelle,\\nand subsequently by Fourcroy and Vanquelin. Urea crystallizes\\nin colorless, quadrilateral, or six-sided, silk-like prisms with\\noblique ends, or, when rapidly crystallized, in delicate white\\nFig. 3.\u00e2\u0080\u0094 Crystals of Urea.\\nneedles, which melt at 120\u00c2\u00b0 C. (248\u00c2\u00b0 F.). They contain no water\\nof crystallization, and are permanent in the air, soluble in cold\\nwater, the solution being neutral in reaction. With nitric acid\\nurea unites to form nitrate of urea (CON 2 H 4 ffN~0 3 which\\ncrystallizes out in octahedral, lozenge shaped, or hexagonal\\nplates, which are less soluble in water than are urea crystals.\\nUrea owes its origin in the economy partly to retrograde\\ntissue metamorphosis, including the blood, and partly to splitting\\n(21)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0049.jp2"}, "50": {"fulltext": "22 ANALYSIS OF URINE.\\nup of unassimilated nitrogenous principles of the food. Thus, the\\ngreater portion of nitrogen taken into the system in the way of\\nfood is excreted by the kidneys in the form of urea. It is there-\\nfore the most bulky single constituent of the urine, ranging in\\nquantity, according to circumstances, from 20 to 40 grammes\\n(300 to 600 grains) in twenty -four hours in the healthy adult.\\nThat the liver constitutes the chief seat of urea formation is\\nnow pretty generally accepted as fact. This was originally\\nclaimed to be the case by Meissner, and more recently confirmed\\nby Brouardei, Schroeder, and Minkowski. It is not improbable,\\nhowever, that the spleen and perhaps the lymphatic and secreting\\nglands to some extent participate in the urea formation. For-\\nmerly it was erroneously supposed that urea was formed in the\\nkidneys but it is now known that after complete extirpation of\\nthe kidneys the formation of urea continues as before, and accu-\\nmulates in the blood. Likewise, in diseases of the kidney entail-\\ning suppression of the urine, urea continues to be formed and\\naccumulates in the organism. The evidence derived from pathol-\\nogy strongly points to the liver as the chief seat of urea forma-\\ntion. Thus, in diabetes, we know that metabolism of the hepatic\\ncells is greatly increased, causing an abundant formation of sugar\\nas well as urea, which pass into the blood and are excreted by the\\nkidneys. On the other hand, in degenerative changes in the liver\\nthe urea formation is markedly diminished. Thus, in acute\\nyellow atrophy of the liver the urea in the urine is greatly dimin-\\nished sometimes absent. The relations of degenerative changes\\nin the liver to urea formation have recently been much elucidated\\nby Noel Paton, 1 who points out that two functions of the liver\\nexist bile formation and urea formation and, moreover, that\\nthey bear a direct relationship to each other. It has already\\nbeen stated that urea owes its origin in the economy to retrograde\\ntissue metamorphosis and nitrogenous principles of the food in\\nother words, the proteid constituents in the organism. Of the\\nintermediate steps in this transformation but little is definitely\\nknown, although much has been written on this subject, most of\\nwhich is conjectural. The excretion of urea reaches its maximum\\n1 British Medical Journal, vol. ii, 1886, p. 207.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0050.jp2"}, "51": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 23\\nquantity upon an exclusive meat diet much less is excreted upon\\na mixed diet, and least of all upon a strictly vegetable diet.\\nVariations in the quantit} T of urea excreted, in a measure,\\nconstitute an expression of the changes in nitrogenous tissue\\nmetabolism, and as such possess definite clinical value. Thus, in\\nacute fevers and inflammations, until the crisis of the disease is\\nreached there is greatly increased elimination of urea. On the\\nother hand, in chronic diseases (cachexias), when tissue meta-\\nmorphosis is retarded through malnutrition, the excretion of urea\\nis diminished. Similar results follow in diseases involving the\\nintegrity- of the liver, the elaborating source of urea. In\\nBright s disease urea excretion is diminished in consequence of\\nimpairment of the structure of the kidneys. Preceding, usually\\nfor some time and during uraemic attacks, the excretion of urea is\\nmarkedly diminished, forming a valuable indication of the ap-\\nproach of this dangerous complication. Mental and muscular\\nactivity hasten urea excretion by accelerating tissue waste and\\nhence urea excretion is more active during waking than during\\nsleeping hours. The variations in the amount of exercise, the\\nquantit} T and quality of food taken, atmospheric vicissitudes, the\\ndegree of activity of the other excretory organs, etc., render the\\nrelative and absolute amount of urea excreted almost as variable\\nas the amount of water. If the mode of life be very regular and\\nequable, the amount remains pretty uniform but great care is\\nnecessary to maintain all the physiological conditions even.\\nUnder the latter circumstances the mean amount of urea ex-\\ncreted in twenty-four hours, by healthy adult males between\\nthe ages of 20 and 40 years, is 33.18 grammes (512.4 grains).\\nClose calculations give the average excretion of urea as .015 to\\n.035 gramme per hour for each kilogramme of body -weight. The\\nabsolute quality of urea excreted by women is below the average\\nof men. The same is true with children but, on the other hand,\\nthe relative quantity excreted by children is much higher than\\nby either men or women.\\nUrea may be separated from the urine as follows First\\nevaporate, then add strong, pure nitric acid in excess, keeping\\nthe mixture cool during acidulation. Pour oif the excess of fluid\\nfrom the crystals of urea nitrate formed strain through muslin", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0051.jp2"}, "52": {"fulltext": "24 ANALYSIS OF URINE.\\nand press between heavy filter-paper. Add to the dry product\\nbarium carbonate in excess, and add sufficient alcohol to form a\\npasty consistence. Dry on a water-bath, and extract with al-\\ncohol filter evaporate the filtrate on a water-bath, and set aside\\nto crystallize. The result is nearly pure urea, plus the coloring\\nmatters of the urine. The simplest method of decolorizing the\\nproduct is to filter through animal charcoal, and afterward purify\\nby recrystallization.\\nDetection. 1. A very simple method of detecting urea is to\\nplace a drop or two of the suspected fluid upon a glass slide, and\\nafter adding a drop of nitric acid gently warm over a spirit-lamp.\\nIf urea, be present, upon evaporation the microscope will show\\nthe characteristic crystals of nitrate of urea, of rhombic or hex-\\nagonal forms, singly or in masses, their acute angles being eighty-\\ntwo degrees.\\n2. Add to the suspected fluid three parts of an aqueous solu-\\ntion of furfur aldehyde, and subsequently a few drops of strong\\nhydrochloric acid, and warm. A series of colors yellow, green,\\nviolet, purple, and red is produced, settling at length into a\\nbrown, sticky mass if urea be present.\\n3. To a few drops of the suspected fluid in a test-tube add\\nan equal quantity of solution of hypobromite of sodium, and a\\nrapid evolution of bubbles takes place if urea be present.\\n4. Warm a few crystals of urea in a test-tube add a trace of\\nsodium or potassium hydrate and a drop of a dilute solution of\\ncupric sulphate. A violet or rose-red color is produced, the\\nbiuret reaction.\\nDetermination of Urea. The methods devised for the purpose\\nof determining the quantity of urea in the urine are very numer-\\nous most of which, however, are founded upon one of three\\nprinciples 1. The mercuric nitrate, or Liebig s method. 2. The\\nhypobromite, or Knop-Hufner method. 3. The differential den-\\nsity method, obtained by measuring the amount of urea by the\\nspecific gravity of the urine lost through decomposition of the\\ncontained urea.\\nLiebicfs Method. The combination between urea and mer-\\ncuric oxide\u00e2\u0080\u0094 (CON 2 H 4 2 Hg (N0 3 2 -f 3 HgO\u00e2\u0080\u0094 forms a white\\nprecipitate, insoluble in water and weak alkaline solutions. It", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0052.jp2"}, "53": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 25\\nis, therefore, necessary to prepare a standard solution of mercury,\\nand to have an indicator by which to detect the point when all\\nthe urea has entered into combination with the mercury, the latter\\nslightly predominating. This indicator is sodium carbonate,\\nwhich gives a yellow color with the excess of mercury, in conse-\\nquence of the formation of hydrated mercuric oxide.\\nTheoretically, 100 parts of urea should require 720 parts of\\nmercuric oxide; but practically 772 parts of the latter are neces-\\nsary to remove all the urea, and at the same time to show the\\n3 r ellow color with alkali therefore, the solution of mercuric\\nnitrate must be of empirical strength in order to give accurate\\nresults. The following solutions are required for testing\\n1. Standard mercuric nitrate solution. Dissolve 77.2 grammes\\n(1158 grains) of red oxide of mercury (weighed after drying over\\na water-bath), or 71.5 grammes (1072 grains) of the metal itself\\nin dilute nitric acid. Expel the excess of acid by evaporation to\\na syrupy consistence. Make up to 1000 cubic centimetres with\\ndistilled water, adding the water gradually. This solution is\\nof such strength that 19 cubic centimetres will precipitate 10\\ncubic centimetres of a 2-per-cent. urea solution. Add 52.6 cubic\\ncentimetres of water to the litre of the mercuric nitrate solution.\\nand shake well; then 20 cubic centimetres (instead of 19) equal\\n10 cubic centimetres 2-per-cent. urea solution, i.e., 1 cubic centi-\\nmetre equals 0.01 urea.\\n2. Baryta mixture. Prepare by mixing two volumes of\\nsolution of barium hydrate with one volume of solution of barium\\nnitrate, both saturated in the cold.\\nAnalysis. Take 40 cubic centimetres of urine, add to this\\n20 cubic centimetres baryta mixture and filter off the precipitate\\nof baryta salts (phosphates and sulphates). Take 15 cubic centi-\\nmetres of the filtrate (corresponding to 10 cubic centimetres of\\nurine) in a beaker. Discharge into it the mercuric nitrate solu-\\ntion from a burette, until, on mixing a drop of the mixture with\\na drop of saturated solution of sodium carbonate on a white tile,\\na pale-lemon color appears. Then read the amount used from the\\nburette, and calculate thence the percentage of urea.\\nCorrections. This method only approaches accuracy when\\nthe quantity of urea present is about 2 per cent., the normal", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0053.jp2"}, "54": {"fulltext": "26 ANALYSIS OF URINE.\\npercentage of urea in the urine. The chlorine in the urine\\nmust be estimated, and the quantity of urea indicated reduced\\nby subtraction of 1 gramme (15 grains) of urea for every 1.3\\ngrammes (19 grains) of sodium chloride found. If the urine\\ncontain less than 2 per cent, of urea, 0.1 cubic centimetre of mer-\\ncuric nitrate solution must be deducted for eveiy 4 cubic centi-\\nmetres used if more than 2 per cent, of urea, a second titration\\nmust be performed, with the urine diluted with half as much\\nwater as has been needed of the mercurial solution above 20 cubic\\ncentimetres. Suppose, then, 28 cubic centimetres have been used\\nin the first titration, the excess is 8 cubic centimetres therefore,\\n4 cubic centimetres of water must be added to the urine before\\nthe second titration is made. When ammonium carbonate is\\npresent, first estimate the urea in one portion of urine, and the\\nammonia by titration with normal sulphuric acid in another;\\n0.017 gramme of ammonia equals 0.030 gramme of urea. The\\nequivalent of ammonia in terms of urea must be added to the\\nurea found in the first portion of the urine.\\nModifications,\u00e2\u0080\u0094 -Rant en berg l and Pfluger 2 have devised the\\nfollowing modifications of Liebig s original method, just de-\\nscribed\\nBautenberg s method consists in maintaining the urea solu-\\ntion neutral throughout by successive additions of calcium\\ncarbonate.\\nPfluger s modification is the one most generally employed,\\nwhich is as follows A 2-per-cent. solution of urea is prepared\\n10 cubic centimetres of this are placed in a beaker, and 20 cubic\\ncentimetres of the mercuric nitrate solution are run into it in a\\ncontinuous stream the mixture is then placed under a burette\\ncontaining normal sodium carbonate, and this is added, with\\nconstant agitation, until a permanent yellow color appears. The\\nvolume so used is noted as that necessary to neutralize the acidity\\nproduced by 20 cubic centimetres of the mercurial solution in\\nthe presence of urea. A plate of glass is then laid on black\\ncloth, and some drops of a thick mixture of sodium bicarbonate\\n1 Ann. Chem. Pharm., vol. cxxxiii, p. 55.\\n2 Zeit. anal. Chem., vol. xix, p. 375. Pfeiffer (Zeit. Biol., vol. xx, p. 540)\\nhas carefully compared the different methods.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0054.jp2"}, "55": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 27\\n(free from carbonate) and water placed upon it at convenient\\ndistances. The mercurial solution is added to the urine in such\\nvolume as is judged appropriate, and from time to time a drop\\nof the white mixture is placed beside the bicarbonate, so as to\\ntouch but not mix completely. A point is at last reached when\\nthe white gives place to yellow both drops are then rubbed\\nquickly together with a glass rod, and the color disappears fur-\\nther addition of the mercuiy is then made to the urine till a\\ndrop rubbed with the bicarbonate remains permanently yellow.\\nNow neutralize hy the addition of the normal sodium carbonate\\nto near the volume found necessary in the preliminary experi-\\nment. If this be quickly done, a few tenths of a cubic centi-\\nmetre of mercuric nitrate will be found sufficient to complete\\nthe reaction. If much time has been lost, however, it may\\noccur that, notwithstanding the mixture is distinctly acid, it\\ngives, even after the addition of sodium carbonate, a permanent\\nT ellow, although no more mercuric nitrate be added. The\\nanalysis, under such circumstances, must be repeated, taking\\nthe first titration as a guide to the quantities which are neces-\\nsary. Pfiiiger s correction for concentration of urea is different\\nfrom Liebig s, and is as follows\\nY 1 volume of urea solution volume of sodium-carbonate\\nsolution volume of any other fluid free from urea which\\nmay be added.\\nV 2 volume of mercuric nitrate solution used.\\nC correction (Y l \u00e2\u0080\u0094Y 2 X 0.08.\\nThis formula holds good for cases in which the total mixture\\nis less than three times the volume of mercuric nitrate solution\\nused with more concentrated solutions the formula gives\\nresults too high.\\nHypobromite Method. This is a far more simple and ready\\nmethod to manipulate. The principle of the method introduced\\nby Knop depends upon the fact that, when urea in solution\\ncomes in contact with sodium-hypobromite solution, nitrogen is\\nset free as a result of the total decomposition of the urea.\\nThus\\nCH 4 0X 2 3NaBrO C0 2 -f 2H 2 3XaBr 2N.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0055.jp2"}, "56": {"fulltext": "28\\nANALYSIS OF URTNE.\\nThe C0 2 is absorbed by the soclium-hydroxid solution. One\\ngramme of urea furnishes 370 cubic centimetres of nitrogen at\\n0\u00c2\u00b0 C and under 760 millimetres pressure. Knop s hypobromite-\\nof-sodium fluid is made as follows In 250 cubic\\ncentimetres of distilled water 100 grammes of\\nsodium hydrate are dissolved, and after cool-\\ning 25 cubic centimetres of bromine are added.\\nA number of apparatuses have been devised\\nfor carrying out this method, the best known\\nof which are those of Hufner, Dupre, and\\nGerrard. But altogether the simplest and\\nmost ready method of carrying out the hypo-\\nbromite test is by means of the instrument\\ndevised by Doremus, of New York, which\\ngives very satisfactory approximate results\\nfor rapid clinical work. 1 The bulb of the\\ninstrument is filled with the alkaline hypo-\\nbromite solution, and by inclining\\nthe tube the long arm is filled to the\\nbend at the bulb. 2 By means of the\\nnipple-pipette, 1 cubic centimetre of\\nthe urine to be tested is slowly dis-\\ncharged up the long arm into the\\nhypobromite solution. A rapid de-\\ncomposition of urea takes place\\nthe bubbles of nitrogen rise in the\\nlong arm of the instrument, while\\nthe displaced liquid flows into the\\nbulb, which serves as a reservoir for\\nIn fifteen minutes the decomposition of urea is\\nK\\nFig. 4.\u00e2\u0080\u0094 Dr. Doremus s\\nUreometer.\\nthe overflow.\\n1 Messrs. Eimer Amend, 205 and 211 Third Avenue, New York, supply\\nthese instruments at very moderate cost.\\n2 As the hypobromite solution does not keep well, it is best to keep the\\nbromine and the sodium-hydrate solution separate, as follows: Have on hand a\\nsolution of sodium hydroxid, 100 grammes to 250 cubic centimetres of water\\n(6 ounces to the pint). In another bottle should be kept the bromine. To pre-\\npare the solution freshly for use, take 10 cubic centimetres of the sodium-\\nhydroxid solution, and add thereto 1 cubic centimetre of bromine (1 to 10).\\nAfter the bromine has been thoroughly mixed with the alkali, dilute with an\\nequal volume of water, and the solution is ready for testing.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0056.jp2"}, "57": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 29\\ncomplete, and the graduation on the long arm will indicate the\\nquantity of urea in the volume of urine tested. Two forms of\\nthe instrument are furnished, one graduated to read fractions\\nof a gramme to the cubic centimetre of urine, and the range is\\nfrom 0.01 to 0.03 gramme. If it be desired to read the per-\\ncentage of urea instead of the grammes per cubic centimetre,\\nsimply remove the decimal-point two figures to the right, thus,\\n0.02 gramme to the cubic centimetre is 2.0 per cent, of urea.\\nThe other form of the instrument is similar, save that it is\\ngraduated to show the number of grains of urea per fluidounce\\nof urine.\\nThe normal quantity of urea in the urine is about 2 per\\ncent., or 0.02 gramme per cubic centimetre, or 10 grains per\\nounce.\\nThe differential density method, as devised by Dr. George B.\\nFowler, of New York, is very simple in application. This\\nmethod is based upon the fact that there is a difference in the\\nspecific gravity of urine before and after the decomposition of\\nits urea by the hypochlorites. Every degree of density lost\\ncorresponds to 0.77 per cent., or about 3^ grains per ounce.\\nThe hypochlorite solution employed is Squibb s solution of\\nchlorinated sodium (Labarraque s solution), of which seven parts\\nwill destroy the urea in one part of urine, unless the amount is\\nvery large, in which case the urine should be diluted with an\\nequal bulk of water and the result multiplied by 2. The process\\nconsists in adding to one volume of urine say, one ounce in a\\nlarge hydrometer jar seven volumes of Labarraque s solution.\\nDecomposition immediately ensues, and at the expiration of a\\nfew hours all the nitrogen of the contained urea has escaped.\\nThe specific gravity of the quiescent mixture is now noted, and\\nalso that of the pure urine. We now have the specific gravity\\nof the mixture of the urine and Labarraque s solution after\\ndecomposition. In order to ascertain what it was before decom-\\nposition, we resort to the law of proportions. Multiply, there-\\nfore, the specific gravity of the Labarraque solution by 7, add\\nthe specific gravity of the urine, and divide the sum b}^ 8. Now,\\nfrom this the specific gravity of the mixture before decompo-\\nsition subtract that obtained after decomposition. Multiply the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0057.jp2"}, "58": {"fulltext": "30 ANALYSIS OF URINE.\\ndifference in degrees by 3^, and the result will be the number of\\ngrains of urea per ounce of urine; or, better, b}^ 0.77, which\\ngives the percentage of urea. The presence of sugar or albumin\\nin the urine does not interfere with this test.\\nUric Acid (C 5 H 4 N 4 3\\nUric acid, like urea, is a nitrogenous product, although it\\nexists in the urine in comparatively small amount, about 0.4 to\\n0.8 gramme being excreted b}^ the kidneys in the healthy man in\\ntwenty-four hours. Upon decomposition uric acid yields about\\n33.3 per cent, of its weight in nitrogen. It is feebly soluble,\\nrequiring 15,000 parts of cold or 1900 parts of boiling water\\nto dissolve it. It is, for the above reason, rarely found in the\\nurine in the free state more often in the form of crystalline\\ndeposit, reddish sand most often, however, it exists in combi-\\nnation as urates.\\nUric acid is dibasic that is to say, it contains two atoms of\\nH which may be substituted by two atoms of a monad metal.\\nUrates containing but one atom of potassium, sodium, or ammo-\\nnium are acid urates those containing two atoms are neutral\\nsalts. Uric-acid crystals usually occur in urines of strongly-\\nacid reaction, although exceptionally they may be found in alka-\\nline urine at the beginning of, or in the early stage of, alkaline\\nfermentation. It is common to find uric-acid crystals deposited\\nfrom highly-concentrated urines (dark-colored urine), such as is\\noften noticed after a diet largely of proteid foods or after free\\nperspiration; and in such cases it is not of special significance.\\nIt is otherwise, however, when deposit occurs from increased\\nformation and excretion, resulting after febrile crises, rheumatic\\narthritis, renal and vesical lithiasis, leukaemia, pernicious anaemia,\\ndiabetes, uric-acid diathesis, and conditions of respiratory in-\\nsufficiency. Crystals of uric acid occurring in physiological and\\npathological urines present many variations, most of which are\\nwell seen in Plate III.\\nUric acid crystallizes in the urine in rhombic, rectangular\\nprisms, wedge- and whetstone- shape, of yellowish-red color, con-\\nstituting, with its salts, the only sediments of the urine thus\\ncolored.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0058.jp2"}, "59": {"fulltext": "PLATE III.\\nUric-Acid Crystals. Normal Color. (After Peyer.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0059.jp2"}, "60": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0060.jp2"}, "61": {"fulltext": "NORMAL CONSTITUENTS OF URINE.\\n31\\nUric acid corresponds with urea in its protein origin in the\\norganism, but the seat of its formation has given rise to much\\ndiscussion. Two different views are held upon this subject 1.\\nThat, like urea, it is formed in the tissues, notably in the spleen\\nand liver, and merely excreted hy the kidneys. This view is\\nsupported by the following facts (a) In the normal condition\\nbut a small amount of uric acid is found in the blood, (b) In\\ngout, where excretion of the uric acid is diminished, it accumu-\\nlates in the blood and tissues.\\n(c) After extirpation of the\\nkidneys it continues to be\\nformed, (d) The secretion of\\nuric acid is most abundant at\\nthe period of digestion, when\\nthe liver and spleen are the\\nmost active. 2. This view sup-\\nposes that the kidneys not only\\nconstitute the seat of excretion,\\nbut also that of formation of\\nuric acid. Garrod has ably\\nsupported this view, 1 basing\\nhis conclusions, first, on the\\nfact of the small amount of uric acid in the blood of birds\\nand reptiles, and also that he was unable to find more uric\\nacid in the liver and spleen of birds than in those organs\\nin mammals. But Schroeder has recently shown (1) that\\nthe liver of birds contains a high percentage of uric acid\\n(2) that after removal of the kidneys uric acid continues to\\nbe formed, and accumulates in the blood and liver (3) that\\nby passing blood through the liver, immediately after removal\\nof that organ from the body, it is found that the uric acid is\\nmuch increased and (4) he regards ammonia as the most im-\\nportant precursor of uric acid, just as in mammals it is the most\\nimportant precursor of urea. 2 In addition to this, the experi-\\nments of Minkowski are still more conclusive. He succeeded in\\nkeeping geese alive for from six to twenty hours after extirpation\\n1 Lumleian Lectures, Lancet, vol. i, 1883.\\n2 Ludwig s Festschrift, 1887, p. 89.\\nFig. 5.\u00e2\u0080\u0094 Uric-Acid Crystals.\\n(After Kuhn.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0061.jp2"}, "62": {"fulltext": "32 ANALYSIS OF URINE.\\nof the liver after the operation their urine contained but 2 or\\n3 per cent, of uric acid, instead of the normal 60 or 70 per cent.\\nthe ammonia was corresponding^ increased to 50 or 60 per\\ncent., instead of the normal 9 to 18 per cent.\\nAll the facts at present available render the following con-\\nclusions probable: 1. That uric acid is formed chiefly in the\\nliver. 2. It is formed by the synthesis of ammonia and lactic\\nacid, which, after the removal of the liver, appear in the urine\\nin equivalent quantities. 3. That the remnant of uric acid in the\\nurine after extirpation of the liver originates from xanthin and\\nsimilar products.\\nThe quantity of uric acid in the urine should never be pre-\\nsumed to be excessive from the mere fact of deposit of uric-acid\\ncrystals in the urine upon cooling, as in fact such may, and very\\noften does, occur when the uric acid is both relatively and abso-\\nlutely deficient. The conditions of the urine which tend to pre-\\ncipitation of uric acid are as follow 1. High grade of acidity\\nof the urine. 2. Poverty in mineral salts. 3. Low percentage\\nof pigmentation. 4. High percentage of uric acid. 5. Long\\nstanding. Any urine upon standing sufficiently long will deposit\\nuric-acid cr3 r stals in consequence of the changes culminating in\\nammoniacal decomposition.\\nAs alread} stated, the quantity of uric acid excreted in twenty-\\nfour hours by the average healthy man ranges from 0.4 to 0.8\\ngramme (6 to 12 grains). The proportion of urea to uric acid\\nis stated by Parkes to be about 45 to 1.\\nUric-acid excretion is increased by a rich animal diet, es-\\npecially if combined with limited exercise in the open air by\\nacute febrile conditions; by lung and heart diseases, attended by\\ndyspnoea by diseases which impede respiration, as large ab-\\ndominal tumors, ascites, etc. b}^ leukaemia and by the so-\\ncalled uric-acid cachex}^. Uric acid, on the other hand, is\\ndiminished in advanced Bright s disease, urina spastica, h}--\\ndruria, arthritis (especially the gouty form), gout, and, in\\ngeneral, wherever urea is diminished in quantity uric acid is\\nusually also diminished.\\nDetection of Uric Acid. 1. Uric acid, as such, is easily recog-\\nnized by the microscope, owing to the characteristic rhombic,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0062.jp2"}, "63": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 33\\nyellowish-red crystals. The microscope also most readily dis-\\ntinguishes uric acid from its compounds.\\n2. The presence of both uric acid and its compounds may be\\nreadily detected by means of the murexide test. The sediment,\\nor residue, after evaporation, is first treated with a few drops\\nof nitric acid in a porcelain capsule, and, after warming over a\\nspirit-lamp until evaporated almost to dryness, a drop or two of\\nammonia is added, and, if present, a beautiful purple-red color\\nimmediately appears, gradually diffusing over the bottom of the\\ncapsule.\\nThe murexide test depends upon the facts that, by the ad-\\ndition of nitric acid and heat to uric acid or urates, first alloxan\\nand subsequently alloxan tin are formed, which, on the addition\\nof ammonia, form murexide, acid purpurate of ammonium.\\n3. If one or two drops of nitrate-of-silver solution be dropped\\nupon white filter-paper, and then touched with an alkaline solu-\\ntion of uric acid (sol. with sodium carbonate), a black color ap-\\npears if 0.001 per cent, of uric acid be present even 0.0005 per\\ncent, of uric acid, if present, will cause a brownish-yellow or\\ngra}dsh stain.\\n4. A solution of uric acid or urate, warmed with copper sul-\\nphate and caustic potash, produces a reddish precipitate of\\ncuprous oxide.\\nDetermination of Uric Acid. An approximate and sufficient^\\naccurate process for most clinical purposes is Heintz s method,\\nwhich is also very simple Take 200 cubic centimetres of urine,\\nand add to it 10 cubic centimetres of li3 T drochloric acid. Let\\nstand for twenty-four hours in a cool room. Collect the precipi-\\ntated uric-acid crystals on a previously-weighed filter, and wash\\nwith cold distilled water. Diy the filter and uric-acid ciystals\\nin a desiccator, and weigh. By subtracting the weight of the\\nfilter, the result will be the w- eight of the uric acid in 200 cubic\\ncentimetres of urine. If albumin be present, it should first be\\nremoved and the urine should always be filtered before applying\\nthe test, otherwise subsequent filtration is very difficult.\\nOccasionally it happens that urine containing uric ncid gives\\nno precipitate as above, and a number of other methods have\\nbeen suggested, but as yet we lack a thoroughly trustworthy and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0063.jp2"}, "64": {"fulltext": "34 ANALYSIS OF URINE.\\nready method for clinical work. Ha}^craft s method has hereto-\\nfore been most employed. This is based upon the fact that uric\\nacid combines with silver as silver urate the silver urate is col-\\nlected, dissolved in nitric acid, and the silver is estimated volu-\\nmetrically by Vollard s method. From the amount of silver\\nfound the amount of uric acid is calculated. Czapek found a\\nlarge error in this method, and Salkowski also regards the process\\nas misleading, because the composition of the silver urate is not\\nuniform, and Gossage confirms this statement. The methods of\\nFokker-Salkowski and Camerer have been strongly recommended,\\nof late. The following method of Hopkins, which is a modifica-\\ntion of Fokker s method, has recently been recommended as the\\nbest to date x\\nHopkins s Method. In this process the uric acid and all the\\nurates are precipitated by saturation with ammonium chloride,\\nwhich converts them all into urates of ammonium. They are\\nthen filtered out and the uric acid separated by the action of\\nhydrochloric acid. The final estimation is then made by titra-\\ntion with a standard solution of potassium permanganate, which\\nis found more accurate than weighing.\\nThe process, as applied to all urines, normal and pathological,\\nis as follows\\n1. In Normal Urine without Deposit. (a) To 100 cubic cen-\\ntimetres of the urine ammonium chloride is added until practi-\\ncally saturated about 35 grammes are necessary. When a small\\nquantity of the chloride remains undissolved, even after brisk\\nstirring at intervals of a few minutes, saturation is sufficient.\\nAs the temperature of the urine again rises, from the depression\\ndue to the process of solution, any residual crystals will, for the\\nmost part, dissolve but there is no necessity for adding more.\\n(b) After having stood for two hours, better with occasional\\nagitation, to promote subsidence, the precipitate produced is\\nfiltered through a thin filter-paper and washed three or four\\ntimes with saturated solution of ammonium chloride. The\\nfiltrate should remain perfect^ clea-r and bright.\\n(c) With a jet of hot distilled water the urate, which will be\\n1 Jour. Pathology and Bacteriology, 1893, vol. i, No. 4, p. 450.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0064.jp2"}, "65": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 35\\nsomewhat pigmented, is now washed off the filter into a small\\nbeaker, and heated just to boiling with an excess of hydrochloric\\nacid. It is then allowed to stand for the uric acid to separate\\nout completely. Two hours is sufficient, if the liquid be cooled.\\nThe acid is then filtered off and washed with cold distilled\\nwater. The filtrate should be measured before the washing has\\nbegun, and 1 milligramme added to the final result for each 15\\ncubic centimetres of liquid present. This need never be more\\nthan from 20 to 30 cubic centimetres.\\nThe acid is now again washed off the filter with hot water,\\nwarmed, with the addition of sodium carbonate, till dissolved,\\nand the solution then made up to 100 cubic centimetres. Being\\ntransferred to a flask of sufficient capacity, it is mixed with 20\\ncubic centimetres of strong, pure sulphuric acid, and immedi-\\nately titrated with one-twentieth normal potassium-permanganate\\nsolution. The latter should be added slowly toward the end of\\nthe reaction, the close of which is marked by the first approach\\nof pink color, which is permanent for an appreciable interval.\\nPreviously, the disappearance of the color will have been instan-\\ntaneous. The flask should be agitated throughout the operation.\\nThe standard solution is made by dissolving 1.578 grammes\\nof pure potassium permanganate in 1 litre of distilled water.\\nOf this, 1 cubic centimetre is equal to 0.003T5 gramme of uric\\nacid. The addition of 20 per cent, of sulphuric acid to the\\nsolution produces a temperature suitable to the reaction, and\\nno thermometer need be used.\\n2. In acid urine containing cystin the author recommends the\\naddition of a few drops of strong ammonia, which will obviate\\nall difficulty.\\n3. In alkaline urine with abundance of \u00e2\u0096\u00a0phosphates, they\\nshould be filtered off after complete precipitation by heat. The\\nammoniacal urate comes down more rapidly in alkaline than acid\\nurine. The only objection to adding ammonia in all cases is\\nits tendency to precipitate the phosphates.\\n4. Albuminous urine does not interfere with accurate deter-\\nmination of uric acid by this method, but requires a little longer\\ndigestion with hydrochloric acid.\\n5. With highly -pig me nled urine the original urate precipitate", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0065.jp2"}, "66": {"fulltext": "36 ANALYSIS OF URINE.\\nis thoroughly digested with alcohol, and after acidification the\\nfiltrate is gradually heated to boiling, and then digested for some\\ntime on a water-bath. The separated crystals are then thoroughly\\nwashed.\\nIn all cases exceedingly accurate results are claimed, and\\nthe process can be carried out with ease and comparative rapidity.\\nXanthin (C 5 H 4 N 4 0,).\\nThis substance contains one atom of oxygen less than uric\\nacid, hence its close alliance chemically with the latter. Xanthin\\nis present in normal urine, although in very small quantity.\\nNeubauer found only 1 gramme in 300 litres of normal human\\nurine. When deposited in the urine spontaneously, it forms\\nbrittle scales of yellowish-white color and of somewhat waxy\\nconsistence. It is insoluble in alcohol and ether, feebly soluble\\nin water, and readily soluble in alkalies, as well as in dilute\\nnitric and hydrochloric acids. Xanthin is a constituent of a\\nvery rare form of calculus, having thus been met with not to\\nexceed half a dozen recorded times, and these always in cases of\\nyouth. As a urinary sediment it has been encountered more\\nfrequently.\\nAlthough xanthin is widely distributed throughout the\\neconomy, having been found in most of the viscera as well\\nas in the blood, the conditions which give rise to its increased\\nand decreased excretion by the kidneys, as well as its occurrence\\nas a urinary sediment, are as yet but little known. Durr and\\nStrohmyer state that its amount in the urine is increased by\\nsulphur-baths.\\nDetection. When dissolved in dilute hydrochloric acid, upon\\nevaporation xanthin separates into hexagonal ciystals. When\\nevaporated to dryness with nitric acid, a yellow residue remains,\\nwhich turns red with potassium hydrate and reddish violet on\\nbeing heated.\\nAllantoin (C 4 H 6 N 4 3\\nThis substance is obtainable from uric acid by oxidation with\\npotassium permanganate (care being taken that the temperature", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0066.jp2"}, "67": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 37\\ndoes not rise), the potassium permanganate taking up water and\\noxygen, forming allantoin and carbonic acid\\n2C 5 H 4 N 4 3 2H 2 2 2C 4 H 6 N 4 3 2C0 2\\nUric acid. Allantoin.\\nAllantoin crystallizes in colorless prisms, which are soluble\\nin hot water, but slightly soluble in cold water, and insoluble in\\nalcohol and ether. It is precipitated from its solutions by mer-\\ncuric salts. Allantoin occurs in mere traces in norma) human\\nurine, except directly after birth, but it is increased by a meat\\ndiet, and by administration of tannic acid. It was found by\\nWohler in the urine of newborn calves, and since then by numer-\\nous observers in the urine of newborn infants. Its close chem-\\nical alliance with uric acid is shown by the fact that Salkowski\\nfound allantoin with urea and oxalic acid much increased in the\\nurine of animals (dogs) by the administration of uric acid.\\nDetection and Determination. Allantoin may be separated\\nfrom the urine b} T precipitation with lead acetate, filtering, pass-\\ning sulphuretted hydrogen through the filtrate, filtering again,\\nevaporating the final filtrate to a syrupy consistence, and letting\\nit stand for several days. Allantoin then crystallizes out.\\nCreatinin (C 4 H 7 1S t 3 0).\\nCreatinin and creatin are both constituents of normal urine,\\nand are subject to interchange one into the other, according to\\ncertain conditions. In alkaline urine creatin appears in greater\\nquantity, while the reverse is the case with strongly acid urine.\\nPhysiologically they may be considered as one body, although\\nchemically they differ in the fact that creatin contains H 2 more\\nthan creatinin, as may be seen by their formulae, creatinin,\\nC 4 H 7 N 3 0; creatin, C 4 H 9 N 3 2 Since the urine is usually\\nacid, creatinin is generally considered the normal constituent.\\nCreatinin is a decided base probably the strongest in the\\neconomy giving a distinctly alkaline reaction with test paper.\\nIt crystallizes in large colorless prisms, soluble in water and\\nalcohol, but almost insoluble in ether.\\nCreatinin is a constant constituent of normal human urine,\\nbeing excreted in nearly the same amount as uric acid, 0.5 to", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0067.jp2"}, "68": {"fulltext": "38\\nANALYSIS OF URINE.\\n0.9 gramme in twenty-four hours (1 to 13 grains). It lias been\\ngenerally considered that creatinin of the urine arises from the\\ncreatin of the muscles, because- when animals are fed on creatin\\nthe creatinin of the urine is increased. But Meissner has shown\\nthat when creatin is injected into the blood it appears in the urine\\nas such unchanged and it would therefore appear that the kid-\\nneys have not the power of converting creatin into creatinin the\\nchange probably takes place normally in muscles, the creatinin\\nentering the blood and being excreted by the kidneys. Bunge,\\nhowever, points out the fact that the relatively small excretion\\nof creatinin cannot account for the large amount of creatin of\\nthe muscles, 90 grammes. He therefore considers it more prob-\\nable that creatinin is ultimately\\nconverted into urea, the crea-\\ntinin of the urine or creatin,\\nif the urine be alkaline being\\nderived from the food.\\nCreatinin is excreted in in-\\ncreased amount upon a meat\\ndiet, and in diminished quant it}^\\nby fasting. Clinically it is\\nexcreted in increased quanthVy\\nin acute diseases, as pneu-\\nmonia, the efflorescent stages\\nof typhoid and intermittent\\nfever, and in some cases of\\ndiabetes, though not in all. It is diminished in- convalescence\\nfrom acute diseases, in advanced degeneration of the kidne3 r s,\\nand tetanus. In diseases characterized by muscular wasting in\\ngeneral, creatinin is usually diminished.\\nDetection and Determination. 1. When a solution of sodium\\nnitro-prussiate is added to a dilute solution of creatinin, and\\nsubsequently sodium hydroxid is added, a red color appears,\\nwhich changes to yellow upon standing (Weyl s test). 2. A so-\\nlution of creatinin, as in the urine, acidulated with nitric acid,\\ngives, with phospho-molybdic acid, a yellow crystalline precipi-\\ntate, soluble in hot nitric acid. 3. With zinc chloride it gives a\\ncharacteristic crystalline precipitate (groups of fine needles) con-\\nFig. 6.\u00e2\u0080\u0094 Creatinin Crystals.\\n(After Kuhn.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0068.jp2"}, "69": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 39\\nsisting of a combination of zinc chloride with creatinin. This\\ntest is used for quantitative estimation of creatinin.\\nThe five bodies just considered in detail viz., urea, uric acid,\\nxanthin, allantoin, and creatinin constitute the chief constit-\\nuents of normal urine of the nitrogenous type, or protein deriva-\\ntion. In addition to these, however, thio- (sulpho-) cyanic acid\\nis found in the urine, in very minute quantities, in the form\\nof thioc} T anates.\\nAROMATIC SUBSTANCES OF THE URIXE.\\nThese comprise four classes (a) Hippuric acid and similar\\naromatic compounds of glycocin. (b) Combinations of glycu-\\nronic acid with aromatic substances, (c) Aromatic oxy-acids.\\n(d) Ethereal sulphates.\\nHippuric Acid (C 9 H 9 X0 3\\nHippuric acid is monobasic and crystallizes either in the form\\nof fine needles or four-sided prisms and pillars terminated by two-\\nor four- sided beveled surfaces. The typical form is that of a ver-\\ntical rhomboid prism. It is colorless, odorless, and of slightly\\nbitter taste. It requires 600 parts of cold water to dissolve it,\\nbut it is much more soluble in hot water and readily so in hot\\nalcohol and ether. It is soluble in ammonia and alcohol, but\\ninsoluble in hydrochloric acid. Hippuric acid is a constant ele-\\nment of normal urine, although present in small amount, 0.5 to\\n1 gramme being excreted by the kiclne} T s in twenty-four hours.\\nHippuric acid is an interesting product in a comparative\\nphysiological sense, since it forms a connecting link between the\\nurine of herbivora, omnivora, and the carnrrora being present\\nin comparatively large amount in the former, much less in the\\nsecond, and absent in the last-named order. It is also interesting\\nin itself, as forming one of the best illustrations of sjmthesis\\noccurring in the organism.\\nIn man the hippurie acid excreted by the kidneys depends\\nchiefly upon the character and quantity of food eaten, being in-\\ncreased by a vegetable diet, especially by certain fruits, as cran-\\nberries, prunes, green gages, etc. The administration of benzoic\\nacid, oil of bitter almonds, toluol, cinnamic acid, benzylamin,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0069.jp2"}, "70": {"fulltext": "40\\nANALYSIS OF URINE.\\nphenylpropionic and kinic acids also cause an increased excre-\\ntion of hippuric acid. On the other hand, an animal diet greatly\\ndecreases its excretion, although it does not disappear from the\\nurine upon an exclusive meat diet. Clinically we find an in-\\ncreased excretion of hippuric acid in diabetes and chorea, as well\\nas in acute febrile processes. Numerous observations go to show\\nthat hippuric acid is formed in the kidneys synthesis, as a rule,\\nfailed after removal of these organs.\\nFig. 7.\u00e2\u0080\u0094 Hippuric-Acid Crystals. (After Peyer.)\\nDetection and Determination. 1. Evaporate the urine with\\nnitric acid, and heat the residue in a dry test-tube. If hippuric\\nacid be present an odor like that of oil of bitter almonds is\\nplainly observable, due to the formation of nitrobenzol. 2. If\\nthe urine contain an excess of hippuric acid, it may be deter-\\nmined by slightly evaporating and feebly acidulating with hydro-\\nchloric acid. Upon standing for a few hours the hippuric acid\\ncrystallizes out and may be recognized by the microscope. The\\nhippuric-acid crystals may be readily separated from uric-acid\\ncrystals by hot water, if the uric acid be present in sufficient", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0070.jp2"}, "71": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 41\\nquantity to interfere with the test. 3. Meissner s method con-\\nsists in precipitating carefully 1000 to 1200 cubic centimetres of\\nurine with strong baryta-water the excess of the latter is re-\\nmoved by a few drops of sulphuric acid (of which an excess is to\\nbe avoided) and then filtered. The filtrate, accurately neutral-\\nized with hydrochloric acid, is then evaporated on a water-bath\\nto the consistency of a thick syrup, and the neutral residue,\\nwhile still hot, is added to 150 or 200 cubic centimetres of abso-\\nlute alcohol in a closed glass vessel. Any succinic-acid salts are\\nprecipitated together with the chloride of sodium, etc., while the\\nhippuric-acid salts remain in solution. After repeated agitation,\\nas soon as the precipitate has settled well the alcoholic solution\\nis decanted and the alcohol completely driven off on the water-\\nbath, the syrupy residue, which on cooling solidifies to a crystal-\\nline mass, is put in a closed vessel while it is still hot, acidulated\\nwith hydrochloric acid, and the hippuric acid extracted by\\nshaking with not too small amounts of ether (100 or 150 cubic\\ncentimetres). After the ether is distilled off, the residue is di-\\nluted with water, and heated to boiling with a little milk of lime.\\nThe hippuric acid separates from the concentrated filtrate, after\\nthe addition of hydrochloric acid, in beautiful crystalline ro-\\nsettes they can be obtained entirely free from color by treating\\nwith pure animal charcoal.\\nCombinations of Glycvronic Acid. This body is closely allied to the carbo-\\nhydrates, and is apt to be mistaken for sugar in the urine. Normally it occurs\\nin mere traces in urine. It occurs partly in combination with aromatic sub-\\nstances.\\nAromatic Oxy-acids. Of these hydroparacumaric acid or oxyphenylpropi-\\nonic acid and oxvphenvlacetic acid are found in minute quantities in the urine,\\nin combination with potassium.\\nEthereal Sulphates.\\nIn 1851 Stacleler discovered, on distilling the urine with di-\\nlute sulphuric acid, small quantities of phenol or carbolic acid in\\nthe distillate. Hoppe-Seyler showed that phenol is not present\\nin the urine in a free state, but as a compound, from which it\\nis liberated by sulphuric acid in distillation. In 1876 Baumann\\ndiscovered that this compound consists of an ethereal compound\\nof phenol and sulphuric acid. Baumann also discovered the pres-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0071.jp2"}, "72": {"fulltext": "42 ANALYSIS OF URINE.\\nence of other like ethereal sulphates in the urine, consisting of\\ncompounds of the radicle HS0 3 sometimes incorrectly termed\\nsulphonates. The most important of this series are the ethereal\\npotassium sulphates of phenol, creosol, catechol or pyrocatechin,\\nindole, and skatole. These compounds are present in the urine of\\nherbivora more abundantly than in carnivora or omnivora but\\nthey are present in the urine of all animals in smaller or larger\\nquantities. They originate in two ways (a) from aromatic sub-\\nstances in food, and (6) in the intestine as the result of putrefac-\\ntive changes. In man, whose food contains but little aromatics,\\nthe origin of these ethereal sulphates is probably chiefly, if not\\nentirely, in the intestines, as above indicated since, if putrefac-\\ntion in the intestines be arrested, these substances disappear\\nfrom the urine. The proportion of the ethereal sulphates to the\\ntotal sulphates of the urine is about 1 to 10.\\nHoppe-Seyler found the ethereal sulphates in the urine in ex-\\ncess under the following circumstances 1. In deficient absorp-\\ntion of the normal products of digestion, such as occurs in peri-\\ntonitis and tuberculosis of the intestine, because the products of\\ndigestion undergo putrefactive changes, and the putrefactive\\nproducts are absorbed. 2. Diseases of the stomach, in which\\nthe food long remains in the stomach and undergoes fermenta-\\ntive changes, always result in excess of ethereal sulphates in the\\nurine. 3. Putrefactive processes outside the alimentary canal,\\nputrid cystitis, putrid abscesses, putrid peritonitis, etc., have\\nthe same effect. The amount of ethereal sulphates is, moreover,\\nin all cases proportional to the severity of the putrefaction, and\\nis increased by the retention and diminished by the discharge of\\nputrid matter as, for instance, in opening an abscess. By these\\nand other observations it has been conclusively established that\\nthe best guide to the occurrence and amount of putrefaction in\\nprogress in the economy is the relation of the ethereal sulphates\\nto the total sulphates.\\nPhenol-Potassium Sulphate (C 6 H 5 OS0 3 K).\\nThe above is the form in which phenol or carbolic acid exists\\nin the urine. Phenol (C 6 H 6 0) was found to be one of the in-\\ntestinal products of putrefaction by Baumann, as already stated.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0072.jp2"}, "73": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 43\\nThis is absorbed and excreted in the above form some of the\\nsulphate comes from tyrosine, which passes through the stages\\nof paracreosol and pa raoxy benzoic acid before conversion into\\nthe phenol salt (Baumann).\\nAfter the use of carbolic acid, externally or internally, the\\namount of phenol sulphate in the urine is increased two sub-\\nstances are formed by splitting up of carbolic acid, called pyro-\\ncatechin and hydroquinon. These become, in alkaline urine, dark\\nbrown upon exposure to the atmosphere producing the well-\\nknown color of the urine in carboluria.\\nDetection. 1. Distil the urine acidulated with sulphuric acid.\\nPhenol appears in the distillate acid bromine-water, a precipitate\\nof tribromophenol appears, deep T ellow. 2. Warm the distillate\\nwith Millon s reagent and a cherry-red color results. 3. Add\\nferric chloride to the distillate and a deep-violet color results.\\nDetermination. Approximate results may be obtained as fol-\\nlows 100 cubic centimetres of urine are concentrated over a\\nwater-bath to 20 cubic centimetres volume. Sulphuric acid is\\nadded in such quantity as to represent 5 per cent, of the mixture.\\nDistil until the distillate is no longer rendered cloud}^ by addition\\nof bromine-water. The distillate is filtered, if necessary, and\\ncolored a permanent light yellow with bromine-water. The mixt-\\nure is allowed to remain two or three days at a moderate tem-\\nperature. A precipitate of tribromophenol (C 6 H 2 Br 3 OH) forms\\nand is collected on a weighed filter, washed with water, and dried\\nin an exsiccator over sulphuric acid to constant weight; 100\\npax-ts of tribromophenol correspond to 28.4 parts phenol.\\nIndoxyl-Potassium Sulphate (C 8 H 6 XO.S0 3 K).\\n(indican\\nIndole (C 8 H 7 X), the basis of the above substance, is formed\\nin the intestines indoxyl, as a radicle thereof, has the formula\\nC 8 H n NO, which, united with S0 3 K, forms the indoxyl-sulphate\\nof potassium of the urine. It occurs in white tablets and plates,\\nsoluble in water, but sparingly soluble in alcohol. By oxidation\\nindigo blue is formed therefrom. Indoxyl-potassium sulphate\\nhas received the erroneous name of indican, under the mistaken", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0073.jp2"}, "74": {"fulltext": "44 ANALYSTS OF URINE.\\nbelief that it is identical with vegetable indican. But the latter\\nsubstance is a glucoside, and only resembles the former in the\\nfact that one of its decompositional products is indigo blue.\\nThe blue, green, and some red urines met with in disease\\nprobably owe their colors to this salt in different stages of oxi-\\ndation. It is excreted in excess on an exclusive meat diet,\\nor the ingestion of indole. Clinically an increased excretion of\\nthis substance by the kidneys is observed in Addison s disease,\\ncholera, carcinoma of the liver, chronic phthisis, central and\\nperipheral diseases of the nervous system, typhoid fever, dys-\\nentery, and the stage of reaction in cholera. In obstructive\\ndiseases of the small intestine its excretion is enormously in-\\ncreased. In general, the appearance of large quantities of this\\nsubstance in the urine implies that abundant albuminous putre-\\nfaction is progressing in some part of the system. Sometimes,\\nas urine is undergoing decomposition changes, a bluish-red pel-\\nlicle, consisting of microscopic crystals of indigo blue and red, is\\nseen, due to decomposition of the indoxyl-sulphate.\\nDetection. 1. Mc Murines method: Equal parts of urine and\\nhydrochloric acid with a few drops of nitric acid are boiled\\ntogether, cooled, and agitated with chloroform. The chloroform\\nis colored violet, and shows an absorption band, before Z due to\\nindigo blue, and another after D, due to indigo red.\\n2. Jaffe s method: Mix 10 cubic centimetres of strong hydro-\\nchloric acid with an equal volume of urine in the test-tube, and\\nwhile shaking add drop by drop a perfectly-fresh saturated solu-\\ntion of chloride of lime, or chlorine-water, until the deepest at-\\ntainable blue color is reached. The mixture should next be agi-\\ntated with chloroform, which readily takes up the indigo and\\nholds it in solution, and the quantity present may be approxi-\\nmately estimated according to the depth of the color.\\nIf the urine contain albumin, it should be removed before\\napplying these tests, otherwise the blue color often arising from\\nthe mixture of hydrochloric acid and albumin after standing may\\nprove misleading.\\n3. Pour 4 cubic centimetres of hydrochloric acid into a small\\nflask, and while stirring add from 10 to 20 drops of urine. If\\nthe proportion of indigo be about normal, the resulting color", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0074.jp2"}, "75": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 45\\nwill be rather light yellow if in excess, the acid will turn violet\\nor blue, the more intense will be the color in proportion to the\\nquantity present. If no coloration appear after waiting a minute\\nor two, there is no excess, however deep a color may subsequently\\nappear.\\nIn addition to those considered, the urine contains three\\nother ethereal sulphates, viz., creosol-potassium sulphate, eate-\\nchol-potassium sulphate, and skatoxyl-potassium sulphate. These\\nfor the most part are present in minute amounts, and possess the\\nsame significance as those considered.\\nURINARY PIGMENTS.\\nNormal Urobilin.\\nUrobilin is the chief coloring agent of normal urine, although\\nit is not the exclusive one, as shown by spectroscopic analysis.\\nNormal urobilin is a dark-brown, amorphous, rather resinous\\nsubstance, sparingly soluble in water, but readily dissolved by\\nalcohol, ether, chloroform, acids, and acidulated water, as well as\\nby solutions of sodium, potassium, or ammonium hydroxid.\\nThe origin of urobilin is still the subject of some difference\\nof opinion. Formerly, it was believed that bilirubin, entering\\nthe intestines with the bile, was acted upon by nascent hydrogen\\nresulting from putrefaction, and as a result it constituted a re-\\nduction product, which Maly considered identical with kydro-\\nbilirubin. It was also supposed that the pigment of the faeces\\nwas partly absorbed, carried to the kidneys, and there excreted.\\nHydrobilirubin, stercobilin, and urobilin were considered identi-\\ncal, but spectroscopic examinations prove them to be different.\\nMcMunn regards the formation of urobilin as the result of\\noxidation processes by means of nascent oxygen, either in the\\nintestines or elsewhere, rather than due to reduction processes.\\nHe bases this view principally on the fact that, by the action of\\nhydrogen peroxide on acid hsematin, he is able to prepare an\\nartificial product, which shows the same spectroscopic appear-\\nances as normal urobilin. The question, then, whether sterco-\\nbilin and urobilin are products of reduction or oxidation is still\\nunsettled. It is important to remember, however, that urobilin\\nmay originate either from bile-pigment or from blood-pigment,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0075.jp2"}, "76": {"fulltext": "46 ANALYSTS OF URINE.\\nCertain facts point to the inference that stercobilin and uro-\\nbilin originate at least, to a limited extent independently.\\nThus 1. In animals with biliary fistula, while no bile enters the\\nintestine, T et the urine still contains urobilin. 2. In Copeman\\nand Winston s case of biliary fistula, in which no bile had entered\\nthe intestine, the faeces were uncolored by stercobilin, yet the\\nurine still contained urobilin. 3. Some cases recorded by\\nMott would seem to indicate that the formation of urobilin is\\nseated in the liver. When destruction of the red corpuscles is\\nexcessive in the portal circulation, the liver contains an excess\\nof iron, and the ferric residue of haemoglobin occurs as urobilin\\nin the urine abnormally abundant.\\nUrobilin exists in normal urine in small amount, the quanthVy\\nbeing much increased in acute fevers, four to five or more times.\\nTyphoid and septic fevers, which cause rapid destruction of the\\nblood-corpuscles, markedly increase the excretion of urobilin.\\nOn the other hand, there is diminished excretion of urobilin in\\nconditions associated with diminished metamorphosis of red\\nblood-corpuscles, as chlorosis and anaemia, in convalescence from\\nacute diseases, as well as in hysteria and nervous diseases. It\\nis an interesting and highly-important clinical fact that increased\\nexcretion of urobilin has been observed in intra-cranial haemor-\\nrhages, haemorrhagic infarctions, retro-uterine haematocele, and\\nextra-uterine pregnancy.\\nAccording to the observations of Lawson, the excretion of\\nurinary pigment is much greater in tropical than in temperate\\nclimates. Thus, assuming the normal unit to be 4.8 in the aver-\\nage adult in temperate climates, he found in the tropics that it\\nrose to 12 or 14. In pneumonia it has been observed to rise to\\n16 and 20 in acute rheumatism, from 30 to 32 at the height of\\nthe disease; in typhoid fever, from 80 to 100; and in a man\\nwho had inhaled arsenated hydrogen, from 600 to 800.\\nDetection. Upon rendering the urine alkaline by the addition\\nof ammonia, and, after filtering, adding some chloride-of-zinc\\nsolution to the filtrate, a beautiful green fluorescence may be\\nobserved by reflected light if urobilin be present. The above\\nsolution furthermore exhibits, with the spectroscope, a dark\\nabsorption-band between Frannhofer s lines b and F.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0076.jp2"}, "77": {"fulltext": "normal constituents of urine. 47\\nUroerythryn.\\nBy some this is considered identical with skatole-pigment, but\\nMcMunn claims for it certain characteristic reactions. It is\\nchiefly this pigment which colors the urates a reddish tint, and\\nit may be extracted therefrom by boiling alcohol. This solution\\ngives two ill-defined bands before F in Fraunhofer s scale. In\\nthe solid state it becomes green with sodium or potassium hy-\\ndroxid. The origin of uroerj^thryn in the economy, as well as\\nits relationship to urobilin, have not been determined.\\nUrochrom.\\nThis name was first applied by Thudicum to the body which\\nhe considered the chief coloring agent in the urine. Urochrom\\nis thought by some to consist of impure urobilin, Certain it is,\\nat least, that urochrom contains much urobilin. Urochrom\\noccurs in yellow scales, which partly dissolve in water, less solu-\\nble still in alcohol, but soluble in ether and dilute mineral acids\\nand alkalies. The aqueous solution becomes dark on standing,\\nfinally changing to a red color, becoming turbid, and depositing\\nresinous flocculi. Urochrom is precipitated from its aqueous\\nsolution by nitrate of silver as a gelatinous mass soluble in\\nnitric acid acetate of lead gives a white flocculent precipitate.\\nMercuric nitrate gives a white precipitate, which, on boiling, be-\\ncomes a pale flesh-color, the supernatant fluid appearing rose-\\nred. B} oxidation there is first formed from urochrom a red\\nsubstance, which corresponds to uroerythrin, and to which the\\nred urine of disease often owes its color.\\nOther Organic Constituents of Urine.\\nOxalic Acid (C 2 H 2 4 This substance never occurs in the urine in\\na free state, but always in combination with calcium (oxalate of lime),\\nwhich is held in solution by the acid sodium phosphate of the urine. It\\nis sometimes absent from the normal urine, though usually present in\\nquantity of about 0.1 gramme for twenty-four hours. When present in\\nexcessive quantities in the urine it is precipitated in the form of oxalate-\\nof-calcium crystals. These are distinguished by their form, quadratic\\noctahedra, with a short principal axis, often termed envelope crystals/\\nOccasionally dumb-bell forms are seen. The origin of oxalic acid in the\\norganism is undetermined but a close relationship evidently exists be-\\ntween it and uric acid.\\n4", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0077.jp2"}, "78": {"fulltext": "48 ANALYSIS OF URINE.\\nSuccinic Acid (C 4 H 6 4 is the third of the series of acids of which\\noxalic acid is the primary. Succinic acid has occasionally been met with\\nin the urine, especially after the ingestion of asparagus and asparagin.\\nLactic Acid (C 3 H 6 3 It is doubtful if lactic acid be present in\\nnormal urine, but it has been found combined with bases after physio-\\nlogical disturbances and severe muscular labor. In such cases it oc-\\ncurs as sarcolactic acid. It has been found in trichinosis, acute yellow\\natrophy of the liver, cirrhosis of the liver, diabetes, phosphorus poison-\\ning, rickets, leucocythaemia, osteomalacia, and in animals after extir-\\npation of the liver.\\nFatty Acids. These are present in normal urine, though in mere\\ntraces, 0.008 gramme per day. They consist of formic, acetic, butyric,\\nand propionic acids. The excretion of fatty acids by the kidneys is in-\\ncreased during the process of ammoniacal fermentation. Certain febrile\\ndiseases cause an increase of these bodies in the urine to 0.06 gramme, and\\nin certain diseases of the liver the increase reaches from 0.6 to 1 gramme\\nper day. These acids apparently exist in the urine in a free state.\\nGlycero -phosphoric Acid (C 3 H 9 P0 6 occurs in faint traces in normal\\nurine, about 15 milligrammes per litre. It is said to be increased in\\nnervous disorders and after chloroform narcosis.\\nCarbohydrates. Much discussion has taken place over the ques-\\ntion as to whether grape-sugar is a constituent of normal urine. One\\ndifficulty in determining this point is the fact that the urine contains a\\nnumber of substances which reduce alkaline solutions of cupric oxide\\nthe chief of these being uric acid, hippuric acid, pyrocatechin, glycuronic\\nacid, and creatinin. Abeles showed, however, that none of these sub-\\nstances undergo alcoholic fermentation with yeast, while this does occur\\nwith the reducing substance of normal urine. Wedenski, by shaking a\\nlarge quantity of normal urine with benzoic chloride, obtained insoluble\\nbenzoyl compounds of carbohydrates, which give all the reactions of\\ngrape-sugar. It may therefore be considered as conclusive, as Brucke\\nfirst affirmed, that minute quantities of sugar exist in normal urine.\\nAnimal Gum. This constitutes a product of mucin, and was first\\nfound in the urine by Landwher also in saliva, the synovia, in colloid\\ncysts, in chondrin, and in connective tissue. It forms an opalescent\\nsolution with water gives a sticky precipitate with copper sulphate, and\\nalso with ferric chloride. It is precipitated by alcohol, and does not re-\\nduce alkaline solutions of cupric salts. It yields oxalic acid upon treat-\\nment with nitric acid, and lsevulic acid after treatment with hydrochloric\\nacid, as does vegetable gum.\\nMilk-sugar occurs in variable quantities in the urine of nursing\\nmothers and lesions of the mammary glands. Hofmeister precipitated\\nurine with lead acetate and ammonia, filtered, shook the filtrate with\\nsilver oxide, filtered, decomposed the filtrate with sulphuretted hydrogen", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0078.jp2"}, "79": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 49\\nto get rid of the silver, filtered to the final filtrate barium carbonate was\\nadded, and the mixture evaporated to dryness. Alcohol removed milk-\\nsugar from the residue, and characteristic crystals thereof were obtained\\nby evaporating off the alcohol. Kaltenbach proved that this was milk-\\nsugar by further obtaining therefrom galactose and mucic acid.\\nInosite This substance has been found in normal urine in small\\nquantities by numerous observers. An increased excretion has been noted\\nin Bright s disease and in diabetes. It may be detected as follows\\nSeveral litres of urine, feebly acidified, are completely precipitated with\\nacetate of lead and filtered. The filtrate is warmed and precipitated\\nwith basic lead acetate. After standing forty-eight hours the precipitate\\nis collected, washed, suspended in water, and treated with a stream of\\nsulphuretted hydrogen the lead sulphide is filtered off; uric acid sepa-\\nrates from the filtrate after a few hours this is also filtered off. The\\nsolution is then evaporated to a syrupy consistence on a water-bath, and\\nabsolute alcohol added. The precipitate is dissolved in hot water, and\\nthree or four times the volume of 90-per-cent. alcohol added. Ether is\\ncautiously added till a permanent cloud appears the inosite crystallizes\\nout, and may be collected. It will then give its characteristic tests, as\\nfollows: 1. With a few drops of nitric acid on a platinum dish, treated\\nwith ammonia and calcium chloride, after evaporating to dryness a\\nbright red or violet color appears. 2. Add a little mercuric nitrate to a\\nsolution of inosite, on a porcelain capsule, a yellow precipitate results.\\nOn gently heating, this becomes red on cooling, the color vanishes.\\nProteids, tyrosin, and sugar must be absent.\\nFerments. Pepsin has been isolated from normal urine by Brucke,\\nSahli, and others. The morning urine is richest in pepsin. The pepsin\\nof urine forms peptone and all intermediate proteoses from fibrin, the\\nsame as does pepsin. Detection Small pieces of fibrin are first soaked\\nin urine until pepsin is absorbed therefrom. If then removed to 0.1 per\\ncent, hydrochloric-acid solution they are rapidly digested. Control ex-\\nperiments, with fibrin not soaked in urine, give negative results.\\nDiastase. Holvotschiner has obtained minute quantities of ptyalin\\nor a similar diastatic ferment from urine.\\nRennet. Helwes and Holvotschiner have both obtained from urine\\ntraces of a ferment which curdles milk.\\nTrypsin. This ferment is doubtless absent from normal urine.\\nSahli alone, of all investigators, claims to have found it; but his results are\\nconsidered as due to non-prevention of putrefaction in his experiments.\\nMucin. This is the chief constituent of the mucus of normal urine,\\nderived from the muciparous glands of the urinary passages, but not\\nfrom the kidneys. In normal urine, mucin occurs in small amount\\nbut in catarrhal diseases of the urinary tract it is increased, often\\nin abundance. In appearance it is viscid, slimy, and tenacious.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0079.jp2"}, "80": {"fulltext": "50 ANALYSIS OF URINE.\\nDetection: 1. Mucin is precipitated from its solutions by vegetable\\nacids, the precipitate being insoluble in excess of the acid. 2. Add to\\none volume of urine three volumes of strong alcohol and let stand for\\nseveral hours. Filter and wash the precipitate with alcohol, and treat\\nwith warm water. The filtrate containing the mucin is then acidified\\nwith acetic acid, and if turbidity results it is due to mucin.\\nINORGANIC CONSTITUENTS.\\nThe inorganic constituents of the urine comprise chiefly the\\nchlorides, carbonates, sulphates, and phosphates. These occur in\\ncombination with potassium, ammonium, calcium, and magnesium.\\nSmall quantities of fluorine, silicic acid, and iron are also present\\nand free gases, including carbonic acid, nitrogen, and traces of\\noxygen. The total amount of these salts in the urine varies\\nfrom 9 to 25 grammes per day. They are derived from (a) the\\nfood ingested and (b) from the metabolic processes or tissue-\\nchanges the latter more especially with regard to the sulphates\\nand phosphates. The salts of the blood and those of the urine\\nare very similar, save that the blood contains but traces of sul-\\nphates, while the urine is rich in these salts.\\nThe sulphates are derived chiefly from the changes occurring\\nin the proteids of the body the nitrogenous elements of the\\nproteids being excreted as uric acid and urea, while the sulphur\\nbecomes oxidized, forming sulphuric acid, which appears in the\\nurine mostly in combination with metallic bases, but also, to\\nsome extent, in ethereal combinations with organic radicles,\\nmaking up the ethereal sulphates just considered.\\nChlorides.\\nThe chlorides of the urine consist chiefly of chloride of sodium\\nwith a small amount of chloride of potassium and ammonium.\\nThe amount of chlorides excreted by the kidneys in the healthy\\nadult averages from about 10 to 16 grammes in twenty-four\\nhours, 6 to 10 grammes of chlorine. The chlorides, therefore,\\nnext to urea, constitute the principal solid constituent of the\\nurine. Chlorine is very widely distributed throughout the\\norganism, nearly always in combination with sodium, potassium,\\nammonium, and magnesium. As chloride of sodium it is ex-\\ncreted with the perspiration, saliva, bile, feces, and urine.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0080.jp2"}, "81": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 51\\nIn health the excretion of the chlorides by the kidneys varies\\nin amount according to the quality and quantity of food ingested.\\nThus, upon a liberal salt diet they are largely increased; the\\noutput representing very closely the amount of chloride of\\nsodium taken in. With active exercise there is also increased\\nexcretion of chlorides by the kidneys, while, on the other hand,\\nduring repose of the body they are diminished.\\nClinically the excretion of chlorides with the urine is dimin-\\nished in all acute febrile conditions, and especially when attended\\nby serous exudations. As a general rule, in such cases there is\\na steacty decrease until the crisis of the disease is reached, after\\nwhich the} gradually increase. A continued increase of chlorides\\nin the urine in febrile states may, therefore, be accepted as an\\nevidence of improvement. In pneumonia the chlorides may dis-\\nappear from the urine, and their absence, under such circum-\\nstances, always indicates a serious condition of the patient. In\\nchronic conditions associated with impaired digestion and\\ndropsy the chlorides are diminished. In the latter case much\\nof the chlorides become stored up in the dropsical fluid in the\\nserous cavities and cellular tissues. The chlorides are excreted\\nby the kidneys in excess in diabetes insipidus and in the declin-\\ning stages of dropsy after the establishment of diuresis.\\nDetection. 1. The urine is treated with nitric acid and a\\nsolution of nitrate of silver added. A caseous precipitate soluble\\nin ammonia, insoluble in nitric acid, shows the presence of\\nchlorides.\\n2. The above test may be made available for approximative\\nestimation as follows A standard solution of nitrate of silver,\\n1 to 8 (1 drachm to the ounce), is first prepared. Take a glass\\nhalf full of urine, and add a few drops of nitric acid; then add\\none or two drops of the standard solution of silver nitrate,\\nand note the changes. If a white, flak}- precipitate occur,\\nquickly sinking to the bottom of the glass without diffusing\\nthrough the urine, the chlorides are undiminished. If a simple\\ncloudiness appear, readily diffusing throughout the urine without\\nthe appearance of curdy flakes, the chlorides are diminished to\\n0.1 per cent., the normal being 0.5 to 1 per cent. Should no pre-\\ncipitate whatever occur, the chlorides are absent. This method,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0081.jp2"}, "82": {"fulltext": "52 ANALYSTS OF URINE.\\nproposed by Ultzmann, is rather obsolete, in view of the rapid\\nand accurate results by advanced centrifugal methods.\\nDetermination. Mohr s Method: Prepare the following solu-\\ntions: 1. Standard nitrate-of-silver solution: Dissolve 29.075\\ngrammes of fused nitrate of silver in 1000 cubic centimetres\\n(1 litre) of distilled water; 1 cubic centimetre of this solution is\\nequal to 0.01 gramme of sodium chloride. 2. A saturated aque-\\nous solution of neutral potassium chromate.\\nProcess. Take 10 cubic centimetres of urine dilute with 100\\ncubic centimetres of distilled water add to this a few drops of\\nthe potassium-chromate solution. Drop into this mixture from\\na burette the standard nitrate-of-silver solution the chlorine\\ncombines with the silver to form silver chloride in the form of\\nwhite precipitate. When all the chlorides are thus precipitated,\\nsilver chromate (red) appears, though not while any chloride\\nremains in solution. The silver nitrate must, therefore, be added\\nuntil a pink tinge appears. Read off the quantity of standard\\nsolution of silver used, and calculate therefrom the quantit}^ of\\nchlorides in the 10 cubic centimetres of urine tested, and from\\nthis the percentage.\\nCorrections. 1. A high-colored urine may cause difficulty in\\ndetermining the appearance of the pink tinge. This may be ob-\\nviated by diluting the urine to a normal color. 2. One cubic\\ncentimetre should be subtracted from the total number of cubic\\ncentimetres of the silver-nitrate solution emplo3 r ed, as the urine\\ncontains small quantities of certain compounds more easily pre-\\ncipitable than the chromate. 3. To obviate such errors the fol-\\nlowing modification of the test as advised by Sutton is employed\\nTen cubic centimetres of urine are measured into a thin porcelain\\ndish and 1 gramme of pure ammonium nitrate added the whole\\nis then evaporated to dryness, and gradually heated over a small\\nspirit-lamp to low redness till all vapors are dissipated and the\\nresidue becomes white. It is then dissolved in a small quantity\\nof water, and the carbonates produced by combustion of the or-\\nganic matter neutralized b}^ dilute acetic acid a few grains of\\npure carbonate of lime are added to remove all free acid, and\\none or two drops oi potassium chromate. The mixture is then\\ntitrated with deci-normal silver solution (16.966 grammes silver", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0082.jp2"}, "83": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 53\\nnitrate per litre) until the pink color appears. Each cubic centi-\\nmetre of silver solution represents 0.005837 gramme of salt con-\\nsequently, if 12.5 cubic centimetres have been used, the weight\\nof salt in 10 cubic centimetres of urine is 0.0T296 gramme, or\\n0.7296 per cent. If 5.9 cubic centimetres of urine are taken for\\ntitration, the number of cubic centimetres of silver solution\\nused will represent the number of parts of salt per 1000 parts\\nof urine.\\nLiebig s method consists in estimating the chlorine with mer-\\ncuric nitrate, but it sometimes fails unless very accurately\\nmanipulated, and, moreover, it often gives erroneous results, and\\ntherefore it is only referred to here.\\nVolhard and Falch Method. This method depends upon the\\naction of soluble sulphocyanides with solutions of silver and\\nferric salts. Soluble sulphocyanides produce in silver solutions\\na white precipitate similar to silver chloride, which is insoluble\\nin dilute nitric acid. A like precipitate of sulphocyanide of sil-\\nver with a solution of nitrate of silver is given by the blood-red\\nsolution of sulphocyanide of iron, and the color of the latter at\\nlast completely disappears. If, therefore, a solution of sulpho-\\ncyanide of potassium be added to an acid solution of nitrate of\\nsilver, to which a little ferric sulphate has been added, every drop\\nof the sulphocyanide solution at first produces a blood-red cloud,\\nwhich, however, quickly disappears again on stirring, while the\\nfluid becomes milk-white. It is not until all the silver is pre-\\ncipitated that the red color of the sulphocyanide of iron remains\\npermanent, and the end of the process is reached. The reaction\\nis one of great delicacy so that it is equally sensitive as Mohr s\\nreaction, while it has the advantage over the latter that titration\\ncan be conducted in acid urine.\\nSolutions Bequired. 1. Standard silver solution is made by\\ndissolving 29.075 grammes of pure silver nitrate in water and\\ndiluting to 1 litre. Each cubic centimetre corresponds to 10\\nmilligrammes of chloride of sodium or 6.065 milligrammes of\\nchlorine.\\n2. Solution of Ferric Oxide. A cold saturated solution of\\ncrystallized ferric alum, free from chlorine, or a solution of ferric\\nsulphate, which contains 50 grammes of iron oxide to the litre.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0083.jp2"}, "84": {"fulltext": "54 ANALYSIS OF URINE.\\n3. Standard S ulphocy an ide-of- Potassium Solution. Since\\nsulphoc}^anide of potassium cannot be readily weighed with ac-\\ncurac} r 10 grammes are dissolved in a litre of water, and this\\nsolution is standardized by silver solution. Thus 10 cubic cen-\\ntimetres of the silver solution are measured off, 5 cubic centi-\\nmetres of the iron solution are added, and then pure nitric acid\\nis added drop by drop until the mixture is colorless. If the\\nsulphocyanide-of-potassium solution be then allowed to flow into\\nit from a burette, each drop at first gives a blood-red color,\\nwhich at once disappears on stirring. When all of the silver is\\nprecipitated as sulphocyanide of silver, the next drop of the\\nsulphocyanide-of-potassium solution gives a permanent red color\\nto the fluid, indicating the end of the reaction. If, for example,\\nto 10 cubic centimetres of the silver solution 9.6 cubic centi-\\nmetres of the sulphocyanide-of-potassium solution have been used\\nbefore the red color is permanent, 960 cubic centimetres are\\nmeasured off, and this is diluted with 40 cubic centimetres of\\nwater to make a litre. Both solutions must now be equivalent,\\nwhich is to be determined by titration.\\nAnalysis. Five or 10 cubic centimetres of the urine, after the\\naddition of 1 or 2 grammes of nitrate of potassium free from\\nchlorine, are evaporated to dryness on a water-bath. The resi-\\ndue is then heated over a free flame, at first gently, afterward\\nstrongly, and a white, fused residue remains. Since the nitrous\\nacid formed in this process prevents the end reaction, the fused\\nsaline mass is dissolved in water, acidulated with nitric acid, and\\nthen the chlorine is precipitated with an excess of the standard\\nsilver solution. After this mixture has been warmed on a water-\\nbath for a time to completely remove the nitrous acid, it is\\nallowed to cool 5 cubic centimetres of the iron solution are\\nadded, and then the sulphocyanide-of-potassium solution, equiva-\\nlent in strength to the silver solution, is added while constantly\\nstirring until the excess of the silver added is precipitated, which\\nis known by the permanent red color of the mixture. The dif-\\nference, then, between the number of cubic centimetres of the\\nsilver and sulphocyanide solutions corresponds to the chlorine\\ncontained in the urine. If, for instance, at first 12 cubic centi-\\nmetres of the silver solution were added to 10 cubic centimetres", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0084.jp2"}, "85": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 55\\nof urine, and 4 cubic centimetres of the sulphocyanide solution\\nwere required to titrate back the excess, the amount of chlorine\\nin the urine corresponded to 12 4 8 cubic centimetres of\\nthe silver solution 8.0 grammes of sodium chloride or 4.852\\ngrammes of chlorine in the litre of urine.\\nPhosphates.\\nThe quantity of phosphoric acid excreted by the kidne}*s in\\nthe healthy adult ranges from 2.3 to 3.5 grammes in twenty-four\\nhours, the average being about 2.8 grammes. Ordinary phos-\\nphoric acid (H 3 P0 4 is tribasic. containing 3 atoms of hydrogen,\\nwhich may be replaced by a metal. In the urine phosphoric acid\\noccurs in combination, in part with the alkaline earths earthy\\nphosphates, and in part with the alkalies alkaline phosphates.\\nThe earthy phosphates are insoluble in water, but soluble in\\nacids, and consist of phosphates of calcium and magnesium.\\nThe calcium phosphates are most abundant those of potassium\\nscanty. They exist in the urine in quantity of about 1 to 1.5\\ngrammes in twenty-four hours excretion, the relative proportion\\nbeing calcium phosphate about 33, and magnesium phosphate\\nabout 67. In acid urine the earthy phosphates are in solution,\\nwhile in alkaline urine they are precipitated and form a sedi-\\nment more marked if heat be applied. If. therefore, an alkaline\\nurine is heated in a test-tube, a precipitate forms, which may be\\nmistaken for albumin. It may, however,- be distinguished from\\nthe albuminous reaction by slight acidification, which readily\\ndissolves the earthy phosphates. This is a frequent source of\\nerror in testing for albumin in the urine by means of heat. If\\nthe acid magnesium phosphate be acted upon by ammonia the\\nammonio-magnesium phosphate is formed, triple phosphate.\\nThis appears in the urine as fern-leaf or snow-flake crystals, or,\\nafter long standing, in the form of prismatic or i% coffin-lid\\nshaped crystals. If urine decompose in the bladder through\\nretention and consequent fermentative changes, ammonia is\\nliberated from the urea, and the free ammonia unites with the\\nacid magnesium phosphates to form the triple-phosphatic ciys-\\ntals so characteristic of chronic cystitis.\\nThe alkaline phosphates of the urine consist of the acid", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0085.jp2"}, "86": {"fulltext": "56 ANALYSIS OF URINE.\\nphosphate of sodium and the phosphate of potassium, that of\\nsodium being most abundant and the potassium phosphate\\nscanty. These (unlike the earthy phosphates) are readily\\nsoluble in water and alkaline fluids. The alkaline phosphates\\nform the chief bulk of the phosphates of the urine, ranging from\\n2.0 to 4.0 grammes in twenty-four hours. As already noted, the\\nacidity of normal urine depends upon its contained acid sodium\\nphosphate, and not upon the presence of a free acid.\\nIn the blood the alkaline phosphates exist as neutral sodium\\nand potassium phosphates but, as Ralfe has shown, 1 these are\\nchanged into acid salts through a decomposition effected by the\\nact of secretion, in which the bicarbonates and neutral phos-\\nphates in the blood are changed into carbonates and acid phos-\\nphates, respectively. The acid salts, in obedience to the law of\\ndiffusion, pass out in the urine, whilst the carbonates remain in\\nthe circulation. The excretion of the alkaline phosphates by the\\nkidnej T s varies in health according to the qualit3 r of food ingested,\\nbeing in excess upon an animal diet.\\nThe phosphoric acid of the urine is derived in part from the\\nfood and in part from the decomposition of lecithin and nuclein.\\nThe excretion of phosphoric acid by the kidneys varies with the\\namount of food taken after the midday meal, especially if much\\nmeat be eaten, it rises, and reaches its maximum in the evening;\\nit falls during the night, reaching its minimum about midday.\\nClinically, the excretion of phosphoric acid by the kidneys\\nis diminished in gout, in most acute diseases, in kidney lesions,\\nin the intervals of intermittent fever, and during pregnancy.\\nThe author regards the diminution of phosphoric-acid excretion\\nby the kidneys almost as constant a feature of the urine in\\nBright s disease and allied lesions of the kidneys as the presence\\nin the urine of albumin.\\nAn increased excretion of earthy phosphates accompanies\\ndiffuse diseases of the bones, osteomalacia, rickets, etc.; also in\\ndiffuse periostitis and diseases of the nerve-centres.\\nA condition of so-called phosphaMc diabetes has been de-\\nscribed by Tessier and confirmed by Ralfe and others, in which\\nthere is a continued excessive excretion of phosphates by the\\n1 Lancet, July, 1874.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0086.jp2"}, "87": {"fulltext": "normal constituents of urine. 51\\nkidneys, attended by symptoms somewhat like diabetes, loss of\\nflesh; aching pains in the lower back and pelvic region; dry,\\nharsh skin tendency to boils, with morbid appetite, etc.\\nDetection. 1. The earthy phosphates ma} T be detected by ren-\\ndering the urine strongly alkaline with sodium, potassium, or\\nammonia, and gently heating, which cause their precipitation\\nin the form of a whitish cloud, that shortly after settles to the\\nbottom of the test-glass. The precipitate is dissolved upon the\\naddition of acetic acid.\\n2. Ultzmann suggests an approximative method with this test,\\nas follows: A test-tube 2 centimetres (0.787 inch) wide is filled\\nwith the urine to the depth of 5.33 centimetres (2.997 inches), to\\nwhich are added a few drops of strong ammonia or potassium\\nsolution, and warmed over a spirit-lamp until the eartln T phos-\\nphates separate. After standing fifteen minutes the depth of\\nthe sediment is measured. If the layer be 1 centimetre (0.3937\\ninch) high, the earthy phosphates are present in normal amount;\\nif 2 or 3 centimetres in depth they are increased; but if the\\nsediment be only a line or so in depth, they are diminished.\\nThe Alkaline Phosphates. 1. First remove the earthy phos-\\nphates by precipitation with potassium or ammonia and filter\\nthem off. Xext add to the urine one-third of its volume of\\nmagnesium fluid. 1 The alkaline phosphates are all precipitated\\nin the form of a snow\\\\^ deposit.\\n2. The above test may be made useful for approximative\\nestimation, as Ultzmann suggests, in the following manner: To\\n10 cubic centimetres of the urine add a third part (say, 3 cubic\\ncentimetres) of magnesium mixture. There is formed a precipi-\\ntate of crystalline ammonium-magnesium phosphate, with which\\ncomes down an amorphous mass of calcium phosphates. If\\nthere ensue through the entire fluid a milky turbidity, the alka-\\nline phosphates are in normal amount if we have a copious\\nprecipitate, which gives the fluid the appearance of cream,\\nthen there is great increase if the fluid remain transparent, or\\nonly slight turbidity ensue, we have a decrease of the alkaline\\nphosphates.\\n1 Magnesium fliiid contains, of magnesium sulphate and ammonium chloride,\\neach 1 part distilled water, 8 parts and pure liquor ammonia, 1 part.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0087.jp2"}, "88": {"fulltext": "58 ANALYSIS OF URINE.\\nDetermination of Total Phosphoric Acid. The following solu-\\ntions are necessary\\n1. A standard solution of uranium nitrate is prepared, con-\\nsisting of 20.3 grammes pure uranic oxide in 1000 cubic centi-\\nmetres of distilled water 1 cubic centimetre corresponds to 5\\nmilligrammes of phosphoric acid.\\n2. Sodium-acetate solution: 100 grammes of sodium acetate\\nare dissolved in 900 cubic centimetres of distilled water, and to\\nthis 100 cubic centimetres of acetic acid are added.\\n3. Saturated solution of potassium ferrocyanide.\\nAnalysis. Fifty cubic centimetres of the urine are poured\\ninto a beaker, and 5 cubic centimetres of sodium-acetate solu-\\ntion are added. The mixture is warmed over a water-bath and\\nthe uranium solution added, drop by drop, as long as a precipi-\\ntate falls. If this be not easily recognized, the mixture should\\nbe stirred, a drop placed upon a porcelain plate, and a drop of\\npotassium ferrocj^anide added. If a reddish-brown color do not\\nappear at the line of contact, the addition of uranium solution\\nshould be continued, the beaker-glass being again warmed. The\\nlimit of reaction occurs when all the phosphoric acid has been\\nprecipitated by the uranium solution. After this is reached, the\\nnext drop of uranium solution, finding no phosphoric acid,\\nforms a reddish-brown precipitate with potassium-ferrocj^anide\\nsolution. The quantity of uranium solution used is next read\\noff, each cubic centimetre being equal to 5 milligrammes phos-\\nphoric acid, from which can be readily calculated the percentage\\namount in the urine.\\nEstimation of PhosphoyHc Acid Combined with Lime and\\nMagnesium. To determine the phosphoric acid in combination\\nwith the earths, 200 cubic centimetres of urine are precipitated\\nwith ammonia, collected after twelve hours on a filter, and\\nwashed with ammonia-water (1 to 3). The filter is then pierced\\nat the point, and the precipitate washed down with a stream of\\nwater into a beaker, and dissolved while warm with as little\\nacetic acid as possible. Add 5 cubic centimetres of sodium-\\nacetate solution, dilute to 50 cubic centimetres, and proceed as in\\npreceding analysis. The difference between the total amount of\\nphosphoric acid and that in combination with the alkaline earths", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0088.jp2"}, "89": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 59\\nalso represents the quantity combined with the alkalies, alkaline\\nphosphates.\\nSulphates.\\nThe sulphates in the urine are of two kinds (1) ordinary\\nneutral sulphates of sodium and potassium, and (2) the ethereal\\nsulphates. Since the sodium salts predominate in the economy,\\nthe sulphate of sodium occurs in the urine in greater quantity\\nthan the potassium sulphate. The quantity of sulphates ex-\\ncreted by the kidneys in the healthy adult varies from 1.5 to\\n3 grammes per day. The sulphates, being extremely soluble\\ncompounds, are, therefore, never met with in the urine in the\\nform of deposits.\\nAn increased excretion of sulphates by the kidneys occurs\\nafter the ingestion of sulphuric acid or its salts, upon active ex-\\nercise, upon an exclusive meat diet, and inhalations of ox}^gen-\\ngas. Clinically an increase occurs in acute fevers, with in-\\ncreased urea secretion. The most marked increase is noted in\\nmeningitis, encephalitis, and rheumatism. In general, it ma} T be\\naccepted that the excretion of urinary sulphates runs parallel in\\nquantity to that of urea.\\nDetection. 1. To 10 cubic centimetres of urine add a few\\ndrops of hydrochloric acid, then add about 3 cubic centimetres of\\nbarium-chloride solution a white, milky precipitate is formed of\\nsulphate of barium.\\n2. More simply still, to 10 cubic centimetres of urine in a\\ntest-tube add one-third the volume of acidulated barium-chloride\\nsolution, 1 when a white, milky precipitate at once appears in the\\npresence of sulphates.\\n3. Approximate estimation may be made by the above as fol-\\nlows If a simple, opaque, milky turbidity result, the sulphates\\nare present in about the normal amount if more opaque, pos-\\nsessing the appearance of cream, the sulphates are excessive if\\nbut a light translucent cloudiness result, the sulphates are\\ndiminished.\\nDetermination. (a) The volumetric method is conducted by\\nadding to a given volume of urine a standard solution of barium\\nchloride as long as precipitation occurs.\\n1 Baric chloride, 4 parts acid hydrochloric, 1 part; distilled water, 16 parts.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0089.jp2"}, "90": {"fulltext": "60 ANALYSIS OF URINE.\\nSolutions Required. 1. A standard ehloride-of-barium solu-\\ntion 30.5 grammes of crystallized barium chloride to 1000 cubic\\ncentimetres of distilled water 1 cubic centimetre of this solution\\ncorresponds to 0.01 gramme of sulphuric acid.\\n2. Solution of potassium sulphate, 20 per cent.\\n3. Pure hydrochloric acid.\\nAnalysis. One hundred cubic centimetres of urine are ren-\\ndered acid b}^ 5 cubic centimetres of hydrochloric acid, and\\nbrought to boiling in a flask. The combined sulphates are thus\\nconverted into ordinary sulphates, and give a precipitate simi-\\nlarly with barium chloride. The ehloride-of-barium solution is\\nallowed to drop into the mixture as long as any precipitate oc-\\ncurs, the mixture being heated before each addition of barium\\nchloride thereto. After adding 5 to 8 cubic centimetres of the\\nstandard solution, allow the precipitate to settle pipette off a\\nfew drops of the clear, supernatant fluid into a watch-glass add\\nto it a few drops of the standard barium solution. If any pre-\\ncipitate occur, return the whole to the flask and add more barium\\nchloride again allow the precipitate to settle and test as before\\ncontinue thus until no more precipitate is formed on the addition\\nof barium-chloride solution.\\nExcess of barium chloride should be avoided when only a\\ntrace of excess is present, a drop of the clear fluid removed\\nfrom the flask gives a cloudiness with a drop of potassium-\\nsulphate solution placed on a glass plate over a black ground.\\nIf more than a cloudiness appear, too large a quantity of\\nbarium chloride has been added, and the analysis must be\\nrepeated.\\nFrom the quantity of barium chloride used, the percentage\\nof sulphuric acid in the urine is calculated, 1 cubic centi-\\nmetre of barium-chloride solution corresponding to 0.01 gramme\\nof S0 3\\n(b) Gravimetric determination is best conducted as suggested\\nby Salkowski. This consists in washing the precipitate of barium\\nsulphate obtained b}^ adding barium chloride to a known volume\\nof urine 100 parts of sulphate of barium correspond with 34.33\\nparts of sulphuric acid (S0 3\\nAnalysis, One hundred cubic centimetres of urine are taken", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0090.jp2"}, "91": {"fulltext": "NORMAL CONSTITUENTS OF UltlNE. 61\\nin a beaker this is acidified with 5 cubic centimetres of hydro-\\nchloric acid. Chloride of barium is added till no more precipita-\\ntion occurs. The precipitate is collected on a small filter of known\\nash, and washed with hot distilled water till no more barium\\nchloride occurs in the filtrate, i.e., until the filtrate remains clear\\nafter the addition of a few drops of hydric sulphate. Then wash\\nwith hot alcohol, and afterward with ether. Remove the filter\\nand incinerate with its contents in a platinum crucible. Cool\\nover sulphuric acid in an exsiccator; weigh, and deduct the\\nweight of the crucible and filter ash the remainder is the weight\\nof barium sulphate formed, from which the S0 3 is readily calcu-\\nlated, 100 parts of barium sulphate corresponding with 31.33\\nparts of S0 3\\nCorrection. As carried out above, a slight error occurs in\\nthe anal} sis from the formation of a small quant \\\\t\\\\ of sulphide\\nof barium. Correct as follows After the platinum crucible has\\ncooled add a few drops of pure sulphuric acid (H 2 S0 4 The\\nsulphide is converted into sulphate. Heat again to redness and\\ndrive off the excess of sulphuric acid.\\n(c) Salkowski s method of estimating the combined sulphuric\\nacid i.e., the amount of S0 3 in ethereal sulphates is as follows\\n100 cubic centimetres of urine are mixed with 100 cubic centi-\\nmetres of an alkaline barium-chloride solution, which is a mixture\\nof two volumes of solution of barium hydrate with one of barium\\nchloride, both saturated in the cold. The mixture is stirred, and\\nafter a few minutes filtered 100 cubic centimetres of the filtrate\\n50 cubic centimetres of the urine) are acidified with 10 cubic\\ncentimetres of hydrochloric acid, boiled, kept at 100\u00c2\u00b0 C. on a\\nwater-bath for an hour, and then allowed to stand till the pre-\\ncipitate has completely settled if possible, it should be thus\\nleft for twenty-four hours. The further treatment of this pre-\\ncipitate combined sulphates) is then carried out as in the\\nlast case [see (6)].\\nCalculations. Two hundred and thirty-three parts of barium\\nsulphate correspond to 98 parts of H 2 S0 4 80 parts of S0 3 or\\n32 parts of S. To calculate the H 2 S0 4 multiply the weight of\\nbarium sulphate by o 9 3 8 3 0.4206 to calculate the S0 3 multiply\\nby sVs 0.34335 to calculate the S, multiply by 0.13734.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0091.jp2"}, "92": {"fulltext": "62 ANALYSIS OF URINE.\\nThis method of calculation applies to the gravimetric estimation\\nboth of total sulphates and of combined sulphates.\\n(d) To obtain the amount of preformed sulphuric acid, sub-\\ntract the amount of combined S0 3 from the total amount of\\nS0 3 The difference is the preformed S0 3\\nExample. One hundred cubic centimetres of urine gave 0.5\\ngramme of total barium sulphate this multiplied by 2 8 3 3 =0.171\\ngramme total S0 3 Another 100 cubic centimetres of the\\nsame urine gave 0.05 gramme of barium sulphate from ethereal\\nsulphates; this multiplied by g 8 =0.017 gramme of combined\\nS0 3 Total S0 3 combined S0 3 =0.171 0.071 0.157\\ngramme of preformed S0 3\\nCarbonates.\\nCarbonate and bicarbonate of sodium, ammonium, calcium,\\nand magnesium are present in minute quantities in fresh urine\\nof alkaline reaction. The ammonium carbonate may be found in\\nlarge quantity as a result of alkaline decomposition of the\\nurine. The carbonates of the urine are derived from the food,\\nfrom lactic, malic, tartaric, succinic, and other vegetable acids in\\nthe food. If the urine contain much carbonates when voided it\\nis turbid, or soon becomes so upon standing, and upon sedimen-\\ntation the precipitate is that of calcium carbonate usually asso-\\nciated with phosphates. Carbonate of lime constitutes the basis\\nof urinary calculus of great rarity in the human subject, very\\nfrequent, however, in herbivora.\\nDetection. The presence of carbonates in the urine may be\\nrevealed by the evolution of colorless gas, upon the addition of\\nacid, and this gas renders baryta-water turbid.\\nDetermination. The following method of March and may be\\nemployed for estimating the free carbonic acid of the urine\\nOne hundred cubic centimetres of urine are placed in a glass\\nflask, closely fitted with a doubly-perforated cork. Through one\\nopening a tube is passed, which dips into the urine, and at the\\nother end is connected with a tube containing some quicklime.\\nThrough the other opening in the cork one arm of a doubly-bent\\ntube is passed this arm does not dip into the urine. The other\\narm is introduced into an empty flask through a tightly-fitting", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0092.jp2"}, "93": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 63\\ncork. This flask is connected by a similar tube with a second\\nflask filled with clear baryta-water, and this with a third and\\nfourth filled with baryta-water.\\nThe urine is heated to 100\u00c2\u00b0 C. over a water-bath; any por-\\ntions boiling over go into the empty flask. The carbonic acid\\ncomes off and forms a white precipitate of barium carbonate in\\nthe flasks filled with baryta-water. Air is then drawn through\\nthe apparatus, any carbonic acid in the atmosphere being\\nremoved by the quicklime. The carbonate of baryta formed is\\ncollected on a filter, washed with distilled water, dissolved in\\nhydrochloric acid, precipitated again b} T sulphuric acid, and\\nweighed as barium sulphate. From the quantity thus obtained\\nthe amount of carbonic acid in the urine can be calculated\\n196.65 parts of barium carbonate correspond to 232.62 parts of\\nbarium sulphate and 44 parts of carbonic acid.\\n(b) The total carbonic acid may be similarly estimated after\\nstrongly acidifj^ing the urine with hydrochloric acid.\\nThe combined carbonic acid is the difference between the total\\nand the free carbonic acid.\\nOther Inorganic Constituents.\\nIron occurs in the urine in small quantities, but its combination is\\nyet unknown. Free ammonia occurs in traces, greatly increased in\\nputrefactive changes of the urine. Hydrogen dioxide was first shown\\nin the urine by Schonben. It exists in small amount, and, so far as\\nknown, is without special signification. It is detected by tetra-paper,\\nwhich, if immersed in its solution, will show the presence of ozone by\\ntaking a blue color. 2. Dilute indigo solution is bleached by dioxide of\\nhydrogen in the presence of iron-sulphate solution.\\nGases. The urine contains small quantities of gases. Carbonic\\nacid, 4 to 9 volumes free gas 2 to 5 combined. Oxygen, 0.2 to 0.6\\nvolume and nitrogen, 0.7 to 0.8 volume. The gases of the urine may\\nbe withdrawn by the air-pump.\\nCENTRIFUGAL ANALYSIS.\\nWith the first edition of this work the author introduced his\\nmethod of centrifugal analysis for the ready approximate deter-\\nmination of bulk percentages of chlorides, phosphates, sulphates,\\nand albumin in the urine. Nothing was claimed for this method\\nat that time further than rapid approximate bulk measurement\\n5", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0093.jp2"}, "94": {"fulltext": "64 ANALYSIS OF URINE.\\nof these sediments, because the method was then new and un-\\ntried, save in the author s laboratory, and it seemed a radical\\ndeparture from methods better known and considered more\\naccurate, such as titration, weighing, etc. Moreover, only bulk\\npercentages had then been worked out without any attempt hav-\\ning been made to give corresponding gravimetric values, much\\nless corresponding values in CI., P 2 5 and S0 3 from the bulk\\npercentages of these combined as salts in the sediment. Since\\nits introduction, however, it has been demonstrated in the au-\\nthor s laboratory that centrifugal analysis of the urine, if car-\\nried out by refined methods and improved apparatus, may readily\\nreach results that are entitled to rank with the older standard\\nmethods, the gravimetric and volumetric included that bulk\\npercentages of sediments may be worked out in their equivalent\\nvalues of their elements, not only with precision, but also with\\na rapidit} and facility that at once renders this method of the\\ngreatest practical value in clinical work.\\nThe essentials for securing accurate results in centrifugal\\nanalysis of urine are in no way complex or difficult of compre-\\nhension, much less to put into practice in the most ordinary\\nlaboratory. The equipment consists of an efficient motor, capable\\nof the standard speed, possessing a standard radius of arm and\\ntube (6| inches) accurately-graduated percentage tubes, and a\\ngauge to regulate the speed. The author s improved electric\\nmotor (described in full at page 149) fulfills all requirements for\\naccurate work. Very recently a further improvement in the\\nauthor s percentage tubes has been adopted as follows The\\npoints have been drawn out finer, and the first 5 cubic centi-\\nmetres have been more minutely graduated so as to indicate\\nmeasurements in 0.25 per cent. percentages) instead of 1 per\\ncent, (one per cent.) as before. 1\\nFor the determination of chlorides, phosphates, and sulphates\\nin the urine by the centrifugal method, the following standard\\nand tables are now adopted in the author s laboratory.\\nFor determination of albumin see page 80.\\nProcess, The double arm of the motor is employed, carrying\\n1 Messrs. Eimer Amend, of 205 and 211 Third Avenue, New York, manu-\\nfacture and supply the author s improved standard percentage tubes.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0094.jp2"}, "95": {"fulltext": "TABLE\\nFor Chlorides in the Urine,\\nshowing the bulk percentages of silver chloride (AgCl) and the correspond-\\ning gravimetric percentages and grains per fluidounce of\\nsodium chloride Nad and chlorine CI\\nBulk\\nPer-\\nPer-\\nGr.\\nPer-\\nGr.\\nBulk\\nPer-\\nPer-\\nGr.\\nPer-\\nGr.\\ncent-\\nage of\\nAgCl.\\ncent-\\nage,\\nNaCl.\\nPER\\nOz.,\\nNaCl.\\ncent-\\nage,\\nCl.\\nper\\nOz.,\\nCl.\\ncent-\\nage of\\nAgCl.\\ncent-\\nage,\\nNaCl.\\nPER\\nOz.,\\nNaCl.\\ncent\\nAGE,\\nCl.\\nPER\\nOz.,\\nCl.\\ni\\n0.03\\n0.15\\n0.02\\n0.1\\n8\\n1.04\\n4.98\\n0.63\\n3.02\\ni\\n2\\n0.07\\n0.31\\n0.04\\n0.19\\n8J\\n1.1\\n5.29\\n0.67\\n3.22\\na\\n4\\n0.1\\n0.47\\n0.06\\n0.28\\n9\\n1.17\\n5.6\\n0.71\\n3.4\\n1\\n0.13\\n0.62\\n0.08\\n0.38\\n9J\\n1.23\\n5.91\\n0.75\\n3.6\\n1}\\n0.16\\n0.78\\n0.1\\n0.48\\n10\\n1.3\\n6.22\\n0.79\\n3.79\\nli\\n0.19\\n0.93\\n0.12\\n0.57\\n10J\\n1.36\\n6.53\\n0.83\\n3.97\\nif\\n0.23\\n1.09\\n0.14\\n0.66\\n11\\n1.43\\n6.84\\n0.87\\n4.16\\n2\\n0.26\\n1.24\\n0.16\\n0.76\\nill\\n1.49\\n7.2\\n0.91\\n4.35\\n2i\\n0.29\\n1.41\\n0.18\\n0.85\\n12\\n1.56\\n7.46\\n0.95\\n4.54\\n2J\\n0.32\\n1.56\\n0.2\\n0.96\\nm\\n1.62\\n7.78\\n0.99\\n4.73\\n2f\\n0.36\\n1.71\\n0.22\\n1.04\\n13\\n1.69\\n8.09\\n1.02\\n4.92\\n3\\n0.39\\n1.87\\n0.24\\n1.13\\n13J\\n1.75\\n8.4\\n1.06\\n5.11\\n3J\\n0.42\\n2.02\\n0.26\\n1.23\\n14\\n1.82\\n8.71\\n1.1\\n5.29\\n3J\\n0.45\\n2.18\\n0.28\\n1.32\\nm\\n1.88\\n9.02\\n1.14\\n5.49\\n3|\\n0.49\\n2.35\\n0.3\\n1.42\\n15\\n1.94\\n9.33\\n1.18\\n5.67\\n4\\n0.52\\n2.49\\n0.32\\n1.51\\n15J\\n2.01\\n9.65\\n1.22\\n5.86\\n4i\\n0.55\\n2.64\\n0.34\\n1.61\\n16\\n2.07\\n9.94\\n1.26\\n6.06\\n4*\\n0.58\\n2.8\\n0.35\\n1.7\\n16J\\n2.14\\n10.27\\n1.3\\n6.24\\n4f\\n0.62\\n2.96\\n0.37\\n1.8\\n17\\n2.2\\n10.51\\n1.34\\n6.43\\n5\\n0.65\\n3.11\\n0.39\\n1.89\\n171\\n2.27\\n10.87\\n1.38\\n6.62\\n5*\\n0.71\\n3.42\\n0.43\\n2.09\\n18\\n2.33\\n11.2\\n1.42\\n6.81\\n6\\n0.78\\n3.73\\n0.47\\n2.27\\n181\\n2.4\\n11.51\\n1.46\\n7.\\n6J\\n0.84\\n4.05\\n0.51\\n2.46\\n19\\n2.46\\n11.82\\n1.5\\n7.19\\n7\\n0.91\\n4.35\\n0.55\\n2.62\\n191\\n2.53\\n12.13\\n1.54\\n7.38\\n71\\n0.97\\n4.67\\n0.59\\n2.84\\n20\\n2.59\\n12.44\\n1.58\\n7.56\\n(Ma)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0095.jp2"}, "96": {"fulltext": "TABLE\\nFor Phosphates in the Urine,\\nshowing the bulk percentages of uranyl phosphate (H[U0 2 ]P0 4 and the\\ncorresponding gravimetric percentages and grains per\\nounce of phosphoric acid (P 2 5\\nBulk Per-\\nPercent-\\nGr. per\\nBulk Per-\\nPercent-\\nGr. per\\ncentage of\\nage,\\nOz.,\\ncentage of\\nage,\\nOz.,\\nH(U0 2 )P0 4\\np 2 o 5\\np 2 o 5\\nH(U0 2 )P0 4\\np 2 o 5\\np 2 o 5\\ni\\n0.02\\n0.1\\n11\\n0.14\\n0.67\\n1\\n0.04\\n0.19\\n12\\n0.15\\n0.72\\n1J\\n0.045\\n0.22\\n13\\n0.16\\n0.77\\n2\\n0.05\\n0.24\\n14\\n0.17\\n0.82\\nn\\n0.055\\n0.26\\n15\\n0.18\\n0.86\\n3\\n0.06\\n0.29\\n16\\n0.19\\n0.91\\n3i\\n0.065\\n0.31\\n17\\n0.2\\n0.96\\n4\\n0.07\\n0.34\\n18\\n0.21\\n1.\\nU\\n0.075\\n0.36\\n19\\n0.22\\n1.06\\n5\\n0.08\\n0.38\\n20\\n0.23\\n1.1\\n6\\n0.09\\n0.43\\n21\\n0.24\\n1.15\\n7\\n0.1\\n0.48\\n22\\n0.25\\n1.2\\n8\\n0.11\\n0.53\\n23\\n0.26\\n1.25\\n9\\n0.12\\n0.58\\n24\\n0.27\\n1.3\\n10\\n0.13\\n0.62\\n25\\n0.28\\n1.35\\nTABLE\\nFor Sulphates in the Urine,\\nshowing the bulk percentages of barium sulphate (BaS0 4 and the corre-\\nsponding gravimetric percentages and grains per\\nfluidounce of sulphuric acid (S0 3\\nBulk Per-\\nPercent-\\nGr. per\\nBulk Per-\\nPercent-\\nGr. per\\ncentage of\\nBaS0 4\\nage, so 3\\nOz., S0 3\\ncentage of\\nBaS0 4\\nage, S0 3\\nOz., S0 3\\ni\\n0.04\\n0.19\\n2i\\n0.55\\n2.64\\n1\\n0.07\\n0.34\\n2h\\n0.61\\n2.93\\n0.1\\n0.48\\nn\\n0.67\\n3.22\\n1\\n0.13\\n0.62\\n3\\n0.73\\n3.5\\n5.\\nH\\n0.16\\n0.77\\n3}\\n0.79\\n3.79\\n\u00e2\u0080\u00a21\\n1\\n0.19\\n0.91\\n3J\\n0.85\\n4.08\\n7\\n0.22\\n1.06\\n3|\\n0.91\\n4.37\\n1\\n0.25\\n1.1\\n4\\n0.97\\n4.66\\n11\\n0.31\\n1.49\\n41\\n1.03\\n4.94\\n1*\\n0.37\\n1.78\\n4\u00c2\u00a3\\n1.09\\n5.23\\n13-\\n0.43\\n2.06\\n4}\\n1.15\\n5.52\\n2\\n0.49\\n2.35\\n5\\n1.21\\n5.81\\n(646)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0096.jp2"}, "97": {"fulltext": "NORMAL CONSTITUENTS OF URINE. 65\\nfour tubes. Three percentage tubes are filled to the 10-cubic-\\ncentimetre mark with the urine (the urine having been previously\\nfiltered if not perfectly clear). To the first tube is added 1 cubic\\ncentimetre of strong nitric acid and 4 cubic centimetres of stand-\\nard solution of silver nitrate. 1 To the second tube is added 2\\ncubic centimetres of 50-per-cent. acetic acid and 3 cubic centi-\\nmetres of uranium-nitrate solution (5 per cent.). To the third tube\\nis added 5 cubic centimetres of the standard barium-chloride mixt-\\nure. 2 The tubes are next inverted three times to insure mingling\\nof the urine and reagents and then allowed to stand for three (3)\\nminutes to secure complete precipitation. In order to balance the\\narm of the motor, the fourth tube is rilled to the 15-cubic-centimetre\\nmark with water. The centrifugal is next operated at a speed\\nof 1200 revolutions per minute for three (3) minutes. The tubes\\nare then removed and the percentages of precipitates are read\\noff on the scale. No. 1 gives the bulk percentage of silver chlo-\\nride (AgCl), No. 2 the bulk percentage of uranyl phosphate\\n(H[U0 2 ]P0 4 and No. 3 the percentage of barium sulphate\\n(BaS0 4 The bulk percentages are converted into their\\nequivalent values in gravimetric percentages by means of the\\nsubjoined tables, and from these the grains or grammes of total\\nchlorine (CI), phosphoric acid (P 2 5 ),and sulphuric acid (S0 3\\nare readily calculated by a glance at the tables. The results are\\nmore accurate if the urine be diluted in the cases of chlorides\\nand phosphates if the bulk percentage of these exceed 15 per\\ncent. The time required to carry out these quantitative deter-\\nminations should not exceed ten minutes. As a rule, the more\\nrapid and ready processes in uranalysis are comparatively few,\\nand, for the most part, limited to qualitative rather than to quan-\\ntitative data. The author, therefore, hopes that the above con-\\ntribution of centrifugal analysis to our resources, which he has\\nworked out with great care and pains, will prove of equal\\nvalue to others in practical urinary work to that found in his\\nown laboratory. Indeed, the amount of practical information\\n1 Standard nitrate-of-\u00c2\u00bbilver solution consists of silver nitrate, 3j distilled\\nwater, gj.\\n2 Standard barium-chloride mixture consists of barium chloride, 4 parts;\\nstrong hydrochloric acid, 1 part distilled water, 16 parts.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0097.jp2"}, "98": {"fulltext": "66 ANALYSIS OF URINE.\\nthat this method is capable of laying before the clinician with-\\nout loss of time cannot fail to prove of inestimable value in\\npractical work. Thus, the time required to carry out these\\nquantitative determinations centrifugally as described above\\nshould not exceed ten minutes. It has, indeed, been repeated^\\ndemonstrated in the author s laboratory that the use of modern\\ncentrifugal methods has made it possible to make a fairly com-\\nplete anal} T sis of urine, both qualitative and quantitative, in\\nfrom twenty minutes to half an hour which formerly required\\ntwenty-four hours time.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0098.jp2"}, "99": {"fulltext": "SECTION III.\\nABNORMAL URINE.\\nProteids.\\nThe four proteids of the blood viz., serum-albumin, serum-\\nglobulin, fibrin, and haemoglobin are met with in the urine in\\nvarious pathological conditions of the kidneys, the blood, or the\\nsystem at large. Other proteids are sometimes met with in the\\nurine which do not exist in the blood, such as egg-albumen upon\\nthe liberal ingestion of eggs as food, and, under certain con-\\nditions, also peptone. Finally, certain proteoses are met with in\\nthe urine in pathological conditions, the more prominent of which\\nare pro-albumose, deutero-albumose, and hetero-albumose.\\nAlbuminuria.\\nThe chief clinical interest with regard to proteids in the urine\\nwill probably always centre about serum-albumin. While albu-\\nmin is doubtless the most common of all the constituents of mor-\\nbid urine, it still remains a debated question if it be present in\\nthe urine in health. No doubts can further exist that the urine\\noccasionally contains a variable usually small but distinct\\namount of albumin when the kidneys present no appreciable\\nalterations of structure; but, as will be shown, albuminuria\\noften arises from causes aside from the kidnej^s themselves.\\nAlbuminuria, therefore, cannot be proved to be a condition of\\nhealth, so long as the kidneys alone are considered yet, the ab-\\nsence of renal lesions would seem to be the chief, if not indeed\\nthe only, condition sought to be established by many advocates\\nof a so-called physiological albuminuria.\\nAlbumin belongs to the class of colloids which do not crys-\\ntallize, and under ordinary conditions do not penetrate animal\\nmembranes but alterations from the normal conditions, as in the\\nintegrity of the basement membrane, in the quality of the albu-\\nmin itself, or in the pressure to which they are both subjected,\\n(67)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0099.jp2"}, "100": {"fulltext": "68 ANALYSIS OF URINE.\\nmay result in transudation. It is altogether probable that most\\nforms of albuminuria are referable to causes corresponding to\\none or more of the above-named conditions. In other words, al-\\nbuminuria may be due (1) to changes in the kidneys themselves,\\nwhich impair the integrity of the structures between the vessels\\nand the excretory channels of the organs (2) alterations in the\\nquality of the blood which render its serum-albumin more diffu-\\nsible (3) alterations in the degree of blood-pressure. Albumi-\\nnuria ma}^ depend upon one or, indeed, all three of the above con-\\nditions.\\nClinical Significance. 1. The more common form of albu-\\nminuria, as well as the most serious in its clinical significance, is\\nthat depending upon pathological conditions of the kidneys. The\\nmost frequent of these are inflammatory and degenerative changes\\nin the renal structure, and include the whole class of disorders\\ncommonly grouped together under the term of Bright s disease.\\nIt is impossible always to estimate the gravity or progress of\\nrenal changes by the quantity of albumin present in the urine.\\nSometimes, however, as in acute inflammatory conditions, when\\nthe amount of albumin ranges high, 1 per cent, by actual weight\\nor more, the quantity may be taken as a rough gauge of the ex-\\ntent of the lesions as well as the progress of the same from clay\\nto day. The same may be said of certain degenerative changes\\nin the kidneys, notably of amyloid disease. This, however, by\\nno means applies to all diseases of the kidneys, for, indeed, in\\ncertain renal diseases of the most serious character, interstitial\\nnephritis, not only is the quantity of albumin in the urine\\nusually small, but it is often temporarily, and even occasionally,\\nabsent throughout. The quantity of albumin in the urine,\\ntherefore, is not a safe guide as to the gravity of the situation in\\ndiseases of the kidneys, especially in cases attended by moderate\\nor even very slight grades of albuminuria.\\n2. The second class of albuminurias depend upon changes in\\nthe constitution of the blood, which so alters the diffusibility of\\nits albumin as to permit it to pass into the renal tubules. The\\nhaemotogenic causes of albuminuria have been most ably ex-\\npounded by Semola, and, although he probably claims too wide\\na range for these causes, there remains no just reason to doubt", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0100.jp2"}, "101": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 69\\ntheir existence. We often meet with such albuminuria in anaemia,\\nand in strumous and enfeebled individuals, when no lesions of\\nthe kidneys can be made out. The effect of certain poisons upon\\nthe blood probably so alters that fluid as to permit of tran-\\nsudation of its albumin into the renal tubules. The effects, also,\\nof some infectious fevers micro-organisms in the blood no\\ndoubt seriously alters the constitution of the circulating fluid,\\nso that transudation of albumin is the rule, while the kidneys do\\nnot always become damaged.\\n3. The third form, disturbances of the circulation, may bring\\nabout albuminuria without inducing structural changes in the\\nkidne} T s, provided they be not too long continued. Circulatory\\ndisturbances, in order to induce albuminuria, must include the\\nrenal vessels. In nature they must consist of acceleration of\\nthe arterial current or slowing of the venous current, in either\\ncase resulting in increased blood-pressure. Probably this cause\\nis responsible for the majority of that large class of cases of\\nso-called physiological or functional albuminurias. This is\\nmost marked upon prolonged or fatiguing muscular exercise.\\nLeube found albumin in the urine in 16 per cent, of soldiers\\nafter prolonged march, and Chateaubourg gives the percentage\\nas even higher. A similar result sometimes occurs after the\\napplication of cold to the surface of the bod} T the blood being\\ndriven to the interior, the renal vessels become overfilled and\\nalbuminuria often results. Again, in some derangements of\\nthe nervous system, which interfere with the vasomotor-nerve\\nregulation of the renal vessels, temporary albuminuria is not\\nan uncommon result. Albuminuria from increased blood-press-\\nure is readily demonstrable by experimentation in the following\\nways 1. By pressure upon the renal veins. 2. Ligature of the\\naorta below one kidney, and extirpation of the other. 3. Com-\\npression of the trachea. The quantity of albumin in the urine\\nfrom disturbances of the circulation is for the most part small.\\nIt may be but temporarily present, or it may become a permanent\\ncondition, depending upon the continuance of the cause. Thus\\nwe may have temporary albuminuria after a seizure of epilepsy\\nwhich soon after the attack subsides, or when depending upon\\norganic disease of the heart it becomes permanent.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0101.jp2"}, "102": {"fulltext": "70 ANALYSIS OF URINE.\\nFinally, albuminuria often owes its origin to two or even all\\nthree of the causes just considered. In fevers, for instance, all\\nthe described causes of albuminuria are sometimes present. We\\nhave, for instance, accompanying changes in blood-pressure, and\\nwhen long continued the febrile state is apt to induce structural\\nchanges in the renal epithelium, while profound changes in the\\nconstitution of the blood are often induced by fevers, more espe-\\ncially the acute infectious ones, which without doubt are the\\nactive cause of albuminuria.\\nIt remains to consider the significance of a form of albumi-\\nnuria which is often intermittent in character, to which Pavy s\\nCyclic Albuminuria and Moxon s u Albuminuria of Adoles-\\ncence doubtless belong. In a large percentage of these cases\\nthe albuminuria is intermittent if not, usually it is remittent the\\nintermission or remission occurring during rest, as at night.\\nOn rising in the morning the urine is often free from albumin,\\nbut soon after rising, and especially upon exercising, the urine\\ncontains albumin, which may or may not wear away toward\\nevening. A large percentage of these cases is observed in\\nyouths and young adults.\\nIn another class of these cases the albuminuria is more con-\\nstant, and if an intermission occur it is usually measured by\\nweeks or months instead of hours. In these cases the age of\\nthe patient is less constant, although the albuminuria is still most\\ncommon before middle age.\\nFor the most part all these cases possess certain features in\\ncommon: 1. The quantity of albumin in the urine is small, usually\\nranging from one-half to one-tenth or two-tenths of one per cent.\\n2. The urine either contains no renal casts or very few perfectly\\nhyaline ones. 3. The specific gravity of the urine is somewhat\\nabove the normal standard, 1024 to 1030. 4. Evidences of car-\\ndiac and general vascular changes of a permanent nature are\\nabsent. 5. Close observation will usually reveal evidence of\\nsome local or general impairment of the functions, as measured\\nby the standard of vigorous health.\\nThe causes of this group of albuminurias are identical with\\nthose already considered, only operating perhaps in milder de-\\ngrees. To changes in the renal structures, alterations in the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0102.jp2"}, "103": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. tl\\nquality of the blood, or abnormal increase of blood-pressure,\u00e2\u0080\u0094 to\\none or more, or all of these combined, we may with great prob-\\nability refer every case of albuminuria as to its essential cause\\nor causes.\\nIt will be seen, from the preceding considerations, that albu-\\nminuria is a symptom of the most variable clinical significance,\\nand therefore, in itself, should never be accepted as proof of\\nthe presence of renal disease. As has been truthfully said, this\\nwas the error of former times. It can only be positively as-\\nserted that albuminuria is the result of renal changes when it is\\naccompanied by those products in the urine which are a conse-\\nquence of renal lesions, such as casts, epithelium, etc. On the\\nother hand, it must be remembered that albumin in notable\\nquantity is not present in healthy urine. On the whole, it will\\nbe safer to accept albuminuria as an evidence of an existing ab-\\nnormal state, the gravity of which must be determined by its\\naccompanying symptoms. The author holds that so-called func-\\ntional albuminuria forms no exception to the above rule, inas-\\nmuch as he has never met with a case of albuminuria in which\\nthe patient did not present more or less evidence of departure\\nfrom the normal balance of perfect health, either local or general.\\nIt is only necessary here to allude to the occurrence of albu-\\nmin in the urine derived from sources other than the kidnej^s.\\nSuch albuminuria has been variously termed adventitious, false,\\nor accidental. In such cases the urine on leaving the kidneys is\\nperfectly normal but, meeting with the products of inflamma-\\ntory changes in the urinary passages, the renal pelvis, ureters,\\nbladder, or urethra, it becomes albuminous. As a rule, in such\\ncases, the source of the albumin may be determined by chemical\\nand microscopical investigation, together with local symptoms.\\nDetection of Albumin in the Urine.\u00e2\u0080\u0094 1. Heat: Boiling the\\nurine constituted the first test employed to detect albumin, by\\nContugno (1770). The more common method of application of\\nthis test is in conjunction with nitric acid. A test-tube of ordi-\\nnary size is filled half full of the suspected urine, and heat is\\napplied until boiling occurs throughout the whole. If a precipi-\\ntate occur, it consists either of albumin or earthy phosphates.\\nA few drops of nitric acid are next added, and if the precipitate", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0103.jp2"}, "104": {"fulltext": "72 ANALYSIS OF URINE.\\nremain undissolved it is due to the presence of albumin. If, on\\nthe other hand, the precipitate disappear upon the addition of\\nthe acid, it consists of the earthy phosphates, and the urine is\\nfree from albumin. In testing, the acid should be added in small\\nquantity, at first, say, 2 to 5 drops, and the urine should then\\nbe re-boiled. If now no precipitate occur, acidulation should be\\ncontinued until precipitation occur or a limit of acidification be\\nreached of about 15 to 20 drops. Some prefer to reverse this\\norder, and first acidify the urine before applying the heat.\\nThe heat and nitric-acid test is subject to certain errors.\\nThus, if there be little albumin present and the acid be in excess,\\nthe albumin may combine with the acid, forming a soluble acid\\nalbumin, syntonine, which is not precipitated by boiling. If,\\non the other hand, the acid be insufficient to distinctly acidify\\nthe urine, and if the phosphates be in excess, a part only of the\\nbasic phosphates may be acidified, while the albumin ma}^ com-\\nbine with the remainder, forming a soluble alkali albuminate,\\nwhich will not be precipitated by boiling. The heat and acid\\ntest throws down albumin, globulin, and mucin, and upon cooling\\nalbumose separates, if present. No reaction occurs with peptone,\\nvegetable alkaloids in the urine, or with the urates. If the urine\\ncontain the pine acids, as sometimes occurs after the use of\\ncubeb or copaibse, these may cause slight precipitation by this\\ntest, which may be mistaken for albumin. The ready solubility\\nof this precipitate in alcohol distinguishes it from albumin.\\nVarious modifications have been suggested, with the view of\\navoiding the mucin reaction which sometimes undoubtedly occurs\\nwith this test, such as first boiling the urine and then very faintly\\nacidifying with nitric acid, or by employing acetic instead of\\nnitric acid in quantity not to exceed 2 drops. Such modifica-\\ntions, however, are not to be depended upon in eliminating the\\noccasional mucin error, as will appear by a study of the chemistry\\nof mucin reactions.\\n2. The Author s Method. Have on hand a saturated aqueous\\nsolution of sodium chloride (table-salt). Fill a clean test-tube\\nabout two-thirds full of the previously-filtered urine, and add to\\nthis about one-sixth of its volume of the sodium-chloride solution-\\nNext add 5 to 10 drops of acetic acid (50 per cent.) and gently", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0104.jp2"}, "105": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 73\\nboil the upper inch or so of the contents of the test-tube for\\nabout half a misut-e If albumin be present, even in the\\nminutest traces, it will appear in the upper, boiled portion of the\\ntest if examined in a good light. This test possesses all the\\nsensitiveness of the heat-and-acid reaction with albumin, while it\\navoids faulty reactions. After repeated and crucial investiga-\\ntions the author confidently recommends this test as superior to\\nall others for distinguishing minute quantities of albumin from\\nother proteids in the urine mucin or nucleo-albumin included.\\n3. Nitric-Acid Test. This test is applied according to Hel-\\nler s method, as follows Upon a column of pure nitric acid in a\\ntest-tube the suspected urine is gentl} r floated, so that the column\\nof urine and that of acid are about an inch in depth. In order\\nto accomplish the above without mixing the acid and urine, the\\ntest-tube should be held in an inclined position and the urine\\nslowly delivered along the inside of the tube, so that the urine\\nmay flow gently down and overlay the acid. If albumin be\\npresent, an opalescent zone will be observed at the point of con-\\ntact between the acid and the urine, which becomes more or less\\npronounced according to the quantity of albumin present. If no\\nchange be perceptible upon careful examination in a good light,\\nthe tube should be set aside and re-examined in half an hour,\\nbecause, when only a trace of albumin is present, twent} T to\\nthirty minutes may elapse before the zone of coagulated albumin\\nbecomes visible.\\nIn concentrated urines with this test the acid is apt to pre-\\ncipitate the amorphous urates in the form of a light, rather\\nbrownish cloud, which may be taken for albumin. The cloud of.\\nprecipitated urates, however, does not appear at the point of con-\\ntact between the aoid and the urine, but higher up, within the\\nurine itself; moreover, it is more diffused than the albuminous\\nzone, and spreads downward through the urine. The precipi-\\ntated urates disappear upon the application of gentle heat.\\nIf the urine contain mucin in excess, a light cloud may come\\ninto view toward the surface of the urine with this test. It will", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0105.jp2"}, "106": {"fulltext": "74 ANALYSIS OF URINE.\\nbe remembered that mucin is soluble in strong nitric acid, but is\\nprecipitated by the same in dilute form, and therefore the mucin\\nreaction always occurs high up in the strata of urine which con-\\ntains the acid w r ell diluted. If the urine contain the pine acids\\na reaction may occur with this test somewhat similar to that of\\nalbumin, though usually less defined. The precipitate due to\\noleo-resins is soluble in alcohol, which distinguishes it from that\\ndue to albumin.\\nThe nitric-acid test precipitates all modifications of albumin,\\nacid and alkaline, as well as albumose. On the other hand, it\\ngives no reaction with peptone or the vegetable alkaloids.\\n4. The Ferrocyanic Test. This test is very simple and\\nrapid in application, as follows\\n1. Fill an ordinary test-tube half-full of urine and add a half-\\ndrachm or more of potassium-ferrocyanide solution (1 to 20).\\nAfter thoroughly mingling the urine and the reagent, add a few\\ndrops of acetic acid (50 per cent.) then pause for a half-minute\\nand note any change. If albumin be present, it will come plainly\\ninto view, within half a minute to a minute, in the form of a\\nwhite, milk-like opacity, diffused throughout the whole contents\\nof the tube.\\n2. Into the bottom of a clean test-tube is poured a half-\\ndrachm of acetic acid; then about a drachm to a drachm and a\\nhalf of potassium ferrocyanide (1 to 20) is added and the two\\nthoroughly mingled. The suspected urine is next allowed to\\ngently flow down the side of the tube and overlay the reagents\\nto the depth of about an inch. If albumin be present, a sharply-\\ndefined white zone or band will come plainly into view. 1 The\\nferrocyanic test applied by either of the above methods precipi-\\ntates all modifications of albumin. On the other hand, it gives\\nno reaction with phosphates, peptones, mucin, the alkaloids,\\nurates, or the pine acids.\\n1 The reaction that sometimes occurs on long-standing between the acid and\\npotassium ferrocyanide should not be mistaken for albumin. The albuminous\\nreaction appears within half a minute or so, while the other occurs only after\\nten minutes to half an hour, and is mingled with more or less blue coloration.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0106.jp2"}, "107": {"fulltext": "abnormal constituents of urine. 75\\nOther Tests for Albumin.\\nWithin the past twenty-five years a number of additional\\ntests for albumin in the urine have been brought forward. While\\nfew, if any, of these may yet be said to have become standard,\\nyet the author will endeavor to here present the more prominent\\nones, together with a brief account of their special individual\\nclaims for recognition.\\n5. TanreVs Test. This test was first proposed by Tanret in\\n18T2 and was subsequenth r pronounced by the Clinical Society\\n(London) the most delicate of a series of reagents for the detec-\\ntion of albumin in the urine at that time investigated. The\\nformula is as follows: Potassium iodide, 3.32 grammes; mer-\\ncuric chloride, 1.35 grammes; acetic acid, 20 cubic centimetres;\\ndistilled water, to 100 cubic centimetres. The potassium iodide\\nand mercuric chloride should be separately dissolved in water,\\nand the solutions mixed; the resulting reagent is the double\\niodide of mercury and potassium, to which the acetic acid is\\nadded and the whole made up to 100 cubic centimetres with\\ndistilled water. Thus prepared, the test is applied b} the con-\\ntact method of Heller; the reagent, being the heavier, is first\\nintroduced into the test-tube, and the urine is allowed to overlay\\nit. The reaction with albumin consists of the development of a\\nsharply-opaque white ring, or band, at the junction of the reagent\\nand urine. The test responds to all modifications of albumin, to\\npeptones, the vegetable alkaloids, and the pine acids. It is\\nclaimed, however, that all reactions other than with albumin,\\nthe pine acids, and nucleo-albumin are dissipated by heat.\\n6. Picric Acid. This test was strongly advocated by Sir\\nGeorge Johnson as a most delicate reagent for albumin in the urine.\\nThe solution is prepared by simply saturating distilled water\\nwith picric acid (6 or 7 grains per ounce). While this test is\\napplied by the contact method (the urine below), yet there must\\nbe an actual mingling of the urine and reagent in the upper\\nstratum of the latter. This is. no doubt, a delicate reagent for\\nalbumin, but it also reacts with creatinin, copaiba, peptone.\\nnucleo-albumins, as well as with alkaloids. Those save with\\nalbumin are claimed to disappear by heating, but they reappear\\nupon cooling.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0107.jp2"}, "108": {"fulltext": "76 ANALYSIS OF URINE.\\n7. Sodium Tungstate. Sonnescliin in 1874, and subse-\\nquently Oliver, advised the use of this agent as a delicate test\\nfor albumin. The solution of this salt (1 to 4) must be acidulated\\nwith acetic or phosphoric acid The test is applied by the usual\\ncontact method, and reacts with albumin, nucleo-albumin, pep-\\ntones, urates, and the vegetable alkaloids all save albumin and\\nnucleo-albumin are probably cleared up by heat.\\n8. Trichloracetic Acid. This agent was first suggested by\\nRaab as a test possessing special advantages in that it is claimed\\nnot to precipitate peptones or nucleo-albumin, while it is exceed-\\ningly sensitive to albumin. Trichloracetic acid is applied in sat-\\nurated solution by the contact method, the reagent below. It\\nprecipitates albumoses, alkaloids, and sometimes uric acid in\\naddition to albumin, all save the latter disappearing on the appli-\\ncation of heat.\\n9. Metaphosphoric acid was suggested by Hindenlang, in\\n1881, as a delicate reagent for albumin in the urine. The appli-\\ncation is simple, viz. in the test-tube is placed a little of the\\nsolid metaphosphoric acid, and upon this the urine is filtered,\\nand agitated, when, if albumin be present, a turbidity results.\\nThis test reacts with albumoses, and sometimes with uric acid,\\nbut these are dissipated by heat.\\n10. Spieglei^s Test. This is composed of a solution of 8\\ngrammes of mercuric chloride, 4 grammes of tartaric acid, and\\n20 grammes of sugar in 200 cubic centimetres of distilled water.\\nOne-third of a test-tube may be filled with the reagent, and the\\nurine allowed to overlay this an inch or more in thickness; if\\nalbumin is present a sharply-defined white ring or zone appears\\nat the line of contact of the two fluids. Globulin and albumoses\\nreact with this test, but peptones produce no change.\\n11. Salicyl-sulphonic acid, or sulphosalicylic acid, was first\\nsuggested by Roch, in 1891, as a delicate reagent for albumin in\\nthe urine; subsequently Macwilliam modified the test and ad-\\nvised its use as follows About 20 drops of the urine are placed\\nin a test-tube (small size) and 1 or 2 drops of a saturated aque-\\nous solution of the reagent added, or more if the urine is alka-\\nline. The tube is next agitated and inspected. Opalescence or\\nturbidity occurring immediately is claimed to indicate greater", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0108.jp2"}, "109": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. I I\\ndelicacy than Heller s method. Turbidity occurring slowly\\none and a half to two minutes implies minute traces of albumin.\\nThe test is lastly boiled and the precipitate remaining is due to\\nalbumin or globulin.\\nThis test is often more simply applied as follows: To the\\nsuspected urine merely add a few crystals of the reagent, agitate,\\nand, if turbidity results, correct by heat. An acid urine is\\nnecessary for this test, and, therefore, if the urine be alkaline, it\\nmust be treated with acetic acid before adding the reagent.\\n12. Phenic- Acetic Acid. This agent, in conjunction with\\nalcohol, was first employed by Mehu for determining the percent-\\nage of albumin. Subsequently Millard modified the formula for\\nqualitative purposes as follows Acid, phenic. glacial., Jlj acid,\\nacetic, pur., 3 y j liquor potassae, 5 Y J oU- As indicated, the\\nquantity of liquor potassae may be varied. The test is applied\\nby the usual contact method. It reacts with peptone, nucleo-\\nalbumin, albumoses, and alkaloids, all of which save that with\\nalbumin are claimed to disappear with heat.\\n13. Stutz s Test. This test consists of a mixture of mercuric\\nchloride, sodium chloride, and citric acid. When added to\\nalbuminous urine, this solution causes an abundant precipitate\\nof albuminate of mercury in the form of a dense, white opacity.\\n14. Resorcin was proposed by Carrez as a test for albumin.\\nOne gramme of resorcin is dissolved in 2 cubic centimetres of\\ndistilled water in a test-tube, and the urine is poured upon its sur-\\nface. If albumin is present a white ring develops at the junction\\nof the two fluids. Peptone is indicated also by a white ring, the\\nlatter disappearing if the tube is immersed in boiling water.\\n15. Nitric-Magnesium Test. This test was proposed by Sir\\nWilliam Roberts. Its composition is 1 ounce of strong nitric acid\\nand 5 ounces of saturated solution of magnesium sulphate. This\\nis applied by the usual contact method, and is claimed to be more\\nsensitive than the cold-nitric acid method of Heller.\\n16. Sodium Xitroprussiate. N\\\\ T a recommends this salt as a\\nreagent for albumin. The test is applied as follows: The urine\\npreviously acidulated with acetic acid is treated with a concen-\\ntrated solution of sodium nitroprussiate. The reagent must be\\nkept from the light to avoid decomposition.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0109.jp2"}, "110": {"fulltext": "7 AXALY- URINE.\\nColor Reactions. The albumins yield certain color reactions,\\nbut they are not suitable for direct qualitative testing, especially\\nin c red urines containing only small amounts\\nof proteid matter. They are more useful as confir: or\\nfurnishing more positive proof that a given precipitate when\\nconsiderable is really proteid. Thus, the supposed albuminous\\nprec nay be tested with Millen s reagent as follows\\nIT. 31 Men s reagent is prepared by dissolving 1 part of\\nmercury in 2 parts of nitric acid of specific gravity of 1.42 and\\nolumes of distilled water. The characteristic\\nreaction is as follows: To 1 drachm of the albuminous solution\\nor urine minims of liillen s reagent and heat to boiling.\\nThe pit of proteid is indicated by the liquid turning red,\\nwhich color will include the precipitate, if any. The test also\\nreacts with numerous derivatives of the aromatic series^\\nIS. Biuret 2V The ur:::e is first treated with a solution\\nof p tass am or sodium h vdroxid and subsequently drop by drop\\nwith a dih; ition of c ;:-iiate. In the presence of\\nproteid firs~ dish, then a reddish-violet, and lastly a violet-\\nblue color is obtained. If albumin is absent from the urine the\\npresence of album oses and peptone may be tested by this method.\\nXanthoproteic Reaction. Add to the urine concentrated\\nnitric acid and boil. Let the liquid cool and then add ammonia.\\nIf albumin is present, an orange color is produced.\\nMany of the tests just considered have many admirers and\\nsome strong s, largely upon their claims for exceeding\\ndelicacy. Doubtless in some cases at least this is really true.\\nThe question naturally a rises, however are these delicate reac-\\ntions trust Upon this point the profession, as well as\\nauthor ent seem divided. Some claim that, for the most\\npart, the tests for which unusual delicacy of reaction is claimed\\nalso react with substances found in many normal urines as well\\nwith sul si ncea in pathological urines other than albumin.\\nXucleo-albumin is most often considered responsible for the\\ndoubtful reactions. Mitchell recently contends, after a review of\\nall these tests, that a number of them including Spiegler s, Tan-\\nret s, picric and trichloracetic acid _ ith\\nurines containing alkaline carbor en albumin is absent.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0110.jp2"}, "111": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 79\\nIt will be noted that almost unexceptionally the newer tests\\nappeal to the influence of heat as their chief corrective a circum-\\nstance that speaks strongly in favor of heat as the crucial\\ndistinguishing agent. The author believes that, while heat may\\nnot be the most delicate test for albumin, yet, when properly\\napplied, it is, in all probability, the most trustworthy we yet\\npossess.\\nWhile, doubtless, it is desirable that we should possess tests\\nfor albumin of somewhat greater sensitiveness than the old\\nmethod of boiling the urine, yet, after all, extreme delicacy of\\nreaction is altogether a matter of secondary consideration, as\\ncompared with accuracy, because, when the quantity of albumin\\nin the urine is very slight, resort must necessarily be had to\\nother means than the presence of traces of albumin in the urine,\\nin order to be able to establish a positive diagnosis of renal dis-\\nease. Notwithstanding the above facts, much unnecessary con-\\nfusion and uncertainty in our present methods have been caused\\nby the multiplication of tests for albumin in the urine whose\\nchief claim for recognition is that of great sensitiveness of reac-\\ntion rather than that of trustworthiness.\\n20. Tests in Paper Form. According to the suggestion of\\nDr. George Oliver, of Harrogate, 1 a number of the tests named\\nhave been prepared and used in paper form. This is accom-\\nplished by saturating chemically inert filtering-paper with solu-\\ntions of the albumin reagents, and with citric acid and then\\ndrying. The papers are then cut into slips of convenient size\\nfor testing, and may be carried about in the pocket-case for use\\nat the bedside of the patient. In testing, the following method\\nis advised: Into a small test-tube containing one drachm of dis-\\ntilled water are dropped a reagent paper and one charged with\\ncitric acid. After agitation for a minute or so the test-papers\\nare removed and the solution is ready for testing. The urine is\\nnow added, and the test may be conducted either hy a mixture\\nof the two or by the contact method, of which Dr. Oliver prefers\\nthe latter.\\nDr. Oliver now advises the use of two reagents only for\\nalbumin, viz. the ferrocyanic and potassio-mercuric papers.\\n1 Bedside Urine Testing. London, 1885.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0111.jp2"}, "112": {"fulltext": "80 ANALYSIS OF URINE.\\nThese will be found very convenient in clinical work, or at the\\nbedside in visiting practice. The ferroc} 7 anie paper is recom-\\nmended as the more ready and trustworthy, since in all cases\\nthe reaction with the mercuric test must be corrected by heating,\\notherwise it is liable to be misleading.\\nQuantitative Estimation of Albumin in Urine. The number\\nof tests proposed methods for estimating the quantity of al-\\nbumin in the urine is scarcely less than those for qualitative\\ntesting, but they are far less satisfactory, because without excep-\\ntion they consume too much time for practical clinical work.\\nFully realizing the necessity for some more ready and rapid\\nprocess, the author introduced the centrifugal method in the first\\nedition of this work as at least a ready approximate process.\\nMore recently the centrifugal method has been worked out with\\ngreat pains and accuracy. The author here presents the im-\\nproved centrifugal method in detail, for which he claims some-\\nthing more than approximate results.\\nThe Author s Centrifugal Method. The process, in brief,\\nconsists of the following steps Precipitation of the albumin in\\nimproved percentage tubes of 15 cubic centimetres capacity. To\\n10 cubic centimetres of the urine, 3 cubic centimetres of 1 to 10\\naqueous solution of potassium ferrocyanide are added and 2\\ncubic centimetres of 50-per-cent. acetic acid are added. After\\nmingling the reagents and urine, the tube should stand for 10\\nminutes to insure entire precipitation of the albumin. At the\\nend of 10 minutes the percentage tubes are placed in a centrif-\\nugal machine, the radius of which, with tubes extended, must\\nbe exactly six and three-quarter (6|) inches. The tubes are\\nnext revolved for exactly three (3) minutes at a uniform speed\\nof fifteen hundred (1500) revolutions per minute. Lastlj T the\\ntubes are removed and the amount of albumin is read off in\\nbulk percentage, which, by consulting the accompanying table,\\ncan be readily converted into percentage by weight and grains\\nper fluidounce. It will be noted that the time necessary to\\ncarry out this test does not exceed 15 minutes, and it has been\\nfound that the results carefully compared with the gravimetric\\nmethod need not amount to errors exceeding 0.01 per cent.\\nMore accurate results than the nbove are not ordinarily claimed", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0112.jp2"}, "113": {"fulltext": "Purdy s Quantitative Method for Albumin in Urine\\n(Centrifugal).\\nTable showing the relation between the volumetric and gravimetric per-\\ncentage of albumin obtained by means of the centrifuge with radius of six\\nand three-quarter inches; rate of speed, 1500 revolutions per minute time,\\nthree minutes.\\nVolumetric\\nPercentage\\nBY\\nCentrifuge.\\nPercentage\\nby Weight\\nof Dry\\nAlbumin.\\nGrains per\\nFluidounce\\nDry\\nAlbumin.\\nVolumetric\\nPercentage\\nby\\nCentrifuge.\\nH Z\\nml\\nGrains per\\nFluidounce\\nDry\\nAlbumin.\\nVolumetric\\nPercentage\\nBY\\nCentrifuge.\\nPercentage\\nby Weight\\nof Dry\\nAlbumin.\\nGrains per\\nFluidounce\\nDry\\nAlbumin.\\n1\\n4\\n0.005\\n0.025\\n131\\n0.281\\n1.35\\n31J\\n0.656\\n3.15\\ni\\n0.01\\n0.05\\n14\\n0.292\\n1.4\\n32\\n0.667\\n3.2\\n3\\n4\\n0.016\\n0.075\\n14}\\n0.302\\n1.45\\n32.1\\n0.677\\n3.25\\n1\\n0.021\\n0.1\\n15\\n0.313\\n1.5\\n33\\n0.687\\n3.3\\nU\\n0.026\\n0.125\\n15*\\n0.323\\n1.55\\n33*\\n0.698\\n3.35\\nn\\n0.031\\n0.15\\n16\\n0.333\\n1.6\\n34\\n0.708\\n3.4\\nit\\n0.036\\n0.175\\nm\\n0.344\\n1.65\\n34*\\n0.719\\n3.45\\n2\\n0.042\\n0.2\\n17\\n0.354\\n1.7\\n35\\n0.729\\n3.5\\n2^\\n0.047\\n0.225\\n17.1\\n0.365\\n1.75\\n351\\n0.74\\n3.55\\n8J\\n0.052\\n0.25\\n18\\n0.375\\n1.8\\n36\\n0.75\\n3.6\\n21\\n0.057\\n0.275\\n18.1\\n0.385\\n1.85\\n36*\\n0.76\\n3.65\\n3\\n0.063\\n0.3\\n19\\n0.396\\n1.9\\n37\\n0.771\\n3.7\\n3J\\n0.068\\n0.325\\n19.1\\n0.406\\n1.95\\n37}\\n0.781\\n3.75\\n3.V\\n0.073\\n0.35\\n20\\n0.417\\n2.\\n38\\n0.792\\n3.8\\n3!\\n0.078\\n0.375\\n20-lr\\n0.427\\n2.05\\n38*\\n0.801\\n3.85\\n4\\n0.083\\n0.4\\n21\\n0.438\\n2.1\\n39\\n0.813\\n3.9\\n41\\n0.089\\n0.425\\n2U\\n0.448\\n2.15\\n39*\\n0.823\\n3.95\\n4J\\n0.094\\n45\\n22\\n0.458\\n2.2\\n40\\n0.833\\n4.\\n43\\n^4\\n0.099\\n0.475\\n22.1\\n0.469\\n2.25\\n40}\\n0.844\\n4.05\\n5\\n0.104\\n0.5\\n23\\n0.479\\n2.3\\n41\\n0.854\\n4.1\\n5*\\n0.111\\n0.55\\n23.1\\n0.49\\n2.35\\n41 1\\n0.865\\n4.15\\n6\\n0.125\\n0.6\\n24\\n0.5\\n2.4\\n42\\n0.875\\n4.2\\n6*\\n0.135\\n0.65\\n24.1\\n0.51\\n2.45\\n42-1\\n0.885\\n4.25\\n7\\n0.146\\n0.7\\n25\\n0.521\\n2.5\\n43\\n0.896\\n4.3\\n7h\\n0.156\\n0.75\\n25*\\n0.531\\n2.55\\n43*\\n0.906\\n4.35\\n8\\n0.167\\n0.8\\n26\\n0.542\\n2.6\\n44\\n0.917\\n4.4\\n8}\\n0.177\\n0.85\\n261\\n0.552\\n2.65\\n44*\\n0.927\\n4.45\\n9\\n0.187\\n0.9\\n27\\n0.563\\n2.7\\n45\\n0.938\\n4.5\\n9J\\n0.198\\n0.95\\n27-1\\n0.573\\n2.75\\n451\\n0.948\\n4.55\\n10\\n0.208\\n1.\\n28\\n0.583\\n2.8\\n46\\n0.958\\n4.6\\n10}\\n0.219\\n1.05\\n28.1\\n0.594\\n2.85\\n46*\\n0.969\\n4.65\\n11\\n0.229\\n1.1\\n29\\n0.604\\n2.9\\n47\\n0.979\\n4.7\\n111\\n0.24\\n1.15\\n291\\n0.615\\n2.95\\n47*\\n0.99\\n4.75\\n12\\n0.25\\n1.2\\n30\\n0.625\\n3.\\n48\\n1.\\n4.8\\n12.1\\n0.26\\n1.25\\n301\\n0.635\\n3.05\\n13\\n0.271\\n1.3\\n31\\n0.646\\n3.1\\nTest. Three cubic centimetres of 10-per-cent. solution of f errocyanide\\nof potassium and 2 cubic centimetres of 50-per-cent. acetic acid are added to\\n10 cubic centimetres of the urine in the percentage tube and stood aside for ten\\nminutes, then placed in the centrifuge and revolved at rate of speed and time\\nas stated at head of the table. If albumin is excessive, dilute the urine with\\nwater till volume of albumin falls below 10 per cent. Multiply result 1 y\\nthe number of dilutions employed before using the table.\\n(80*)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0113.jp2"}, "114": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0114.jp2"}, "115": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. bl\\nfor the gravimetric method itself. In order to insure accurate\\nresults, the following conditions should be complied with (a)\\nIf the albumin be excessive, the urine should be diluted with one\\nor more volumes of water, until the volumetric percentage does\\nnot materially exceed 10 per cent. Observations conducted in\\nthe author s laboratory have demonstrated the fact that accurate\\nand uniform volumetric measurements of albumin in the urine\\nby this method are only possible when the percentage does not\\nmaterially exceed 10 per cent, (b) The reagents and the urine\\nmust stand after mingling 10 minutes to insure entire precipitation\\nof the albumin, (c) The centrifuge must possess the following\\nessentials or be capable of such modification as to include them,\\nviz. The arm should possess a radius of exactly 6| inches\\nthat is to say, the linear distance from the centre of the axle to\\nthe tip of either tube must be just 6| inches. The motor must\\nbe capable of an even and sustained speed of 1500 revolutions\\nper minute, with the stated radius and carrying 30 cubic centi-\\nmetres of urine. Lastly, some trustworthy method of gauging\\nthe exact speed of the motor must be emplo} T ed.\\nThe advantages claimed for this method over those hitherto\\nin use are its rapidit}^, simplicity, accuracy, and comprehensive-\\nness in expression of results the volumetric percentage, its\\ncorresponding percentage of dry albumin, the number of grains\\nof dry albumin per ounce, and from these the total weight of dry\\nalbumin in 24 hours, all being apparent by a glance at the accom-\\npanying table.\\nThe Gravimetric Method. The process consists in coagu-\\nlating the albumin, which may be accomplished either by (a)\\nboiling or (b) by means of a chemical agent. The succeeding\\nsteps are filtering out the albumin, collecting, drying, and\\nweighing.\\n1. Coagulation by Heat. To 100 cubic centimetres of urine\\nacetic acid is added until the urine is distinctly acid, after which\\nit is filtered, and gradually heated to boiling and the boiling con-\\ntinued for half a minute. The urine is next passed through a\\nfilter, the weight of the filter having first been ascertained and\\nnoted. The flask in which the urine was boiled is next washed\\nwith distilled water to secure all particles of albumin, and the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0115.jp2"}, "116": {"fulltext": "82\\nANALYSIS OF URINE.\\n1 1 111\\ncontents are again thrown on the filter. Next the albumin on\\nthe filter is washed with boiling distilled water, the washing-\\nbeing continued until the albumin is perfectly clean and white.\\nThe filter is next placed in an oven the tempera-\\nture being 100\u00c2\u00b0C. (212\u00c2\u00b0F.), and there left until\\ndrying is complete. Drying is known to be\\ncomplete when two weighings at an interval of\\nan hour are identical. From the whole weight\\nthat of the filter is deducted, and the difference\\nrepresents the weight of albumin in 100 cubic\\ncentimetres of urine, from which the whole\\namount may be readily calculated.\\n,2. Coagulation by Chemical Agent. There\\nare a number of processes of which Menu s will\\nserve as an example 2 or 3 drops of acetic acid\\nare added to the urine and the latter filtered.\\nOne hundred cubic centimetres of the filtered\\nurine are next taken and 2 cubic centimetres of\\nnitric acid are added, with 10 cubic centimetres\\nof the following solution Crystallized carbolic\\nacid, 10 grammes; acetic acid, 10 cubic centi-\\nmetres; alcohol (90 per cent.), 20 cubic centi-\\nmetres. The albumin immediately coagulates\\nupon the addition of the above, and the whole is\\nthrown on the filter. Drying and weighing are\\nto be conducted as already described.\\nThe tediousness of the gravimetric process\\nis its chief drawback for clinical use, since the\\nprocess cannot be carried out in less time than\\nfive or six hours.\\nEsbach s Method. This test is conducted\\nby means of a standard graduated glass tube or\\nalbuminometer, shown in the cut (Fig. 8). The\\nfollowing standard solution is required: Picric\\nacid, 10 grammes; citric acid, 20 grammes;, distilled water, to\\n1000 cubic centimetres (1 litre).\\nProcess. Fill the albuminometer tube with the urine to the\\nletter C7, then add the test solution to B; close the tube with\\n-Jill\\n-ii\\nFig. 8.\u00e2\u0080\u0094 Esbach s\\nAlbuminometer.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0116.jp2"}, "117": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. t.i\\nI lie stopper and invert several times, until the urine and the test\\nsolution are thoroughly mingled. Stand the tube in a rack for\\nI wenty-four hours and then read off the number of grammes of Al-\\nbumin per litre, as will be indicated on the side of the tube on a\\nlevel where the albumin settles. If it be desired to know the per-\\ncentage of albumin instead of the number of grammes per litre,\\nremove the decimal point one figure to the left thus 5 grammes\\nper litre would be 0.5 per cent. If the urine be highly albumi-\\nnous, it should be diluted with one or more volumes of water,\\nbefore testing, and the result multiplied by the number of dilu-\\ntions emploj^ed. This test has attained some popularity largely\\non account of its extreme simplicity. Its disadvantages for\\nclinical use are that it takes twenty-four hours to complete the\\nprocess, and the results are only claimed to be approximately\\naccurate in the end.\\nTitration Method of Tanret. Tanret recommends for the\\nvolumetric estimation of albumin its precipitation by the follow-\\ning solution Potassium iodide, 3.22 grammes mercuric chloride,\\n1.35 grammes: distilled water, to 100 cubic centimetres. For\\nthe confirmatory solution Mercuric chloride, 1 gramme distilled\\nwater, 100 cubic centimetres. One drop of the precipitating\\nsolution given by a pipette of standard size precipitates 0.005\\ngramme of albumin so that as many drops as it takes to\\nprecipitate all the albumin so many times 0.005 gramme of\\nalbumin must be contained in the urine. To save trouble in\\ncalculation, a certain quantity of urine should always be em-\\nployed, a convenient quantity being 10 cubic centimetres, since\\nthen the number of drops of the solution that it takes to precipi-\\ntate all the albumin in this quantity of urine represents so many\\nhalf-grammes per litre.\\nProcess. Take 10 cubic centimetres of the urine and add 2\\ncubic centimetres of acetic acid, and stir with a glass rod add\\nthe precipitating solution drop b}^ drop, stirring carefully after\\neach drop, until the albumin is no longer affected by the reagent,\\nas ascertained as follows After adding each drop of the reagent\\nplace a drop of the urine on a porcelain dish and note if a 3 ellow-\\nish-red color appears on adding a drop of the confirmatory solu-\\ntion. As soon as it does all the albumin is precipitated and th*.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0117.jp2"}, "118": {"fulltext": "84 ANALYSIS OF URINE.\\nprocess is completed. The amount of albumin per litre will he\\narrived at by taking the number of drops of the reagent emploj ed,\\nsubtracting 3 as having been employed in excess to make the\\nyellow color perfectly apparent, then considering the remainder\\nas so many half-grammes.\\nProteoses.\\nThese substances are the intermediate products in the hydra-\\ntion of proteids, the final products being peptones. In the\\nbody they are formed by the action of the gastric and pancreatic\\njuices, and they may be formed artificially by heating albumin\\nwith water, more readily by dilute mineral acids or sulphuretted\\nsteam. They correspond to the propeptone of Schmidt-Mulheim,\\nand to the A-peptone of Meissner. They are uncoagulable by\\nheat, are precipitated but not coagulated by alcohol; they all\\nrespond to the biuret reaction, and are precipitated by nitric\\nacid, the precipitate thus formed being dissolved by heat, but\\nre-appearing upon cooling.\\nThese substances may be subdivided into albumoses, globu-\\nloses, vitelloses, caseoses, myosenoses, depending upon the pro-\\nteid from which they are formed. The albumoses and globuloses\\nare absent from normal urine, but appear in the urine under a\\nnumber of abnormal conditions.\\nAlbumosuria. The albumoses are of two varieties: hemi-\\nalbumoses, or those convertible by further digestive action into\\nhemi-peptone and anti-albumoses, or those similarly converted\\ninto anti-peptone. Albumoses have also been classed according\\nto their solubilities, as follows (a) Proto-albumose soluble in\\ncold and hot water, and in saline solutions. They are precipi-\\ntated as are globulins, by saturation with sodium chloride and\\nmagnesium sulphate, (b) Hetero-albumose insoluble in water;\\nsoluble in 0.5 to 15 per cent, sodium-chloride solutions in the\\ncold, but precipitable by heat at 65\u00c2\u00b0 C, the precipitate being\\nreadily soluble in dilute acid or alkali. It is precipitated by\\nalcohol as is other albumoses, but, unlike them, it is partly con-\\nverted into an insoluble dys-atbumose. Hetero-albumose is pre-\\ncipitated by dialyzing out the salines from its solutions, and,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0118.jp2"}, "119": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 85\\nlike proto-albumose, it is precipitated by saturation with salines.\\nProto- and hetero- albumoses constitute the first products of\\nthe hydration of proteids, and have hence been called primary\\nalbumoses. (c) Deutero-albumose is soluble in cold and hot\\nwater, is not precipitated from its solutions by saturation with\\nsodium chloride or magnesium sulphate, but it is precipitated by\\nstrong solutions of ammonium sulphate. It is not precipitated\\nby copper sulphate, and only gives the nitric-acid reaction (char-\\nacteristic of albumoses) in the presence of excess of saline. It\\nis therefore, in reactions, nearest to peptones of the albumoses it\\nis an intermediate stage in the conversion of primary albumoses\\ninto peptone.\\nClinical Significance. Albumose, like peptone, is found in\\npus but, unlike the latter, it is also present in the blood, most\\nnotably so during digestion. An albumose was first discovered\\nin the urine by Bence Jones in a case of osteomalacia, and in a\\nlike case since hy Kuhn. Virchow has found this albumose in\\nthe medulla of bones in osteomalacia, while Fleischer found it\\nin the medulla of normal bone. Senator has found albumoses\\nin a number of cases in the urine, viz., tertiary syphilis, hemi-\\nplegia, double pneumonia, diphtheria, carcinoma, and muscular\\natrophy. Hoppe-Seyler has found it in a number of cases of\\natrophy of the kidnej S. Lassar has found it in the urine of\\npeople rubbed with petroleum, while Oertel has met with it in\\na few cases after severe exertion. Albumose and peptone are\\nboth found in the urine of animals when injected into their cir-\\nculation. Deutero-albumose so closely resembles peptone in its\\nreactions that it is often mistaken for the latter substance. Its\\ndistinction from peptone will be considered in connection with\\npeptonuria. The clinical significance of albumosuria, so far as\\nour present knowledge extends, is very indefinite; so that prac-\\ntical conclusions in connection with its presence in the urine are\\nas yet lacking. In the few diseases in which it has been noted,\\nits appearance, under similar circumstances, has subsequently\\nbeen found inconstant.\\nDetection. The proteoses are known by their solubilities\\nand reactions, as follows Proteo-albumose soluble in both hot\\nand cold water, in both hot and cold saline solution (10 per cent.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0119.jp2"}, "120": {"fulltext": "86 ANALYSIS OF URINE.\\nNaCl), is precipitated with strong solutions of sodium chloride\\nand magnesium sulphate also by saturated solution of Am 2 S0 4\\nis precipitated by nitric acid in the cold not soluble on heating,\\nor only slightly so it is precipitated by copper sulphate.\\nHetero-albumose insoluble in hot and cold water, is precipi-\\ntated by dialysis from saline solutions soluble in both hot and\\ncold solutions of sodium chloride of 10-per-cent. strength,\\ni.e., is partly precipitated, but not coagulated, on heating to\\n65\u00c2\u00b0 C. is precipitated by saturation with sodium chloride or\\nmagnesium sulphate; also with saturated ammonium sulphate;\\nand is precipitated by nitric acid in the cold, the precipitate\\nbeing dissolved with heat and re-appearing on cooling.\\nDeutero-albumose is soluble in hot and cold water soluble\\nin hot and cold solutions of sodium chloride of 10-per-cent.\\nstrength is not precipitated by saturation with sodium chloride\\nor magnesium sulphate, but is precipitated b} 7 saturation with\\nammonium sulphate while with nitric acid it is only precipi-\\ntated in the presence of excess of salt.\\nPeptonuria.\\nPeptones are best known as the final products of gastric and\\npancreatic digestion. They are also products of retrogressive\\nchanges in albuminoids and of the corpuscular elements, of the\\nblood, and as such assume importance in their clinical relations.\\nIt has just been stated that peptones are the final products\\nof gastric and pancreatic digestion. If hydration were con-\\ntinued a step farther, peptone would be split up into simpler\\nsubstances, and would no longer constitute a proteid. Pep-\\ntones are soluble in water, uncoagulable by heat, and are not\\nprecipitated by nitric acid, copper sulphate, ammonium sul-\\nphate, potassium ferrocyanide, and a number of other pre-\\ncipitants of proteids. They are precipitated by tannin, potassio-\\nmercuric iodide, phosphomolybdic acid, phosphotungstic acid,\\nand picric acid.\\nPeptones are divisible into two forms (a) Hemipeptone,\\nwhich by further action of the pancreatic juice is split up into\\nleucin and ty rosin and such simpler products. (6) Antipeptone\\nwhich is not decomposed further by pancreatic juice. It, fur-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0120.jp2"}, "121": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 87\\nthermore, does not yield tyrosin on treatment with sulphuric\\nacid, and does not respond to Millon s reagent.\\nBoth forms of peptone are readily diffusible through animal\\nmembranes, albumoses being only slightly so, and albumin not\\nso at all, under, ordinary circumstances. The peptones are not\\nprecipitated by saturation with ammonium sulphate, in which\\nrespect the} differ from albumoses.\\nClinical Significance. Peptone is absent from normal urine,\\nbut has been described in the urine in connection with numerous\\npathological conditions. Since the recent publication of Kuhn\\nand Chittenden s work on proteoses and peptones, it has been\\nmade evident that many of the cases formerly described as pep-\\ntonuria were, in reality, albumosuria, the real proteid present\\nbeing deutero-albumose. and. therefore, much of our supposed\\nknowledge of peptonuria needs revision.\\nPeptonuria has been frequently described as associated with\\nthe following conditions In phosphorus poisoning, in suppura-\\ntive diseases, in croupous pneumonia, acute rheumatism, typhoid\\nfever, typhus, small-pox, scarlet fever, mumps, tuberculosis, ery-\\nsipelas, empyema, cancer of the viscera (notably of the liver and\\nintestines), catarrhal jaundice, apoplexy, etc. The local some-\\ntimes termed the pyogenic causes seem to be connected with\\nresorption of exudations so situated as to favor the products of\\ndisorganization the peptone constituent of leucocytes being\\nabsorbed into the circulation, from whence it is eliminated by\\nthe kidneys. This form of peptonuria is met with in the declin-\\ning stages of pneumonia, in purulent pleuritis, suppurating\\ntuberculosis, chronic bronchial catarrh, psoas abscess, purulent\\nmeningitis, and acute articular rheumatism.\\nIn acute inflammatory affections the appearance of pep-\\ntonuria may be taken as an evidence that suppurative changes\\nhave been established, other known causes of peptonuria being\\nexcluded. Jaksch insists that, as a means of distinguishing\\nbetween tubercular and epidemic cerebro-spinal meningitis,\\npeptonuria is of crucial significance, being absent in the former\\nand characteristic of the latter. In this connection, however,\\nulcerative changes in the lun\u00c2\u00b0;s must be excluded to render this\\nsign trustworth}\\\\", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0121.jp2"}, "122": {"fulltext": "88 ANALYSIS OF URINE.\\nIn like manner, peptonuria appearing as is usual in septi-\\ncaemia may serve to distinguish it from latent disseminated\\nsarcoma when, as often happens, the clinical symptoms are very\\nsimilar. In short, Maixner has declared it the law that peptone\\nis always present in the urine when pus is forming in the\\norganism.\\nIn addition to the pyogenic causes of peptonuria, extensive\\ndestruction of the corpuscular elements of the blood seems to\\nconstitute a prominent cause, and hence the frequent appearance\\nof peptonuria in acute infectious diseases and toxic conditions\\nalready enumerated.\\nPeptonuria also arises from a few additional causes. It is\\nalmost invariably associated with cancer of the liver, and this\\nfact has led Pecancowski to the conclusion that the liver in\\nhealth is concerned in the conversion of peptone into albumin.\\nMaixner has shown that in ulceration of the intestines the\\npeptic products of the stomach pass directly into the blood\\nthrough the ulcerated surfaces, and give rise to peptonuria.\\nThen, again, we have puerperal peptonuria, Fischel having\\nshown that peptone is a normal constituent of the urine in the\\npuerperal condition. Finally, when injected into the blood,\\npeptone quickly appears in the urine.\\nDetection. Peptone may be recognized by the following\\nmethod Saturate the urine (slightly acidified first with acetic\\nacid) with ammonium sulphate, and filter out any precipitate\\nformed which may consist of albumin, globulin, proto-albumose,\\nhetero-albumose, or deutero-albumose. Any proteid remaining\\nmay be precipitated by potassio-mercuric iodide or picric acid,\\nand can only be peptone. This is, in fact, the only certain\\nmethod of identification of peptone.\\nDifferentiation. Since peptone and deutero-albumose so\\nclosely resemble each other in reactions, it is well to be able\\nto distinguish them, more particularly since the frequency with\\nwhich they have been confounded has undoubted ty led to\\nnumerous clinical errors. Halliburton contrasts them as fol-\\nlows", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0122.jp2"}, "123": {"fulltext": "2. Is not precipitated by saturation\\nwith ammouium sulphate.\\nABNORMAL CONSTITUENTS OF URINE. 89\\nPeptone. Deutero-albumose.\\n1. Gives no precipitate with nitric I 1. Gives no precipitate with nitric\\nacid. acid unless a considerable amount of\\nsalt be added. This precipitate dis-\\nappears on heating and re-appears on\\ncooling.\\n2. Is precipitated by saturation with\\nammonium sulphate.\\nIll all other respects these two substances, as far as known,\\nbehave similarly.\\nRecent researches by Kuhn 1 have shown that, in order to\\neffect complete separation of the albumoses from peptones, the\\nmixture containing these substances should be saturated whilst\\nboiling with ammonium sulphate. Furthermore, a single satu-\\nration with ammonium sulphate should not be depended upon\\nto remove all the deutero-albumose, but saturation should be\\nrepeated till precipitation no longer occurs.\\nGlobulinuria.\\nGlobulin is insoluble in water, but dissolves in dilute neutral\\nsalt solutions. From these solutions it is precipitated by suf-\\nficient dilution with water, and on heating it coagulates. Globu-\\nlin dissolves in water on the addition of very little acid or alkali,\\nand on neutralizing the solvent it re-precipitates. Solutions of\\nglobulin in a minimum amount of alkali are precipitated by\\ncarbon dioxide, but the precipitate may be dissolved by excess\\nof the precipitant. The neutral solutions of globulin containing\\nsalts are precipitated on saturation with sodium chloride and\\nmagnesium sulphate at normal temperatures. Normal urine is\\nfree from globulin, but this proteid appears in the urine in a\\nnumber of pathological conditions.\\nClinical Significance. Globulinuria is nearly alwa} T s asso-\\nciated with albuminuria, and, indeed, globulin may greatly ex-\\nceed the quantity of albumin present in some cases, although the\\nproportion of globulin in the blood is only as 1 to albumin 1.5.\\nGlobulin is, however, a more diffusible form of proteid than\\nalbumin, which may account for its proportional excess in the\\n1 W. Kuhn, Erfahrungen tiber Albumosen and Peptone, I. Reinigung der\\nPeptone von Albumosen. Separatabdruck aus der Zeitschrift f. Biologie, 1893.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0123.jp2"}, "124": {"fulltext": "90 ANALYSIS OF URINE.\\nurine at times. From the fact already stated, that globulin is\\nnearly always associated with albumin in the urine, its clinical\\nsignificance is nearly identical with that of albuminuria. In a\\nfew cases, however, its presence in the urine seems to imply a\\nspecial significance. Thus, globulin is noted in unusual quanti-\\nties in the urine in catarrhal inflammations of the bladder, in\\nacute nephritis, and especially in amyloid degeneration of the\\nkidneys. The same is said to be the case in albuminuria asso-\\nciated with digestive disorders. On the other hand, in chronic\\nB right s disease globulin is said to be present in very small\\namount, or even at times absent.\\nDetection. 1. Exactly neutralize the urine, filter, and treat\\nwith magnesium sulphate in substance until it be completely satu-\\nrated at an ordinary temperature, or with a saturated solution of\\nammonium sulphate. In both cases a white precipitate is formed\\nif globulin be present. In using ammonium sulphate with urines\\nrich in urates, precipitation of ammonium urate ma} r appear.\\nThese, however, do not immediately appear, but only after some\\ntime, and they may thus be distinguished from the globulin pre-\\ncipitate.\\nIn detecting serum-albumin in the same urine, heat the fil-\\ntrate after precipitation of the globulin to boiling, after the\\naddition of a few drops of acetic acid.\\n2. Globulin fails out of solution when the urine is diluted\\nuntil the specific graA r ity is about 1002, and upon the above fact\\nRoberts suggested the following simple test: Fill a wineglass\\nor test-tube with water and let fall into it several drops of albu-\\nminous urine. If globulin be present in any quantit}^ each drop\\nas it falls is followed by a milky streak, and when a number of\\ndrops have been added the water assumes a milky opalescence\\nthroughout. The addition of acetic acid causes the opalescence\\nto disappear.\\nDetermination. The separate determination of globulin and\\nalbumin may be accomplished by carefully neutralizing the urine\\nand precipitating with magnesium sulphate added to saturation,\\nor by simply adding an equal volume of saturated solution\\n(neutral) of ammonium sulphate. The precipitated globulin is\\nthoroughly washed with saturated magnesium sulphate, or half", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0124.jp2"}, "125": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 91\\nsaturated ammonium-sulphate solution, dried at 110\u00c2\u00b0 C, boiled\\nwith water, extracted with alcohol and ether then dried, weighed,\\nand ashed; then weighed again, and the weight is the amount of\\nglobulin.\\nDifferential Testing.\\nSerum-albumin, serum-globulin, hetero-proteose, dentero-pro-\\nteose, and peptone may all be present in the urine simultaneously.\\nThis is very unusual, but in doubtful cases the only certain\\nmethod is to test for each one in the list. The best method of\\ndoing this is that proposed by Halliburton, as follows\\n1. If the urine give no precipitate on boiling after acidulation,\\nalbumin and globulin are absent. If a precipitate occur, albu-\\nmin or globulin, or both, are present.\\n2. If the urine after neutralization give no precipitate on\\nsaturation with magnesium sulphate, globulin and hetero-proteose\\nare absent. If such precipitate occur, one or the other is present.\\n3. If the urine be saturated with ammonium sulphate and\\nfiltered, and the filtrate gives no xanthoproteic or biuret reaction\\n(a large excess of potash must always be added), peptone is\\nabsent.\\n4. If the urine give no precipitate on boiling after acidu-\\nlation, no precipitate with nitric acid, and no precipitate on\\nadding ammonium sulphate to saturation, peptone can be the\\nonly proteid present. Confirm this b}^ the biuret reaction.\\n5. If all proteids are present, thej^ may be separated as fol-\\nlows\\nSaturate the urine (faintly acidified with acetic acid) with\\nammonium sulphate. A precipitate is produced. Filter.\\nPrecipitate.\\nContains albumin, globulin, hetero-\\nand deutero- proteose.\\nCollect the precipitate on a filter, wash it with saturated solu-\\ntion of ammonium sulphate, and redissolve it by adding a small\\nquantity of water. To this solution add ten times its volume of\\nalcohol a precipitate is formed collect this, and let it stand in\\nabsolute alcohol for from seven to fourteen days. Then filter off\\nthe alcohol, dry the precipitate at 40\u00c2\u00b0 C, extract with water and\\nfilter. An insoluble residue is left.\\n7\\n(b) Filtrate.\\nContains peptone.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0125.jp2"}, "126": {"fulltext": "92 ANALYSIS OF URINE.\\n(a) Residue.\\nThis consists of albumin and globu-\\nlin coagulated by alcohol.\\n(6) Extract.\\nThis contains the proteoses in solu-\\ntion.\\nHetero-proteose is precipitated by heating the solution to\\n65\u00c2\u00b0 C, or by saturating a portion of the extract with magnesium\\nsulphate. Deutero-proteose remains in solution.\\nTake another portion of the urine, neutralize it, and saturate\\nwith magnesium sulphate. A precipitate is produced. Filter.\\n(a) Precipitate.\\nThis consists of globulin and hetero-\\nproteose, which may be separated by\\nthe prolonged use of alcohol, as above.\\n(b) Filtrate.\\nThis contains albumin, deutero-pro-\\nteose, and peptone. Add alcohol, as\\nabove albumin is rendered, in seven\\ndays, insoluble in water. The deutero-\\nproteose and peptone are soluble, and\\nmay then be separated by ammonium\\nsulphate.\\nThe reactions of the several proteids in the urine already con-\\nsidered may be seen at a glance in the following table, after\\nHalliburton. (See next page.)\\nHEMOGLOBINURIA.\\nHaemoglobin, the red pigment of the blood, is a somewhat\\nremarkable compound in that it contains iron, is intimately asso-\\nciated with a proteid, and gives the proteid reaction it is hence\\nnon-diffusible, but yet is crystalline. It exists in the blood in\\ntwo conditions, in arterial blood it is termed oxyhemoglobin,\\nbeing charged with oxygen in venous blood it is deoxygenated\\nor reduced haemoglobin. Haemoglobin belongs to the group of\\nblood-proteids, which yields splitting products and small amounts\\nof volatile fatty acids with about 96 per cent, albumin and about\\n4 per cent, liaemochromogen, containing iron, which, in the pres-\\nence of ox3 gen, is readily oxidized into haematin. Haemoglobin\\nprepared from different kinds of blood has not always the same\\nconstitution, indicating the probable presence of different haemo-\\nglobins. This is further shown by the facts that different kinds of\\nblood also differ in solubility and crystalline form, and possess a\\nvarying quantity of water of crystallization.\\nThe Clinical Significance. The blood-pigment, haemoglobin,\\nsometimes appears in the urine without the appearance of any", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0126.jp2"}, "127": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE.\\n93\\n1\\no\\nS\\n1\\nCO\\ncr\\nGO\\no\\np\\niff\\nGO\\nO\\nc\\nC+ CT\\nr 5\\no\\ncr\\nP GO\\nP CD\\np pa\\np. p\\nla\\nGO\\no\\n5*\\nGO\\nO\\nc\\n-d cr\\nS p S r\\nGO\\nf\\nr\\nP GO\\ni c=-S r\\n3 a Pa (K3 _.\\n3 on dp c s*\\nr p c\\nl-fccj\\n^s\\n\u00e2\u0096\u00baa\\nto\\nCD\\n\u00e2\u0096\u00ba5\\nP e\\ne*-\\nCD\\nP.\\nCD\\nca\\na\\n5\\nCD\\n\u00e2\u0096\u00baa\\nc*-\\np\\nCD\\nP\\no\\np\\nCD\\npi\\nCD\\n\u00e2\u0096\u00baa\\np_\\nCD\\nP\\nCD\\nCD\\nP\\ncT\\nP 1\\nCD\\n\u00e2\u0096\u00ba5\\nP\\no\\np 1\\ncd\\nP\\nc+\\nCD\\nP*\\nCD\\nCD\\nP\\nerf-\\nCD\\nPi\\nCD\\nO\\nP\\nc-t-\\nCD\\na?\\n2.\\np\\nCD\\nP J\\nu\\nS ft\\nGc o\\n\u00e2\u0096\u00baa\\nCO\\np\\nr*-\\ncd\\np.\\nglS 1\\nO o 2\\ng\\no c\\nx pa\\ni. 8 i\\ncc CI\\nH\\nCD\\non\\nP\\nCD\\nP\\n01\\nP_-\\npa\\n3\\na\\nen\\nra hd\\nCo r^ 2\\no 2.\\nCD i\u00e2\u0080\u0094 vj\\nP U\\ne*- CD 2 c^\\np. o p\\n1\\na\\nNot\\nprecipitated.\\nCD\\nP\\ns\\n5\\nCD\\nCD\\n\u00e2\u0096\u00ba5\\np\\nCD\\np.\\nCD\\nCD\\ncf-\\nP\\nCo\\nA?\\n5\\n5\\nCD\\nI*\\no\\non\\nIs\\n?.pa\\nO CD\\n3\\n5 S\\ns a\\n\u00c2\u00a73\\nDO\\no* cT\\no a", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0127.jp2"}, "128": {"fulltext": "94 ANALYSIS OF URINE.\\ncorpuscles associated therewith, as was first shown by Pavy.\\nThis is always the result of the destruction of the blood-cor-\\npuscles in the circulating stream. The haemoglobin thus liberated\\nis thrown out by the kidneys and appears in the urine. This may\\nbe produced by injection into the circulation of substances which\\nact as solvents of the corpuscles, such as glycerin, solutions of\\nthe bile-salts, distilled water, and the injection of the blood of\\none animal into another. Similar results follow in cases of\\npoisoning with arseniuretted hydrogen hydrochloric, sulphuric,\\ncarbolic, and pyrogallic acids phosphorus, and potassium chlo-\\nrate. In certain diseases, notably pyaemia, typhus, scurvy, fat-\\nembolism, in some cases of jaundice, and after extensive burns,\\nhaemoglobinuria often results. The most interesting and marked\\npathological condition in which haemoglobin appears in the\\nurine is the disease known as paroxysmal hemoglobinuria, which\\nwill form the subject of special consideration in a subsequent\\nsection of this work.\\nDetection.\u00e2\u0080\u0094 1. Solutions of haemoglobin may be determined\\nby spectroscopic examination with great precision. They\\nstrongly absorb the rays lying between and I). In a proper\\ndilution the solution shows a spectrum with one broad, not\\nsharply-defined band between D and F. This band does not lie\\nin the middle, between D and E, but is toward the red end of\\nthe spectrum, a little over the line D.\\n2. Guaiacum Test. Mix in a test-tube equal volumes of\\ntincture of guaiacum and old turpentine which has become\\nstrongly ozonized by the action of air under the influence of\\nlight. To this mixture, which must not have any blue color, add\\nthe urine to be tested. In the presence of haemoglobin, first a\\nbluish green, and then a beautiful blue ring appears where the\\ntwo liquids meet. On shaking, the mixture becomes blue. Nor-\\nmal urine, and albuminous urine, do not give this reaction.\\nUrine containing pus also gives a blue color with the above re-\\nagents but in this case the tincture of guaiacum alone, without\\nthe turpentine, is colored blue by the urine. The blue color\\nproduced b} r pus differs from that produced by haemoglobin by\\ndisappearing on heating the urine to the boiling-point.\\nUrines, if alkaline from decomposition, must first be made", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0128.jp2"}, "129": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 95\\nfaintly acid before applying this test. The turpentine should be\\nkept exposed to the light, while the guaiacum should be kept in\\na dark-glass bottle.\\n3. Heller s Test. If a neutral or faintly-acid urine containing\\nhaemoglobin be heated to boiling, there is obtained a mottled\\nprecipitate of albumin and haematin. If caustic sodium be added\\nto the boiling-hot test, the liquid becomes clear and turns green\\nwhen examined in thin layers, and a red precipitate, appearing\\ngreen by reflected light, re-forms, which consists of earthy phos-\\nphates and haematin.\\nFlBRINURIA.\\nFibrin is a whitish, stringy solid when fresh, but upon\\ndrying it becomes of a grayish color. It is feebly soluble in\\n6-percent, solutions of potassium nitrate, in 5- to 15-percent.\\nsolutions of sodium chloride, in 5- to 10-per-cent. solutions of\\nmagnesium sulphate; and in solutions of other neutral salts,\\nsuch as sodium sulphate and ammonium sulphate, most readily\\nat a temperature of 40\u00c2\u00b0 C. It is insoluble in water, alcohol, and\\nether. It swells up in weak hydrochloric-acid solutions (0.2 per\\ncent.), and also in sodium or potassium hydrate solutions (0.2\\nper cent.), into a gelatinous mass. Stronger acids slowly dis-\\nsolve fibrin with the formation of acid albumin (sj^ntonin) and\\nalbumoses.\\nDigestive ferments act readily on fibrin. Thus, pepsin in an\\nacid solution and trypsin (from the pancreas) in an alkaline\\nsolution cause, in the first place, a splitting up of the fibrin into\\ntwo globulins, one coagulating at 56\u00c2\u00b0 C, the other at 75\u00c2\u00b0 C.\\nThen the formation of albumoses and peptones follows.\\nFibrin separates on the so-called spontaneous coagulation of\\nthe blood, lymph, and transudations.\\nClinical Significance. Fibrin max appear in the urine from\\nvarious causes, either in solution or in coagulated flakes or masses.\\nIn the urine fibrin constitutes the basis of the so-called coagu-\\nlable urine, which, upon standing some time, forms the fibrinous\\ncoagula. The quantit}^ of fibrin present in the urine determines\\nthe extent of coagulation; sometimes only a sticky sediment\\nforms at the bottom of the vessel more rarel} the coagulation", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0129.jp2"}, "130": {"fulltext": "96 ANALYSIS OF URINE.\\ninvolves the whole volume of urine, converting it into a sticky,\\ngelatinous mass. This form of fibrinuria is seldom met with in\\nthe United States, but it occurs frequently as a special form of\\ndisease in Brazil and the Isle of France.\\nFibrinuria, as it occurs with us, uniformly indicates that an\\nexudation of fibrinous fluid blood-plasma has gained access\\nto some part of the urinary tract. In most cases it comes from\\nthe kidneys, although it may result from intense inflammation\\nof the lower urinary passages. It is often associated with\\nhaemorrhages into the urinary tract, and it has been observed\\nfrequently in cases of villous tumors of the bladder.\\nIt is important to distinguish between fibrinuria and those\\ncases of pyuria in which large quantities of pus are present in\\nhighly-alkaline urine. In cystitis of long standing the ammo-\\nnium carbonate resulting from bacterial decomposition of the\\nurine may form with pus a gelatinous, sticky mass, which mny\\nbe readily mistaken for fibrin coagulum. Such a urine, however,\\nis thinned b} r the addition of w r ater, and, moreover, if treated\\nwith acetic acid, a white precipitate falls, consisting of alkaline\\nalbuminate.\\nDetection. The coagulum should be separated by filtration\\nand washed with water, when it will show the following char-\\nacters\\n1. It does not dissolve in water, but it swells up in 1-per-cent.\\nsolutions of hydrochloric acid, and is only dissolved when pepsin\\nis added.\\n2. Separate the coagula from the urine by filtration through\\nfine muslin, and wash witli cold water. Treat a part of the\\nmass with dilute solution of sodium hydroxide; if insoluble\\nupon long standing, the indication is that it is fibrin, since albu-\\nminous bodies dissolve in sodium-hydroxide solutions. Treat\\nanother portion of the mass with a 1-per-cent. solution of sodium\\ncarbonate. Fibrin dissolves complete^ in this solution if\\nwarmed gently several hours on a water-bath. This solution is\\nthen filtered and treated with Millon s reagent, when a deep-red\\ncoloj is produced.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0130.jp2"}, "131": {"fulltext": "abnormal constituents of urine. 97\\nNucleo-albumin (Mucin\\nIt has been well known that a substance exists in nearly\\nevery normal urine that is precipitated by acetic acid, insoluble\\nin the latter in excess, but soluble in strong mineral acids. The\\nmucoid appearance of this urinary proteid led to its long being\\nknown as mucin. More recent investigations, however, have\\ndemonstrated that it does not yield a reducing substance on\\nhydrolysis, while, on the other hand, it is rich in phosphorus. It\\nhas, therefore, of late been customary to look upon this body as\\nnucleo-albumin. While it is probably true that minute quanti-\\nties of nucleo-proteid derived from the cells of the urinary pas-\\nsages are seldom, if ever, absent from the urine, it has, on the\\nother hand, been shown by recent researches made upon large\\nquantities of urine, that the precipitate given by acetic acid con-\\ntains small quantities of ordinary mucin, or phosphorous-free\\nmucoid, as well as nucleo-proteid. The truth appears to be,\\ntherefore, with regard to nucleo-albumin and mucin, that they are\\nboth constituents of normal urine. In the majority of cases the\\namount of these substances in the urine is very minute so minute,\\nindeed, that it is difficult to demonstrate their presence. In cases\\nof irritation of the urinary passages, catarrhal inflammation\\nattended by free exfoliation of epithelial cells, and in certain\\nfebrile conditions of the system there may be great increase of\\none or both of these substances in the urine. The mucin of the\\nurine has its origin in the urinary passages, notably the lower\\ntract and especially in the bladder it never originates from the\\nkidneys (which are devoid of muciparous glands), much less from\\nthe blood. Nncleo-albumin of the urine, for the most part, origi-\\nnates from the epithelial cells throughout the urinary tract,\\nthrough some loss of integrity of the cells whereby the\\nprotoplasm yields to the macerating influences of the salines con-\\ntained in the urine, thus effecting more or less solution. Nucleo-\\nalbumin and mucin have doubtless lent considerable confusion\\nto a number of the methods of testing for albumin in the urine,\\nnotably in those tests requiring previous acidification of the\\nurine with acetic acid. This is evident from the fact that both\\nmucin and nucleo-albumin are precipitated by acetic acid. The\\nauthor has previously called attention to the fact, however, that", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0131.jp2"}, "132": {"fulltext": "93 ANALYSIS OF URINE.\\nby charging the urine with a concentrated saline (sodium chlo-\\nride) before the addition of the acid, both these bodies are sub-\\nsequently held in solution in the presence of both acetic acid\\nand heat. Likewise with the ferrocyanic test if the reagent be\\nadded first to the urine it acts as does the saline, and holds these\\nbodies in solution so that tbey are unaffected by subsequent\\naddition of the acid.\\nDetection and Distinction. To detect mucin in the urine,\\nthe urine should first be diluted with water, otherwise uric acid\\nmay be precipitated upon addition of the acid. The dilution\\nalso reduces the solvent influence of the salts of the urine over\\nthe mucin. After dilution add an excess of acetic acid. The\\nprecipitate may be purified by dissolving in water with a little\\nsodium hydrate and reprecipitated by acetic acid. To distin-\\nguish nucleo-albumin from mucin the precipitate must be bo led\\nwith a dilute mineral acid, and, if no reducing substance is found\\nby this means, mucin is absent. Oil s method of detecting\\nnucleo-albumin in the urine is as follows To the urine is added\\nan equal quantit} r of saturated salt solution, and Almens s tannin\\nsolution 1 is slowly added. If nucleo-albumin is present, even in\\nsmall amount, an abundant precipitate will appear.\\n1 AlmeDs s tannin solution is composed of tannin, 5 grammes 25-per-ceut.\\nacetic acid, 10 cubic centimetres 40-per-cent. methylated spirit, 240 cubic centi-\\nmetres.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0132.jp2"}, "133": {"fulltext": "SECTION IV.\\nCARBOHYDRATES.\\nThe carbohydrates resemble one another in their chemical\\ncomposition, in all containing 6 atoms of carbon, or a multiple\\nthereof. They also resemble one another in their chemical char-\\nacters, being neutral in reaction, not prone to enter into combi-\\nnations, and, with the exception of inosite, they all possess a\\nstrong rotatory power over polarized light.\\nA number of carbohydrates are met with in the urine, viz.,\\nglucose, levulose, lactose, inosite, etc., but the chief clinical\\ninterest with regard to this class of compounds at present\\nbelongs to grape-sugar.\\nGlycosuria.\\nGrape-sugar, or dextrose, in its pure form crystallizes in\\nrhombic tablets, is soluble in its own weight of water, and gives\\na dextro-rotatory power over polarized light of -f 56\u00c2\u00b0 (Hoppe-\\nSeyler). Its solutions become brown when boiled with liquor\\npotassae, but with picric acid a deep mahogany red. In alkaline\\nsolutions it reduces salts of silver, bismuth, mercury, and cop-\\nper with the first three the metal is precipitated, cupric being\\nreduced to cuprous compounds, with separation of cuprous\\noxide. Faintly-alkaline solutions of grape-sugar, colored blue\\nby indigo, when boiled exhibit a beautiful color reaction, begin-\\nning with violet and ending in yellow. With solutions of sodium\\nacetate it reduces phenylhydrazin hydrochloride to phenylglu-\\ncosazone, forming highly characteristic and beautiful, golden-\\nr ellow, acicular eiystals.\\nGrape-suo-jir exists in minute quantity in normal blood,\\nvarying chiefly with the functional activity of the liver. In\\nsome abnormal states of the system the amount of sugar in the\\nblood becomes markedly increased, reaching its maximum\\nabout T L per cent. in the more pronounced diabetic conditions.\\nThe ardently-disputed question if sugar be present in normal\\nurine seems to have been conclusively settled in the affirmative", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0133.jp2"}, "134": {"fulltext": "100 ANALYSIS OF URINE.\\nthrough the researches of Wedenski (see Section II), although\\nthis is by no means universally conceded. Clinically speaking,\\nthis question is one of minor importance, since, if sugar be\\npresent in normal urine, it exists in such exceedingly minute\\nquantity that it is unrecognizable by the ordinary methods of\\ntesting, and such quantities give rise to no marked clinical\\nsymptoms.\\nClinical Significance. Glycosuria may appear as a temporary\\ncondition in the course of a number of diseases, as cholera,\\nintermittent fever, scarlatina, gout, cerebro-spinal meningitis,\\ndiseases of the lungs, liver, and the brain, especially if involving\\nthe fourth ventricle or vicinity. The administration of certain\\ndrugs and toxic substances causes the appearance of sugar in the\\nurine, such as curare, carbonic oxide, amyl nitrite, methyl-\\ndelphinin, morphine, chloral, hydrocyanic acid, sulphuric acid,\\nmercury, alcohol, strychnine, salicylic acid, turpentine, uranium\\nnitrite, benzol, acetone, and phloridzin. Recent investigations\\nhave shown, however, in some of these cases, that the toxic\\nagent merely causes the appearance of reducing agents l in the\\nurine other than sugar.\\nGlycosuria maybe produced experimentally by various lesions,\\nas follows By puncture of the floor of the fourth ventricle of the\\nbrain; injury to the vermiform process of the cerebellum; sec-\\ntion of the spinal cord in different locations; destruction of\\nvarious S} r mpathetic ganglia; section of the splanchnic nerves;\\nirritation of the vagus section and stimulation of the central\\nend of large motor nerves, as the sciatic and by total extir-\\npation of the pancreas in dogs. In addition to these, experi-\\nmental gtycosuria may be induced by measures which cause\\nincreased determination of blood to the liver, as by tying the\\naccessory branch of the portal vein in animals, irritation of the\\nliver by needle-punctures, compression of the aorta, etc.\\nGlycosuria in mild form may occur from disorders of the\\nstomach, and, in some cases, the overingestion of starchy and\\nsaccharine foods will cause the appearance of sugar in the urine.\\nGlycosuria, however, of pronounced and persistent form\\nUsually glycuronic acid.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0134.jp2"}, "135": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 101\\nbelongs to the province of diabetes mellitus, and may always be\\nregarded as symptomatic of grave defects either in the brain,\\nliver, or pancreas. In young subjects the disease is almost uni-\\nformly progressive toward a fatal termination in from a few\\nmonths to tour or live years, notably so with patients under 20\\nyears of age. During the middle period of life the disease is\\noften less severe and less fatal. After the age of 50 it is often\\nmild and amenable to treatment. Persistent glycosuria is the\\nmost constant and certain of all the symptoms of diabetes\\nmellitus, being, in fact, sometimes the only symptom of the\\ndisease, and herein lies its great value for diagnostic pur-\\nposes. It, therefore, becomes highly essential to be able to\\nreadily detect the presence of sugar in the urine, since diag-\\nnostic data of the most positive nature often hinges upon this\\npoint alone.\\nDetection of Sugar in the Urine. The most popular method\\nof searching for sugar in the urine has, heretofore, been by\\nmeans of the copper tests. These all depend upon the fact,\\nalready noted, that in strongly-alkaline solutions grape-sugar\\nreduces cupric oxide to lower grades of oxidation.\\n1. Trommer s Test. This test may be conveniently per-\\nformed as follows About 1 drachm of urine, in an ordinary\\ntest-tube, is first treated with sufficient cupric-sulphate solution\\nto render the urine a light-green color; then an equal volume of\\nliquor potassae is added. At first a blue precipitate of hyd rated\\ncupric protoxide results, which dissolves upon shaking the tube,\\nforming a beautiful, clear, blue solution. If allowed to stand\\nhalf an hour or so, reduction gradually takes place, especially if\\nmuch sugar be present, resulting in precipitation of yellow or\\nyellowish-red suboxide of copper. If, instead of standing half\\nan hour, gentle heat be applied, this test becomes more delicate,\\nand reduction, moreover, occurs at once.\\nThis test is open to two objections: (a) If it be not sub-\\nmitted to boiling it is not very sensitive, only detecting sugar\\nwhen present in considerable quantity, (b) If boiled especially\\nlong the test is rendered oversensitive, so that reaction may\\noccur with substances in the urine other than sugar. The power\\nof reducing cupric oxide in alkaline solution is possessed, to", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0135.jp2"}, "136": {"fulltext": "102 ANALYSIS OF URINE.\\na feeble degree, by a number of substances 1 in both normal and\\nabnormal urine, and in Trommer s test the quantity of urine sub-\\nmitted to the copper solution is relatively large, which greatly\\nincreases the chances of reduction by non-saccharine agents.\\n2. Fehling s Solution. The original formula for this test is\\nas follows: 34,639 grammes of cupric sulphate solution of sodic\\nhydroxid (sp. gr., 1.12), about 500 cubic centimetres chemically-\\npure neutral sodium tartrate, 173 grammes. Prepare by dissolv-\\ning the cupric sulphate in 100 cubic centimetres of distilled\\nwater; add the copper solution, little by little, and finally, with\\ndistilled water, bring the volume of the whole to 1000 cubic\\ncentimetres (1 litre). Apply by placing about 1 drachm of the\\nsolution in an ordinary test-tube and boiling. If the solution\\nremain clear, add the suspected urine a few drops at a time,\\ncontinuing the boiling. If sugar be present the solution assumes\\nan opaque-yellow color, and shortly after a dense yellowish-red\\nsediment falls to the bottom. Should no change occur, the\\naddition of urine may be continued until its volume equals, but\\nmust not exceed, the volume of the test. In addition to the\\nfact that Fehling s solution slowly undergoes spontaneous de-\\ncomposition, Seekamp 2 has shown the instability of tartaric acid\\nin aqueous solution on exposure to light; and, moreover, Fenton 3\\nhas demonstrated that its oxidation takes place in the presence\\nof iron and alkali. Again, very recently M. L. Jovitschitsch\\nhas shown 4 that alkaline copper solutions freshly prepared ac-\\ncording to Fehling s formula deposit cuprous oxide, either at\\nordinary temperature or when heated, if it has been partially\\nneutralized with sulphuric acid, hydrochloric acid, or nitric\\nacid. This result he ascribes to decomposition of the tartrates\\npresent in the liquid. Finally, Tingle has reviewed and con-\\nfirmed these observations, 5 and, moreover, adds: Purdy s\\nformula is not thus affected by the presence of mineral acids.\\nSpecimens treated in the same manner described by Jovitschitsch,\\n1 Chiefly uric acid, creatin, creatiuin, hippuric acid, hypoxanthin, tannin,\\n\u00e2\u0080\u00a2irbolic acid, alkaloids, and glycuronic acid.\\n2 Ann. Chem. (Liebig), 278, 373 also Rotto, Berichti, 1894, 27, 799.\\n3 Jour. Chem. Soc. (London), 1894, 899; 1896, 546; 1897, 375.\\n4 Berichti, 16, 33, 2431.\\n6 American Chemical Journal, vol. xx, No. 2, February, 1898.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0136.jp2"}, "137": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 103\\nboth at ordinary temperature and at the boiling-point, gave no\\nsign of reduction. The reduction of Purdy s formula is shown\\nby the weakening or complete discharge of the blue color, and not\\nby the production of a precipitate, as in the case of Fehling s solu-\\ntion and it may be kept indefinitely without undergoing change.\\nThe author desires it to be distinctly understood that he does\\nnot advise the use of his formula for qualitative work, but only in\\nquantitative determinations of sugar, for which it was designed.\\n3. Haines s Test. The best form of copper test for sugar,\\nqualitatively, is that devised by Prof. Walter S. Haines, of\\nChicago. The original formula for this test is as follows Pure\\ncupric sulphate, 30 grains; pure glj-cerin, 4 drachms; caustic\\npotash (in sticks), 3 drachms distilled water, to 6 ounces.\\nThe solution is prepared by dissolving the cupric sulphate and\\nglycerin in part of the water and the caustic potash in the\\nremainder, Mix the two solutions.\\nFor purposes of greater convenience, Professor Haines has\\nrecently simplified this formula, as follows Take pure copper\\nsulphate, 30 grains; distilled water, ounce; make a perfect\\nsolution, and add pure glycerin, ounce; mix thoroughly, and\\nadd 5 ounces of liquor potassae.\\nIn testing with this solution, take about 1 drachm and\\ngently boil it in an ordinary test-tube. Xext add from 6 to 8\\ndrops not more of the suspected urine, and again gently boil.\\nIf sugar be present, a copious yellow or yellowish-red precipitate\\nis thrown down. If no such precipitate appear, sugar is absent.\\nThis test is stable, and, though kept on hand indefinitely, it may\\nalwa} T s be depended upon to be in order for testing.\\nWith regard to the copper tests in general It is important\\nto bear in mind that, if boiling be continued too long, slight\\nreduction is apt to occur with the urine, even when free from\\nsugar, as evidenced by a slight greenish (not yellow) opacity;\\nabout half a minute should constitute the usual limit of boiling.\\nIt should also be borne in mind that strongly alkaline solutions\\nare apt to precipitate the earthy phosphates of calcium and\\nmagnesium of normal urine in the form of a grayish cloud,\\nwhich should not be mistaken for sugar.\\n4. The Fermentation Test. This test depends upon the fact\\nthat grape-sugar is decomposed in the fermentation set up by", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0137.jp2"}, "138": {"fulltext": "PLATE IV.\\nCrystals of Phenylglucosazone.\\n(After v. Jakscli.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0138.jp2"}, "139": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 105\\nuntil a drop of Frohm s reagent 1 no longer produces a cloudiness.\\nBy this means an approximate estimation may be made of the\\nquantity of hydrochloric acid which should be added to the\\nurine. Acidify the urine with such quantity of hydrochloric\\nacid, add the reagent, and filter. The filtrate, which should now\\nremain clear upon adding hydrochloric acid, or the reagent,\\nshould be boiled with an excess of potassium or sodium hydrate,\\nas in Bottger s method; and, if a gray or black color result,\\nsugar is present.\\n6. Phenyl-hydrazin Tekt. This test, suggested by Fischer,\\ndepends upon the power, possessed b} T phenyl-ln drazin bydro-\\nchloride, of forming with grape-sugar a highly-characteristic\\ncrystalline compound, termed phenylglucosazone. The best\\nmethod of applying this test is as follows To 25 cubic centi-\\nmetres of suspected urine add 1 gramme of phenyl-hydrazin\\nlrydrochloride, 0.75 gramme of sodium acetate, and 10 cubic\\ncentimetres of distilled water in a capsule. The capsule should\\nbe placed in a water-bath and warmed at least an hour, then re-\\nmoved and allowed to cool and if sugar be present even in\\nminute quantity, there forms a yellowish deposit, which may ap-\\npear amorphous to the naked eye, but which, when examined\\nunder the microscope, is seen to contain fine, bright-yellow,\\nneedle-like crystals, either single or in stars, phenylglucosazone,\\nwhich melt at 204\u00c2\u00b0 C. (Plate IT). The presence of small or\\nlarge yellow scales or powerfully-refracting brown spherules\\nmust not be taken for evidences of sugar, as only the bright-\\nyellow, needle-like ciystals are conclusive. 2\\nT. Jaksch applies this test as follows 2 parts of pheind-\\nhydrazin hydrocbloride and 3 parts of sodic acetate are placed\\nin a test-tube with 6 to 8 cubic centimetres of urine. If the\\nsalts do not dissolve on warming, a little water is added and\\nthe test-tube is placed in boiling water. After twenty minutes\\n1 Frohm s reagent is prepared by mixing 1.5 grammes of freshly-precipitated\\nbismuth subnitrate with 20 grammes of water, heated to boiling then 7 grammes\\nof potassium iodide and 20 drops of hydrochloric acid are added.\\n3 In manipulating the phenyl-hydrazin hydrochloride caution should be\\nobserved not to get it on the hands, as it often causes troublesome eczema of very\\nacute grade.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0139.jp2"}, "140": {"fulltext": "106 ANALYSTS OF URINE.\\nit is removed to cold water, and, if sugar be present the char-\\nacteristic crystals are soon deposited.\\nThis test gives very trustworthy results with every variety\\nof morbid urine, and is therefore equally applicable whether\\nalbumin be present or not. It gives no reaction with uric\\nacid, urates, creatin, creatinin, oxy butyric acid, urochloralic\\nacid, uroxanthic acid, tannin, morphine, salicylic acid, or\\ncarbolic acid.\\nA number of other tests have been proposed for the detection\\nof sugar in the urine, among which may be mentioned Boiling\\nwith sodium or potassium hydroxid (Moore), picric acid (John-\\nson), acetate of lead and ammonia (Rubner), alpha-naphthol\\nand thymol (Molisch), indigo carmine (Mulder), bichloride of\\ntin (Maumene), chromic acid (Hunefeld), diazo-benzol-sulphonic\\nacid (Penzoldt), and sulphuric acid (Runge). None of the above\\ntests possess special advantages over those already described,\\nwdiile, on the contrary, most of them are greatly inferior.\\nIn addition to these, tests for sugar are prepared in paper\\nform, by charging chemically-inert filtering-paper with sodium\\ncarbonate and indigo carmine. The chief merit of these papers\\nis their portabilit} since they are neither sensitive nor trust-\\nworthy in detecting sugar in the urine.\\nTesting for Sugar in the Urine. In searching for sugar in\\nthe urine, a test should, if possible, be selected which is simple\\nin application, reasonably trustworthy, and perfectly stable, so\\nthat it may be depended upon when required, in routine work.\\nIn these respects Haines s test is very satisfactory.\\nBefore submitting the urine to reagents always thoroughly\\ncleanse all of the utensils to be employed in the analysis. In\\nthe use of the copper tests, always employ a minimal amount\\nof urine at first, gradually increasing until reaction is obtained\\nor the stated limit of urine be reached. This method greatly\\ndiminishes the chances of reduction by other substances in\\nthe urine than sugar, and, moreover, it gives a rough idea of\\nthe quantit5 r of sugar when present. Thus, if Haines s test be\\nselected, after gently boiling a drachm of the solution, add 2 or\\n3 drops of urine then wait a moment, to see if reduction occur,\\nbefore adding more urine, meantime continuing the boiling if", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0140.jp2"}, "141": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. JOT\\nno reaction occur after a few seconds, add 2 or 3 more drops of\\nurine, and so on until 8 drops be added, but no more.\\nIf Fehling s solution be employed, gently boil a drachm of\\nthe test and, if it remain clear, add but a few drops of the sus-\\npected urine then pause for a moment, continuing the boiling,\\nand, if no reaction occur, add a few more drops of urine, and so\\non. If no reaction occur, continue the addition of urine until\\nthe volume thereof equals that of the test solution, but not\\nmore.\\nIf any doubts arise as to the presence of sugar in the sus-\\npected urine, after the application of a routine test, an appeal\\nshould be made to one or more of the others described. For\\nsuch purpose the phen3 T l-hydrazin test is desirable above all\\nothers, both because of its exceeding delicac} and its property\\nof reacting with practically no substances in the urine other\\nthan grape-sugar.\\nDetermination of Sugar in the Urine. Having detected the\\npresence of sugar in the urine, it becomes all important to deter-\\nmine its quantity in all cases, because (a) such knowledge fur-\\nnishes the most precise evidence of the grade and severity of\\nthe diseased state upon which it depends (b) it furnishes the\\nmost solid basis upon which to construct the diagnosis (c) it\\ngives the most trustworthy evidence as to the results of treat-\\nment.\\n1. The Fermentation Method. The best results are reached\\nwith this test after the method suggested by Roberts. 1 It has\\nalready been stated that grape-sugar is decomposed in the fer-\\nmentation set up by yeast, yielding alcohol, carbon dioxide, and\\na number of other products, with resulting decrease in the spe-\\ncific gravity of the urine. Each degree of specific gravity lost\\nin fermentation corresponds to 1 grain of sugar per fluidounce.\\nThus, if before fermentation the specific gravity of the urine\\nbe 1.040, and after fermentation it be 1.020, it will have contained\\n20 grains of sugar per ounce. The method advised by Roberts\\nis as follows About 4 ounces of saccharine urine are put into a\\n12-ounce bottle, and a lump of German yeast is added to it.\\n1 Edinburgh Monthly Journal, October, 1861.\\n8", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0141.jp2"}, "142": {"fulltext": "108 ANALYSTS OF URINE.\\nThe bottle is then corked with a nicked cork (which permits the\\nescape of the carbonic acid) and set aside, in a warm place, to\\nferment. Beside this is placed a tightly-corked 4-ounce bottle,\\nfilled with the same urine, but without any contained T east. In\\nabout twentj -four hours the fermentation will have ceased. The\\nfermented urine is then decanted into a urine glass and its spe-\\ncific gravity is taken at the same time, the density of the\\nun fermented urine in the companion bottle is observed and the\\ndensity lost ascertained. The degrees of density lost represent\\nthe number of grains of sugar in each fluidounce of the urine\\ntested. The percentage may be approximately ascertained by\\nmultiplying the number of degrees lost by 0.23.\\nThe chief objection to this method for clinical work is the\\nfact that it requires from eighteen to twenty-four hours to com-\\nplete the analysis.\\n2. The Author s Method. The formula for the author s\\nstandard solution is as follows: Pure cupric sulphate, 4.T52\\ngrammes; potassium hydroxid, 23.50 grammes; strong am-\\nmonia (U. S. P.; sp. gr., 0.9), 350 cubic centimetres; glycerol,\\n38 cubic centimetres distilled water to 1000 cubic centimetres\\n(1 litre). Prepare by dissolving the cupric sulphate and glycerin\\nin 200 cubic centimetres of distilled water with the aid of gentle\\nheat. In another 200 cubic centimetres of distilled water dis-\\nsolve the potassium hydroxid. Mix the two solutions, and when\\ncooled add the ammonia. Finally, with distilled water bring the\\nvolume of the whole to exactly 1000 cubic centimetres (1 litre).\\nThe principle of the test depends upon the fact that, in the re-\\nduction of cupric oxide in solutions of definite strength by\\ngrape-sugar, the blue coloration disappears by addition of a\\ndefinite quantity of grape-sugar 35 cubic centimetres to 0.02\\ngramme of sugar without any attendant precipitate, but\\nleaving the reduced solution perfectly transparent and colorless.\\nThirty-five cubic centimetres of this solution are reduced by\\nexactly 2 centigrammes (0.02 gramme) of grape-sugar.\\nThe analysis is best conducted as follows Have on hand a\\nglass flask (150 or 200 cubic centimetres capacity), an ordinary\\nretort-stand, a 10-cubic-centi metre finely-graduated burette, and\\na large spirit-lamp or Bunsen burner. Proceed by measuring", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0142.jp2"}, "143": {"fulltext": "TABLE.\\nBy means of this table the amount of sugar in the urine may be readily calculated\\nwith the author s formula (metric), both in percentage amount and in grains per\\nfluidounce, from one titration. The table indicates all ratios of reduction in fractions\\nof hundreths per cent, from 5 per cent, down to 0.2 of 1 per cent, when undiluted\\nurine is titrated with 35 cubic centimetres of the test-solution.\\nDegrees\\nOF THE\\nBurette\\nC. C.\\nPer-\\ncentage\\nOF\\nSugar.\\nGrains of\\nSugar per\\nFluid-\\nounce.\\nDegrees\\nOF THE\\nBurette\\nC. C.\\nPer-\\ncentage\\nOF\\nSugar.\\nGrains of\\nSugar per\\nFluid-\\nounce.\\nDegrees\\nOF THE\\nBurette\\nC. C.\\n1 Per- Grains of\\ncentage Sugar per\\nof Fluid-\\nSugar. ounce.\\n0.4\\n5.\\n24.\\n0.76\\n2.63\\n12.6\\n1.65\\n1.21\\n5.8\\n0.41\\n4.88\\n23.4\\n0.77\\n2.6\\n12.5\\n1.7\\n1.18\\n5.7\\n0.42\\n4.76\\n22.8\\n0.78\\n2.56\\n12.3\\n1.75\\n1.14\\n5.5\\n0.43\\n4.65\\n22.3\\n0.79\\n2.53\\n12.1\\n1.8\\n1.11\\n5.3\\n0.44\\n4.55\\n21.8\\n0.8\\n2.5\\n12.\\n1.85\\n1.08\\n5.2\\n0.45\\n4.44\\n21.3\\n0.81\\n2.47\\n11.9\\n1.9\\n1.05\\n5.\\n0.46\\n4.35\\n20.9\\n0.82\\n2.45\\n11.8\\n1.95\\n1.03\\n4.9\\n0.47\\n4.26\\n20.4\\n0.83\\n2.41\\n11.6\\n2.\\n1.\\n4.8\\n0.48\\n4.17\\n20.\\n0.84\\n2.38\\n11.4\\n2.1\\n0.95\\n4.6\\n0.49\\n4.08\\n19.6\\n0.85\\n2.35\\n11.3\\n2.2\\n0.9\\n4.3\\n0.5\\n4.\\n19.2\\n0.86\\n2.33\\n11.2\\n2.3\\n0.87\\n4.2\\n0.51\\n3.92\\n18.8\\n0.87\\n2.3\\n11.\\n2.4\\n0.83\\n4.\\n0.52\\n3.85\\n18.5\\n0.88\\n2.27\\n10.9\\n2.5\\n0.8\\n3.8\\n0.53\\n3.77\\n18.1\\n0.89\\n2.25\\n10.8\\n2.6\\n0.77\\n3.7\\n0.54\\n3.7\\n17.8\\n0.9\\n2.22\\n10.7\\n2.7\\n0.74\\n3.6\\n0.55\\n3.64\\n17.5\\n0.91\\n2.2\\n10.6\\n2.8\\n0.72\\n3.5\\n0.56\\n3.57\\n17.1\\n0.92\\n2.17\\n10.4\\n2.9\\n0.7\\n3.4\\n0.57\\n3.5\\n16.8\\n0.93\\n2.15\\n10.3\\n3.\\n0.66\\n3.2\\n0.58\\n3.45\\n16.6\\n0.94\\n2.13\\n10.2\\n3.25\\n0.61\\n2.9\\n0.59\\n3.4\\n16.3\\n0.95\\n2.1\\n10.1\\n3.5\\n0.57\\n2.7\\n0.6\\n3.33\\n16.\\n0.96\\n2.08\\n10.\\n3.75\\n0.53\\n2.5\\n0.61\\n3.28\\n15.7\\n0.97\\n2.06\\n9.9\\n4.\\n0.5\\n2.4\\n0.62\\n3.23\\n15.5\\n0.98\\n2.04\\n9.8\\n4.25\\n0.47\\n2.3\\n0.63\\n3.17\\n15.2\\n0.99\\n2.02\\n9.7\\n4.5\\n0.44\\n2.1\\n0.64\\n3.12\\n15.\\n1.\\n2.\\n9.6\\n4.75\\n0.42\\n2.\\n0.65\\n3.08\\n14.8\\n1.1\\n1.82\\n8.7\\n5.\\n0.4\\n1.9\\n0.66\\n3.03\\n14.5\\n1.15\\n1.74\\n8.4\\n5.5\\n0.36\\n1.7\\n0.67\\n3.\\n14.4\\n1.2\\n1.66\\n8.\\n6.\\n0.33\\n1.6\\n0.68\\n2.94\\n14.1\\n1.25\\n1.6\\n7.7\\n6.5\\n0.31\\n1.5\\n0.69\\n2.9\\n13.9\\n1.3\\n1.54\\n7.4\\n7.\\n0.29\\n1.4\\n0.7\\n2.86\\n13.7\\n1.35\\n1.5\\n7.2\\n7.5\\n0.27\\n1.3\\n0.71\\n2.82\\n13.5\\n1.4\\n1.43\\n6.9\\n8.\\n0.25\\n1.2\\n0.72\\n2.78\\n13.3\\n1.45\\n1.38\\n6.6\\n9.\\n0.22\\n1.1\\n0.73\\n2.74\\n13.1\\n1.5\\n1.33\\n6.4\\n10.\\n0.2\\n1.\\n0.74\\n2.7\\n13.\\n1.55\\n1.29\\n6.2\\n0.75\\n2.67\\n12.8\\n1.6\\n1.25\\n6.\\nExample. If 35 cubic centimetres of the standard test-solution be reduced\\n(decolorized) upon boiling by 0.4 cubic centimetre of the undiluted urine, the latter\\ncontains exactly 5 per cent, of sugar, or 24 grains per ounce if it require 1 cubic\\ncentimetre of urine to reduce the 35 cubic centimetres of test-solution, there is just\\n2 per cent, of sugar, or 9.6 grains per ounce if it require 4 cubic centimetres of\\nurine to reduce the test, there is just 0.5 per cent., or 2.-1 grains of sugar per ounce, etc.\\nNote. If the percentage of sugar be high (above 5 per cent. the urine should be\\ndiluted by three volumes of water, in which case the product should be multiplied by\\n4 after using the table.\\n(108a)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0143.jp2"}, "144": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0144.jp2"}, "145": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 109\\naccurately 35 cubic centimetres of the test-solution into the flask,\\nadd water to nearly half-fill the flask, and bring the contents\\nthereof to the boiling-point. Fill the burette witli the urine to\\nbe tested and slowly discharge the urine into the boiling test-\\nsolution, drop by drop, until the blue color begins to fade then\\nstill more slowly, three to five seconds elapsing after each drop,\\nuntil the blue color completely disappears and leaves the test-\\nsolution perfectly transparent and colorless. The number of cubic\\ncentimetres required to discharge the blue coloration in 35 cubic\\ncentimetres of the test contain exacth T 2 centigrammes (0.02\\ngramme) of sugar. 1 The following, therefore, is the percentage\\nrelationship of reduction of the test. If it require 2 cubic centi-\\nmetres of urine to reduce 35 cubic centimetres of the test-solution,\\nthere is present exactly 1 per cent, of sugar if it require but 1\\ncubic centimetre of urine to reduce the 35 cubic centimetres of\\ntest-solution there is present 2 per cent, of sugar if it require\\ncubic centimetre of urine to reduce the test, there is 4 per cent.\\nof sugar present but if it only require cubic centimetre of\\nurine to reduce the 35 cubic centimetres of test-solution, 8 per\\ncent, of sugar is present.\\nThe best results are reached y first diluting the urine before\\ntitration. Of course, any dilution may be emploj^ed and the\\nresult multiplied by the number of dilutions. If the quantity\\nof sugar be very large (over 5 per cent.), 3 volumes of water\\nand 1 of urine will prove best, and multiply the product by 4\\nIf the quantity of sugar be small (2 per cent, or less) 1 volume\\nof urine to 1 of distilled water is better, and multiply the\\nresult by 2.\\nThose who find it more convenient to work with the English\\nweights and measures may obtain the same rapid and accurate\\nresults b} using the following formula and methods Formula\\npure cupric sulphate, 44 grains potassium hydroxid, 214 grains\\nstrong ammonia (TJ. S. P. sp. gr., 0.9), 9 fluidounces; glycerol\\n(pure), 6 drachms; distilled water, to 20 ounces.\\n1 It will be noted, after testing, that upon standing some time the test- solu-\\ntion slowly resumes the blue color again. This is due to re-oxidation, which is\\nsomewhat rapid and should not be mistaken for imperfect reduction or defect\\nin the test-solution.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0145.jp2"}, "146": {"fulltext": "110 ANALYSIS OF URINE.\\nPrepare by dissolving the copper sulphate and glycerin in 4\\nounces of distilled water, with the aid of gentle heat. In another\\n4 ounces of distilled water dissolve the potassium hydroxicl.\\nMix the two solutions and cool to 65\u00c2\u00b0 F. then add the am-\\nmonia. Finally, with distilled water bring the volume of the\\nwhole to exactly 20 ounces. Ten drachms of the above solution\\nare reduced upon boiling by exactly grain of sugar. The test\\nis conducted in the same manner as described in the metric\\nsystem, save that a minim burette is substituted for the cubic\\ncentimetre burette, and the result is reckoned in grains instead\\nof grammes. 1 The best results are obtained by diluting the\\nurine with 2 volumes of distilled water before titration then the\\nnumber of minims in 1 ounce (480) are divided by the number\\nof minims of diluted urine it takes to reduce the 10 drachms of\\nthe test, and the product is the number of grains of sugar present\\nin each ounce of urine tested.\\nExample. If 48 minims of diluted urine (1 to 2) reduce 10\\ndrachms of the test-solution, there are just 10 grains of sugar\\nper ounce\\n480\\n-To 10 grains of sugar.\\nIf it be desired to know the percentage-amount of sugar\\npresent, divide the number of grains of sugar per ounce by 4.8.\\nThe detection and determination ot sugar by means of the copper tests is a\\nmatter of some historic interest. Trommer first proposed in 1841 2 to detect the\\npresence of sugar in the urine by means of its reducing power over cupric oxide\\nin strongly-alkaline solutions. About seventeen years later Fehling proposed 3\\nthe formula that bears his name as an improvement on Trommer s test, and sub-\\nsequently this became a means of quantitative determination by applying the\\ntitration method thereto, and this became almost universally standard for the\\npurpose for many years. Ultimately, however, it became well known that\\nFehling s formula was faultily constructed, owing to the instability of its con-\\ntained tartaric salts. Later on, Schmiedeburg proposed to remedy this defect by\\n1 Messrs. Richards Co., of Chicago and New York, prepare and keep in\\nstock this test, both in metric and English weights. They also manufacture and\\nkeep in stock the burettes in both systems, for conducting titration with this test.\\n3 Ann. Chem. und Phar., xxxix, 360, 1841.\\n9 Ann. Chem. und Phar., lxxii, 106, 1848 cvi, 75, 1858.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0146.jp2"}, "147": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE.\\nIll\\nsubstituting for the sodic tartrate pure maniiite. This somewhat improved, but\\nby no means corrected, the instability of the test-solution, and accordingly Pavy\\nagain modified Fehling s original formula, substituting potassium hydroxid for\\nsodic hydroxid, and furthermore divided the test into two solutions, keeping each\\nsolution separately until required, as follows\\n1. Neutral potassic tartrate, 640 grains potassic hydroxid, 1280 grains\\nwater, 10 ounces.\\n2. Cupric sulphate, 320 grains water, 10 ounces.\\nLater on Pavy 1 proposed to keep the elements of the two solutions in the\\nform of pellets. The latter, though convenient, were found, like the original\\nformula, liable to undergo change.\\nFig. 9.\u00e2\u0080\u0094 The Author s Apparatus for Quantitative Determination\\nof Sugar in Urine.\\nThe difficulties encountered in qualitative testing for sugar with Fehling s\\nformula were slight, however, as compared with those in quantitative work.\\nThe reduction of cupric oxide being attended by a precipitate greatly obscures\\nthe end-reaction, entailing tedious delay and uncertainty. In order to remedy\\nthis Pavy brought forward his ammonio-cupric test 3 for quantitative work, as\\n1 Clinical Soc. London, January, 1880.\\n3 Chemical News, xl, 77.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0147.jp2"}, "148": {"fulltext": "112 ANALYSIS OF URINE\\nfollows Cupric sulphate, 4.158 grammes potassic sodic tartrate, 20.4 grammes\\nBtrong ammonia-water (sp. gr., 0.880), 1 litre. Ten cubic centimetres of this is\\nequal in oxidizing power to 0.005 gramme of sugar, the reduction being attended\\nby disappearance of the blue color without any resultant precipitate, the latter\\nbeing dissolved by the ammonia. This undoubtedly constituted the greatest\\nadvance in the copper test for quantitative work yet brought forward, for which\\nthe profession is under perpetual obligations to Pavy. One unfortunate draw-\\nback remained, however, in the fact that Pavy still retained the treacherous\\ntartaric salt.\\nIn the autumn of 1888, while in London, Dr. Pavy kindly demonstrated his\\nammonio-cupric test to the author in his private laboratory. Being especially\\nstruck with the beautiful end-reaction thereof, the test was put in use in the\\nauthor s laboratory. But a brief experience was necessary to prove the im-\\nmense convenience of the improved end-reaction but it also demonstrated the\\ninstability of the test-solution, and this the author set about to remedy if\\npossible.\\nAs the result, a year or so later the author brought forward his formula after\\nconsiderable experimentation. The ammonia was retained to secure the striking\\nand beautiful end-reaction, but the sodic tartrate was substituted by glycerol\\nas the organic element, which has since proved entirely satisfactory in preserving\\nthe stability of the solution however long it be kept on hand. The test has since\\nbeen carefully worked out, both in the metric and English systems, and its\\naccuracy checked by thousands of practical determinations. Theoretically, a\\nfew objections have been raised against the test, chiefly by those who have not\\nused it, while one or two have objected apparently on general principles, not\\nhaving given any reasons for their objections. Thus it has been claimed, since\\nammonio-cupric solutions are so highly oxidizable, that, unless measures be\\nadopted to exclude the atmosphere while testing, reduction is sufficiently inter-\\nfered with to prevent accurate results. This objection is more theoretical than\\npractical. Kepeated experiments in the author s laboratory in testing, in which\\nmeasures were adopted to exclude the atmosphere during titration, such as passing\\na current of coal-gas through the flask, and even overlaying the test-solution with\\nparaffin-oil, conclusively proved that the variation of reduction was too small to\\nbe reckoned.\\nOne distinguished chemist objected to the test on the grounds that the\\nfumes of ammonia evolved in testing were disagreeable in the laboratory. If\\nsuch were in reality so, it would be the simplest possible matter to conduct\\nthe fumes through a glass tube and perforated cork into a wash-bottle containing\\ndilute hydrochloric acid, which would not only dispose of this, but also prac-\\ntically of the previous objection.\\nThese devices have all been tested in the author s laboratory, where quan-\\ntitative sugar testing is often in progress for hours at a time, and for the\\nmost part they have been abandoned as unnecessary. If the flask containing\\nthe test-solution be fitted with a piece of ordinary glass tubing about one\\nquarter of an inch in diameter, with a bend at right angle above the mouth\\nof the flask, it will serve both to conduct the fumes of the ammonia aside\\nand also to retard the ingress of air sufficiently to preserve the absolute", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0148.jp2"}, "149": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 113\\naccuracy of the testing, even to the satisfaction of the most scrupulous\\nmanipulator. It has been found that when it has been thus manipulated\\nthe ammonio-cupric test corresponds in results with great accuracy to the gravi-\\nmetric method. 1\\n3. Fehling s Test. This is conducted by the titration method\\nwith Fehling s solution, the formula of which has already been\\ngiven both in one solution and also divided into two parts, to be\\nmixed when used (see page 102). The latter form is always\\npreferable. The principle of the process is the same as in the\\nauthor s method, previously described, save that reduction is\\naccompanied by a precipitate in addition to disappearance of\\nthe blue coloration of the test. Each 10 cubic centimetres of\\nFehling s solution corresponds to 0.05 gramme of sugar, or 200\\ngrains to 1 grain of sugar. The urine should be diluted to a\\nknown degree, usually 1 to 10, unless the quantity of sugar\\nbe very small, in which case 1 to 5 is better. Titrate precisely\\nas with No. 2, save that, after each few drops discharged from\\nthe burette, the test should be allowed to stand for a short time,\\nso that the precipitate may settle and the observer may see if\\nthe mixture contain any blue color. As soon as the blue color\\nhas disappeared, the quantity of diluted urine employed is read\\noff, and since it takes just 0.05 gramme of sugar to remove the\\nblue coloration in the 10 cubic centimetres of the test-solution,\\nfrom this the percentage of sugar in the urine may be reckoned.\\n4. Optical Saccharimetry. As already stated, grape-sugar\\npossesses a right-rotatory power over polarized light, and upon\\nthis fact has been based a method of quantitative testing for\\nsugar b} r the polariscope. Among the more elaborately-con-\\nstructed instruments for this purpose are those of Lippich,\\nMisterlich, Soleil, Laurent, Wild, an J von Flieschel.\\nUltzmann has devised a polarizing saccharimeter, which pos-\\nsesses several important advantages over the instruments named,\\nas follows (a) No artificial light is needed, for the concave\\nmirror of the microscope-stand brilliantty illuminates the field\\n1 The superior stability of the ammonio-cupric test over other copper tests is\\nlargely due to the fact that the ammonia constantly maintains a high degree of\\noxidation of the copper salt in solution.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0149.jp2"}, "150": {"fulltext": "114\\nANALYSIS OF URINE.\\nof vision, (b) The apparatus itself is small, scarcely longer\\nthan the elongated tube of the ordinary microscope, and needs\\nno separate stand, (e?) By means of this instrument the per-\\ncentage of sugar can be directly calculated, (d) The entire\\napparatus can be had for a comparatively small cost.\\nFig. 10.\u00e2\u0080\u0094 Ultzmann s Polarizing Saccharimeter Adjusted to\\nMicroscope-Stand.\\nIn using this saccharimeter, the tube, objectives, and ocular\\nof the microscope are removed, and in their place the sacchari-\\nmeteris inserted and made fast bj r means of a small screw. The\\nconcave mirror is then adjusted, and, by looking through the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0150.jp2"}, "151": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE.\\n115\\ninstrument, it is determined whether or not it is properly ad-\\njusted.\\nIn Fig. 11 a is the biconcave and b the objective lens of a\\nsmall Dutch telescope, the focal distance of which extends top;\\nc is the upper Xicol prism, with which a vernier is closely con-\\nnected d is a glass tube for holding the suspected fluid, which\\nshould be filtered or otherwise cleansed\\nbefore analysis p is a double plate of\\nright and left rotating quartz, and\\nthe lower Nicol prism.\\nThe arc or fixed scale is so divided\\nthat one division of it represents 1 per\\ncent, of grape-sugar at a temperature\\nof 20 c C. By means of the vernier,\\ntenths of a degree (i.e.. of 1 per cent.)\\ncan be approximately determined.\\nSince 10 degrees of the vernier corre-\\nspond exactly with 9 degrees of the\\narc. to the percentage of sugar found\\nmust be added as many tenths as\\nspaces are counted on the vernier up\\nto that division which exactly coincides\\nwith a division of the arc.\\nIf. for example, the zero-point of\\nthe vernier does not quite reach\\n(toward the right) the 5-point of the\\nscale, it indicates that the percentage\\nof sugar is more than 4 and less than\\n5 per cent. If it be desired to esti-\\nmate the tenths per cent., and the sixth\\ndivision of the vernier is the first\\n(counted from the zero-point) to co-\\nincide with a division of the arc. then 6 is the number of\\ntenths required, and the apparatus would indicate, in this case.\\n4.6 per cent, grape-sugar present. In estimating the strength\\nof cane-sugar solutions, it is to be borne in mind that the\\npolarization power of cane-sugar is three-fourths that of\\ngrape-sugar.\\nP\\nVia. li,\u00e2\u0080\u0094 sectional View\\nof Ultzkann s Polariz-\\ning- Sacciiaedieter.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0151.jp2"}, "152": {"fulltext": "116 ANALYSIS OF URINE.\\nCane- and grape- sugar, as well as lactose, turn the polarized\\nray to the right, while albumin and levulose, on the other hand,\\nturn it toward the left. If the glass tube of the saccharimeter\\nbe empty, or contain a fluid holding in solution substances\\nhaving no optical influence (as normal urine), the zero-point of\\nthe vernier coincides exactly with the zero-point of the scale,\\nand the two halves of the field of vision are exactly isochro-\\nmatic. If, on the contrary, an optically-active substance be\\ncontained in the fluid, as, for example, sugar, the normal\\nisochromatism of the two halves disappears, and a distinctly\\nunequal coloring takes place. This is the more apparent the\\ngreater the amount of optically-active substance present in\\nsolution. When this unequal coloring occurs the vernier is to\\nbe moved toward the right or left (according to the presence of\\nsugar or albumin) until the color of the two halves is again\\nexactly the same. The percentage is then read off the scale in\\nthe way above mentioned.\\nIf a diabetic urine be very light colored and clear, it can at\\nonce be put into the glass tube of the instrument and the\\ndetermination made. If, however, it be dark and cloudy, and\\ncontain albumin, it is advantageous to first clarify it and remove\\nall disturbing substances. This is best accomplished by means\\nof a 10-per-cent. aqueous solution of sugar of lead. The lead\\nacetate causes in urine a copious white precipitate, consisting of\\nlead chloride, phosphate, and sulphate, and the precipitate\\ncarries down with it all the coloring matter of the urine and such\\nalbumin as may be present. If the urine be then passed through\\na dry filter, the resulting filtrate is almost as clear as water, and\\nis particularly well adapted for the apparatus. Since, however,\\nthe amount of sugar in the mixture (after the addition of the\\nlead-acetate solution) differs from that in the urine, the amount\\nof dilution must be taken into account in estimating the sugar\\npresent. It is best, therefore, to take 75 cubic centimetres of\\nurine, and to that add 25 cubic centimetres of lead-acetate solu-\\ntion, shake, and filter. In estimating the sugar present in the\\nurine, one-third of the percentage of the mixture added to that\\npercentage will give the percentage of sugar in 100 cubic centi-\\nmetres of urine. In other words, the percentage of the mixture", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0152.jp2"}, "153": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 11 Y\\nis three-quarters that of the urine. Thus, if to 75 cubic centi-\\nmetres of a dark, albuminous, saccharine urine have been added\\n25 cubic centimetres of lead-acetate solution, the mixture filtered,\\nand found to contain 4.8 per cent, sugar, then 1.6 per cent, must\\nbe added to give the percentage in 100 cubic centimetres of\\nurine, which would, therefore, contain 4.8 1.6 per cent. 6.4\\nper cent, sugar. In rilling the glass tube care must be observed\\nthat no air-bubbles are included in the fluid. It is well, there-\\nfore, to fill the tube as full as possible and push the glass\\ncover on from one side before screwing down the cover (Ultz-\\nmann).\\nThe author uses this instrument, obtaining fairly rapid and\\nsatisfactory results if the quantit}^ of sugar be over 1 per cent.,\\nbut in quantities much less than this the results are uncertain.\\nLevulosuria.\\nFruit-sugar, or levulose, has been found in the urine of per-\\nsons whose symptoms correspond closehv with those of diabetes\\nmellitus. In such cases the levulose may be associated with\\ngrape-sugar, or it may appear alone, but usuallj the former is\\nthe case.\\nLevulose turns the plane of polarization to the left, and this\\nfact enables us to distinguish it from grape-sugar, which turns it\\nto the right. Levulose reduces copper salts as does grape-sugar,\\nalthough more feebty than the latter. It also yields the charac-\\nteristic reaction of yellow crystallization with phenyl-hydrazin\\nhydrochloride, but these crystals melt at 150\u00c2\u00b0 C, while those\\nformed from grape-sugar require a temperature of 204\u00c2\u00b0 C. to\\nmelt them. Levulose does not ciwstallize, and does not melt so\\nreadily as does grape-sugar. When cane-sugar is treated with\\ndilute mineral acids, it undergoes a process known as inversion,\\ni.e., it takes up water and is converted into a mixture of equal\\nparts of dextrose and levulose.\\nClinical Significance. Aside from the fact that levulose is\\nsometimes found in the urine in diabetic conditions, either alone\\nor, as is more common, in association with grape-sugar, little else\\nis known of its clinical relations. It has been stated that excess-\\nive ingestion of cane-sugar, as well as the sugars of certain kinds", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0153.jp2"}, "154": {"fulltext": "118 ANALYSIS OF URINE.\\nof fruits, may cause the appearance of levulose in the urine, more\\nespecially in conditions of disturbed digestion. This, however, is\\nrather conjectural than the result of observation, although cane-\\nsugar is converted in the intestines into glucose and levulose.\\nDetection. If saccharine urine deflect polarized light strongly\\nto the left, we may infer that the saccharine substance is levulose.\\nIf other known substances which turn polarized light to the left\\nbe excluded, it may be regarded as certain that levulose is\\npresent.\\nLactosuria.\\nLactose, or milk-sugar, crystallizes in white, rhombic prisms,\\nwhich are soluble in 6 parts of cold and 2-^ parts of hot water.\\nIt has only a faintly-sweet taste, and is insoluble in alcohol and\\nether. Aqueous solutions of lactose possess a right, or dextro-\\nrotatory, power over polarized light of 59.3\u00c2\u00b0, and do not\\nreadily undergo alcoholic fermentation. It reduces the copper\\nsalts upon boiling in alkaline solutions, but about one-third less\\npowerfully than does grape-sugar. If long boiled with dilute\\nacids, it forms galactose, which, treated with nitric acid, yields\\nmucic acid.\\nClinical Significance. Lactose occurs frequently in the urine\\nof women who are nursing, the quantity usually being small,\\nalthough it may reach as high as 3 per cent., and be attended by\\nall the usual symptoms of diabetes, as in a case reported by\\nRalfe, at the London Hospital. In this case the woman was suf-\\nfering from debility, and lactosuria occurred after three success-\\nive confinements, the urine being free from sugar during the\\ngestation.\\nLactose is nearly always present in the urine of women two\\nor three days after confinement, and just before milk appears in\\nthe mammary glands (during milk fever) and the same ma} 7 be\\nsaid of women within a day or two after weaning their children.\\nLactosuria may also arise from any cause that prevents the milk\\nescaping from the mammary glands during lactation, such as\\ninflammations involving the mammary ducts.\\nDetection. If urine give the characteristic reaction of grape-\\nsugar with alkaline solutions of cupric salts, and if it also cause\\nextreme deflection of the polarized ray to the right, it is prob-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0154.jp2"}, "155": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 119\\nable that lactose is present. Confirm by treating the urine with\\nan excess of lead acetate, filter, and to the filtrate add ammonia\\nuntil a permanent precipitate forms. The fluid is then heated,\\nbut not boiled and if a rose-red color gradually develop, which\\nslowly vanishes on standing, grape sugar is present; if no such\\nreaction occur, lactose is present (Rubner).\\nInosituria.\\nInosite, or muscle-sugar, ciystallizes in large, colorless, mono-\\nclinic prisms, sometimes grouped in rosettes. They are soluble\\nin 6 parts of water at 20\u00c2\u00b0 C, insoluble in alcohol and ether.\\nInosite does not undergo alcoholic fermentation, and possesses\\nno rotatory power over polarized light. It does not reduce\\nalkaline solutions of cnpric salts, although it gives with them\\na greenish tint upon boiling, which clears up on standing, and\\nagain turns green on boiling.\\nAlthough termed muscle-sugar, inosite has been found in the\\nlungs, spleen, liver, kidne3 s, and brain, and it has been found in\\nthe urine in a number of pathological conditions.\\nClinical Significance. Inosituria has frequently been noted\\nin association with diabetic conditions. It has also been ob-\\nserved in t3 T phus, phthisis, syphilitic cachexia, and in diseases\\nof the medulla. In a number of cases of inosituria Ralfe\\nobserved moderate polyuria, loss of flesh, general malaise, and\\naching in the limbs, although no tangible disease could be made\\nout. Inosituria not infrequentl} takes the place of glycosuria,\\nespeciall}^ in the milder grades of diabetes or in convalescence\\nfrom the latter. Inosituria is also occasional^ associated with\\nalbuminuria in Bright s disease. Gallois found inosite in the\\nurine of 7 out of 102 patients examined. Of these, it occurred\\n5 times in 30 cases of diabetes and in 25 cases of albuminuria.\\nDetection. 1. If a solution of inosite be evaporated with a\\nlittle nitric acid on platinum almost to diyness, and the residue\\nbe moistened with a little ammonia and solution of calcium\\nchloride, and the mixture again be evaporated carefully to dry-\\nness, a vivid rose-red or violet color arises, which is apparent\\nwith even 1 milligramme of inosite (Scherer). Other sugars do\\nnot give this reaction.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0155.jp2"}, "156": {"fulltext": "120 ANALYSIS OF URINE.\\n2. Add a little mercuric nitrate solution 1 to a solution of inosite\\non a porcelain dish a yellow precipitate is produced. On heat-\\ning this gently it will become red on cooling the color van-\\nishes, but re-appears again on gently heating. Uric acid, urea,\\nstarch, lactose, mannite, glycocoll, tannin, cystin, and glycogen\\ndo not give this reaction. Albumin is colored red and grape-\\nsugar black, and therefore, if present, these should be removed.\\n3. Inosite may be isolated from the urine, as follows After\\nfirst removing the albumin, if present, the urine is treated with\\nneutral lead acetate until precipitation ceases. It is then filtered\\nand the warmed filtrate treated with subacetate of lead as long\\nas any precipitate occurs. It is well to concentrate the urine to\\none fourth of its bulk before precipitation. The lead precipitate\\ncontaining the inosite combined with lead oxide is collected\\nafter twelve hours, and, after w r ashing, is suspended in water\\nand decomposed with sulphuretted hydrogen. A little uric acid\\nfirst separates upon standing awhile the fluid is separated\\ntherefrom by filtration and the filtrate concentrated by boiling,\\nand is treated with three or four volumes of alcohol while boil-\\ning. A heavy precipitate results, and the hot alcoholic solution\\nis poured off, unless the precipitate be flocculent and non-\\nadhesive, in which case it may be filtered through a heated\\nfunnel and allowed to cool. If, after twenty-four hours, inosite\\ncrystals have deposited, as is usual, in groups, they are filtered\\nand washed with cold alcohol. If, however, no crystals of\\ninosite have separated, ether is added to the clear, cold, alcoholic\\nfiltrate until a milky cloudiness results upon standing, and it is\\nthen allowed to stand in the cold for twenty-four hours. If too\\nlittle ether has not been employed, almost all of the inosite\\npresent is separated in the form of shining, pearly leaflets.\\nAllied Substances Occasionally Found in Urine,\\nglycuronic acid.\\nThis substance is closely allied to carbohydrates, its formula being C 6 H 10 O 7\\nWhen pure it is not crystalline, but its anhydride forms colorless, acicular crys-\\ntals. It is insoluble in ether, but soluble in water and hot alcohol, crystallizing\\n1 Prepared by dissolving 1 part of mercury in 2 parts of nitric acid, and\\nevaporate to one-half and add \\\\y 2 parts of water. After twenty-four hours, pour\\nthe clear fluid from the basic salt.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0156.jp2"}, "157": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 121\\nout from the latter on cooling. Though so closely related chemically to the car-\\nbohydrates, it yields, with urea, decomposition products of an aromatic nature,\\nas orthonitrobenz} T l alcohol. It occurs in the urine as a potassium salt,\\nC 6 H 9 K0 7 Bromine converts glycuronic acid into saccharic acid, indicating its\\nclose relationship to dextrose, as well as to the aldehyde group. It has been\\nthought to arise from dextrose in the organism, though Kulz suggested its\\norigin to be from inosite.\\nGlycuronic acid, of all substances met with in the urine, is most likely to be\\nmistaken for grape-sugar, since it gives a heavy yellow or even red precipitate\\nwith cuprous oxide, reduces bismuth, silver, and mercury salts, and is dextro-\\nrotatory.\\nSignificance. Glycuronic acid occurs in the urine abundantly after the ad-\\nministration of such drugs as chloral and butyl-chloral, nitrobenzol, camphor,\\ncurare, morphia, chloroform, etc., in consequence of which it was formerly\\nthought that the use of these substances caused the appearance of grape-sugar\\nin the urine. It sometimes, though not frequently, occurs in the urine of people\\nwho are apparently in good health and are not diabetic so that it is important\\nto distinguish between this condition and glycosuria.\\nDetection. 1. If the urine reduce cupric oxide and is dextro-rotatory, but\\nfails to undergo alcoholic fermentation with the yeast test, glycuronic acid is\\npresent. 2. It may be isolated from the urine by the method of Schmiedeberg and\\nMayer, as follows A large quantity of urine is decolorized by animal charcoal,\\nevaporated to a syrup, and then digested with large quantities of damp barium\\nhydrate in the presence of gentle heat over a water-bath. It is then extracted\\nwith absolute alcohol glycuronic acid and other substances are left undissolved.\\nThe residue is mixed with water and filtered more baryta is added to the filtrate\\nit is again filtered, and the filtrate evaporated down over a water-bath. An amor-\\nphous barium compound separates out this is washed with water, decomposed\\nby sulphuric acid; the barium sulphate is filtered off, the filtrate is evaporated\\ndown and dried in vacuo, when crystals of the anhydride will be obtained.\\nCANE-SUGAR.\\nAfter abundant use of cane-sugar as food, traces of it may be found in the\\nblood and sometimes in the urine. Pure cane-sugar possesses no reducing power\\nover cupric oxide but as met with commercially it sometimes contains other\\nsugars as impurities, which may cause slight reduction of the copper tests.\\nCane-sugar crystallizes in monoclinic prisms, aqueous solutions of which\\npossess strong dextro-rotatory powers 73.8\u00c2\u00b0. By boiling with water, or more\\nreadily with dilute mineral acids, it undergoes inversion, i.e., it takes up water\\nand separates into dextrose and levulose. Nitric acid oxidizes cane-sugar into\\nsaccharic acid.\\nDetection. It has been stated that if cane-sugar be boiled some time in water\\nit undergoes inversion, becoming glucose and levulose. With solutions of cane-\\nsugar the polarization is dextro-rotatory, but after inversion it becomes levulo-\\nrotatory, because the left-handed action of the molecule of levulose produced\\n106\u00c2\u00b0 is only partly neutralized by the right-handed action of the glucose\\n+56\u00c2\u00b0,\\n9", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0157.jp2"}, "158": {"fulltext": "122 ANALYSIS OF URINE.\\nGLYCOGEN.\\nThis substance is found in the liver, muscles, placenta, white blood-corpus-\\ncles, cartilage-cells, pus-cells, and in embryonic tissues. It has also been found\\nin the urine, notably in some diabetic conditions. Pure glycogen is a snow-white,\\namorphous powder, tasteless and odorless, soluble in water, insoluble in alcohol\\nand ether. Glycogen is strongly dextro-rotatory 211\u00c2\u00b0, but does not reduce\\ncupric oxide. Glycogen gives with iodine a port-wine red color the color dis-\\nappears on heating, and re-appears on cooling.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0158.jp2"}, "159": {"fulltext": "SECTION V.\\nABNORMAL URINE {continued).\\nACETONURIA.\\nAcetone C 3 H 6 is a thin, watery, colorless liquid, of spe-\\ncific gravity 0.T92, which boils at 56.5\u00c2\u00b0 C, and possesses a pe-\\nculiar ethereal or fruit-like odor. It may be obtained in consid-\\nerable quantity hy distillation of the urine as well as the blood\\nof diabetic patients. Acetone is also sometimes found in the\\nurine of children apparently in good health.\\nHeated with potassium iodide and potassium hydrate, iodo-\\nform is evolved; with solutions of nitroprusside of sodium and\\nammonia a rose-red color is produced.\\nAcetone and aceto-acetic acid are sometimes both present in\\nthe urine, sometimes only one of them. Y. Jaksch holds that\\nacetone is a normal constituent of urine, though occurring in\\nminute quantity (0.1 gramme in twenty-four hours). On the\\nother hand Le Xoble holds that acetone only occurs in health)\\nurine after the use of alcohol or foods rich in proteids. Both\\nacetone and aceto-acetic acid seem to be decomposition products\\nof albumins.\\nClinical Significance. Acetonuria of pronounced degree\\noften accompanies high febrile states, probably caused by blood\\nchanges which result from exalted temperatures, since acetonuria\\nbelongs to no special form of fever. Moreover, the amount of\\nacetone in the urine in febrile conditions corresponds closely\\nwith the degree of temperature elevation, always rising and fall-\\ning with the latter,\\nAcetonuria often occurs in diabetes mellitus, more especially\\nin advanced cases. In such cases it sometimes precedes the more\\ndangerous symptom of diaceturia. Acetonuria is frequently\\nassociated with certain forms of cancer, notabbv carcinoma. It\\nis also observed in cases of inanition or starvation and in cere-\\nbral psychosis, especially if accompanied by great mental excite-\\n(123)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0159.jp2"}, "160": {"fulltext": "124 ANALYSIS OF URINE.\\nment. Acetonuria may result from excessive use of animal\\nfoods, and this may, in a measure, account for its frequent\\nappearance in diabetes, since such patients are usually restricted\\nlargely to nitrogenous diet. A condition of auto-intoxication\\nwith acetone sometimes occurs, which is accompanied by aceto-\\nnuria. This state gives rise to symptoms of restlessness, excite-\\nment, and even delirium, but unless accompanied hy diaceturia\\nit tends toward a favorable termination (Jaksch), although it\\nmay end in coma and death in some cases.\\nAcetonuria occurs in association with the following diseases\\nSmall-pox, typhus, pneumonia, scarlet fever, measles, Bright s\\ndisease, perityphlitis, and strangulated hernia, but it is never\\naccompanied or followed by diabetic coma in such cases.\\nDetection. 1. Liebenh iodoform test, as modified by Ralfe,\\nis as follows: 20 grains of potassium iodide are dissolved in a\\ndrachm of liquor potassse and boiled the urine is then floated\\nupon the surface of the fluid in a test-tube. At the point of\\ncontact a precipitation of phosphates occurs, which, if acetone\\nbe present, becomes yellow and studded with yellow points of\\niodoform.\\nA more delicate method of application of this test is to first\\ndistill a small quantity of the urine, and apply the test to the\\ndistillate. This test has one disadvantage lactic acid and etlryl\\nalcohol behave with it similarly to acetone.\\n2. Chaidard l s Test. A drop of aqueous solution of magenta\\ndecolorized by sulphurous acid gives, with fluids containing over\\n0.01 per cent, of acetone, a violet color. This appears in dilute\\nsolutions after four or five minutes.\\n3. Le Noble s Test. On adding an alkaline solution of sodium\\nnitroprusside so dilute as to have only a slight red tint to a\\nfluid containing acetone, a ruby-red color is produced, which in\\na few minutes changes to yellow, and on boiling, after adding\\nacid, to greenish blue or violet. A quarter of a milligramme of\\nacetone can be thus detected.\\n4. Baeyer s Indigo Test. A few crystals of nitrobenzalde-\\nhyde are dissolved b}^ heat in the suspected urine on cooling\\nthe aldehyde separates in the form of a white cloud. The mixt-\\nure is thus made alkaline with dilute sodium solution, and, if", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0160.jp2"}, "161": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 125\\nacetone be present, first yellow, then green, and lastly an indigo-\\nblue color will appear within ten minutes.\\n5. Reynolds s Test. This test depends upon the fact that ace-\\ntone promotes the solution of mercuric oxide. The test may be\\nconducted as follows The 3-ellow precipitate of mercuric oxide,\\nobtained by the reaction of mercuric chloride with an alcoholic\\nsolution of potassium hydrate is added to a small quantity of\\nthe urine, which is shaken and filtered. To the clear h ltrate\\nammonium sulphate is carefully added, and if acetone be present\\nsome of the mercuric oxide is dissolved and a black ring of\\nsulphide of mercury appears at the plane of contact between the\\ntwo liquids.\\nDlACETURIA.\\nDiacetic or ethyl-diacetic acid (C 6 H 10 O 3 is a colorless,\\nstrongly-acid liquid which mixes with water, alcohol, and ether in\\nall proportions. On heating to boiling with water, especially with\\nacids, diacetic acid decomposes into carbon dioxide and acetone.\\nIt differs from acetone in giving a violet-red or brownish-red\\nmahoganj color with solution of ferric chloride. This color\\ndecreases at ordinary temperatures within twenty-four hours,\\nand more rapidly upon boiling, in which respects it differs from\\nphenol, salicylic acid, acetic acid, and sulphocyanides.\\nDiacetic acid has frequently been confused with and mistaken\\nfo^ acetone. Under the influence of alkalies it takes up water\\nand splits into acetone, alcohol, and carbonic acid\\nC 6 H 10 O 3 +H 2 O C 3 H 6 O C 2 H 6 O CO 2\\nIf this take place in the blood or urine, it is probably the\\nsodium salt which undergoes similar decomposition\\nC 6 a 9 Na0 3 +2H 2 C 3 H 6 C 2 H 6 0-|-NaHC03.\\nSodium-ethyl Acetone Alcohol Sodium-hydrogen\\ndiacetate. Acetone. Aiconoi. carbonate.\\nThis view of the origin of neetone is supported by the fact\\nthat alcohol is often found in the urine at the same time. There\\nare, it is true, other substances in the urine at times which give,\\nunder certain circumstances the ferric-chloride reaction, viz.,\\n^-hj droxybutyric acid, snlpbo- (thyo-) cyanates, ncetic acid, and\\nformic acid and, according to Legal and Ham mars ten, the urine", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0161.jp2"}, "162": {"fulltext": "126 ANALYSIS OF URINE.\\nof patients who have taken thallin, antipyrin, salicylic acid, and\\ncarbolic acid may give the reaction. If, however, as already\\nstated, the urine be previously boiled, diacetic acid still gives\\nthe ferric-chloride reaction, wdiile the other substances do not.\\nFleischer found that the substance which gives the ferric-chlo-\\nride reaction in the urine is not taken up by ether after the urine\\nis acidulated with sulphuric acid, whereas diacetic acid is soluble\\nin ether. Salkowski confirmed this observation, and found, more-\\nover, that the urine, after boiling, did not give the ferric chloride\\nreaction. These last-named observers hold that in most cases it\\nis not diacetic acid from which acetone originates, but some\\nat present unknown substance, possibly hydroxj r butyric acid\\nalready mentioned (Halliburton).\\nClinical Significance. Diaceturia is always pathological, and,\\nfor the most part, it may be regarded as a symptom of serious\\nimport. It is of least serious significance when occurring, as is\\nnot uncommon, in febrile conditions in children. Under such\\ncircumstances recovery usually follows. In the case of adults\\nit is always of more grave significance. In diabetes the occur-\\nrence of diaceturia may be looked upon as a very probable\\nprelude to coma, which usually terminates quickly in death. Yon\\nJaksch, indeed, considers that diabetic coma is due to the pres-\\nence of diacetic acid in the blood, and he, therefore, proposes to\\nsubstitute the term diacetic coma for the former name.\\nDiaceturia is most common in the advanced stages of dia-\\nbetes, and more especially in young subjects of the disease. It\\ndoes not, apparently, depend upon large quantities of sugar in\\nthe urine, at least directly so, since the appearance of diaceturia\\nis often preceded by decided diminution of sugar.\\nIt sometimes occurs at the height of acute fevers, and in\\nadults such occurrence is of grave significance.\\nDiaceturia is sometimes the index of auto-intoxication di-\\nacetsemia and is accompanied hy such S3 7 mptoms as vomiting,\\ndyspnoea, jactitation, which shortly ends in coma and death\\nwithout other discoverable disease or lesion.\\nDetection. This is best accomplished by Gerhardt s reaction,\\nas follows: 1. Take a recently-voided sample of urine, and add\\na few drops of ferric-chloride solution to it. If the phosphates", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0162.jp2"}, "163": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 12*7\\nbe precipitated filter them off, and to the filtrate add a few drops\\nmore of ferric-chloride solution. If a dark-red color is pro-\\nduced, diacetic acid is probably present. 2. The above color\\ndisappears on boiling, or is not produced if the urine be pre-\\nviously boiled. 3. Acidify the urine with sulphuric acid and\\nshake with ether. Xext shake the removed ether with very\\ndilute ferric chloride, and the watery color becomes claret-red.\\nSalicylic acid, phenol, antipyrin, or thallin in the urine give the\\nsame color with ferric chloride, which remains unchanged by\\nboiling.\\nCholuria.\\nThe biliary acids and pigments are the chief bile-elements of\\nclinical interest met with in the urine.\\nbiliary acids.\\nIt is an unsettled question as yet if the bile-acids occur in\\nthe urine under physiological conditions. According to Yogel,\\nDragendorff, Hone, and Oliver, traces of bile-acids occur in\\nnormal urine, although Hoppe-Seyler and Udransky hold the\\nopposite view. Oliver s new and delicate method of testing for\\nthe bile-acids gives his results much weight, and it may be as-\\nsumed that the evidence is in favor of the view that the bile-\\nacids are present in minute quantities in the urine of health.\\nClinical Significance. Dr. Oliver estimates the amount of\\nbile-salts in normal urine as about 1 part in from 10,000 to 15,000\\nparts. Furthermore, in a series of observations he has noted\\nthat the normal percentage quantity varies with the time of da}^,\\nreaching the maximum during periods of fasting, as in the\\nmorning urine and that passed before meals while it quickly\\ndiminishes after meals, reaching the minimum about three hours\\nafter food. Dr. Oliver also observed an increase of the bile-acids\\nin the urine upon active muscular exertion and he suggests\\nthat changes of temperature, atmospheric pressure, use of alcohol,\\netc., also influence the degree of discharge of the bile-salts by\\nthe kidneys. The bile-salts in the urine are markedly augmented\\nin all forms of jaundice, and, moreover, according to Oliver s\\nobservations, this occurs both before the appearance of the bile-\\npigments and long after their disappearance from the urine.\\nIn so-called acute bilious attacks i.e., biliary engorgement", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0163.jp2"}, "164": {"fulltext": "128 ANALYSIS OF URINE.\\nfrom defective bile excretion there appears to be an overflow of\\nthe bile-elements into the blood, accompanied by such symptoms\\nas feeble pulse, pallor, coldness of the extremities, sensations of\\nchilliness, slow respiration, nausea and vomiting, w T ith headache,\\nand sometimes diarrhoea. During these symptoms the bile-salts\\nin the urine are at first diminished, but after a time they are in-\\ncreased, and thereupon immediate relief from these symptoms\\nfollows.\\nAcute cholaemia from retention of bile-salts in the blood may\\npass beyond the ordinary bilious attack and produce the more\\nserious symptoms of lowered temperature, convulsions, albumi-\\nnuria, with evidences of blood dissolution such as hsemo-\\nglobinuria.\\nHepatic congestion, early cirrhosis, and malarial poisoning\\nare accompanied by increased elimination of the bile-acids in the\\nurine, more especially if accompanied by constipation. Dr.\\nOliver has noted excess of the bile-acids in the urine in carci-\\nnoma, amyloid disease, enlargement of the liver, cirrhosis, and\\nin hepatic tumors. Choluria always follows a rise of tempera-\\nture, and in high fevers the increase of bile-acids may reach 400\\nper cent, above the normal range. In splenic leucocythsemia,\\nanaemia, haemoglobin uria, and scurvy a large excess of the bile-\\nacids appears in the urine. Lastly, Dr. Oliver has noted\\na decided and persistent decrease of the bile-acids in the urine\\nin cases of chronic interstitial nephritis, granular kidney. 1\\n1 In view of the fact that nearly all advanced chemico-physiologists are now\\nagreed that the liver constitutes the chief agent of destruction of those sub-\\nstances which we know to be auto-intoxicants to the organism, Dr. Oliver s\\nexplanation of the hepatic origin of certain symptoms seems to the author vastly\\nmore reasonable than the explanation of many of the same symptoms by Haig s\\nuric-acid theories. The author has searched in vain among the classic experi-\\nments of Bouchard, as well as others, for proof that uric acid is in any way toxic\\nto the organism, even when injected into the blood in the enormous dose of 0.64\\ngramme per kilogramme of body-weight. On the other hand, the bile-salts are\\ntoxic in almost infinitesimal doses they are not only toxic, but in aqueous solu-\\ntions of 2 per cent, they kill 1 kilogramme of weight the cholate of sodium in dose\\nof 54 centigrammes, and cholate of potassium in dose of 46 centigrammes. The\\nenormous toxic power of bile, as a whole, may be judged from the following\\nstatement of Bouchard as a result of direct experimentation We must conclude\\nthat during twenty-four hours a man makes, by the activity of his liver alone,\\nenough poison to kill three men of his own weight.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0164.jp2"}, "165": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 129\\nDetection. 1. PettenkofTer s method is as follows The urine\\nis mixed with concentrated sulphuric acid, taking care that the\\ntemperature does not rise higher than 60\u00c2\u00b0 to 70\u00c2\u00b0 C. Then a\\n10-per-cent. solution of cane-sugar is added drop by drop, con-\\ntinually stirring with a glass rod. The presence of bile-acids is\\nindicated b} T the production of a beautiful red liquid, the color\\nnot disappearing at ordinary temperature, but becoming more\\nbluish violet in the course of a day or so. This red liquid shows\\na spectrum with two absorption bands, the one at i^and the\\nother between D and E near E.\\nThis test fails if the solution be heated too high or an im-\\nproper quantity usually too much sugar be added. In the\\nlast case the sugar carbonizes and the test becomes dark brown\\nor brown. The reaction fails if the sulphuric acid contains sul-\\nphurous acid or the lower oxides of nitrogen. Since many other\\nsubstances, such as albumin, oleic acid, amylalcohol, morphine,\\ngive a similar reaction; in doubtful cases the spectroscopical\\nexamination must not be omitted.\\nIf the urine be icteric and of pronounced color, the bile-acids\\nmust first be isolated from the urine by Hoppe-Seyler s method\\nbefore applying the above test, as follows Strong^ concentrate\\nthe urine and extract the residue with strong alcohol. The\\nfiltrate is freed from alcohol hy evaporation and then precipitated\\nby basic lead acetate and ammonia. The washed precipitate\\nis treated with boiling alcohol, filtered hot, the filtrate treated\\nwith a few drops of sodium solution, and evaporated to dryness.\\nThe dry residue is extracted with absolute alcohol, filtered, and\\nan excess of ether added. The amorphous or, after a longer\\ntime, crystalline precipitate, consisting of alkali salts of the\\nbiliary acids, ma}- then be submitted to the above-described test.\\n2. Dr. Olivers method of detecting the bile-acids is most\\nsensitive and simple. The principle of this method depends\\nupon the physiological fact that such products of gastric diges-\\ntion as peptone and propeptone are precipitated in the duodenum\\nby contact with the bile-acids. Therefore, since peptone in an\\nacid solution, as the urine, is precipitated by the bile-acids or\\ntheir derivatives as cholate of sodium, 1 an acid solution of\\n1 The form in which the bile-acids occur in the urine.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0165.jp2"}, "166": {"fulltext": "130 ANALYSIS OF URINE.\\npeptone may be used as a test for the bile-acids. The following\\nis the formula for the test solution Pulverized peptone (Savory\\nand Moore s), 3 s s salicylic acid, 4 grains acetic acid, 5 SS\\ndistilled water to 8 ounces. To be filtered repeatedly until\\nrendered transparent. In testing, the urine must be perfectly\\ncleansed, if not already so, and rendered acid if it be alkaline or\\nneutral, and the specific gravity reduced to 1008 if it be above\\nit. To 60 minims of the test solution 20 minims of the urine\\nare added. If bile-acids be present in normal amount, there\\nwill be no immediate reaction visible, but shortly a slight tinge\\nof milkiness will be produced. If in excess, a distinct milkiness\\nat once appears, becoming more intense in proportion to the\\nquantity of bile-acids present. On agitation the opalescence\\ndiminishes, and may even disappear, but it returns upon the\\naddition of more of the test solution. On this fact is based an\\napproximate quantitative test, for which is prepared a standard\\nsolution by adding equal parts of test fluid and normal urine\\ndiluted to specific gravity 1008. Any urine requiring 60 minims\\nor more to bring its opacity up to that of the standard does not\\ncontain an excess of bile-acids.\\nDr\\nOliver s Standard\\nTable.\\nUrine\\nPercentage Increase\\nof Bile-Salts 0:er\\nUrine\\nPercentage Increase\\nof Bile-Salts Over\\nMinims\\nDrops.\\nthe Normal.\\nMinims.\\nDrops.\\nthe Normal.\\n1\\nor\\n2\\n6000\\n20\\nor\\n40\\n300\\n2\\nor\\n4\\n=5\\n3000\\n25\\nor\\n50\\n240\\n3\\nor\\n6\\n2000\\n30\\nor\\n60\\n100\\n4\\nor\\n8\\n1500\\n35\\nor\\n70\\n83\\n5\\nor\\n10\\n=5\\n1200\\n40\\nor\\n80\\n66\\n10\\nor\\n20\\n600\\n45\\nor\\n90\\n50\\n15\\nor\\n30\\n400\\nPercentage increase over 700 above the normal is rarely\\nencountered. With the above test Dr. Oliver detects 1 part of\\nbile-salts in 18,000 or 20,000 parts of sodium-chloride solution.\\nIf careful attention be paid to details in preparation of the\\nurine, nothing as yet found in urine interferes with the test.\\nBILIARY PIGMENTS.\\nBile coloring matters appear in the urine in a number of con-\\nditions. The urine in such cases is always abnormally colored,\\nyellow, yellowish brown, deep brown, greenish yellow, green-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0166.jp2"}, "167": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 131\\nish brown, or even nearly pure green. On shaking the urine it\\nfroths and the bubbles are yellow or 3 ellowish green in color.\\nThe morphological elements of the sediment often take the color\\nof the abnormal pigment in the urine.\\nClinical Significance. The biliary pigments are met with in\\nthe urine in jaundice, from whatever cause it arises, but most\\ncommonly, perhaps, when due to obstruction of the bile-ducts.\\nIn such cases the bile-elements make their way into the\\nlymphatics and the general circulation and are eliminated by\\nthe kidneys. The bile-pigments appear in the urine several\\ndays before the icteric coloration of the skin is perceptible, and\\ntherefore they may sometimes be taken as a prognostic of the\\napproach of jaundice.\\nThe biliary coloring matters are also found in the urine in\\nnumerous pathological conditions of the liver, in which icterus\\nmay or may not be present also. The}^ may also appear in the\\nurine as a result of blood changes, and after haemorrhage into\\nthe tissues and in such cases they are derived from their\\nprimary source in the blood itself. Lastly, bile-pigments in large\\namounts always appear in the urine in cases of phosphorus\\npoisoning.\\nDetection. 1. Gmelin s method consists in introducing a\\ncolumn of strong nitric acid, containing a little yellow nitrous\\nacid of commerce (HX0 3 -f XO^) into a test-tube, and upon this\\ngently floating a column of similar depth of urine. In the zone\\nbetween the fluids appears from above downward the colors\\ngreen, blue, violet, red, and }^ellow. The green is most predomi-\\nnant, while the blue is most indistinct or sometimes absent.\\n(a) In Rosenbach s modification of this test the urine is fil-\\ntered through a fine, thick filter. After filtration a drop of\\nnitric acid containing a little nitrous acid is applied to the inside\\nof the filter. A pale-yellow spot will be formed, which is sur-\\nrounded by colored rings which appear yellowish red, violet, blue,\\nand green. This modification is very delicate, and it is hardly\\npossible to mistake other coloring matters for the bile pigments.\\n(b) DragendorfF has adopted still another modification of the\\nabove test, which consists in placing a little of the urine on a\\nplaster-of-Paris disc, and, when nearly absorbed, a drop of nitric", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0167.jp2"}, "168": {"fulltext": "132 ANALYSIS OF URINE.\\nacid is allowed to fall on the moistened spot. If the bile-pig-\\nments be present a ring forms about the acid drop, in which\\ngreen is predominant.\\n2. HupperVs test detects the faintest traces of bile-pigment\\nin the urine. The urine is treated with lime-water, or first with\\nsome CaCl 2 solution, and then with a solution of sodium or am-\\nmonium carbonate. The precipitate, consisting of bile-pigments,\\nmay be shaken out with chloroform after washing in water, and\\nafter acidification with acetic acid. The bilirubin is taken up b}\\nthe chloroform, which is colored nr ellow thereby, while the acetic-\\nacid solution is colored green by the bilirubin.\\nThe lime-pigments may also be used directly for Gmelin s test\\nin the following way Spread them on a porcelain dish in a thin\\nlayer, and acid a drop of nitric acid. The reaction usually appears\\nvery beautiful.\\n3. Ultzmami s test consists in treating 10 cubic centimetres\\nof the urine with 3 or 4 cubic centimetres of concentrated caustic-\\npotash solution and then acidifying with hydrochloric acid. The\\nurine will turn a beautiful green color if the bile-pigments be\\npresent.\\nIndoxyl-sulphuric Acid.\\nIndoxyl-sulphuric acid (C 8 H 7 NS0 4 also called urine in-\\ndican, and formerly known as uroxanthin, occurs in normal urine\\nas an alkali salt, whose properties have been fully considered in\\nSection II. Indoxyl-sulphuric acid is derived from indole, w T hich\\nis first oxidized in the system into indoxjd and then is united\\nwith sulphuric acid. Indole is formed by the putrefaction of\\nproteids, and hence the quantity excreted by the kidneys is\\ngreater upon a meat than upon a vegetable diet.\\nClinical Significance. Variations in the quantity of so-called\\nindican in the urine occur within comparatively narrow range in\\nhealth but in certain pathological conditions the increase be-\\ncomes very marked. Clinically, therefore, an increased excretion\\nof this substance by the kidneys is observed in Addison s dis-\\nease, cholera, carcinoma of the liver, chronic phthisis, central\\nand peripheral diseases of the nervous system, typhoid fever,\\ndysentery, acute general peritonitis, multiple lymphoma, fetid", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0168.jp2"}, "169": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 133\\nbronchitis, ichorous pleural exudations, diabetes mellitus. as well\\nas in a number of others.\\nIn obstructive diseases of the small intestine its excretion\\nis sometimes enormously increased, owing probably to the favor-\\nable conditions for the absorption of indole. The simple ob-\\nstruction of the colon does not cause its increase in the urine.\\nObstruction of the large intestine, only when it causes consider-\\nable disturbance in the motion of the contents of the upper\\nileum, gives rise to its increased excretion by the kidneys.\\nIn general, it has been considered that the appearance of large\\nquantities of so-called indican in the urine implies that an abun-\\ndant albuminous putrefaction is progressing in some part of the\\nS3^stem. Thus, in pleurisy it indicates a copious, unhealthy exu-\\ndation, and in peritonitis it may be taken as an evidence of the\\nformation of unhealthy pus. The putrefaction of secretions rich\\nin albumin in the intestines explains its increase in the urine\\nduring starvation.\\nDetection of Urine Indican. JafYs method consists in mixing\\n10 cubic centimetres of strong hydrochloric acid with an equal\\nvolume of urine in a test-tube, and, while shaking, add drop by\\ndrop a perfectly fresh, saturated solution of chloride of lime, or\\nchlorine-water, until the deepest obtainable blue color is reached.\\nThe mixture may next be titrated with chloroform, which readily\\ntakes up the indican and holds it in solution, and the quantity\\npresent may be approximately estimated according to the depth\\nof the color. If the urine contain albumin it should be removed\\nbefore applying this test, otherwise the blue color, often arising\\nfrom the mixture of hydrochloric acid and albumin after standing,\\nmay prove misleading.\\n2. MacMunn J s Method. (a) Equal parts of urine and hydro-\\nchloric acid with a few drops of nitric acid are boiled together,\\ncooled, and agitated with chloroform. The chloroform becomes\\nviolet if much indican be present, and shows an absorption\\nband before D, due to indigo blue, and another after D, due to\\nindigo red.\\nThis method is more trustworthy than Jaffe s, because chlo-\\nride of lime destroys small quantities of indigo.\\n(6) A rough, approximate method may be employed upon the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0169.jp2"}, "170": {"fulltext": "134 ANALYSIS OF URINE.\\nforegoing principle, as follows Ponr 4 cubic centimetres of hy-\\ndrochloric acid into a small flask, and while stirring add from 10 to\\n20 drops of urine. If the proportion of indican be about normal\\nthe resulting color will be rather light-yellow if in excess the\\nacid will turn violet or blue the more intense will be the color\\nin proportion to the quantity of indican present. If no color-\\nation appear after waiting a minute or two the indican is not in\\nexcess, however deep a color may subsequently appear.\\nIf 2 or 3 drops of nitric acid be added to the test, as in the\\noriginal method, it becomes more delicate. (See also page 43.)\\nThe Diazo Reaction in Urine.\\nThe diazo test was suggested by Ehrlich, in 1882, as a valu-\\nable diagnostic measure in typhoid fever, although he admitted\\nthe occurrence of this reaction in a few other conditions shortly\\nto be considered.\\nThe diazo reaction depends upon the fact that if sulphanilic\\nacid (amidosulphobenzol) be acted upon by HN0 2 diazosulpho-\\nbenzol is formed, which unites with certain aromatic substances\\noccasionally present in the urine to form aniline colors.\\nDr. Frieclenwald has recently reviewed the literature of this\\nreaction, 1 and shown that many of the contradictor}^ results\\nobtained by some observers are due to failure in carrying out\\nEhrlich s methods in performing the test, which is best accom-\\nplished as follows\\nTo obtain diazosulphobenzol in a perfectly fresh condition,\\nsulphanilic acid is kept in solution with hydrochloric acid to\\nthis sodium nitrite is added, whereupon HNO2 is liberated and\\ndiazosulphobenzol is formed.\\nProcess, Two solutions are prepared, as follows\\n1. Two grammes of sulphanilic acid 50 cubic centimetres of\\nhydrochloric acid 1000 cubic centimetres of distilled water.\\n2. A 0.5-per-cent. solution of sodium nitrite.\\nIn performing the test 50 parts of No. 1 and 1 part of No. 2\\nare mixed, and equal parts of this mixture and of the urine in a\\ntest-tube is rendered strongly alkaline with ammonia. If the\\nreaction be positive the solution assumes a carmine-red color,\\n1 New York Medical Journal, December 23, 1893.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0170.jp2"}, "171": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 135\\nwhich on shaking must also appear in the foam. Upon standing\\nfor twenty-four hours a greenish precipitate is formed.\\nThe test must not be considered positive unless a distinct red\\ncoloration extends to and includes the foam on shaking.\\nClinical Significance. Ehrlich s original claims for the diazo\\nreaction were as follow\\n1. The reaction is most commonly found in typhoid fever\\nfrom the fourth to the seventh day and thereafter, and if the\\nreaction be absent the diagnosis is doubtful.\\n2. Cases of typhoid fever characterized by faint reaction and\\noccurring only for a short time may be predicted to be of very\\nmild type.\\n3. The reaction is occasionally noted in phthisis pulmonalis,\\nbut only in cases pursuing a rapid course toward a fatal ter-\\nmination.\\n4. The reaction is sometimes, but not often, observed in\\ncases of measles, miliary tuberculosis, pyaemia, scarlet fever, and\\nerysipelas.\\n5. In diseases unaccompanied by fever, as chlorosis, hy-\\ndremia, diabetes, diseases of the brain, spinal cord, liver, and\\nkidneys, the reaction is always absent.\\nThe weight of clinical evidence strongly confirms all of\\nEhrlich s original claims for this reaction, but more especially so\\nwith regard to typhoid fever and pulmonary tuberculosis if\\npresent in the latter disease any length of time, the prognosis is\\nvery unfavorable.\\n/3-Oxybutyric Acid (C 4 H 8 3\\nThis acid forms an odorless syrup which is readily miscible\\nwith water, alcohol, and ether. It is an optically active sub-\\nstance, being, in fact, dextro-rotatoiy so that it interferes with\\nthe estimation of sugar in the urine by polarimetry. It is non-\\nprecipitable by lead acetate and ammoniacal basic lead acetate.\\nOn boiling with water in the presence of a mineral acid, it\\ndecomposes into a-crotonic acid which melts at 72\u00c2\u00b0 C. and\\nwater. It yields acetone upon oxidation with chromate mixture.\\nClinical Significance. The appearance of hydroxy butyric\\nacid in the urine was first demonstrated bv Minkowski, Kulz.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0171.jp2"}, "172": {"fulltext": "136 ANALYSIS OF URINE.\\nand Stadelmann. It is usually accompanied by diacetic acid in\\nthe urine, and sometimes by acetone. It is especially noted in the\\nurine in severe or chronic cases of diabetes mellitus. It has\\nalso been observed in the urine in cases of measles, scurvy,\\nscarlet fever, and in diseases of the brain. Aside from these,\\nlittle is at present known of its clinical relations.\\nDetection. 1. If a urine be dextro-rotatory after fermenta-\\ntion with yeast, it is strongly probable that hydroxy butyric acid\\nis present. 2. Ruiz s method consists in evaporating the fer-\\nmented urine tt a syrupy consistence, and, after the addition of an\\nequal volume of concentrated sulphuric acid, distill directly with-\\nout cooling CL-crotonic acid is produced, which is distilled, and,\\nafter strongly cooling, the distillate is collected in a glass crys-\\ntals which melt at -f- 72\u00c2\u00b0 C. separate. If no crystals be obtained,\\nthen shake the distillate with ether and test the melting-point\\nwith the residue, which has been washed with the water obtained\\nafter evaporating the ether.\\nPtomaines and Leucomaines.\\nThe term ptomaine was originally used to designate those\\nproducts of putrefaction which give the reaction of vegetable\\nalkaloids and possess more or less poisonous characters. It has\\nsince been found that similar alkaloids are formed during the\\nlife of animal organisms these are termed leucomaines. Pto-\\nmaines, or putrefactive bases, are transition products of decom-\\nposition or, in other words, temporary forms through which\\nmatter is being transformed from the organic to the inorganic\\nstate by means of the action of bacterial life. They are chem-\\nical compounds of a basic nature, and their deep interest and\\nimportance in the field of modern medicine may at once be per-\\nceived from the fact that they constitute the chemical factors in\\nthe causation of all infectious diseases.\\nIt has been erroneously supposed that all ptomaines are\\nhighly poisonous; but not only are many of them inert, but it\\nmay be stated that the majority of them isolated to date do not\\nproduce harmful results to the organism in ordinary quantities.\\nOn the other hand, some of them are highly toxic, and such\\nBrieger first proposed to designate as toxins.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0172.jp2"}, "173": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 137\\nPtomaines resemble vegetable alkaloids in that they all con-\\ntain nitrogen as the chief element of their basic character. Some\\nof them also contain oxygen, corresponding to the vegetable\\nfixed alkaloids, while those devoid of oxygen correspond to the\\nvolatile alkaloids.\\nSelmi was probably the first in 1880 to claim that the basic\\nsubstances formed in the organism during pathological changes\\noften appeared in the urine, constituting an index to the patho-\\nlogical condition of the patient. He demonstrated, in the urine\\nof a patient with progressive paralysis, two bases resembling\\nnicotine and coneine. Since then Bouchard, Yilliers, Le pine,\\nGautier, and others have demonstrated the presence of a few\\nother basic products in the urine in other diseased conditions.\\nIt is now well known that the urine in certain diseases, as\\ncholera and septicaemia, is decidedly toxic in character. Bouchard\\nChavrin, and Ruffer have proved that bacterial poisons generated\\nin the system through disease can be excreted in the urine.\\nThey produced imniunhVy to the action of the bacillus pyocy-\\naneus upon animals hy previous injections of urine of animals\\ninoculated with that bacillus as well as with filtered cultures\\nthereof. Unfortunately, as 3 r et these investigations have not\\nbeen pushed to sufficient completion to furnish much practical\\ndata in reference to infectious diseases, since but few bacterial\\nptomaines have yet been isolated from the urine. The impor-\\ntance, however, of this comparatively new field of uranafysis\\ncan scarcely be overestimated, since it is strongly probable that\\ncareful investigation of the urine in this direction may throw\\nimportant light upon a large class of diseases.\\nIt only remains here to refer to the few ptomaines which have\\nbeen isolated from the urine, and the methods by which this has\\nbeen accomplished. First, with regard to normal urine, much\\ndifference of opinion prevails as yet in reference to the presence\\nor absence of alkaloidal toxins. When through defective renal\\naction the leucomaines become retention products, they at once\\nassume immense importance in the chemistry of the urine. The\\nresearches of Pouchet strongly confirm the presence of toxic\\nalkaloids in normal urine while, on the other hand, Villiers\\ndenied their existence, claiming that the observed physiological\\n10", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0173.jp2"}, "174": {"fulltext": "138 ANALYSIS OF URINE.\\naction is wholly due to the presence of potassium salts. Since\\nwe know that toxins of an alkaloidal nature (leucomaines) are\\nformed in the organism through tissue metabolism, and, further-\\nmore, that the urine constitutes at least one channel of escape\\nfor similar compounds, there seems no reason to doubt their\\npresence in urine at least, in minute quantity. Bouchard,\\nGuerin, and Lepine have shown that at least that which has been\\ntaken for these compounds is greatly increased in the urine in\\npathological states.\\nWith regard to the isolated ptomaines, Baumann and Udransky separated\\nseveral basic derivatives, amongst them cadaverin, putrescin, and a small\\namount of a third base from the urine of a patient suffering from catarrhal cys-\\ntitis normal urine being found free from these substances.\\nPutrescin C 4 H 12 N 2 is closely related to cadaverin, since they nearly\\nalways occur together or alternately from the same source. Brieger obtained it\\nfrom putrefying human viscera after exposure of from three days to three weeks\\nat ordinary temperatures. It has been obtained from herring (twelve days ex-\\nposure), from pike (six days exposure), from haddock (two months exposure),\\nand from decaying mussel (sixteen days exposure). It is especially abundant\\nin cultivations of comma or cholera bacillus, and hence it is believed that sub-\\nstances similar to putrescin are the true chemical poisons in cholera. Putrescin\\nhas been isolated from the urine in cases of cystinuria by several observers since\\nBrieger s first discovery. It is toxic to the organism, but its tetra-methyl deriva-\\ntion is incomparably more so, causing symptoms of salivation, dyspnoea, contrac-\\ntion of the pupils, muscular paralysis of the limbs and trunk, ejaculation of\\nsemen, dribbling of urine, and violent convulsions.\\nCadaverin CsH 14 N ii appears in decomposing tissues usually before the\\noccurrence of putrescin. Brieger obtained it from putrefying heart, liver,\\nlungs, etc., at ordinary temperatures, in three days exposure; from putrid\\nmussel in sixteen days. Like putrescin, it is a constant product of comma bacil-\\nlus upon any soil upon which they may be cultivated. Cadaverin is a constant\\nassociate perhaps a product of the activity of vibriones, since it never occurs\\nin cultures in which this genus is absent. It is therefore absent from both nor-\\nmal and typhoid stools, as well as from cultures of the bacillus of Emmerich\\nand Eberth. Both putrescin and cadaverin may be obtained from the urine of\\ncystinuria by precipitation with benzoyl chloride (Baumann s method).\\nTrimethylamine C 3 H 9 N has been found in human urine. This base occurs\\nboth in animal and vegetable tissues. It has been obtained from ergot, the blood\\nof calves, herring-brine, in the putrefaction of yeast, in cheese, in human liver\\nand spleen (two to seven days exposure), in perch (six days exposure), in\\ncultures of streptococcus pyogenes on broth and blood-serum. It is not a violent\\ntoxin, large doses being required to markedly disturb the system.\\nBeatin C 5 H 13 N0 3 is a well-known base, the product of cotton-seed, beet-\\njuice, turnip, vetch-seeds, etc. It has been found in the urine by Liebrich.\\nThis base is of no pathological significance, since it is non-toxic to the organism.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0174.jp2"}, "175": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 139\\nJaksch, who has studied the subject of basic derivatives of the urine, both\\nnormal and pathological, finds that, while normal urine and that of some diseases\\nhold these substances only in minute quantity, in certain other morbid states\\nthis amount is very considerable. He makes the following suggestions as a\\nguide for investigation in this field of work\\nIn the first place, he suggests that it would be well to follow the example of\\nBrieger, Baumann, and Udrasky in withholding the name alkaloids from the\\nbodies diamines, which are derived from the system under morbid conditions,\\nbecause all that have been recognized as yet are simply diamines, and do not ex-\\nhibit the characteristic property of alkaloids, viz., the pyridin radicle. In the\\nsecond place, it is desirable to discriminate between the physiological bases of\\nthe urine creatinin, reducin, etc., which belong to normal urine, and those which\\nare associated only with certain diseased states. It is not intended to imply by\\nthis that the physiological bases leucomaincs cannot under any circumstances\\ngive rise to diseased or poisonous symptoms. On the contrary, it is highly prob-\\nable that retention, and still more the increased formation of such products,\\nunder certain circumstances may induce very grave symptoms, and even greatly\\nimperil the life of the patient. Again, it seems probable that in certain acute\\ndiseases, specific substances of a toxic nature, not present in normal urine, may\\nbe excreted with that fluid.\\nJaksch makes the following suggestive classification of the subject\\nClinical (morbid) symptoms depending upon retention of the physio-\\nlogical basis. Under this head would come uraemia and certain of the symptoms\\nof obstruction retention toxicosis.\\n(b) Clinical symptoms referable to the presence of basic products which are\\nfound in the system (blood, etc.) in disease and eliminated with the urine noso-\\ntoxicosis.\\n(c) Clinical symptoms which are caused by the formation of toxic basic sub-\\nstances from morbid matter, such as pathological fluids lodged in certain parts\\nof the organism. Such bases being absorbed give rise to symptoms of severe\\npoisoning. Under this head would come the collective symptoms of ammo-\\nnisemia, and others which follow the absorption of gangrenous pus auto-toxicosis.\\n(d) Clinical symptoms, and consequently morbid types induced by the action\\nof toxic bases taken into the system with the food, such as the poison of sausages,\\ncheese, canned fruits, etc., etc. exogenic toxicosis.\\nDetection. A number of methods are in use for the detection and isolation\\nof these bases, the more prominent of which are those of Dragendorf, Stas-Otto,\\nBrieger, Gautier, and Etard. Since all of these methods are somewhat difficult\\nand tedious, only the most suitable methods for uranalysis will here be described.\\nFor such purposes Brieger s method serves best but in some cases it is important\\nthat the urine be first concentrated in vacuo. Sufficient hydrochloric acid is first\\nadded to render the urine acid, and the mixture is then boiled for a few minutes\\nand filtered. The filtrate is concentrated at first over a flame, and subsequently\\nover a water-bath, to a syrupy consistence.\\nIn consequence of the instability of the bodies sought, it is advisable to\\nevaporate in vacuum and at the lowest possible temperature, more especially so\\nif the urine be foul.\\nThe thick fluid is next mixed with 96-per-cent. alcohol, filtered, and the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0175.jp2"}, "176": {"fulltext": "140 ANALYSIS OF URINE.\\nfiltrate treated with a warm alcoholic solution of lead acetate. The resulting lead\\nprecipitate is removed by filtration and the filtrate concentrated preferably in\\nvacuo to a syrup, and again taken up in 96-per-cent. alcohol. The alcohol is\\nnext evaporated, and the residue, dissolved in water, is freed from lead by the\\naddition of sulphuretted hydrogen and filtration. The filtrate is acidified with\\nhydrochloric acid and evaporated to a syrupy consistence. It is then diluted\\nwith alcohol, and alcoholic solution of mercuric chloride is added. The resulting\\nprecipitate is boiled in water, and certain ptomaines may separate at this stage\\nin consequence of different solubilities of the double salts of mercury. The better\\nto secure this, the precipitate may be treated successively with water at various\\ntemperatures. Should it be thought that the lead precipitate may have retained\\nsome of the ptomaines, it may be suspended in water, the lead converted into\\nsulphide, and the fluid treated in the manner just described.\\nThe solution obtained as above is filtered, freed from mercury, and evapo-\\nrated the excess of hydrochloric acid is carefully neutralized with sodium\\ncarbonate (the reaction is kept feebly acid), then it is again extracted with\\nalcohol to free it from inorganic salts. The alcohol is evaporated, the residue\\ndissolved in water, the remaining traces of hydrochloric acid neutralized with\\nsodium, the whole acidified with nitric acid and treated with phosphomolybdic\\nacid. The phosphomolybdate double compound is separated by filtration and\\ndecomposed by neutral lead acetate or, more readily, by heating over a water-\\nbath. The lead is next removed by means of sulphuretted hydrogen (hydrogen\\nsulphide) the filtrate is evaporated to a syrupy consistence and taken up with\\nalcohol. Several ptomaines are thus separated as hydrochlorates, and may be\\nobtained in the form of double salts of gold, or platinic chloride, and of picric\\nacid. The chloride of the base is obtained by removing the metallic base by\\nprecipitation with sulphuretted hydrogen, while the picrate is taken up with\\nwater, acidified with hydrochloric acid, and repeatedly extracted with ether\\nto remove the picric acid. The last step is to ascertain if any ptomaines remain\\nin the phosphomolybdic-acid filtrate after precipitation of the phosphomolybdic\\nacid.\\nBrieger has obtained some of his ptomaines by a simpler modification of his\\nabove complete method. Thus he has obtained neurodin by treating the aque-\\nous extract of the organic matter, after boiling and filtration, with mercuric\\nchloride, collecting the precipitate, decomposing it with sulphuretted hydrogen,\\nevaporating the filtrate over a water-bath, and extracting the base with alcohol.\\nProperties of Animal Bases. 1. They all have an alkaline\\nreaction.\\n2. They are insoluble in water; soluble in acids forming\\ncompounds precipitated from such compounds by ammonia.\\n3. Iodine and potassium iodide give a brown, flocculent\\nprecipitate.\\n4. Potassio-mercuric-iodide solution produces flocculent,\\nyellowish-white precipitates, insoluble in acids and dilute alka-\\nlies, easily soluble in alcohol, and generally, also, in ether.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0176.jp2"}, "177": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 141\\n5. Iodide of bismuth and potassium give orange precipitates\\nin solution acidulated with dilute sulphuric acid.\\n6. Phosphomolybdic acid gives a bright or brownish-yellow\\nprecipitate, insoluble in water and dilute mineral acids.\\n7. Metatungstic and phosphotuugstic acids give a white,\\nflocculent precipitate, with difficulty soluble in water and dilute\\nacids.\\n8. Tannin in neutral or feebly-acid solutions give yellow or\\nwhite precipitates with most ptomaines.\\n9. Chloride of gold gives a yellow or yellowish-white precipi-\\ntate, either amorphous or ciystalline.\\n10. The} x are all oxidizable and unstable, especially under the\\ninfluence of an excess of mineral acid, which colors them red and\\nthen converts them into a resinous mass.\\n11. Picric acid precipitates most of them, the color of the\\nprecipitate usually being pale yellow.\\n12. The animal bases are energetic reducing agents, decompos-\\ning chromic acid, iodic acid, and silver nitrate. With potassium\\nferrocyanide and ferric chloride they give Prussian blue. This\\nwas formerly considered to be characteristic of the animal alka-\\nloids, but it is now known that many vegetable alkaloids give\\nthe same reaction, and a few of the animal alkaloids (especiail} r\\nthose containing oxygen) do not give it. As yet there is no\\nknown class reaction by which the animal bases can be separated\\nfrom those of vegetable origin.\\nTHE URINE AS A TOXIN.\\nIt has long been generally believed that normal urine is an\\nauto-intoxicant. The well-known fact that suppression of the\\nurine is invariably followed by certain uniform toxic symptoms\\nending in death seemed to leave no further proof of the truth of\\nthis belief necessary. It was not, however, until a comparatively\\nrecent period (1881) that Feltz and Hitter first demonstrated the\\nactual toxicity of normal urine by injecting it into the blood of\\nanimals, thereby invariably invoking symptoms which were fol-\\nlowed b} T death of the animals when the dose approached a certain\\nrelative amount. These experiments were soon after repeated and\\nconfirmed by Bocchi, Schiffer, and others. Two or three years", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0177.jp2"}, "178": {"fulltext": "142 ANALYSIS OF URINE.\\nlater Dupard, Lepine, and Guerin established the special toxicity\\nof certain pathological urines which has since been confirmed by\\nnumerous observers.\\nFollowing the researches of Feltz and Hitter, Bouchard\\ncommenced the investigation of the toxicity of normal urine, and\\nveiy recently Lenoir gives a complete review of this subject, as\\ndoes Charrin. The method of investigation pursued by Bou-\\nchard 1 consisted of intra-venous injections of urine in animals\\n(chiefly rabbits), and the results would seem to have established\\nthe following conclusions\\n1. That the toxic power of normal urine as a whole is such that\\nan average of 45 cubic centimetres of urine kills 1 kilogramme of\\nliving animal and, therefore, the urine of two days and four\\nhours contains sufficient toxic matters to kill a man of 60 kilo-\\ngrammes weight.\\n2. The toxic symptoms induced by intra-venous injections of\\nurine are as follow (a) Myosis contraction of the pupils begin-\\nning with the injection of 10 cubic centimetres to 15 cubic centi-\\nmetres of urine per kilogramme the pupils contracting to pin-\\nhole size, and thus remain until after death, after which they\\nsometimes dilate, (b) The respirations become hastened and of\\ndiminished range, (c) Somnolence and coma follow, (d) Diu-\\nresis becomes marked, micturition occurring every two or three\\nminutes, (e) Marked lowering of temperature succeeds, (f) Di-\\nminished palpebral and corneal reflexes are present, (g) Death\\nsucceeds in coma or convulsions. The heart continues to\\nbeat for some time after death.\\n3. The toxicity of the urine varies with certain circumstances,\\nviz. (a) The urine is twice more toxic during the day than\\nduring the night, (b) The night urine is strongly convulsive\\nand but feebly narcotic, while the day urine is the reverse,\\nstrongly narcotic, but feebly convulsive, (c) Active muscular\\nexertion in the open air diminishes the toxic power of the urine\\none-third, and this diminution of toxicity continues for from\\ntwenty-four to forty-eight hours after cessation of the exercise.\\n4. The toxicity of the urine is not due to urea, uric acid, or\\n1 Auto-Intoxication in Disease, Ch. Bouchard. Translated by T. Oliver.\\nPublished by The F. A. Davis Co., Philadelphia, 1894.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0178.jp2"}, "179": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 143\\ncreatinin, since the injection of these substances into the blood\\nin much larger proportional amounts than those in which they\\nexist in normal urine proves non-toxic.\\n5. The toxicity of urine increases by permitting it to stand\\nsome time, as well as by increasing its temperature, even though\\nfermentation be prevented. By this means a urine that ordi-\\nnarily kills by coma becomes not only more toxic, killing in\\nsmaller doses, it also causes convulsions instead of coma.\\n6. The following facts are brought out regarding the isolation\\nof the toxic elements of the urine (a) If the urine be decolor-\\nized by charcoal it deprives it of about one-third (33 per cent.)\\nof its toxic powers, (b) An aqueous extract of the urine\\n(containing chiefly the mineral elements) causes contraction of\\nthe pupils, convulsions, and lowered temperature, but no coma,\\ndiuresis, or salivation, (c) An alcoholic extract of the urine\\nproduces somnolence, deep coma, and diuresis but it does not\\ncause contraction of the pupils or convulsions.\\nT. In acute uraemia the urine becomes non-toxic, and it may\\nbe injected into the blood in quantity equal to that of water\\n(about 90 to 120 cubic centimetres per kilogramme) before it\\nproves lethal, and then only mechanically, by interfering with\\nthe normal osmosis.\\nIt will be seen, from these investigations, that normal urine\\nowes its toxic properties not to any one, but to several constitu-\\nents and although Bouchard has not succeeded in completely\\nisolating these, yet his results are suggestive in that direction.\\nBriefly stated, his results are as follow At least seven toxic\\nagents are present in normal urine\\n1. A diuretic substance, which is fixed and of organic nature,\\nnon-removable by filtration through carbon, but is soluble in\\nalcohol. This substance answers to all the features of urea, and\\nis only toxic in enormous doses.\\n2. A narcotic substance, also fixed and of organic nature,\\nnon-removable by carbon, and soluble in alcohol. It is not\\nurea, since it does not induce diuresis but, on the other hand,\\nit causes narcosis.\\n3. A sialogenous substance which produces salivation. It\\nis only present in small amount in normal urine, and hence its", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0179.jp2"}, "180": {"fulltext": "144 ANALYSIS OF URINE.\\neffects are unobservable in quantities of urine sufficient to kill\\nfrom other contained toxic agents. This substance is stable, of\\norganic nature, non-removable by carbon, and soluble in alcohol.\\n4. Two substances capable of causing convulsions (a) One,\\nfixed, stable, of organic nature, is both retained and destroyed\\nby carbon, and is insoluble in alcohol. It is doubtless an alka-\\nloid, and is present during the day in less amount than the nar-\\ncotic substance, and also of less physiological activity than the\\nlatter, (b) A substance which causes myosis; it is fixed, organic,\\nand removable by carbon. It is probably a coloring substance\\nof normal urine.\\n5. A substance which reduces body-heat. It is fixed, of or-\\nganic nature, and insoluble in alcohol. It may also be a urinary\\npigment.\\n6. Another convulsive substance of mineral nature, which is\\ndoubtless potassium.\\nPathological Urine. In pathological conditions the toxicity\\nof the urine may become diminished, or it may. become greatly\\nincreased. As a rule, in acute infectious diseases and fevers, if\\nthe kidneys remain unaltered, the urine becomes more powerfully\\ntoxic than in health. On the other hand, in pathological states\\nof the kidneys themselves, the toxic powers of the urine become\\nmore or less diminished, according to the degree of functional\\nincapacity of the kidneys. Thus, in acute nephritis or extensive\\nchronic changes which greatly cripple the functional capacity of\\nthe kidneys, the urine may become almost non-toxic. As the\\ncondition of the kidneys improves the urine becomes more and\\nmore toxic, and this fact may be taken advantage of as a prog-\\nnostic indication in treatment. For instance, if it require 80\\ncubic centimetres of urine to kill a rabbit of 1 kilogramme weight,\\nit may be assumed- that the capacity of the kidneys is crippled\\nabout one-half (50 per cent.). If in a w r eek later 60 cubic centi-\\nmetres of urine kill a rabbit of 1 kilogramme w T eight, it furnishes\\nsubstantial evidence that the condition of the kidneys is much\\nimproved.\\nIt has already been stated that the urine in acute uraemia is\\nnon-toxic. Under such circumstances the kidneys can no longer\\neliminate the usual toxic agents from the system, and the organ-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0180.jp2"}, "181": {"fulltext": "ABNORMAL CONSTITUENTS OF URINE. 145\\nism becomes poisoned urseruic and all the phenomena described\\nas due to intra-venous injections of urine are evoked.\\nOur present knowledge of this subject warrants the statement\\nthat the healthy organism is onlv saved from lethal auto-intoxi-\\ncation by the liver and kidneys the former destroys the larger\\nproportion of the systemic toxins, and those not so destroyed\\nare eliminated chiefly by the kidneys, if the latter be healthy.\\nIn a large proportion of pathological urines (the kidnej S re-\\nmaining sound) the normal toxicity of the urine becomes in-\\ncreased, and, moreover, new toxic properties are developed,\\nnotably those with convulsive powers. Thus, in tetanus the\\nurine is powerfully toxic, and if injected into the circulation it\\nevokes most of the tetanic phenomena. M. Labbe injected the\\nurine of a tetanic patient into the circulation of an animal, with\\nthe following results After the sixth cubic centimetre (per kilo-\\ngramme) mild tremors occurred the pupils became punctiform\\nat 10 cubic centimetres. From 12 cubic centimetres violent\\ntonic spasms with convulsions occurred up to 34 cubic centi-\\nmetres. At the latter point death occurred from opisthotonos.\\nThe urine in pneumonia is strongly toxic, the symptoms\\nbeing nearly as pronouncedly convulsive as in the case of tetanus.\\nThe urine in pneumonia proves lethal in from 19 cubic centi-\\nmetres to 38 cubic centimetres per kilogramme. In typhoid\\nfever, on the other hand, Bouchard has observed that the urine\\nproduces only the toxic symptoms of normal urine death occurs\\nat from 50 to TO cubic centimetres per kilogramme with only\\nslight myosis, coma being present, but not convulsions. In leu-\\ncocythsemia the urine is highly toxic, causing convulsions and\\ndeath at 15 to 20 cubic centimetres per kilogramme.\\nThe urine possesses special and marked toxic powers in\\ncholera. Thus, C}~anosis is only produced by choleraic urine\\nmuscular cramps follow, unlike the convulsions produced by\\nother urines, since the spasms begin long after the beginning\\nof the injections, and they continue long after the injections are\\ndiscontinued. Cooling of the body is more pronounced than\\nfrom injections of any other urine. Albuminuria appears at\\nonce and in marked degree, while with normal urine albuminuria\\nis rare and only occurs late. Diarrhoea always follows injections", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0181.jp2"}, "182": {"fulltext": "146 ANALYSIS OF URINE.\\nof choleraic urine the stools become pale, watery, and devoid of\\nbile. The albuminuria increases until complete anuria occurs, in\\nabout thirty-six hours, and death soon after occurs with a rectal\\ntemperature of 33\u00c2\u00b0 or 34\u00c2\u00b0 C.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0182.jp2"}, "183": {"fulltext": "SECTION VI.\\nURINARY SEDIMENTS.\\nUrinary sediments are most conveniently classified, for pur-\\nposes of study, into two divisions, viz.. chemica s and\\nChemical s with but few exceptions, exist in the\\nform of solution in normal urine, arid their appearance as crys-\\ntalline, amorphous, or other form of sediments may result from\\nexcessive formation or excessive excretion, or alterations in the\\nurine affecting its solvent powers. The chief chemical\\nmet with in the urine are u: the urates, calcium oxalate.\\nin, leucin, tyrosin, xanthin. and phosphates.\\nThe s are in most cases foreign sub-\\nstances, and therefore do not exist in normal urine. They consist\\nrpuscles, blood, renal casts, sperma-\\ntozoa, fragments of growths, furfgi. infusoria, etc. The ana-\\ntomical eleni ind in the urine are more or less insoluble,\\nand, therefore, when the urine stands they fall to the bottom as\\nsediment.\\nOur methods of examining urinary sediments are both chem-\\nical and mici a.L Thus, the chemical deposits may often\\nbe recognized by their characteristic reactions: or the micro-\\nscope may be employ letermine the characteristic form of\\nthe deposit when crystalline, which is often of itself diagnostic.\\nIn determining the character of the anatomical deposits the\\nmicroscope constitutes the chief resource, although, in some\\ncases, chemistry materially aids the investigation.\\nSedimentation or Urine.\\nThe older method of obtaining urinary sediments for inve-::-\\nn consisted in letting the urine stand in conical vessels for\\nby-four hours o: aen the sediment would usually be\\nfound collected in the bottom of the vessel. Much difficulty was\\nformerly encountered by this method in securing sediments for\\n(147)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0183.jp2"}, "184": {"fulltext": "148 ANALYSIS OF URINE.\\nexamination which remained unchanged, since the length of time\\nnecessary to secure the deposit almost necessarily involved alter-\\nations in the urine at ordinary temperatures. Of late years this\\nhas been in a measure overcome by the addition of preservative\\nagents to the urine, such as chloral hydrate, salicylic acid,\\nresorcin, etc. These, however, all interfere with the chemical\\nexamination of the urine, more especially in making examina-\\ntions for sugar and urea. But the most serious objection to the\\nold method was the necessit}^ of waiting for several hours before\\na satisfactory microscopical examination of the urine could be\\nmade.\\nMore recent experience has demonstrated the immense ad-\\nvantages of the centrifugal method of obtaining urinary sedi-\\nments for purposes of microscopical examination. The principle\\nof this method depends upon the fact that when the urine is\\nplaced in tubes and revolved upon horizontal rotating arms at a\\nhigh speed, a centrifugal force is exerted upon all solid particles\\nin the urine hundreds of times greater than gravity and, conse-\\nquently, the urinary sediment is deposited in the bottom of the\\ntubes almost immediately, irrespective of the specific gravity of\\nthe urine or the character of the sediment.\\nOf the very large number of centrifugals at present on the\\nmarket, unfortunately but very few of them are capable of effi-\\ncient practical work, as the large number of discarded instru-\\nments of this order in medical offices to-da} T will demonstrate.\\nIn previous editions of this work the author pointed out the\\nprime essentials of the centrifuge for urinary work. Chief of\\nwhich are capability of a speed of from 1500 to 2000 revolutions\\nper minute, with a radius of at least 6J inches, and a tube\\ncapacity of 15 cubic centimetres each. These requirements have\\nnot been met by the hand-centrifugals thus far. Since the early\\neditions of this work were published the author has, with the aid\\nof Williams, Brown Earie, the manufacturers, not only\\ngreatly improved his electric centrifuge (originally designed\\nfor urinary work), but also made important additions thereto, so\\nthat it is now designed to cover the entire range of centrifugal\\nwork for medical and bacteriological purposes. Very great", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0184.jp2"}, "185": {"fulltext": "PRECIPITATION OF URINARY SEDIMENTS.\\n149\\ncredit is due to the above-named gentlemen 1 for so cheerfully\\nco-operating with the author, sparing neither pains nor time in\\ncarrying out the designs the result of which is an apparatus\\nthat the author takes pleasure in recommending as altogether\\nefficient and satisfactory in practical work. 2\\nThe author s electric centrifuge, shown in Fig. 12, can be\\noperated indefinitely on all ordinary electric currents without\\noverheating, viz. on the interrupted incandescent illuminating\\nFig. 12.\u00e2\u0080\u0094 The xYuthor s Electric Centrifuge.\\ncurrent, on the constant incandescent illuminating current, on\\nthe storage current, and on the galvanic current (sulphuric cell).\\nThe motor is furnished suitably adjusted for operation upon any\\nof these currents at any voltage from 10 to 120 volts, if the\\nnature and strength of the current be specified.\\n1 The author s electric centrifuge is exclusively manufactured by Williams,\\nBrown Earle, 918 Chestnut Street, Philadelphia.\\nQ The author has no commercial interest in the centrifugal that hears his\\nname, neither has he had at any time he therefore feels entirely free to speak\\nof its merits.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0185.jp2"}, "186": {"fulltext": "150 ANALYSIS OF URINE.\\nThis centrifugal was designed with special regard to strength,\\ndurability, efficiency, and perfect safety at the highest possible\\nrates of speed. It is easilj T capable of all grades of speed from\\n500 to 10,000 revolutions per minute, according to the strength\\nof the current employed and the resistance of the arm. With\\nthe large urine arm, it carries 1 ounce of urine at a speed of\\n2500 revolutions per minute, with a radius of 6| inches; with\\nthe double arm for four large tubes it carries 2 ounces of urine\\nat a sustained speed of 1600 revolutions per minute. With the\\nnew special arm for sedimenting micro-organisms, it easily carries\\ntwo 1 -centimetre tubes at a sustained speed of 10,000 revolutions\\nper minute, with a radius of i\\\\ inches. A speed-indicator is\\nfurnished for this motor (Fig. 12a) which indicates the exact rate\\nof speed at which the motor is operating, and the speed can be\\nFig. 12a.\u00e2\u0080\u0094 Speed-indicator.\\naccurately graded on all currents of varying voltages by means\\nof the indicator and the resister (or rheostat). In order to test\\nthe exact rate of speed of the motor, the indicator is grasped\\nfirmly between the thumb and forefinger with the dial toward the\\noperator as shown in Fig. 12a. Next place the conical rubber tip\\nof the indicator in the hollow depression on the top of the axle\\nof the motor above the arm, and press rather lightly upon the\\nindicator, when the hand on the dial will revolve more or less\\nrapidly according to the speed attained. Care should be ob-\\nserved, on the one hand, to grasp the indicator firmty between\\nthe thumb and finger lest the vibrations of the motor cause the\\noperator to lose his hold on the indicator and thus result in an\\naccident on the other hand, the indicator should not be pressed\\ntoo firmly against the axle of the motor, as this would greatly\\nincrease the friction and corresponding^ diminish the speed.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0186.jp2"}, "187": {"fulltext": "PRECIPITATION OF URINARY SEDIMENTS.\\n151\\n_\\nEach revolution of the hand on the dial indicates 100 revolutions\\nof the motor. The glass tubing is provided with aluminum\\nguards, which effectually prevent any damage from breakage.\\nThe percentage and sediment tubes for urine and bulky\\nfluids, shown in Fig. 126, were specially designed for this motor,\\nin order to avoid the defects in the old bulb-tipped Continental\\ntubes, it having been found by experience in practical work that\\nthe latter would not hold small deposits of\\nsediment in the tips. These tubes retain the\\nmost minute deposits of sediment intact,\\neven though the tubes be inverted and the\\nfluid be decanted from the sediment. The\\npercentage-tubes are accurately graduated in\\nfortieths of a cubic centimetre up to 0.5 cubic\\ncentimetres, then in fourths of a centimetre\\nup to the 15-cubic-centimetre mark, the\\nlatter to measure the reagents employed in\\nprecipitation. By means of these tubes and\\nthe methods laid down by the author accurate\\ndetermination of bulk percentage may be\\nmade with this motor of the leading normal\\nconstituents of the urine, such as chlorides,\\nphosphates, and sulphates also such morbid\\nelements in the urine as pus, blood, and al-\\nbumin with great rapidity. Thus, with the\\ndouble arm, four quantitative determinations\\nmay be made with ease in three minutes.\\nFinally, a new device for sedimenting\\nand manipulating micro-organisms has been\\nperfected and adapted to this motor. The\\namount of work and time that this device is capable of saving,\\nand the ease and certaint} r with which it isolates micro-organisms\\nin fluid media, are sufficient to render the apparatus an essential\\nof the equipment of the pathological laboratory. This device\\nconsists of an arm, as shown in Fig. 12c, twenty-three centimetres\\nin length, which carries two tubes of a little less than one cubic\\ncentimetre in capacity each. These tubes are conical at one\\nend, which fits against a soft-rubber washer at the bottom of the\\nFig. 126.\u00e2\u0080\u0094 Author s\\nPercentage Tube.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0187.jp2"}, "188": {"fulltext": "152 ANALYSTS OF URINE.\\nslot B. These rubber washers are furnished in quantity, so that\\na new one may be, if necessary, used each time the tube is em-\\nployed, or the} may be readily picked out with a fine forceps and\\nthoroughly cleaned. The large end of the tube is closed by a\\nsoft-rubber cork at A. This arm carries two of these tubes with\\nperfect ease and safety at a sustained speed of 10,000 revolu-\\ntions per minute if desired. At a much less speed from 1000\\nto 8000 revolutions per minute practical experience has demon-\\nstrated that from T5 to 80 per cent, of the micro-organisms\\npresent in the tubes are deposited within the extreme tips in\\nfrom three to five minutes.\\nDirections for Operating the Motor in Practical Work.\\nIn sedimenting urine for ordinary microscopical examination, fill two tubes\\nto the 15-cubic-centimetre mark with the urine, place them within the alumi-\\nnums turn on the current gradually,\u00e2\u0080\u0094 never abruptly in full strength, gauging\\nthe speed by the indicator until a speed of about 1200 revolutions per minute is\\nTir\\nFig. 12c\u00e2\u0080\u0094 Arm for Sedimenting Micro-organisms.\\nattained. With urines of about normal specific gravity, continue this speed for\\ntwo or three minutes. With urines of very low specific gravity, 1000 revolutions\\nare sufficient if there be much sediment. With urines of very high gravity and\\nlittle sediment it is well to increase the speed to about 1500 revolutions and main-\\ntain it for two or three minutes. The sediment is best manipulated by means of a\\nnipple pipette about eight inches in length, as follows After thoroughly cleans-\\ning the pipette slowly carry its point down the tube to within an inch and a half\\nof the tip then stop and expel from 5 to 10 bubbles of air from the point by\\ngentle pressure upon the rubber nipple. Next carry the point of the pipette\\nfirmly to the bottom of the tube and draw in about 5 drops of the sediment.\\nRemove the pipette and expel from its point two or three drops of the sediment\\nupon a previously cleaned glass slide, upon which is a three-fourths- inch ring of\\ngold size (rather thickly laid on and dried) within the ring. Next cover with a\\ncover-glass, and take up the excess of urine with a strip of filter-paper, and the\\nslide is ready for examination. This form of slide is better than the ordinary\\nslide with ground-out cell, because it affords a perfectly flat field. The advantage\\nof the temporary mounting is that it can be examined at any angle of light\\nunder the microscope.\\nThe contents of serous cavities, cysts, abscesses, and, in short, all media\\nobtained by means of aspiration, may be dealt with in the manner just described.\\nPercentage determinations, by the author s standard method, of chlorides,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0188.jp2"}, "189": {"fulltext": "PRECIPITATION OF URINARY SEDIMENTS. 153\\nphosphates, and sulphates have already been described in a previous section of\\nthis work (pages 63 to 66). The author s quantitative method for albumin has\\nalso been detailed on page 83. The bulk percentages of pus and blood may be\\ndetermined by simply filling the percentage-tubes with the urine to the 10-cubic-\\ncentimetre marks, placing them in the aluminums, and revolving at the 6ame\\nspeed and length of time as in the case for albumin. In order to obtain the\\nauthor s uniform results in percentage determinations, care must be exercised to\\nemploy the stated speed, length of time of revolutions, and the motor must be\\noperated with exactly 6%-inch radius. It must be obvious to any intelligent\\nperson that, with tubes of varying capacities and form, different lengths of arms,\\nand with no grading of speed whatever, uniform or accurate results are impos-\\nsible, and that such methods are mere guess-work.\\nMicro-organisms, In sedimenting micro-organisms, remove the large arm\\nfrom the motor and in its place adjust the arm for the small tubes shown in\\nFig. 12c. In searching for micro-organisms in bulky media, such as the urine, it\\nis best first to throw down the coarse pus-sediment in the large urine-tubes by\\nFig. 12d.\\nabout 2000 revolutions for four or five minutes. Next, with a pipette take up\\nrather more than one centimetre of this sediment from the large tube remove\\nthe soft-rubber cork from the small tube at J., and, while holding the finger very\\nfirmly over the point B, transfer the sediment from the pipette to the small tube,\\nwhich must be filled to overflowing in order to prevent the ingress of air-bubbles.\\nNext, while still holding the finger firmly over the point of the small tube, press\\ndown the soft-rubber cork with a twist until it is about half-way into the large\\nend of the tube. Next, draw back the spring in the arm of A; insert the point\\nof the tube in the hollow at B, pushing it firmly against the rubber washer; let\\ngo the spring at A, and the tube will be firmly locked in the arm. Next turn on\\nthe current and increase it until the indicator shows a speed of at least 5000 to\\n7000 revolutions per minute, and continue this speed for about two to three\\nminutes. Remove the tube from the arm by drawing back the spring at A\\n11", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0189.jp2"}, "190": {"fulltext": "154 ANALYSIS OF URINE.\\nhave at hand a clean glass slide, and place the point of the small tube on the\\nmiddle of the slide, and by gentle pressure with the thumb or finger (as shown\\nin Fig. 12d) on the top of the soft-rubber cork, a drop, or, if need be, a fraction\\nof a drop, of the now-highly-concentrated sediment may be deposited precisely\\nwhere it is required to be stained and prepared for examination under a high\\npower. It will be seen that, proceeding as above directed, the search for micro-\\norganisms sparsely scattered through bulky media, as, for instance, tubercle\\nbacilli in urine, is rendered easy and almost absolutely certain, because prac-\\ntically we obtain 75 to 80 per cent, of the micro-organisms in one ounce of uiine\\nconcentrated within one or two minims, and manipulation results in no loss\\nwhatever.\\nWith media of smaller bulk, as sputum, etc., it may be placed directly in\\nthe small micro-tubes after such preparation as individual preference shall de-\\ntermine, and sedimentation is carried out as already described. The sediment\\nmay then be transferred to the slide with the greatest possible ease and precision,\\nas already detailed, and examined under the microscope for elastic fibres,\\nCharcot- Leyden crystals, tubercle bacilli, etc.\\nIn working with sputum, urine containing much mucus, fibrinous exudates,\\nand media that is very viscid and tenacious, it will be found that the micro-\\nFig. 12e.\\norganisms will be more quickly and more completely sedimented if the media be\\nfirst thoroughly broken up and liquefied, and this can be very readily and quickly\\ndone with the author s apparatus for the purpose figured here. 1 Slight dilution\\nof viscid media, such as sputum, with physiological salt solution greatly assists\\nin liquefaction, and does not interfere with subsequent staining.\\nThe Hcematokvit Attachment. The haematokrit first suggested by Blix, for\\nthe purpose of determining the percentage and relative proportions of the red\\nand white corpuscles of the blood is readily adjusted to the small arm of this\\nmotor. The haematokrit consists of a graduated glass tube 50 millimetres in\\nlength and 0.5 millimetre bore to receive the blood. The tube is marked by a\\nscale ranging from to 100, the scale being rendered visible by a lens front\\n(prism form). The outer end of the tube fits into a small cup-like depression at\\nthe end of the arm, the bottoms of which are covered with the rubber disks\\nalready shown, while the inner extremity is held in position by the spring at B.\\nMessrs. Sharp Smith, of 92 Wabash Avenue, Chicago, make and keep\\nthese instruments in gfcnek.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0190.jp2"}, "191": {"fulltext": "PRECIPITATION OF URINARY SEDIMENTS. 155\\nTo use the haematokrit in blood-examinations proceed as follows The rubber\\ntube with mouth-piece at one end is slipped over the end of the haematokrit and\\nthe latter is filled by suction on the mouth-piece from a drop of blood obtained\\nby a prick of the finger. The blunt end of the tube is next quickly covered with\\nthe finger tip, and the tube is inserted into the arm in the same manner as ad-\\njusting the tubes for micro-organisms. The current is next turned on and the\\nspeed increased gradually to 10,000 revolutions per minute, and thus steadily\\nmaintained for from two to three minutes. The haematokrit may next be re-\\nmoved and the percentage of red corpuscles is read off from the scale. In health\\nthe volume of red corpuscles is about 50 per cent. One per cent, by volume\\nrepresents about 100,000 red blood-corpuseles therefore, by adding five ciphers\\nto the percentage of volume it gives the number of red corpuscles in one cubic\\nmillimetre of blood. Thus, in a given ease, if the reading were 25; multiply\\nthat number by 100,000, and the product, 2,500,000, would represent the number\\nof red blood-corpuscles in one cubic millimetre of blood. The amount of haemo-\\nglobin in each corpuscle may be approximately determined, also, by dividing the\\nquantity of haemoglobin ascertained by Fleischl s or Gowers s instrument by the\\nnumber of corpuscles determined by means of the haematokrit.\\nThe white blood-corpuscles, or leucocytes, will be found to occupy a second,\\nFig. 13.\\nbut much shorter, column immediately above the column of red corpuscles, and,\\nif leucocytosis be present, even though to a very slight degree, it is easily\\nrecognized.\\nThe accurate regulation and determination of speed by this motor greatly\\nimproves determinations of blood, by means of the haematokrit, rendering the\\ntedious and tiresome use of cytometers no longer necessary.\\nFurther details in reference to the adjustment of this centrif-\\nugal to the various electric currents that may be available, and\\nits establishment in working order in the laboratory or office,\\nwill be cheerfully furnished by the manufacturers upon applica-\\ntion and the author cannot but commend the satisfactory\\nmanner in which they have thus far met the requirements de-\\nmanded.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0191.jp2"}, "192": {"fulltext": "156 ANALYSIS OF URINE.\\nCHEMICAL SEDIMENTS.\\nLlTHURIA.\\nUric-acid crystals occur as a sediment rarely, if ever, in other\\nthan sharply-acid urine. They differ from all other urinary de-\\nposits in possessing a deep-yellow or orange-red color they may\\nat times be pale yellow, but are never colorless. The crystalline\\nnature of this deposit may usually be detected readily by the\\nnaked e} r e. The essential or primary form of the uric-acid crystal\\nis that of rhombic prism, and the great variety in which it is\\nfound all constitute combinations or modifications of this form.\\nThus, the angles may be nearly equal, forming quadrangular\\nplates, or sometimes nearly cubes may be seen. Again, they\\nmay be seen with rounded ends, forming ovoids or circles. Elon-\\ngated crystals are sometimes observed, and these frequently join\\nat one end, forming stars. The beauty and variety of these star-\\nshaped clusters are very marked. (See Plate Y.) Sometimes\\nfan-shaped forms are produced by elongation of the crystals in\\none direction only, instead of the star form. The rough and\\npointed forms of uric-acid crystals are claimed by Ultzmann to\\nbe of diagnostic significance, being almost always an accom-\\npaniment of renal calculi. For properties and tests of uric acid,\\nsee Section II, pages 30 to 36.\\nUric acid possesses a strong tendency to crystallize upon\\ncontact with any solid substance, organic or inorganic. This\\nmay be observed by its behavior in a vessel upon standing, when\\nit will often be noted that the crystals cling to the sides of the\\nglass or to threads or specks suspended in the urine. This ten-\\ndency renders it more liable than any other crystalline deposit\\nto form around some nucleus in the urinary channels, and ulti-\\nmately form gravel. This is one of the reasons why nearly TO\\nper cent, of the stones found in the bladder are of the uric-acid\\nvariety.\\nThe deposit of uric-acid crystals can only be regarded as of\\npathological import when the deposit occurs shortly after the\\nurine is voided, say, within four to six hours. It has already\\nbeen shown that perfectly healthy urine usually deposits uric-\\nacid crystals after standing ten or more hours. But, on the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0192.jp2"}, "193": {"fulltext": "PLATE V.\\nUric Acid Crystals with Amorphous Urates,\\n(After Peyer.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0193.jp2"}, "194": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0194.jp2"}, "195": {"fulltext": "CHEMICAL SEDIMENTS. 157\\nother hand, if uric acid be precipitated from the urine shortly\\nafter it cools.it very justly forms the foundation for fear that\\nthe same may occur before it be voided, and thus give rise to\\nthe formation of calculi and gravel, with the long train of painful\\nsymptoms entailed by such conditions. Before speaking of the\\npathological conditions which usually attend deposits of uric\\nacid, it may be well to allude to the conditions of the urine\\nwhich favor such deposits.\\nSir William Roberts, who has carefully investigated this\\nsubject recently. 1 makes the following interesting observations:\\nThe presence of uric acid in human urine is somewhat anom-\\nalous, as it is not needed as a vehicle for the elimination of\\nnitrogen. Its place is taken by urea, which, by its easy solu-\\nbility, is better adapted to the liquid urine of animals. Perhaps\\nuric acid is a vestigial remnant in mammalian descent. But,\\nalthough physiologically insignificant, uric acid is pathologically\\nthe most prominent component of the urine, chiefly because of\\nits tendency to form concretions.\\nAll acid urines tend inevitably to deposit their uric acid\\nsooner or later. The time of onset of precipitation varies from\\na few hours to five or six days, or even longer. The inference\\nfrom this is that pathological gravel is due to an exaggeration\\nof conditions which exist in a less pronounced degree in health.\\nTo get at an explanation of this spontaneous precipitation it is\\nnecessary to examine the states of combination of uric acid in\\nthe urine.\\nUric acid (C 5 H 4 X 4 3 =H 2 F) is a bibasic acid, and forms\\ntwo regular orders of salts, namely, neutral or normal urates\\n(M 2 U) and acid urates or biurates (MHXJ) 2 But. in addition\\nto these, it forms a series of hyperacid combinations, first discov-\\nered by Bence Jones, and termed by him qua dr urates (MHU.H 2 XJ).\\nThe neutral urates are never found in the animal body, and are\\nonly known as laboratory products. The biurates are only\\nencountered pathologically as gouty concretions. The quad-\\nrurates, on the other hand, are especially the salts of uric acid.\\nThey constitute the exclusive combination in which uric acid\\n1 Proceedings of the Medico-Cbirurgical Society, 1S90, p. So.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0195.jp2"}, "196": {"fulltext": "158 ANALYSIS OF URINE.\\nexists in solution in normal urine, and they become visible some-\\ntimes as the amorphous urate sediment. The urinary excretion\\nof birds and reptiles is composed exclusively of quadrurates.\\nThe special and characteristic reaction of quadrurates is that\\nthe} T are immediately decomposed by water into free uric acid\\nand biurates. They exist in acid urine in the presence of water\\nand of superphosphates. These conditions necessarily involve\\nthe ultimate liberation and precipitation of uric acid. The first\\nstep is the breaking up of the quadrurate by the water of the\\nurine into free uric acid and bin rate, according to the following\\nequation\\n(MHtJ.H 2 IJ) H 2 (H 2 U) (MHtJ).\\nQuadrurate. Free uric acid. Biurate.\\nThis explains the liberation of half the uric acid. But the\\nbiurate thus formed is forthwith changed in the presence of\\nsuperphosphates into quadrurates. Thus\\n2(MHtJ) (MH a P0 4 =(MHIJ.H 2 tJ) (M 2 HP0 4\\nBiurate. Superphosphate. Quadrurate. Dimetallic phosphate.\\nBy these alternating reactions all the uric acid is at length set\\nfree. 1\\nSeeing that uric acid exists in acid urine (that is, for some\\nsixteen hours out of the twenty-four), amid conditions which,\\nif the quadrurates stood alone and uncontrolled, would lead to its\\nimmediate precipitation, and yet that in the normal course no\\nsuch early precipitation occurs, it is obvious that the urine must\\ncontain certain ingredients which inhibit or greatly retard its\\nwater from breaking up the quadrurates. These inhibitory in-\\ngredients consist chiefly of (1) the mineral salts and (2) the\\npigments of the urine. The conditions of the urine which tend\\nto accelerate the precipitation of uric acid, as in the formation\\nof concretions and deposits, are (1) high acidity, (2) poverty in\\nmineral salts, (3) low pigmentation, and (4) high percentage of\\nuric acid. The converse conditions tend to retard precipitation.\\nOn the interaction of these factors the occurrence or non-\\noccurrence of uric-acid precipitation appears to depend, and\\n1 In these formulae the symbol M represents a monad metal, and the symbol\\nU the radicle C 5 H 2 N 4 3", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0196.jp2"}, "197": {"fulltext": "CHEMICAL SEDIMENTS. 159\\nprobably the most important of these factois is the grade of\\nacidity.\\nClinical Significance. Uric-acid sediments are perhaps most\\noften encountered in acute fevers and inflammations attended by\\npronounced elevation of temperature. In such cases there is\\ndiminution of the aqueous elements of the urine, entailing in-\\ncreased acidity. As a consequence of increased tissue meta-\\nbolism, there is also absolute increase of uric acid, as of most\\nother urinary solids. In the so-called uric-acid diathesis there\\nis often an habitual and pronounced deposit of uric-acid crystals\\nin the urine. The causes of this state are partly defective\\nphysiological action of the liver, and partly errors in diet,\\ncoupled with sedentary habits of life; and it is often accom-\\npanied by headache, emaciation, and hypochondriasis. Since\\nthis condition is induced by fault} habits of living which entail\\noverwork of the liver, with defective supply of oxygen, it in\\nnowise merits the name of diathesis.\\nIn the early stages of interstitial nephritis, uric-acid deposits\\nare often to be observed indeed, the urine frequently throws\\ndown this deposit habitually for some time before the interstitial\\ndefect is made known by pronounced symptoms. This is due to\\ntwo causes (a) the polyuria of the early stages of the disease\\nlessens the relative amount of coloring matters in the urine,\\nand it will be remembered that the pigments tend to hold the\\nuric acid in solution (b) both interstitial nephritis and uric-\\nacid deposits are often the outgrowth of the same habits of\\nliving, viz., the overindulgence in animal foods. The author has\\nrepeatedly observed that people who possess generous appetites,\\nand indulge in the use of animal foods two and three times\\ndaily, are exceedingly apt to have uric-acid deposits in their\\nurine at middle age, and somewhat later to develop interstitial\\nnephritis. Uric-acid deposits are frequent in cases of children\\nconvalescing from scarlatina, with or without accompanying ne-\\nphritis, and concretions or gravel are very prone to arise under\\nsuch circumstances.\\nUrates.\\nThe acid urates of sodium, potassium, ammonium, and, more\\nrarely, of calcium are met with as sediments in the urine.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0197.jp2"}, "198": {"fulltext": "160\\nANALYSIS OF URINE.\\nThe acid urate of sodium occurs chiefly as minute, irregular,\\namorphous granules, although sometimes, also, in crystalline\\nform, star-shaped, needle-like clusters, often of fan-shape ar-\\nrangement. This deposit is more or less deeply stained brown\\nor pink, according to the degree of pigmentation of the urine,\\nsince it possesses a great affinit^y for the above-named pigments.\\nThe sodium-urate deposit occurs in acid urine, and forms a\\nlarge bulk of the brick-dust, or mixed urate, deposit found in\\nFig. 14.\u00e2\u0080\u0094 Soditjm-Urate Crystals. (After Peyer.)\\nthe bottom of the vessel after the urine has cooled. Acid\\nsodium urate is extremely insoluble, requiring 1150 parts of cold\\nor 124 parts of boiling water to effect its solution.\\nAcid potassium urate occurs only in amorphous form as a\\ndeposit, and, like sodium urate, forms a part of the mixed urate\\ndeposit met with in acid urines. It is much more soluble than\\nthe sodium urate.\\nAcid calcium urate occurs as a urinary deposit but rarely,\\nand in minute quantities. It consists of a white or grayish", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0198.jp2"}, "199": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0199.jp2"}, "200": {"fulltext": "PLATE VI.\\nAmmonium Urate, showing Spherules and Thorn-\\napple-shaped Crystals. (After Peyer.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0200.jp2"}, "201": {"fulltext": "CHEMICAL SEDIMENTS. 161\\namorphous powder, highly insoluble, and on fusion leaves a\\nwhite residue, consisting of calcium carbonate. The acid calcium\\nurate, like the potassium and sodium urate deposits, occurs only\\nin acid urine.\\nAmmonium urate occurs as a crystalline deposit, consisting\\nof dark-brown, spherical masses studded with fine, sharp-pointed\\nspicula, thorn-apple crystals. The spicula may be long,\\nsometimes curved, branched, or bent, forming various shapes.\\n(See Plate VI.) The smaller crystals often closely resemble\\nthose of sodium urate, and by some they are claimed to be\\nidentical.\\nThis sediment most frequently occurs in alkaline urine,\\nassociated with amorphous calcium phosphate and triple phos-\\nphate crystals. The ammonium-urate deposit is, in fact, the\\nonly urate sediment found in alkaline urine.\\nThe mixed urate deposit consists of a reddish, granular-\\nlooking sediment, with color always deeper than the urine from\\nwhich it precipitates. It may vary all the way from a faint\\npinkish haze to a brick-red color. (See Plate V.) Most fre-\\nquently it sinks quickly to the bottom of the quiescent vessel,\\nbut part of it may long remain suspended, imparting to the\\nurine an opalescent turbidity at the same time a pellicle may\\nform on the surface or cling to the sides of the vessel, notably\\nat the surface-line of the urine. By gently heating the urine the\\nmixed urate sediment promptly dissolves, and this forms a\\nready method of its recognition, as no other urinary deposit\\nbehaves similarly. The mixed urate deposit gives the murexide\\nreaction similar to uric acid. It is dissolved by solutions of\\nthe caustic alkalies with mineral acids it is decomposed, with\\nresulting precipitation of nric-acid crystals.\\nIt is an interesting fact that urines of high density are most\\nprone to throw down deposits of mixed urates, while those of lower\\ndensity are more apt to throw out of solution uric acid. Thus,\\nwith urines of specific gravity at 1026 to 1030. when the} cool,\\nthe excess of urates come down because of their limited degree\\nof solubility; while in urines of specific gravity below 1020. the\\ndiminished pigmentation often permits the uric acid to fall out\\nof solution and form a deposit.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0201.jp2"}, "202": {"fulltext": "162 ANALYSIS OF URINE.\\nClinical Significance. The mixed urate deposit, like that of\\nuric acid, is most frequently encountered in febrile states even a\\nslight elevation of temperature is often sufficient to cause their\\ndeposit. A more constant deposit of mixed urates may be noted\\nin diseases of the viscera, which entail progressive emaciation,\\nnotably in the liver and in the so-called wasting diseases. Func-\\ntional disorders of the stomach are frequently associated with\\namorphous urate deposits, due, in all probability, to incomplete\\ntransformation of proteid foods. In gout the urates are usually\\ndeposited during the attack, but disappear upon the approach\\nof convalescence.\\nOXALURIA.\\nOxalate of lime is met with as a urinary sediment either in\\nacid or alkaline urine, but most often in the former. If it occur\\nin acid urine it is often associated with uric-acid deposits, but\\nwhen occurring in alkaline urine its most frequent associated\\ndeposit is the triple phosphate.\\nThe calcium-oxalate deposit occurs in crystalline form, con-\\nsisting chiefly of two varieties of crystals, (a) and most frequent\\nare the octahedral ciystals, very beautiful and highly refracting.\\nThey are made up of four-sided pyramids, situated base to base,\\nas seen in their long diameters. When viewed from the side\\nthey appear as squares crossed obliquely by two sharp lines,\\nforming the characteristic envelope-shaped crystals. When\\nsmall, the lines crossing in the centre form a bright spot, highly\\nrefractive of light, star-like. (6) The second form of calcium-\\noxalate deposit is the so-called dumb-bell crystals. Their true\\nform is that of ovoid or circular disc, with round margins and\\ndepressed at the centre on either side. Their variable appear-\\nance depends upon their different positions when viewed, as ma} r\\nbe seen by causing the crystals to roll over under the cover-\\nglass.\\nCalcium oxalate is insoluble in alcohol, ether, water, alkalies,\\nand acetic acid, but readily soluble in hydrochloric or other\\nmineral acids, characteristics which serve to identify this salt;\\nbut in practice the microscopical appearance is the most conclu-\\nsive, since the crystals are so characteristic in form that they are\\nreadily distinguishable from all other crystalline deposits the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0202.jp2"}, "203": {"fulltext": "CHEMICAL SEDIMENTS.\\n163\\ndeposits of triple phosphate and uric acid are the only ones\\nwhich have the least resemblance thereto.\\nWith regard to the triple-phosphate crystals, it is only the\\nsmaller, imperfect, and short prisms that are ever confounded\\nwith calcium-oxalate crystals. In such cases the body of the crys-\\ntals, instead of forming a parallelogram, is shortened so that it\\nbecomes a square, and the prism then gives somewhat the ap-\\npearance of the envelope-shaped calcium-oxalate crystal. The\\nFig. 15.\u00e2\u0080\u0094 Various Forms of Calciu.m-Oxalate Crystals. (After Peyer.)\\ncalcium-oxalate crystals, however, are always smaller and more\\nhighly refracting. Should any doubt remain, after careful ocular\\nexamination, they may be readily distinguished by their behavior\\nwith acetic acid, which promptly dissolves the triple-phosphate\\ncrystals, while the calcium oxalate is unaffected thereby.\\nThe dumb-bell form of uric acid may usually be distin-\\nguished from the calcium-oxalate crystals of similar form by the\\nbrown color of the former, as well as by their solubility in\\nalkalies.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0203.jp2"}, "204": {"fulltext": "164 ANALYSIS OF URINE.\\nClinical Significance. The occurrence of calcium oxalate as\\na urinary deposit is brought about by the strong affinity which\\noxalic acid possesses for calcium. Oxalic acid occurs under\\nphysiological conditions in very small amounts in urine, about\\n0.02 gramme in twenty-four hours. According to generally\\nreceived opinion, it exists in the form of calcium oxalate, which\\nis kept in solution by the acid phosphates of the urine. The\\nquality of food taken often materially influences the degree of\\nphysiological oxaluria. Thus, vegetables containing much oxalic-\\nacid combinations, as cabbage, spinach, asparagus, sorrel,\\napples, grapes, tomatoes, turnips, and sugar, when taken in\\nexcess, may cause excretion of calcium oxalate in considerable\\namount. Calcium oxalate is also excreted in excess upon an\\nexclusive or excessive diet of flesh and fat, indicating its forma-\\ntion from proteids.\\nThe question of so-called oxalic-acid diathesis possesses\\nmuch practical interest. As early as 1842, Bird described a\\nseries of nervous and dyspeptic symptoms, which he alleged\\nwere associated with deposits of calcium oxalate in the urine.\\nLater on, Bigbie still more minutely described the symptoms\\nof the so-called oxalic-acid diathesis of which the following\\nis a brief summary These patients are mostly males in the\\nprime of life, ordinarily of sanguineous or melancholy tempera-\\nment, of sedentary habits, and accustomed to overindulgence\\nin the luxuries of the table. Indigestion in its varied forms\\nis a prominent feature. These patients are often capricious,\\nsensitive, irritable, or dull, despondent, and melancholic. The\\ntongue is coated and the skin is dry. In inveterate cases a\\ndirty, dingy countenance, increasing emaciation, falling out of\\nthe hair, tendency to boils, carbuncles, psoriasis, and other cuta-\\nneous disorders are frequently observable. Accompanying these\\nure often deep pains in the back and loins, hsemorrhages from\\nthe intestines and bladder, incontinence of urine, impotence and\\nirritation of the bladder.\\nAttractive though the theory be of the so-called oxalic-acid\\ndiathesis in the light of more recent and wider observation\\nthe name diathesis seems in nowise merited by any of the\\nstates associated with deposits of calcium oxalate in the urine.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0204.jp2"}, "205": {"fulltext": "CHEMICAL SEDIMENTS. 165\\nIt is true that oxalic acid, when taken internally in any consid-\\nerable amount, exerts a poisonous action upon the organism, not\\nonly locally on the intestines, but also generally on the heart and\\nnervous s} r stem and this gave rise, no doubt, to the supposition\\nthat a large formation of oxalic acid or its retention in the system\\nmight produce toxic, and even dangerous, symptoms. Distinct\\nproof, however, is yet lacking to show that the symptoms of the\\nso-called oxalic-acid diathesis are due to an accumulation of\\noxalic acid in the blood. Indeed, nearly all the evidence tends\\nin the opposite direction. In the first place, large deposits of\\ncalcium oxalate, and even the formation of oxalic calculus, is\\nrepeatedly observable in people who are otherwise in the enjoy-\\nment of the most tj^pical good health. In the second place, the\\ngroup of symptoms described as characteristic of the oxalic-\\nacid diathesis, as Roberts has observed, is one common to the\\nclinician minus the deposits of calcium oxalate. Lastly, the\\nstates of the system associated with deposits of calcium oxalate\\nare altogether too varied to admit of so narrow a classification\\nas that of a special diathesis. It seems most reasonable to con-\\nclude that oxaluria is dependent upon a variet}^ of conditions of\\nthe system, many of which are associated with little or no\\ndeparture whatever from ordinar}^ health.\\nThe conclnsions of Beneke, who has thoroughly investigated\\nthis subject, are as follow\\n1. Oxaluria accompanies the lighter or severe forms of ill-\\nness has its proximate cause in an impeded metamorphosis,\\ni.e. in an insufficient activity of that stage of oxidation which\\nchanges oxalic acid into carbonic acid.\\n2. Oxalic acid has its chief source in the azotized constit-\\nuents of the blood and food; hence, everything which retards\\nthe metamorphosis of these constituents gives rise to oxaluria.\\n3. Such retardation of the metamorphosis of azotized ele-\\nments of the blood may be determined b}^ the following causes\\n(a) excessive use of azotized articles of food (b) excessive use\\nof saccharine and starchy articles of food; (c) insufficiency of\\nthe red blood-corpuscles, entailing diminished oxidation (d) in-\\nsufficient access to pure fresh air; (e) organic lesions which in\\nany way impede respiration and circulation; (f) conditions of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0205.jp2"}, "206": {"fulltext": "166\\nANALYSIS OF URINE.\\nthe nervous system entailing depression, whether arising pri-\\nmarily from mentnl derangement or from pathological states of\\nthe blood.\\n4. Excess of alkaline bases in the blood.\\nPhosphaturta.\\nIt has already been shown in Section II that phosphorus\\nexists in normal urine in combination with the alkalies and the\\nearths, the alkaline and earthy phosphates. It is only, how-\\nFig. 16.\u00e2\u0080\u0094 Triple-Phosphate Crystals. (After Ultzmann.)\\n1. Rosette or star-shaped crystals. 2. Coffin-shaped crystals.\\never, the latter salts that are met with as urinary deposits. The\\nearthy phosphates consist of {a) triple phosphate or ammonio-\\nmagnesiuin phosphate, and (6) calcium phosphate or phosphate\\nof lime.\\nAmmonia-magnesium phosphate (MgNH 4 P0 4 6H 2 0), or triple\\nphosphate, is essentially a crystalline deposit, occurring in two\\nforms. The first most frequent and typical form is that of a\\ntriangular prism with beveled ends, very distinctive and often\\ntermed coffin-shaped crystals. Many modifications of this\\ntypical form are met with. Thus, the crystals may be shortened", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0206.jp2"}, "207": {"fulltext": "CHEMICAL SEDIMENTS.\\n1GT\\nto the form of squares, instead of being oblong, or one or more\\ncorners may be absent.\\nThe second and less frequent form in which triple phosphate\\nappears as a urinary sediment is that of star-shaped, feathery\\ncrystals, the points appearing not unlike fern-leaves. These are\\noften but rudiments of the prismatic form of triple-phosphate\\ncrystals, into which latter they often become gradually trans-\\nFig. 17.\u00e2\u0080\u0094 Calcium-Phosphate Crystals. After Peyer.)\\nformed, and therefore between these two forms numerous inter-\\nmediate ones are to be observed (Pig. 16),\\nCalcium phosphate is met with as a urinary sediment in two\\nforms. (a) amorphous, (b) crystalline. The amorphous form\\nof calcium phosphate is a whitish, flocculent deposit, often mis-\\ntaken by the naked eye for pus or granular organic matter, and\\nwhen precipitated from the urine by heat it is sometimes mis-\\ntaken for albumin. Under the microscope this sediment appears\\nin the form of minute, pale granules, arranged in irregular\\npatches.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0207.jp2"}, "208": {"fulltext": "168 ANALYSIS OF URINE.\\nThe crystalline form of calcium phosphate is a comparatively\\nrare deposit, occurring less frequently than any other form of\\nphosphatic deposit. Its essential or elementary form is that\\nof crystalline rods, sometimes lying unarranged, but more often\\ngrouped in stellar or rosette form, while often they may be\\nobserved grouped in club or wedge form, but always marked by\\nlines of crystallization (Fig. 17). The earthy phosphates are\\nessentially a product of alkaline urine, and, with the exception,\\nof the crystalline form, they are never met with in acid urine.\\nThe above-named exception only occurs with feebly -acid urine\\ntending to ammoniacal change.\\nThe following are the chief conditions of the urine which lead\\nto phosphatic sediments\\n(a) If the urine be alkaline from fixed alkali.\\n(6) If the earthy phosphates be in excess (the urine being\\nalkaline or neutral).\\n(c) If the urine be alkaline from volatile alkali, the result of\\ndecomposition of urea into ammonium carbonate in the urinary\\npassages, the ammonia uniting with the magnesium phosphate\\nto form the triple phosphate of ammonium and magnesium.\\nClinical Significance. In those cases in which the phosphatic\\ndeposit occurs in alkaline urine from fixed alkali, the deposit is\\nchiefly precipitated calcium phosphate, though often mixed with\\ntriple-phosphate crystals. The urine in these cases is usually\\nof high specific gravity, alkaline in reaction when voided, more\\nor less cloudy, and effervesces upon the addition of acid, after\\nwhich the urine immediately clears. The clinical symptoms cor-\\nresponding to the above are often those of general debilit}\\nwith feeble respiration favoring the accumulation of carbonic\\nacid in the system. Thus, in convalescence from exhausting\\nacute diseases, deposits of calcium phosphate are frequently to\\nbe noted. Flatulent dyspepsia is a frequent cause of alkaline\\nurine from fixed alkali and the deposit of calcium phosphate.\\nAs Ralfe has pointed out, the acids formed by fermentative\\nchanges being of the fatty acid series, upon entering the blood\\nthey are oxidized into carbonic acid, and, uniting with the bases\\nof the alkaline oxides from carbonates of these bodies, increase\\nthe alkalescence of the blood and in consequence diminish the.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0208.jp2"}, "209": {"fulltext": "CHEMICAL SEDIMENTS. 169\\nacidity of the urine or even render it alkaline, which permits the\\nphosphates to fall out of solution. This is most frequently\\nnoted in debilitated persons with flatulence of the small intes-\\ntine. It is associated with such features as loss of weight,\\nirregular bowels, sallowness of complexion, despondency, and\\nfrequent micturition.\\nIn those cases in which the deposit of calcium phosphate is\\nthe result of excessive elimination, very often marked systemic\\ndisturbances are associated therewith. The urine is usually\\nalkaline, copious in volume, and the deposit is of dense whitish\\nform. If persistent, the symptoms are usually those of nervous\\nirritability, dyspepsia, emaciation, and backache. Sometimes\\nsymptoms akin to diabetes are observable in inveterate cases,\\nand the condition has been called phosphatic diabetes/ 1 Indeed,\\nit is claimed that this condition not infrequently ends in diabetes\\ninsipidus.\\nThe deposit of the crystalline form of calcium phosphate in\\nquantity is, in the experience of Roberts, often an accompani-\\nment of some grave disorder. such as cancer of the pylorus,\\nphthisis, and exhaustion from obstinate chronic rheumatism.\\nIn cases of phosphatic deposits in the urine resulting from\\nthe presence of volatile alkali, the sediment, as before stated, is\\nthat of triple phosphate of ammonium and magnesium. It has\\nalready been shown that ammoniacal fermentation always occurs\\nin healthy urine upon standing sufficiently long, and then the\\ntriple phosphates are precipitated. But in the class of cases\\nunder present consideration the urine is alkaline when voided\\nand precipitation of triple phosphates takes place immediately.\\nIn these cases ammoniacal decomposition of the urine occurs in\\nthe urinary passages. In addition, therefore, to the triple-\\nphosphate deposits in such cases, the urine also contains pus\\nand more or less mucus.\\nThe clinical symptoms attending this state of the urine are\\nmost often those of septic inflammations of the urinary passages,\\nsuch as pyelitis and cystitis. The most frequent class of causes\\nof this condition of urine are the obstructive diseases of the\\nlower urinary conducting channels. Whatever cause operates\\nto retain the urine in the bladder sooner or later gives rise to\\n12", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0209.jp2"}, "210": {"fulltext": "170 ANALYSIS OF URINE.\\ncystitis and the deposit of triple-phosphate crystals. Thus, in\\nenlarged prostate, atony and paralysis of the bladder, paraplegia,\\nand diseases of the lower spinal cord, the urine nearly always\\nprecipitates the triple phosphates. This condition of urine\\nnearly alwaj^s precedes so-called surgical kidney and those\\nseptic conditions so dangerous to life which result from the use\\nof instruments in the lower urinary channels. Therefore, when\\nthe urine is found to contain deposits of triple phosphate with\\npus, and is alkaline when voided, it constitutes a signal for the\\nexercise of the greatest possible caution on the part of the sur-\\ngeon in passing instruments into the urethra and bladder for the\\nfirst time, more especially in the cases of elderly men.\\nIt is well known that men addicted to exhaustive mental\\nlabor and people laboring under worry and anxiety are apt to\\nhave precipitates of earthy phosphates in their urine. If to\\nsuch conditions be added habits of vegetarianism, which tend\\nto depress the acidity of the urine, triple phosphates in addition\\nmay readily fall out of solution and form deposits.\\nCystinuria.\\nCystin (C 3 H 6 NS0 2 is comparatively rarely met with as a\\nurinarj^ deposit. Its origin in the economy is not clearly under-\\nstood, although its highly sulphurous composition (about 25 per\\ncent.), together with its close resemblance in composition to\\ntaurin, suggest the possibility that the liver may be its source.\\nThe discovery of ej^stin in the livers of typhus patients by\\nScherer, as well as the discovery of C} T stinuria in cases of dimin-\\nished bile secretion by Marowski, would further favor the above\\nview. Stadthagen claims that C}^stin is absent from normal\\nurine, though Goldman and Baumann succeeded in separating it\\nin very small quantities from healthy urine as a benzojd com-\\npound.\\nCystin is a crystalline compound of feeble chemical affinities,\\nand occurs in two forms, (a) most commonly in six-sided tablets\\nof variable sizes, and somewhat resembling the six-sided ciystals\\nof uric acid. These tablets possess an opalescent lustre,\\nmother-of-pearl appearance, and when traced with fine lines\\nof secondary crystallization, or formed into rosettes, they pre-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0210.jp2"}, "211": {"fulltext": "CHEMICAL SEDIMENTS.\\n171\\nsent microscopical pictures of great beauty, (b) The second\\nform of cystin crystals is that of four-sided square prisms, which\\nlie separately or in stellate form. They are highly refractive,\\nand when their sides lie out of the direct line of vision they\\nappear almost black, forming a strong contrast with those sides\\npresented vertically to the light, which appear of a brilliant-white\\ncolor. Cystin is soluble in the caustic alkalies, oxalic and strong\\nFig. 18.\u00e2\u0080\u0094 The More Common Form of Cystin Crystals. (After Peyer.)\\nmineral acids. It is insoluble in boiling water, acetic acid, alco-\\nhol, and ether.\\nDifferentiation. Cystin may be readily distinguished from\\nthe pale, lemon-colored, six-sided crystals of uric acid, as follows\\nPermit a drop of ammonia to mingle with the deposit on a glass\\nslide, when either form of crystals disappear. Next, evaporate\\nand if cystin be present the crystals re-appear, showing that they\\nwere merely in solution. If, on the other hand, the crystals\\nwere uric acid, no re-appearance occurs upon evaporation, but.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0211.jp2"}, "212": {"fulltext": "1*2 ANALYSIS OF URINE.\\ninstead, crystals of ammonium urate appear, showing chemical\\ncombination, and not solution.\\nAnother simple method consists in treating the crystals with\\noxnlic or hydrochloric acid, which promptly dissolves cystin\\ncrystals, but leaves uric acid unchanged.\\nFrom triple-phosphate crystals cystin is readily distinguished\\nby its behavior with acetic acid, the former being immediately\\ndissolved therewith, while cystin remains unchanged.\\nThe urine containing cystin is usually pale in color, of faintly-\\nacid reaction, and upon standing develops the odor of sulphu-\\nretted hydrogen, as well as that of ammonia. The sediment is\\nof pale-lemon color, and often changes to green upon standing.\\nClinical Significance. Unfortunately but little at present of\\na positive nature is known as to the clinical relations of cystin-\\nuria. Its frequent association with hepatic disorders may be\\nsaid to be established. Cystin deposits are said to be results of\\nextensive renal degenerations. Chlorotic women and strumous\\nchildren are also believed to be prone to cystic deposits in their\\nurine. Ebstein has noted the presence of cystin deposits together\\nwith albumin in the urine in cases of acute articular rheumatism.\\nCystin deposits have been known to occur repeatedly in the same\\nfamily by a number of independent observers, among whom are\\nMarcet, Lenoir, Civiale, Toel, and Ebstein. Cystin calculus\\nis well known to run in certain families. Cystinuria is said to\\nbe most common in young males, although no age or sex can be\\nsaid to be exempt from it. It may be present and continue for\\nyears without any noticeable impairment of health.\\nThe chief interest connected with cystic deposits is their\\nproneness to form concretions of cystin gravel and although\\nthese are comparatively rare occurrences, their consequences are\\nnone the less serious when occasionally encountered.\\nLeucinurta and Tyrosinuria.\\nLeucin (C 6 H 13 N0 2 and tyrosin (CgH^NOg^as will be seen\\nfrom their formulae, are closely related, being products of decom-\\nposition of proteid bodies or of their derivatives. Since they are\\nnearly always found associated with each other in the urine, they\\nwill be considered together.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0212.jp2"}, "213": {"fulltext": "CHEMICAL SEDIMENTS.\\nLex cin occurs as a urinary sediment for the most part in\\nform of yellowish, highly-refracting though not qui:\\nhigh, ring as oil-globules, which they somewLa: resemble.\\nIn a pure state it 3 in scales or re settes, often of in Bg-\\nular shapes, and it has greasy feel Leacin is insoluble in\\nether, which readily distinguishes it from oil-glo boles. It is\\nins I able in mineral acids, but is partly soluble in water and alcohol\\nand is coin; soluble in caustic alkalies. For ordinary\\nFig ::-:.:t:3axd Liz; :y. Aftei ?eyer.)\\npractical purposes leucin may be known by the microscopical\\n:\\\\rance of the crystals, and in this way very minute t:\\nmay be determined with certainty. Confirmation by chemical\\ntests maybe employed if a fair amount of the material be at\\nhand, (a) Thus, solutions heated with proto-nitrate of mercury\\ngive deposits metallic mercury (Hoffineister). (6) When\\n1 with nitric acid on platinum-foil it k i less i e sidue.\\nwhich if heated with in hydrate forms drops of an oil-like\\nfluid which do not adhere to the platinum (Scherer). (c) I", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0213.jp2"}, "214": {"fulltext": "174 ANALYSIS OF URINE.\\nbeating leucin in a glass tube open at both ends to about 1*70\u00c2\u00b0 C.\\nit sublimes in feathery particles, which float about in the air\\nwithin the tube. Further heat causes it to fuse and mostly dis-\\nappear into carbonic acid and amilymin. Leucin may be sepa-\\nrated from the urine by evaporating the latter and dissolving the\\nresidue in boiling alcohol. Upon cooling the leucin present will\\nbe deposited in whitish plates or masses. Leucin is normally\\npresent in the liver, pancreas, spleen, tymph glands, salivary\\nglands, and in the thyroid and thymus glands.\\nTyrosin crystallizes in the form of very fine needles, arranged\\nin sheaf-like collections. In masses the crystals are snow-white,\\ntasteless, and odorless. If crystallized from an alkaline solution\\ntj-rosin often assumes the form of rosettes composed of fine\\nneedles arranged radiately (Fig. 19). Tyrosin is insoluble in\\nalcohol and ether, feebly soluble in cold water, readily soluble in\\nacids, alkalies, and hot water. Aside from its crystalline form\\nand characteristic solubilities, tyrosin may be readily recognized\\nby several pronounced reactions.\\n(a) Hoffmann 1 s Reaction. When heated with Millon s reagent,\\nsolutions of tyrosin yield a brilliant crimson or pink coloration,\\nwhich, if much tyrosin be present, is accompanied finally by a\\nsimilarly-colored precipitate. The test in its original form was\\napplied by heating with a solution of mercuric nitrate in presence\\nof nitrous acid. 1\\n(b) Piria s Reaction. If tyrosin be moistened on a watch-\\nglass with concentrated sulphuric acid, and warmed for five or\\nten minutes on a water-bath, it turns pink, owing to the formation\\nof tyrosin-sulphonic acid,\u00e2\u0080\u0094 C 9 H 10 (SO 2 OH)]S T O 3 2H 2 0. This\\nis then diluted with water, warmed, neutralized with barium\\ncarbonate, and filtered while hot. The filtrate yields a violet\\ncolor on the careful addition of very dilute perchloride of iron.\\nThe color is readily destroyed b}^ an excess of the iron salt.\\n(c) Tyrosin gives out the odor of phenol and nitro-benzol\\nupon heating (Kuhn). Tyrosin may be separated from the\\nurine by first precipitating the coloring matters and extractives\\nof the urine by means of basic lead acetate, then decomposing\\nthe filtrate with sulphydric acid and again filtering. Upon\\n1 Liebig s Annal., Bd. lxxxvii, 1853, S. 124.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0214.jp2"}, "215": {"fulltext": "CHEMICAL SEDIMENTS.\\n17;\\nevaporating the filtrate to the thickness of syrup, tyros in crys-\\ntals will be deposited upon cooling.\\nClinical Significance. Leucin and tyrosin, as already stated,\\nusually occur together, and this applies both to the urine and the\\norganism at large. Being products of decomposition of proteids,\\nthey form in the system in very minute quantities, if at all,\\nduring normal metamorphosis. When metamorphic changes of\\na retrograde nature are rapid, as in extensive suppuration and\\ngangrene, the} r form in large amounts. They ma} in such cases\\npass into the urine, largely supplementing urea.\\nLeucin and t} T rosin are found in the urine in acute atrophy\\nof the liver, in acute phosphorus poisoning, often in very con-\\nsiderable amounts. The} have also been observed in the urine in\\ncases of leucocythsemia, typhoid, and small-pox.\\nMel anuria.\\nMelanin is a black pigment which occurs pathologically in\\nthe urine under various circumstances. It is insoluble in cold\\nalcohol, ether, acetic acid, and dilute mineral acids. It is soluble\\nin boiling, strong mineral acids, in boiling acetic and lactic\\nacids, and in strong solutions of sodium, potassium, and am-\\nmonium hydroxid.\\nMelanin contains carbon, nitrogen, iron, and sulphur, the\\nlatter in large amount. The urine containing melanin is not\\nusually dark when voided, but it soon becomes so upon exposure\\nto the atmosphere, and it becomes intensely black if submitted to\\nsuch oxidizing agents as sulphuric and hydrochloric acids and\\nchloride of iron. Melanin occurs as a urinary deposit in the\\nform of small, lump} granules, much resembling carbon parti-\\ncles. In the urine it may be detected by several reactions\\n(a) By the addition of bromine-water to urine containing\\nmelanin a yellow precipitate is deposited, which gradually\\nblackens. This is considered by Zeller the most delicate test\\nfor melanuria. (b) When melanotic urines are treated with solu-\\ntions of ferric chloride, they yield, according to the concentra-\\ntion of the reagent, either a dark-brown cloudiness or else a\\nblack precipitate, soluble in excess of the precipitant. This test\\nis both delicate and characteristic, (c) When melanin is present", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0215.jp2"}, "216": {"fulltext": "176 ANALYSIS OF URINE.\\nin the urine, if treated with a dilute so kit ion of nitro-prusside\\nof sodium and some caustic potassium be added, a pink or red\\ncoloration usually appears, which turns blue on the addition of\\nacids, owing to the formation of Prussian blue. The latter\\nreaction is not due to the melanotic pigment, but to some other\\nsubstance simultaneously excreted.\\nClinical Significance. Melanuria is frequently observed in\\npeople who are subjects of pigmented tumors, notably melanotic\\ncancer or sarcoma. It has also been observed in people suffering\\nfrom repeated attacks of intermittent fevers. The urine of\\npeople in wasting diseases sometimes contains considerable de-\\nposits of melanin. The practical significance of melanuria, as\\nJaksch has pointed out, is greatly weakened b} T the facts that the\\nurine may contain a large quantity of melanin in wasting dis-\\neases, while in melanotic cancer or sarcoma the urine may be free\\nfrom it. For diagnostic purposes, therefore, so far as sarcoma\\nis concerned, it should only be regarded as adjunct.\\nLipurta.\\nNormal urine contains small amounts of fatty matter, pal-\\nmatin, and stearin, about 2 grains per gallon. It is probable\\nthat these neutral fats are increased upon a fatty diet, since\\nnumerous cases are recorded in which fat has been found in\\nabnormal quantities unaccompanied by pathological conditions.\\nFat is soluble in hot alcohol, ether, benzol, carbon disulphide,\\nand chloroform. When mixed with colloids in an alkaline solu-\\ntion, fat is broken up into fine globules, becoming white like\\nmilk, an emulsion. Under the microscope fatty sediments\\nappear in the urine in the form of highly-refracting globules of\\nvarious sizes, with dark and somewhat irregular margins. If the\\nurine contain fat in considerable quantity, it is usually of a milky\\ncolor, but this readily clears bj shaking it with ether.\\nClinical Significance. Small quantities of fat are frequently\\nmet with in the urine in chronic parenchymatous nephritis, in\\nfatty changes in the kidne} r s, in phosphorus poisoning, and in\\ndiabetes mellitus. In one case of diabetes mellitus the author\\nmet with a large amount of fat in the urine, the occurrence of\\nwhich was intermittent, alternating with the appearance of sugar.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0216.jp2"}, "217": {"fulltext": "CHEMICAL SEDIMENTS. 177\\nRalfe also states that he found an abundance of oil-globules in\\nthe urine of a patient who died of diabetic coma. Ebstein\\nfound a large amount of fat in the urine in a case of hydro-\\nnephrosis. Lipuria is a physiological condition with pregnant\\nwomen. Roberts has recorded several cases in which pure oil\\nappeared in the urine after the administration of codliver-oil.\\nHenderson has reported three cases of lipuria associated with\\nheart disease.\\nIn diseases of the pancreas lipuria is not uncommon, and\\nin such cases lipuria has appeared before oil was to be noted in\\nthe stools. Fat is also frequently observed in the urine after\\nfracture of bones and during the course of repair. In acute\\nT ellow atrophy of the liver, followed by fatty changes in the\\nrenal epithelium, the urine contains an excess of fatty matters.\\nIn chyluria the urine contains a large amount of fatt} T matters\\nas well as albumin and blood-corpuscles. The features of this\\ndisease, however, will be fully considered in a future section of\\nthis work.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0217.jp2"}, "218": {"fulltext": "SECTION VII.\\nANATOMICAL SEDIMENTS.\\nHEMATURIA.\\nBlood-corpuscles appear as a urinaiy sediment in a number\\nof conditions, all of which are pathological. Their appearance\\nvaries according to the character of the urine in which they\\nare found, and the location of the tract from which they exude.\\nThe typical microscopical appearance of blood-corpuscles is so\\ncharacteristic that little difficulty is encountered in distinguishing\\nthem from all other urinary sediments (Fig. 20). Their original\\nform is that of biconcave discs of }^ellowish color. In focusing\\nFig. 20.\u00e2\u0080\u0094 Normal Blood-corpuscles. (After Peyer.)\\nwith the fine adjustment of the microscope, the margins of the\\ncorpuscles undergo reversal of light and shade owing to their bi-\\nconcave form. Blood-discs are distinguished from pus-corpuscles\\nby the absence of visible cell-contents and nuclei of the former.\\nIn acid urine blood-corpuscles long retain their characteristic\\nfeatures, although in time they shrivel somewhat, and become\\ndentated at their margins more or less stellate in form. In urine\\nthey do not, as a rule, tend to run together, or to form rouleaux\\nas when drawn from a blood-vessel, but are for the most part\\ndistributed pretty evenly over the field of vision. Exceptions to\\n(178)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0218.jp2"}, "219": {"fulltext": "ANATOMICAL SEDIMENTS. 1 7 9\\nthis rale sometimes occur in cases of pronounced haemorrhage\\nfrom the bladder or urethras.\\nIf the urine be concentrated the biconcave character of blood-\\ncorpuscles becomes exaggerated, but the corpuscles shrink some-\\nwhat and are more apt to become indeutated or jagged at their\\nmargins. On the other hand, if the urine be dilute i.e.. of low\\nspecific gravity the corpuscles swell and become biconvex, or\\neven spherical, and at the same time they lo e their optical\\ncharacteristics as well as their coloring matters. This occurs\\nthe more readily if the urine be aminouiacal.\\nThe urine containing blood is usually cloudy and more or less\\nreddish in color, according to the quantity present. If the quan-\\ntity of blood be considerable and the urine be acid the color is\\ndark red. but if the urine be alkaline the color is bright red. If\\nthe quantity of blood in the urine be small the color may give\\nno indication of its presence, especially if the urine be concen-\\ntrated. Generally speaking, if the blood come from the kidneys\\nit is diffused evenly through the urine, imparting to the latter a\\nreddish, hazy tint. If. on the other hand, the blood be derived\\nfrom the lower urinary tract, the color is usually bright, and clots\\nare not infrequently present. Lastly, if blood appear in the urine\\nin quantities however small, a distinct albuminous reaction is\\na 1 w a y s o bt a i n abl e\\nClinical Significance. The clinical significance of hematuria\\nembraces a very wide and varied class of pathological conditions.\\nIn order, therefore, to afford any practical information it must\\nfirst be determined from what source the hematuria arose.\\nIn haemorrhages from the kidney the urine is usually of an\\nhomogeneous, reddish-brown color, of acid reaction, of lowered\\nspecific gravity, and it often contains renal casts and renal\\nepithelium. After standing the urine deposits more or less\\nbrown, coffee-colored sediment. If pyelitis be present, the urine\\nmay have an alkaline reaction. In hae uraturia of renal origin\\nclots are usually absent from the urine, unless they be of the\\nlong, slender, rod-like variety, showing that they have been\\nmolded in passing through the ureters. The recognition of\\nblood-casts in the urine forms the most conclusive proof of the\\nrenal origin of hematuria. The most frequent cause of renal", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0219.jp2"}, "220": {"fulltext": "180 ANALYSIS OF URINE.\\nhematuria is the class of renal diseases grouped together under\\nthe term of Bright s disease. In the acute forms of these lesions\\nhaematuria is nearly always present. The haemorrhage is not\\nvery pronounced in these cases, being of parenchymatous origin.\\nIt usually subsides with the more acute symptoms of the disease.\\nOf the chronic Bright s lesions the interstitial form is the most\\nfrequent cause of haematuria, and in such cases the haemorrhage\\nis the most pronounced and obstinate of all renal haemorrhages,\\nexcept that from malignant and cystic disease of the organs.\\nThis is due to the accompanying vascular changes, including\\ncardiac enlargement and atheromatous arteries.\\nAmyloid disease less frequently gives rise to haematuria,\\nalthough it is by no means rare in such cases, since the small\\nrenal vessels in this disease undergo pronounced degenerative\\nchanges. In chronic diffuse inflammatory lesions of the kidney\\nhaematuria is almost unknown.\\nMalignant growths of the kidney give rise to most trouble-\\nsome, profuse, and repeated attacks of haematuria. Such cases\\nare to be recognized by renal tumor, pain, and general cachexia\\nof the patient. Tubercular disease of the kidney not infrequently\\ngives rise to haematuria. The urine in such cases contains more\\nor less pus and broken-down tissue debris which do not alto-\\ngether subside as a sediment. Haematuria from tuberculosis,\\nlike in cancer, is intermittent in character, and there may also be\\npresent tumor, but usually no pain. The diagnosis rests upon the\\ngeneral symptoms of tuberculosis, such as emaciation, elevation\\nof temperature, etc. but most conclusively upon the isolation\\nand propagation of the bacillus tuberculosis from the urine.\\nRenal calculus, whether confined to the kidney or, as is more\\nfrequent, when occupying the renal pelvis, nearly always gives\\nrise to haematuria sooner or later. In these cases the haemor-\\nrhage is most marked upon exercise, and usually diminishes or\\nsubsides upon continued rest. Pus-cells are always present in\\nthe urine in haematuria of calculous origin. Fixed pain in the\\nregion of the kidney, usually with tenderness upon deep pressure\\nover a certain point, sometimes retraction of the testicle as well\\nas reflected pain upon the affected side, often extending down the\\nleg, serve to diagnosticate haematuria of calculous origin.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0220.jp2"}, "221": {"fulltext": "ANATOMICAL SEDIMENTS. 181\\nIn endemic hematuria of the tropics the cause is due to a\\nminute parasite in the kidney Bilharzia hsematobi which will\\nbe described later on. Among the other causes of hematuria of\\nrenal source may be mentioned cystic disease of the kidneys,\\nabscess, renal embolism, hydatids, acute febrile processes, purpura\\nhemorrhagica, uterine and crural phlebitis. Renal hematuria\\nmay arise from the ingestion of certain drugs, as turpentine, can-\\ntharidis, and a number of toxic substances. Lastly, hematuria\\nof renal origin may arise in consequence of traumatisms involving\\nthe kidneys, either directly as by blows or wounds, or indirectly\\nfrom concussion.\\nIn vesical hematuria the urine is usually alkaline in reaction,\\nalways so if accompanied by cystitis of long standing. In such\\ncases the urine is ammoniacal and thick from muco-pus, and\\ncrystals of triple phosphate are usually present. In vesical\\nhematuria clots are more common than in other forms of haemor-\\nrhage. These are usually of an irregular or ragged shape. The\\nblood is brighter in color and less intimately mixed with the\\nurine than in hematuria of renal origin. Stone in the bladder\\nis perhaps the most frequent cause of hematuria of vesical\\norigin, and, in such cases, the blood is almost normal in appear^\\nance and is passed mosthr at the close of the act of micturition.\\nThe grade of hematuria in these cases depends largely upon the\\nacuteness of the attack. In cystitis of the vesical neck the\\nsymptoms closely resemble those of stone. The most pronounced\\nhematuria of vesical origin is that associated with villous\\ngrowths and carcinoma of the bladder-walls. The urine is\\nusually normal in quantity and specific gravity in such cases,\\nand the reaction is usually feebly acid. The sediment is brownish\\nred, flocculent,and often contains flesh-colored fibres and shreds.\\nThe quantity of blood may be so pronounced in these cases as\\nto cause coagulation within the bladder, or, as is more frequent,\\nshortly after the urine is voided. Tesical hematuria is also\\ncommon with neoplasms of the organ, fibrous tumors, polypi,\\nand varicose conditions of the vesical neck.\\nHematuria of urethral origin may be known by the hemor-\\nrhage preceding the flow of urine as well as between the acts of\\nmicturition, the urine itself being usually unaltered in any of its", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0221.jp2"}, "222": {"fulltext": "182\\nANALYSTS OF URINE.\\nessential characters. It may arise from acute gonorrhoea, neo-\\nplasms, traumatisms, urethral chancre, or from surgical operations\\nsuch as cutting or divulsion of strictures.\\nPyuria.\\nPus ma} T be derived from any part of the urinary tract and\\nappear in the urine as a sediment. The urine containing pus is\\nalways more or less turbid when voided, and gives the albuminous\\nreaction. In their normal state pus-corpuscles appear under the\\nFig. 21.\u00e2\u0080\u0094 Pus-corpuscles. (After Ultzmann.)\\n1. Normal corpuscles. 2. Pus-corpuscles with prolongations showing amoeboid move-\\nments. 3. Pus-corpuscles with nuclei rendei ed distinct by acetic acid. 4. Pus-coi*puscles\\naltered by chronic pyelitis. 5. Pus-corpuscles swollen by ammonium carbonate.\\nmicroscope as circular, pale, finely-granular discs, averaging in\\nsize nearly double that of the red blood-corpuscle. They contain\\ndistinct nuclei, which are often multiple, two or three. If pus\\nbe diluted with water, the corpuscles may be observed to slowly\\nswell up and become paler, with more delicate outlines. This\\nprocess is more quickly produced by acetic or other organic acid,\\nwhich renders the nuclei very distinct, but causes the granulated\\nappearance of the cell-protoplasm to disappear (Fig. 21).\\nPus-corpuscles are similar to, indeed practically identical\\nwith, mucous corpuscles, the white corpuscles of thp blood and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0222.jp2"}, "223": {"fulltext": "ANATOMICAL SEDIMENTS. 183\\nlymph. When examined in the fresh state they exhibit the\\namoeboid movements, and also show the usual glistening appear-\\nance of living protoplasm. As seen in the urinary sediment,\\npus-corpuscles are dead, the protoplasm being coagulated into\\ncoarse granules.\\nThe chief constituents of pus-corpuscles are albuminous bodies,\\nof which the largest proportion is nucleo-albumin. which is in-\\nsoluble in water, and which expands into a tough, slim}^ mass\\nwhen treated with sodium-chloride solution. This substance is\\nsoluble in alkalies, but quickly changed thereby into Rovida s\\nhyaline substance. Besides this pus-corpuscles contain an albu-\\nminous substance which coagulates at 49\u00c2\u00b0 C, as well as serum-\\nalbumin and peptone. The cell-protoplasm also contains, in addi-\\ntion to the above, lecithin, cholesterin, xanthin bodies, fat, soaps,\\nand cerebrin. In pus from congested abscesses which have\\nstagnated some time there is peptone, leucin, and ty rosin, free\\nfatty acids and volatile fatty acids, such as formic acid, butyric\\nacid, valerianic acid. Pyin also is a specific constituent of\\npus, a nucleo-albumin precipitable by acetic acid.\\nPus may be derived either from the free mucous surface of\\nthe urinary tract, an ulcer, or from tissue-substance, and in each\\ncase it is likely to be mixed with elements from its place of\\norigin which become of great diagnostic value. In addition to\\nthis pus-corpuscles themselves frequently contain micro-organ-\\nisms which explain the pathological conditions of the parts from\\nwhence they are derived. Pus-corpuscles are greatly changed\\nby contact with potassium or ammonia the corpuscles swell\\nup and coalesce into an homogeneous, sticky mass, in which all\\nbut the nuclei are indistinguishable by the microscope. Ani-\\nmoniacal urine containing pus deposits a vitreous-looking, slimy\\nmass, so sticky that in decanting it from a vessel it slips out en\\nmasse. The peculiar behavior of pus with caustic alkalies just\\nalluded to forms the principle of Donnes s test for pus, by which\\nthe latter may usually be known without recourse to the micro-\\nscope. The test is performed as follows After the sediment has\\nsettled to the bottom of the glass or test-tube, pour off the\\nsupernatant urine and add liquor potassa? to the deposit.\\nIf the sediment be pus it is at once converted into a glairy,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0223.jp2"}, "224": {"fulltext": "184 ANALYSTS OF URINE.\\ngelatinous-like substance which adheres to the glass or flows in\\na mass.\\nThe turbidity of the urine containing pus, as well as the sedi-\\nment itself, often resembles that due to the pale, granular urates.\\nThe distinction, however, is easy, since heat dissipates the\\nturbidit} r due to urates, while it only serves to increase the cloud\\ndue to the presence of pus by coagulating its contained albumin.\\nThe pus-deposit also frequently resembles the earthy phosphatic\\nsediment, but the distinction here is also easy. The addition of\\nan acid promptly dissolves the phosphate deposit, while it only\\nincreases the turbidity due to pus by coagulating its contained\\nalbuminous elements.\\nClinical Significance. Of all sediments met with in the urine\\nthat of pus is the most common. Any affection of any part of\\nthe urinary tract, from the slightest forms of irritation up to the\\ngravest lesions, are usually accompanied by pyuria. The clinical\\nsignificance of pyuria, therefore, embraces a wide range of\\npathological conditions.\\nThe first point to be determined, if possible, is to locate the\\nparticular field of the urinary tract from whence the pus origi-\\nnated. This may often be determined by the general characters\\nof the urine, together with the nature of the accompanying de-\\nposits. When pus originates from the kidney or renal pelvis\\nthe urine is most apt to retain its normal acidity. Round epi-\\nthelium and even casts may be present, and if so it gives the\\nmost conclusive evidence of the source of the pyuria, especially\\nthe presence of casts. When the pyuria has its source in the\\nkidney or renal pelvis the pus is intimately mingled with the\\nurine when voided, but it quickly settles upon standing, forming\\na whitish, flocculent sediment. The absence of bladder symp-\\ntoms in pyuria goes far toward establishing the renal source of\\npyuria.\\nPyuria is usually associated with such renal lesions as chronic\\ndiffuse inflammations, pyonephrosis, pyelonephritis, cancer, tu-\\nberculosis, and nephritic abscess. In pyelitis, either of calculous\\nor obstructive origin, pyuria is always a prominent accompanying\\nsymptom.\\nWhen pyuria is of vesical origin the urine is often alkaline", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0224.jp2"}, "225": {"fulltext": "ANATOMICAL SEDIMENTS. 185\\nammoniacal when voided; if not, it soon becomes so upon\\nstanding. The urine is likely also to contain considerable mucus\\nso that the deposit is more glairy and sticky than in renal pyuria.\\nIn addition to pus the urine is likel} to contain such associated\\ndeposits as amorphous and triple phosphates and flat epithelium\\nin excess from the bladder-walls. Local symptoms such as fre-\\nquent and painful micturition aid in pointing to the source of\\nthe pus-formation.\\nCystitis of all grades is always associated with pyuria, and\\nthe quantity of pus-deposit in these cases is often pronounced.\\nObstructive cystitis, vesical stone, ulceration, tuberculosis, and,\\nin short, all bladder affections are ordinarily associated with\\npyuria.\\nIn uncomplicated diseases of the prostate pus appears fre-\\nquently in the urine, often in the form of threads long drawn\\nout. Somewhat similar threads of muco-pus appear in the urine\\nin chronic gonorrhoea. These are often rolled into little balls\\nby the stream of urine as it flows down the urethral canal. The\\npyuria in acute gonorrhoeal conditions is almost self-evident as\\nto its source. If any doubts arise upon the question they may\\nbe readily settled by directing the urethra to be flushed, when\\nthe urine voided immediately after will be free from pus, if of\\nurethral origin.\\nDetermination of Blood and Pus in the Urine. When, as is\\nfrequently the case, the urine contains a very considerable quan-\\ntity of blood or pus, it is of practical importance to be able readily\\nto determine the amount of either from day to da} in order to\\nestimate the results of treatment. This may be rapidly accom-\\nplished by means of the author s percentage tubes and centri-\\nfuge. The process consists simply in sedimenting the urine in\\nthe percentage tubes until the urine is clear, the sediment being\\ncompletely packed in the tips of the tubes, when the bulk per-\\ncentage may be read off from the scale.\\nEpithelium.\\nEpithelium from some part of the urinary tract usually\\nforms a part of every urinary deposit, and, furthermore, it is usual\\nto find scattering epithelial cells in the urine when the latter is in\\n13", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0225.jp2"}, "226": {"fulltext": "186 ANALYSIS OF URINE.\\nall respects normal. Epithelium is the normal product of mucous\\nsurfaces, and may be expected to be found in small amounts in\\nany given sample of healthy urine. But in diseased states of the\\nurinary tract the lining epithelium is often thrown off in very\\nconsiderable amount, forming plainly-visible urinary sediments.\\nIt was formerly believed that the various divisions of the\\nurinary tract possessed their own special forms of epithelium, and,\\ntherefore, the special forms of epithelial cells found in the urine\\nbecame valuable aids in locating the seat of lesions of the urinary\\ntract. This view is, indeed, still held by a number of prominent\\nobservers. More accurate and extensive observations, however,\\nhave shown that this can only be depended upon in a very\\ngeneral way. Very often the epithelium claimed to be charac-\\nteristic of certain divisions of the urinary tract has been found\\nin all its typical peculiarities in a totally different location. This,\\nhowever, is the more likely to be the case in divisions most\\nnearly located to each other. The divergent views upon this\\npoint, held even by the ablest and most experienced observers,\\nmay be illustrated by the following Sir William Roberts\\ndescribes the epithelium shed from the renal pelvis as that of\\nvery irregular, spindle-shaped, tailed, three-cornered, elongated,\\nrudely circular, etc. Dr. Dickinson has carefully figured the\\nepithelium taken from the bladder, and, in reply, laconically\\nobserves It will be seen that these varieties of form, even to\\nthe et caetera, are equally characteristic of vesical disease.\\nThe epithelium in the urine may be classed under three\\ndivisions (Fig. 22) (a) Small round cells, spheroidal, finely\\ngranular, with comparatively large nuclei and nucleoli, the latter\\nexcentrically located. They occur singly or collected into groups\\nin the latter case often cohering rather firmly, so that they float\\nabout in masses. They sometimes contain fatty matter, when\\nspringing from long-diseased locations. These cells may be\\nfound in their most typical form in the convoluted tubes of the\\nkidney. They also occur in the deep laj^ers of the mucous tract\\nof the renal pelvis, bladder, and male urethra. These cells are\\nto be distinguished from pus-cells by their somewhat larger size,\\nlarger and more distinct single nucleus, requiring no acetic acid\\nto develop or bring the nucleus into view. No positive conclu-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0226.jp2"}, "227": {"fulltext": "ANATOMICAL SEDIMENTS.\\n187\\nsions can be drawn from the mere appearance of these cells in\\nthe urine in reference to the precise location from which the}\\noriginated. It may be the kidney, renal pelvis, ureter, bladder,\\nurethra, or urethral glands. If, in a given deposit, the round\\ncells in their typical form greatl} predominate, and if the urine\\ncontain albumin and there be other evidences of renal disease,\\nit may be inferred that the cells come from the kidney, (b) The\\nsecond form of epithelium met with in the urine is the columnar\\nvariety. These cells are of irregular, though always elongated,\\nform. They are described as caudate-, spindle-, and cjdindrical-\\nshaped. They are inclined to angularity in outline, and, like the\\nround cells, have a well-marked nucleus, visible without the\\nFig. 22.-\\n-Epithelitjm from Various Parts of the Urinary Tract.\\n(After v. Jaksch.)\\na, at, squamous epithelium; b, bt, bff, epithelium from the bladder; c, cf, ctf, cfff,\\nepithelium from the kidney d, df, fatty epithelium from kidney e to h, epithelium from\\nthe bladder.\\naction of reagents. They may occur singly or in groups. The\\ncolumnar epithelium may be derived from the superficial layer\\nof the mucous membrane of the renal pelvis, or from the deep\\nlayers of the bladder, ureters, or urethra. The statement of\\nEbstein, 1 that tailed epithelial cells associated with pyuria con-\\nstitute the most positive evidence of pyelitis, is quite untenable.\\nMore recent and accurate observation has amply demonstrated\\nthat these cells exist in all their typical forms throughout the\\nwhole urinary tract, excepting the kidney itself, (c) The third\\nvariety of epithelium met with as a urinary sediment is the\\n1 Von Ziemssen s Cyclopaedia of Medicine, vol. xvi, p. 574,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0227.jp2"}, "228": {"fulltext": "188\\nANALYSIS OF URINE.\\nsquamous or pavement form. These cells are large, flat, some-\\nwhat rounded, though irregular in outline, and have a distinct\\nand usually central nucleus, very prominent without the aid of\\nreagents. These cells are derived chiefly from the bladder and\\nvagina in the latter case the cells are usually larger than those\\nfrom the bladder.\\nClinical Significance. As already stated, little more than\\ninferences are to be drawn from the appearance of a particular\\nform of epithelium in the urine, as to the precise location of its\\norigin. While certain forms of epithelium predominate upon the\\nsuperficial surface of the mucous tract in certain locations, the\\ndeeper layer always contains transition cells, which approach\\nmore nearly those of the surface kyer in other locations. In\\ndiseased conditions, therefore, cells are thrown off from both the\\nsurface and deep layers, and the epithelium is nearly always,\\naccordingly, of mixed varieties.\\nBut if we are unable to locate the anatomical seat of a lesion\\nby the character of the deposited epithelium, we may, neverthe-\\nless, gather information of value as to the nature of the patho-\\nlogical condition present from the exfoliated cells found in the\\nurinary sediment. With regard to renal lesions, it may be stated\\nthat practically the whole class of so-called B right s lesions are at-\\ntended by epithelial sediments in the urine. In the acute diffuse\\ninflammations of the kidney the round epithelial cells from the\\nurinary tubes are often thrown off in large quantity, so as to form\\na very considerable sediment. For the most part, in such cases,\\nthe epithelium is in a good state of preservation, the nuclei and\\noutlines of the cells being sharply marked. In the more chronic\\nlesions of the kidney the round epithelium appearing in the\\nsediment is often fatt} r the space between the nuclei and cell-\\nwalls being sometimes filled with oil-globules. The cells them-\\nselves are often partly disintegrated or broken down, presenting\\na ragged appearance. These partly-disorganized cells may often\\nbe seen adhering to renal casts, or they may themselves become\\nadhered together, forming casts.\\nIn chronic interstitial nephritis and uncomplicated amyloid\\ndisease of the kidne} r s but little desquamation from the renal\\ntubules occurs, and in these cases the fewest round cells occur in", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0228.jp2"}, "229": {"fulltext": "ANATOMICAL SEDIMENTS. 189\\nthe urine. On the other hand, in acute scarlatinal nephritis the\\nnumber of round epithelial cells in the urine is sometimes enor-\\nmous. In acute congestive conditions of the kidney a very\\ndecided deposit of round cells are sometimes met with in the\\nurine, without other pronounced changes in the latter save\\nalbuminuria.\\nIn pyelitis and diseases of the renal pelvis considerable de-\\nposits of epithelium are met with, and in such cases, although\\nround cells may be present, the tailed and spindle-shaped cells\\ncolumnar are more apt to predominate.\\nIn cystitis there is more or less deposit of large flat epi-\\nthelium. If the cystitis be of mild grade or largely confined to\\nthe superficial surface of the mucous coat of the bladder, the large,\\nflat, irregular-shaped epithelium predominates, but in cystitis\\ninvolving the deeper layers the large flat cells are more likely to\\nbe mingled with the columnar variety.\\nURINARY CASTS.\\nUrinary casts have always and very properly been regarded\\nof the highest diagnostic value. They were probably first seen\\nby Vigla and Raver, but the able investigations of Henle and\\nRovida gave to the profession the most complete information as\\nto their character and significance.\\nThree chief views have been held as to their nature and mode\\nof production\\nFirst, that they are the result of disintegration of the epi-\\nthelium of the renal tubules, the resulting products becoming\\npacked into molds by the pressure of urine, until at length they\\nslip through the smaller convoluted into the large straight tubes\\nand appear in the urinary sediment.\\nSecond, that they consist of a secretion of the morbidly\\nirritated epithelium lining the renal tubules, which become caked\\ninto molds and are washed down with the urine.\\nThird, that they consist of coagulable elements of the blood\\nwhich gains access to the renal tubules through pathological\\nlesions of the latter, and that any free or partly-detached prod-\\nucts of the tubules become entangled in this coagulable product,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0229.jp2"}, "230": {"fulltext": "190 ANALYSIS OF URINE.\\nassisting to form the molds of the tubules, which subsequently\\nappear in the urine as casts.\\nThe last view is the one most generally accepted, at least so\\nfar as the nature and origin of the great majority of casts are\\nconcerned.\\nAlthough the substance forming the basis of casts is evi-\\ndently closely allied to proteids, yet it is certain that it is not\\nidentical with any proteid with which we are at present familiar\\nperhaps it is a derivative thereof. Rovida claims for hyaline\\ncasts the characteristic of being soluble in dilute mineral acids.\\nRenal casts have been variously classified, but the most useful\\ndivision for clinical study is as follows\\n1. Those consisting of anatomical elements such as epithelial\\ncells, blood- and pus- corpuscles.\\n2. Those consisting of the products or broken-down elements\\nof anatomical substances.\\n3. Those clear casts often termed hyaline the nature of\\nwhich, as well as is their origin, is still a disputed question.\\nThe first division naturally includes those casts largely made\\nup of (a) red blood-corpuscles, (b) leucocytes, (c) epithelial cells,\\n(d) masses of bacteria.\\nThe second division comprises (a) granular casts, (b) fatty\\ncasts.\\nThe third division comprises (a) narrow hyaline casts, (b)\\nbroad casts, (c) composite casts or those largely clear, but more\\nor less coated w r ith the elements enumerated in the first and\\nsecond divisions, such as blood, pus, epithelium, fat, etc.\\nBlood-Casts. These appear in the urine under conditions\\nwhich give rise to haemorrhage within the urinary tubules.\\nUnder the microscope they often appear as veiy beautiful objects.\\nThe perfectly-preserved corpuscles may be observed glued to-\\ngether in perfect molds of the tubules, being usually short, of\\npretty uniform diameter throughout, and with rounded ends.\\nThese casts are met with in the urine in hematuria, acute\\ndiffuse nephritis, acute renal congestion, and hsemorrhagic in-\\nfarctions of the kidneys. Blood-casts do not in themselves\\nfurnish positive evidence of organic renal disease, since any\\nhaemorrhage of the kidney may have associated therewith blood-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0230.jp2"}, "231": {"fulltext": "ANATOMICAL SEDIMENTS.\\n191\\ncasts in the urine. On the other hand, it may be stated that the\\npresence of blood-casts in the urine constitutes the only positive\\nevidence of the existence of renal haemorrhage. Blood-casts\\nmay be considered as belonging to the rarer forms of renal casts\\nfound in the urine, and they are usual \\\\y difficult to find, since a\\nlarge sediment of free blood-corpuscles usually accompanies\\nthem, which greatly obscures the microscopical field.\\nEpithelial Casts. These result from pathological conditions\\nFig. 23.\u00e2\u0080\u0094 Epithelial Casts. (After Peyer.)\\nwhich cause exfoliation of the epithelium of the renal tubules.\\nSometimes the epithelial lining of the tubules is thrown off intact\\nfor short distances, resulting in epithelial cylinders which possess\\nlumens. The epithelial cast also occurs in a solid form, the\\nbod}- being made up of hyaline substance and the surface covered\\nwith epithelial cells. These cells, as viewed under the microscope,\\nappear more or less swollen and granular, with ill-defined margins.\\nIn some cases the epithelial cells appear in rows or in patches\\nover the surfaces of the casts (Fig. 23). In other cases the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0231.jp2"}, "232": {"fulltext": "192\\nANALYSIS OF URINE.\\nepithelial cells have partly undergone degeneration or contain\\ndotlets of fat. These are significant of chronic or, at least, fixity\\nchanges in progress in the kidney. Finally some casts are to\\nbe seen which are entirely composed of epithelial cells aggluti-\\nnated together. Epithelial casts are usually of medium size and\\nlength, refracting light to a comparatively high degree, and are\\ntherefore easy to discover in the microscopical field. They resist\\nthe action of chemical reagents to a greater degree than most\\nother casts, except those that are partly metamorphosed. The\\npresence of epithelial casts in the urinary sediment may be taken\\nas a positive evidence of inflammation in the anatomical struct-\\nures from whence they originate and they are consequently\\nsediments of the highest diagnostic value.\\nPus -Casts. Casts composed exclusively of pus-corpuscles\\nare exceedingly rare. Not infrequently, however, compound\\ncasts are met with, composed of epithelium or granular matter,\\nin which scattering pus-corpuscles may be seen dotted over their\\nsurfaces. Johnson has described and illustrated casts entirely\\ncomposed of pus-corpuscles which came from subjects who sub-\\nsequently died of multiple abscess of the kidneys. Such casts,\\nhowever, have rarely been noted by other observers.\\nBacterial Casts. It is no rare occurrence to meet with casts\\nin the urine which are composed of masses of micrococci. In\\nappearance they closely resemble the dark granular casts, but\\nthey are readily distinguishable from the latter by their resist-\\nance to such chemical agents as strong mineral acids and caustic\\nalkalies. They are more opaque than other casts, of a grayish\\ncolor, and are uniform and very fine in their outlines. The use of\\nhigh microscopical powers will render confusion in distinguishing\\nthese casts almost impossible. The discovery of casts in the\\nurine made up of bacterial masses must be taken as a factor of\\nvery grave significance, since they are chiefly found in septic\\nforms of nephritis often accompanied by embolism. They occur,\\ntherefore, in interstitial suppurative nephritis or ascending pye-\\nlonephritis.\\nGranular Casts. This form of renal cast comes under the\\nsecond division named, being the result of metamorphosis of\\nanatomical elements, usually of epithelium, pus, or blood. Granu-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0232.jp2"}, "233": {"fulltext": "ANATOMICAL SEDIMENTS.\\n193\\nlar casts are found in the urine in great variety, as is shown by\\nthe terms frequently employed to designate them, such as finely\\ngranular, coarsely granular, granular, highly granular, moder-\\nately granular, light granular, dark granular, etc.\\nGranular casts vary much in size and shape, as well as in\\nappearance. They are most often met with in fragmentary\\nforms, only occasionally preserving their entirety or perfect\\nforms. They are irregular both in their coarse and fine outlines,\\nFig. 24.\u00e2\u0080\u0094 Granular Casts. (After Peyer.)\\nand their ends are usually ragged, as if recently fractured. The\\ngranulations are often exceedingly fine, requiring high powers to\\ndistinguish them while, again, they are coarsely granular, which\\nis apparent with comparatively low powers (Fig. 24). They are\\nof various colors, as yellowish, white, gray, and brown. They\\nmay have scattered over their surfaces epithelium, leucocytes, fat-\\nglobules, or fatty crystals. Granular casts have generally been\\nregarded as indicative of pathological conditions of the kidneys\\nof chronic or degenerative character.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0233.jp2"}, "234": {"fulltext": "194\\nANALYSIS OF URINE.\\nFatty Casts. It has already been stated that fatty elements\\nare sometimes seen mingled with the elements of epithelial casts,\\nand the same may be said with regard to granular and many\\nother forms of casts. But, in addition to these, highly-refracting\\ncasts are often met with in the urine, whose surfaces are com-\\npletely studded over with fatty globules and, less often, with fine,\\nneedle-like, fatty crystals (Fig. 25). Fatty casts are the result\\nof a different form of transformation of anatomical elements from\\nFig. 25.\u00e2\u0080\u0094 Fatty Casts. (After Peyer.)\\nthe last described. They constitute the index of fatty changes\\nin the kidneys, and are found in their most typical form in\\na large white kidney. They may be looked upon as evidences\\nof pathological states of the kidney, the chief feature of which\\nis extreme chronicity, since they are probably the result of com-\\nplete destruction of the cell-protoplasm, which becomes replaced\\nby fatty elements.\\nHyaline Casts. These are pale structures of variable but\\nusually considerable length, sometimes very difficult to detect in", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0234.jp2"}, "235": {"fulltext": "ANATOMICAL SEDIMENTS.\\n195\\nthe sediment (Fig. 26). Sometimes they exhibit no granulation\\nwhatever upon their surfaces, being, in fact, almost transparent.\\nMuch more frequently, however, they exhibit very fine granula-\\ntion of a very light color. They may exhibit here and there a\\ndotlet of oil or a fragment of epithelium upon their surfaces,\\nand. indeed, this is usually the case, although such casts are\\nconsidered strictly of the hyaline order.\\nWith regard to the origin of hyaline casts, much difference\\nFig. 26.\u00e2\u0080\u0094 Narrow Hyaline Casts. (After Peyer.)\\nof opinion has prevailed. Oertel contended that they were the\\nresult of secretion from the epithelial cells of the renal tubules.\\nand in this opinion he was supported by Rovida. Bartels. on\\nthe other hand, holds that these casts are formed by a coagula-\\ntion of the albumin or its derivatives excreted with the urine.\\nAs evidence of this, he states that they are only present in urine\\nthat is albuminous, or that has very recently been albuminous\\nfor the occurrence of albuminuria and casts are not always\\nsimultaneous.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0235.jp2"}, "236": {"fulltext": "196\\nANALYSIS OF URINE.\\nWhile the origin of the hyaline easts is not at present so\\nclearly understood as most of the other forms, it is probable\\nthat they are formed by coagulable elements of the blood which\\nhas gained access to the renal tubules. The experiments of\\nRibbert upon animals indicate that hyaline casts may result\\ndirectly from exudation of albumin into the tubules and their\\ndisappearance from alkaline urine upon standing further indi-\\nFig. 27.\u00e2\u0080\u0094 So-called Waxy Casts. (After Peyer.)\\ncates their close relationship to albuminous bodies, as long since\\ndemonstrated by the author. 1\\nNumerous observers have claimed to have found hyaline casts\\nin non-albuminous urine, but the author agrees distinctly with\\nBartels in that he has never met with them save in albuminous\\nurine or urine that has recentl} r been albuminous.\\nThe disposition by some to regard hyaline casts of the small,\\nnarrow order as of no serious import is a mistake of the gravest\\ncharacter, for, indeed, they are often the chief evidence, so far as\\n1 Journal of the American Medical Association, September 12, 1885.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0236.jp2"}, "237": {"fulltext": "ANATOMICAL SEDIMENTS. 191\\nthe urine is concerned, of the existence of a most serious form\\nof renal disease, viz.. interstitial nephritis: for it should be re-\\nmembered that in such cases albuminuria is nearly always small\\nin quantity.\\nIn addition to narrow hyaline casts which doubtless come\\nfrom the smaller tubules within and above the middle zone of\\nthe kidney, the urine often contains large, broad hyaline casts,\\nevidently emanating from the large, straight tubes of the pyra-\\nmids. As a rule, these larger, clear casts are more refracting.\\nand consequently more distinct both in body and outline than\\nthe narrow casts. They are also more indentated at their mar-\\ngins, although pretty uniform i: ons. There is a\\nform of hyaline cast, usually of large size, that occasionally not\\nalways exhibits the characteristic amyloid reaction with methyl-\\nviolet and iodo-potassic iodine solutions. They are large and\\nusually rather long, and their surfaces may be marked by inden-\\ntations showing imperfect vertical segmentations.\\n/of-m (Fig. 27). The term waxy as applied to these casts is\\ninappropriate. It was formerly thought that these casts were\\ncharacteristic of amyloid changes in the kidneys, but more ex-\\ntended observations have shown that they are found in all forms\\nof nephritis. These casts may exhibit the amyloid reaction in\\nthe absence of amyloid kidneys, or they may fail. to exhibit it\\nwhen amyloid disease of the kidney is present, and therefore no\\ndiagnostic value can be attributed to the reaction, save, perhaps.\\nas indicating degenerative changes in the casts themselves\\nRoberts These casts are of comparatively rare occurrence.\\nCylindroids. In addition to the casts described, the uri\\nsometimes contains the so-called cylindroids of Thomas, who first\\nsrved them in the urine in a case of scarlatina. These are\\nlong. wavy, ribbon-like structures, which often divide and sub-\\ndivide at their end- with diminishing diameters. These ends\\nmay be folded or twisted in corkscrew form. They are pale.\\ncolorless, and of greater length than the ordinary casts described.\\nand rarely, if ever, have attached to them any cellular elements\\nwhatever. T flat and do not give the impression, to\\nthe eye. of being solid struer :e true renal casts. It seems\\nnot impr however, that these cylindroids come from the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0237.jp2"}, "238": {"fulltext": "198 ANALYSIS OF URTNE.\\nrenal tubules. They occur in nephritis, cystitis, and renal con-\\ngestion, and may be present in urine that is free from albumin.\\nThey are not characteristic of kidney disease, but probably more\\noften caused by irritation of the lower urinary tract, which has,\\nin a measure, extended to the kidneys.\\nLastly, it may be stated that casts are sometimes met with in\\nthe urine composed of urinary crystals or granular salts. Only\\nthose composed of urates and hsematoidin have thus far been\\nFig. 28.\u00e2\u0080\u0094 False Casts. (After Peyer.)\\nobserved, and they are of little practical significance, being only\\nfound in the urine of infants, or in cases of gout, renal conges-\\ntion, etc.\\nMethod of Searching for Casts. Since the more recent\\nmethods of obtaining the urinary sediment by means of the\\ncentrifuge, we no longer encounter the obstacles which were\\noften very annoying and sometimes almost impossible to sur-\\nmount in making a satisfactory microscopical inspection of the\\nurine. The obstacles referred to especially were the following:", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0238.jp2"}, "239": {"fulltext": "ANATOMICAL SEDIMENTS. 199\\n(a) The difficulty often encountered in getting easts to settle\\nin urines of high specific gravity, because renal casts are of\\ncomparatively light weight and often float in such urines for\\nhours without subsiding, (b) The changes in the urine upon\\nstanding often altered the essential features of the deposit, as\\nbefore stated, sometimes rendering them unrecognizable. (V In\\nurine which stood long enough to secure the sediment, the micro-\\nscopical field sometimes became so crowded with micro-organisms\\nthat the organic products were completely obscured from vision.\\nHappily, these difficulties are now matters of the past and it is\\nonly necessary to secure a freshly-voided sample of urine, submit\\nit to the centrifugal apparatus for two or three minutes, and we\\nhave a true and unaltered sediment, that exactly represents the\\npathology of the urine as it leaves the urinary tract.\\nThe urinary sediment obtained always preferably by the\\ncentrifuge\u00e2\u0080\u0094 is best examined in a shallow cell, upon a glass slide\\ncarefully covered with a cover-glass. This is best secured by\\ntaking up about 4 to 6 drops of the sediment in a nipple-pipette\\nfrom the bottom of the sediment-tubes of the apparatus, and\\nplacing them upon a carefully-cleaned slide, then placing the\\ncover-glass over the cell, and with the thin, freshly -torn edge of\\na piece of blotting-paper removing the excess of urine, which\\ntends to spread over the cell and along the slide. By this means\\nthe sediment constitutes a temporary mount, so that it may be\\nexamined at any angle without flowing out of the cell. The slide\\nis next placed under the microscope, which is adjusted with a\\n^-inch objective for ordinary search, and examination conducted\\nin a clear, but not too bright, light.\\nThe greatest difficulties encountered in searching for casts in\\nthe urine will usually be met with in the case of narrow hyaline\\ncasts. These bodies are so transparent and non-refracting that\\nthey are exceedingly liable to be overlooked. This may often be\\navoided by proceeding as follows After securing an accurate\\nfocus of the field by careful regulation of the fine adjustment of\\nthe instrument, gradually darken the field by the mirror-adjust-\\nment and throw the light obliquely across it. illuminating the\\nfield, in fact, but about one-half or two-thirds its extent. Xext,\\nby slowly moving the slide about, the different features of the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0239.jp2"}, "240": {"fulltext": "200 ANALYSIS OF URINE.\\nsediment are presented to view in different lights, and the outlines\\nor shadows of fine hyaline casts will often be brought into view,\\nw r hen they would be perfectly transparent and unobservable in a\\nmore direct reflection of sharp light. Once the outline is seen,\\nhy careful re-focusing the cast often stands out with distinctness.\\nIf doubts remain as to its true nature, by depressing both ends\\nof the slide with the finger-tips currents will be created in the\\nurine beneath the cover-glass (if mounted as directed), so that\\nthe cast will be made to move and even roll over, which will often\\nsettle any question as to its nature. The author has not found\\nit necessary to treat these casts with staining agents to bring\\nthem into view, although this may be practiced successfully. It\\nis, however, preferable, if possible, to view the microscopical de-\\nposit, and especially renal casts, as nearly as possible in their\\nnative state, for obvious pathological reasons.\\nSpermatozoa.\\nSpermatozoa are thread-like bodies provided with a head and\\na long, tapering, tail-like extremity. The head is of a flattened\\noval shape with a central depression on either side. The head\\nand tail are united by an intermediate, cylindrical-form body or\\nneck of uniform size. The entire length of a spermatozoon is about\\ns^ inch. When freshly ejected with the spermatic fluid sperma-\\ntozoa exhibit active, eel-like movements, as though endowed with\\nseparate life, and under favorable circumstances warmth and\\nmoisture they long retain this capability. These movements\\nmay be observed in the body for several days after death, and in\\nthe uterine secretion longer than a week. The cause of the\\nmovements in spermatozoa is unknown, though it has been con-\\ntended that the}^ are mere floating cilia. Acid liquids stop these\\nmovements immediately, as do strong alkalies, especially ammo-\\nniacal liquids also distilled water, alcohol, ether, etc. Sperma-\\ntozoa show great resistance to chemical reagents. They do not\\ndissolve completely in sulphuric acid, nitric acid, acetic acid, nor\\nin boiling-hot sodium solutions but they are dissolved in boiling\\npotassium-hydrate solution. They resist putrefaction, and after\\ndrying they may be obtained again in their original form by\\nmoistening them with a 1-per-cent. sodium-chloride solution. By", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0240.jp2"}, "241": {"fulltext": "ANATOMICAL SEDIMENTS.\\n201\\ncareful heating and burning to ash the shape of these bodies are\\nsaid to be seen in the ash (Hammarsten).\\nAs found in the urine spermatozoa are nearly alwaj^s in the\\nquiescent state, and they may be found in the urine which has\\nstood for days, their typical form being well preserved (Fig. 29).\\nClinical Significance. Spermatozoa are only found in semen\\nor fluids mingled therewith. Their persistent absence from\\nseminal fluid indicates sterility or incapability of procreation.\\nFig. 29.\u00e2\u0080\u0094 Spermatozoa in Urinary Sediment. (After Peyer.)\\nSpermatozoa may be found in the urine after every ejaculation\\nof seminal fluid, and therefore they may aid the physician in de-\\ntecting masturbation. Spermatozoa are found in the urine in\\nsome cases of severe illness, such as typhoid fever, typhus pneu-\\nmonia, and after epileptic attacks. A very constant deposit of\\nspermatozoids in the urine constitutes an essential feature of\\nspermatorrhoea. In such cases the urine often shows the presence\\nof white flakes, which under the microscope appear as masses of\\nspermatozoa and finely-granular matter.\\n14", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0241.jp2"}, "242": {"fulltext": "202 analysis of urine.\\nFragments of Tumors.\\nContrary perhaps to general belief, fragments of new growths\\nare rarely met with in the urine, and those that are occasionally\\nencountered nearly alwa} T s originate in the bladder. Small\\npolypi have been found in the urine a few times, as well as frag-\\nments of villous growths. More often, perhaps, carcinoma of\\nthe bladder parts with some of its constituents, which subse-\\nquent^ appear in the urine. In such cases the fragments are\\nusually necrotic, and therefore practically impossible to recognize.\\nThe typical villous growth appears in its finest subdivisions as\\ncharacteristic, tree-like branches fringe-like which consist\\nof enlarged vessels covered with a single layer of epithelium but,\\nowing to the necrotic changes resulting in their disintegration,\\nthese fragments are seldom seen in the urine in typical form.\\nThe epithelium has usually undergone molecular degeneration,\\naccompanied by bacterial life, and the villus itself is infiltrated\\nwith the products of suppuration. It is only occasionally that\\nforms are met with which assist in diagnosticating villous\\ngrowths. Thus, crystals of hsematoiclin may be observed in the\\nnecrotic masses, or they may be brought out frequently by\\ntreating the masses with glycerin. The^y may be recognized by\\ntheir brownish-yellow color; small, rhomboidal form; or yellow,\\ngrass-like tufts. Treated with nitric acid and observed under\\nthe microscope, the well-known play of rainbow colors reveals\\nthe presence of biliary coloring matters. Since hoematoidin\\noccurs in the urine only in isolated ciystals, it follows that, if\\nfound imbedded in necrotic masses, it goes far to establish a\\ndiagnosis of cancer, since such conditions are onlv found with\\nsuch growths (Jaksch). Haematoidin villus is rarely recognized\\nsave in acid urine, because in alkaline urine the villous tissue is\\nmore disintegrated and mixed with phosphatic deposits.\\nCancer of the kidney can rarely, if ever, be diagnosticated\\nfrom the nature of the anatomical sediments in the urine. The\\ntransitional epithelium, more or less abundantly present in all\\ninflammatory conditions of the urinary tract, simulates so closely\\nthose of cancer that it is never safe to draw any positive conclu-\\nsions as to the presence of cancer from this source. It is only\\nwhen considered in connection with other symptoms, such as", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0242.jp2"}, "243": {"fulltext": "ANATOMICAL SEDIMENTS. 203\\nhaemorrhage, pain, cachexia, etc., that a positive diagnosis may\\nusuall} T be reached.\\nBACTERIURIA.\\nIt has been generally accepted that healthy urine when freshly\\nvoided is free from bacteria, and is, in fact, an aseptic fluid.\\nOver thirty years ago Pasteur demonstrated that such urine is\\nsterile, and this has been repeatedly confirmed since. If, how-\\never, the ordinary normal urine be allowed to stand for some time\\nat ordinary temperatures it becomes crowded with micro-organ-\\nisms. This is due to the fact that the urine contains so large a\\npercentage of organic matter that it practically constitutes a\\nculture medium for many forms of these organisms.\\nAbnormal urine nearly always contains micro-organisms, of\\nwhich nearly forty varieties have been\\nisolated to date. They practically all\\nbelong to the class of fungi, and for\\npurposes of study may be divided into\\ntwo classes, viz. (a) nonpathogenic\\nfungi, or those which are innocuous,\\nand (b) pathogenic fungi, or those\\npossessed of p3~ogenic powers.\\nNon-pathogenic Fungi. These in-\\nclude molds, yeasts, and fission fungi.\\nMolds are of comparatively rare\\noccurrence in urine, even when under-\\ngoing ordinary decomposition but if\\ndiabetic urine be allowed to undergo alcoholic fermentation, at\\nits conclusion molds make their appearance in quantities upon\\nthe surface of the urine, which also becomes crowded with\\n}^east-fungi.\\nThe yeast-jilants of the urine (saccharoniyces urinse) are\\nsingle cells of about the size of blood-corpuscles. They are dis-\\ntinguishable from blood-cells by the irregular and occasionally\\nlarge size of the cells, the presence of a nucleus in the larger\\nsporules, and their more elongated or oval form. Usually these\\ncells are arranged in bead-like forms, some of the beads having\\nseveral small bud-like cells attached to them (Fig. 30). For their\\ndevelopment it is necessary that the urine be distinctly acid, and\\nO\\nig. 30.\u00e2\u0080\u0094 Yeast-Fuxgtts in\\nUrine. (After Harley.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0243.jp2"}, "244": {"fulltext": "204 ANALYSIS OF URTNE.\\nthey cease to multiply if the urine become alkaline. The pres-\\nence of yeast-fungi in the urine in large numbers may be taken as\\ncertain evidence of the presence of sugar.\\nFission-fungi are associated with urine tending toward putre-\\nfactive changes. Such urine is more or less cloudy when voided\\nit is never sharply acid; on the contrary, it is usually neutral in\\nreaction or feebly alkaline. Examined under the microscope it\\nis seen to be crowded with micro-organisms in active motion,\\nsuch as the more common forms in decomposing organic fluids,\\nthe most familiar being the well-known bacterium termo. The\\nurine on standing does not clear, and, moreover, it does not clear\\nby filtration, and it tends to rapidly pass on into ammoniacal\\ndecomposition. This condition of urine is\\nmost often met with in weakly and en-\\nfeebled people, and in men who have\\nurethral stricture, or who have frequently\\nhad catheters or bougies passed. In the\\nprocess of ammoniacal fermentation of\\nthe urine, urea is transformnd into ammo-\\nnium carbonate through the agency of\\nbacterial life. To each molecule of urea\\nFig. 31. Micrococcus ^wo molecules of water are supplied, and\\nUre.e. (After v.Jaksch.) the chemico-vital change wrought by\\nbacterial activity results in two molecules\\nof ammonium carbonate. The chief agent concerned was\\nformerly believed to be the micrococcus urese, as almost pure\\ncultures of this organism are often observable upon the surface\\nof the decomposing urine. It has recently been shown, however,\\nthat nearly all microbes found in the urine possess the above\\npowers to a greater or less extent. The micrococci urese are\\norganisms of comparatively large size, and are most frequently\\nobserved in long, chain-like strings although they also occur\\nas free and independent, minute, round objects (Fig. 31).\\nAmmoniacal bacteriuria is most frequently met with in cases\\nof obstructive cystitis, in which more or less residual urine\\nremains in the bladder, as often results from paraplegia or\\nenlarged prostate, and urethral stricture of small calibre. The\\nfrequent use of instruments in the urethra and bladder often\\nresults in this condition.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0244.jp2"}, "245": {"fulltext": "ANATOMICAL SEDIMENTS. 205\\nIn addition to the micrococcus ureae. the urine may contain\\nvarious other forms of non-pathogenic fungi, including rod-like\\nbacteria of various forms and sizes. Occasionally long, spiral\\nbacilli, with large spores and cocci, are met with in the urine.\\nThese are often grouped in various-shaped masses, usually of\\ndark color and variable sizes. For the most part, these organ-\\nisms gain access to the bladder through the urethra. This may\\ntake place through discharges or. more commonly, by the use of\\ninstruments.\\nPathogenic Fungi. The pathogenic bacteria found in the\\nurine for the most part belong to two orders, viz., micrococci\\nand bacilli.\\nThe micrococci found are those characteristic of suppurative\\ndiseases in general, and include the staphylococcus pyogenes albus.\\naureus, citreus. and the streptococcus pyogenes. The action of\\nthese germs is general, which accounts for their frequent presence\\nin the urine. To these must be added the gonococcus of Neisser,\\nwhich will be considered later.\\nThe bacilli met with in the urine include the urobacillus\\nliquefaciens septicus. the bacillus coli communis, the tubercle\\nbacillus of Koch, besides a number of others less well known.\\nIn all infective diseases in the healthy organism, if life be\\nnot destroyed thereby, the microbes must either be destroyed in\\nthe blood and tissues by the process termed phagocytosis, or be\\neliminated through the excretory organs, usually in an active\\nstate. The fact of the rapid disappearance of most micro-\\norganisms from the blood, when injected into the circulation of\\nthe healthy organism, indicates that the corpuscular elements\\nof the blood have the power of destroying these organisms. at\\nleast, to a large extent. Passing from the blood into the tissues.\\nthese organisms meet with the same warfare in the tissue-cells.\\nShould, however, both of these sources of phagocytosis prove\\nunsuccessful in destroying these organisms, there still remains a\\nmethod by which the unassisted organism may rid itself of these\\nmicrobes. viz., by means of elimination throu\u00c2\u00b0;h the excretorv\\nchannels and in this process the kidneys and intestinal canal\\nare the chief organs concerned. The frequency with which the\\nkidneys become infected in the course of o eneral tuberculosis", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0245.jp2"}, "246": {"fulltext": "206 ANALYSIS OF URINE.\\nfurnishes proof that these organs are the source of elimination\\nof tubercle bacilli. Furthermore, Philipowicz has succeeded in\\nproducing tuberculosis in animals by injecting urine into the\\nperitoneal cavity which was taken from tuberculous subjects.\\nNeumann has demonstrated the characteristic microbes of\\ntyphus, pneumonia, and pyaemia in the urine in the course of\\nthese diseases, and he has cultivated from the urine, in acute\\nendocarditis and osteomyelitis, the staphylococcus pyogenes\\naureus. Neumann furthermore claims that the microbes which\\ngain access to the circulation often localize in the capillary\\nvessels of the kidney, there causing multiple lesions without in-\\nvolving the whole organ; and through these lesions some of the\\nmicrobes gain access to the uriniferous tubes and appear in\\nthe urine.\\nSchweiger has conclusively demonstrated that the urine of\\nscarlatinal subjects is distinctly contagious and he regards all\\nrenal lesions arising in the course of infectious fevers of microbic\\norigin. Finally, it may be mentioned that Rimann has conclus-\\nively demonstrated the passage of bacilli through the kidneys\\nin the following manner The bacilli discovered in the pus of\\nozsena was cultivated in gelatin and agar and stained intensely\\ngreen after dilution with physiological solution of salt, the\\nculture was injected directly into the circulation of a dog, cat,\\nand rabbit after a time these stained microbes appeared in the\\nurine in large numbers.\\nOf the various pathogenic micro-organisms found in the\\nurine, the recognition of the bacillus tuberculosis of recent years\\nclaims the greatest clinical interest. It may be stated that the\\npresence of this bacillus in the urine, especially when arranged\\nin S-shaped aggregations, or in colonies of irregular masses,\\npoints with unmistakable certainty to tubercular ulceration of\\nthe urinary tract. Fortunately for diagnostic purposes, if the\\ntubercle bacillus appear in the urine at all, it usually occurs in\\nabundance, and may, with recent methods, be recognized in\\nmasses often arranged as in pure cultures.\\nIn all cases of purulent urine accompanied by anaemia, wast-\\ning, and evening temperature, the urinary sediment should be\\nexamined for the presence of tubercle bacilli. Of course, more", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0246.jp2"}, "247": {"fulltext": "PLATE VII.\\nV\\nf v\\n\u00e2\u0096\u00a0V\\nIP*\\n4\\nTubercle Bacilli en Uri^apt Skdem\\n(After t. Jakscli.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0247.jp2"}, "248": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0248.jp2"}, "249": {"fulltext": "ANATOMICAL SEDIMENTS. 207\\npatient search is necessary than in the examination of sputa,\\nowing to the dilution of tubercular pus by the urine, and it is\\nnecessary to concentrate it as much as possible for the same\\nreasons. This is best accomplished by the centrifuge for obvious\\nreasons. The purulent deposit of tubercular urine should be\\ntreated precisely as the sputum in searching for tubercle bacilli.\\nShould difficulties be encountered in finding the bacilli when the\\nsymptoms strongly point to their presence, or should doubts\\narise as to the true character of the bacilli found in the urine in\\nany given case, the inoculation of animals with the sediment\\nor plate cultures thereof should be resorted to before negative\\nconclusions can be positively reached. Indeed, unless the time\\nrequired for the latter be a matter of importance in the case\\n(which is very seldom), the plate cultures are the easiest and\\nmost certain method of success.\\nGonococci were first discovered in the pus of gonorrhoea by\\nNeisser. The} consist of minute, roll-shaped cocci. They are\\nchiefly met with as diplococci, the individual cocci being seem-\\ningly divided by a bright, transverse band, often presenting the\\nso-called roll-form also termed kidney- or bean- shape.\\nThe cocci usually appear in pairs lying close together, their flat-\\ntened surfaces usually presented to each other. The}^ multiply by\\neach coccus splitting in two. Bodies in all respects resembling\\ngonococci, so far as present methods are able to determine, have\\nbeen found in the genital tract under the most variable conditions,\\nand this fact has tended greatly to diminish the diagnostic value\\nof these organisms. On the other hand, it is pretty well estab-\\nlished that the presence of gonococci within pus-cells in purulent\\nurethritis is characteristic of infective gonorrhoea. In all cases\\nof recent infection with gonorrhoea the specific gonococci are to\\nbe found within the pus-cells in abundance, although they are\\nnot limited to this location, but may be seen in the epithelia, as\\nwell as floating in the liquor puris. This cannot be said of the\\nnon-infective forms of diplococci. The gonococcus is best stained\\nin gentian violet, meth} r lene blue, or fuchsin, after which it mRj\\nbe rinsed in water and examined under the microscope.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0249.jp2"}, "250": {"fulltext": "208 ANALYSIS OF URINE.\\nVERMES.\\nDistoma Haematobium. This parasite has frequently been\\nfound in the portal vein and its branches, in the splenic and\\nmesenteric veins, and in the venous plexuses of the bladder and\\nrectum (Pig. 33). From the investigations of Bilharz, it would\\nseem that more than half the adult Fellaheen and Coptic popu-\\nlation of Egypt suffer from this parasite.\\nThe eggs of this parasite are found in numbers in the urinary\\npassages and in the urine. They are usually accompanied by\\nblood, pus, and sometimes by considerable fat. -The eggs are\\noval, flask-shaped bodies, with rather sharp projections from\\nFig. 32.\u00e2\u0080\u0094 Eggs of Distoma from Urinary Sediment.\\ntheir anterior extremities. They measure rather less than -^lo\\ninch in length.\\nWhen confined to the larger veins, these parasites do not pro-\\nduce much damage but if they invade the smaller vessels,\\nnotably those of the submucous tissues of the urinary tract, they\\ninduce severe and, in some cases, fatal consequences. In the\\nintestines the result is often that of severe dysentery.\\nThe most serious results of the ravages of this parasite are\\nmet with in the urinary passages. The lesions produced here,\\naccording to Griesinger, consist of raised patches of injected\\nand eccrrpnosed tissue, which often pass into ulcerations, giving\\nrise to severe haemorrhages. These patches are covered with\\nmucus and brownish exudations of bloody matters containing\\nmasses of ova. If no lesions of the mucous membrane occur", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0250.jp2"}, "251": {"fulltext": "ANATOMICAL SEDIMENTS. 209\\nover these patches, they may remain as nodules of more or less\\nfirm and indurated tissue.\\nWhen these parasites invade the ureters and renal pelvis, the\\nresults are apt to be still more serious, as the} threaten the in-\\ntegrity of the kidney from two sources. First, by consequent\\nthickening they ma} r cause occlusion of the ureters and resulting\\nhydronephrosis or pyonephrosis, as in a case observed by Grie-\\nsinger. Second, severe pyelitis is often set up by invasion of the\\nrenal pelvis, which ma}- result in ascending pyelonephritis.\\nhi addition to these consequences the masses of ova extruded\\ninto the urinary passages are exceedingly liable to become the\\nnuclei for urinary calculous formation and, indeed, this is claimed\\nto constitute the cause of the great frequency of calculous dis-\\nease in Egypt.\\nFrom the variety of lesions caused by invasion of the Distoma\\nFig. 33.\u00e2\u0080\u0094 Distoma H^matobium, Male axd Female, with Eggs.\\nhaematobium, as might be expected, a corresponding variety of\\nclinical symptoms result. In the milder cases but little dis-\\nturbance of the urinary function is to be observed. Some pain,\\ndescribed as of a burning character, is notable on micturition.\\nThis, however, is but momentary, aud is chiefly due to the pass-\\nage of the ova along the urethra, which they irritate by means\\nof their sharp projections. At the termination of micturition a\\nfew drops of blood, or a blood-clot, are sometimes noted. The\\nurine contains pus and blood-cells, with the eggs of the parasite\\nas represented in Fig. 32. The symptoms become more dis-\\ntressing with the involvement of the bladder, entailing various\\ngrades of cystitis, always accompanied by more or less hema-\\nturia. To these may be added the discomforts and deterioration\\nof the general health entailed by p} elitis w T hen the parasite in-\\nvades the renal pelvis. Septic infection, nephritis, and uraemia\\nare among the most serious consequences entailed by extension", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0251.jp2"}, "252": {"fulltext": "210\\nANALYSIS OF URINE.\\nof the morbid changes set up by the parasite in the upper urinary\\ntract. Finally, it may be noted that Bilharz and Griesinger,\\nduring the course of their investigations in Egypt, found strong\\nevidence that the distoma disease sometimes takes the course of\\nan acute and rapidly fatal disorder. Griesenger observes We\\nfound on two occasions, in the bodies of persons who had rapidly\\ndied from an unknown acute disease, abundant recent distoma\\nchanges in the bladder, recent pyelitis, and a uniform dark-red\\nhyperemia of the kidneys. In other cases of supposed rapid\\ntyphus the same changes were found in the bladder and ureters.\\nFig. 34.\u00e2\u0080\u0094 Filaria in Human Blood. (After Mackenzie.)\\nFilaria Sanguinis Hominis. Dr. Lewis, of Calcutta, was the\\nfirst to describe this parasite as occurring in the human organism.\\nIn 1872 Lewis made the interesting announcement that, as ob-\\nserved in India, chylous urine always contained large numbers\\nof these parasites. He later on discovered that these worms\\nwere present in great numbers in the blood of patients suffering\\nfrom chyluria. This haematozoon is about the width of a red\\nblood-corpuscle and about fifty times longer than its width. It\\npossesses a short, rounded head, with a tongue-like protuberance,\\nand a rather long and pointed tail. The parasite is inclosed in\\na loose sac, in which it moves with freedom. This covering", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0252.jp2"}, "253": {"fulltext": "ANATOMICAL SEDIMENTS. 211\\nappears structureless, but the parasite itself, as viewed under\\nthe microscope, is seen to be very granular, with transverse\\nstriations.\\nIt was early supposed that the minute haematozoon described\\nand figured (Fig. 34) was but the young of a larger, parent worm,\\nand in 1876 Bancroft, of Brisbane, succeeded in demonstrating\\nthe mature worm in a lymphatic abscess of the arm. The\\nmature form is a nematode worm, about the thickness of a hair\\nand three or four inches in length. Dr. Manson has established\\nthe origin of this parasite in the mosquito, which deposits the\\nlarvae in ponds, the water of which being swallowed, the subject\\nbecomes the seat of its further development. The most curious\\nand interesting circumstance in reference to the habits of this\\nparasite is the fact, pointed out by Manson, that the embryo\\niilaria is very active at night, but quiescent during the day; it\\nis therefore to be found abundantly in the blood of subjects of\\nthis disease during the night, but not to be found during the\\nday. Dr. Mackenzie observed, however, that upon reversing the\\norder of sleeping and waking, the filarise changed their nocturnal\\nhabits, coming out when the subject slept and remaining hidden\\nduring the waking hours. It would, therefore, seem that the\\nactivity of filarise in the blood depends upon quiescence of the\\nsubject. What becomes of the filariae, or where they conceal\\nthemselves temporarily during their disappearance, as yet remains\\na mystery.\\nThe filariae, though greatly obstructing the lymph-channels\\nand literally swarming in the blood, of themselves do but com-\\nparatively little mischief. The embryos appear to pass readily\\nthrough the capillary vessels without causing obstruction, irrita-\\ntion, or emboli. It is, however, altogether different with the ova\\nif they remain unhatched in the blood, lymphatics, and the\\nurine. Owing to their greater diameters, they become arrested in\\nthe smaller lymphatic vessels and, becoming impacted, accumu-\\nlate until the gland becomes impervious, resulting in lymphatic\\ncongestion and even necrotic changes; elephantiasis, or lymph-\\nscrotum, is one of the results of this condition. Chyluria is\\none of the most frequent consequences, also, of this condition.\\nThis is brought about through the obstruction of the larger", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0253.jp2"}, "254": {"fulltext": "212 ANALYSIS OF URINE.\\nlymphatics, the thoracic duct, or large channels between it and\\nthe urinary organs.\\nEchinococci. The booklets and scolices of the echinococcus\\ncyst are among the rarer forms of sediments met with in the\\nurine (Fig. 35). It is exceptional for echinococci cysts to develop\\nin the urinary passages more often the products of these cysts\\nFig. 35.\u00e2\u0080\u0094 Echinococcus, with Two Booklets and Section of Cystic\\nMembrane Greatly Magnified. (After Peyer.)\\nmake their way into the urinary passages from the kidney or\\nsome neighboring organ by means of rupture. If the charac-\\nteristic booklets appear in the urine, the} are usually accom-\\npanied by blood, pus, and more or less cellular debris, as well\\nas shreds of the membrane forming the cystic envelope.\\nEchinococci are minute ovoid parasites barely visible to the\\nnaked eye. They consist of a head not unlike that of the tape-\\nworm, provided with four mouths or suckers and a double row\\nof hooks. The echinococci are developed within a germinal\\nmembrane, and exist in groups of from six to ten. The hydatid", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0254.jp2"}, "255": {"fulltext": "ANATOMICAL SEDIMENTS. 213\\ngrowth consists of an outer, fibrous capsule by which it is\\nattached to the organ in which it is developed. Within the\\ncapsule is the hydated cyst, which varies in size from that of\\na marble to that of a distended urinary bladder, or even larger.\\nWithin the large cyst a great number of secondary or so-called\\ndaughter-cysts develop and float freely in a serous or rather\\nsaline, aqueous fluid. These daughter-cysts also vary in size\\nfrom that of an apple to minute points requiring the microscope\\nfor their recognition. The mother-cyst may, in rare cases, be\\nentirely barren, i.e., contain nothing but fluid, or it ma} con-\\ntain thousands of secondary or daughter-cysts.\\nSiebold pointed out the interesting fact that the hydatid\\nworm in man is the encysted form of development of a very\\nminute tape-worm which infests several animals, notabhv the\\ndog, pig? monkey, sheep, etc. This tape-worm is the Taenia\\nechinococcus, and is very minute about the size of a millet-seed.\\nThe intestines of the dog are usually infested with great num-\\nbers of these worms. The eggs are discharged with the stools,\\nand, finding their way into food, reach the stomach in man,\\nwhere they find suitable conditions for their development. The\\nembryo, upon hatching in the stomach, burrows its way or is\\ncarried by the blood to some organ, most often the liver or\\nkidne ys, where it develops as the hydatid vesicle, in which\\nare contained the echinococci described. In Iceland, where the\\nnatives live with their dogs in huts, it is said that one-seventh\\nof the deaths are due to the ravages of these parasites.\\nStrongylus Gigas. This nematode worm has been found in\\nthe renal pelvis of dogs, wolves, horses, oxen, and other animals,\\nand less frequently in the human kidney. It somewhat resembles\\nthe Ascaris lumbricoides, but it has six papillae about the mouth\\ninstead of three, and it attains a much greater length, one to\\nthree feet, and it is nearly a quarter of an inch in thickness. It\\nmay further be distinguished from the common round intestinal\\nworm by its reddish color. This parasite may be said to be\\npeculiar to the kidney, being very rarely met with elsewhere.\\nLeuckart has, after some research, questioned the appearance of\\nthis parasite in the human organism, but there is, beyond doubt,\\nat least half a dozen well-authenticated cases on record, in", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0255.jp2"}, "256": {"fulltext": "214 ANALYSIS OF URINE.\\naddition to a specimen in the Hunterian Museum, taken from\\nthe kidney of a patient of Sheldon s (Dickinson).\\nIn addition to the parasites described, ascarides have been\\nfound in the urine in exceptional cases. In such cases the worms\\nhave usually made their way from the lower intestines into the\\nurinary tract, usually by way of abnormal openings. In cases\\nof women, these thread-worms have made their way into the\\nbladder through the urethra.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0256.jp2"}, "257": {"fulltext": "SECTION VIII.\\nTHE MICROSCOPE.\\nThe following general suggestions are designed for the use\\nof beginners and as supplementary to special works on the micro-\\nscope, one of which every student should possess preferably\\none that deals concisely and clearly with the optical principles\\nand mechanism of the instrument 1 In purchasing a microscope\\none should buy the best instrument within one s means, and,\\nnow that good microscopes may be had at very reasonable\\nprices, there remains no valid excuse for the physician to be\\nwithout one. While it is true that the best microscopes are\\nmade chiefl} by foreign manufacturers, yet in all respects excel-\\nlent instruments are now turned out by a number of American\\nfirms, among which an example is shown in Fig. A. It may be\\nadded that this firm (Spencer) also furnishes admirable objectives\\nwhich, indeed, are quite equal to those of European makers.\\nWhen a new microscope is received from the maker or dealer\\nit usually arrives carefully packed in a wooden case. Before its\\nremoval from the case careful stud} should be given to its posi-\\ntion therein, so that it may be readily replaced when desired.\\nIn handling the instrument it should always be seized by its\\nsolid parts, as the foot or post just above the foot, and under no\\ncircumstances should violence be employed. If the instrument\\nis to be in daily use, it will be found convenient to keep it under\\na glass shade, or after use a silk cover may be spread over it\\nand the instrument placed on a library-shelf for the night. The\\nmicroscope should not be kept in an overheated room, lest the\\ncement about the lenses become softened on the other hand, it\\nshould not be kept in a very cold place, else, when the cold\\noptical parts of the instrument are approached by the hands or\\nface, the glasses become coated with moisture, entailing delay or\\nunsatisfactory work. The illustration (Fig. B) will serve to\\n1 Gasre on The Microscope, published by the Comstock Publishing Co.,\\nIthaca, N. Y., can be highly commended to the beginner.\\n(215)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0257.jp2"}, "258": {"fulltext": "216 ANALYSIS OF URINE.\\nindicate the mechanism and different parts of the microscope,\\nand the beginner should become thoroughly familiar with the\\nterms employed to designate them, as well as their special uses.\\nThe ocular, or eye-jriece, consists of one or more converging\\nlenses, the combined action of which is to magnify the image\\nformed by the objective. It is the piece at the upper end of the\\ntube (^4) which the eye approaches when looking through the\\nmicroscope. The objective consists of a system of converging-\\nlenses at the distal end of the tube which give an enlarged inverted\\nimage of the object. Upon this piece depends the initial magnif-\\nication of the object examined. In the cut will be observed two\\nspring clips for the purpose of holding the object to be examined\\nfirmly on the stage. In high-class instruments a mechanical\\nstage is furnished, and by removing the spring clips the mechan-\\nical stage may be fastened to the platform by means of which\\nthe object under examination may be moved systematically in\\ndifferent directions by means of milled head-screws. Diaphragms\\nare perforated stops that fit under the central opening of the\\nstage, and serve to admit the light for the purpose of illuminat-\\ning the object under examination. The diaphragms vary in size\\nin order that different amounts of light may be emplo} T ed for the\\ndifferent degrees of illumination required. The iris-diaphragm\\n(J) is the most convenient and useful form of stop, since by the\\nsimple movement of a small lever at its side the diaphragm opens\\nand closes as does the iris of the eye, and thereby the light may\\nbe gradually increased or decreased as desired. The reflector\\n(S) is the small mirror beneath the stage, and serves to illuminate\\nthe object under observation by reflecting the light upon it. One\\nsurface of the reflector is plain for the purpose of reflecting the\\nlight in parallel rays, while the other surface is concave and\\nserves to converge, or focus, the light upon the object. The con-\\ncave mirror without the condenser is usually emplo} r ed with low-\\npower dry objectives, while the plain mirror in conjunction with\\nthe condenser is usually used with high-power objectives and\\nwith immersion objectives. The coarse adjustment T) is the\\nrack-and-pinion mechanism which serves to rapidly raise or lower\\nthe barrel, or tube, of the instrument. The fine adjustment, or\\nmicrometer -screw (m), serves the purpose of very gradually and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0258.jp2"}, "259": {"fulltext": "Fig. A.\u00e2\u0080\u0094 Spencer s stand No. 0, showing objectives, eye-piece, and nose-piece\\n(one-half full size).\\n(21 T)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0259.jp2"}, "260": {"fulltext": "2 IS ANALYSIS OF URINE.\\nmore accurately raising and lowering the tube, so as to bring the\\nobject into accurate focus. The nose-piece (B) consists of a collar\\nattached to the lower, or distal, end of the tube. It permits of\\nseveral objectives being attached to the microscope in such a\\nmanner that by simpl} r rotating the nose piece the various objec-\\ntives attached thereto may be brought into use success ively.\\nThe most useful form for general work is the triple nose-piece\\ndesigned for three objectives, as shown in the cut. The substage\\ncondense?* [G (Abbe s is most employed)] consists of a system\\nof lenses arranged immediately beneath the central opening of\\nthe stage. The object of this arrangement is to condense the\\nlight reflected from the mirror so that it becomes focused upon\\nthe object, thus furnishing brilliant illumination. The iris-dia-\\nphragm is arranged immediately below the condenser, for the\\npurpose of modifying the light passing from the reflector\\nthrough the condenser. Some instruments are provided with a\\nsecond iris diaphragm, situated above the condenser and immedi-\\nately beneath the stage. This diaphragm is employed when the\\ncondenser is not in use, and vice versa. The draw-tube (A) is a\\nvery important part of all high-grade microscopes, because, by\\nits skillful manipulation, the errors clue to refraction occasioned\\nby the varying thickness of the cover-glasses can be largely cor-\\nrected. Thus, b}^ varying the length of the draw-tube an effect\\nmay be produced upon the image similar to that of making the\\nback lens approach or recede from the front lens of the objective\\nby means of the correction-collar. Those beginning microscop-\\nical work will do well to familiarize themselves with the influence\\nexerted by varying the length of the draw-tube, and this is best\\naccomplished by the study of some delicate test-object of the\\ndiatom order, such as Pleurosigma angulatum, keeping in mind\\nthe rule that, the thinner the cover-slip, the longer should be\\nthe tube, and vice versa. In order to facilitate adjustment, the\\ndraw-tubes of the best microscopes are furnished with a scale in\\nmillimetres on the side of the tube.\\nFor urinary work as, indeed, for sputum and blood examina-\\ntions an instrument of medium size is more convenient than the\\nlarger stands with heavy, mechanical stage. The substage\\nshould possess all the essentials for arrangement and modifica-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0260.jp2"}, "261": {"fulltext": "Fig. B.\\n(219)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0261.jp2"}, "262": {"fulltext": "220 ANALYSTS OF URINE.\\ntion of light, such as an Abbe condenser, iris-diaphragm, and\\npreferably a lateral swinging mirror, or reflector. The mechan-\\nical stage is not a necessity, although a great convenience.\\nNearty every maker now supplies a portable mechanical stage\\nthat can be fitted to his particular instrument when desired.\\nSpecial care should be exercised in choosing a microscope that\\nthe mechanical adjustments (notably the rack-and-pinion move-\\nment and micrometer-screw) work with smoothness, ease, and\\nprecision.\\nThe most important accessories of the microscope are the\\nobjectives, and the quality of all microscopical w^ork must depend\\nvery largely upon their excellence. In urinary work a or\\ninch (5 or 6 millimetres) focus objective, and a j- or |-inch (3 to\\n3 J millimetres) focus objective are an absolute necessit\\\\^. To\\nthese should be added, if practicable, a y^-inch oil-immersion\\nobjective, especial^ if the work is to include bacterial search.\\nWith the above-named equipment of lenses all urinary work may\\nbe readily compassed as well as the fields of blood and sputum\\nexaminations in short, such equipment will cover the ordinary\\nrange of purposes for which the general physician requires a\\nmicroscope. While the quality of lenses varies very much, one\\ncan scarcely go astray in this particular if one patronizes only\\nthe leading manufacturers, among whom may be mentioned\\nZeiss, Reichert, Leitz, and Hartnack, abroad, and especially\\nSpencer at home It is of prime importance to keep in mind\\nthe suitabilit}^ of the objectives to the nature of the work to be\\ndone rather than to purchase a certain set, consisting of a low\\nand a medium power, because of a certain saving in the price of\\nthe outfit. The latter course is sure to result in the necessity of\\nadding another lens or two to the equipment. For the coarse\\nexamination of urinary sediments as casts, epithelium, etc. no\\nlens is so generally useful and satisfactoiy as a or ^-inch ob-\\njective. If left to the maker or dealer, as a rule a or ^-inch is\\nusually furnished but this is too low a power. Reiehert s No. 5\\nwill be found very suitable. Zeiss, unfortunately, does not make\\nan appropriate power: his C is too coarse and his D is too fine\\nfor this special purpose. For the more minute examination of\\nurinary sediments, i.e., for studying the morphological features", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0262.jp2"}, "263": {"fulltext": "THE MICROSCOPE. 221\\nor casts, blood- and pus- corpuscles, epithelium, and granular\\nsediments, a comparatively high-power objective is necessary\\nabout a or ^-incli focus. Reichert s la and Zeiss s D are suit-\\nable for this special purpose. The slightl} 7 -higher magnifying\\npower of the former has an advantage in searching for tubercle\\nbacilli and other micro-organisms if one has no immersion object-\\nive in his equipment. As before mentioned, the Spencer Lens\\nCompany turns out objectives that are in every way first class.\\nThe objectives just considered belong to the class of dry lenses;\\ni.e., lenses that are used without the interposition of any medium\\nbetween the lens and the object examined, save the atmosphere.\\nThese objectives answer excellent^ for coarse and medium\\npowers of magnification. When, however, very high power is\\nrequired, a dry lens, from its short focus, must approach very\\nnear the object, and in so doing much of the light bearing the\\nimage of the object is lost through refraction. Refraction is the\\nterm expressing the optical fact that light passing from one\\nmedium to another whose densities differ (as air and water) be-\\ncomes bent in its course. Thus, the rays composing a pencil of\\nlight, in passing from the object through the cover-glass, many\\nof them, especially near the periphery of the pencil, become so\\nbent as to fall outside of the arc of the front lens of the objective,\\nthereby reducing its power of definition. With coarse- or medium-\\npower objectives the focus being much longer, the lens much\\nlarger, as is also the pencil of light itself comparatively few of\\nthe ra} T s are lost, and consequently the resolving power of the\\nlens is not materially impaired through refraction.\\nThe oil-immersion objective, also termed the homogeneous\\nsystem, is so constructed that when in use the pencil of light\\npassing from the object through the objective traverses only media\\nof the same refractive power. This is accomplished b} r placing\\nbetween the lens and the cover-glass a medium which refracts\\nlight to the same degree as do the cover-slip and the lenses com-\\nposing the objective. For this purpose a drop of oil possessing\\nthe identical power of refraction as the glass is placed on the\\nfront of the lens or on the cover-slip, and the observation is made\\nthrough the oil (usually cedar-oil). It will be perceived that\\nthus there is no loss whatever of light through deflection, or re-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0263.jp2"}, "264": {"fulltext": "222 ANALYSIS OF URINE.\\nfraction, as in the dry system of objectives. Immersion lenses\\nare usually constructed for use with oil or water as the interven-\\ning medium, and they cannot be used as dry lenses, neither can\\ndry lenses be used as immersion objectives. Low- and medium-\\npower dry objectives are usually made in fixed mountings.\\nMany high-power dry objectives have a screw, or correction-collar\\nattachment. By means of the correction-collar the back lens\\ncan be brought near or removed farther from the anterior lens.\\nThe object of this device is to permit of a limited amount of cor-\\nrection, which is found necessaiy on account of the varving thick-\\nness of the cover-slips, for it is found that an objective of medium\\nor high power corrected for a thin cover will not give its best\\nresults with a thick one, unless provided with a correction-collar\\nadjustment. With the immersion sj~stem correction is unneces-\\nsary, as it has already been shown that the refractive power of\\nthe immersion fluid is identical with that of the cover-slip.\\nIn using medium- and, above all, high- powder dry objectives\\nwhich have no correction collars too little attention has hitherto\\nbeen given to the proper selection of the cover-slips. From that\\nwhich has already been said regarding refraction, it w r ill be gleaned\\nthat upon its proper regulation depends much of the defining\\npower of the objective. Cover-glasses for use w r ith medium- and\\nhigh- power dry objectives should be selected with scrupulous\\ncare, and only those turned out as No. 1 by reputable makers or\\ndealers should be purchased. Such cover-slips are carefully\\nselected as to thickness, and, as rule, vary in this respect within a\\ncomparativel} narrow range, sa} r from ten to twenty micro-\\nmillimetres (0.1 to 0.2 mm.). The objectives turned out Vy\\nmost prominent makers in dry fixed mounts without correction-\\ncollars are adjusted for a thickness of cover-glass varying only\\nfrom one and one-half tenths to two-tenths millimetre (0.15 to\\n0.2 millimetre). Where very fine work is to be done, it is bet-\\nter to measure the exact thickness of cover-slips by means of a\\ncover-gauge, and, having ascertained their exact individual thick-\\nness, put them away in boxes accurately labeled for future use.\\nThis is of special importance in cases in which objectives w T ith\\ncorrection collars are to be employed. In such cases the exact\\nthickness of the individual cover-olass should be recorded on the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0264.jp2"}, "265": {"fulltext": "THE MICROSCOPE. 225\\nglass slide or mount, and the collar can then be adjusted accu-\\nrately for the thickness of the cover-glass when the object is\\nunder examination. The author never makes permanent mounts\\nwithout recording the exact thickness of the cover-glass upon\\neach mount.\\nThe tube, or barrel, of the microscope is made in two forms\\na long and large tube (8 to 10 inches long), known as the English\\ntube, and a short tube (6 J inches 160 millimetres), known as the\\nContinental tube. The latter is the more desirable form, because\\nmost of the best makers of objectives adjust them for use with\\nthe Continental tube.\\nApochromatic objective is the term introduced by Professor\\nAbbe to designate a form of lens made by combining new kinds\\nof glass with natural mineral (calcium fluoride, or fluoride, or\\nfluor-spar). Apochromatic objectives were introduced in 1886,\\nwith the object of attaining the higher kind of achromatism, in\\nwhich rays of three spectral colors are combined in one focus,\\nin place of rays of two colors, as in the case of the ordinary\\nachromatic objectives. The special features of these objectives\\nwhen used with compensating e} r e-pieces l are as follow (a)\\nThree rays of different colors of the spectrum are focused at the\\nsame point, leaving a minute tertiary spectrum onlv, while with\\nachromatic objectives made from crown and flint glass only\\ntwo different colors are brought to the same focus, (b) With\\napochromatic objectives the correction of spherical aberration is\\nobtained for two different colors in the brightest part of the\\nspectrum and the objective show r s the same chromatic correction\\nfor the marginal, as for the central, part of the aperture. In the\\nachromatic objective correction of spherical aberration is limited\\nto one color, the correction only covering the central part of the\\naperture, the objective remaining undercorrected spherically for\\nred rays and overcorrected for the blue rays, (c) Apochromatic\\nobjectives admit the use of very high eye-pieces unfortunately\\ntheir high price excludes them from general use. Fortunate^,\\n1 The compensation eye-pieces are especially constructed for use with achro-\\nmatic objectives, in place of the old form of Huggian eye-pieces used with\\nachromatic objectives.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0265.jp2"}, "266": {"fulltext": "224 ANALYSIS OF URINE.\\nthey are not a necessit}^ save in photography, where it is impor-\\ntant to abolish chromatic aberration.\\nIllumination constitutes a most important feature in the use\\nof the microscope, and upon its proper management very much\\nof the efficiencj T of the work depends. Direct unmodified sun-\\nlight is unsuitable and should not be emploj^ed for ordinary\\nwork. North light is most uniform, and is preferable, especially\\nthat reflected from white clouds, rather than from a clear sky.\\nIt is best when working to face the light, in order to avoid the\\nshadows produced by the hands in adjusting the mirror or other\\nparts of the instrument. A shade should be used to protect the\\neyes and one may also be employed to shade the stage. The use\\nof lamp-light should, as far as possible, be avoided; when neces-\\nsary-, however, it is best to insert a slip or two of blue glass be-\\ntween the reflector and the object to soften the light. The begin-\\nner should practice with the eye as near the eye-piece as possible,\\nalso to use each eye alternately, keeping the eye open which is\\nnot engaged in observation. Too much light is to be avoided,\\nas it injures the eyes and detracts from the qualit}^ of the work.\\nIn urinary work oblique and axial light are most suitable, but\\nespecially the former. By the term axial light is understood\\nlight reaching the object with the rays parallel to each other\\nand to the optic axis of the microscope, or a diverging or con-\\nverging cone of light whose axial, or central, ray is parallel with\\nthe optic axis of the microscope. In each case the object is uni-\\nformly illuminated.\\nBy the term oblique light is meant light in which parallel\\nrays from a plane mirror form an angle with the optic axis of\\nthe microscope; or, if a concave mirror is used, the light is\\noblique when the axial ray of the cone of light forms an angle\\nwith the optic axis. Since oblique light is by far the most effi-\\ncient for the examination of most urinary sediments, it is well to\\nbear in mind the following methods of empkying it (a) The\\nfirst and best method is by placing the reflector to one side of\\nthe stage, since bj r this means almost any angle of obliquity nuiy\\nbe secured without limiting cutting off any material part of\\nthe pencil or cone of light from the reflector. For these reasons,\\noilier things being equal, an instrument is preferable that is ar-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0266.jp2"}, "267": {"fulltext": "Fig. C\u00e2\u0080\u0094 Zeiss s stand IVa. showing objectives, eye piece, anil nose-piece, without\\nswing-out condenser (one-half full size). The above form of Zeiss stand is\\nthat most used in America for general medical purposes, and is recommended\\nas the most suitable form of this make for urinary work.\\n(\u00e2\u0080\u00a2225.)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0267.jp2"}, "268": {"fulltext": "226 ANALYSIS OF URINE.\\nranged with a swinging reflector rather than one with the reflec-\\ntor fixed; ie., only movable perpendicularly, (b) Microscopes\\nprovided with a fixed reflector i.e., only movable perpendic-\\nularly and on a plain with the axis usually have a sliding stop\\nwhich, by moving aside, cuts off much of the direct rays from the\\nobject, admitting onty or largely the peripheral rays, which must\\nfull somewhat obliquely upon the object, (c) A third method\\nof obtaining oblique light is that with the Abbe condenser as\\nfollows First, focus the light from the condenser upon the ob-\\nject, then rack the condenser down until the focus is consider-\\nably below the object; the rays coming from the condenser come\\nto a point (focus) below the object, and continuing past the focus\\nthey decussate and diverge so that, when they fall upon the object,\\nall but the axial rays are oblique. Asa summary of the make-up\\nof the microscopical equipment suitable for urinary work it should\\nconsist as follows: A medium-sized stand with Continental tube;\\ntwo eye-pieces, or oculars substage, fitted with Abbe condenser;\\nan iris-diaphragm; a triple nose-piece, and preferably a swinging\\nreflector; three objectives should complete the equipment, viz.:\\na ^-inch and a |-inch dry objective, and a y^-inch oil-immersion\\nobjective. The workmanship of the instrument should be first\\nclass in all particulars. While undoubtedly the best microscopes\\nare those at present turned out hy Zeiss, unfortunately they are\\nalso the most expensive. The author knows of few microscopes\\nat present in the market that fulfill all of the above conditions\\nat the moderate expense of the one shown in the cut 1 (Fig. D).\\nCare of the Microscope. Should the lenses or oculars become\\nblurred or spotted from dirt or dust, proceed as follows If on\\nthe ocular, it will be discovered by rotating the ocular in the tube\\nwhile looking through the instrument, since the dust will be\\nseen to rotate with the eye-piece if the dust be upon the object-\\nive, it will remain unmoved when the ocular is rotated. The\\ncondition of the lenses may be further ascertained by holding\\nthem toward the light and at a distance from the eye, when, if\\nthe lenses are clean, a clear picture of the reduced image of the\\n1 The equipment shown in the cut (Fig. D) is sold by Richards Co., 12\\nEast 18th Street, New York, and 108 Lake Street, Chicago, for $100.", "height": "4888", "width": "3208", "jp2-path": "practicaluran00purd_0268.jp2"}, "269": {"fulltext": "Fig. D.\u00e2\u0080\u0094 Keicliert/s stand No. III6, showing objectives, eye-pieces, iris-diaphragin,\\nAbbe condenser, aud round, dustless nose-piece.\\n(227)", "height": "4888", "width": "3208", "jp2-path": "practicaluran00purd_0269.jp2"}, "270": {"fulltext": "228 ANALYSIS OF URINE.\\nwindow will be seen. It is recommended to remove dust from\\nthe optical parts by means of lens paper or a soft linen cloth.\\nThe author prefers silk, however, in all cases, as it leaves no fluff\\non the glass. The lens may first be breathed upon if this does\\nnot succeed, the silk may be moistened witli a little distilled\\nwater should this prove ineffectual, the silk may be slightl} r\\nmoistened with alcohol, but care must be taken that there be no\\nexcess of alcohol on the silk, otherwise it may get between the\\nlenses and dissolve the cement and thereb3 r render the lens use-\\nless. After using the oil-immersion objective it should be\\ncleaned as follows Wipe off the homogeneous liquid with a silk\\npocket-handkerchief; then, in the case of cedar-oil, wet one corner\\nin benzin and wipe the front lens with it; immediately after\\nwipe with a dry part of the silk. The cover-glass of the prepara-\\ntion may be cleaned similarly.\\nGlass surfaces should never be touched with the fingers.\\nThe oculars and objectives should never be allowed to fall upon\\nthe table, much less so upon the floor. All parts of the instru-\\nment should be kept free from liquids, more especially acids,\\nalkalies, alcohol, benzin, turpentine, and chloroform. When an\\nobjective is left in position on the instrument, an e} r e-piece\\nshould also be left in position in the upper end of the tube to\\nprevent dust from accumulating on the back lens of the object-\\nive. To clean the mechanical parts of the microscope Gage ad-\\nvises the use of some fine oil (olive-oil or liquid vaselin and\\nbenzin, equal parts) on a piece of chamois-leather or on lens-\\npaper, rubbing the parts well; then with a clean, dry piece of\\nchamois-leather wipe off most of the oil. If the mechanical parts\\nare kept clean in this way, a lubricator is rarely needed. In\\ncleaning lacquered parts benzin alone answers well, but it\\nshould be quickly wiped off with a clean piece of lens-paper. Do\\nnot use alcohol or ammonia, as they dissolve the lacquer and mar\\nthe finish of the instrument. The special features of the micro-\\nscopes turned out b} r different makers should be studied in the\\ncatalogues, which are very complete and, for the most part, admi-\\nrably illustrated.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0270.jp2"}, "271": {"fulltext": "the microscope. 229\\nExamination of Urinary Sediments.\\nPreparation of the Sediment. The sediment having first been\\nthoroughly concentrated by means of the centrifugal apparatus,\\nas detailed on page 149, the next point of importance is to so\\narrange it that it can be examined in detail under the microscope.\\nFor the coarser examination the most satisfactoiy method is to\\nmake a temporary mount of two or three drops of the sediment\\nin a shallow cell on a glass slide. For this purpose slides are\\nsold containing in the centre a hollow, ground-out depression, or\\ncell, for the sediment. A much better arrangement, however, is\\nto prepare a few slides as follows By means of a turn-table and\\na fine sable-brush a ring of gold-size should be made, three quar-\\nters of an inch in diameter, in the centre of an ordinary glass\\nslide after thoroughly drying, two or three more layers of gold-\\nsize should be added to the ring, when the cell will be found of\\nthe requisite depth. After drying four or five days, the slide is\\nready for use. A number should be made up and kept on hand\\nready for use as required. Such cells have the great advantage\\nof affording a perfectly flat and even field so that one does not\\nrequire to refocus the microscope each time the slide is moved,\\nas in the case of the ground-out cell. In mounting the sediment\\nthe author is in the habit of proceeding as follows First having\\nthoroughly cleaned and dried a slide containing a cell, and a slide\\nperfect 1} plain with no ring, as well as two or three circular\\ncover-slips (f-inch circles), these are all arranged standing slant-\\ningly ngaiiist the edge of some object about half an inch thick,\\nsuch as a tile, on the table. The best way to clean the slides and\\ncovers is to hold them under the warm-water faucet; then dry\\nthem with an old, but clean, soft-silk handkerchief. The slides\\nshould be tipped against the tile with the ring surface downward\\nin order to avoid dust from settling in the cell. jN ext take up a\\nslender and rather narrow-pointed nipple pipette and carry the\\npoint down the sediment-tube to within an inch or so of the\\npoint of the tube then stop, and by gentle, but stead} pressure\\nupon the rubber nipple expel from 3 to 6 or T bubbles of air;\\nnow carry the point of the pipette to the bottom of the sedi-\\nment-tube, release the pressure from the rubber nipple, and the\\nsediment will quickly flow into the point of the pipette. Xext,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0271.jp2"}, "272": {"fulltext": "230 ANALYSIS OF URINE\\nwith one hand withdraw the pipette from the sediment-tube, and\\nwith the other hand take up the slide with the cell, turn it over,\\nand deposit within the ring from 2 to 4 drops of the sediment.\\nNext, while holding the slide steadily in a horizontal position\\nin one hand, lay down the pipette from the other hand, and take\\nup a pair of fine-pointed forceps, and with the latter seize a\\ncover-glass by its edge, turn it over, and bring its edge to\\nthe outer edge of the ring composing the cell; lastly, gently\\nlower the cover-glass slowly and evenly over the cell so that\\nthe sediment spreads out evenly, leaving no air-bubbles be-\\nneath the cover-glass. More or less excess of sediment usually\\nescapes from beneath the cover on the slide. With a small\\nslip of filter-paper take up this excess, and the slide is ready\\nfor examination. Thus prepared, the sediment can be exam-\\nined in any position, and any obliquity of the instrument or\\nof light may be employed, without disturbing the sediment,\\nand the latter remains without changes from evaporation for\\nhours. The author in special cases varies the above method of\\nmanipulation somewhat, according to the quantity and character\\nof the sediment. Thus, it is not uncommon to meet with urine\\nso heavily charged with pus or other cellular elements that when\\nconcentrated with the centrifuge it is unsuitable for examination\\nundiluted. In such case the pus, or it may be blood-cells, so\\ncompletely fill the field as to hide certain more delicate and less\\nhighl} -refracting structures as hyaline casts from view, and\\nthe latter are likely to escape detection. In such cases the\\nfollowing method will usually succeed better After taking up\\nthe sediment in the nipple pipette, discharge but 1 drop or so\\nof it in the cell on the glass slide; then cleanse the pipette and\\ntake up a few drops of distilled or filtered water, or better of the\\nclear urine above the sediment, and discharge from 1 to 3 drops\\nof the latter into the cell with the sediment agitate the whole\\ntill evenly mingled, and lastl} r toy on the cover-glass as already\\ndescribed. Thus diluted, not only is there greater chances of\\ndetecting the presence of casts, but the morphological features of\\nthe cellular elements are nlso more plainly made out. Having\\nmounted one or two slides with cells as just described, the plain\\nslide remains. Upon the centre of this plain glass slide is next", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0272.jp2"}, "273": {"fulltext": "THE MICROSCOPE. 231\\ndeposited 1 or 2 drops of the sediment, and then a thin clean\\ncover-glass is gently lowered over it. The excess of sediment\\nescaping from beneath the cover-slip is now taken np by means\\nof filter-paper, and the slide is ready for the microscope. This\\nlast mount secures a very thin film or layer of concentrated sed-\\niment between the slide and a thin cover-glass, very suitable for\\nexamination under a higher power. This form of mount should\\nbe examined at once, since evaporation is more rapid than with\\nthe cell-mo nnt.\\nMicroscopical Search. The slides having been prepared, as\\nalready described, the microscope is placed in a convenient\\nlight on rather a low table, and arranged for use as follows The\\n^-inch objective, if on the nose-piece, is swung into position the\\nslide with cell-mount is placed in position upon the upper sur-\\nface of the stage, the tube of the microscope is racked down\\nuntil the front lens of the objective is very near the cover-glass\\nthe concave surface of the reflector is next turned toward the\\ncentral opening in the stage, the condenser is swung aside the\\niris-diaphragm is brought up under the stage very close to the\\nmount, and the diaphragm is closed down to a minute opening.\\nLastly, the reflector is swung well to one side, and while looking\\nthrough the microscope the reflector is turned about between the\\nfingers until it throws the light upon the sediment to be exam-\\nined. Xext. the tube is very slowly racked upward, until some\\nof the outlines of the sediment begin to appear, then by turning\\nthe fine-adjustment screw the instrument is focused. It will be\\nfound somewhat difficult in the case of beginners to readily find\\nthe exact focus at all times, and a few hints upon this subject\\nmay be of assistance. Great care should be exercised in lower-\\ning the tube of the microscope toward the mount by means of\\nthe rack and pinion, while looking through the instrument, be-\\ncause the eye. being engaged in looking through the microscope,\\ncannot judge distance with any degree of accuracy consequently\\nthe objective is exceedingly liable to be forced violently against\\nthe mount by this practice, to the ruin of both. It is a much\\nsafer practice to rack down the tube while looking sidewise\\nacross the stage, until the objective is very close to the stage\\nand beyond the plane of focus then, while looking through the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0273.jp2"}, "274": {"fulltext": "232 ANALYSIS OF URINE.\\ntube very slowly reverse the coarse movement, raising the tube\\nuntil the outlines of the sediment appear, finally effecting accu-\\nrate adjustment by means of the micrometer-screw. Having\\nfocused the instrument upon the sediment and regulated the\\nlight, the slide may be searched as follows Slowly move the\\nslide forward on the stage until the edge of the ring appears\\nin the lower right-hand corner of the field of vision next move\\nthe slide to the right in a direct line until the opposite side of\\nthe ring appears in the lower left side of the field next move\\nthe slide toward the bod} of the instrument a little more than\\nthe width of the field; next move the slide in a direct line to the\\nleft until the edge of the ring again appears in the right side of\\nthe field. Continue these movements in the order named until\\nthe upper edge of the ring appears in the field, when the whole\\ncontents of the cell will have passed under observation. In\\ngoing over the slide, if the fingers are employed to move the\\nmount instead of the mechanical stage, the slide may be moved\\nby two methods, as follows (a) Mark with the eye the extreme\\nlateral border of the field by fixing the vision on some structure,\\nas a pus-corpuscle or epithelial cell, then quickly move the slide\\nsidewise till the structure appears at the opposite border of the\\nfield, scan the field deliberately, and then again move the slide\\nthe width of another field, and so on until the slide is exhausted.\\n(b) Another method is by a steady, but continuous, movement\\ncarry the slide along, affording time for the eye to take note of\\nall the details of the moving picture, only pausing as something\\nof special note appears in the field. In either case from time to\\ntime move the fine-adjustment screw from right to left, and\\nreverse, to be sure that the instrument is in focus.\\nCasts. In searching for casts note any elongated structures\\nappearing in the field, and study carefully their outlines under\\ndifferent ranges of focus; note their morphological features.\\nNote carefully the character of the body of the supposed casts,\\nwhether granular or clear; if an} cellular elements are attached,\\nsuch as epithelia, blood, or pus; and, if any of these be found\\nattached, observe if they be well preserved, as indicated by\\nsharply-defined outlines, or if they be granular and ragged, and\\npartly disintegrated or broken down. Note if there be any", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0274.jp2"}, "275": {"fulltext": "THE MICROSCOPE. 233\\nsmall, round, highly-refracting globules attached to the cast, in\\nother words, fat-globules. Observe carefully the relative sizes\\nof the casts, as the predominance of certain sizes in a manner\\nindicates the seat of the most prominent pathological changes in\\nthe kidneys. Thus, if the casts found are mostly of the small,\\nnarrow order, we may assume that the more prominent changes\\nin progress are situated in the outer border of the cortex near\\nthe capsule; if the medium-size casts predominate, it indicates\\nmore deeply-seated changes, viz., in the middle zone; while if\\nthe large, broad casts are numerous, we infer that the morbid\\nchanges involve the straight collecting tubes in the areas of the\\npyramids. There will be little difficulty experienced in detect-\\ning granular and cellular casts, as they are, comparatively speak-\\ning, highly refracting and stand out prominently in the field of\\nvision. It is altogether different with hyaline casts, which are\\noften exceedingly difficult to find. This is because, in the first\\nplace, they are very transparent, and have very feeble refractive\\npowers and, in the second place, they are usually sparse. The\\nfollowing hints may aid the beginner in his search Bear in\\nmind the facts that cellular elements, notably pus- and blood-\\ncorpuscles, as, indeed, also epithelia, are comparatively heavy\\nand usualty settle to the bottom of the cell, while by their com-\\nparative lightness hyaline casts often partly float, and do not\\nsettle so low. The instrument should first be brought to a focus\\nupon some epithelial or other cell; then the focus should be\\nchanged to a higher field, indicated bv the cell becoming fainter\\nor more hazy in outline. If now the field be darkened b}^ closing-\\ndown the diaphragm to a small point, and the reflector kept well\\nto one side b}^ slowly moving the slide about, an occasional film\\nor thread of mucus will appear. This is very near the proper\\nrange of focus and illumination, and, by carefully going over the\\nslide under such conditions, if hyaline casts are present they\\nwill be found. In thus going over a slide, if any elongated\\nshadow appears the focus should be changed upon it, and one\\nwill often be rewarded by observing the well-defined outline of an\\nundoubted hyaline cast emerge from the shadow.\\nDiagnosis of Casts. The distinguishing features of rennl\\ncasts under the microscope are: (a) Uniformity of marginal out-\\n16", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0275.jp2"}, "276": {"fulltext": "234 ANALYSIS OF URINE.\\nlines throughout the greater part or whole of the structures.\\nThe margins of casts, it is true, may be in places indented, and\\nfor considerable distance in places even ragged and broken look-\\ning but, for the most part, the outline is even and uniform, and\\nstands out sharply cut as the edge of a rule. It does not look\\naccidental in appearance, but rather, as it really is, molded.\\n(b) For the most part, renal casts are uniform in their individual\\ndiameters, that is to sa} T they do not suddenly appear bulged\\nin one place and narrowed in others. It is true that in cases of\\nvery long casts which are comparatively uncommon a con-\\nsiderable difference may be observed in the diameter of such\\ncasts at their distal portions but this difference is gradually\\nnever suddenly reached. The body of a renal cast never ap-\\npears split. It may be found curved and even twisted, though\\nthe latter is rarely the case. Lastly, renal casts, as found under\\nthe microscope, for the most part are either short or of medium\\nlength, not unlike a finger; very rarely they attain considerable\\nlength. The reason of this is because they are fragile and easily\\nfractured, and they are subject to many accidents before they\\ncan be brought to view under the microscope, (c) The ends of\\nrenal cas ts are either rounded like the end of the finger or they\\nare abrupt and ragged, plainly showing evidences of fractures.\\nThe ends of renal casts never appear split or bifurcated.\\nFalse casts, or psendocasts, are structures very commonly met\\nwith in the urine, and are a source of more or less confusion to\\nthe beginner. For the most part, false casts consist of mucous\\nthreads, and are nearly always to be found in mild grades of irri-\\ntation of the bladder and urinary tract, though sometimes they\\ncome from some of the minute ducts along the urinary passages.\\nFalse casts, for the most part, possess distinct features which\\nare in striking contrast with true casts, as they appear to the\\nexperienced observer. Indeed, nearly all the essential features\\nof false casts are directly opposite to those of true renal casts.\\nThus, the outlines of false casts are indistinct or non-linear,\\nand are more or less irregular. Their diameters, consequent!}^\\nare exceedingly variable; in one place small or narrow, and im-\\nmediately after they swell out in spindle forms. Their ends are\\noften tapered out in fine, slender points, or they may be split,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0276.jp2"}, "277": {"fulltext": "THE MICROSCOPE. 235\\nbifurcated, or branched; but they never possess the smooth,\\nrounded ends or abruptly-fractured terminals of true casts.\\nThey are rarely, if ever, cellular or granular, bat under a high\\npower they appear marked with longitudinal striatums, or mark-\\nings, as though largely composed of fibres. They are often wavy\\nand ribbon-like in form, and they sometimes appear twisted and\\nbent into grotesque forms. In short, false casts lack the regu-\\nlarity and design, as it were, both in outline and detail, that true\\ncasts possess in their essential composition.\\nEpithelia. Various forms of epithelia are met with in nearly\\nevery specimen of urine, normal and abnormal, and careful note\\nshould be made of their form, size, and the condition of their\\nprotoplasm or contents. They are highly refracting, and, con-\\nsequently, very plainly visible under the microscope, their out-\\nlines standing out sharply and distinctly. The general character\\nof epithelia found in the urine corresponds to the three varieties\\nfound throughout the body, viz. (1) flat, or squamous: (2) cu-\\nboid I; and (3) columnar, or cylindrical. All epithelia are gran-\\nular, and possess one or more nuclei, though the latter may not\\nalways be visible, but inay, through maceration in the urine, drop\\nout, leaving vacuoles. The character of the granulation varies,\\nsometimes being coarse, at other times fine. Epithelia are subject\\nto certain changes in the urine by the absorption of water they\\nswell up and become more regular in outline; indeed, the\\nsmaller forms may thus become spherical. The small-sized cu-\\nboidal and columnar epithelia have always attracted the most\\ninterest in urinary sediments, since such cells come from the\\nconvoluted tubes and straight collecting tubes of the kidneys,\\nthough not exclusively from these sources. By careful study\\nof the description and illustration of the various forms of epi-\\nthelia. on pages 186 and 1ST, no difficulty should be experienced\\nin recognizing these structures under the microscope.\\nCrystals. Little difficulty will be experienced in recognizing,\\nmuch less in finding, the various forms of crystals met with\\nin the urinary sediment. For the most part, they are compara-\\ntively large and highly refracting, and are therefore best viewed\\nby low yowers and moderate illumination. A few exceptions to\\nthis rule occurs, notably in the case of the small envelope-shaped", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0277.jp2"}, "278": {"fulltext": "236 ANALYSIS OF URINE.\\nciystals of calcium oxalate which are often very minute. As a\\nrule, the brown colored crystals met with in the urine are uric\\nacid or ammonium urate, and their various forms should be\\nstudied so that they are familiar pictures. As a rule, the large,\\nclear prisms are triple phosphate, while the smaller forms of\\nhighly-refracting stars, envelope shapes, and dumb-bell forms are\\noxalate of lime. These comprise the more common forms met\\nwith. Special and unusual forms should be studied. (See pages\\n156-177.)\\nPus- and Blood- Corpuscles. In order to make a satisfactory\\nstudy of the morphological features of pus- and blood- cells in\\nthe urinary sediment, resort must be had to a higher power than\\nin the case of casts and epithelia The student should proceed\\nas follows A ^-inch to ^-inch objective is placed in proper posi-\\ntion and the plain-mounted slide (without cell) is then placed\\nupon the stage in position for examination. The concave re-\\nflector is adjusted, as already described, to secure oblique illu-\\nmination, and the diaphragm is opened so as to admit more\\nlight, since greater illumination is necessaiy. The form and\\ncharacteristics of pus- and blood- cells have been so fully de-\\nscribed in another section (Section VII) that but little requires to\\nbe added here. It may, however, be stated that confusion is\\nsometimes experienced by beginners in distinguishing pus- from\\nblood- cells, nay, even the small, round epithelia have been mis-\\ntaken for one or the other, but especially for pus-corpuscles.\\nThis is not likely to occur when all three are present at once in\\nsufficient numbers to admit of careful study but where only\\nscattering cells of one order are present a mistake is more likely\\nto occur. It is well for the student to keep in mind the relative\\nsizes of these structures as a general guide. Pus-corpuscles are\\nnearly always to be found in the urinary sediment, and these\\nshould first be sought and identified as the small granular disks\\nwith multiple nuclei, two or more. They constitute the medium-\\nsized round cells met with in urinary sediments. Somewhat\\nsmaller in size about one-third smaller will be noted the pale,\\nnon-granular, non-nucleated hemispherical disks, or red blood-\\ncells while at least one-third larger than pus-cells w r ill be noted", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0278.jp2"}, "279": {"fulltext": "THE MICROSCOPE. 237\\nthe granular, very large, nucleated round cells, the so-called renal\\nepithelia.\\nAfter the outlines and general features of casts, epithelia,\\npus- and blood- corpuscles have been recognized, a closer study\\nshould next be made of their minute features under the higher-\\npower lens. Careful search should be made for evidences of\\npathological changes in all these structures, more particularly\\nfor evidences of fatty changes, as evidenced by the presence of\\nsmall, spherical, highly-refracting globules of fat in the proto-\\nplasm. The state of preservation of the cells should be noted,\\ni.e., whether they retain their uniform unbroken outlines or if\\nthey are partly broken down and the protoplasm essentially\\naltered. Finally, note should be taken of the quantit} T and so\\nfar as possible the character of the granular sediment, which\\nmay consist of albuminous granules or amorphous inorganic\\nelements.\\nMicro-organisms.\\nThe presence of micro-organisms, their motility, and even\\nsome of their morphological features may often be made out\\namong other elements of the urinary sediment when prepared\\nas already described. A satisfactory examination in detail of\\nthese bodies, however, is not practicable without some special\\npreparation and staining. As very little has been written, com-\\nparatively speaking, of the preparation of urinary bacteria for\\nexamination under the microscope, the author will here outline\\nthe method found convenient and useful in his laboratory, since\\nit is exceedingly simple.\\nThe urine having first been thorough^ sedimented in the\\ncentrifugal machine, much better with the special attachment\\nprovided for this purpose, a few cover-glasses of known thick-\\nness are cleaned and arranged convenient^ for use. One of the\\nclean cover-slips is placed upon a clean card, and upon the centre\\nof the cover-slip is placed 1 or 2 drops of the highly-concen-\\ntrated sediment. Next, the sharp corner of a freshly-torn slip\\nof filter-paper is allowed to touch the extreme margin of the\\nsediment. The filter-paper should be held steady till saturated", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0279.jp2"}, "280": {"fulltext": "238 ANALYSIS OF URINE.\\nwith the liquid elements of the sediment; then ii fresh piece of\\nfilter-paper should be applied to another point at the margin of\\nthe sediment. This should be continued until the aqueous ele-\\nments of the sediment have been as far as possible removed,\\nleaving a glistening, gelatinous-looking residue. Another clean\\ncover-slip is next seized in a sharp-pointed forceps and gently\\nlowered over the sediment, exactly covering the slip that holds\\nthe sediment. The two cover-glasses should next be seized be-\\ntween the previously-cleansed thumb and forefinger of one hand\\nand gentle pressure made, when the remaining aqueous elements\\nof the sediment will ooze from between the cover-slips. Next,\\nwith a soft clean silk pocket-handkerchief wipe the edges of the\\ncovers b} T a circular movement, holding the thumb and finger\\nmore or less tightly as the axis around which the covers revolve\\nwhile being wiped. Gradually increase the pressure, both in\\nholding the cover-slips and wiping, until the organic elements\\nof the sediment are spread out in a thin film between the\\ncover-slips and all the aqueous elements are wiped away.\\nFinally, slide the cover-slips quickly apart, dry the films, and,\\nlastly, pass them two or three times through a Bunsen or\\nspirit- flame.\\nIt will be perceived that this simple process frees the sedi-\\nment from its aqueous elements, and the latter carries with it the\\ndissolved urinary salts which would, if left, greatly interfere with\\nthe subsequent staining, or, by crystallization on the cover-slip\\nin drying, mar the preparation.\\nWith regard to staining, nearly every work on bacteriology\\nis replete with instructions and directions how to proceed, and\\nthe subject is, indeed, so extensive that special works upon the\\nsubject should be consulted in order to attain proficiency.\\nCertain general stains are very useful for urinary sediments,\\namong which may be mentioned carbol-fuchsin, gentian-violet,\\nmethyl-blue, etc. The first named may be made use of for\\nstaining both gonococci and tubercle bacilli, and therefore it\\nshould always form a part of the laboratory equipment. As\\na general stain for micro-organisms, found in the urine, the\\nauthor prefers thionin in the form of a 5- to T-per-cent. aqueous\\nsolution.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0280.jp2"}, "281": {"fulltext": "THE MICROSCOPE. 239\\nMounting. The prepared and stained cover-slips containing\\nthe micro-organisms are mounted very simply, as follows A\\nbottle of good Canada balsam thinned with xylol should be kept\\non hand, as well as some perfectly clean thin glass slides of\\ngood quality. The cover-slips having been thoroughly dried, a\\nclean glass slide is placed upon a white card, and by means of a\\nglass rod a small drop of balsam is let fall upon the centre of\\nthe slide, taking care that no air-bubbles are attached thereto.\\nNext, with a fine forceps take up the cover-slip and gently lower\\nit, tilm-side down, over the drop of balsam on the slide. If the\\ndrop of balsam is not too large the balsam will flow evenly\\nunder the cover-slip, little or none running out upon the free\\nsurface of the slide. If the drop be large the extra balsam may\\nbe wiped away with a piece of filter-paper. The preparation,\\nafter proper labeling, is permanent and ready for examination\\nat any time.\\nBacterial Examination. The microscope should be arranged\\nfor high-power work as follows The diaphragm should be\\nthrown wide open and the condenser brought up close to the\\nstage, so that the light is focused upon the film. The plane sur-\\nface of the reflector is turned toward the stage of the microscope,\\nas parallel rays are preferable w T ith the condenser. The draw-tube\\nshould be so arranged that the distance from the upper edge of\\nthe objective to the top of the tube where the eye-piece fits in is\\njust 160 millimetres (6^- inches). The top of the stage should\\nbe shaded from direct light from any source. The instrument\\nshould be placed in nearly a perpendicular position, i.e., w r ith\\nthe tube perpendicular if the immersion objective is to be em-\\nployed, otherwise the immersion fluid is apt to drain away from\\nthe field of work. With the immersion objective in position,\\nand the light arranged, the tube is lowered slowly, after first\\nhaving placed a large drop of immersion fluid on the centre of\\nthe cover-slip. While lowering the tube with the rack-and-\\npinion movement, the observer should look across the stage with\\nthe eye nearly on a level with the latter, and while so doing\\nbring the tube slowly down until the front lens of the objective\\ntouches the immersion fluid. The observer should next look\\nthrough the instrument, adjust the light properly, and move the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0281.jp2"}, "282": {"fulltext": "240 ANALYSIS OF URINE.\\nslide about until some distinct tint appears in the field. The\\nstain having been recognized, the micrometer adjustment will\\nreadily be made to bring the microscope in focus with the\\nmicro-organisms, which may now be examined in detail.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0282.jp2"}, "283": {"fulltext": "SECTION IX.\\nGRAVEL AXD CALCULUS.\\nConcretions of a more or less hard and dense character are\\nliable to form in the urinary passages. These bodies are va-\\nriously termed, according to their size, location, etc., sand, gravel,\\nstone, and calculi. These formations are called primary when\\nthey are deposited from urine which has undergone no decom-\\npositional changes, and are the result of some original defect of.\\nor foreign addition to. the composition of the urine. The sec-\\nondary formations, on the other hand, are due to decomposition\\nof the urine with resulting precipitation of its elements, and, for\\nthe most part, comprises those ammoniacal changes of the urine\\nresulting from inflammatory disorders of the lower urinary\\npassages. Concretions of small size not too large to make\\ntheir way spontaneously through the urethra have been some-\\nwhat arbitrarily termed gravel while, on the other hand, the\\nlarger concretions have received the name of stones or calculi.\\nConcretions vary greatly in size some of them being so minute\\nas to require the microscope for their recognition, while others\\nattain the enormous size of an orange or even larger. The\\nsmaller concretions mostly emanate from the kidneys or renal\\npelvis, while those of large size come from the bladder.\\nThe most practical classification of urinary concretions is\\nthat which corresponds to the chief constituents of which they\\nare composed. This comprises the following divisions (1) uric\\nacid; (2) urates; (3) oxalate of lime (4) cystin (5) xanthin\\n(6) urostealith (7) basic calcium jjhosphate (8) calcium car-\\nbonate; (9) calcium phosphate with ammonio-magnesium phos-\\nphate. These are all strictly of urinary origin, and composed\\nof urinary ingredients. In addition to these, at least two other\\nclasses of concretions are met with, whose origin are extra-\\nurinary, viz., jjrostatic calculi and fibrin or blood concretions.\\nConcretions may consist exclusively of one ingredient, uric\\nacid and calcium oxalate being the most frequent examples.\\n(241)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0283.jp2"}, "284": {"fulltext": "242 ANALYSIS OF URINE.\\nFar more frequently, however, two or more primary deposits\\noccur in separate and alternate layers, constituting the so-called\\nalternating calculus, the most common of which are those com-\\nposed of uric acid and calcium oxalate. The number and thick-\\nness of these layers in alternating calculi vary very greatly ac-\\ncording to the age of the calculi and the f requeue} 7 of the changes\\ngiving rise to the alternating deposits. The thickness of the\\nlayers also varies to some extent inversely with their number.\\nIf a calculus consist of but one primary substance, its arrange-\\nment is usually stratified, exhibiting a larger or smaller number\\nof concentric layers. Such are usually uric-acid, calcium-oxalate,\\nand phosphatic formations. The great majority of concretions\\nconsist of a central division or nucleus, and an excentric division\\nor body. There may be in addition, especially in old or large\\ncalculi, an external envelope or crust, which is nearly always\\nphosphatic. The nucleus varies much in size and composition.\\nIt ma} T consist of the same material as the body of the calculus,\\nespecially when the latter is made up of such primary deposits\\nas uric acid, calcium oxalate, etc. Frequently, however, the nu-\\ncleus consists of some organic product, as blood-clots, coagulated\\nmucus, or epithelium. Exceptionally foreign bodies introduced\\nfrom without into the bladder become the nuclei for subsequent\\ncalculous formations.\\nThe causes of urinary concretions comprise (a) the con-\\nditions favorable for their origination (b) the conditions favoring\\ntheir formation and growth. The conditions favoring the origin\\nof calculi have received some light through the researches of\\nCarter, who found that the actual nucleus nearly always consists\\nof globular forms of urates and calcium oxalate, rather than\\ncrystals of these substances; and, furthermore, that a colloid\\nmatrix was always an essential element of the nuclear formation.\\nRainey and Ord have furthermore shown that the globular forms\\nof urates and oxalates referred to are onl3 T produced when pre-\\ncipitation occurs slowly in the presence of a colloid medium.\\nFrom this it would appear that morbid conditions of the urinary\\npassages accompanied by exudations of colloid matter, such as\\nmucus or albuminoids, constitute the initial step in the forma-\\ntion of calculi. In the presence of such colloids precipitation", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0284.jp2"}, "285": {"fulltext": "GRAVEL AND CALCULUS. 243\\nof urates, oxalates, etc., occurs, which, combining with the col-\\nloids, form globular aggregations that constitute the basis for\\nsubsequent development of stone. The conditions favoring the\\ngrowth and development of concretions embrace chiefly the\\nstates of the system or of the urine itself which favor precipita-\\ntion of the urinary solids. Under the first set of causes may be\\nmentioned digestive disorders, organic diseases of the kidneys,\\nand diseases of the urinary passages, most notably cystitis.\\nThe conditions of the urine favoring the growth of calculi are\\nvariable, and in some cases directly opposite. Among these\\ncauses may be mentioned (a) excess in the urine of the precipi-\\ntated substance (b) overacidity of the urine. This disposes\\nmore especially to the growth of uratic concretions, as it dimin-\\nishes the solvent powers of the urine over uric acid and the\\nurates, thus leading to their precipitation, (c) An alkaline con-\\ndition of the urine. This may lead to precipitation of the phos-\\nphates or carbonates of calcium and magnesium. If the urine\\nbe alkaline from fixed alkali, the earthy phosphates or carbonates\\nof calcium may be precipitated and favor calculous growth of\\nthat order, a rare condition, however. If the urine be alkaline\\nfrom volatile alkali ammonia the result is precipitation of\\ntriple-phosphate of ammonium and magnesium, an exceedingly\\ncommon occurrence, (d) Deficiency of urinary salines and of\\nsodium and alkaline phosphates in the urine weaken its solvent\\npowers over the urates and cause precipitation, (e) Lastly,\\ndeficiency of the normal urinary coloring matters greatly weakens\\nits solvent powers and favors precipitation of various constitu-\\nents, especially uric acid and the urates.\\nUric-Acid Concretions.\\nCalculi composed entirely or chiefly of uric acid comprise\\nthe great majority of stones met with in human urine. Sta-\\ntistics give the proportion to all other forms at from T5 to 90\\nper cent. Indeed, the great f requeue} of this form of gravel\\nled early observers to the conclusion that all stones were com-\\nposed of uric acid in whole or in part; hence the name lithuria,\\nfor a long time, was applied to gravel in general, and even at\\nthe present time is sometimes erroneously applied.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0285.jp2"}, "286": {"fulltext": "244 ANALYSIS OF URINE.\\nUric acid may be passed in the form of crystalline clusters,\\nor as smooth, spherical bodies, ranging in size from a pin-point\\nto that of a grain of wheat, or, again, in roughened concretions\\nas large as a pea. These are derived from the kidney or renal\\npelvis, and ma3 T be washed out with the urine singly or in num-\\nbers at different intervals. The passage of uric-acid gravel from\\nthe kidneys is usually attended by more or less pain, sometimes,\\nindeed, so acute that it has received the name of renal colic\\nAll these uric-acid concretions present a yellowish-brown or\\nreddish appearance. If retained in the bladder, these small\\nconcretions grow, more or less rapidly, into round or oval or\\nelongated and flattened stones. Their surfaces are tuberculated\\nand irregular, and they vary in weight from a few grains to four\\nor five ounces. They are hard and brittle, and, upon section,\\nthey may be seen to be marked with concentric laminae.\\nUric acid may be recognized by the murexid test (see page\\n33). It is soluble in solutions of lithium, potassium, and sodium,\\nand also in piperazin, while in solutions of sodium and potassium\\nbicarbonate it is insoluble, as well as in water and dilute acids.\\nSince the combination of uric acid and lithium is more soluble\\nin water than its combination with sodium or potassium, it has\\nbecome popular to treat the so-called uric-acid diathesis with\\nmineral waters containing a few grains of lithium carbonate to\\nthe gallon. As Bunge has shown, 1 however, this naive idea\\nsimply implies ignorance of Bertholett s law in reference to the\\ndiffusion of bases in the economy, as no such solvent action of\\nuric acid in the economy is obtained thereb}\\nThe formation of uric-acid calculi is most frequent in early\\nand late life; that is to saj in children and old people. A\\nhighly-acid state of the urine is the most essential condition for\\ndeposition of this form of concretion. Uric acid frequently\\nforms the basis of calculi which, subsequentl} becomes the\\nnuclei for further formation with other urinary constituents,\\nconstituting mixed calculi. The most frequent of these second-\\nary formations is calcium phosphate less frequently, calcium\\noxalate. Should the urine become alkaline at any time from\\n1 Text-Book of Physiological and Pathological Chemistry, London, 1890,\\npp. 356 and 357.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0286.jp2"}, "287": {"fulltext": "GRAVEL AND CALCULUS. 245\\nvolatile alkali, triple phosphates will be deposited and add to\\nthe growth of the calculus. This, indeed, is almost an essen-\\ntial in the late stages of calculous life in the bladder, since alka-\\nline urine is one of the features of vesical inflammation which\\nattends nearly all calculi of any size, especially during their late\\nsojourn in the bladder. The conditions favoring the deposition\\nof uric acid have been more fully considered in another section\\nof this volume (page 32).\\nUrate Concretions.\\nUrates rarely constitute the sole constituent of stone in\\nadults, but with uric acid they are frequently met with in the\\ncalculi occurring in children. On the other hand, in connection\\nwith calcium oxalate, urates form a large percentage of calculi\\nfound. Urate concretions have been regarded as consisting of\\nammonium urate, but calcium and sodium are to be found in\\nthem quite generally upon analysis. They do not attain a large\\nsize, as in the case of uric-acid stones, rarely being found larger\\nthan a small marble. They are usually of a light-grayish color\\nand multiple in number, two or more being found together.\\nThey are not so hard and dense as the uric-acid calculi. Like\\nuric acid, urate stones are nearly always deposited from acid\\nurines the exceptions to this rule consist chiefly of the mixed\\nstones of triple phosphate and ammonium urate, which are the\\noutgrowths of ammoniacal urine.\\nThe urate deposits possess a great tendency to form infarcts\\nin the renal tubules during early infancy. These consist of\\nammonium and sodium urate, which form yellowish-brown lines,\\noften reaching from the papillae to the bases of the pyramids,\\nfollowing the lines of and blocking the interiors of the large,\\nstraight, uriniferous tubes. They occur most frequently from\\nthe second to the tenth day after birth, although the} ma}- occur\\nas late as ten or twelve weeks after birth. It is significant that\\nthese infarcts are not found in the kidneys of stillborn children.\\nThe conditions leading to these deposits in infants is physio-\\nlogical rather than pathological. due to the highl}--concentrated\\nstate of the urine at birth the deficiency of aqueous elements\\nin the urine does not permit either of solution or washing out", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0287.jp2"}, "288": {"fulltext": "246 ANALYSIS OF URINE.\\nof the uratic components of the urine, which, upon the establish-\\nment of respiration, become greatly in excess.\\nIn febrile conditions in children deposits of sodium urate\\nare common, and no doubt frequently form the nuclei and pri-\\nmary deposit for the subsequent development of gravel. The\\nfrequent occurrence of calculi in children may be largely attrib-\\nuted to this source.\\nCalcium-Oxalate Concretions.\\nOxalate of-lime concretions are met with most often as large,\\nrough, dark, tuberculated masses commonly called mulberry\\ncalculus. Less often they occur as small, rounded, smooth,\\ndark-grayish bodies, called hemp-seed calculi. Calcium-oxa-\\nlate concretions are extremely hard and brittle, and when crushed\\npresent sharp, angular lines of fracture. The nucleus often con-\\nsists of uric acid or urates, or it may be colloid. Pure calcium-\\noxalate calculi are often met with, but much more frequently\\nmixed calculi of calcium oxalate and uric acid occur in alternating\\nstrata around a mixed nucleus. Less often calculi are met with\\nconsisting of oxalate of lime as the basis, surrounded by a more\\nor less deep incrustation of triple phosphate.\\nThe urine associated with calcium-oxalate calculi is always\\nacid, unless in cases of long standing, in which the stone has set\\nup cystitis, when it may be found ammoniacal. In short, the\\ncondition of the urine in these cases is very similar to that with\\nuric acid, as might be expected from the fact that calculi are so\\noften encountered composed of alternating layers of these two\\nsubstances.\\nCystin Calculus.\\nThis form of concretion is comparatively rarely met with in\\npractice. Although not usually attaining the large size of uric-\\nacid calculi, they may be found in the bladder exceptionally of\\nconsiderable dimensions. As a rule they are of medium size,\\noval or cylindrical in form, with finely-granular surfaces, over\\nwhich may be seen small crystals of a decidedly yellow color.\\nAlthough these concretions are rather soft and compressible,\\nthey break with a crystalline fracture. Upon section they pre-\\nsent a radiated appearance of }^ellow color not unlike bees-wax,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0288.jp2"}, "289": {"fulltext": "GRAVEL AND CALCULUS. 247\\nbut they turn gray upon exposure to light. The causes of cystin\\ndeposits in the urine have already been discussed in the pre-\\nceding section. The most notable feature in this connection is\\nits tendency to occur repeatedly in members of the same family.\\nCystin is readily recognized by its ready solubility in ammo-\\nnia, depositing, upon evaporation, its beautiful and character-\\nistic six-sided crystals. It is also soluble in mineral acids as\\nwell as in the fixed alkalies and their carbonates while it is\\nprecipitated by vegetable acids and ammonium carbonate.\\nXanthin Concretions.\\nXanthin calculi are exceedingly infrequent; in fact, they are\\nperhaps the rarest of all concretions met with in the urine. 1\\nThe} seem to be entirely confined to young subjects, none as yet\\nhaving been met with either in adult or in advanced life.\\nXanthin concretions are of a whitish, yellowish-brown, or\\ncinnamon-brown color, of medium hardness, with amorphous\\nfracture, and on rubbing appear like wax. They vary in size\\nfrom a pea to that of a hen s egg. They burn completely when\\nheated on platinum-foil. The} give the xanthin reaction with\\nnitric acid and alkali, which should not be mistaken, however,\\nfor the murexid reaction.\\nCalcium-Phosphate Concretions.\\nPhosphate-of-lime calculi are among the rarer forms of un-\\nmixed concretions. They possess a chalk-like appearance and\\nbreak with an amorphous fracture. They may be dense in\\nstructure or loose and spongy. Two forms of calcium-phosphate\\ncalculi occur: (a) Round or oval-form, varying in size from a\\nsmall bean to a hen s egg. These are of a white, chalky appear-\\nance, of friable surface, and break with an amorphous fracture.\\nThese are usually vesical calculi of elderly people, especially\\ndyspeptic people with alkaline urine, (b) The second form are\\nirregular, sometimes branched in shape, of a grayish-white color,\\ncompact in texture, brittle, and of porcelain-like fracture. These\\nare usually found in cysts and pockets of the urinary channels,\\nand appear to be of local origin.\\n1 Less than a dozen cases are at present on record.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0289.jp2"}, "290": {"fulltext": "248 ANALYSIS OF URINE.\\nThe earthy phosphates are often abundantly deposited in the\\nurine, but, owing to their amorphous form, they possess little\\ntendency to concrete; otherwise this form of calculus would\\ndoubtless rank among the most frequent of urinary concre-\\ntions. It is well known that patients may void alkaline urine,\\nturbid from undissolved earthy phosphates, for months without\\nstone formation.\\nAmmonio-Magnesium-Phosphate Concretions.\\nCalculi composed exclusively of this salt are uncommon\\nbut, on the other hand, it very frequently forms the exterior of\\nother forms of calculi, such as uric acid or calcium oxalate.\\nAmmonio-magnesium-phosphate concretions are always signifi-\\ncant of ammoniacal urine, and herein lies the explanation of its\\nfrequenc3 r as a secondary deposit upon other primary concre-\\ntions. The mechanical irritation set up b}^ any primary calculus\\nof much size invariably leads to ammoniacal decomposition of\\nthe urine, usually in the bladder. The result of these changes\\nis prompt precipitation of triple phosphates of highly-crystalline\\nnature, and therefore readily tending to concrete upon an}\\nnucleus in the bladder. It has been stated that triple phosphate\\ncalculi are rare this applies to concretions of marked size.\\nMixed Phosphate Concretions.\\nThe most common variety of mixed phosphatic calculi are\\nthose composed of calcium phosphate with triple phosphate of\\nammonium and magnesium. This has been termed the fusible\\ncalculus, because under the blow-pipe it fuses into a black,\\nenamel-like mass. These calculi often attain a large size. They\\nare of grayish-white color, often covered on the surface with\\nbright, glistening points, triple phosphatic crystals. In text-\\nure the} are friable and somewhat spongy, often composed of\\nconcentric strata, easily fractured into thin laminae, the fract-\\nured surfaces often presenting bright deposits of crystalline\\ntriple phosphates. This calculus is very soluble in mineral\\nacids, but is insoluble in water and alkalies its chief character-\\nistic is its fusible property under the blow-pipe.\\nThese calculi nearly always form upon some other primary", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0290.jp2"}, "291": {"fulltext": "GRAVEL AND CALCULUS. 249\\nnucleus, such as uric acid or calcium oxalate, and they often\\nincrust fungous or other growths of the bladder. They are\\nalways the result of ammoniaeal urine, and originate chiefly\\nwithin the bladder.\\nCalcium-Carbonate Concretions.\\nConcretions of carbonate of lime belong to the rarer forms\\nof calculi met with in human urine, very few authenticated cases\\nbeing on record. They are small in size, of smooth surface,\\ngray or bronze-like in color, and often very hard in texture.\\nThey are mostly spherical in shape, often translucent, and on\\nsection present numerous concentric lines. The nucleus is\\nusually multiple, and upon crushing these calculi they break\\ninto sharp fragments.\\nOther Forms of Concretions.\\nA few additional varieties of concretions are occasionally\\nmet with in the urine.\\nFatty Concretions. These consist of fatty matters saponified\\nby the alkalies of the urine. This substance has received the\\nname of urostealith. These concretions are soft and friable,\\nusually of brownish or yellowish color, and often incrusted with\\nphosphates. The} 7 burn with a flame when heated on platinum-\\nfoil, and give off an odor similar to resin or shellac, These\\ncalculi have only been met with a few times.\\nIndigo Concretions. Indigo has been met with in the urine\\nin the form of calculus. It is doubtless derived from the in-\\ndoxyl-potassium sulphate of the urine, which ma} r be changed\\nby highl} T -acid urine into indigo. Such cases are exceedingly\\nrare, however, but one or two having been recorded.\\nFibrin and blood concretions are mentioned as having been\\nmet with in the urine, but these must be looked upon as anoma-\\nlous occurrences, except as forming the nucleus of other calcu-\\nlous growths.\\nProstatic Concretions. Prostatic calculi ma} 7 be mentioned\\nas sometimes encountered in the urine, although not strictly\\nspeaking urinary products. Sir Henry Thompson found these\\ncalculi invariably in the adult prostate at the autopsy. They\\nXI", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0291.jp2"}, "292": {"fulltext": "250 ANALYSIS OF URINE.\\nare found in the follicles of the prostate; at first consisting\\nentirely of albuminoid matter, they later become impregnated\\nwith earthy matter, and ultimately become as hard as other\\nforms of calculi. It is exceptional that they give rise to special\\nsymptoms only so when they attain an unusual size and en-\\ncroach on the gland-tissue or project into the urethra. It is\\nonly exceptionally that these concretions are spontaneously dis-\\ncharged with the urine.\\nClinical Differentiation. It would add greater precision to\\nthe treatment of calculus if the nature of the stone could be\\nmade out. The accuracy with which this can be compassed will\\nvary considerably in different cases. The most trustworthy in-\\nformation is obtainable from examination of calculi already\\nvoided with the. urine. In a very considerable percentage of\\ncases the habit of spontaneous expulsion of small concretions\\nhas been established. If the discovery of a retained calculus be\\nnot too remote from the spontaneous passage of a concretion\\nwhich has been secured and examined, and, furthermore, if the\\ncharacters of the urine correspond, it furnishes the most certain\\nevidence of the nature of the retained calculus. It is of the\\nutmost importance, therefore, to preserve all concretions that\\nmay be spontaneously voided with the urine, however minute\\nthey may be, and to make an accurate note of their composition,\\nas well as of the characters of the urine at the time they were\\nvoided.\\nIn the absence of the above information it is still possible,\\nin a large majority of cases, to make out with very great proba-\\nbility the composition of the retained concretion. The evidences\\nhere are to be drawn from the characters of the urine notably\\nits chemical reaction and the character of the deposits. In\\naddition to these, certain inferences are to be drawn from the\\nconstitutional peculiarities of the patient, as well as the age,\\ntogether with the known frequency of the different forms of\\nconcretions considered with regard to their location.\\nIf the urine be frankly acid at the time voided, the calculus is\\nnearly certain to be either uric acid or calcium oxalate. Uric-\\nacid calculi being by far the more frequent, the chances are in\\nfavor of the presence of that form of concretion. If, in addition", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0292.jp2"}, "293": {"fulltext": "GRAVEL AND CALCULUS. 251\\nto the sharply-acid reaction of the urine, directly upon cooling\\nit precipitates crystals of uric acid, and the symptoms appear in\\nvigorous subjects addicted to the liberal use of meat diet, it\\nbecomes reasonably certain that the calculus is of the uric-acid\\nform.\\nIf, on the other hand, the freshly -voided acid urine precipi-\\ntate habitually the calcium-oxalate crystals, the patient being of\\nsedentary habits and prone to indulgence in the use of both\\nsaccharine and proteid foods, it may be pretty confidently con-\\ncluded that a calcium-oxalate calculus is retained. As already\\nobserved, calculi are very frequently met with composed of\\nalternating layers of uric acid and calcium oxalate, because they\\nare both the outgrowth of acid urine, as well as largely of simi-\\nlar habits of living. But the predominance of either variety\\nmay usually be made out by repeated observation of the features\\njust considered. Cystin and xanthin concretions are also met\\nwith in acid urine, but these formations are so rare that the} T\\nmay, for practical purposes, be ignored, unless the presence of\\nthese substances be discovered in the urinar}^ sediment, in which\\ncases the probabilit} 7 of the presence of these rarer forms of\\ncalculi ma} 7 become a proper subject for consideration.\\nThe forms of calculi met with in alkaline urine next demand\\nattention. For the most part these are vesical calculi. As a\\nrule, they are more complex in composition, because the con-\\nditions of the urine during the formation and growth of these\\nconcretions are subject to greater change. Renal calculus is\\nfrequently composed of a single constituent, because its origin\\nand growth is practically in the same location and subject to the\\nsame conditions of the urine throughout. With vesical calcu-\\nlus, on the other hand, the nucleus ma}^ originate in the kidney\\nwhen the urine is acid, or even alkaline from fixed alkali, while\\nits subsequent development occurs in the bladder, where the\\nurine ma} T be ammoniacal, as a consequence of its residence there\\nor otherwise, and its growth will be influenced D3 7 the elements\\nconsequent to ammoniacal urine.\\nThe most frequent calculus met with in alkaline urine is that\\ncomposed of mixed phosphates, or the calculus with uric-acid\\nor urate nucleus covered with mixed phosphates. If the urine", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0293.jp2"}, "294": {"fulltext": "252 ANALYSIS OF URINE.\\nbe alkaline from fixed alkali, the calculus is pretty sure to con-\\nsist of calcium carbonate or phosphate. In such cases the urine\\nhas usually long been alkaline, and the calculus is likely, accord-\\ningly^ to consist uniformly of the same substance throughout.\\nIf the urine be ammoniacal the nucleus and body of the\\ncalculus is very likely to be composed of different substances,\\nThe nucleus may be uric acid, urates, or oxalate of lime, but\\nthe crust is pretty sure to consist of mixed phosphates. Re-\\nmembering the rapidity with which urine undergoes ammoniacal\\nchanges in vesical disturbances, special care should be ob-\\nserved to see if the urine be ammoniacal in these cases at the\\ntime it was voided, otherwise the observer may be greatly misled\\nin his conclusions. The intensity of ammoniacal reaction of\\nthe urine, the deposit of phosphatic fragments, and the amount\\nof deposit of triple-phosphate ciystals, together with the grade\\nof the accompanying cystitis, will furnish some idea of the age\\nand magnitude of the phosphatic calculus.\\nAnalysis of Calculi.\\nIn conducting the analysis of urinary calculi the size, color,\\nform, and density of the concretion should first be noted, as\\nthese often indicate, with considerable probability, their compo-\\nsition, or at least the direction in which the chemical examination\\nshould be pursued. Since many calculi are composed of more\\nthan one deposit, in order to ascertain with greater precision the\\nseveral components, section should first be made of the calculus\\nby means of a fine saw. If the calculus be brittle it will often\\nanswer the purpose to break it into as large pieces as possible.\\nUpon section or fracture, portions should be scraped from the\\ndifferent-appearing strata for separate examination. A portion\\nof the calculus should first be subjected for some time to a red\\nheat upon platinum-foil, either over a spirit-lamp or by means of\\na blow-pipe. In the latter case the best method is to lay the\\nplatinum-foil on a plaster-of-Paris cast, when the powdered cal-\\nculus and foil may be raised to any desired degree of heat with-\\nout danger of burning the fingers. If upon ignition little or\\nno fixed residue be left, the calculus is composed of some of\\nthe organic deposits as uric acid, ammonium urate, xanthin,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0294.jp2"}, "295": {"fulltext": "GRAVEL AND CALCULUS. 253\\ncystin, proteid substances, or urostealith. If, on the other hand,\\nthe fused calculus leave a considerable residue, it consists of\\nsome of the inorganic bases, either alone or in combination, such\\nas urates of sodium, potassium, or ammonium, calcium oxalate,\\ncalcium carbonate, calcium phosphate, or amnionio-magnesium\\nphosphate.\\nIf the concretion burn up and leave little or no residue, it\\nis necessaiy next to proceed by chemical methods to determine\\nwhich of the organic deposits it be composed\\nUric Acid. A portion of the powdered concretion is sub-\\nmitted to the murexid test (see page 33), and if the character-\\nistic color-reaction be obtained with nitric acid and ammonia,\\nthe calculus consists of uric acid or ammonium urate. A por-\\ntion of the finely-powdered calculus is subjected to boiling\\nwater, when, if complete solution be effected, the calculus is am-\\nmonium urate but, if slightly or not at all solvent, it may be\\nconcluded that it is a uric-acid calculus. If further confirmation\\nbe necessary, let the solution stand until cool ammonia will be\\nevolved when treated with potassium hydroxid, if ammonium\\nurate be present and red litmus will be turned blue if suspended\\nover the solution. If the result be negative no ammonia\\npresent the calculus is uric acid.\\nXanthin does not give murexid reaction, but its solution in\\nnitric acid upon evaporation leaves a bright citron-yellow\\nresidue, insoluble in potassium carbonate, but soluble in potas-\\nsium hydroxid, with resulting deep reddish-yellow color.\\nCystin does not give murexid reaction. Owing to its con-\\ntained sulphur, if dissolved in potassium hydroxid and a little\\nlead acetate be added, upon boiling a black precipitate of lead\\nsulphide forms and imparts to the solution an inkj T appearance.\\nCystin also dissolves in ammonia, and upon evaporation crys-\\ntallizes in regular hexagonal plates. If dissolved in hydro-\\nchloric acid and slowh evaporated, it forms diverging crystals\\narranged in sheaf-like form.\\nProtein concretions do not give murexid reaction upon heat-\\ning they evolve the odor of burnt horn or feathers. The}^ are\\ninsoluble in water, alcohol, and ether, but are soluble in potas-\\nsium hydroxid.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0295.jp2"}, "296": {"fulltext": "254 ANALYSIS OF URINE.\\nUrostealith gives no murexid reaction, but dissolves in ether,\\nand yields fatty acids upon boiling with baryta-water. It dis-\\nsolves in potassium hydroxid when heated and becomes sapo-\\nnaceous.\\nIf the concretion be incombustible and leave, after ignition,\\na relatively large residue, it is necessary next to proceed to\\ndetermine its composition, as follows:\\nUrates of the Fixed Alkalies (Sodium and Potassium Urates).\\nIn order to isolate these fixed bases the concretion is finel}\\npowdered, and after boiling in distilled water is filtered. The\\nurates pass through the filter in solution, while the less soluble\\nuric acid remains on the filter. The solution is next evaporated\\nand then ignited, and the residue consists of the fixed bases. If\\nthe residue turn moistened turmuric paper brown, it is either\\npotassium or sodium; if it be the latter, it imparts to the flame\\nof the blow-pipe a yellow color.\\nMagnesium and calcium, if present in the residue, may be\\ndissolved in dilute acids, and, upon addition of sodium phos-\\nphate and ammonia, the calcium and magnesium are precipitated\\nas ammonio-magnesium and lime phosphates.\\nCalcium Oxalate. These concretions first blacken upon\\nheating, but upon further ignition they finalty leave considerable\\nwhite ash, which dissolves in hydrochloric acid with effervescence.\\nIf this solution be neutralized with ammonia, and oxalic acid\\nbe added, characteristic envelope-shaped crystals of calcium\\noxalate are precipitated, and may be recognized readity Ivy the\\nmicroscope.\\nCalcium carbonate, like calcium oxalate, at first blackens\\nupon ignition, but ultimately burns white, leaving considerable\\ninfusible ash. Calcium carbonate, however, is distinguished\\nfrom calcic oxalate by its highly-characteristic property of dis-\\nsolving in Uydroehloric acid with effervescence. It will be\\nremembered that the fused ash of calcium oxalate not the cal-\\nculus dissolves in hydrochloric acid with effervescence.\\nAmmonio-magnesium phosphate with more or less calcium\\nphosphate usually occur together, and as such constitute the\\nmixed phosphatic or fusible calculus. Upon ignition this cal-\\nculus melts into an enamel-like mass. Upon prolonged ignition", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0296.jp2"}, "297": {"fulltext": "GRAVEL AND CALCULUS.\\n.oiJ\\nOn Heating the Powder on Platinum-Foil,, it\\nDoes not burn\\nDoes burn\\nTbe powder when\\nHC1\\ntreated with\\nWith flame\\nWithout flame\\nDoes not effervesce\\nThe gentlv-heated powder\\nwith HC1\\nThe powder when\\nmoistened with a little\\nKHO\\no\\nw o\\nS\u00c2\u00ab\\npffi\\no o\\nP Z*\\n*2\\n11\\np\\ns\\nla\\np w\\nw\\nP\\nr M\\n\u00e2\u0080\u00a2a 3\\nsrp.\\no\\np\\npi\\nR\\nPi\\nR\\nft\\ns.\u00c2\u00a9\\nzt\\nII\\np\\nII\\nCD\\nSo\\nS9-\\n2o\\na\\np\\n1\\n\u00c2\u00a9E\\nP o\\no\\np\\na en\\nP-B\\ni.\\nBq S\\n\u00c2\u00a7P\\nCD g\\nP\u00c2\u00ab\\no\u00c2\u00bb\\n3 p\\nc\\nHfcO\\np\\np\\ny.\\nR\\na\\n-p\\n\u00c2\u00a9o\\nP.P\\n8.S\\nB\\ni\u00e2\u0080\u0094 $a\\nP\\na\\n3\\nl\\nIT\\nDB p\\n3\\nP\\no\\nP c\\nRa\\no\\nc s\\nSp\\nP\\n_1\\nn\\na\\nP\\nGO\\nBB\\n\u00c2\u00bbd c*\\nc\\nST\u00c2\u00a9\\np.\\no\\nP\\n5w\\nO\\nx 2\\nHa\\nCD\\nGO\\nSi\\nO\\nI-S\\nP P\\ncr\\n5*\u00c2\u00b0\\np\\nc a\\n-t\\n\u00c2\u00abr+\\nHI\\nC\\np c*\\nW\\n5\\nB-p-\\np\\nn\\nhJ\\np.\\nc\\nGO\\nCO\\npi\\nO\\nce\\nce\\nCO\\no\\nP\\nB\\no*\\nP\\nP\\n3\\na\\no\\np\\np\\np\\no\\ng\\no\\na a\\na P\\nco O\\nPJ3\\nCD\\np rt\\nIs\\na\\nd3\\nr-P-\\np p\\nP -7.\\ne* CC\\np. 5\\na I.\\np c\\nc\\np\\nThe powder\\ngives the mu-\\nrexid test\\nThe powder\\nwhen treated\\nwith KHO\\ngives\\no\\np\\nR\\nX\\np\\np\\nt?\\np\\no\\nc\\non?\\n2.\\np\\nB\\no", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0297.jp2"}, "298": {"fulltext": "256 ANALYSIS OF URINE.\\nthey do not show an alkaline reaction like calcium oxalate and\\ncarbonate. The fused ash of this calculus dissolves in hydro-\\nchloric acid without effervescence.\\nThe excellent table on preceding page, from Heller, shows at\\na glance the chief features of the analysis of the various calculi,\\nand will be found to greatly facilitate the analysis of calculus by\\nthe student.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0298.jp2"}, "299": {"fulltext": "Part II.\\nUrinary Diagnosis.\\nDISEASES OF THE URINARY ORGANS AND URINARY\\nDISORDERS.\\nTHE URINE IN OTHER DISEASES\\n(257)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0299.jp2"}, "300": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0300.jp2"}, "301": {"fulltext": "SECTION X.\\nDISEASES OF THE URINARY ORGANS, AND URINARY\\nDISORDERS.\\nUrinary diagnosis, as considered in the subsequent pages of\\nthis work, will include First, diagnostic data derivable from the\\nurine which relate directly to pathological conditions of the\\nurinary organs themselves. Second, diagnostic data derivable\\nfrom the urine which relate to pathological conditions, either\\nlocal or general, but the prominent feature of which is some\\nmarked and characteristic departure from the normal condition\\nof the urine itself. Third, diagnostic data derivable from the\\nurine which relate to pathological conditions primarily inde-\\npendent of the urinary organs, in which the latter may or may\\nnot become involved.\\nIn order to bring the range of urinary diagnosis more fully\\nwithin the field of practical clinical work, the plan will be fol-\\nlowed of first describing the changes effected in the urine b} T the\\nvarious forms of disease, followed by a brief epitome of the\\nleading clinical symptoms, and, where necessary, also the differ-\\nential features in each case.\\nA perusal of the eight preceding sections will familiarize the\\nstudent with the process of secretion and excretion of the urine\\nthe chemical and microscopical characters of the latter, both\\nnormal and abnormal and the clinical significance of the various\\nmorbid products met with in the urine in the course of disease.\\nIn order now to compass the entire groundwork of knowledge\\nessential for practical urinary diagnosis, it only remains to con-\\nsider the most approved methods of physical examination of the\\nurinary organs themselves. This requires a practical knowl-\\nedge of the regional anatomy of the urinary organs, and, while\\ndoubtless most readers of this volume are already familiar with\\nthe subject through the numerous and excellent text-books on\\nanatomy now in general use, it is T et believed that a brief and\\npractical survey of the subject here will facilitate the study of\\nthe subjects shortly to be considered.\\n(259)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0301.jp2"}, "302": {"fulltext": "260 urinary diagnosis.\\nAnatomical Considerations.\\nThe Kidneys. These are two large, glandular organs situated\\nin the upper and posterior part of the abdominal cavity, on\\neither side of the spinal column. Each kidney is about four\\ninches in length, two inches in its transverse diameter, and\\nrather more than one inch in thickness. These dimensions vary\\nsomewhat in individual cases. The left kidney is ordinarily\\nslightly longer and narrower than the right kidney. The weight\\nof each kidney is from 4 to 5 ounces, the male kidney being\\nordinarily 2 or 3 drachms heavier than that of the female. The\\nleft kidney in both sexes weighs about 100 grains more than the\\nright one. The combined weight of both organs, in proportion\\nto the body-weight, is about 1 to 240.\\nIn form the kidney resembles a haricot or kidney-bean.\\nIt is compressed from either side, presenting an anterior and\\nposterior surface, both of which are slightly convex, the anterior\\nsurface most so. The outer border presents an elongated con-\\nvex line, while the inner border is concave, with a deep notch in\\nthe centre, the hilum. The upper and lower extremities of\\nthe kidney are slightly wider than the middle of the organ, the\\nupper being somewhat the wider of the two. The anterior sur-\\nfaces of the kidneys look obliquely outward and forward from\\neither side of the bodies of the vertebrae. The posterior surfaces\\nof the kidneys rather more flattened than the anterior look\\noblique^ backward and inward toward the spines of the verte-\\nbrae. The upper end of the kidney somewhat knobbed and\\nlarger than the lower is nearer the spinal column, and has a\\nslightly more posterior position than the lower end. The inner\\nborder of the kidney, at its upper part, is about one inch from\\nthe middle line of the body; the outer border, at its lower part,\\nis three and three-fourths inches from the middle line of the\\nbody. The outer or convex border of the kidney looks obliquely\\nupward, while the concave or inner border looks obliquely\\ndownward and forward.\\nThe kidneys are situated deep in the loins, on either side of\\nthe vertebral column. The upper border of the kidney corre-\\nsponds with the space between the eleventh and twelfth ribs,\\nwhile the lower border corresponds with the middle of the third", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0302.jp2"}, "303": {"fulltext": "ANATOMICAL CONSIDERATIONS\\n261\\nlumbar vertebra. The pelvis of the kidney is about on a level\\nwith the spine of the first lumbar vertebra. During deep inspi-\\nration both kidneys are usually depressed by the diaphragm\\nabout half an inch, though not always so.\\nAn horizontal line passing through the umbilicus would lie\\njust below the lower borders of both kidneys while a vertical line\\nFig. 36.\u00e2\u0080\u0094 Topographical. Relations of Kidneys, Anteriorly.\\n(After Morris.)\\nextending perpendicularly upward from the middle of Poupart s\\nligament to the costal arch would pass directly over the kidnej T\\nslightly external to its median line. Posteriorly, a line parallel\\nwith and one inch from the vertebral column, extending from\\nthe lower edge of the tip of the spinous process of the eleventh\\ndorsal vertebra to the lower edge of the spinous process of the\\nthird lumbar vertebra, would fall just inside of the inner border", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0303.jp2"}, "304": {"fulltext": "26:\\nURINARY DIAGNOSIS.\\nof the kidney. If now two lines be drawn, from the ends of the\\nline just described, horizontally outward for two and three-fourths\\ninches, and if the outer ends of these two lines be joined by a\\nperpendicular line, the whole kidney would normally lie within\\nthe four lines described (Morris).\\nThe kidneys rest on the crura of the diaphragm, on the\\nanterior lamella of the posterior aponeurosis of the transversalis\\ni\\n1\\n\\\\J UB\\nUisa\\nI\\nI\\n1\\n1 f\\nFig. 37.\u00e2\u0080\u0094 Topographical Relations of Kidneys, Posteriorly.\\n(After Morris.\\nmuscle. To a slight extent they also rest upon the psoas muscle.\\nThe right kidney is somewhat lower than the left, owing to the\\nposition of the liver, which it touches by its suprarenal capsule\\nat its upper end then the peritoneum passes over its anterior\\nsurface near the upper end, and the duodenum and commence-\\nment of the transverse colon are in contact with it where they\\nare uncovered by peritoneum. The left kidney, rather higher", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0304.jp2"}, "305": {"fulltext": "ANATOMICAL CONSIDERATIONS.\\n263\\nthan the right, is covered in front by the great end of the\\nstomach, the spleen, and the descending colon. The front of the\\norgan touches the fundus of the stomach, and then comes in\\ncontact with the pancreas and, lower down, with the commence-\\nment of the descending colon. The external border of the left\\nkidney, in the upper two-thirds of its extent, is in contact with the\\nspleen. (See Fig. 38.)\\nThe kidneys are surrounded by a thick layer of fat contained\\nFig. 38.\u00e2\u0080\u0094 Relations of the Kidneys. (After Sappey.)\\n1-1, the two kidneys; 2-2, fibrous capsules: 3. pelvis of the kidney 4, ureter: 5,\\nrenal artery; 6, renal vein 7. suprarenal body; 8-8, liver, raised to show relations of its\\nlower surface to right kidney: 9. gall-bladder 10. terminus of portal vein 11, origin of\\ncommon bile-duct 12. spleen. turned outward to show relations with left kidney; 13. semi-\\ncircular pouch on which the lower end of the spleen rests: 14, abdominal aorta; 15, vena\\ncava inferior lfi, left spermatic vein and artery: 17, right spermatic vein, opening into\\nvena cava inferior 18, subperitoneal fibrous layer or fascia propria, dividing to form renal\\nsheaths 19, lower end of quadratus lumborum muscle.\\nin the meshes of a loose areolar tissue and constitute the tunica\\nadiposa. It is thicker and more abundant posteriorly than\\nanteriorly, but everywhere it completely invests the fibrous cap-\\nsule of the organs. The amount of fat contained in the tunica\\nadiposa is subject to great variation in different subjects. This", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0305.jp2"}, "306": {"fulltext": "2G4 URINARY DIAGNOSIS.\\nfact should not be forgotten, since in stout persons it may be so\\npronounced as to mislead one as to the size of the kidney itself.\\nOn the other hand, in spare subjects, the fatty elements of the\\ntunica adiposa may become so far absorbed that this tunic\\nbecomes loose, and its connections with the kidney and sur-\\nrounding parts are relaxed so that the kidneys are capable of a\\nvery considerable degree of mobility.\\nThe capsule of the kidney is a thin, smooth, firm, and closely-\\nfitting envelope. Composed of numerous firm, elastic fibres, it\\npossesses considerable power of stretching and contracting,\\nregulated b}^ the degree of vascular tension of the kidney. The\\ncapsule adheres, by minute fibres of connective tissue and capil-\\nlary vessels, to the surface of the kidney, from which, however,\\nit can be readily separated in the healthy organ without dragging\\nany of the glandular structure of the organ proper with it. The\\ncapsule, following the notch or hilum in the renal substance,\\npasses into the sinus of the kidney and becomes continuous,\\naround the bases of the papillae of the pyramids, with the\\nstronger external fibres and elastic tissues of the calyces and\\npelvis. The pedicle of the kidney is composed of the dilated\\nupper end of the ureter, the renal artery and vein, a quantity\\nof connective tissue, and a large number of lymphatics and\\nnerves. The relations of the vessels and ureter to each other in\\nthe pedicle are as follow From above downward, artery, vein,\\nand ureter; from before backward, vein, artery, and ureter.\\nThis arrangement occasionally varies.\\nThe kidney is liberally supplied with blood; indeed, out of\\nall proportion so, according to its relative size. The renal artery\\nis of large size and arises from the aorta a little below the origin\\nof the superior mesenteric artery, the right usually arising a\\nlittle lower than the left. As the aorta lies to the left of the\\nmedian line, the right renal artery is longer than the left and\\ncrosses behind the vena cava inferior. Before reaching the\\nnotch or hilum of the kidney each artery divides into four or\\nfive chief branches, which sink into the sinus behind the corre-\\nsponding branches of the renal vein and in front of the pelvis.\\nDeep in the notch of the kidney these branches break up into\\na number of smaller branches, which leave the veins between", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0306.jp2"}, "307": {"fulltext": "ANATOMICAL CONSIDERATIONS. 265\\nthe calyces and enter the substance of the kidney between the\\npapillae.\\nThe renal vein is a short, wide vessel, and, like the arterj r\\ntakes an almost horizontal course. Its primary branches four\\nor five in number issue from the hiluru in front of the arterial\\nbranches, and then the vein continues in front of the artery until\\nit joins the vena cava. The left renal vein is joined by the sper-\\nmatic vein, both right and left renal veins receiving branches\\nfrom the suprarenal capsule of their respective sides.\\nThe nerves of the kidney consist of filaments from both the\\nsympathetic and cerebro-spinal systems. They accompany the\\nrenal artery, and are derived from the renal plexus and the lesser\\nsplanchnic nerve.\\nThe kidneys are surmounted by two small, yellowish, flat-\\ntened bodies,\u00e2\u0080\u0094 the suprarenal capsules, which dip slightly\\ndownward over the upper borders. The right one is somewhat\\ntriangular-shaped, the left one semilunar. They are connected\\nwith the kidneys by the common investing areolar tissue, and\\neacli capsule is marked on its anterior surface by a fissure which\\nappears to divide it into two lobes. The right suprarenal body\\nis closely adherent to the posterior and under surface of the\\nliver; the left lies in contact with the pancreas and spleen. Both\\ncapsules rest against the crura of the diaphragm, on a level with\\nthe tenth dorsal vertebra, and by their inner borders are in rela-\\ntion with the great splanchnic nerve and semilunar ganglion.\\nThe Renal Pelvis. As the ureter passes upward it loses its\\ncylindrical form on a level with the lower end of the kidney, and\\nit there begins to expand into a large, funnel-shaped dilatation,\\nwhich is known as the pelvis of the kidney. After entering\\nthe hilum or notch the pelvis divides into two or three primary\\ntubular branches, which in turn end in several short truncated\\nbut wide pouches, named calyces or infundibula, the mouths of\\nwhich receive the papillae as does a glove the fingers. A\\nsingle calyx often surrounds two or three papillae, so that the\\ncalyces are fewer in number than the pyramids of the kidney.\\nThe Ureter begins at the lower, pointed end of the funnel-\\nshaped renal pelvis, at a point about the level of the lower\\nborder of the kidney, and extends, in length from fourteen to\\n18", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0307.jp2"}, "308": {"fulltext": "266 URINARY DIAGNOSIS,\\nsixteen inches, to the base of the bladder, into which it opens by\\na constricted, slit-like opening, after having passed obliquely for\\nnearly an inch between its muscular and mucous coats.\\nThe ureter is a cylindrical, membranous tube, about the\\ndiameter of a goose-quill; but the lumen of the tube is not\\nuniform. The ureter, in passing downward and inward to the\\nbrim of the pelvis, lies directly behind the peritoneum, resting on\\nthe psoas muscle, and is crossed by the spermatic vessels. In\\nthe pelvis it enters the per itoneal fold constituting the posterior\\nfalse ligament of the bladder, and runs downward and forward\\nby the side of the bladder, entering the wall of the latter about\\ntwo inches from the ureter of the opposite side. In the female\\nthe ureters pass by the neck of the uterus, about an inch from\\nthe latter.\\nThe Bladder. This is a hollow, musculo-membranous organ\\nsituated behind the pubis within the pelvis, in front of the rectum\\nin the male, the uterus and vagina intervening between it and\\nthe rectum in the female. The shape of the bladder varies with\\nthe age, sex, and degree of distension of the organ. In infancy\\nit is conical in form and projects above the pubis. In the adult,\\nwhen empty, it is small and triangular in form, situated deeply\\nin the pelvis, flattened from before backward, and rises on a\\nlevel with the upper border of the pubic symplr^sis. When\\nslightly distended, the bladder is rounded in form and partly\\nfiHs the pelvis when greatly distended it is oval in shape and\\nrises into the abdominal cavitj r sometimes extending as far as\\nthe umbilicus. It is largest in its vertical diameter, and its long\\naxis is directed obliquely downward and backward. When mod-\\nerately distended (containing one pint) it measures about five\\ninches in length by about three inches in width. The bladder is\\ndivided -into summit, body, base, and neck. The summit consti-\\ntutes the upper, rounded border of the organ, which is covered\\nby peritoneum. The bod} of the bladder, posteriori} is also\\ncovered by peritoneum, but anteriorly it is uncovered by that\\nmembrane. The base of the bladder is directed downward and\\nbackward, resting, in the male, upon the rectum in the female,\\nlying in contact with the lower part of the cervix uteri, and ad-\\nherent to the anterior vaginal wall. The neck of the bladder is", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0308.jp2"}, "309": {"fulltext": "PHYSICAL EXAMINATION. 267\\nthe constricted portion continuous with the urethra; in the male,\\nsurrounded by the prostate gland.\\nPhysical Examination.\\nFor examination of the kidney by means of percussion the\\npatient should lie upon the abdomen, across a rather hard\\npillow. In this position there will be found, in the lumbar\\nregion of the normal subject with normal kidneys, a space\\nbetween the last rib and the pelvic brim, rather less than\\ntwo inches broad, five centimetres, which elicits a dull note\\nupon sharp percussion. Anteriorly, this dullness is abruptly\\nexchanged for tympanitic resonance as the intestines are ap-\\nproached. The dull note is continuous upward and outward\\nbeyond the limits of the kidney on the right side continuous\\nwith that due to the liver on the left side continuous with that\\ndue to the spleen while below, the pelvic brim (within which\\nthe lower border of the kidney lies) prevents the lower border\\nof the kidne3 T from being defined. It will, therefore, be seen\\nthat the normal kidney elicits but little information upon per-\\ncussion, owing to its unfavorable position for that purpose, for\\neven moderates-enlarged kidneys cannot, with percussion, be\\nthus outlined. Obscured by the thickness of the abdominal\\nwalls, covered in part by the lower ribs, liver, and spleen, in\\npart arched over b} r the vertebral processes, covered by the\\nbody of the sacro-spinatus muscle, the lateral border of which\\nclosely corresponds with the convex border of the kidney, it\\nwill be readily seen that these organs present the greatest obsta-\\ncles to percussion. In abnormal conditions of the kidney, how-\\never, notably those of large tumor, percussion becomes of very\\ndecided utility, but for such purposes the patient should be\\nplaced upon the back, in the position for palpation.\\nPalpation of the kidney is best conducted by placing the\\npatient upon the back, with the thighs slightly flexed and some-\\nwhat separated from each other. The examiner should approach\\nthe side of the patient which he desires to palpate, and with one\\nhand upon the anterior wall of the abdomen he should pass the\\nother hand behind the patient, pressing deeply with his fingers\\nfrom behind forward in the renal region (between the lower", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0309.jp2"}, "310": {"fulltext": "268 URINARY DIAGNOSIS.\\nborder of the ribs and the iliac crest), pushing firmly forward\\nany tumor against the opposite hand.\\nIn pathological conditions of the kidneys, notably if the\\norgans be very much enlarged or displaced, physical examination\\noften elicits valuable diagnostic information. Thus, in the case\\nof morbid growths, some knowledge of their nature is obtain-\\nable by the sense of touch and manipulation. Thus, the organs\\nmay feel smooth, uneven, globular, lobulated, fluctuant, soft, or\\ndense. They move but slightly with respiration. If tumor be\\npresent, the kidney may leave its normal bed beneath the dia-\\nphragm and be seen in front; but a normal movable kidney is\\nnot visible upon anterior inspection.\\nA circular, symmetrical swelling between the borders of the\\nribs and the pelvic brim, extending posteriorly toward the spine,\\nwith cedematous condition of the skin and tissues beneath, may\\npoint to perinephritis with perinephritic abscess. Tenderness\\nupon pressure is obtainable in acute, but rarely, if ever, in\\nchronic, diffuse nephritis. It is present in renal stone, espe-\\ncially if the latter has excited inflammation. In l^dronephrosis\\nit is usually present, and in perinephritis it is especiallj r promi-\\nnent. Large formations, as carcinoma, sarcoma, hydronephro-\\nsis, pyonephrosis, perinephritis, and echinococcus, are plain ly\\npalpable the latter may show, by quick, short, bimanual\\npercussion-strokes, a peculiar whiz, the u hydatid vibration. 1\\nSince the kidney lies behind the peritoneum, when it becomes\\nenlarged by growths so as to extend forward it usually pushes\\nbefore it the ascending or descending colon against the anterior\\nabdominal wall in such case the colon ma}^ be made to fur-\\nnish valuable differential knowledge, because other abdominal\\ngrowths, being intra-peritoneal, push the colon aside, and there-\\nfore furnish no tympanitic note from this source. Since the\\ncolon is best distinguished when it contains air, it is often\\nadvisable to inflate it for diagnostic purposes. Movable kidney\\nis know r n by its form, mobility, size, often its capability of\\nreplacement, and occasionally pulsation of the renal artery ma} r\\nbe felt.\\nAlthough palpation is usually sufficient to reveal the pres-\\nence of renal tumors of any considerable size, anterior or", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0310.jp2"}, "311": {"fulltext": "PHYSICAL EXAMINATION. 269\\nlateral percussion is usefully employed for confirmative purposes.\\nIn the author s experience, one of the most valuable methods is\\nthat of anterior auscultatory percussion for this special purpose.\\nBy placing the stethoscope over the centre of a viscus or tumor,\\nand by the finger-tips very gently tapping the abdominal wall in\\na radiating direction from the instrument, the outline of the\\nbody upon which the stethoscope rests can be made out with\\ngreat precision by the impulse and pitch of the note conveyed\\nto the ear.\\nThe method of diagnosticating unilateral dislocation of the\\nkidney by bilateral percussion, upon the theory of differential\\nbilateral resonance, although formerly much relied upon, has,\\nupon wider experience, proved untrustworthy.\\nThe differential features between renal tumors and those of\\nadjacent organs often require most careful consideration. Thus,\\nthe differential features between a moderately displaced right\\nkidney downward and a distended gall-bladder, an echinococcus\\ncyst or other growth upon the lower border of the liver is not\\nreadily made out by palpation or percussion. Respiratory mo-\\nbility, if pronounced, may, with considerable degree of certainty,\\nexclude the kidney. Capability of replacement, on the other\\nhand, so that the tumor disappears, proves the tumor to be renal.\\nMovable left kidney is differentiated from movable spleen by\\npalpation and percussion. Palpation may reveal characteristic\\nnotches in case of the spleen while in movable kidne} T the\\npulsations of the renal artery may sometimes be felt by deep\\npressure at the hilum of the organ. The course and relations\\nof the colon, as ascertained by percussion, are also here valuable\\nguides. Respiratoiy mobility may or may not accompany splenic\\nenlargement if present it argues against the renal nature of the\\ntumor.\\nThe ureters are so inaccessible that they furnish but little\\ninformation upon palpation or percussion. A few surgeons,\\nnotably Simon, have repeatedly felt the ureters b} T anaesthetizing\\nthe patient and introducing the hand into the rectum. Recently\\npalpation of the ureters per vaginam has come to be practiced.\\nThis offers no special difficulty, as the ureters can be plainly felt\\nfor nearly three inches of their lower extremities, and growths", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0311.jp2"}, "312": {"fulltext": "270 URINARY DIAGNOSIS.\\nor stones in this portion of the canal can be clearly made out\\nTo a less extent palpation of the ureter may be practiced per\\nrectum with the finger, but only about the last inch or so of the\\ntube can thus be ordinarily defined, as it lies within the bladder-\\nwall.\\nAbdominal palpation is rarely successful in ureteral exami-\\nnations, and only in cases of very spare subjects, when the ureters\\nare greatly distended or are occupied by large growths. The\\nvesical orifice of the ureter may be inspected by means of the\\ncystoscope, and morbid conditions of that part of the canal can\\nbe determined satisfactorily. Catheterization of the ureters, as\\nyet, is applicable only to limited cases in the female. This\\nimmensely valuable means of diagnosis, especially desirable for\\nrenal as well as ureteral purposes, must very shortly be per-\\nfected in connection with the cystoscope. The author s instru-\\nment, devised by Leiter for this purpose, has never proved satis-\\nfactory nor can airy of the instruments in present use be\\ndepended upon to meet the purpose.\\nThe bladder is only noticeable on external inspection in cases\\nof extreme distension, when it rises into the abdominal cavitj r\\nPalpation is applicable in moderate distension of the bladder\\nabove the symphysis pubis. It may also be practiced per\\nvaginam and per rectum either by one hand or, often with ad-\\nvantage, bimanually. Sir Henry Thompson proposed and prac-\\nticed digital exploration of the bladder by opening the urethra\\nat or about the membranous portion and making a passage\\nsufficient to admit the index finger into the bladder. While\\nthe operation is in itself usually a harmless one, more recent\\nmeasures (the cystoscope) for the most part render it unneces-\\nsary. Percussion over the region of the bladder reveals an area\\nof more or less extended dullness, according to the degree of\\ndistension of the organ. But percussion of the bladder for\\nthe purpose of distinguishing tumors of the vesical region is\\nscarcely necessary, since catheterization will usually quickly\\ndetermine if they be of vesical origin or not.\\nA very decided advance in our methods of inspecting the\\nbladder has taken place since 1887, when Nitze first published\\nhis methods of examination of the bladder by means of electric", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0312.jp2"}, "313": {"fulltext": "ACUTE RENAL HYPEREMIA. 271\\nillumination. 1 Since then the complete work of Fenwick on\\nElectric Illumination of the Bladder and Urethra (1888) and\\nNitze s Text-Book of Cystoscopy (1889) have furnished in\\ndetail all the technique of this method of examination of the\\nbladder. By means of the cystoscope we are now able to obtain\\nmost complete knowledge of a large number of pathological\\nconditions of the bladder. Its use plainly discloses ulcera-\\ntions, their character and extent. It enables us to see diver-\\nticula, to find and locate foreign bodies, to not only plainly see\\nstones, but also to ascertain their size, number, shape, character,\\nand even to percuss them with the instrument, the encysted\\nstones no longer escaping detection. Above all, the diagnosis\\nof morbid growths of the bladder by this means is rendered\\ncomparatively easy and sufficiently early to render far more\\nefficient their treatment. Certainly, no longer can a diagnosis\\nof obscure disease of the bladder be considered complete without\\nthe use of the cystoscope.\\nRenal Hyperemia.\\nHyperemia of the kidne} r s is met with in two forms (a)\\nactive or acute hyperemia, consisting of active determination of\\narterial blood to the kidneys (b) passive hypereemia, or venous\\nstasis, consisting of a retention of venous blood in the kidneys,\\nusually the result of some obstruction to the venous circulation,\\neither local or general.\\nacute renal hyperemia.\\nThis condition nuvy be said to mark the initial stage of nearly\\nall forms of acute nephritis. It may be brought about by\\nnumerous causes. In the course of eruptive fevers and inflam-\\nmatory diseases, such as diphtheria, erysipelas, pneumonia, and\\nacute rheumatism, the kidneys, in common with other internal\\norgans, become more or less pronouncedly hyperemia Toxic\\ninfluences and certain irritants are very common causes of renal\\nhypersemia. If the toxin or irritant be quickly removed, the\\nnormal condition of the renal circulation is rapidly established\\n1 Contribution to Endoscopy of the Male Bladder, Archiv f. klin.\\nChir., vol. xxxvi, p. 661.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0313.jp2"}, "314": {"fulltext": "272 URINARY DIAGNOSIS.\\nagain; but if protracted sufficiently long, the prolonged hyper-\\nemia is very apt to result in active nephritis.\\nA number of substances when swallowed are capable of\\ninducing active renal hyperemia, the best known of which are\\ncantharidis, turpentine, sulphuric and other mineral acids, phos-\\nphorus, cubebs, and potassium chlorate. Acute renal hyper-\\nsemi a may also be induced by local auto-irritation, as in the case\\nof lithuria and oxaluria when long continued. Exposure to\\ncold and moisture constitutes a frequent cause of the condition\\nunder consideration. In the majority of such cases the hyper-\\nemia subsides without, perhaps, having attracted special atten-\\ntion, but sometimes it passes on into acute nephritis. In late\\nstages of diabetes the kidneys usually become hyperemic, and\\neven albuminuria and mild grades of nephritis may also result.\\nThe Urine. In acute hyperemia of the kidneys the urine\\ncontains more or less blood, the quantity depending upon the\\ndegree of congestion present. In mild cases only a few r scatter-\\ning corpuscles are to be seen, while in active congestion the\\nurine may be very bloodjr. The color of the urine will depend\\nmostly upon the degree of hemorrhage. Albumin is always\\npresent, but usually in small amount, rarely exceeding 10 or 15\\nper cent, bulk measure. The urine usually contains a few renal\\ncasts, mostly of the hyaline order, and of small size and free epi-\\nthelium from the renal tubules may often, though not invariably,\\nbe observed. The quantity of urine at first is increased, and,\\ncorresponding to this, the specific gravity is somewhat reduced,\\nand the proportion of solids is reduced, though the absolute\\nsolids may be normal. The urine retains its normal acidity.\\nIf the congestion continue long, most of the physical char-\\nacters of the urine just named are apt to become reversed. The\\nspecific gravity becomes increased, as do the solids, while the\\nquantity becomes diminished. In some cases of acute renal\\nhyperemia, especially when induced by cantharidis, fibrinous\\ncoagula may appear in the urine.\\nLeading Clinical Features. When the cause is toxic, the\\nsymptoms are to be looked for in the resultant effects on other\\norgans of the substance ingested. Locally, more or less fre-\\nquency of micturition is present, sometimes with pain, urgency,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0314.jp2"}, "315": {"fulltext": "PASSIVE RENAL HYPEREMIA. 9 73\\nand perhaps vesical tenesmus. Some pain is apt to be present\\nin the region of the kidneys, but, in the absence of this, some\\ntenderness may usually be elicited upon deep pressure in the\\nsame location. In febrile forms the usual features of pyrexia\\nare to be observed, more or less marked, according to the grade\\nand character of the fever present.\\nPASSIVE RENAL HYPEREMIA.\\nVenous stasis or passive hyperaemia of the kidneys is not at\\nany time a primary renal disease, but is always secondary to\\nFig. 39.\u00e2\u0080\u0094 Urinary Sediment in Passive Hyperemia of the Kidneys.\\n(After Peyer.)\\nsome obstructive disease of the heart or circulatory organs.\\nMitral disease of the heart and valvular insufficiency, or stenosis,\\nare the active causes of most of these cases.\\nThe Urine. The quantity of the urine in uncomplicated cases\\nis always diminished, and the specific gravity is increased, usu-\\nally ranging from 1025 to 1030. The color of the urine is dark\\nbrownish-red, and the chemical reaction is frankly acid. The", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0315.jp2"}, "316": {"fulltext": "274 URINARY DIAGNOSIS.\\ntransparency of the urine is somewhat diminished, owing to the\\npresence of undissolved urates and increase of mucus. The\\nquantity of uric acid is relatively, and sometimes absolutely,\\nincreased, and free uric-acid crystals are usually to be seen in\\nthe sediment, as are the amorphous urates. There is usually\\nno reduction, either in the relative or absolute quantity of\\nurea present. The urine usually contains a small and variable\\namount of albumin; sometimes merely traces are present; occa-\\nsionally, though rarely, it is absent, while sometimes it may\\nreach one or two grammes per litre the degree of stasis, seem-\\ningly, does not correspond with the degree of albuminuria. The\\nsediment usually contains a few hyaline casts of small size, and,\\noccasionally, scattering blood-discs or nuclei may be seen at-\\ntached to these casts (Fig. 39). A few scattering blood-cor-\\npuscles are usually to be seen in the sediment occasionally this\\nis considerable, although such is more rarely the case than the\\nappearance of the urine would indicate, owing to the concentra*\\ntion of the urine.\\nLeading Clinical Symptoms. These are very characteristic,\\nand comprise dropsy, mostly of the feet and lower extremities\\ngeneral cyanosis, dyspnoea, hacking cough prominence of the\\nlarge veins, notably those of the abdomen weak, thread} pulse,\\nand cardiac lesions.\\nDifferentiation. Venous stasis of the kidne} is to be dis-\\ntinguished from interstitial nephritis by the increased volume\\nof the urine in the latter disease, its low specific gravity, pale\\ncolor, normal transparency, spare deposit; absence, as a rule, of\\nblood from the deposit, and constant deficiency of urea, both\\nrelatively and absolutely. To these may be added, as the most\\nprominent clinical features of interstitial nephritis, a full, hard\\npulse, always showing increased tension cardiac enlargement\\n(left ventricle hypertrophied), visual disorders in late stages,\\nabsence of dropsy till very late, chronic ursemic disturbances,\\nand the habit of nocturnal micturition, all of which are absent\\nin passive renal hyperemia.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0316.jp2"}, "317": {"fulltext": "acute diffuse nephritis. 275\\nAcute Diffuse Nephritis.\\nThis is the so-called acute Bright s disease, and is marked by\\nvery pronounced and characteristic features, clinically as well as\\nurinary. The causes include those already considered as provo-\\ncative of acute renal hypersemia, any of which, if of sufficient\\nintensity or duration, are capable of bringing on acute diffuse\\nnephritis. Of the use of toxic drugs, as a matter of actual experi-\\nence, acute nephritis is rarely thus induced, probably because\\nthe exciting cause is rarely prolonged sufficiently to bring about\\nhigh grades of nephritis. Acute diffuse nephritis is most often\\nmet with in practice as a result of the acute infectious fevers,\\nnotably scarlatina, pneumonia, typhoid fever, diphtheria, relaps-\\ning fever, and epidemic influenza. Less often violent exposure to\\ncold and certain local affections of the skin, including extensive\\nburns, erysipelas, carbuncles, etc., give rise to this disease.\\nLastlj r pregnancy must be recognized as the causative factor of\\na very considerable number of these cases.\\nThe Urine. In acute diffuse nephritis the urine possesses\\nthe following typical characteristics The quantity is invariably\\ndiminished, and sometimes extremely so. At the height of the\\ndisease but a few ounces of urine may be voided during the\\nwhole twent3 T -four hours but later on, if improvement occur,\\nthe quantity gradually increases until the normal volume, or\\neven more, may be reached. If the quantity of urine rise above\\nthe normal it may be taken as an evidence that the acute char-\\nacter of the disease is modified, and the tendency is toward reso-\\nlution. On the other hand the urine, at the very height of acute\\nnephritis, may become practically suppressed, and, if this con-\\ntinue, death ma}^ be invariably predicted within a very few days.\\nThe specific gravit}^ of the urine depends upon the quantity\\nvoided, and, as already shown, this varies with the course of the\\ndisease; so will this feature of the urine. In the early and very\\nacute stage of the disease the specific gravity of the urine usu-\\nally rises above normal, often reaching 1025 to 1030 or even\\nhigher. With continuance of the disease the tendency is toward\\na lowered specific gravity of the urine, corresponding with the\\nincreased volume.\\nThe color of the urine varies considerably at different periods", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0317.jp2"}, "318": {"fulltext": "076 URINARY DIAGNOSIS.\\nof the disease, the variation depending jn part upon the quantity\\nof urine voided, and in part upon the quantity of contained\\nblood. As a rule, the color of the urine is dark, more or less\\napproaching chocolate color. The transparency of the urine is\\ndiminished, the urine presenting a smoky, opaque appearance,\\nin which the normal lustre is completely lost. A diminution of\\nthis character of the urine denotes changes tending toward reso-\\nlution. The chemical reaction of the urine, uninfluenced by\\nmedication, is always sharply acid; but upon the use of alkaline\\nsalts, so much employed in treatment, the urine is often found\\nto be alkaline.\\nThe gross quantity of the urinary solids is diminished in\\nacute nephritis, the urea suffering the most pronounced reduc-\\ntion. The relative amount of solids varies with the volume of\\nurine excreted so that in the early stage, marked by great re-\\nduction in the volume of urine, the relative amount of solids\\nmay be normal or above. It is important to make the distinction\\nhere, however, that the gross solids for twent} r -four hours are\\nalways reduced. Upon convalescence the gross solids are in-\\ncreased, especially the urea and chlorides, which were merely\\nheld back. At the height of the disease the urea is often re-\\nduced to 100 grains or even less for twenty-four hours. The\\nurine contains albumin in variable, but always large amount in\\nacute nephritis. It may reach as high as 2 per cent., or even\\nmore by actual weight so that upon coagulation it nearly fills\\nthe test-tube. More frequently, however, the range is in the\\nvicinity of to 1 per cent., 5 to 10 grammes per litre (Esbach s\\nmethod). A few cases of acute nephritis following scarlatina\\nare recorded, in which the urine was free from albumin. It is,\\nhowever, rare in such cases that albuminuria is absent through-\\nout the whole course of the disease more often it is of sudden\\nonset at some stage, and occasionally it has been observed in\\nintermittent form.\\nThe degree of albuminuria is considered to mark the degree\\nand course of acute nephritis toward a favorable or unfavorable\\ntermination and while the degree of albuminuria can rarely be\\ntaken as a safe guide in this direction in general, it may be more\\ndepended upon as such in this special form of nephritis than", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0318.jp2"}, "319": {"fulltext": "ACUTE DIFFUSE NEPHRITIS. 27 T\\nperhaps in any other form of renal disease. On the whole, a\\ncontinuous diminution in the quantity of albumin in the urine\\nin acute nephritis may be accepted as evidence of progress\\ntoward resolution.\\nThe presence of blood in the urine may be regarded as one\\nof the essential features of this disease, though varying greatly\\nin amount in different cases as well as at different periods in\\nthe same case. Fluctuations are frequent during the course of\\nthe disease, and, indeed, the blood may alternately appear and\\ndisappear. Hematuria is developed early, being in most cases\\namong the first symptoms noticed, while it usuallj^ subsides\\nmuch earlier than does albuminuria. The quantity of blood\\nlost in the average case of acute nephritis is very considerable\\nif the disease continue long; this is partly evident b}~ the in-\\ncreasing pallor of these subjects. Hematuria may be regarded\\nas a valuable prognostic indication in this disease, being rarely\\nabsent in severe cases its appearance marks, with early and great\\ncertainty, relapses of the acute process, when previous progress\\nwas favorable.\\nThe urinary sediment in acute diffuse nephritis is large in\\nquantity, usualhv brownish in color from admixture with blood,\\nurates, and coloring matters. Microscopical investigation of the\\nsediment discloses the presence of red blood-corpuscles in larger\\nor smaller numbers. These are somewhat altered, and appear\\nwashed out and ragged, unless in cases of marked haemor-\\nrhage, when the} present more nearly their normal appearance.\\nSome pus-corpuscles are to be noted in the field, but rarely in\\nan y considerable number. Cellular forms are characteristic of\\nthis deposit; mostly small, round, uninuclear cells from the renal\\ntubules, which may be present in great numbers; while less\\nnumerous are the narrow-pointed, small-tailed cells from the\\nrenal pelvis. The epithelium is well preserved, and affords char-\\nacteristic pictures of these structures under the microscope.\\nRenal casts are present in large numbers, and may have attached\\nto them (a) blood-corpuscles, (6) leucocytes, (c) renal epithelium\\n(Fig. 40). The above varieties of casts are characteristic of the\\nbeginning of acute nephritis, or the disease at its height; but\\nthey are subject to alterations in character as the disease con-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0319.jp2"}, "320": {"fulltext": "278\\nURINARY DIAGNOSIS.\\ntinues some time. With advancing changes consequent to\\nthe disease, disorganization of the epithelium occurs, and we\\nfind the metamorphosed casts, such as the dark, granular,\\nand broad, hyaline ones, with more or less organic molecular\\ndebris. With advance toward resolution the quantity of sedi-\\nment diminishes and the casts become less and less numerous.\\nAs already noted, the uric acid of the urine is increased in acute\\nnephritis, the chlorides are diminished, and in very acute cases\\nFig. 40.\u00e2\u0080\u0094 Urinary Sediment in Acute Nephritis. (After Peyer.\\nthe latter ma} disappear altogether. When advancing toward\\nrecovery the volume of urine increases, and with this diuresis\\nthe chlorides and urea become markedly increased, having been\\nheld back by defective eliminative power of the kidney during\\nthe height of the disease.\\nLeading Clinical Features. The most prominent clinical\\nfeatures of typictil acute diffuse nephritis are as follow Dropsy,\\nwhich is always present, and of a general character, involving\\nthe face, hands, feet, and cellular tissues in general. A very", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0320.jp2"}, "321": {"fulltext": "CHRONIC DIFFUSE NEPHRITIS. 270\\nnoticeable pallor steals over the patient, though less prominent\\nthan in the chronic form of the disease. The temperature rises\\nto 100\u00c2\u00b0 or 102\u00c2\u00b0 F., and the pulse is over 100, full, resisting, and\\nmarked by increased tension. Headache is present, often severe,\\npersistent, and most often frontal. Nausea is frequent and often\\nattended by vomiting. Acute uraemia is common, often mani-\\nfested by acute visual disorders, stupor, temporary paralysis, and\\nsometimes convulsions. The appetite is abolished, thirst is\\nprominent, and there is dull, aching pain or stiffness felt in the\\nloins and tenderness upon deep pressure in the renal region.\\nChronic Diffuse Xephritis.\\nThis disease may be a sequel of the acute nephritis just con-\\nsidered, but more often it develops insidiousty from the begin-\\nning. It is more apt to result from the acute form when the\\nlatter is the outgrowth of scarlatina, pneumonia, diphtheria, or\\nsome of the acute infectious fevers. The student is advised to\\nmake a most careful differential stud} T of this disease, more espe-\\ncially with regard to amyloid disease of the kidney, with which\\nit has since the da} r s of Bright himself been frequently con-\\nfounded, with disastrous results to the treatment, since they are\\nalmost diametrically opposite in character.\\nThe Urine. The quantity of urine, as a rule, is diminished\\nin progressive chronic diffuse nephritis. Although no such\\nmarked reduction occurs as in acute nephritis, yet a reduction\\nof 40 or 50 per cent, of the normal volume is not uncommon.\\nThe fluctuations of the dail} T quantity are marked, more so than\\nin the acute disease. In the late stages the volume of urine in-\\ncreases, and in chronic cases tending toward secondaiy contrac-\\ntion of the kidne} r the quantit} r of urine often exceeds the normal\\namount. This is because interstitial changes have been set up\\nand the s} T mptoms tend to conform to the interstitial variety of\\nnephritis. The specific gravity of the urine is below normal.\\nIn cases marked by unusual reduction in the quantity of urine,\\nthe specific gravit} T may rise above normal. This, however, is\\nunusual, and results from concentration of the urine. With\\na normal volume of urine, and often much less, the specific\\ngravity rules below 1020, and in late stages tending toward renal", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0321.jp2"}, "322": {"fulltext": "280 URINARY DIAGNOSIS.\\ncontraction the specific gravity of the urine often sinks to 1010\\nor below.\\nThe color of the urine varies from pale lemon to dark brown,\\nmore often approaching the former than the latter color. The\\nurine is always cloudy, the more so as the quantity is diminished.\\nWhen the volume of urine is nearly normal the color is often\\nvery light, but tiie transparency is always diminished more or\\nless, the appearance of the urine being of a hazy, dirty character.\\nThis depends upon the invariable presence in the urine of a large\\namount of sediment, consisting of epithelium, renal casts, pus-\\ncorpuscles, and molecular matter.\\nThe urine always contains albumin, and usually in large\\nquantities. In fact, albuminuria may be said to reach its max-\\nimum as a symptom in this form of disease, often reaching as\\nhigh as 3 or even 4 per cent, by actual weight. In such cases\\ncoagulation becomes so pronounced with reagents that an accu-\\nrate estimate of the quantity by bulk measurement can only be\\nmade by largely diluting the urine previous to testing. While\\nthe average quantity of albumin in the urine in this disease,\\ntherefore, ranges very high, it fluctuates markedly in different\\ncases as well as in the same case from time to time. It would\\nseem to maintain a fairly constant ratio to the specific gravity of\\nthe urine in most individual cases more especially so when the\\nchanges in the specific gravity are sudden, or are observed over\\nshort periods of time. Thus, if the specific gravity of the urine\\nbe 1014 one day, while the next day it rises to 1018, a decided\\nincrease in the amount of the albumin is sure to be noted. These\\nchanges, however, are only relative the absolute loss of albumin\\nfor twenty-four hours remains pretty uniform over short periods\\nof say a few days. Any decided increase in the absolute\\nquantity of albumin in these cases indicates an extension or\\naggravation of the disease. In cases characterized by great\\nchronicity, more especially in those cases tending toward con-\\ntraction of the kidneys, the quantity of albumin in the urine\\noften becomes reduced both relatively and absolutely.\\nThe solids of the urine suffer more or less reduction in this\\ndisease, urea and the chlorides most notably so. Occasionally,\\nwhen dropsy is subsiding under diaphoretic measures, there may", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0322.jp2"}, "323": {"fulltext": "CHRONIC DIFFUSE NEPHRITIS.\\n281\\nbe a temporary increase of the solids of the urine, especially\\nthat of urea, which may even exceed the normal. This, however,\\nis of brief duration, and, after a time, falls back again below the\\nnormal standard.\\nThe urinary sediment furnishes the key to the diagnosis of\\nthis disease. As already stated, the sediment is relatively large\\nin quantity and consists of casts, white blood-corpuscles, epi-\\nthelium, and cellular remnants. The casts are numerous and of\\nFig. 41.\u00e2\u0080\u0094 Urinary Sediment en Chronic Diffuse Nephritis, showing\\nResults of Fatty Changes in Progress. (After Peyer.)\\nnearly all known varieties, but the most distinctive ones are the\\ndark granular, broad hyaline, and more especially the so-called\\nfatty casts (Fig. 41). In the more recent cases the casts rnay be\\nless numerous, and, as a rule, the hyaline, slightly dotted, or\\nfaintly granular ones, as well as those dotted with cell-fragments,\\npredominate. The longer the disease continues, the more nu-\\nmerous the casts become, and, moreover, the more predominant\\nbecome the dark granular casts, the broad casts from the large,\\nstraight tubes, and the casts with fat-droplets attached to them.\\n19", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0323.jp2"}, "324": {"fulltext": "282 URINARY DIAGNOSIS.\\nThe fatty casts may almost be said to be characteristic of this\\ncondition. Red blood-corpuscles are rarely met with in this\\nlesion, perhaps only in cases which have recently sprung from\\nthe acute form of nephritis. On the other hand, leucocytes are\\nalways to be found in larger or smaller numbers. A very\\nmarked sediment of granular debris is observed in this lesion,\\nconsisting of broken-down cellular elements.\\nEpithelial cells from the renal tubules are to be found, some-\\ntimes in numbers. They are less perfectly preserved than in\\nthe acute lesion, disorganization of structure being everywhere\\napparent.\\nLeading Clinical Features. The leading clinical features of\\nchronic diffuse nephritis are briefly and concisely the following:\\nFirst and most prominently drops}^, which is progressive, obsti-\\nnate, general, and sooner or later extreme, involving the cel-\\nlular tissues and ultimately the serous cavities. Anaemia is no\\nless marked and striking, palpable in the pallid, puffy face and\\ndough-like extremities and body, and pale mucous surfaces\\nwherever visible. Debility is prominent and progressive these\\npatients being feeble and helpless, often bedridden. Emaciation\\nis progressive, but masked by the dropsy. The appetite and\\ndigestion fail, owing to the charged condition of the blood with\\neffete products which the kidneys fail to eliminate. Uraemia,\\nwhen present, is of the less active or chronic order, coma and\\nconvulsions being rare, except at the close or the result of acute\\ncomplications.\\nChronic Interstitial Nephritis.\\nUnder the above head will now be considered the diagnostic\\nfeatures of those usually slowly-advancing chronic processes,\\nwhich ultimately terminate in granular contraction or atrophy\\nof the kidneys, known as renal cirrhosis or chronic Bright s dis-\\nease. Many of the early writers seem to have confounded this\\nlesion with diffuse nephritis, at least so far as to consider it the\\noutgrowth of that primary lesion. We now know that while\\nrenal contraction is sometimes the result of long-continued dif-\\nfuse nephritis, yet the overwhelming majority of cases begin not\\nonly independently of that lesion, but are essentially interstitial", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0324.jp2"}, "325": {"fulltext": "CHRONIC INTERSTITIAL NEPHRITIS. 283\\nand atrophic processes from the beginning, and, moreover, are\\nthe outgrowth of totally-opposite conditions of the system and\\nhabits of life from those in chronic diffuse nephritis. The pre-\\nviously robust, hearty, and overnourished are almost invariably\\nthe subjects of the interstitial lesion while, for the most part,\\nthe opposite class of people are more commonly the subjects of\\nthe other-named lesion.\\nIt may be premised that primary interstitial nephritis is one\\nof the most stealth}- and insidious of all diseases in its manner of\\napproach, giving rise to few, if any, noticeable symptoms until\\nin progress for a number of years, often ten to fifteen. The\\nlesions, though wide-spread, including the heart and arterial\\nsystem, are yet almost imperceptible in their manifestations in\\nthe earl} stages at the same time they are slowly progressive\\nand permanent in character. Notwithstanding all this, with due\\ncare and minute scrutiny of all the surrounding features of the\\ncase, interstitial nephritis may always be diagnosticated, however\\nearly and slight the lesion, if only attention be called to the\\nmatter; and the method of compassing this will now be con-\\nsidered.\\nIn the stud}- of interstitial contracting kidney it should be\\nborne in mind that, as a rule, it is accompanied by a progressive\\nhypertrophy of the left ventricle of the heart in at least 80 per\\ncent, of the cases. While the cardiac hypertrophy is in progress,\\nthe symptoms, both urinary and general, are pretty uniform and\\ninvariable. If the patient survive sufficiently long, however, the\\nhypertrophied heart undergoes degenerative changes, and with\\nthe consequent heart-failure many of the characters of the urine,\\nas well as the general symptoms, change completely. If this\\nfact be kept in mind it will serve to prevent the confusion so\\napt to arise in consequence of the variability of the symptoms\\nin different cases, as well as in the same case at different periods\\nof the disease.\\nThe Urine. In typical interstitial nephritis the urine is\\nincreased in quantity, is slightly paler than normal in color,\\nperfectly transparent, rather sharply acid in reaction, and the\\nspecific gravity somewhat below the normal range. Albumin is\\nusually present in small quantity only a few scattering casts", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0325.jp2"}, "326": {"fulltext": "284 URINARY DIAGNOSIS.\\nlire present, and these are of the narrow, perfectly hyaline order;\\nrenal epithelium and cellular elements are rarely observable, but\\nuric-acid and calcium-oxalate crystals are often to be seen under\\nthe microscope. The chlorides of the urine are nearly normal\\nin quantity, the urea more or less deficient, and the phosphates\\nare reduced considerably.\\nA more minute analysis of these features shows the following\\ncharacters The quantity of urine is usually increased from the\\nbeginning. This polyuria is maintained uniformly and pro-\\ngressively until a comparatively late period of the disease, when\\nheart-failure sets in and the volume of urine often then sinks\\nbelow normal nor can it in such cases again be maintained reg-\\nularly up to the normal standard during the remainder of the\\npatient s life. The specific gravity of the urine becomes pro-\\ngressively lowered in the beginning a falling off of but two or\\nthree points is usual later on the reduction is more marked,\\nthough it never descends as low as in chronic diffuse nephritis\\nor amyloid disease, but in pronounced cases it ranges between\\n1010 and 1016. With heart-failure and consequent diminution\\nof the volume of urine the specific gravity rises somewhat, and\\nmay even approach again the normal standard, after having\\nremained for years constantly reduced.\\nWhile albuminuria is the rule in this lesion, many ex-\\nceptions have been noted. The exceptions are often apparent\\nrather than real, because albuminuria of interstitial nephritis is\\nnotoriously intermittent in character, sometimes disappearing\\nfor days and weeks, to return again and again, regardless of the\\nstage of the disease. It is probable that if these so-called non-\\nalbuminuric cases were kept under constant observation albumin\\nwould be found in the urine in many of them some time during\\nthe course of the disease. This has been the experience of the\\nauthor, although he has met with a few cases in which the urine\\nwas absolutely free from albumin throughout. So long as inter-\\nstitial nephritis remains uncomplicated the quantity of albumin\\nin the urine is invariably small, usually ranging below 10 per\\ncent, volumetric measurement by the author s centrifugal method.\\nGeneral or local disturbances, such as catching cold mild febrile\\nattacks, etc., quickly increase the albuminuria. In late stages", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0326.jp2"}, "327": {"fulltext": "CHRONIC INTERSTITIAL NEPHRITIS. 285\\nof this lesion associated with cardiac failure albuminuria becomes\\naugmented considerably, the quantity of albumin may reach from\\n30 to 40 per cent, bulk measure. In no case, however, does\\nalbuminuria approach the extreme grade in this lesion that it\\ndoes either in acute or chronic diffuse nephritis.\\nBoth the relative and absolute amount of urea in the urine\\nbegins to suffer reduction from the beginning. At first it is\\nslight, but as the disease advances it becomes a constant and, in\\nmany cases, a marked feature. It is not at all uncommon, in ad-\\nvanced interstitial nephritis, to note a reduction of the absolute\\namount of urea of from 50 to 75 per cent. More or less reduc-\\ntion is also to be noted of the quantity of all the urinary solids,\\nthe chlorides suffering the least reduction and the phosphates\\nmost. With regard to the phosphates in particular, a diminu-\\ntion in quantity of the phosphates in the urine may be regarded\\nalmost as constant a feature of this lesion as the presence of\\nalbumin.\\nCasts from the renal tubules are probably always present in\\nthe urine in this lesion, but the} T are rarely numerous, some-\\ntimes extremel}^ sparse and difficult to find. This is due to\\nthe fact that they are of such delicate, hyaline, non-refracting\\ncharacter that the most careful search is necessaiy to detect\\nthem besides, their small numbers, rendered still more sparse by\\nthe accompanying polyuria, it often becomes necessary to con-\\ncentrate the sediment in order to find them. As the disease\\nadvances the casts become more numerous, and often the} T show\\nfine granulations they are largely of the narrow hyaline and\\ngranular orders.\\nThe crystalline deposit in the urine in this lesion consists\\nchiefly of uric acid and calcium oxalate, both of which are often\\nto be noted together. For the most part these deposits are\\nnoticeable in the early stages. of the disease. The uric acid is\\nprecipitated chiefly in consequence of the diminished pigmen-\\ntation of the urine in this lesion, rather than in consequence of\\nthe excess of the former. The oxalic deposit occurs most often\\nin gouty subjects.\\nOn the whole, the urinary sediment in this lesion is remark\\nabl} small in quantity and practically free from cellular elements,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0327.jp2"}, "328": {"fulltext": "286 URINARY DIAGNOSIS.\\nsave those that are common to normal urine. It is not unusual\\nto find, even upon standing twenty-lour hours, or centrifugation\\nof the urine, little or no sediment noticeable to the naked eye.\\nToward the termination of the disease, however, a sediment is usu-\\nally noticeable, in consequence partly of the more concentrated\\nstate of the urine, as well as the wider extension of the lesion.\\nInterstitial nephritis renders the kidneys extremely prone to\\ntake on subacute or even acute attacks of nephritis upon expo-\\nsure to certain causes, especially that of cold and febrile or\\ninflammatory diseases. In such cases the quantity of albumin\\nin the urine becomes markedly increased, the volume of urine\\ndiminished, and the sediment becomes more pronounced and\\napproaches, in its special features, those of acute nephritis\\nalready described. In such cases it is necessary, in addition to\\nthe urinary examination, to carefully regard the history and\\ngeneral clinical features of the case, in order to diagnosticate\\nthe true conditions present.\\nLeading Clinical Features. In typical cases of chronic\\ninterstitial nephritis we may look for the following clinical\\nfeatures The patient habitually rises at night once, twice, or\\noftener to void urine which, to the eye, appears normal in its\\ntransparency and nearly so in color. The pulse is ahvays full,\\nhard, and resisting to the finger, and marked by decided tension\\nas measured by the sphygmograph. The second cardiac sound,\\nas heard best in the second right intercostal space, within an\\ninch and a half of the sternum, is always distinctly accented,\\nsharper and louder than normal. In most cases at least 80 per\\ncent. the normal area of cardiac dullness is more or less ex-\\ntended below and to the left, and, in man} r cases, notably if the\\nlesion be advanced, this feature is very prominent. Disorders\\nof vision are common some time during the course of this\\nlesion, not very frequently early, but almost certain in late stages.\\nUrsemic disorders are encountered during the course of the\\ndisease in some of the following forms: Mild post-cervical\\nneuralgia is very common, almost characteristic; diarrhceal\\nattacks, which mark eliminative efforts of the system vicariously\\ndyspnoea, which often appears of an asthmatic type; drowsiness,\\ncoma, and sometimes convulsions.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0328.jp2"}, "329": {"fulltext": "CHRONIC INTERSTITIAL NEPHRITIS. 2 6~i\\nAttacks of bronchitis are common and difficult to get rid\\nof; winter cough of the aged frequently owes its origin to this\\ncause. Acute inflammations of the pleura, lungs, or peritoneum\\nare prone to be suddenly kindled and run a fatal course. Drops} r\\nis absent, save in advanced cases, and then it is due rather to\\nthe cardiac failure than to the renal lesion.\\nThe early diagnosis rests upon the following points A\\nprevious condition of robust health is usual age, over 40 years\\npatient rises habitually at night to void urine of normal appear-\\nance the pulse is full and hard (never weak) the second sound\\nof the heart is abnormally loud the urine is deficient in urea\\nsmall quantities of albumin are usually present, and hyaline\\ncasts are to be observed under the microscope if the sediment\\nbe concentrated.\\nThe diagnosis of the advanced lesion can scarcely be over-\\nlooked by the most superficial observer. The plains-observable\\nhypertrophy of the heart; the presence of uraemic disorders, as\\nheadache, dyspnoea, visual defects, diarrhoeal attacks, and per-\\nhaps drowsiness at times together with certain changes in the\\nurine, notably albuminuria, deficiency of urea, the presence of\\ncasts of the hyaline and granular order almost exclusively, serve\\nboth to call attention to the disease and mark its special char-\\nacter.\\nInterstitial contracting kidney in main of its features is not\\nunlike passive hyperaemia of the organs. The differential features\\nof the two have already been noted in connection with the de-\\nscription of the latter. (See page 273.)\\nAmyloid Disease of the Kidney.\\nAmyloid change in the kidney is a local manifestation of a\\ngeneral constitutional defect moreover, this lesion is seldom\\nconfined to the kidneys, but nearly always involves the liver,\\nspleen, and gastro-intestinal tract. Amyloid, or, as it is some-\\ntimes termed, waxy degeneration, is essentially the outgrowth\\nof a cachectic condition of the system, and most often follows\\nin the wake of syphilis, chronic suppurative processes, such as\\nabscesses, extensive ulcerations, or necrosis. Tuberculosis is\\nfrequently traceable in the family history of these cases.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0329.jp2"}, "330": {"fulltext": "288 URINARY DIAGNOSIS.\\nThe changes in the kidneys in amyloid disease are very\\nmarked, and give rise to a very pronounced train of symptoms;\\nthe latter, upon superficial examination, might be mistaken for\\nthose of chronic diffuse nephritis. Both the lesions and symp-\\ntoms, however, are essentially and widely different in character.\\nThe author desires to emphasize in the strongest possible manner\\nthe importance, therefore, of carefully distinguishing these two\\nrenal lesions, since over and over again he has been a witness to\\nthe melancholy results of such error. Repeatedly have these ca-\\nchectic, ill-nourished subjects come under his observation in the\\nlast stages of the disease, who had long been consigned to the\\nstarvation process of a milk diet, under the impression that\\ntheir albuminuria was the result of nephritis.\\nThe Urine. The characteristic features of the urine in typical\\namyloid lesions of the kidneys are concisely as follow The\\nvolume of urine is above normal, the color lighter than usual;\\nthe transparency is unchanged, the specific gravity is low, albu-\\nmin is present in marked quantity, and the sediment is very\\nslight in quantitj^, containing little or no cellular elements and\\nbut a moderate number of casts are present, most of which are\\nof medium size and broad, hyaline orders.\\nBefore considering more minutely these features of the urine\\nit may be premised that the characters of the urine in this\\nlesion of the kidney are exceedingly apt to fluctuate rather\\nwidely in different cases but, notwithstanding this fact, well-\\nmarked diagnostic characteristics are not difficult to trace\\nthroughout the progress of the disease in most if not, indeed,\\nin all cases.\\nThe quantity of urine in amyloid lesions of the kidneys rules\\nabove normal from the beginning, and in most cases the increase\\nis decided. The volume of urine is subject to temporary periods\\nof falling off, and at such periods it may fall below the normal\\nstandard. These periods of temporary reduction in the volume\\nof urine ma}^ often be accompanied by corresponding attacks of\\ndiarrhoea. The specific gravity of the urine is pretty uniformly\\nreduced in marked cases, ranging from 1008 to 1014. Sometimes,\\nhowever, even in cases attended by a marked degree of albu-\\nminuria, the specific gravity ranges as high as 1016 to 1018, and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0330.jp2"}, "331": {"fulltext": "AMYLOID DISEASE OF THE KIDNEY.\\n289\\nin such cases the prognosis is more favorable. In fact, the few\\ncases of ultimate recovery from this disease observed by the\\nauthor have, without exception, been cases attended by a com-\\nparatively high range of specific gravity of the urine. Cases, on\\nthe other hand, are not infrequently met with in which the specific\\ngravity of the urine sinks remarkably low, perhaps lower than\\nin any other form of renal lesion, 1006 and even 1004. Such\\nFig. 42.\u00e2\u0080\u0094 Waxy Casts in Urine of Amyloid Disease of the Kidney.\\n(After Peyer.)\\nfeatures are, however, only met with in very late stages, and are\\nusually associated with marked polyuria.\\nThe presence of albumin in the urine may be regarded as an\\nessential feature of amyloid lesions of the kidneys. The urine\\nnot only always contains albumin in this lesion, but the albumin\\nis present in considerable, often in large, amount. The usual\\nrange is about 4 to 1 grammes per litre (Esbach s method), though\\nit is not uncommon for it to rise to double that amount. The\\ncourse of albuminuria in amyloid lesions of the kidney is quite\\nvariable as to quantity in the early stages it may be slight,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0331.jp2"}, "332": {"fulltext": "200 URINARY DIAGNOSIS.\\nthough subject to sudden increase, and with the advent of poly-\\nuria may again fall off. The urine always contains globulin in\\nthis lesion, often in larger quantity than that of serum-albumin.\\nSome reduction of the urinary solids is usually to be noted\\nin this lesion. The urea is slightly below the normal standard,\\nprobably due chiefly to the lowered state of general nutrition,\\nrather than to the influence of the lesions over the function of\\nthe kidneys, since uraemia is rare in uncomplicated amyloid\\nkidneys.\\nThe casts are subject to some variation in number and variety.\\nWith the polyuria the casts are often very scarce and almost\\nexclusively of the hyaline order. On the other hand, when casts\\nare comparatively numerous, so-called waxy, yellowish, refracting\\ncasts may be present, and occasionally dark, granular ones. The\\nchief distinctive feature about most of the renal casts met with\\nin this lesion is their comparatively large size and hyaline char-\\nacter.\\nThe urinary sediment is comparatively small in quantity in\\nthis lesion, in fact unnoticeable, as a rule, to the naked eye, and\\nit is practically devoid of cellular elements throughout if the\\ndisease remain uncomplicated.\\nLeading Clinical Features. Amyloid lesions of the kidneys\\nappear in the wake of the so-called wasting diseases, or are often\\npreceded by syphilis or some exhausting suppurative process.\\nThese patients appear unhealthy and plainly cachectic, except\\nin a few syphilitic cases. The skin assumes a sallow or bronze-\\nlike tint, the tongue is nearly always heavily coated, dyspepsia\\nis prominent, and diarrhoeal attacks are common. Dropsy is\\npresent in most cases, but exceptionally it may be absent until\\nlate. Uraemia is exceedingly rare. The liver and spleen become\\nenlarged some time during the course of the disease in the ma-\\njority of cases. These patients are weakly, anaemic, and en-\\nfeebled, with small, thready pulse and cold extremities; but\\nthe predominant features throughout are the disorders of the\\nstomach and bowels dyspepsia or diarrhoea or both demand\\nalmost constant attention as the disease becomes advanced.\\nThe distinction between amyloid disease of the kidneys and\\nchronic diffuse nephritis hinges upon the following points In", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0332.jp2"}, "333": {"fulltext": "CYSTIC DISEASE OE THE KIDNEY. 291\\nnephritis the urinary sediment is large in quant it} and contains\\na large number of casts, including epithelial, dark granular, and\\nfatty casts, as well as those with fragmentary cellular elements\\nattached. Leucocytes, cellular elements, and granular debris are\\nprominent features of the sediment. Dyspepsia and diarrhoea\\nare not especially prominent features, nor is cachexia a common\\naccompaniment. The liver and spleen are not enlarged, but\\nanaemia is very pronounced. In amyloid disease the reverse of\\nthe above features prevail.\\nCystic Disease of the Kidney.\\nThis disease is met with in two forms (a) As a congenital\\nobstructive disease, usually associated with absence of the ureter,\\nor other malformation interfering with escape of urine, (b) As\\na disease of adult life, and independent of the congenital form\\nand in many of its features allied to chronic interstitial nephritis,\\nindeed, by some authors considered a form of the latter.\\nPractically, the latter form only possesses a clinical interest\\nto physicians, and to this form the following considerations\\napply :_\\nIt is not uncommon to find cysts of considerable size in\\nchronic contracting kidney as the result of distal constriction\\nof the uriniferous tubes, which result in proximate dilatation by\\nthe urine. In the disease under consideration, however, the\\ncystic formation, though undoubtedly the same in origin (tubular\\ndilatations), yet it so greatly exceeds all other changes in the\\nkidney that the organ increases in bulk sufficiently to entitle it\\nto rank among abdominal tumors. The shape of the kidney is.\\nin the main, retained, and the weight of the organ may reach\\nfrom 2 to 16 pounds. The disease is almost uniformly bilateral.\\nDickinson noted but 1 case out of 26 in which the disease was\\nconfined to one kidney. Both the medulla and cortex of the\\norgan are replaced by cysts varying in size from a pin-point\\nto the size of grapes or walnuts, the larger ones being usually in\\nthe centre of the organ. They contain fluids which vary in\\ncolor, some being pale straw-colored, deep-yellowish, purple, or\\nbloody. In consistence the contents of the cysts may be serous,\\nviscid, syrupy, caseous or almost solid, consisting of fat mole-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0333.jp2"}, "334": {"fulltext": "292 URINARY DIAGNOSIS.\\ncules, epithelium, crystals of cholesterin, uric acid, and triple\\nphosphates. The cysts do not intercommunicate or terminate\\nwith the large conducting tubes, calyces, or renal pelvis, but are\\nessentially closed cavities.\\nThe Urine. This somewhat resembles the urine in chronic\\ninterstitial nephritis. In typical cases the urine is albuminous,\\nthe quantity of albumin varying from 5 to 30 per cent, bulk\\nmeasure. The urine is pale in color when free from blood of\\nlow specific gravity, varying from 1010 to 1015, though it has\\nbeen noted as low as 1005. Renal casts are usually found, nearly\\nalways of the granular order and large size. The urine contains\\nblood at intervals, and sometimes in large quantities. In one of\\nthe author s cases the hsematuria was so severe and persistent for\\nmonths that the patient became blanched and anaemic to an ex-\\ntreme degree, notwithstanding absolute rest in bed and the use\\nof styptics.\\nHsematuria largely contributes toward exhaustion in many\\nof these cases. In most cases pus is present in the urine in\\nmoderate amount. The quantity of urea is markedly reduced,\\nboth relatively and absolutely. The phosphates are sometimes\\nincreased in quantity, which is rarely the case in interstitial\\nnephritis. The chlorides and sulphates suffer but little change.\\nTriple-phosphate crystals are frequently noted in the sediment,\\nnotably in late stages of the lesion, when, as is usual, more or\\nless cystitis is present.\\nClinical Features. The most prominent clinical features of\\nthe disease, aside from the urine, are enlargement of the left\\nventricle of the heart, without valvular disease, and increased\\narterial tension, as shown by the sphygmograph. The skin is\\npale and sallow, and cachexia is apparent. The patients are\\nalways adults, mostly between the ages of 45 and 60 years.\\nHematuria is prominent, recurrent, obstinate in character, and\\noften profuse. There is usually tumor in renal region bilateral,\\nthough often unequal in size; soft, but non-fluctuant, and pre-\\nserving the shape of the kidney. In late stages of the lesion\\nthere is nausea, vomiting, headaches, suppression of the urine,\\ncoma or convulsions, the latter being the most frequent cause\\nof death. Less frequently death results from exhaustion (through", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0334.jp2"}, "335": {"fulltext": "CYSTIC DISEASE OF THE KIDNEY, 293\\nrenal haemorrhage), bronchitis, pneumonia, or pulmonary oedema\\nattended by severe dyspnoea.\\nCystic disease of the kidney is distinguished from chronic\\ninterstitial nephritis by the non-fluctuant swelling in the sides,\\nthe recurrent and often severe hsematuria, and the sallow,\\ncachectic appearance of the patient. From cancer it is distin-\\nguished by the absence of pain and slower progress in cystic\\ndisease. In cancer there is rapid growth of the tumor, which is\\nof nodular outline and unequal resistance. The age, in cancer,\\nis either under 5 years or over 60, while in cystic kidney the\\nmost common age is from 40 to 55. Finally, the aspirating\\nneedle will determine if the tumor be cystic or of solid growth.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0335.jp2"}, "336": {"fulltext": "SECTION XL\\nDISEASES OF THE URINARY ORGANS, AND URINARY\\nDISORDERS {Continued).\\nRenal Tuberculosis.\\nIn the light of recent facts and investigations, tuberculosis\\nof the genito-urinary tract, through hetero-infection, must be\\nconsidered rare, if indeed possible. Certainty, so far as the\\nkidneys are concerned, it seems out of the question. While\\ncareless or unclean catheterization may cause infection of the\\nprostate, involving the vesicula and extending to the epididymis,\\nthe anatomy of the urethra and the fact that tubercle bacilli do\\nnot multiply in the urine or possess in themselves any degree\\nof motor power negative the view heretofore held by some, that\\ninfection ma}^ occur through coitus, or the infection reach the\\nkidneys or upper urinary tract through the urine.\\nTuberculosis of the kidney occurs in two distinct forms\\n(a) acute miliary tuberculosis and (6) local caseating tuberculosis\\nor scrofulous kidney. The miliary form is mostly met with\\nin children under 10 }^ears of age. It is pretty uniformly bilat-\\neral, although the organs often differ in degree of infiltration.\\nThe caseating or scrofulous kidney is most frequent in r oung\\nand middle adult life, although it may be met with late in life,\\nand it is rare under 10 years of age. Scrofulous kidney is nearly\\nas often unilateral as it is bilateral. Of the two forms of renal\\ntuberculosis the miliary form is about twice as frequently met\\nwith as is the caseating or scrofulous kidney. Miliary tubercu-\\nlosis is always associated with tuberculosis in other parts of the\\norganism, most often phthisis pulmonalis, tubercular meningitis,\\nand tabes mesenterica. This form rarely gives rise to distinct-\\nive symptoms, being merged for the most part into general\\ntuberculosis, and, therefore, scrofulous kidney only deserves\\nspecial consideration in this connection.\\nChronic localized tuberculosis of the kidney, renal phthisis,\\ntubercular pyelitis, tuberculous pyelonephritis, or scrofulous\\n(294)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0336.jp2"}, "337": {"fulltext": "RENAL TUBERCULOSIS. 295\\nkidney, as it is severally known, begins usually at the papillary\\napices, in the calyces, or renal pelvis, and from thence by the\\nblood- and lymph- channels it extends to the kidney proper. De-\\nposits of cheesy matter infiltrate the renal papillae, and in the\\ncourse of a few weeks these form irregular, softened areas, which\\nby progressive infiltration spread deeply inward, involving the\\nparenchyma of the kidney. The organ becomes, in consequence,\\nenlarged and lobulated. The renal pelvis and ureter, on the\\nother hand, become contracted in consequence of thickening of\\nthe mucosa, and later on the ureter often becomes choked or\\nblocked by softened and caseous masses detached from ulcerated\\ncaseating surfaces above. At the same time the tubercular\\nnodules within the kidney, after reaching considerable size,\\nundergo necrotic changes and break down, forming irregular,\\nrudely-globular cavities. These, as they enlarge, become pyri-\\nforra in shape and extend until they coalesce, and at length the\\nwhole medulla and most of the cortex become involved. The\\ndestructive process continuing, the contents of the renal cavities\\nat length burst into the renal pelvis and the whole organ becomes\\npractical^ an abscess-cavit} If the ureter be pervious the\\nurine washes down the debris, which present characteristics soon\\nto be considered in detail. Should the ureter, however, become\\npermanently blocked, dilatation and sacculation of the kidne}\\nresult, practical ly a tubercular pyonephrosis. In case one\\nkidney remain uninvolved the diseased organ either becomes an\\nhydronephrotic cyst or a shrunken, putt} r -like mass in both\\ncases little, if an} of the secreting tissue proper can ultimately\\nbe found. The disease is usually a chronic one in character, and\\nduring its course neighboring organs are often involved by direct\\nextension through the capsule of the kidne} more especially the\\nliver and spleen.\\nThe Urine. Pol} T uria from tubercular irritation is probably\\nthe earliest urinary change. The quantity of urine is increased\\nand the calls to micturate are more frequent than normal. Traces\\nof albumin and a few blood-corpuscles are usually to be found\\nalso before destructive ulceration sets in. The urine is usual ly\\npale and murky in appearance, of somewhat lowered specific\\ngravity, and of acid reaction.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0337.jp2"}, "338": {"fulltext": "296 URINARY DIAGNOSIS.\\nWhen ulcerative changes set in the urine presents the follow-\\ning changes more or less marked, according to the degree of\\ndegeneration in progress. The urine is of a pale, milky color,\\nthe transparency is diminished, the specific gravity is below\\nnormal, and the reaction is, as a rule, alkaline. The urine con-\\ntains pus in gradually-increasing quantity. The pus is less\\nvariable in quantity from day to day (unless the ureter becomes\\nblocked) than in most other forms of pyuria. The pus imparts to\\nthe urine a more or less pronounced milky appearance, which\\ndoes not completely subside as in most other conditions of\\npyuria, but much of the pus remains in suspension even after\\nlong standing; this is very significant of renal tuberculosis.\\nThe urine contains blood in rather more than 25 per cent, of the\\ncases. If the blood come from the renal pelvis it is usually\\nsmall in quantity, often un appreciable to the naked ej r e. Some,\\ntimes very marked hematuria occurs, usually at intervals and\\nthis denotes ulcerative changes within the renal parenchyma.\\nAs the disease becomes advanced the urine usually becomes\\nammoniacal and markedly offensive, contains ropy mucus, and\\ndeposits triple phosphates, small caseous masses, and renal\\ndebris. The urine is albuminous, sometimes highly so; always\\nin excess of the ratio, due to contained pus and blood.\\nThe bacillus tuberculosis of Koch is present in the urine in\\nmost cases after necrotic changes set in, and its discovery is\\ndiagnostic. The tubercle bacillus can often be demonstrated in\\nthe urine by the methods already considered, though this is by\\nno means so easy as in the sputum, owing to the fact that they\\nare relatively few and scattered in the average sample of urine.\\nIt is safer, therefore, when suspected, but not found by direct\\nexamination, to resort to cultures in gelatin after the usual\\nmanner and the inoculation of animals.\\nLeading Clinical Features. The leading clinical features of\\nrenal tuberculosis are concisely as follow Polyuria and dysuria,\\nthe latter prominent and progressive. The bladder will not\\ntolerate the urine, and is only free from pain or distress wnen\\nempty. Pain begins about the middle of the act of micturition\\nand continues to the close, but, as a rule, not after. Some pain\\nis usual in the renal region, accompanied by tenderness upon", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0338.jp2"}, "339": {"fulltext": "RENAL CANCER. 29?\\ndeep pressure. The evening temperature is usually from 2 to 4\\ndegrees higher than normal, or sometimes periods of fever occur,\\nlasting for several days, followed by periods of remission. These\\npatients suffer from profuse night-sweats, loss of appetite, de-\\nbility, and emaciation in the course of the lesion while cough\\nand diarrhoea are scarcely less frequent accompanying features\\nof the disease. Ursemic complications are rare.\\nFrom calculus the distinction hinges on the slow develop-\\nment and irregular degree of pyuria, which is usually preceded\\nby slight hematuria in calculus. The general nutrition is better\\npreserved than in tuberculosis. The pain on micturition is re-\\nlieved at the close in tuberculosis, while in stone it is increased.\\nAbsence of temperature and constitutional symptoms charac-\\nterize the progress of calculous disease, while they are prominent\\nin tuberculosis.\\nRenal Cancer.\\nPrimaiy cancer of the kidney may appear in the form of\\ncarcinoma, sarcoma, and rarely as lymphadenoma. Sarcoma is\\nmost frequently met with in childhood, while carcinoma is ruosthv\\nmet with after 40 years of age, the encephaloid being the most\\nfrequent variety of the latter, though occasionally the melanotic\\ngrowth is met with. Primary cancer usually attacks but one\\nkidney only exceptionally is it bilateral. Of 59 cases collected\\nby Ebstein, 31 involved the right kidney, 23 the left, and 5 both\\nkidneys. Encephaloid cancer of the kidne} sometimes attains\\nan enormous size, 14 to 56 pounds.\\nRenal cancer is more frequent in males than in females.\\nThough slow of development, often remaining quiescent for\\nyears, when once it has begun it rapidly progresses toward a\\nfatal termination, usually within a year or two. The disease\\nbegins in the fibrous stroma of the cortex or in the tubular epi-\\nthelium sometimes, however, primary invasion begins in the\\nlymphatics about the hilum. Wherever the primary lesion be-\\ngins, the whole organ eventual^ becomes infiltrated. There is\\nusually appreciable tumor after the disease becomes thorougly\\nestablished.\\nThe Urine. The most prominent feature of the urine in cancer\\nis hematuria. In carcinoma this is especially pronounced, often\\n20", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0339.jp2"}, "340": {"fulltext": "208 URINARY DIAGNOSIS.\\nrecurring and frequently uncontrollable. In the other forms of\\ncancer hematuria may sometimes be absent throughout. Hsema-\\nturia is variable, occurring sometimes early, and subsiding as the\\ndisease progresses, when it may disappear and not return. Again\\nthe disease may become advanced before blood appears in the\\nurine. As a rule, when palpable tumor is present there is\\nhematuria. The hematuria is somewhat characteristic in its\\nirregular intermittency, appearing and disappearing at intervals\\nwithout apparent cause while often profuse, it is yet rarety so\\nexcessive as to rapidly produce ansemia or exhaustion. Albumin\\nis usually present in the urine in small quantity always present\\nif there be blood. The quantity of urine is usually increased\\nunless the ureters become blocked by blood-clots. Pus is present\\nbut in small quantity, save in advanced cases, attended by\\ndecided destructive changes in the kidney and even then the\\nquantity of pus is remarkabl} r small in amount, considering the\\nextent of necrotic changes in progress.\\nIn carcinoma the urine frequently contains acetone, even\\nbefore there is advanced emaciation. Frequent micturition is\\nthe rule, and it may be so pronounced as to call attention chiefly\\nto the bladder when only the kidney is involved. The presence\\nof organized substances in the urine, such as epithelium, casts,\\netc., are of little diagnostic value in renal cancer. Cancer-cells\\nare not recognizable in the urine in this disease, and those alleged\\nto have been found were doubtless transitional epithelium, which\\nis often present in considerable quantity if malignant disease\\ninvade the renal pelvis. The only significant feature in this con-\\nnection would be the discovery of particles of the morbid growth\\nwith distinct alveolar structure in the urine, but in malignant\\ndisease limited to the parenchyma of the kidney this is prac-\\ntically unknown.\\nLeading Clinical Features. Increasing tumor is the almost\\ninvariable rule, which is to be looked for in the anterior lumbar\\nregion, between the costal arch and the crest of the ilium. If\\nlarge the tumor approaches the umbilicus, extending upward and\\ndownward into hypochondrium and iliac, and even to the inguinal\\nregions. The tumor is usually lobulated or presents obtuse mar-\\ngins the lobulations often possess unequal degrees of hardness.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0340.jp2"}, "341": {"fulltext": "RENAL CALCULUS. 299\\nThe tumor is nearly always fixed. Pain occurs early, usually per-\\nsistent in character, though sometimes intermittent. It is most\\nsevere in the affected kidne} but may be reflected to neighbor-\\ning parts. The character of the pain is dull and aching, often par-\\noxysmally increased, but not greatly aggravated by body move-\\nments. At first the pain is usually slight or even vague, and\\nat times absent, becoming again severe and prolonged. From\\ndull in the beginning it may later on become lancinating,\\neither spontaneously or evoked by pressure, but not by move-\\nments. When tumor becomes large and presses upon the larger\\ntrunk-nerves, pain often extends to the chest, across median\\nline, and downward to the hips and limbs, simulating sciatica.\\nThe pressure exerted by tumor when the latter is large often\\ncauses oedema of the feet and legs, ascites, and prominence\\nof the superficial abdominal veins, as well as constipation,\\ndisturbances of the stomach, and icterus. The constitutional\\nsymptoms include emaciation, anaemia, cachectic appearance,\\nbrowning or sallowing of the skin, failure of strength and\\nvitality. Uraemia is rarely, if ever, present, unless nephritis\\nco-exist. Accidental or complicating features are sometimes\\nadded such as paraplegia from spinal pressure, vesical paralysis\\nwith retention of urine, asthmatic or laryngeal dyspnoea, and\\nspasmodic cough from extension of the pathological process.\\nDifferential Features, From hepatic tumors cancer of the\\nkidney differs as follows The former have no intestine in front\\nof them; the dullness upon percussion is uniform throughout.\\nRenal tumors lie in part behind ascending colon, which passes\\nobliqueh T up and to the left, giving clear note of percussion on\\nlower and inner margin. Splenic enlargement presents rigid,\\nthin borders instead of round and lobulated ones, and, more-\\nover, as a rule, splenic tumor has more mobility, and deep per-\\ncussion often elicits intestinal resonance through its substance.\\nThere is usually antecedent history of ague or intermittent\\nfever, leucocythaemia, etc., in splenic enlargement.\\nRenal Calculus.\\nCalculi may originate in the secreting structure of the kidney\\nusually in the tubules or in the renal calyx, but their develop-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0341.jp2"}, "342": {"fulltext": "300\\nURINARY DIAGNOSIS.\\nment is most common within the renal pelvis; although this\\nsometimes takes place in the infundibula, calyces, or even in the\\ndilated tubules, which form cavities for their location in the\\nparenchyma of the organ.\\nRenal calculus is usually unilateral, though many exceptions\\noccur to this general rule. The calculus when large is usually\\nsingle, the smaller ones being more apt to be multiple.\\nRenal calculus occurs at all ages, including intra-uterine life.\\nIt is, however, most common before 15 and after 50 years of\\nage. In young people and children calculus is most frequent\\namong the poor, while calculus in advancing life is most common\\nin people of comfortable circumstances and luxurious habits.\\nAs a rule, the calculi in infancy is of the ammonium-urate\\nvariety that in young adults, uric acid that after 40 years of\\nage is usually calcium oxalate.\\nThe Urine. Blood appears in the urine in the vast majority\\nof cases of renal calculus, and presents the following features:\\nHaematurine not profuse, but appears in repeated parox} r sms\\nincreased by exercise. The blood is intimately mingled with the\\nurine is not bright in color, but smoky-brownish or porter-\\ncolored. The volume of the urine is not increased in uncom-\\nplicated renal calculus, but is rather diminished. The urine is\\nusually sharply acid and of high color. The above are usually\\nthe early features of the disease, before pyelitis begins. After\\npyelitis is established the urine undergoes the following changes\\nPus and mucus appear in the urine in greater or less quantities.\\nMore or less frequency of micturition is present, and the act\\nis accompanied by uneasiness, sometimes amounting to pain.\\nThis may be so pronounced as to lead to an impression that\\ncystitis exists. The deposits in the urine are significant, but care\\nshould be taken to secure only primary deposits, not those due\\nto decomposition changes. Centrifugal sedimentation of the\\nurine is the only trustworthy method of securing this. Urates\\nand oxalates are often observed in the sediment, the former fre-\\nquently in quantity. With the advent of pyelitis, more or less\\nphosphatic deposit is to be found in the urine. Epithelium in\\ngreater or less quantity is found in the sediment in advanced\\nrenal calculus, most often the angular and spindle form. Lastly,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0342.jp2"}, "343": {"fulltext": "RENAL CALCULUS. 301\\nthe appearance of small-sized concretions in the urine often\\nfurnish diagnostic data of the highest value.\\nLeading Clinical Features. These consist of dull aching pain\\nsituated deeply in the loin, usually unilateral, and often radiating\\nalong the ureter toward the testicle, down the thigh, and some-\\ntimes extending as far as the foot. The pain ma} T be sharp and\\nlancinating at times intensely severe paroxysms are occasional\\nfeatures (renal colic), lasting a few hours and then suddenly\\nsubsiding. The ordinary pain of renal calculus is invariably\\nincreased by exercise, either walking or riding it is, therefore,\\nmore marked in the evening than in the morning. Tenderness\\nupon deep pressure anteriorly is to be found, especialty if the\\ncalculus has excited inflammation. Gastric disturbances are\\ncommon, including nausea, vomiting, and periods of more or less\\ndisorder of digestion, acidity, flatulence, etc.\\nDifferential Features. The early stages of renal tuberculosis\\nare most likely to be confounded with renal calculus. In renal\\ntuberculosis there is usually tuberculous history in the family,\\nand often tuberculosis may be found elsewhere in the patient, as\\nin the joints and glands, and the age is usually from 20 to 40.\\nPolyuria is not prominent, and renal colic is rare save late, and\\nthen less severe, usually not causing retraction of the testicle.\\nHematuria is more persistent, but not so much influenced by\\nmovements or exercise. The urine is cloudy from the beginning,\\nof low specific gravity, depositing more pus, and albuminuria is\\nearly and more pronounced. Tubercle bacilli usually are present\\nin the urine, and inoculation of animals with urine deposit induces\\ntuberculosis. General symptoms are prominent, such as anaemia,\\nemaciation, weakness, rapid pulse, and evening temperature, with\\nnight-sweats. These features are, for the most part, absent in\\nstone.\\nFrom malignant disease the distinction rests upon the more\\ndecided hematuria of the former, which often results in anaemia.\\nHaemorrhage is uninfluenced by movement, and therefore it\\noccurs at night as well as by day.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0343.jp2"}, "344": {"fulltext": "302 urinary diagnosis.\\nRenal Embolism.\\nRenal embolism consists of an impacted thrombus which has\\nformed in some part of the circulatory system, usually in the\\nheart, and is carried by the blood-current to the kidney, where it\\nblocks one of the renal vessels. Recent endocarditis furnishes\\nthe most frequent source of renal embolism. As the fibrinous\\nclots accumulate upon the cardiac valves, sooner or later they\\nbecome detached in whole or in part, and those from the left\\nside of the heart are liable to be carried by the blood-current\\ninto either kidney. The anatomical results of embolism are\\nvery constant and striking, and in few organs are they more\\noften noticed at the autopsy than in the kidneys, though they\\nare not so frequently recognized during life as in some other\\nlocations, notably in the lungs or brain.\\nThe Urine. Changes in the urine are very striking in renal\\nembolism, although they are not wide-spread. Sudden and pro-\\nnounced albuminuria is almost invariable. Albumin may appear\\nin the urine in a few hours after the attack, but sometimes not\\nfor twenty-four hours or so after impaction. The albuminuria is\\nmarked in degree for from two to five days it then gradually\\ndiminishes and completely disappears, or leaves only mere traces\\nafter two, three, or four weeks. The specific gravity of the urine\\nis decidedly increased in the beginning, often reaching 1030 to\\n1035 it gradually lowers from day to day, and the normal\\nrange is reached after a few days or weeks. The quantity of\\nurine is decidedly diminished at first, the color is dark brown,\\nand the reaction is sharply acid. Blood is usually present from\\nthe beginning in variable, but rarely excessive quantity. Some\\ndegree of pyuria is to be noted, but this is rarely pronounced.\\nThe urine contains casts in this lesion, often in considerable\\nnumbers. At first they are mostly hyaline later on epithelial\\ncasts appear, as well as those with pus-corpuscles attached to\\nthem. After the first five to seven days the casts become less\\nnumerous, they are mostly hyaline, and at length they disappear\\nfrom the urine. It will be seen from the above features that the\\nurinary changes begin abruptly, but that the urine progressively\\nand steadily resumes its normal characteristics, and, in from a\\nfew days to three or four weeks, all manifestations of urinary", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0344.jp2"}, "345": {"fulltext": "UREMIA. 303\\ndisturbance pass away. The block, if aseptic, remains in the\\nkidney, but ceases to become a source of renal irritation.\\nLeading Clinical Features. A previous history of endocarditis\\nis the rule. The impaction is followed at once by sudden pair, in\\nthe renal region, often accompanied by chills, which latter may be\\nrepeated, and some irregular action of the heart, with sense of\\nprecordial oppression, or clogging, and frequently dyspnoea,\\nSome slight elevation of temperature is usual. If the pain be\\nvery severe vomiting is usual, and even some degree of collapse\\nmay follow.\\nUraemia.\\nThe intimate toxic character of uraemia as yet remains an\\nunsolved problem, only known to us by its results. Our knowl-\\nedge of this matter, therefore, is inexact as yet, and remains for\\nthe chemico-physiologist to unravel. In the light of our present\\nknowledge of this subject, the only conclusions that seem justifi-\\nable are as follow (a) All theories attempting to explain the\\ncause of uraemia through the action of any single product or\\ntoxin must be abandoned as fallacious, as the toxin is un-\\ndoubtedly multiple, (b) The general cause of uraemia lies in the\\nfailure of the kidne} r s to excrete the urine in part or in whole,\\nand that the urine or its primary elements, as retention products,\\nact as direct toxins upon the organism, evoking the symptoms\\ntermed uraemic. (c) That the most successful attempt at isolation\\nof these products of the urine to date we owe to the investi-\\ngations of Bouchard. (See Section Y, page 143.)\\nUraemia may appear as an acute and rapidly overwhelming\\ntoxicosis, causing coma, convulsions, and death within a few\\nhours or it may linger for weeks or for months as a milder\\nform of toxic disturbance, with symptoms such as somnolence,\\nrestlessness, headaches, nausea, attacks of diarrhoea, dyspnoea,\\nvisual disorders, and general disturbance of nutrition.\\nThe Urine. This furnishes the key to the diagnosis of uraemia\\nwith great uniformity. The essential feature of the urine in\\nuraemia is diminution of the absolute amount of solids, but more\\nespecially of urea. The quantity of urea excreted, instead of\\nbeing 500 grains for an average body-weight, becomes reduced\\nto 200 or 100, and even less than 50 grains in some cases. As a", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0345.jp2"}, "346": {"fulltext": "304 URINARY DIAGNOSIS.\\nrule the activity of the symptoms bear an inverse ratio to the\\nquantity of urea excreted, and therefore, in those cases attended\\nby extreme diminution of the excretion of urea, the symptoms\\nare sure to be pronounced and threatening so long as this con-\\ntinues. The uric acid, chlorides, phosphates, and sulphates of\\nthe urine also suffer marked reduction in uraemia, but, with the\\nexception of uric acid, these are probably of no special signifi-\\ncance. As a rule the volume of the urine is diminished, and the\\ndegree of diminution varies through all degrees up to complete\\nsuppression. The specific gravity of the urine, notwithstanding\\nthe decreased volume, is also decreased, and sometimes markedly\\nso, descending frequently to 1008 or below. Exceptions to this\\nrule are noted sometimes in acute diffuse nephritis, when the\\nvolume of urine is reduced to a few ounces, the urea being still\\ndecreased both relatively and absolutely but the febrile con-\\ndition accompanying the acute nephritis causes some increase\\nin the other solids, which proportionally become excessive, and\\nthus raise the specific gravity of the urine sometimes even to\\nthe normal range.\\nWith regard to the morbid constituents of the urine in\\nuraemia, albumin is the most constant feature, and is present in\\nall grades, from mere traces up to 2 or 3 per cent, by actual\\nweight, depending upon the nature of the associated lesion. It\\nshould be borne in mind, however, that while albumin is usually\\npresent in the urine in uraemia, exceptional cases occur in which\\nit is said to be absent; though this is rare. Even in those cases\\nof chronic interstitial nephritis characterized by absence of albu-\\nmin in the urine, the exciting cause of a uraemic attack, espe-\\ncially if acute, is apt to be of sufficient congestive character to\\ncause, at least, mild albuminuria. It may, therefore, be repeated\\nthat active uraemia is extremely rare without accompanying\\nalbuminuria.\\nThe urinary sediment in uraemia includes a very wide range of\\nmorbid products with no very constant associated features. We\\nmay have casts, epithelium, pus, blood, bacteria, together with\\ncrystalline or amorphous deposits of urates, phosphates, oxa-\\nlates, etc. The only products that may be considered at all con-\\nstant are renal casts, which are rarely perhaps never absent in", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0346.jp2"}, "347": {"fulltext": "UREMIA. 305\\nuraemia. Sometimes they are extremely sparse and may be over-\\nlooked without due care notably so in chronic interstital lesions\\nof the kidney, in which their form is often limited to the small,\\nperfectly-clear, non-refracting variety of casts, which are con-\\nfessedly difficult to find; bat failure to find them does not, with-\\nout every precaution, prove their absence. With our improved\\nmethods casts should be found when present. The nature and\\nnumber of renal casts will depend upon, and correspond to, the\\ncharacter of the renal lesion present, which need not be repeated\\nhere. For full consideration of this subject consult Section\\nVII, page 189.\\nCorresponding Clinical Features. Among the milder symp-\\ntoms of uraemia may be mentioned dyspepsia, flatulence, nausea,\\noccasional diarrhoea, neuralgia or headaches, vertigo, dyspnoea of\\nan asthmatic type, bronchial catarrh, and various nervous dis-\\nturbances, such as insomnia, restlessness, mental depression,\\nnumbness of certain parts of the body, drowsiness, and certain\\nvisual disorders.\\nThe more pronounced symptoms include severe headache,\\nusually frontal; vomiting, extreme nervousness, twitching of the\\nmuscles, drowsiness; pulse increased to 100 or over, usually hard\\nand tense temperature lowered unless some inflammatory action\\nbe associated; tongue coated with dry, brown fur; breath foul\\n(uraemic), and often more or less profound stupor or coma, or\\nconvulsions, or both.\\nDifferential Features. Uraemic coma may be mistaken for a\\nvariety of conditions, notably apoplex}-, epilepsy, alcoholic or\\nopium narcosis.\\nUraemic coma may be known by the following features The\\nsubjects are usually young or middle-aged previous attacks are\\nunlikely; renal lesions are present in some form appearance of\\nthe patient is pallid, sometimes cachectic; pulse increased to\\n100 or over; the pupils tend to dilate; the respirations ma} or\\nmay not be hastened; breathing is stertorous and labial; un-\\nconsciousness is not complete, the patient may be partly aroused\\nby efforts a peculiar odor of breath is present (uraemic) the\\nconvulsions are of recurrent order, and, as a rule, albuminuria is\\npresent.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0347.jp2"}, "348": {"fulltext": "306 URINARY DIAGNOSIS.\\nApoplexy is differentiated as follows The age of the patient\\nis nearly always past medium life, often advanced; previous\\nattacks unlikely heredity marked granular kidney often asso-\\nciated appearance of patient normal pulse slow, full, 60 per\\nminute or under; pupils unequal; respirations slow, stertorous,\\nand deeply guttural; insensibility complete and profound;\\npatient cannot be aroused hemiplegia is present.\\nEpilepsy is most common under 30 years of age previous\\nattacks are the rule the appearance of the patient is dusky,\\npurple, gradually becoming paler; pulse slightly accelerated,\\nsmall, feeble, and dicrotic temperature normal, or a degree or\\nso above pupils normal; respirations stertorous, guttural, un-\\nsteady; unconsciousness is not complete, coma of brief duration;\\ngreat muscular relaxation present.\\nAlcoholism is common to all adult ages previous attacks are\\nthe rule. The features are suffused and bloated, the lips livid,\\nand the expression vacant pulse frequent, small, and feeble\\ntemperature slightly lowered, pupils dilated; respirations are\\ndeep and slow stertor is intermittent breath is alcoholic\\nvomiting is common the conjunctivae are injected the features\\nare swollen, and the subject can usually be partly aroused.\\nOpium coma is most frequent in the young, and may be\\nhabitual or accidental. The features are shrunken, pallid, cya-\\nnotic expression is ghastly pulse usually slow and feeble\\ntemperature not increased, rather lowered pupils contracted\\nrespiration slow, shallow, and feeble, and opium may be detected\\nin the breath.\\nHEMOGLOBINURIA.\\nHemoglobinuria constitutes a condition characterized by the\\nescape of the blood coloring elements by way of the urine, very\\nlittle, if any, of the corpuscular elements of the blood accom-\\npanying the pigmentary elements. From whatever general\\nsource it may originate, it is primarily due to dissolution of the\\nred corpuscles of the blood, which permits the coloring matters\\nto escape in solution. As an occasional phenomenon it may be\\nmet witli in the course of certain infectious diseases, extensive\\nburns, and in various forms of poisoning. In addition to this it\\noccurs as an idiopathic disease of intermittent character, and to", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0348.jp2"}, "349": {"fulltext": "HEMOGLOBINURIA. 307\\nsuch the following considerations are intended especially to\\napply\\nThis disease is most common in males, three or four to one.\\nIt occurs at all ages, from 3 to 52 years, but most often between\\n20 and 50. Malaria seems to be the most prominent historical\\nfeature of these patients, while cold is undoubtedly the most\\nfrequent exciting cause.\\nThe Urine. The appearance of the urine in the intervals\\nbetween the attacks is perfectly normal but with the attack\\nits appearance becomes at once strikingly altered, apparently\\nbloody. The color assumes a dark-red, port-wine, or porter\\ncolor, and is somewhat turbid or smoky in appearance, and de-\\nposits, upon standing, an abundant chocolate-like sediment. The\\nspecific gravit} of the urine varies from 1015 to 1030, the average\\nrange being slightly above normal, 1023 to 1025. The reaction\\nof the urine may be acid or faintly alkaline, and the volume is\\nsomewhat above normal. In most cases the quantity of urea is\\nincreased. The urine gives a highly albuminous reaction, and\\nfurther testing shows the presence of globulin.\\nThe urinary sediment is chiefly made up of amorphous gran-\\nular matter, doubtless disorganized blood-corpuscles, in which\\nare often to be seen minute crystals of haematin. Casts are\\nusually present, chieny dark, granulated ones, though often, also,\\nhyaline casts may be found. Many of the casts are made up of\\nhaemoglobin. Calcium-oxalate crystals are usually present, and\\nless frequently are uric-acid crystals found. Blood-corpuscles\\nare either absent or only a few scattering ones are to be\\nfound. The urine gives the characteristic blood reaction with\\nguaiacum and ozonic ether even the interparoxysmal urine often\\nshows the blue reaction. The spectroscopical examination of the\\nurine shows the two absorption bands between Frauenhofer s D\\nand E lines characteristic of oxyhemoglobin. Renal epithelium\\nis often seen in the sediment, sometimes deeply stained by the\\nblood-pigment. Amorphous urates are usually present in abun-\\ndance, especially as the attack is subsiding. The chlorides of the\\nurine are usually deficient, the phosphates and sulphates in ex-\\ncess, and so-called indican is not infrequently present in consider-\\nable excess.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0349.jp2"}, "350": {"fulltext": "308 URINARY DIAGNOSIS.\\nProminent Clinical Features. The symptoms of idiopathic\\nhemoglobinuria are distinctly paroxj-smal, beginning with chill,\\nsometimes continued rigors for an hour or more, which are\\nusually due to previous exposure to cold. The exposure, however,\\ndoes not cause the disease, but merely provokes the paroxysm, as\\nis proved b} T the fact that so long as the patient remains warm he\\ncontinues free from S3^mptoms. The chill is accompanied or fol-\\nlowed by retching and often vomiting, as well as pain in the\\nback and limbs; often with retraction of the testes. General\\nmalaise succeeds with yawning and stretching. Sometimes ten-\\nderness in the renal region is to be elicited upon deep pressure.\\nThirst, headache, and drowsiness are frequent features, and the\\nskin sometimes becomes jaundiced. In from half an hour to\\ntwo hours the patient voids more or less port-wine-colored urine,\\nThe urine retains this abnormal color for two or three passages\\nthe whole attack usuali}^ being completed in twenty-four hours\\nor less time more rarely it may continue for several days. The\\nattack is often succeeded by griping pain in the umbilical region,\\nand more or less pallor and weakness succeed the attack for a\\nday or two. Urticaria is an occasional accompaniment of the\\ndisease.\\nThe temperature is lowered during the cold stage (96\u00c2\u00b0 F.),\\nbut often rises above normal when the chills subside. After the\\nattack the patient remains apparentty well for a longer or shorter\\ntime, it may be for months, until again exposed to cold.\\nNephritis is not an infrequent result protracted cases are char-\\nacterized by repeated paroxysms.\\nChyluria.\\nThis disease usually arises in consequence of some lesion of\\nthe lymphatic system, whereby the chyle is diverted from the\\nnatural channels into some part of the urinary tract. As an\\nidiopathic disease chyluria has heretofore been almost exclu-\\nsively confined to the tropics, or to those who have spent much\\nof their lives there. As such it depends upon the invasion of\\nthe blood and urinary tract by a parasite, the Filaria sanguinis\\nhominis, as first pointed out by Dr. Lewis, of Bengal, and\\nalread} T described and illustrated (page 210). Besides the en-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0350.jp2"}, "351": {"fulltext": "CHYLURIA. 309\\ndemic form, the disease is occasionally met with in people who\\nhave never lived in the tropics, and, when thus occurring, it may\\nbe considered an accidental condition, brought about by trauma-\\ntisms or diseases which have established communications between\\nthe lymph-channels and the urinary passages. The accidental\\nform of the disease is comparatively rare at least nine-tenths\\nof the cases met with, even in temperate climates, are the result\\nof infection in the tropics of people who previously there resided\\nand contracted the disease.\\nThe endemic form prevails widely in the tropics, including\\nespecially India, China, the West Indies, notabl}- in Barbados,\\nTrinidad, and Demarara, also Cuba, Bermuda, Brazil, Mauri-\\ntius, the Isle of Bourbon, and South Australia. The disease\\nattacks indifferently both natives and foreigners, males and\\nfemales, and shows but little preferences as to age of the subject.\\nThe peculiar and interesting nature and habits of the parasite\\nwhich causes this disease have already been fully described\\n(p. 211).\\nThe Urine. The peculiar condition of the urine in chyluria\\nfurnishes the key to the recognition of the disease. The appear-\\nance of the urine is characteristically milky, and it so remains\\nupon standing for days without settling, in consequence of the\\nfinely molecular division of the contained fat, thus permitting it\\nto remain in suspension. It is unusual for oil-globules of any\\nsize to be found in the urine in this lesion indeed, the emulsion\\nis so complete that only minute granular matter is seen. Some-\\ntimes, upon standing, the fat rises to the surface of the urine\\nand collects in cream-like flakes. The quantity of fat found in\\nthe urine in chyluria varies greatly, depending largely upon the\\nquantity and quality of the food taken the urine of digestion\\n(after food) is richest in fat, while that of fasting contains the\\nleast.\\nIf the urine be shaken with ether the fat is dissolved and the\\nurine assumes its normal color and appearance. In addition to\\nfat, chylous urine usually contains blood in sufficient quantity\\nto impart a very noticeable pink color to the fluid. The pink\\ntint is fainter than would be expected in proportion to the\\nquantity of blood actually present, the opacity caused by the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0351.jp2"}, "352": {"fulltext": "310 URINARY DIAGNOSIS.\\nfat greatly obscuring the coloration due to the blood-corpuscles.\\nUpon standing, however, the contrast becomes striking the\\nbright sediment of precipitated blood is then plainly visible.\\nThis precipitated blood-clot becomes more pronouncedly pink\\nupon exposure to the atmosphere, as first pointed out by Dr.\\nVandyke Carter.\\nA notable characteristic of chylous urine is its tendency to\\nspontaneous coagulation upon standing. If the urine be at all\\nrich in fibrin, shortly after it is voided it will coagulate into a\\nfirm, vibrating, jelly-like mass resembling corn-starch blanc-\\nmange. Unfortunately, sometimes coagulation takes place in\\nthe urinary channels, notably the bladder, and may give rise to\\nmost distressing symptoms until it be dissolved or broken up\\nand removed. The clots which form after the urine is voided\\noften become very firm, and long retain the form of the vessel in\\nwhich the urine stood if in bottles they may even have to be\\nbroken in order to remove the coagulum. The coagulation of\\nchylous urine depends directly upon the fact of the almost con-\\nstant presence of fibrin in the urine, although the quantity\\nvaries considerably. At times it is insufficient to cause coagu-\\nlation. The quantity of fibrin present is usually in inverse ratio\\nto the amount of contained molecular fat.\\nThe uniform presence of albumin in the urine is attested by\\nthe constant coagulation of the urine by heat or other albumin\\nprecipitants. Corpuscular elements are sometimes present in the\\nurine, besides red blood-cells resembling lymph-cells, as well as\\nlarge oval and rounded cells which microscopically and chemically\\nevince the characteristics of epithelium. The urine is usually\\ndevoid of renal casts unless nephritis be excited by the disease\\nand since the urine always contains fibrin, this would indicate\\nthat the lesions are not situated in the kidneys, but rather in the\\nconducting channels of the urine. Filaria are sometimes found\\nin the urine, especially of the tropical form of the disease, if\\nsought for in the night urine. In urine excreted during the day\\nthey are rarely to be found, owing to the fact that the parasite\\nis quiescent during the day. Pus-cells are more or less numerous\\nin the sediment.\\nThe solids of the urine suffer some reduction owing to the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0352.jp2"}, "353": {"fulltext": "DIABETES INSIPIDUS. 31 1\\ndrain upon the elements which go to furnish nutrition. The\\nspecific gravity is lowered to a moderate, rarely to an extreme\\ndegree, 1016 to 1010. The urea, chlorides, and sulphates are\\nusually deficient, especially the two former, while the phosphates\\nare often considerably increased. It is common to find a con-\\nsiderable deposit of uric-acid crystals in the freshly-voided urine\\nupon cooling.\\nLeading Clinical Features. The clinical symptoms are rather\\nnegative; drops}^, uraemia, and frequent micturition being absent.\\nThere is usually an indefinite dragging pain in the back and\\nloins, especially preceding the attacks. Anaemia becomes more\\nor less marked according to the extent and continuance of the\\ndrain. Loss of strength and depression are prominent features\\nduring the escape of chyle these, however, are at once relieved\\nif this cease. Tuberculosis often becomes a complicating feature\\nof very chronic cases. The disease pursues an intermittent\\ncourse, especially so the tropical endemic, due to successive\\nruptures of lymphatics the accidental form is more uniform in\\nits course. The duration of the disease is indefinite, but always\\nchronic, lasting from ten to fort} -seven years.\\nDiabetes Insipidus.\\nThis disease has been variously designated under the terms\\ndiuresis, polyuria, polydipsia, and hydruria. Little or nothing\\ndefinite is known as to the pathology of the disease it is not\\nimprobable that it is caused by a number of different morbid con-\\nditions. The disease is much more frequent in males than in\\nfemales. It may appear at any age, but in the majorit} 7 of cases\\nthe disease appears between 5 and 30 years of age. From the\\nnumber of alleged causes of the disease by various authors, it is\\nverj- evident that nothing definite is known of the etiology, save\\nin those cases that can be distinctly traced to traumatisms, intra-\\ncranial growths, or other lesions of the nervous system.\\nThe Urine. The chief features of the urine are enormous\\nincrease of volume, lowered specific gravity, and absence of both\\nsugar and albumin. The daily volume of urine not infrequently\\nreaches from 15 to 40 pints. The urine is pale in color, almost,\\nin fact, watery in appearance, and the specific gravity ranges", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0353.jp2"}, "354": {"fulltext": "312 URINARY DIAGNOSIS.\\nfrom 1002 or 1003 to 100 1. The reaction is feebly acid or\\nneutral. Upon standing, the urine soon becomes ammoniacal\\nand turbid from precipitation of earthy phosphates, and gives a\\nrather offensive, fish-like odor. The urea, while proportionately\\nreduced, is, in fact, absolutely increased considerably above the\\nnormal range. Uric acid is apparently greatly deficient, and\\nit is even claimed to be often absent. The increase of urea and\\ndeficiency of uric acid favor the presumption that the latter\\nundergoes conversion into the former. The chlorides, phos-\\nphates, and sulphates are more or less increased, more especially\\nthe phosphates, which sometimes become greatly excessive. Al-\\nbumin is usually absent from the urine, although in protracted\\ncases it is often present in small quantities. Inosite is frequently\\npresent in the urine, as Strauss claims, merely as the result of\\nirrigation of the tissues, since he succeeded in producing the\\nsame condition, experimentally, upon subjects by administering\\ncopious draughts of water.\\nProminent Clinical Features. The most prominent symptoms\\nof this disease are as follow Inordinate, constantly-recurring\\nthirst, which is only briefly quenched by copious draughts of\\nwater. Less constantly the appetite is increased. These patients\\nare sensitive to cold and are easily chilled, the temperature being\\nsomewhat lowered. The tongue is dry, and more or less dis-\\ncomfort is experienced in the stomach pain and diarrhoea are\\noften present. The skin is dry, pinched, and dusky. The patient\\nbecomes spare and weak, though, exceptionally, fair strength and\\nhealth is maintained for years. In late stages of the disease,\\noedema of the lower extremities sometimes appears.\\nDiabetes Mellitus.\\nSaccharine diabetes constitutes a perverted state of the elab-\\norative functions in which certain elements which go to make\\nup nutrition notably starches and sugars fail to reach their\\nnormal destinations in the economy. The symptoms evoked are\\npartly due to lack of nutrition and partly to the damaging effects\\nof the waste products (chiefly sugar) upon the tissues. The direct\\ncause of the disease is an impaired functional capacity of the\\nliver in its glycogenic relations. This may, however, be induced", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0354.jp2"}, "355": {"fulltext": "DIABETES MELLITUS. 313\\nthrough impaired nervous influences, which may be central or\\nreflected. In addition, some complemental relationship exists\\nbetween the functions of the liver and pancreas, which often\\npermits lesions of the latter organ to evoke the phenomena of\\ndiabetes mellitus. The precise nature of this relationship is\\nunknown.\\nSomething over 30 per cent, of the cases can be traced heredi-\\ntarily. The disease is notably frequent among Hebrews. It\\nattacks males twice more frequently than females. It occurs\\nmost often between the ages of 25 to 65, and is infrequent at the\\ntwo extremes of life. In young people under 30 years of\\nage the disease is almost uniformly progressive toward a fatal\\nissue in from a few months to four or five years. If the disease\\ndo not appear until between 40 and 50 years of age, it is often\\nmore amenable to treatment after 50 it may usually be held in\\ncontrol by proper management. The disease is more severe\\nin spare than in stout subjects, at all ages. In the young death\\nis most frequent from diabetic coma, while in those advanced in\\nlife the end is often reached through cardiac degeneration, gan-\\ngrene, or exhaustion.\\nThe Urine. The physical characters of the urine are character-\\nistically altered in typical saccharine diabetes. The urine is light\\nin color and of a greenish, rather than yellowish, tint. It remains\\nperfectly transparent and froths much if poured from one vessel\\ninto another. The specific gravity is markedly increased, rang-\\ning from 1030 to 1045, or even higher. The reaction is sharply\\nacid, and it long remains so upon standing. The quantity of\\nurine is greatly increased, the increase being usually in direct\\nratio to the quantity of contained sugar. From 6 to 12 pints\\nof urine are often voided in twenty-four hours j but in severe\\ncases 25 to 40 pints are sometimes excreted.\\nThe most characteristic feature of the urine is the presence\\nof sugar, which forms the index to the disease. The quantity\\nof sugar varies from 1 to 8 per cent., averaging perhaps 4 or 5\\nper cent. One and a half to two pounds of sugar per day consti-\\ntute the highest range of sugar excreted in the more extreme\\ncases, while half a pound is not uncommonly excreted in ordi-\\nnary cases. The quantity of urea is markedly increased. A\\n21", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0355.jp2"}, "356": {"fulltext": "314 URINARY DIAGNOSIS.\\nmarked decrease in the quantity of urea may be considered as\\nan unfavorable indication. The uric acid is usually deficient,\\noften reaching but half the normal amount or even less. Not-\\nwithstanding the above fact, uric-acid crystals are frequently\\ndeposited from freshly-voided diabetic urine the deficiency of\\ncoloring matters and disproportion of salines permitting it to\\nfall out of solution. The sulphates of the urine are not materi-\\nally altered in quantity, probably because of the large amount\\nof animal food usually eaten in these cases. The gross chlo-\\nrides, like the sulphates, remain essentially unaltered in quantity,\\nthough often varying considerably from day to day. The phos-\\nphates vary greatly according to the quantit}^ and quality of\\nfood taken, but, on the whole, the tendency is toward increase.\\nThe urine often contains, in the advanced stages, acetone or\\nan acetone-yielding substance. Diacetone is occasionally pres-\\nent in the urine, but only in serious cases, and it is usually the\\nindex of approaching diabetic coma. Albumin is often present\\nin small quantity in chronic cases. It may be due to co-existing\\nnephritis, but more often to disturbance of the renal circulation,\\nimpaired nutrition of the renal epithelium, or degeneration of\\nthe parenchyma of the kidneys.\\nProminent Clinical Features. The most prominent symptoms\\nare: thirst, polyuria, lowered temperature, hunger, weakness,\\nemaciation, and nervous disorders. The thirst is constant, and\\nseemingly unquenchable in character. Although the amount of\\nwater consumed is sometimes enormous, the mouth and throat\\nremain dry and parched. The appetite is always increased, at\\nfirst sometimes inordinate, and but little appeased by food. As\\na result the stomach sooner or later becomes disordered under\\nthe strain of constant overloading, so that in late stages of the\\ndisease the appetite fails, and dyspepsia follows. Constipation\\nand attacks of diarrhoea are common. The mouth, tongue, and\\nfauces become intensely red and congested the gums become\\ntender and shrunken so that the teeth sometimes loosen. The\\ntemperature is lowered, 96\u00c2\u00b0 to 97\u00c2\u00b0 F. being common, but even\\na temperature of 93\u00c2\u00b0 F. has been observed. Chilly sensations are\\nfrequent so that these patients instinctively seek the fire and\\nrequire extra clothing. Colds are excited upon slight exposures.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0356.jp2"}, "357": {"fulltext": "URTNARY FEVER. 315\\nPeriods of somnolence are common, and various nervous mani-\\nfestations appear, as neuralgia, cutaneous hyperesthesia, sensa-\\ntions of abnormal heat of skin, sudden spells of perspiration.\\nThese patients become irritable, fretful, uneasy, A ascillating, and\\nthe mind deteriorates somewhat. The sexual power declines\\nor is completely lost. The skin is dry, harsh, unperspirable,\\nwrinkled, and loose, causing an early aged appearance. Emaci-\\nation progresses sometimes with rapidity the muscles feel weak\\nand tired, so that movements become laborious and exhausting,\\nthese patients do not care to exercise. The pronounced and per-\\nsistent polyuria produces frequent micturition, which harasses\\nthe patient both day and night. Tuberculosis sometimes sets in\\nin the late stages of the disease, often, however, preceded by\\nbronchitis or localized pneumonia. Gangrene of the extremities\\nis common in aged subjects. Cardiac enlargement, high-tension\\npulse, and degenerative changes of the heart often supervene in\\nlong-standing cases.\\nFinally, gastric pain, dyspnoea, and more or less drowsiness\\nannounce the approach of diabetic coma, which quickly termi-\\nnates life.\\nUrinary Fever.\\nVarious names have been applied to this disease, such as\\nurethral fever, catheter fever, urinary fever, shock, urinary\\npoisoning, ursemic poisoning, urinary infection. names which\\nsuggest the various and conflicting views held both of the\\netiology and pathology of this condition, which, indeed, still\\nremain unharmonized.\\nThe term urinary fever was first employed by G-uyon to\\ndenote the febrile disturbance and accompanying phenomena set\\nup by instrumentation of the urethra or bladder, or by opera-\\ntions upon the urinary organs, or by impressions upon the\\nurethra or bladder by other means. The morbid phenomena\\nevoked by instrumentation of the urethra and bladder may\\nbecome so wide-spread as to include septic inflammations of the\\nrenal pelvis, the kidney itself, and even pyaemia or it may bring\\nabout acute uraemia, with its attendant consequences, often ter-\\nminating in death. In most of these conditions some previous\\ndisease existed either in the kidneys, bladder, or urethra, and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0357.jp2"}, "358": {"fulltext": "316 URINARY DIAGNOSIS.\\nthe instrumentation merely served to convert a chronic disease\\ninto an acute and often highly-dangerous condition. Much of\\nthe confusion in the past, and, to some extent, still existing, in\\nreference to the pathology of urinary fever, has arisen from the\\nmistake of describing the various inflammatory and septic proc-\\nesses set up in abnormal urinary organs by instrumentation, and\\nattempting to harmonize these with the temporary fever induced\\nby instrumentation of the urethra and bladder. We may, for\\ninstance, have all the conditions present which tend toward the\\ndevelopment of septic nephritis, such as obstructive cystitis or\\nascending pyelitis. The use of the catheter under such circum-\\nstances, especially in elderly men, is very apt to at once evoke\\nacute (septic) interstitial nephritis, resulting in death. While\\nthe exciting cause in such case was instrumentation, pathological\\nconditions pre-existed, and the instrumentation merely served to\\nconvert a chronic into an acute septic disease.\\nBy urinary fever, as here considered, is meant the elevation\\nof temperature and accompanying symptoms evoked by the\\npassage of a sound or catheter, by operations or other impres-\\nsions made upon the lower urinary tract, the kidneys and urinary\\norgans being free from disease.\\nThe passage of a catheter into a healthy urethra, when the\\nbladder and kidneys are perfectly healthy, may evoke symptoms\\nand results of all grades, from a mere transient faintness, recov-\\nered from in a few minutes, to violent chill, elevated tempera-\\nture (103\u00c2\u00b0 to 105\u00c2\u00b0 F.), suppression of urine, convulsions, and\\neven death in from six to foiiy-eight hours. Morris has es-\\npecially pointed out that the nervous connections with the genito-\\nurinary tract are so peculiarly constituted that, if a local irrita-\\ntion be at all pronounced, conditions are favorable for the most\\nwide-spread nervous storm to prevail over the entire sympathetic\\nand cerebro-spinal systems, involving the cardiac, pulmonary,\\nand renal circulations to the extent of inducing syncope, im-\\npaired respiration, acute renal congestion, convulsions, and even\\ndeath.\\nBut even the slighter forms of local irritation (measured by the\\ndegree of instrumentation), as the gentle passage of a sound, are\\nas likely to evoke an attack of urinary fever as operations upon", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0358.jp2"}, "359": {"fulltext": "URINARY FEVER. 317\\nthe urinary organs of very considerable extent, such as lithotonrv\\nor lithotrity.\\nThe Urine. The quantity of urine is more or less dimin-\\nished in urinary fever. The diminution is usually very decided\\nand even complete suppression inay occur, lasting for one to\\nthree days. Very decided diminution is the rule complete\\nsuppression rather the exception. In cases of recurrent urinaiy\\nfever unattended by suppression the volume of urine is much\\ndiminished during the febrile period, while during the intervals\\nthe volume increases considerably. The color of the urine\\nis increased and often presents a bloody tint. The urine is\\nsmoky in appearance, the transparency being more or less di-\\nminished or absent. The reaction of the urine is acid and the\\nspecific gravity reduced. The solids are diminished, notably\\nthe urea. Blood is nearly always present in marked cases, vary-\\ning from microscopical quantities to frank hematuria. Albumin\\nis constantly to be found in the urine the range, however, is\\nusualty moderate, one to two grammes per litre, although ex-\\nceptionally two or three times that amount is present, and this\\nis always of grave significance. Casts may or may not be\\npresent. The} 7 are always associated with high grades of albu-\\nminuria, and, like the latter, are of serious significance.\\nProminent Clinical Features. After passing a catheter, or\\nsome operative manipulation of the lower urinary tract, in from\\na few minutes to six or eight hours the patient is suddenty seized\\nby a chill of various degrees of severity, from merely chilly sensa-\\ntions to pronounced and violent rigor, accompanied by chattering\\nof the teeth and vibrations of the limbs or whole body. This\\nis followed by pain in the back and limbs. The temperature\\nrapidly rises from 2 to 7 degrees headache and injection of the\\nconjunctiva are present, and nausea, vomiting, and even delirium\\nare common. Dyspnoea and cardiac irregularity are occasionally\\nto be noted. The pulse becomes rapid, hard, and tense, vibrat-\\ning. After a time a pronounced perspiration succeeds, and with\\nthis the temperature lowers and more or less relief is experi-\\nenced. The pulse grows less frequent and less tense the tem-\\nperature diminishes, but thirst continues unabated. After six\\nto twelve hours the fever subsides, leaving the patient weak but", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0359.jp2"}, "360": {"fulltext": "318 URINARY DIAGNOSIS.\\nconvalescence, as a rule, is established in a day or two. In\\nsome cases the patient has a recurrence of the paroxysm on the\\nfollowing da} r or in two or three days, and these may be re-\\npeated a number of times. In the absence of definite lesions\\nthe attacks soon subside and the patient regains his normal\\ncondition.\\nDifferential Features. From pyelonephritis and suppurative\\nnephritis urinary fever is distinguished by the sudden onset of\\nthe latter and the brief duration of the fever by the history of\\nthe case, such as previously healthy kidneys and healthy state\\nof the bladder and lower urinary tract.\\nFrom uraemia more difficulty is encountered in making a dis-\\ntinction, since suppression may occur for several days and death\\nresult, at least in part, from uraemia. In urinary fever suffi-\\nciently severe to cause death, it does so more rapidly than does\\nuraemia. The absence of coma and convulsions, the retention of\\nconsciousness, etc., exclude uraemia. Septicaemia is distinguished\\nby its slower onset, low typhoid character, and continuous pro-\\ngressive course without intermission.\\nHydronephrosis.\\nThe above term was first employed by Rayer to denote the\\noverdistension of the kidney with urine. It is, in fact, a result\\nof mechanical obstruction to the outfloAV of the urine, the obstruc-\\ntion being located in the ureter, bladder, or urethra. This dis-\\nease should be carefully distinguished from pyonephrosis, a\\ncondition also of distension of the kidney with urine plus puru-\\nlent matter. It should also be distinguished from large cysts of\\nthe kidney the contents of which are fluid, but not urinous.\\nHydronephrosis in its pathological significance has been best\\nexpressed by Terrier and Baudouin as an aseptic dilatation of\\nthe pelvis by urine, the flow of which is obstructed by some\\nmechanical obstacle. About 35 to 40 per cent, of the cases are\\ncongenital, the remainder being acquired. The congenital causes\\ncomprise twists of the ureter upon its axis, undue obliquity of\\nthe ureteral opening into the bladder, reduplication, valve-like\\nfolds of the ureteral mucous membrane, and imperforate ureter.\\nThe acquired causes include cancer of the pelvic organs, notably", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0360.jp2"}, "361": {"fulltext": "HYDRONEPHROSIS. 319\\nof the ovaries hydatids and other growths within or im-\\npinging upon the ureters; calculus in the ureter; traumatisms,\\nincluding renal dislocations, twists, etc. abdominal tumors,\\nvesical growths involving the ureteral openings, and obstructive\\ndiseases of the prostate.\\nThe Urine. The quantity of urine varies according to the\\ndegree of obstruction, and whether the disease be confined to one\\nor both kidneys. In the milder forms of obstruction the quan-\\ntity of urine varies greatly, there being periods of diminution\\nfollowed b}^ periods of increased flow. On the whole, the\\nvolume of urine is diminished. The urine is of low specific\\ngravity, and reduced in its solid constituents, conditions which,\\nas Dickinson has pointed out, always exist with urine secreted\\nagainst pressure. The urine sometimes contains blood, which\\nis discharged with great pain (renal colic), especially if clots be\\npresent. Slight albuminuria is usually present, though this is\\nnot invariably so. The urea is markedly reduced, both relatively\\nand absolutely the phosphates are greatly reduced in most\\ncases, while the chlorides and sulphates suffer the least dimi-\\nnution. Sedimentation of the urine shows excess of epithelium,\\nin which the spindle-shaped and angular cells predominate. Renal\\ncasts, as a rule, are absent, but a few scattering pus-corpuscles\\nand blood-discs are usually present.\\nProminent Clinical Features. Dull, aching pain is usually\\npresent in the renal region, with some increased frequency of\\nmicturition. Tumor is present in most cases, gradually en-\\ncroaching on the median line and downward toward the iliac\\nfossa. About one-fourth of the cases of single lrvdronephrosis\\nextend beyond the median line, and in a considerable number of\\nthese tumor occupies a very considerable area of the abdominal\\ncavity. Sudden diminution in size of tumor, coincident with\\nexcretion of unusual quantity of non-purulent urine, may be\\nconsidered diagnostic.\\nVomiting sometimes occurs during periods of retention, and\\nsometimes a urinous odor may be observed in the perspiration at\\nsuch times. Constipation is a frequent result of pressure upon\\nthe colon more rarely diarrhoea may be present from the same\\ncause. So long as the hydronephrosis be single and the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0361.jp2"}, "362": {"fulltext": "320 URINARY DIAGNOSIS.\\nremaining kidney be sound, there is absence of ursemic symp-\\ntoms. If, however, the remaining kidney be diseased or the\\nhydronephrosis be bilateral, suppression of urine and uraemia\\nare liable to result at any time and prove fatal.\\nDifferential Features. Hydronephrosis is to be distin-\\nguished from other abdominal tumors by the presence of urea\\nand uric acid in the fluid withdrawn b}^ aspiration, and by the\\nabrupt diminution in the size of the tumor coincident with\\ncopious discharge of urine. Hydronephrosis ma}^ be confounded\\nwith renal cancer or cystic degeneration of the kidney. In\\nhydronephrosis the tumor is evenly and distinctly fluctuant, no\\ndullness on percussion being observable throughout its extent.\\nThe tumor, furthermore, does not conform to the shape of the\\nkidney it is usually unattended by dropsy, hematuria, or\\ncachexia. In cystic disease the tumor is bilateral, non-fluctuant,\\npreserves the form of the kidney, is painless, sometimes attended\\nby dropsy, nearly always associated with hematuria, and the\\ntumor does not rapidly change in size.\\nIn cancer the tumor is unilateral, non-fluctuant, irregular in\\nform, rapid in growth, attended by severe pain copious, recur-\\nrent, and persistent hematuria occurs, and in late stages pro-\\nnounced cachexia is present.\\nPyonephrosis.\\nPyonephrosis is a dilatation of the renal pelvis and calices of\\nthe kidney with purulent urine, or, in other words, it is hydro-\\nnephrosis with suppurative inflammation added. In marked\\ncases the suppurative process extends be} ond the calices and\\nresults in compression, atrophy, and destruction of the paren-\\nclryma of the kidney. The causes are the same as those of\\nhydronephrosis plus suppurative inflammation.\\nThe Urine. Pus is always present if the obstruction be in-\\ncomplete. If complete at times, and not at others, pus will\\nappear intermittently in the urine if the disease be unilateral.\\nThe quantity of urine voided will depend upon the degree of\\npressure exerted. If the ureter be blocked, as often occurs for\\nsome periods of time, the urine will be greatly diminished in\\nvolume during the period of obstruction. If only partly oc-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0362.jp2"}, "363": {"fulltext": "PYONEPHROSIS. 321\\neluded, the quantity of urine, as well as that of pus, will vary\\neven during twenty-four hours. If the obstruction be tem-\\nporarily relieved, large quantities of urine are voided which\\ncontains blood and pus, while during the period of occlusion the\\nurine is clear and normal in appearance, unless the disease be\\nbilateral.\\nIn the early stages of this lesion the urine contains blood\\n(sometimes only in microscopical quantify), more or less mucus,\\nand epithelium and pus. The urine is usually acid in reaction,\\nof low specific gravity, and contains albumin, as a rule cor-\\nresponding with the quantity of blood and pus in the urine. As\\nthe disease advances, pyuria becomes more pronounced. The\\nurine is still acid, unless in very advanced cases, when saccula-\\ntion of the kidney occurs, in which case it ma} become ammo-\\nniacal. In all stages the urine is of lowered specific gravity,\\nthe solids more or less decreased, and micturition is somewhat\\nmore frequent than normal.\\nProminent Clinical Features. The prominent symptoms of\\npyonephrosis comprise pyuria with constitutional symptoms, such\\nas rigors, evening temperature, emaciation, anaemia, prostration,\\nand, in advanced cases, hectic. If tumor form, it may be elastic\\nand fluctuant or hard, and extend both forward and downward.\\nPain is present, varying with the size of the tumor and degree\\nof fluctuation. It often appears in paroxysms of intensity,\\nrenal colic. Pressure over the anterior of the tumor greatly\\nincreases the pain, or develops it, if not before present. On the\\nother hand, lateral pressure may relieve the pain when present.\\nThe bowels are usually disturbed, constipation or diarrhoea being\\nfrequent. When the ureter becomes suddenly and completely\\nblocked, sharp constitutional s}mvptoms often follow, such as\\nchill followed by rise of temperature, which may reach 103\u00c2\u00b0 to\\n105\u00c2\u00b0 F. profuse perspirations, rapid pulse, quickened respira-\\ntions, and sharp pain in the affected side. These symptoms\\nusually continue for some time, and are suddenly relieved by\\na copious flow of urine, which had previously been greatly\\nreduced in quantity.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0363.jp2"}, "364": {"fulltext": "322 URINARY DIAGNOSIS.\\nAcute Interstitial Nephritis.\\nThis disease has been described under several names, viz.,\\nu supjjurative nephritis acute interstitial nephritis pyelo-\\nnephritis and surgical kidney. It is, in fact, an acute inter-\\nstitial nephritis with numerous points of suppuration in the\\nkidney, varying in size from mere dots to large abscesses, which\\nmay occupy almost the entire organ. It is seldom observed as\\na primary disease; by far the greater number of cases are sec-\\nondary and consequent to urethral stricture, prostatic enlarge-\\nment, large vesical calculi, atony of the bladder, infectious em-\\nboli, or traumatisms. It sometimes complicates typhus, typhoid\\nfever, diphtheria, carbuncles, pyaemia, cholera, and like infec-\\ntious diseases. Obstructive diseases of the urinary conducting\\nchannels, with decomposing urine from retention, are strong\\npredisposing as well as exciting causes. Under such conditions\\ncareless instrumentation of the urethra and bladder are exceed-\\ningly prone to induce acute interstitial nephritis hence the mis-\\napplied term surgical kidney\\nThe Urine. This is always cloudy, of pale, dirty-yellowish\\ncolor, and of peculiarly foul odor. The specific gravity is re-\\nduced, 1016 to 1006, and the quantity of urine is reduced.\\nThe reaction may be acid, neutral, or alkaline. If acid, the dis-\\nease is likety to be limited to the kidney but if alkaline, pyelitis\\nand perhaps cystitis also exist. Whatever be the chemical re-\\naction of the urine when voided, upon standing it rapidly under-\\ngoes ammoniacal decomposition. The normal constituents of\\nthe urine are reduced in quantity, notably the urea. Albumin is\\nalways present in the urine, though in variable quantity, the\\namount always exceeding that due to the contained pus and\\nblood.\\nThe urinary sediment is always abundant, and consists, for\\nthe most part, of pus, blood, bacteria, organic debris, epithelium,\\nand usually casts. The presence of pus is an essential feature\\nof the disease it is alwaj^s present and may be very copious in\\nquantity.\\nThe microscope reveals the presence of micro-organisms in\\nabundance, and sometimes fine^-formed casts of bacteria are to\\nbe seen. A sudden and marked increase in the quantity of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0364.jp2"}, "365": {"fulltext": "CHRONIC PYELITIS. 323\\npus in the urine, especially if containing recognizable remnants\\nof glomeruli or urinary tubules, denotes the formation of renal\\nabscess.\\nProminent Clinical Features. The commencement is marked\\nby pronounced rigor or a succession of chills followed by rise of\\ntemperature, which in the evening raay reach 103\u00c2\u00b0 to 105\u00c2\u00b0 F.,\\nwhile the morning temperature may be below 100\u00c2\u00b0 F. Weak-\\nness, drowsiness, flatulence, and sense of abdominal fullness\\nfollow. Rapid emaciation, pinched features, and dull, leaden, or\\nsallow appearance succeed. In the evening the skin becomes\\nhot and great thirst is present. Profuse perspiration is common\\nthe tongue may remain comparatively clean, but more often it\\nbecomes dry and coated with a brownish-white fur. Xausea is\\nfrequent, and vomiting occasionally follows. Renal pain and\\ntenderness are usually absent, but considerable pain is present in\\nthe limbs and along the spine. In unfavorable cases the symp-\\ntoms continue until exhaustion succeeds or renal suppuration\\nbecomes established, either of which usually terminates life within\\na few days.\\nChronic Pyelitis.\\nThe more acute forms of pyelitis are included in pyonephrosis\\nand acute interstitial nephritis, just considered. The general\\ncauses include the acute infectious diseases, such as typhoid,\\ndiphtheria, pyaemia, cholera, puerperal septicaemia, and such dis-\\neases as carbuncle.\\nIn addition to these we have chronic pyelitis of a more cir-\\ncumscribed character, which may result from an acute attack, or\\nit may be induced by less active causes, being essentially chronic\\nin nature from the beginning. Chronic pyelitis is rarelj 7 a pri-\\nmary disease, but is usually associated with other renal lesions\\nor vesical diseases, especial^ septic inflammations of the lower\\nurinary tract.\\nOf the local causes gravel constitutes the most frequent\\nsource, which may act either by direct irritation or through\\nobstruction. Tuberculosis is a frequent local cause, notably the\\nform of slowly-developing cheesy nodules which set up inflam-\\nmatory changes both in the pelvic mucous membrane and neigh-\\nboring tissues.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0365.jp2"}, "366": {"fulltext": "324 URINARY DIAGNOSIS.\\nThe various obstructive diseases of the lower urinary channels\\nare frequent causes of inflammation of the mucous membrane of\\nthe renal pelvis. These include urethral stricture, enlarged pros-\\ntate, large vesical calculi, atony of the bladder, etc. The re-\\ntained urine in such cases is extremely prone to be contaminated\\nwith p3 T ogenic germs introduced from without. These organisms,\\nupon introduction, rapidly multiply and spread, causing changes\\nboth in the urine and mucous structures, including that of the\\nrenal pelvis. These micro-organisms are, for the most part,\\nmicrococci, but rod-like forms or bacilli may also be present,\\nboth in the urine and mucosa of the renal pelvis.\\nPyelitis should not be confounded with suppurating nephri-\\ntis. This is a common error, due, perhaps, to the fact that they\\nare often, though by no means always, associated but uncompli-\\ncated pyelitis is unattended by the usual general symptoms of\\nseptic absorption which are present in suppurating inflammation\\nof the kidney.\\nThe Urine. The renal irritation consequent to pyelitis in-\\nduces polyuria so that the volume of urine is augmented in\\nthis lesion. The color of the urine is pale straw-colored, de-\\nscribed as whey turbid and sometimes tends toward a greenish\\ntint. The specific gravity is reduced and the chemical reaction is\\nusually faintly acid. Pus is present in varying quantity, but\\nalways the most prominent feature of the sediment (Fig. 43).\\nThe solids are relatively reduced owing to the polyuria, but the\\nabsolute solids suffer no material changes in amount. Albu-\\nminuria is a constant feature of pyelitis, the quantity of albumin\\nexceeding that depending upon the contained pus. The sediment\\nis flocculent, of considerable volume, of greenish^ellow tint, not\\nso viscid or sticky as in cystitis, and, as already stated, is\\nchiefly composed of pus. The pus-corpuscles often exhibit tooth-\\nlike margins, notably so in chronic cases. They often become\\npressed together in the papillary ducts and form masses of\\nround, oval, or long pings, which are considered characteristic\\nof pyelitis. Epithelium is present only in small quantities.\\nThis lesion cannot be diagnosticated by the presence of spindle-\\nshaped epithelium in the urine alone, as has been frequently\\nasserted. In truth, much of the epithelium lost by the mucosa", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0366.jp2"}, "367": {"fulltext": "CHRONIC PYELITIS.\\n325\\nof the renal pelvis breaks down into pus-cells and granular\\nmatter. Blood-corpuscles are rarely present, save when the pye-\\nlitis is due to calculus, tuberculosis, growths, or entozoa. If, as\\nis usually the case, the pyelitis be unilateral, the urine sometimes\\npresents one or two anomalous features in reference to its chemi-\\ncal reaction. Thus, the urine may be putrescent and offensive from\\ndecomposition, and yet remain acid. Again, it is not uncommon\\nto meet with triple-phosphate crystals in the urine which gives\\nFig. 43.\u00e2\u0080\u0094 Urinary Sediment in Pyelitis. (After Peyer.)\\na distinctly acid reaction. These features have been explained by\\nthe fact that the urine from the sound kidney overcomes the\\nalkalinity of the urine from the diseased kidney as they mingle\\ntogether in the bladder, and it is thus voided before it has had\\nsufficient time to become ammoniacal. The triple-phosphate\\ncrystals met with in the urine under such circumstances often\\nshow evidences of their existence in acid urine in their super-\\nficial solution, their sharp angles being rounded. The urine in\\npyelitis is peculiarly offensive, not merely ammoniacal, but", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0367.jp2"}, "368": {"fulltext": "326 URINARY DIAGNOSIS.\\nrather also suggestive of sulphuretted hydrogen, while in cys-\\ntitis the odor is almost purely ammoniacal. Once experienced,\\nthe odor of the urine in pyelitis may afterward be recognized as\\ncharacteristic when present. This property of the urine, how-\\never, varies from time to time, and may even be temporarily\\nabsent if the ureter of the affected side become blocked.\\nProminent Clinical Features. These comprise aching, drag-\\nging pains, central in the lumbar region, but often radiating\\nalong the course of the ureter toward the bladder. The pain\\nis not usually severe, is always increased by deep pressure by\\nthe finger-tips, and it may be absent at limited, but considerable,\\nperiods of time, and it is increased by exercise. Renal colic is\\napt to form a feature of the history of this lesion, but especially\\nso when the cause is connected with stone, hydatids, tuberculo-\\nsis, or cancer. Micturition is more frequent than normal, but it\\nis rarely attended by pain, being rather of reflex character.\\nOccasionally, when the ureter becomes blocked and retention of\\nurine occurs in the affected organ, elevation of temperature\\noccurs with the usual febrile symptoms. The fever is nocturnal,\\nusually of mild grade, and often accompanied by cutaneous\\neruptions not unlike rotheln.\\nMovable Kidney.\\nThe subject of misplacements of the kidney embraces three\\nconditions of the organs 1. Simple misplacements of the kidney.\\n2. Movable kidney. 3. Floating kidney.\\nSimple misplacement of the kidney is met with either as a\\ncongenital or acquired condition. Of the congenital order, the\\nhorseshoe kidney is most common the next most frequent con-\\ngenital malposition is above the sacro-iliac synchondrosis. The\\nsuprarenal bodies are often found congenitally misplaced, espe-\\ncially when the kidneys are higher than normal. Congenital\\nmisplacement is most often unilateral, and most often involves\\nthe left kidney. Simple acquired misplacement may be brought\\nabout by pressure of adjacent organs, such as enlargement of\\nthe spleen or liver, or from pressure of large morbid growths.\\nTight lacing has been alleged as a frequent cause of downward\\ndisplacement of the kidney, but this is now considered as an", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0368.jp2"}, "369": {"fulltext": "MOVABLE KIDNEY. 32?\\nexceptional cause. Both acquired and congenitally misplaced\\nkidney may be mistaken for new growths. As a rule, misplaced\\nkidney, if unattended by mobility, gives rise to no special symp-\\ntoms, and is only observed at the autopsy. It therefore deserve-\\nno extended study by the clinician.\\nMovable kidney differs from floating kidney in that the former\\nlies loosely between the peritoneum in front and the muscular\\nwall of the abdomen behind, while the floating kidney is in-\\nclosed in peritoneum, which forms a mesonephron The float-\\ning kidney, therefore, floats within the abdominal cavity, as do\\nthe intestines. Movable kidney, as a rule, is acquired, while\\nfloating kidney is always congenital. Movable kidney is most\\ncommon in females. The right kidney is about twelve times\\nmore frequently movable than the left, which is probably due to\\nthe weight and unyielding nature of the liver, the greater length\\nof the right renal vessels, and the less firm attachments to the\\ncolon on the right, together with the greater right tension and\\nstrain in right-handed people. Movable kidney is bilateral\\nabout once in every twenty cases. It is most frequent from\\n30 to 40 years of age. a large proportion of the cases occurring\\nin women who have rapidly borne children.\\nAbsorption of the fatty elements of the renal capsule is now\\nregarded as the most common predisposing cause of movable\\nkidney, and this is borne out by the remarkable frequency of its\\noccurrence in spare subjects. Lastly, movable kidney is often\\nthe result of dislocation from falls or blows.\\nThe Urine. It has been denied by many authors that movable\\nkidney produces any effect on the character of the urine. Those\\nwho have seen much of such cases, however, will scarcely have\\nfailed to observe frequent urinary disturbances, which form an\\nimportant, almost essential, part of the pathology of this con-\\ndition. The urine is often scanty, high colored, and usually\\ndeposits more or less sediment at other times it is more copious\\nthan normal. Hematuria is not unfrequent in movable kidney.\\nThe twists of the ureter attendant upon renal mobility neces-\\nsarily entail more or less interference with the circulation. The\\nduration and degree of this interference determine the degree of\\nsuppression, the discharge of blood, presence of albumin, epi-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0369.jp2"}, "370": {"fulltext": "328 URINARY DIAGNOSIS.\\nthelial denudation, and pyelitis. Suppression of urine usually\\noccurs only at short periods, because the loosening of the renal\\ncapsule from the posterior abdominal wall permits the renal pelvis\\nand part of the ureter to also separate from the abdominal wall\\nand follow the renal movements. Thus, the obstacle to the\\nescape of urine is more easily overcome by pressure of retained\\nurine within the renal pelvis.\\nDiminished excretion (25 to 30 ounces) and short periods of\\nsuppression, followed by short periods of copious flow of pale-\\ncolored urine of low specific gravity, are common features of this\\ncondition, though these are not so marked as in pyonephrosis.\\nDuring periods of suppression mild ursemic symptoms have\\nbeen noted; these are rarely pronounced, because the flow is\\nsoon restored. The urine very often contains a small amount of\\nalbumin, owing to the circulatory disturbances in the kidney.\\nProminent Clinical Features. The chief clinical symptoms of\\nmovable kidney are sensations of dragging weight in the side oc-\\ncasional sense of movement severe paroxysms of pain, like renal\\ncolic pain of a dull, aching character neuralgic pains in trunk-\\nnerves of the affected side. Nausea and vomiting are often pres-\\nent, and may be severe. Intestinal disturbances are common,\\nsuch as diarrhoea or constipation. Loss of appetite, weakness, de-\\nbility, flatulence, emaciation, and depression are frequent features\\nobservable. Nearly all the symptoms are increased by move-\\nment or standing, while they are relieved by rest and quietude.\\nMenstruation and pregnancy usually aggravate the symptoms.\\nManipulation of tumor causes peculiar sinking or fainting sen-\\nsations, often attended by nausea. The tumor possesses more or\\nless mobility.\\nDifferential Features. Limited contractions of the recti,\\ntrans versalis, or abdominal oblique muscles sometimes give\\nimpressions of smooth, oval tumors, which may even disappear\\non pressure, not unlike movable kidnej 7 Anaesthesia and strong\\npercussion over tumor will usually distinguish the true con-\\ndition.\\nA tumor of the liver, or distended gall-bladder, or a liver\\ndeformed from tight lacing, or an hypertrophied liver may give\\nrise to similar percussion-sounds, as well as similar gastric dis-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0370.jp2"}, "371": {"fulltext": "CYSTITIS. 3^9\\norders, and vague abdominal sensations and pain not unlike\\nmovable right kidnej Distinction is most difficult, but may be\\naccomplished by palpation, urinary changes or their absence,\\netiological elements, and by results of treatment. Percussion\\ncannot be depended on in these cases alone if the tumor can be\\ncompletely separated from the liver by palpation, it goes far\\ntoward establishing movable right kidney.\\nMovable spleen is distinguished from movable kidney by the\\nformer lying imniediately beneath the abdominal wall through-\\nout all movements, while a kidney when pushed upward retreats\\nfrom the abdominal Avail beneath the intestines. The percussion-\\nnote over the spleen is, therefore, always dull, while over the\\nkidney it is dull tympanitic or tympanitic.\\nThe distinction between uterine or ovarian tumor and mova-\\nble kidney is determined chiefly by the direction of mobility. If\\nmobility can be made to extend to lumbar region without pain,\\ntumor of the uterus or ovaries may be excluded. On the other\\nhand, movable kidney must not be excluded by mobility toward\\nthe pelvis, as such tumor may exceptionally be renal. If the\\nrenal artery can be grasped and pulsations felt, the diagnosis be-\\ncomes clear. Capability of replacement of kidney with disap-\\npearance of tumor renders renal source of tumor certain.\\nCystitis.\\nMuch confusion has existed as to the nature of cystitis in\\nconsequence of the diversified classifications of this affection.\\nWriters speak of purulent cystitis, hemorrhagic cystitis, cysti-\\ntis of the neck, cystitis of the body of the bladder, and catarrhal\\ncystitis of several grades. Acute cystitis and chronic cystitis\\nare emploj^ed as denoting intensity or duration of inflammatory\\nprocess, rather than the character of the lesions present, and as\\nsuch the terms are convenient for descriptive purposes.\\nIn the light of modern investigations and present pathological\\nknowledge cystitis is coming to be better understood and its\\nsignification has assumed more accurate and definite meaning.\\nIn all its varying phases cystitis must now be considered as a\\nlocal bladder infection by bacterial germs. Normal urine, as\\nalready pointed out, is an aseptic fluid characterized by the\\n22", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0371.jp2"}, "372": {"fulltext": "o30 URINARY DIAGNOSIS.\\nabsence of septic germs, while cystitis is always associated with\\nthe presence of septic micro-organisms in greater or less abun-\\ndance.\\nThe same causes which bring about local infection elsewhere\\nmay be looked for to explain the presence of bladder infection.\\nComprehensively considered, they include the following con-\\nditions: Weakened vitality of the tissues; favorable soil for\\ndevelopment and the presence of micro-organisms possessing\\npyogenic powers. If we consider for a moment the many con-\\nditions to which the urinary bladder is exposed, which tend to\\nweaken its resisting power to the action of germs the many\\nsources of exposure to local infection, and the favorable medium\\nthe urine constitutes as a culture medium for many pyogenic\\ngerms, it no longer seems strange that cystitis is one of the most\\nfrequent diseases of the urinary tract. Since the discovery of\\nthe micrococcus urese by Pasteur, thirty-five years ago, to the\\npresent time, a large number of micro-organisms have been dis-\\ncovered in pathological urine. Although many of these possess no\\npathogenic powers, a number of them are, without doubt, closely\\nassociated with cystitis in the relationship of cause and effect.\\nThe older theory, that cystitis is set up by ammonia evolved\\nin the decomposition of the urine by the micrococcus urese, is no\\nlonger accepted. It has been conclusively demonstrated by\\nGuiard and Guyon that ammoniacal fermentation of the urine\\nin the bladder takes place as a result of cystitis, and in the\\nabsence of the latter the former does not occur. The question,\\nthen, of the local etiology of cystitis must be narrowed down to\\nlocal infection of the bladder by pathogenic germs, and the\\nresults of their action constitute cystitis.\\nOf the many etiological factors which favor bladder-infection\\nmay be mentioned the following Retention of urine, trauma,\\ndeep gonorrhoea, stricture of the urethra, prostatitis, calculus,\\nmorbid growths, exposure to cold, sexual excesses, gout, para-\\nplegia, etc.\\nThe Urine. Pus is present in the urine as the most essential\\nfeature of cystitis, its absence being proof that the bladder is\\nuninflamed. The quantity of pus present depends upon the\\ndegree and extent of the cystitis and the length of time cystitis", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0372.jp2"}, "373": {"fulltext": "CYSTITIS.\\n331\\nhas been established. Early in the lesion the quantity is small,\\nsometimes observable only under the microscope. If the urine\\nbe acid the cystitis is recent, and the pus readily settles. If the\\nurine be alkaline ammoniacal the pus settles in a viscid, sticky\\nmass, the cystitis is chronic, often termed chronic catarrhol\\ncystitis. 1 Blood is nearly always present in acute cystitis, and\\nsometimes also in the chronic lesion. It is increased in quantity\\nFig. 44.\u00e2\u0080\u0094 Urinary Sediment en Cystitis. (After Peyer.)\\nby movements or standing. In acute cases it is due to conges-\\ntion the quantity is comparatively small, and for the most part\\nit appears at the close of micturition. In tumors and varicose\\nconditions of the vessels, blood is mixed more uniformly with\\nthe urine, and the quantity may in such cases be large.\\nThe quantity of albumin in the urine is inconstant in this\\nlesion. In the early course of the disease it is usually due to\\npus or blood, and consequently the amount is small. In chronic\\ncases the quantity is more considerable, since denudation of the\\nvesical mucous surface permits of more ready escape of blood-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0373.jp2"}, "374": {"fulltext": "332 URINARY DIAGNOSIS.\\nserum. The reaction of the urine is usually acid in the early\\ncourse of the disease as well as in mild cases while chronic,\\nlong-continued cases are mostly characterized by alkaline urine\\nfrom volatile alkali. Accompanying the ammoniacal changes,\\nmore or less copious deposits of triple-phosphate ciystals are to\\nbe found in the urine. In addition to this, amorphous phos-\\nphates are often present in considerable quantity, and less fre-\\nquently, also, are urates.\\nRecent cystitis differs from the chronic form as follows In\\nthe former the quantity of urine is usually normal color is\\ndark the reaction is acid when voided, quickly becoming alka-\\nline after it is voided the specific gravity of the urine is usually\\nnormal; the appearance is turbid and smoky. Microscopical\\ninspection shows the presence of vesical epithelium, pus, often\\nblood, and bacteria and on standing a few crystals of triple\\nphosphates usually are observed.\\nIn chronic cases the quantity of urine is about normal the\\ncolor is light, the reaction alkaline, the specific gravity somewhat\\nlowered, and albumin is usually present. Microscopical inspec-\\ntion shows the presence of pus usually in abundance, sometimes\\nblood, bacteria always, and vesical epithelium. The appearance\\nof the urine is turbid, the odor is ammoniacal, and the sediment\\nsticks to the glass or vessel upon standing. The micro-organisms\\nmost often met with in cystitis are as follow The staphylococcus\\npyogenes aureus, albas, and citreus the streptococcus pyogenes;\\nthe urobacillus liquifaciens septic us and the bacillus coli com-\\nmunis. These are all pathogenic germs. Those most frequently\\nmet with are the bacillus coli communis, and next is the staphy-\\nlococcus pyogenes aureus.\\nProminent Clinical Features. Frequent micturition, pain, and\\npyuria are the most constant symptoms of cystitis. Frequent\\nmicturition varies with the intensity of the disease and the sensi-\\ntiveness of the bladder. In acute cystitis the desire to micturate\\nis nearly continuous. The frequency is increased upon standing\\nor walking, while rest tends to relieve it. The pain also varies\\naccording to the acuteness of the attack. The pain is often very\\nintense at or just before the beginning of micturition, is more or\\nless relieved during the flow of urine, while at the close of mic-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0374.jp2"}, "375": {"fulltext": "VESICAL STONE. 333\\nturition, and immediately following, for a few seconds the pah)\\nbecomes greatly increased. The latter is most notably the case\\nwhen cystitis is associated with stone or prostatitis. In cases of\\nhighly arumoniacal urine considerable pain is often experienced\\nduring the act of micturition. There is more or less discomfort,\\nsometimes amounting to pain, with sensation of weight above\\nthe pubis, in cystitis, irrespective of the act of micturition. The\\nbladder is sensitive to rectal touch, as well as to instrumenta-\\ntion, and also to distension by injections of fluids, however\\nbland they may be. Haemorrhage, if present, indicates, as a rule,\\nthe more acute grades of cystitis, unless in large amounts, which\\nare more common in chronic forms. Constitutional symptoms\\nare absent unless the disease be associated with tuberculosis,\\nmalignant disease, etc.\\nVesical Stone.\\nThe etiology and symptomatology of calculous disease have\\nalread}^ been considered in detail. More than one-half the cases\\nof vesical stone met with in hospital practice occur before the\\nage of puberty about 22 per cent, occur between the ages of\\n50 and TO years while not above 2 per cent, are met with above\\n70 }^ears of age. The statistics of Sir Heniy Thompson, as well\\nas those gathered from large hospitals, substantially confirm the\\nabove proportions. In private practice, however, the above pro-\\nportions are almost directl} reversed. Thus, in Sir Henry\\nThompson s private practice the patients between 50 and TO\\nyears of age comprised 65 per cent, of the whole and those\\nover TO comprised 22 per cent, of the whole while those under\\n16 comprised less than 1 per cent. From these facts Sir Henry\\nThompson draws the following deductions Insufficient food,\\nclothing, and fresh air, the necessary accompaniments of poverty,\\nappear to encourage calculous formations among children, but\\nnot among adults. Habits of self-indulgence, in relation chiefly\\nto diet and indolence, encourage calculous formations in early\\nadult males, but the children of such parents are not affected.\\nHard physical labor and a regimen which necessarily contains\\nsimple diet, largely cereal, with animal food in small proportion,\\neven although often associated with intemperate habits and", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0375.jp2"}, "376": {"fulltext": "334 URINARY DIAGNOSIS.\\nunhealthy dwellings, discourage calculous formations among all\\nclasses of the community alike. The foregoing only applies to\\np r i ma ry format ion s\\nThe Urine. Before the onset of cystitis the urine may remain\\nbut little changed from the normal. The quantity is normal the\\nspecific gravity is not materially altered the urine remains clear,\\ntending to increased color, perhaps, and the reaction may be\\neither acid or alkaline. The history often reveals habitual de-\\nposits of red sand or white, gritty powder for months or years\\nbefore special symptoms appear. In the early stages, when, to\\nall appearances, the urine remains normal, the microscope usually\\nreveals the presence of uric-acid crystals or those of calcium\\noxalate, together with scattering blood- and pus- corpuscles.\\nCystitis sooner or later appears, when the urine becomes cloudy\\nfrom increased pus formation, together with the presence of epi-\\nthelium, crystals of uric acid, calcium oxalate, triple phosphates,\\nor amorphous urates or phosphates. If the urine remain acid\\nthe ciystalline deposit will be uric acid or calcium oxalate, often\\nboth together. If the urine be alkaline the crystalline deposit\\nwill consist of triple phosphates, and the pus deposit will be\\nmore or less viscid and stick}^. The degree of pyuria indicates\\nthe extent of denudation or ulceration of the mucous surface of\\nthe bladder. Blood is often present in variable amount, but rarely\\nexcessive. Albumin is always present in the urine if cystitis\\nco-exist, and frequently in excess of the contained pus or blood.\\nMicro-organisms are present also in all cases attended by cystitis,\\nand for the most part of the same order.\\nClinical Features. Pain is present as one of the most typical\\nfeatures, tending to reflection along the urethra, in the testes, or\\ndown the thighs. Pain is sharply increased at the close of mic-\\nturition and for a few seconds afterward, especially noticed in\\nthe glans penis. Spasm of the bladder is common at the close\\nof micturition. The pain is always increased by the erect pos-\\nture and by motion, including riding, walking, and even by turn-\\ning in bed sometimes. There is more or less increased frequency\\nof micturition, augmented by motion and relieved by continued\\nrest and recumbency. Micturition is sometimes suddenly shut\\noff in the middle of the act, in consequence of the stone rolling", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0376.jp2"}, "377": {"fulltext": "VESICAL TUBERCULOSIS. 335\\nforward over the urethral inlet. On lying upon the back this\\nsymptom is relieved.\\nHsematuria is the rule in this disease, the blood usually being\\nclear, bright in color, and usually consists of a few drops at the\\nclose of micturition, the urine at the beginning of micturition\\nbeing mostly free from blood. Sometimes haemorrhage is more\\nconsiderable, and the blood becomes more generally diffused\\nthrough the urine in such cases. Hematuria is increased by\\nmovement, as walking and riding, etc., and is relieved by rest\\nand recumbency, and therefore it is always less in the morning\\nand more in the latter part of the day or in the evening. To\\ncomplete the diagnosis exploration is often necessary. This may\\nbe done (a) per vaginam or rectum by means of the finger; (b)\\nby means of the vesical sound (c) by means of the cystoscope\\n(d) b} T digital examination through the dilated urethra in women.\\nThe most satisfactory methods are those of the sound and the\\ncystoscope.\\nVesical Tuberculosis.\\nPrimary tuberculosis of the bladder is comparatively rare,\\nand w-hen present it invariably begins in the trigone. More\\noften it results from extension of tubercular disease from the\\nprostate, testes, or recto-vesical fold of the peritoneum, less\\noften by infection from the upper portions of the urinary tract.\\nThe bladder may become infected from above either by direct\\nextension of the disease along the ureter or by inoculation\\nthrough the urine from tuberculous kidney.\\nWhen infection occurs from surface inoculations through the\\nurine from above the symptoms rapidly supervene and the dis-\\nease is acutely progressive. On the other hand, when the disease\\nis primary the symptoms are more slow in development and the\\ncourse of the disease is more apt to be protracted.\\nThe Urine. Blood is usually present in the urine in this\\nlesion in small amount, often transitory and recurrent, a few\\ndrops often following the close of micturition, as in stone.\\nSometimes, however, haamaturia is pronounced, in consequence\\nof ulceration about the tubercular deposits. The urine contains\\nsmall quantities of pus from the beginning, which gradually\\nincrease until appreciable deposits thereof are regularly present.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0377.jp2"}, "378": {"fulltext": "Si56 URINARY DIAGNOSIS.\\nThe urine is murky, of light color, of normal specific gravity,\\nand it is usually feebly acid or neutral until it becomes ammo-\\nniacal from the presence of cystitis. The urine is not especially\\noffensive, although it may be ammoniacal, as just stated.\\nWith the occurrence of cystitis all the features of the urine\\ncharacteristic of that disease supervene, and that in the most\\npronounced form. These include pyuria, hsematuria, deposits\\nof triple-phosphate crystals, amorphous phosphates, epithelium\\nin states of progressive necrosis, and micro-organisms in abun-\\ndance.\\nProminent Clinical Features. These patients are young, usu-\\nally from 15 to 30 years of age, with family histories of tuberculous\\ndisease in some form. The early symptoms consist of increasing\\nfrequency of micturition for a few months, especially during the\\nday. Blood appears in the urine, and with this the patient begins\\nto rise at night to micturate. The pain in micturition is referred\\nchiefly to the mid-penis. Sharp, vesical tenesmus becomes devel-\\noped as the disease proceeds, and in such cases the pain is\\nincreased at the finish of micturition. The constitutional symp-\\ntoms include debility, emaciation, weakness, elevation of temper-\\nature in the evening, and night-sweats. With these symptoms\\nare often associated tuberculosis of the lungs, joints, glands-, or\\nelsewhere.\\nDifferential Features. Tubercular cystitis in many of its\\nmanifestations resembles stone in the bladder. Tuberculosis of\\nthe bladder, how r ever, is more frequent in youth the family his-\\ntory is often tuberculous the irritability of the bladder is often\\nmarked at night, greatly disturbing the patient s rest hsematuria\\nis often sudden and without apparent cause, being less dependent\\nupon exercise there is greater relief from pain at the close of\\nmicturition pain is in mid-penis, rather than in glans penis\\nthere is persistent post-scrotal perineal pain the urine is light\\nin color, murky, inodorous, and purulent from the beginning, and\\nperiods of quiescence if the symptoms do not correspond to qui-\\nescence and rest. In late stages evening temperature is present,\\nmarked constitutional symptoms arise, implication of epididy-\\nmis is common, and knobljy or shotty feel of prostate per rectum\\npoints to the tubercular character of the disease.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0378.jp2"}, "379": {"fulltext": "CANCER OF THE BLADDER. 337\\nCancer of the Bladder.\\nThe great majority of malignant growths of the bladder are\\nof the carcinomatous order. Carcinoma of the bladder usually\\nbegins at the base of the organ, or. more accurately speaking, at\\nthe lower third of the organ. It manifests a peculiar tendency\\nto long remain a local disease, with little tendency of extension\\nto neighboring structures. This has been explained by the\\nscarcity according to some, the absence of lymphatics in the\\nbladder-walls.\\nThe Urine. The urine contains blood in the vast majority\\nof these cases. Seldom being entirely absent from the urine, it\\nis subject to periods of marked augmentation without any ap-\\nparent exciting cause. Attacks of marked hematuria are quite\\nas likely, therefore, to occur at night as during the hours of ex-\\nercise through the day. The quantity of blood is often greater\\nthan in almost any other disease of the urinary organs; so that\\nthe bladder is liable to become partly filled with large blood-\\nclots. As a rule, the quantity of blood in the urine irregularly,\\nbut continuedly, increases as the disease advances. The color\\nof the blood is usually bright red. especially when it is abun-\\ndant, but if in small quantity it may be dull red or brownish in\\nappearance. The blood is not intimately mingled with the urine\\nas it is in renal hematuria.\\nThe urine often contains shreds or detached bits of the morbid\\ngrowth, which may even be noticeable to the patient. To the\\nnaked eye the^e appear as k washed-out bits of tissue, which\\nin reality they are. and they vary in size from minute specks to\\npieces as large as a pea or small bean. Their presence merely\\nindicates the presence of some growth without indicating its\\ncharacter. !Xo trustworthy inferences are to be drawn as to the\\nnature of these shreds from microscopical examination, since\\nboth malignant and benign growths of the bladder may present\\npapillary surfaces of practically the same microscopical appear-\\nance. Since, however, such shreds are most frequently the\\nproduct of papilloma ta or malignant growths, their presence\\nmay be considered as simply presumptive of one or the other of\\nthese forms of growth.\\nThe urine nearlv always contains an abundant sediment in", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0379.jp2"}, "380": {"fulltext": "338 URINARY DIAGNOSIS.\\nmalignant disease of the bladder, of which epithelium constitutes\\na prominent feature. The epithelium is of small or moderate\\nsize, but with very large and plainly-visible nuclei. The quan-\\ntity of urine remains normal, as does the specific gravity, save\\nin late stages, when the latter becomes somewhat reduced. The\\nurine is turbid, often brownish red, and the reaction is acid until\\ncystitis becomes established with the appearance of the latter\\nthere is pyuria, ammonuria, bacteriuria, and the usual accompany-\\ning s\\\\/mptoms.\\nProminent Clinical Features. Pain is a prominent and early\\nsymptom, usually preceding the haematuria. The character of the\\npain is often sharp, radiating to the thighs, above the symphysis\\npubis, or in the post-scrotal region. The pain is not espeeialty\\nincreased by moA^ements. Fenwick has recently called especial\\nattention to the fact, as he claims that, if the disease do not in-\\nvade the trigone, pain may be practically absent until a late\\nperiod of the disease. This may account for the occasional ab-\\nsence of pain almost throughout the disease. Frequency of mic-\\nturition is more or less pronounced from the beginning, and this\\nis attended by pain, which is most notable just before the begin-\\nning of the flow. Rectal examination develops local tenderness\\nand patches of induration.\\nBenign Vesical Growths.\\nThe chief varieties of benign growths met with in the bladder\\nare papilloma, myxoma, and myoma Of these, papillomata are\\nby far the most frequent. These consist of proliferations of the\\nnatural structure of the vesical mucosa, forming papillae or pro-\\ntrusions covered with cylindrical epithelium. Sometimes these\\npapillae are long and slender and float in the urine in numerous\\nfilaments from a common base or stalk. Examined in a dry state\\nthey collapse and form a soft, strawberry -like mass. The base\\nor pedicle always contains more or less fibrous tissue, and usually\\nsome non-striped muscular fibres. Sometimes the growth ex-\\npands to form a polypoid-like mass of more decided firmness, or\\nit may have a wider attachment to the bladder. Again, it some-\\ntimes appears expanded into several bunches not unlike cauli-\\nflower. When the fibrous elements are numerous the structure", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0380.jp2"}, "381": {"fulltext": "BENIGN VESICAL GROWTHS. 339\\nis more dense, and this form has been termed fibrous papil-\\nloma. The latter are, for the most part, tumors of some con-\\nsiderable solidity, and often have comparatively limited papillary\\nmargins.\\nThe myxoma, or simple mucous polyp, is rarely met with in\\nthe bladder thus far, only in childhood. Sometimes it is con-\\ngenital. The growth is that of fibroid undergoing mucoid trans-\\nformation. This growth is single, pedunculated in form, and\\nresembles the ordinary nasal polypus.\\nMyoma is only occasionally met with in the bladder. It is\\nusually of moderate size, with wide base, round or oval in form,\\nrather firm in consistence, and chiefly made up of muscular fibre,\\nevidently the outgrowth of the muscular coat of the bladder.\\nThe last two described growths are so uncommon in the bladder\\nthat for practical purposes papillomata only require special con-\\nsideration.\\nThe Urine. The most important feature of the urine in\\npapilloma of the bladder is the presence of blood. hematuria.\\nThis occurs early, and at first in paroxysms, followed by more or\\nless lengthy intervals of absence. Commencing insidiously, often\\nappearing in the form of small dark clots, like flies v appearing\\nand disappearing alternately for a few days at each time or\\nagain, the urine, instead, may appear slightly blood-stained, or a\\nlittle clear blood may appear at the close of an otherwise mictu-\\nrition of clear urine or, again, the whole urine voided may appear\\nbloody. dark coffee-colored The haematuria usually presents\\nthese various types in succession, without other prominent feat-\\nures, for long periods of time. often for years. Sooner or later,\\nhowever, attacks of more or less profuse haemorrhage occur and\\nrecur as the growth increases. The blood is not of pronounced\\narterial color, but more inclined to darker shades. Aside from\\nthe presence of blood in the urine, the latter is not otherwise\\nespecially altered in its physical characters the specific gravity\\nand volume remain about normal the solids are relatively and\\nabsolutely unchanged and the urine remains acid, though often\\nfeebly so, until late stages, attended by cystitis, when the reaction\\nmay become alkaline.\\nThe urine contains considerable sediment of a finelv-flocculent", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0381.jp2"}, "382": {"fulltext": "340 URINARY DIAGNOSIS.\\nnature, brownish red in color for the most part, and contains\\nblood-corpuscles, more or less pus, epithelium, and often ragged\\nshreds of tissue. The deposit of epithelium from the vesical\\nmucosa is a prominent feature of the sediment, often exceeding\\nthat in any other condition. With regard to the shreds often\\nvoided with the urine in these cases, it w T as formerly held that\\nmicroscopical examination of these readily established the nature\\nof the growth. Unfortunately, however, more extended experi-\\nence has shown that, while the epithelial character of these\\npieces is easily enough recognized, yet, in consequence of the fact\\nthat any bladder-growth, benign or malignant, may possess a\\nperipheral epithelial fringe, no positive deductions can be drawn\\nfrom their recognition. We are only able to say, presumptively\\nfrom these, that papilloma is most probable, because it is most\\nfrequently attended b}^ the appearance in the urine of those\\nstructures recognized as epithelial formations.\\nProminent Clinical Features. The most prominent symptoms\\nare long duration of haematuria without marked pain or other\\nassociated symptoms. In other words, haematuria precedes, for\\nlonger or shorter periods, vesical symptoms, such as pain and fre-\\nquent micturition Some slight increased frequency of micturition\\ndevelops after a time, with tendency to increase with the progress\\nof the disease. Pain is scarcely ever a pronounced feature of\\nthe disease, usually only so when obstruction occurs from clot\\nor growth situated near the margin of the urethra, when it may\\nstop the flow of urine. In cases of this order tenesmus, frequent\\nmicturition, and pain become prominent, and may even precede\\nthe haematuria. The general condition of the patient remains\\nnormal, save, perhaps, anaemia, which is apt to result to a greater\\nor less extent, according to the amount of the haematuria.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0382.jp2"}, "383": {"fulltext": "SECTION XII.\\nTHE URIXE IN OTHER DISEASES.\\nSimple Pyrexia.\\nCertain changes in the character of the urine in pyrexia are\\nsufficiently constant to merit the term M pyrexial urine n often\\nemployed. Generally speaking, these comprise diminution in\\nquantity or. more accurately speaking, deficiency of water;\\nincreased color, due to increase of pigment, both relative and\\nabsolute; increased acidity, and high specific gravity. In addi-\\ntion to these physical changes in the urine, provided no acci-\\ndental circumstances interfere, more important changes take\\nplace in the composition of the urine. Among the most promi-\\nnent of these changes is a decided increase, both relatively and\\nabsolutely, of the nitrogenous elements, viz.. urea and uric acid.\\nSince, for the most part, but little food is taken in pyrexial\\nstates, and the urea and uric acid rise considerably above the\\nhealthy range, we must conclude that the pyrexial state entails\\na more or less pronounced waste of tissue. While the amount\\nof uric acid excreted varies in different forms of pyrexia as\\nwell as in different cases of the same fever, it is undoubtedly\\nmore uniformly increased than is any other urinary constituent.\\nThis increase of uric acid is proportionately independent of\\nurea, which seems somewhat paradoxical considering that they\\nare both derived from the same tissue-base. In addition to the\\nincrease of uric acid and urea, hippuric acid is often present in\\nthe urine in large quantity as a consequence of the pyrexial\\nstate, indicating, in all probability, a disturbed function of the\\nliver.\\nThe increased excretion of pigment is chiefly due to the de-\\nstructive metamorphosis of the red blood-corpuscles, the latter\\nbeino; a well-known result of nearly all forms of fever. As mi^rht\\nbe expected, considering the excess of uric acid and urea, the\\nsulphates are also markedly increased in pyrexia, constituting\\n(341)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0383.jp2"}, "384": {"fulltext": "342 URINARY DIAGNOSIS.\\nanother evidence of the destructive metamorphosis of nitrogenous\\n(sulphur-holding) tissues.\\nThe chlorides and phosphates, as a rule, are reduced, both\\nrelatively and absolutely, in pyrexia. With regard to the former\\nthe diminution is probably due, at least in part, to retention but\\nas regards the phosphates (save in cases of acute inflammations\\nof the nervous or muscular tissues) there is undoubtedly de-\\nficient excretion.\\nAs a whole, then, pyrexia entails an excessive excretion of\\nsolids by the urine. This excessive excretion begins with the\\nonset of fever, and usually maintains a parallel ratio with the\\ntemperature in short, the presence of the latter invariably\\nimplies the former. The urine often contains a small percentage\\nof albumin in simple pyrexial conditions, and the same may be\\nsaid of acetone.\\nThe urinary sediment in pyrexia is often considerable in\\namount, and consists of uric-acid crystals, urates, sometimes\\nscattering hyaline casts, a few leucocytes, and epithelium. Aside\\nfrom the modifications of the above features of the urine by special\\nforms of fever, typical pyrexial urine is subject to certain vari-\\nations through certain special circumstances, as follow When,\\nduring the course of a fever, an organ becomes the seat of disease,\\nwhere tissue-changes furnish special urinary products, the prod-\\nucts may appear in the urine in excess. As examples, note the\\nincrease of phosphates in the urine in inflammatory diseases of\\nthe nervous system, and the increase of bile-acids in hepatitis.\\nThe overaction of other eliminating organs may disturb the\\ntype of febrile urine. Thus, the diarrhoea of typhoid fever\\nmodifies the character of the urine, as likewise does the sweat-\\ning stage of intermittent fever. These are a few of the influ-\\nences that may produce special variations of the febrile type of\\nurine to a limited degree but, on the whole, the general py-\\nrexial characters stand out with sufficient prominence for general\\nrecognition.\\nIt may be stated, as a general rule, that the amount of tissue-\\nmetamorphosis, as indicated by the excretory waste in the urine\\nin fevers, constitutes a good indication of the severity of the\\ndisease, often, indeed, better than the thermometer or pulse.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0384.jp2"}, "385": {"fulltext": "ACUTE INFECTIOUS DISEASES. 343\\nUpon subsidence of pyrexia the urine assumes directly the\\nopposite characters of the pyrexial state. The chlorides become\\nincreased, while the urea, uric acid, phosphates, and pigments\\nare below the normal range. The volume of urine is increased.\\nIn short, everything points to delayed metamorphosis, conserva-\\ntion of tissue, and repair.\\nAcute Infectious Diseases.\\nTyphoid Fever. The quantity of urine is diminished about\\n50 per cent, during the febrile stage of typhoid, and the volume\\ngradually rises to normal in the third, fourth, or fifth week.\\nThe specific gravity of the urine ranges from 1025 to 1030,\\noccasional^ reaching as high as 1040. The quantity of urea is\\nincreased 25 per cent, or over; as high a range as 78 grammes\\nper day has been recorded. In cases of marked splenic enlarge-\\nment, copious haemorrhages, and complicating nephritis the\\nquantity of urea becomes lessened instead of increased. The\\nchlorides suffer marked reduction, especially during the first\\nweek, but they gradually increase as convalescence approaches,\\nwhile with urea this order is reversed. The uric acid is uni-\\nformly increased, the increase being relatively greater than that\\nof urea. The gross amount of uric acid increases usually until\\nabout the end of the second week, when it reaches about double\\nthe normal range. Deposits of urates are common. The phos-\\nphates are somewhat diminished, and the pigments are increased\\nrelatively and absolutely. The reaction of the urine is sharpl} r\\nacid when voided, but often rapidly turns alkaline upon stand-\\ning, owing to ammoniacal transformation of the large output of\\nurea.\\nAlbumin is present in the urine in a large proportion of the\\ncases of typhoid fever, probably in the majority. Few observers\\nplace the proportion less than 20 per cent, of the whole, while\\nsome claim to have found it in nearly all cases. The author s\\nobservations lead him to conclude that albuminuria is present in\\nfrom TO to 80 per cent, of all cases of typhoid. The quantity\\nof albumin in the urine is usually small but occasionally it is\\ndecided in quantity, and is attended by nephritis. In such cases\\nthe prognosis of the disease is always to be considered grave. In", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0385.jp2"}, "386": {"fulltext": "344 URINARY DIAGNOSIS.\\nmost cases the albuminuria is temporary, setting in soon after\\npyrexia becomes established and subsiding soon after the latter\\ndisappears. In a very considerable proportion of the cases,\\nhowever, larger than has been generally supposed, albumin-\\nuria fails to subside with pyrexia, and becomes permanent.\\nLeucin and tyrosin are usually to be found in the urine in\\ntyphoid, although in no very decided quantities.\\nRenal casts, epithelium, and blood are frequently seen in the\\nurine. Indeed, with regard to casts, it is probable that they are\\nnearly always to be found during the first and second weeks, if\\ncarefully sought. The typhoid bacillus is present in the urine\\nin a large proportion of typhoid-fever patients, in fact, it has\\nbeen demonstrated thus far in about 20 to 25 per cent, of the\\ncases examined. Moreover, the presence of this bacillus often\\ncontinues in the urine for two and even three weeks after the\\ntemperature returns to normal and the patient is convalescent,\\nwhich shows the dangers that may arise from infection if care\\nbe not exercised in disposing of the urine in these cases.\\nThe following claims are made by Ehrlich regarding the\\ndiazo reaction in typhoid fever: The reaction is found\\nin typhoid fever after the fourth or fifth day, and if ab-\\nsent the diagnosis is doubtful. If the reaction be slight,\\nand only found for a short time, the case will usually be\\nvery mild. In simple febrile intestinal catarrh, chlorosis, hy-\\ndrsemia, diabetes, and in diseases of the brain, spinal cord, liver,\\nand kidneys, the reaction is never obtained. The reaction is\\nobtained occasionally in phthisis pulmonalis, rarely in measles,\\npyaemia, scarlet fever, and erysipelas.\\nThe diazo reaction in typhoid has no dependence upon the\\nheight of temperature, nor is it influenced by the medication.\\nThe morning and evening urine give the same intensity of reac-\\ntion. If the reaction cease in the second or third week, the rule\\nis that the fever will early decline and the further course of the\\ndisease be mild. On the other hand, long-continued reaction\\nindicates severity and long continuance of the disease. If relapse\\noccur, the reaction returns if it has previously disappeared.\\nThe importance of the subject justifies a repetition of the\\nessentials of the test, especially since it is strongly probable that", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0386.jp2"}, "387": {"fulltext": "ACUTE INFECTIOUS DISEASES. 345\\nmuch of the diversity of views as to the value of the reaction in\\ntyphoid fever has arisen in consequence of faulty methods in\\nperforming the test.\\nThe principle of the test depends upon the fact that diazo-\\nsulphobenzol unites with certain aromatic substances met with\\nin the urine in typhoid, which form analines. The diazo-\\nsulphobenzol being unstable, Ehrlich obtains it fresh for testing\\nby keeping sulpho-anilic acid in solution with hydrochloric acid.\\nTo this solution sodium nitrate is added, which liberates HN0 2\\nand forms diazosulphobenzol. A full description of the test\\nand the proper method of its manipulation are described on\\npages 134 and 135.\\nScarlatina. The urine in scarlatina assumes the usual febrile\\ncharacters, more or less marked in proportion to the degree of\\npyrexia present. During the first week the volume is reduced,\\nthe urea and uric acid are increased, and sediments of urates are\\nprecipitated. The chlorides are often decidedly reduced. From\\nthe sixth to the eighth day, if the disease proceed favorably, the\\nurine becomes abundant, pale in color, and the general characters\\napproach the normal standard.\\nBut the urine in scarlatina should alwa}^s be the subject of\\nspecial observation, in consequence of the fact that it is often\\nespecially affected in this disease. This is due to the frequent\\nalmost invariable implication of the kidneys some time during\\nthe course of the disease. Recent observations on an extensive\\nscale indicate that nephritis exists in scarlatina, either in acute\\nform or in mild, evanescent attacks, almost as constantly as the\\nrash or the angina. The number of acute cases of nephritis\\nattended by dropsy and high grades of albuminuria in scarlatina\\nis estimated as about one in every six cases met with, 1 though\\nthe proportion varies greatly in each special epidemic of the\\ndisease.\\nAs a rule, albumin appears in the urine about the fifth to the\\neighth day, usually subsiding within about nine days if the dis-\\nease proceed favorably The quantity of albumin in the urine\\nis subject to the widest variation, sometimes amounting to mere\\n1 See section on Scarlatinal Nephritis in Bright s Disease and Allied\\nKidney Affections, by the author. Lea Bros. Co., Philadelphia, 1886.\\n23", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0387.jp2"}, "388": {"fulltext": "346 URINARY DIAGNOSIS.\\ntraces, while, again, the urine becomes almost solid with albu-\\nminous coagulum when boiled or treated with albumin precipi-\\ntants. A few cases are on record in which both nephritis and\\ndropsy were present in scarlatina, while albumin was absent from\\nthe urine.\\nCasts are almost invariably to be found in the urine if care-\\nfully sought for. In cases proceeding favorably the casts are\\nchiefly hyaline, often preceded by the so-called cylindroids of\\nThomas. If nephritis become established, the sediment contains\\nthe usual elements characteristic of that lesion, more or less\\npronounced in proportion to its grade. Thus, we may meet with\\nepithelial and bloody casts, as well as granular, in chronic cases.\\nIn addition to these, free blood-corpuscles and often large\\nshowers of round epithelium are observable. As occasional\\nfeatures, the urine in scarlatina has been found to contain sugar\\nin small amount, haemoglobin in severe usually malignant\\ncases, and sometimes peptone or, more accurately speaking,\\ndeutero-proteose, which is usually taken for peptone.\\nAlbuminuria sometimes subsides during the early course of\\nscarlatina, to re-appear later with nephritis. If acute nephritis\\nof pronounced type occur in scarlatina, it usually appears about\\nthe eighteenth to the twenty-fourth day more rarely it arises in\\nthe latter part of the second week more rarely still during the\\nfifth week.\\nCholera. During the algid stage of cholera the urine is more\\nor less completely suppressed. This is due, in the main, to\\ncollapse, weakened circulation, perhaps to some extent, also,\\nto thickened blood and exudation into the renal tubules. After\\nthe cold stage is passed the volume of the urine slowly increases,\\nor it ma} r remain suppressed in the latter case the patient dies\\ncomatose. If the secretion of urine become re-established, it\\nusually does so during the third day from the attack, forty-\\neighth to the seventj^-second hour. The quantity of the first\\nurine is small, gradually increasing if the patient recover and\\non the fifth or sixth day the volume reaches the normal range,\\nor often considerably above. The specific gravity of the urine\\nat first, upon re-appearing, is below normal, often 1006 or 1008.\\nIt may fall still lower at first, but gradually rises to normal as\\nconvalescence is established,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0388.jp2"}, "389": {"fulltext": "ACUTE INFECTIOUS DISEASES. 347\\nThe quantity of urea in the urine is greatly reduced in\\ncholera. in fact, during the first day it may amount to but\\n2 or 3 grammes, and Bigbie even found it absent. It usually\\nincreases somewhat on the second day. and in favorable cases it\\nincreases on the third to the sixth day to considerably above the\\nnormal range. The prognosis may be considered favorable in\\nproportion to the amount of urea excreted in cases which have\\npassed the algid stage. Uric acid is usually present, though in\\nreduced quantity. It often falls out of solution in a colorless\\nstate, owing to the absence of pigment in the urine. The phos-\\nphates are greatly reduced in the first urine passed: but. like\\nurea, they become markedly increased with the re-establishment\\nof the urine, and for several days even considerably exceed the\\nnormal amount. The chlorides at first are absent, or nearly so\\nafter the fourth or fifth day they gradually return, and increase\\nto, but rarely very much above, normal. The increase of chlo-\\nrides is considered as even more favorable a prognostic sign\\nthan that of urea. As the urine becomes re-established its\\nacidity becomes greatly increased. The normal urinary pig-\\nments are nearly absent for the first two days, gradually return-\\ning by the sixth day or so to the normal range. The first urine\\nvoided in all cases contains so-called indican indoxyl-potassium\\nsulphate in marked quantities. Indeed, before the isolation of\\nthe cholera bacillus the presence of this substance in the urine\\nwas by many considered the best diagnostic indication of cholera\\nwhere the symptoms were so mild as to cause doubts as to the\\nnature of the disease. Our knowledge of so-called indicanuria.\\nhowever, has so far increased that we know it is not uncommon\\nin intestinal catarrhs of various kinds, as well as in certain\\ngeneral diseases attended by pronounced albuminous transform-\\nation.\\nThe first urine passed in cholera almost invariably contains\\nalbumin. So constant is this the case that if the urine were\\nalways free from albumin in other forms of diarrhoea, cholera\\nmight almost be diagnosticated by the accompanying albumin-\\nuria. As a rule, the albuminuria of cholera is of comparatively\\nbrief duration, subsiding within a week after its appearance.\\nThere is no doubt, however, that the albuminuria sometimes pur-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0389.jp2"}, "390": {"fulltext": "348 URINARY DIAGNOSIS.\\nsues an acute course, accompanied by nephritis, which latter is\\nthe direct cause of death by ursemic coma. As a general rule,\\nthe quantity of albumin in the urine is proportional to the degree\\nand duration of the algid stage.\\nRenal casts are invariably to be found in the urine of cholera\\npatients, as well as large deposits of epithelium. With these,\\nblood-corpuscles and uric-acid crystals are usually found. Later\\non, calcium-oxalate crystals are deposited, either alone or asso-\\nciated with amorphous urates.\\nDiphtheria. The urine in diphtheria is decidedly reduced in\\nvolume, of high specific gravity, of sharply-acid reaction, and it\\ndeposits a copious sediment of uric acid, amorphous urates, ox-\\nalates, and sometimes phosphates. The urine contains albumin\\nin over 50 per cent, of the cases of diphtheria, varying in quan-\\ntity from mere traces to the most pronounced types of albumin-\\nuria. The albumin usually appears early in this disease. If of\\nmild grade it sometimes subsides temporarily, and may occur\\neven repeatedly. There is no doubt that the kidneys become im-\\nplicated in many of these cases, but the tendency to spontaneous\\nrecovery from nephritis seems greater than in scarlatina or pneu-\\nmonia. The quantity of urea is largely increased, and this con-\\ntinues throughout, unless the function of the kidneys becomes\\nmuch crippled in consequence of associated nephritis. At the\\nheight of the disease the quantity of urea is often double the\\nnormal range. Renal casts are frequently present in the urinary\\nsediment; less often, blood. Pus sometimes appears in con-\\nsiderable quantity as a consequence of pyelitis, which is often\\nevoked by this disease.\\nVariola. In small-pox the urine assumes the usual typical\\nfeatures common to pyrexia, which continue until about the\\ntwelfth day. The urea is moderately increased, and reaches its\\nhighest average with the highest temperature. Even in the ab-\\nsence of marked temperature and upon a spare diet the urea is\\nstill above the normal range. The uric acid is excreted pretty\\nuniformly in excess throughout the course of the disease, and\\ndeposits of urates are constant. The chlorides are somewhat,\\nthough not decidedly, reduced. The sulphates suffer slight re-\\nduction, though to no marked degree, probably only consequent", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0390.jp2"}, "391": {"fulltext": "ACUTE INFECTIOUS DISEASES. 349\\nto the lessened quantit}^ of food ingested. The pigment is very\\nconsiderably increased.\\nAlbumin appears in the urine in about 30 per cent, of the\\ncases of small-pox. It usually appears at the height of pyrexia,\\nthough in severe cases it often appears at the onset of the dis=\\nease. As a rule, albuminuria is only temporary in variola, the\\ntendency to leave behind serious nephritis being comparatively\\nslight, although such results sometimes occur. The presence of\\nbile-pigment in the urine is a frequent and noteworthy fact first\\nobserved by, Schonlein in these cases. In malignant forms of the\\ndisease the urine contains haemoglobin. In less severe cases\\nhaematuria is not uncommon, and often of pronounced degree.\\nCasts, epithelium, and other evidences of nephritis are to be\\nfound in the urinary sediment in cases associated with albu-\\nminuria.\\nYellow Fever. The quantit}^ of urine is markedly diminished\\nfrom the onset of this disease. In many cases it becomes nearly\\nor even quite suppressed, and in such cases all the manifestations\\nof uraemia follow. The reaction of the urine is usually acid\\nthroughout the first stage, and becomes alkaline during conva-\\nlescence. The color of the urine varies it may be bright yellow,\\ndirt} r orange-colored, greenish brown, olive black, or sometimes\\nred from the presence of blood. The urine becomes albuminous\\nalmost without exception, and very often highly so. A very\\nclose relationship undoubtedly exists between the more serious\\nS}anptoms of the disease and the associated renal lesions, for in\\nsuch cases albuminuria is always present in the urine, together\\nwith tube-casts, epithelium, blood, and the morphological ele-\\nments common to acute nephritis. In addition to this, all the\\nusual phenomena of uraemia follow in most of such cases, but\\nespecially coma. The urea is greatly diminished sometimes it\\nis totally absent. The uric acid is also greatly diminished, and\\nis even said to be absent in some cases.\\nTyphus Fever. The volume of urine is gradual^, though\\nnot profoundly-, diminished up to the third week of this disease.\\nThe color is increased up to the crisis, after which it becomes\\nnormal, and during convalescence it is lighter than in health.\\nThe reaction of the urine is sharply acid. The urine may remain", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0391.jp2"}, "392": {"fulltext": "350 URINARY DIAGNOSIS.\\npractically free from deposit, although about the crisis a deposit\\nof urates is frequent. The quantity of uric acid is increased,\\nthough less marked, and less uniformly so than urea. The most\\nnotable feature of the urine, however, in typhus is the marked\\nreduction in the quantity of chlorides, which in severe cases\\npractically amounts to complete absence or retention. This is\\nnot due to diarrhoea, lack of food, or other readily explainable\\ncause, but seems a constant feature of the disease itself.\\nThe urine in typhus is frequently albuminous, perhaps more\\nfrequently so than in t} 7 phoid, although there is some difference\\nof opinion upon this point. Most are agreed, however, that in the\\nmore severe forms of the disease albuminuria is the rule. The\\nquantity of albumin in the urine varies much, but is frequently\\nin large amount in serious cases appearing usually toward the\\ncrisis of the disease, most often on or about the sixteenth day.\\nDiseases of the Liver.\\nCirrhosis. The quantity of urine is constantly diminished in\\ncirrhosis of the liver, so constantly indeed that a copious flow\\nof urine may be considered strongly presumptive evidence of the\\nabsence of this disease. Diuretics act with difficulty or fail to\\nbe effective until the congestion of the liver be modified by mer-\\ncurials or purgatives, and it is in such cases that calomel acts as\\na diuretic. The color of the urine is markedly increased, being\\ndark, red, brown, and even blackish. The acidity of the urine\\nis increased, and, unlike in pyrexial states, the acidity rapidly\\nintensifies after the urine is voided. The dark coloration of the\\nurine is due to the presence of bile-pigments in the urine. So\\nconstant, indeed, is the association of bile-pigment in the urine\\nin this disease that it may serve to distinguish ascites of hepatic\\norigin from that of peritoneal effusion, especially in non-febrile\\nforms of the latter. The excessive bile-pigmentation of the\\nurine in cirrhosis of the liver receives its most plausible expla-\\nnation in the facts of long detention of the blood in the liver,\\nwhere the red corpuscles are subjected to prolonged meta-\\nmorphosis.\\nThe solids of the urine vary widely in quantity in cirrhosis\\nof the liver, chiefly in consequence of the great variability of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0392.jp2"}, "393": {"fulltext": "DISEASES OF THE LIVER. 351\\nthe appetite and digestion, the stomach being subject to more or\\nless disturbance in these cases through implication with the cir-\\nrhotic process. With a normal appetite and digestion the quan-\\ntity of urea is subject to little change. On the other hand, the\\nquantity of uric acid is pretty uniformly above normal, and\\noften very considerabty so. The chlorides are somewhat de-\\nficient most so in cases attended by ascites, the ascitic fluid\\nbecoming heavily charged with sodium chloride. Deposits of\\namorphous urates and calcium-oxalate crystals are common.\\nAlbuminuria is rare, save in cases depending upon valvular\\nlesions of the heart. The urinary sediment, as a rule, does not\\ncontain renal casts and other evidences of nephritis, save in very\\nexceptional cases, mostly due to cardiac disease.\\nJaundice. As a rule, the volume of urine suffers some reduc-\\ntion in jaundice, although it is often quite up to the normal\\nrange. The quantity of urea, as a rule, is diminished the uric\\nacid is increased the sulphates are not especially altered in\\nquantity; hippuric acid is usually absent the urine is alwa\\\\ s\\nhighly acid, the acidity rapidly intensifying after the urine is\\nvoided. The color of the urine depends upon the presence of bile-\\npigments, and varies from saffron-yellow to dark greenish brown\\nor sometimes porter color. The bile-pigments are sometimes pres-\\nent in the urine in very large quantity, as well as the bile-acids.\\nBenzoic acid fails to be eliminated by the urine as hippuric acid,\\ncontrary to conditions of health. In marked cases sugar some-\\ntimes appears in the urine, and this ruay be regarded as an\\nunfavorable indication.\\nThe chief value of examinations of the urine in jaundice is\\nto establish the diagnosis at an early period. Our present tests\\nfor bile-pigments enable us to ascertain when the disease is\\ncoming on, as these products appear in the urine very early. The\\npresence or absence of bile-elements, as well as leucin and tyrosin,\\nin doubtful cases assists in distinguishing between obstructive\\nand non-obstructive jaundice.\\nAcute Yellow Atrophy. This somewhat rare and rapidly-fatal\\ndisease is attended by marked icterus and by extensive destruc-\\ntion of the hepatic cells. The urine is strongly acid in this\\nlesion, and contains both bile-pigments and the bile-acids. The", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0393.jp2"}, "394": {"fulltext": "352 URINARY DIAGNOSIS.\\nquantity of the urine is much diminished, though not suppressed,\\nand the color is usually very dark brown. The urine usually\\ncontains leucin or tyrosin or both, the former nearly always, and\\nsometimes in very large quantity. The quantity of urea is\\ngreatly lessened and sometimes nearly absent uric acid and\\nphosphates are usually reduced in quantity. The urine some-\\ntimes contains albumin and casts, although with no great con-\\nstancy, and when casts are present they often appear yellow from\\nstaining with bile-pigment.\\nArticular Diseases.\\nAcute Rheumatism. In rheumatic fever the general features\\nof the urine are typically those of pyrexia. The quantity of\\nurine is diminished the specific gravity is increased, as is also\\nthe color the reaction is sharply acid, and on cooling the urine\\ndeposits sediments of deeply-colored urates. The quantity of\\nsolids is increased, but chiefly that of urea. The increase of\\nurea usually reaches from 150 to 250 grains above the normal daily\\nrange. The quantity of uric acid is somewhat increased, though\\nto a much less extent than urea. A copious precipitate of urates\\nusually occurs at or shortly following the crisis of the disease,\\nand as convalescence becomes established this tendency subsides.\\nThe chlorides are subject to a considerable reduction in quantit} 7\\nthough not to so extreme a degree as in pneumonia. The return\\nof chlorides is comparatively early, usually as soon as the tem-\\nperature declines to 100\u00c2\u00b0 F. and the joint-swellings begin to sub-\\nside. The sulphates are increased in quantity to a marked\\ndegree, usually reaching double the normal range. In acute\\nrheumatism and pneumonia the blood contains a marked excess\\nof fibrin, and these two diseases furnish the most marked exam-\\nples of increase of sulphates in the urine of all acute fevers. The\\nquantity of phosphates in the urine is not materially altered in\\nacute rheumatism.\\nAlbumin often appears in the urine in small amount, but it is\\nusually transient. Exceptionally it occurs in marked quantity,\\nattended by nephritis. In such cases, morphological elements\\nare found in the urinary sediment characteristic of nephritis.\\nThe kidneys, however, are less frequently, as well as less pro-\\nfoundly, affected than in pneumonia.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0394.jp2"}, "395": {"fulltext": "ARTICULAR DISEASES. 353\\nAcute Gout. Before the attack of gout, or, in other words,\\nbetween the paroxysms, the urine is more or less deficient in\\nsolids, especially those of uric acid, urea, extractives, and phos-\\nphates. In the case of uric acid the reduction is greatest im-\\nmediately before the attack, when it may, indeed, be totally\\nabsent. The same thing occasionally occurs in chronic gout\\nduring the formation of tophaceous deposits.\\nDuring the attack the volume of urine diminishes more or\\nless markedly. Exceptions to this rule occur in cases character-\\nized by chronicity. The frequent co-existence of cardiac hyper-\\ntrophy and early renal cirrhosis in chronic gouty subjects fur-\\nnishes the key to the solution of the occasional polyuric form\\nof gout, as well as those exceptional cases attended by deficiency\\nof urea in the urine. As a rule, the excretion of urea is not\\nmaterially altered during the paroxysm of gout. Garrod first\\npointed out the now well-known fact that the urine is greatly\\ndeficient in uric acid in gout and this applies both to the attack\\nand the intervals between the paroxysms. Sir William Roberts,\\npursuing the chemistry of the subject further, has shown 1 that\\nthe uric acid is retained and precipitated in the tissues in a state\\nof combination as biurate, The urinary pigment, on the whole,\\nis somewhat deficient in gout. Exceptions to this occur in cases\\nattended by pyrexia. The phosphates of the urine are markedly\\ndeficient, notably those of sodium, which doubtless goes to make\\nup the tophaceous deposits in the joints. The sulphates are not\\nessentially altered in quantity.\\nThe urine frequently contains albumin, nearly always in\\nminute quantity, and sometimes it is a permanent condition.\\nCasts are often to be seen in the urine, nearly alwaj^s of the\\nsmall, narrow, hyaline order. These features are usually the\\nresult of accompanying cirrhosis of the kidney, which is verj^\\nfrequent in gout. Crystals of calcium oxalate are frequent\\nfeatures of the urinary sediment. In chronic gout this same\\ndeficiency of uric acid occurs throughout, though more intermit-\\ntently so.\\n1 Croonian Lectures for 1892.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0395.jp2"}, "396": {"fulltext": "354 urinary diagnosis.\\nDiseases of the Nervous System.\\nEpilepsy. In the intervals between the epileptic seizures\\nobservations thus far have failed to establish any changes of a\\nconstant character in the urine, although the urea, uric acid,\\nchlorides, and phosphates have been claimed to be diminished.\\nImmediately succeeding the attacks the volume of the urine is\\noften markedly increased, of pale color, of low specific gravity 5\\nfeebly acid in reaction, and sometimes contains albumin, more\\nrarely sugar. During and immediately succeeding the attacks\\nthe urea and phosphates are increased and deposits of urates\\nand uric acid are common.\\nHysteria. Perhaps no physical phenomenon is more widely\\nknown than the marked increase and pale, aqueous appearance\\nof the urine during or immediately succeeding an attack of hys-\\nteria.. The urine resembles precisely that voided after copious\\nlibations of water. The color is pale, watery, the specific\\ngravity is greatly lessened, the acidity is diminished, and the\\nsolids are relatively reduced. The quantity of urine voided by\\nhysterical patients is sometimes very large two or even three\\npints is not at all uncommon at one passage. It is, perhaps, not\\ngenerally or widely known that in hysterical states the urine is\\nsometimes totally suppressed. Laycock was the first to point\\nout this fact, and more recently Charcot has called special atten-\\ntion to this matter, and has recorded a case in which no urine\\nwhatever was secreted for eleven days. The utmost watchful-\\nness of the patient was ordered, so that deception was not possi-\\nble. The patient suffered much of the time from vomiting,\\nand the ejections contained urea. No other serious symptoms\\nensued, and the urine was ultimately re-established sponta-\\nneously. The author has observed, in cases of hysteria due to\\nnervous exhaustion, that the volume of urine for twenty-four\\nhours often becomes reduced to 15 ounces or even less, which he\\nattributes to the deficient vascular tension and insufficient supply\\nof nervous force to the kidneys.\\nMeningitis. The urine in meningitis is more or less highly\\nconcentrated. The specific gravhVv is accordingly high, but the\\nreaction is weakly acid, sometimes alkaline. The phosphates\\nare greatly in excess, and are readily precipitated in large", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0396.jp2"}, "397": {"fulltext": "DISEASES OF THE RESPIRATORY ORGANS. 355\\namount upon boiling the urine. The chlorides are normal or\\nslightly increased. The quanthy of urea is uniformly above\\nnormal, the increase usually amounting to 25 per cent, or more.\\nThe urine usually contains a small quantit} r of albumin as a\\ntransient condition.\\nDiseases of the Respiratory Organs.\\nPulmonary Tuberculosis. The urine is subject to considera-\\nble variation in its characters in tuberculosis of the lungs, in con-\\nsequence of the numerous incidental complicating conditions\\npresent, such as diarrhoea, pyrexial periods, copious diapho-\\nresis or expectoration, as well as the great variability in the\\nquantity of food taken. As a rule, the volume of urine is some-\\nwhat augmented. This is largely due to the increased quantity\\nof water consumed, thirst being more or less constant in conse-\\nquence of the pyrexia. During attacks of diarrhoea the volume\\nof urine decreases temporarily, often to 30 ounces and sometimes\\neven to 15 ounces. The same decrease precedes a fatal termina-\\ntion of the disease. If the appetite remain good, and the disease\\nbe proceeding without marked disturbing features, the urea re-\\nmains about normal in quantity, perhaps slightly below. Dur-\\ning marked hectic the quantity of urea diminishes decidedly,\\nespecially just before the rigors after the rigors it rises rapidly\\nand reaches its highest excretion about an hour before the sweat-\\ning stage begins. In cases of intestinal irritation accompanied\\nby vomiting, diarrhoea, anorexia, etc., the quantity of urea is sub-\\nject to sudden and decided decrease. Uric acid suffers little, if\\nany, reduction in fact, it usually rises above the normal range.\\nThe sulphates are little, if any, affected, perhaps slightly re-\\nduced. The excretion of chlorides varies very much, the varia-\\ntion depending chiefly upon the quantit} of food taken, the\\ndegree of pyrexia, and the degree of elimination by the skin and\\nbowels. The quantity of pigment varies in phthisical urine\\nowing to the disturbing influences of hectic, diarrhoea, and py-\\nrexia. A pink sediment is often seen in phthisical urine, es-\\npecially during hectic stages, and the precipitated urates often\\nbecome of a pink or carmine hue. In cases rapidly progressing\\ntoward a fatal issue the cliazo reaction of Ehrlich is sometimes", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0397.jp2"}, "398": {"fulltext": "356 URINARY DIAGNOSIS.\\nobtained in the urine. If this reaction be present for any length\\nof time the prognosis may be regarded as unfavorable.\\nAlbumin is often present in the urine of phthisis, the quantity\\nbeing usually small, except in cases complicated by amyloid\\nkidneys. The milder grades of albuminuria are chiefly due to\\nimpaired nutrition of the renal epithelium, though occasionally,\\nperhaps, the result of pyrexia. Renal casts, epithelium, and\\nblood are found in the urine exceptionally, the casts chiefly in\\ncases complicated by renal lesions, of which amyloid disease is\\nthe most frequent, and this is usually associated with cases of\\nmarked chronicity.\\nPneumonia. The general pyrexial characters of the urine\\nare well marked in pneumonia. The quantity of urine is dimin-\\nished one-third to one-half. The quantity of urea is increased, as\\nis also uric acid the greatest increase occurs on the so-called\\ncritical days. It is at such times that enormous deposits of\\namorphous urates are so often observable in pneumonia, more\\nmarked than in other febrile diseases of equal degree of pyrexia.\\nThe specific gravity of the urine is increased 1025 to 1035.\\nPigmentation of the urine is markedly increased, which inten-\\nsifies the color of the precipitated urates to deep brown, red, or\\neven carmine. The increase of pigment often reaches two or\\nthree times the normal range.\\nThe chlorides are invariably greatty diminished or absent\\nduring the early stages and commencing hepatization. This\\ndeficiency of chlorides continues until convalescence is well\\nestablished, sometimes for several days after, when they re-appear\\nin great excess, indicating their retention during the active\\nstages of the disease. The absence of chlorides indicates a\\nperiod of danger in pneumonia. The sulphates are uniformly\\nincreased in pneumonia from one-fourth to one-third above the\\nnormal range only exceptionally do cases occur without being\\nattended by this increase. The quantity of phosphates in the\\nurine suffers more or less reduction.\\nOf the morbid products met with in the urine in pneumonia,\\nalbumin is by far the most constant, the average being about 45\\nper cent, of all cases. Albumin usually appears in the urine at\\nthe height of the disease, especially during the stage of consoli-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0398.jp2"}, "399": {"fulltext": "DISEASES OF THE RESPIRATORY ORGANS. 357\\nelation. Its appearance in notable quantity must be looked upon\\nas an unfavorable indication the death ratio reaches from 45\\nto 50 per cent, in such cases, while in non-albuminuric pneumonia\\nthe death ratio is only about 15 per cent. The fact that albu-\\nminuria is so frequent in pneumonia perhaps as frequent as in\\nany other febrile disease strongly favors the now generally-\\naccepted view of the infectious nature of the disease, for albu-\\nminuria is now known to be one of the most frequent features\\nof infectious fevers. Furthermore, the albuminuria of pneumo-\\nnia is evidently independent of the intensity or extent of the\\nlocal pulmonary lesions and of the disturbed function of the\\nlungs, since frequently cases of the most extensive consolidation\\nand urgent dyspnoea are unattended by albuminuria while, on\\nthe other hand, cases of comparatively mild grade are often\\naccompanied b}~ both albuminuria and nephritis. The kidneys\\nare often seriously damaged in pneumonia the nephritis some-\\ntimes remains comparatively latent throughout convalescence, as\\nin scarlatina, to be discovered weeks or months after the pneu-\\nmonia has subsided, attention being called to the condition\\nthrough uraemia, dropsy, or some of the usual symptoms of\\nnephritis. From the above considerations, as might be expected,\\nthe urine of pneumonia often contains blood, epithelium, casts,\\nand the usual products associated with nephritis. The urine\\nalso contains an excess of mucus, which renders the urine un-\\nstable hence, the urine in pneumonia possesses a decided ten-\\ndency toward alkaline decomposition, and its reaction quickly\\nbecomes alkaline upon standing.\\nExceptionally pneumonia is attended not only by diminished\\nvolume of urine, but also by decrease of the solids, including\\nurea and uric acid. Such cases are almost invariably character^\\nized by delayed convalescence, diarrhceal attacks, and slow re-\\ncovery. The proportion of solids in the urine is, in fact, one of\\nthe most trustworthy guides for prognosis in pneumonia, and\\ncases attended by diminished excretion never proceed so favor-\\nably as those in which the solids are excessive.\\nDuring convalescence the volume of the urine increases the\\nquantity of uric acid, urea, and sulphates, previously excessive,\\nnow gradually diminish to or below the normal range while the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0399.jp2"}, "400": {"fulltext": "358 URINARY DIAGNOSIS.\\nchlorides, previously held back, now increase considerably above\\nnormal, often, in fact, to an extraordinary degree.\\nAcute Pleurisy. The urine in pleurisy presents the usual\\nfebrile type, though not so pronounced^ 7 as in pneumonia. The\\nvolume is reduced the organic solids are increased, notably\\nduring pyrexia. Both urea and uric acid are somewhat ex-\\ncessive. The chlorides, sulphates, and phosphates are but little\\nchanged sometimes there is a reduction in the quantity of chlo-\\nrides, but not to any marked degree. Albuminuria is uncommon\\nin pleurisy sometimes it appears in mild form, but it is usually\\nof temporary duration. The urine often contains a very con-\\nsiderable amount of peptone, especially during the stage of reso-\\nlution, when absorption of large serous effusion is in progress.\\nPleurisy presents an example of the fact that intense pain often\\ncauses but little effect over tissue metamorphosis, since few\\nP3 T rexial states present so little alterations in urine indicative of\\ntissue waste as does simple pleurisy.\\nAcute Bronchitis.\u00e2\u0080\u0094 The urine in bronchitis varies much in\\ncharacter in different cases. This, indeed, is to be expected,\\nsince the grades of the disease are of all degrees, from slight\\ncatarrh of the large tubes to disease including nearly all the\\nsmall tubes of both lungs, with collapse of the air-cells, to the\\nextent of entailing sharp dyspnoea. In the latter case the urine\\napproaches the same characters as those in pneumonia.\\nIn cases of severe diffuse capillary bronchitis accompanied\\nby dyspnoea, there is usually a marked diminution of nearly all\\nthe solid constituents of the urine, more so than perhaps in any\\nother disease save cholera. Parkes records the case of a young\\nman who, during two days, voided but 294 cubic centimetres of\\nurine per da} 7 containing only 244 grains of total solids, 176\\ngrains of which were urea, 10.8 grains of sulphates, and no chlo-\\nrides. There was no albuminuria or symptoms of uraemia, and\\nthe urine became gradually established as the patient recovered.\\nMoos has recorded a similar case in a girl who, during the height\\nof the disease, excreted only 9 grammes of urea (139 grains) and\\n2 grammes of sodium chloride. The conditions favoring the re-\\ntention of chlorides are those interfering with proper aeration of\\nthe blood, and there is reason to believe that when these con-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0400.jp2"}, "401": {"fulltext": "DISEASES OF THE DIGESTIVE SYSTEM 359\\nditions are extreme the same influence extends to the entire\\nsolids of the urine. The urine is occasionally albuminous in\\nbronchitis, but this condition is nearly always transient impli-\\ncation of the kidneys being rare.\\nDiseases of the Digestive System.\\nUnder the term dyspepsia a number of symptoms are com-\\nmonly grouped which are often of widely different causation, and\\nmany of which are only recently becoming understood, notably\\nsome of the forms associated with auto-intoxication. In chronic\\ndisorders of the stomach and intestines the urine is often in-\\ncreased in quantity, of pale color, of lowered specific gravity,\\nwith a tendency toward alkaline reaction from fixed alkali. In\\nconsequence of the alkaline tendency of the urine, there is a\\nproneness to precipitation of the earthy phosphates, and such\\nurine is often turbid from this cause when voided. As a sec-\\nondary consequence, vesical irritation is a common accompani-\\nment which not infrequently leads to the formation of gravel.\\nThe quantity of urea depends upon the digestive power of the\\nstomach. Usually the quantity of urea in the urine is below\\nnormal, often markedly so; the quantity of chlorides correspond\\nclosely with the amount of food taken.\\nIn disorders of the intestinal tract attended by increased\\nalbuminous decomposition the urine is apt to contain large\\namounts of so-called indican, and this is especially favored by\\nobstinate constipation or obstructive diseases.\\nIn organic diseases of the stomach and intestines, especially\\nif associated with ulcerative changes, the urine often contains\\nnotable quantities of peptone. A mild type of albuminuria is\\nsometimes associated with disorders of the stomach, and it is,\\nindeed, remarkable how frequently the so-called functional albu-\\nminuria is found associated with disorders of the stomach. In\\nsuch cases, though the albuminuria is persistent, often extending\\nover periods of years, it is rare to find casts in the urine or\\nother evidences of nephritis. Small quantities of sugar are\\nsometimes found in the urine in dyspeptic conditions. Of the\\nurinary sediments found in digestive disorders, calcium-oxalate\\ncrystals and amorphous phosphates are the most common.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0401.jp2"}, "402": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0402.jp2"}, "403": {"fulltext": "APPENDIX A.\\nEXAMINATION OF URINE FOR LIFE-INSURANCE.\\nThe examination of the urine for life-insurance has for its\\nobject the determination of the presence or absence of diseases\\nof the urinary organs which tend to abridge the normal expect-\\nancy of life. As a special field of urinary diagnosis, this has\\ngrown to very extensive proportions in nearly all civilized\\ncountries, and, since the interests involved are so important\\nand wide-spread, the subject is well deserving of special con-\\nsideration.\\nThe questions involved in the examination of the urine for\\npurposes of life-insurance often call for a high order of skill and\\njudgment for their accurate determination, and experience has\\ndemonstrated that the adoption of systematic methods of con-\\nducting the examination not only simplifies the subject, but also\\nrenders the conclusions reached more trustworthy. It has, there-\\nfore, become the custom with many insurance associations to\\nfurnish certain rules as a guide in conducting examinations of\\nthe urine, which are intended to cover the more important points\\nof information desired. Notwithstanding these precautions, life-\\ninsurauce associations still find a very large percentage of their\\nunprofitable risks arise through diseases of the kidneys which\\nhave escaped detection. It is with a view of contributing to the\\navoidance of such losses, on the one hand, and, on the other, of\\nsecuring to applicants the privileges of life-insurance to which\\nthey may be fairly entitled, that the following suggestions are\\npresented as a guide for medical examiners.\\nA due regard for the interests of his company, as well as for\\nhis own reputation, should prompt the medical examiner to per-\\nsonally ascertain that the urine about to be examined has been\\nvoided by the applicant. Substitutions of healthy urine by un-\\n24 (361)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0403.jp2"}, "404": {"fulltext": "362 APPENDIX.\\nhealthy applicants are matters of undoubted facts in the history\\nof insurance circles, and, though fortunately of infrequent occur-\\nrence, the examiner should be on his guard against such possible\\nsource of imposition. The applicant should be directed to retain\\nhis urine for, say, two or three hours before presenting himself\\nfor examination and upon his arrival he should be given a clean\\nglass vessel and requested to void therein his urine, which is\\nalways preferably done in the presence of the medical examiner\\nbut if this be impracticable, the temperature of the urine should\\nbe immediately noted in order to guard against possible imposi-\\ntion. This method also secures a perfectly fresh sample of urine\\nalways a matter of prime importance and, moreover, voided\\nat a time most desirable for the purpose, viz., after food and\\nexercise for it should not be forgotten that the urine voided\\non rising in the morning (which it has become somewhat\\nthe custom to furnish for these purposes) is the least likely to\\ncontain either albumin or sugar, when these* are present in\\nminute quantities.\\nIf the examination of the urine be unsatisfactory, or if there\\nbe reason to believe that the sample examined be not a fair aver-\\nage, it will be advisable to have the whole twenty-four hours\\nproduct of the kidneys collected, mixed, and measured, and a\\nsample of this mixture examined, and compared with a freshly-\\nvoided sample of the urine.\\nPhysical Examination of the Urine.\\nHaving secured a perfectly-fresh sample of the applicant s\\nurine, it should be allowed to stand until it cools down to a tem-\\nperature of about 75\u00c2\u00b0 or 78\u00c2\u00b0 F., and careful observation made of\\nits appearance and physical characters. If the color be very\\nlight (watery), it suggests diminished specific gravity, possibty\\nhydruria, diabetes insipidus. Should the color be of decided\\ngreenish tint, the possible presence of sugar is suggested\\nshould the color be unduly increased, reddish, excess of\\nurates or the presence of blood is inferred; in the first case\\nsuggesting rheumatic or gouty conditions in the latter, cal-\\nculi or some organic renal or vesical lesion. The transparency\\nor opacity of the urine should be carefully noted if cloudy, add", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0404.jp2"}, "405": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 363\\na few drops of acetic or other acid to a sample in a test-tube, and\\nif the urine become perfectly cleared thereby the earthy phos-\\nphates in suspension was the cause of the opacity, their suspen-\\nsion being due to diminished acidity of the urine, and it suggests\\nsome such condition as fasting, dyspepsia, or general debility.\\nIf the opacit}^ of the urine fail to yield to the action of an acid,\\ngently warm the upper laj^ers of the urine by holding tbe test-\\ntube over a spirit-flame, and if it now clear the opacity was\\ndue to suspension of the amorphous urates, the significance of\\nwhich has already been stated. If, however, the urine still re-\\nmain cloudy after treating it with both heat and acid, the opacity\\nis due to the presence of pus, bacteria or cellular elements, and\\nthe necessity of microscopical examination is suggested for diag-\\nnostic purposes.\\nThe specific gravity of the urine should next be observed by\\nthe aid of a good instrument, preferably a Squib Vs specific\\ngravity instrument (urinometer), and the range should be near\\n1020. If the specific gravity, however, be above 1025, it suggests\\nthe possible presence of sugar; if below 1018, it is suspicious of\\nthe presence of albumin, and should lead to further investiga-\\ntions in these special directions.\\nThe chemical reaction of the urine should next be ascertained\\nby means of litmus-paper. If found to be very sharply acid, as\\nindicated by intense reddening of blue litmus, the possibility of\\nthe presence of sugar is suggested, since the urine is more\\nsharpty acid when it contains sugar than in most other con-\\nditions, Should the urine be frankly alkaline in reaction, as\\nindicated by decided blue coloration of red litmus-paper, the\\npaper should be dried in order to ascertain if the alkalinit}^ of\\nthe urine be due to fixed or volatile alkali. If the red color\\nreturn upon drying, after having turned blue in contact with\\nthe freshly-voided urine, ammonia is present or volatile alkali,\\nand this suggests the presence of some chronic inflammatory\\ncondition of the lower urinary tract, most likely the bladder. If,\\non the other hand, the blue color remain permanent upon drying\\nthe paper, the urine is alkaline from fixed alkali, and indicates\\nunusual alkalescence of the blood, which may suggest fasting,\\ndyspepsia, or vegetarian habits of eating.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0405.jp2"}, "406": {"fulltext": "364 APPENDIX.\\nA careful survey of the physical characters of the urine, as\\njust indicated, will often lead further investigation in certain\\ndirections, and also lend confirmation to the points brought out\\nby further investigations of the urine. But even though all the\\nphysical characters of the urine be found perfectly normal, the\\nurine cannot be positively asserted to be healthy until search\\nhas been made at least for sugar and albumin, since either or\\nboth of these may exceptionally be present in small amounts\\nwithout their presence being indicated by a physical inspection\\nof the urine.\\nChemical Examination.\\nThe most simple chemical examination of the urine for pur-\\nposes of life-insurance should, at least, include a search for sugar\\nand albumin and a quantitative estimation of the urea.\\nAlbumin. If the urine contain albumin in large or even\\nmedium quantity, it will be made apparent by almost any of the\\nordinary tests for albumin in use. When, however, the urine\\ncontains but minute quantities of albumin, the case is altogether\\ndifferent, and the greatest care is absolutely necessary not only\\nto be able, in all cases, to positively identify it, but also to inter-\\npret its true significance. To the search for small quantities of\\nalbumin in the urine, therefore, the following considerations are\\nintended chiefly to apply\\nThe urine in all cases should first be filtered before submitting\\nit to albumin-reagents. After filtration of the urine one or both\\nof the following methods ma} T be followed\\n1. Fill an ordinary test-tube half- full of the urine, and to this\\nadd ferrocyanide-of-potassium solution (1 to 20) to the depth\\nof about an inch; after mingling the urine and the reagent thor-\\noughly by inverting the tube a few times, add a few drops of\\nacetic acid and again invert the test-tube a few times until the\\nurine and reagents are well mingled. Finallj T stand the tube in\\na good light and note any changes appearing. If albumin be\\npresent, in a half-minute or so a diffuse, milk-like turbidity\\nwill gradually appear throughout the test, more or less pro-\\nnounced according to the quantity of albumin present. If the\\nreaction seems doubtful, it will be found useful to stand another", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0406.jp2"}, "407": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 365\\ntube filled with the filtered urine beside the one containing the\\ntest for purposes of comparison.\\n2. Fill a test tube about half or two-thirds full of the filtered\\nurine and to this add about one-sixth its volume of saturated\\nsolution of common salt (sodium chloride). Next, mingle the\\nurine and sodium-chloride solution by inverting the tube a num-\\nber of times, and then add a few drops of acetic acid. Lastly,\\nheat the upper third of the test over a spirit-flame until it gently\\nboils, and then stand the test in a good light for observation.\\nIf albumin be present, a white cloud, more or less dense, will\\nappear in the upper, boiled portion of the test, while the lower,\\nunboiled portion will remain clear and unclouded.\\nBoth of these tests possess the great advantage over most\\nother albumin reagents of giving no reaction with nucleo albu-\\nmin or mucin. In point of delicacy they are probably as sen-\\nsitive as at present attainable, coupled with trustworthiness.\\nHeller s nitric-acid method has been much employed hereto-\\nfore in insurance circles indeed, few, if any, albumin tests have\\nbecome so popular and so generally adopted. Its simplicity\\nleaves little to be desired. Then, too, many observers are\\nwedded to the contact method of testing, and, certainly, when the\\neye is trained to this method it requires practice to acquire a\\nnew method. However, accuracy and trustworthiness are, after\\nail, the prime desiderata in insurance as in all other urinary\\nwork, and after many r eaiV careful and patient investigation\\nthe author does not hesitate to give the preference to the two\\ntests above described over all other methods for detecting small\\nquantities of albumin in the urine.\\nThe nitric-acid method of Heller is a read} and excellent\\ntest in the presence of considerable amounts of albumin in the\\nurine. When mere traces of albumin are present, however,\\nit requires from twenty minutes to half an hour to bring it\\nto light with certainty. In addition to this the reactions of\\nthis test with mucin, oleoresins, urates, etc., require correc-\\ntions and precautions which demand skillful manipulation and\\ninterpretation to reach trustworthy results; and, therefore, the\\ninterests both of the company and the applicant are best served\\nby the use of the more trustworthy methods. The quantity of", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0407.jp2"}, "408": {"fulltext": "366 APPENDIX.\\nalbuinin in the urine is most rapidly determined by the centrifu-\\ngal method described on page 83. x\\nSignificance of Albuminuria.-\u00e2\u0080\u0094 Having positively identified\\nthe presence of albumin in the urine, in all cases its true signifi-\\ncance should be next traced.\\nAs a rule, minute quantities of albumin in the urine are less\\nlikely to be the result of serious disease of the kidneys in young\\npeople than when met with in people beyond middle age. A\\nvery considerable percentage of such cases in the young belong\\nto that class which has been termed physiological or functional\\nalbuminuria, terms which are meant to indicate that the kidneys\\nare not structurally damaged. In such cases, in addition to the\\nfact that the subjects are mostly young, the urine presents certain\\nfairly uniform features, viz. the specific gravity of the urine is\\nusually increased to 1025 or above albumin is often absent from\\nthe urine on rising in the morning, but appears plainly after\\nexercise, food, or mental excitement the urine is free from renal\\ncasts and significant morphological elements and the quantit y of\\nurea in the urine remains normal. While many such cases con-\\ntinue for years without any marked changes either in the urine\\nor in the general health of these subjects, yet a certain propor-\\ntion of them ultimately develop into serious nephritis. The fact\\nthat we possess no positive data by means of which we can with\\ncertainty distinguish the special cases of this class which will\\nultimately terminate unfavorably from those which will pursue a\\nfavorable course, and, furthermore, since nephritis is more liable\\nto arise from slighter causes in these cases than ordinarily, it\\ncannot be affirmed that these cases are safe risks. It has been\\nsuggested by some authorities that these cases might be accepted\\nfor a limited endowment insurance of, say, five or ten years, but\\n1 It has been shown (pages 83 and 84) that the unit of measurement of\\nEsbach s albuminometer-tubes, as ordinarily supplied by the dealers, is too large\\n(1 gramme) for accurate measurement of small amounts of albumin in the\\nurine. Messrs. Eimer Amend, of 205 and 211 Third Avenue, New York, now\\nmanufacture and supply these albuminometers, the first three grammes of the\\nreading being graduated in tenths of a gramme, which obviates the above-named\\nobjection. Moreover, these tubes are specially adapted for use with the author s\\nelectric centrifuge, so that those who prefer Esbach s quantitative method to the\\nauthor s may carry out the test in two or three minutes.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0408.jp2"}, "409": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 361\\nthe safer course for the company would be delay for sufficient\\ntime to determine the ultimate course of the case. These ques-\\ntions, however, will be determined by the medical director at the\\nhome office, to whom all the facts and particulars of such cases\\nshould be carefully reported.\\nTraces of albumin are sometimes observable in the urine of\\nperfectly healtli3 T people, the reaction being due to dissolved\\nmorphological elements, and such is most frequently observed\\nin women the subjects of leucorrhoea, or in men with slight\\nbladder irritation. If such urine be permitted to stand in a\\nconical glass for a few hours, or if it be submitted to the centrif-\\nugal apparatus, a deposit, mostly of epithelium and mucous cor-\\npuscles, becomes plainly visible to the naked e^ye. The nucleo-\\nalbumin of these structures becoming dissolved out, often ren-\\nders the urine sufficiently albuminous to cause slight reaction\\nin testing if the quantity of epithelium, etc., be abundant. It\\nmay be necessary, therefore, in the cases of women, to direct a\\nvaginal douche to be used previous to voiding the urine for\\nexamination, while in other cases it may be necessary to quell\\nthe vesical irritation by medical treatment before passing opinion\\nupon the true state of the urine.\\nMinute quantities of albumin are often observed in the urine\\nof men at and beyond middle age, who not only appear perfectly\\nhealthy, but who have, as a matter of fact, enjoyed the most\\ntypical robust health all their live*. Among this class will be\\nfound the largest number of those cases which have always\\nproved so unprofitable to life-insurance associations, through\\nconcealed or overlooked disease of the kidneys.\\nTwo features in this class of cases stand out so prominently\\nthat they are well calculated to mislead the medical examiner,\\nviz., (a) the robust general condition of seemingly perfect health\\nof the applicant and (b) the minute (often doubtful without careful\\ntesting) traces of albumin in the urine often accompanying these\\ncases. These facts teach us two highly -important lessons which the\\nmedical examiner would do well to remember: 1. That a healthy\\nappearance or healthy personal record of the subject carries less\\nweight, in reaching conclusions as to certain pathological con-\\nditions of the kidneys, than in any other disease. 2. That the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0409.jp2"}, "410": {"fulltext": "368 APPENDIX.\\npresence of traces of albumin in the urine, however minute, are\\noften the index of irretrievably-damaged kidneys.\\nChronic interstitial nephritis, or so-called chronic Bright s\\ndisease, to which the foregoing facts especially apply, is nearly\\nalways the outgrowth and sequel to robust life, the kidneys\\nbeing the first organs to fail under the stress of long-continued\\nfunctional activity in eliminating the waste-products, which are\\nalways excessive in people of large appetites and ample nourish-\\nment. These cases present the following typical features The\\nsubjects are, as a rule, over 40 years of age; usual history of\\nrobust health appetite always good, often heavy and the food\\nhas consisted largely of meat and highly-nitrogenous products.\\nThese people usually rise regularly at night once, twice, or\\noftener to void their urine, which, to all appearance, is normal\\nand free from sediment. The urine, however, is usually of\\nlowered specific gravity, 1018 to 1014, more or less deficient\\nin urea, and contains a small amount often mere traces of\\nalbumin. Microscopical examination merely shows the presence\\nof a few small, perfectly lrvaline casts. The pulse is alwa} T s full,\\nhard, and unresisting to the finger, almost characteristically\\nso; the second sound of the heart is abnormal^ loud, and in\\nmany cases enlargement of the heart is plainly to be observed.\\nIf the above-named points be kept in view, the medical examiner\\nwill have no difficulty in recognizing this dangerous class of\\nrisks.\\nSugar. In searching for sugar in the urine, it is of prime\\nimportance to have on hand some trustworthy and stable\\ntest that ma}- be depended upon when required. Fehling s\\nsolution has been much depended upon, but its well-known\\ninstability greatly detracts from its usefulness for the purposes\\nunder consideration. Fehling s solution will not keep, for\\nreasons explained (page 111), and its preparation requires some\\ntime and pains. A better test, more simple in preparation\\nand sufficient^ stable that it may be kept on hand for months\\nwithout impairment of its qualities for testing, is that devised\\nby Professor Haines (page 103). This test, if properly manip-\\nulated, will yield as trustworthy results as it is possible for any\\ncopper test to give.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0410.jp2"}, "411": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 369\\nIn searching for sugar with Haines s test, 1 drachm of the\\ntest-solution, in an ordinary test-tube, should be raised to the\\nboiling-point over a spirit-lamp, and the suspected urine should be\\nadded, drop by drop, until 8 or 10 drops are added, but not more.\\nThe test should now be boiled for about half a minute, and, if\\nsugar be present, a copious yellow or yellowish-red precipitate\\nwill suddenly appear throughout the whole mixture. If no such\\nreaction take place, sugar is absent. The chief feature in the\\nmanipulation to be kept in mind is not to add more than the\\nstated limit (8 or 10 drops) of urine. If this be disregarded and\\nthe urine be added (as in Fehling s test) to a volume equal to the\\ntest-solution, or thereabout, any urine may cause reaction when\\nsugar is absent. This is due to the fact that normal urine con-\\ntains certain substances (chiefly uric acid, creatinin, etc.) which\\npossess feebly reducing powers over copper tests; and, there-\\nfore, if the urine be added in excess the test is liable to respond\\nto these agents.\\nIn exceptional cases the urine may contain an excess of\\nuric acid or other reducing substances just named, or such\\nforeign elements as tannin, carbolic acid, or vegetable alkaloids,\\nwhich may cause slight reaction with this or any copper test.\\nFor the most part, this reaction is usually an imperfect one, the\\ntest-solution turning green rather than yellow or red, though\\nexceptional!} a frank yellow precipitate may be formed. Such\\ncases, however, in reality are very rare, if the test be manipu-\\nlated as directed. Should any doubts, however, arise as to the\\npresence of sugar, after thorough cleansing of the test-tube and\\ncarefully repeating the test in all particulars, as directed, an\\nappeal ma} be made to the phenyl-hydrazin test, as described\\n(page 105), which may be considered conclusive. Having identi-\\nfied the presence of sugar in the urine, its exact quant it} may\\nbe readily and rapidly determined by the author s method,\\nalready described in the text (page 108).\\nSignificance of Sugar in the Urine. The presence of sugar\\nin the urine, in a general sense, is nowise less serious in its\\nsignification than is that of albumin. As in the case of albumin,\\nthe tendency has been to look upon small quantities of sugar in\\nthe urine as of no grave import but recently this view of the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0411.jp2"}, "412": {"fulltext": "370 APPENDIX.\\nsubject is giving way to a belief that, as a rule, the presence\\nof sugar in the urine, regardless of the quantity, means serious\\ndefect, either in the brain or the liver, or in both, and this view\\nwill prove the safer one to follow. It is true that in a few con-\\nditions, notably in some forms of indigestion, as well as over-\\ningestion of highly-saccharine or amylaceous foods, small quan-\\ntities of sugar may appear in the urine in the absence of a\\ndiabetic state. On the other hand, genuine diabetes mellitus is\\noften preceded for a time by precisely these symptoms, viz.\\nthe appearance of small quantities of sugar in the urine, often,\\nindeed, intermittent, but always aggravated by indulgence in\\nsaccharine or starchy foods. The author is unable to identify\\nthe special cases of the former class which subsequently do or\\ndo not terminate in diabetes, but he is able to affirm, from observa-\\ntion, that many of these cases of so-called digestive glycosuria\\nend in fatal diabetes, more especially in young subjects. It has\\nbeen truthfully said, by an author of wide experience on this\\nsubject, that a man with sugar in his urine is like a house that is\\nundermined he will surely fall, but no one can predict the pre-\\ncise time that the disaster will occur. It will be safer to accept\\nthis assertion as a guide in such cases.\\nUrea. An examination of the urine can scarcely be con-\\nsidered complete which does not include an estimate of the\\nquantity of its contained urea. Representing, as it does, by far\\nthe greater bulk of the organic output of the kidneys, the quan-\\ntity of urea in the urine becomes a valuable index of the func-\\ntional capacity of the kidneys, and, therefore, serious forms of\\ndisease of these organs is usually quickly and markedly reflected\\nin the diminished excretion of urea.\\nThe estimation of urea in the urine is now a matter of such\\nsimplicity and rapidity that it ranks among the more simple\\nmanipulative methods, such as testing for albumin and sugar,\\nand, in reality, requires but little more time. The method best\\nsuited for the purposes under consideration is that known as the\\nhypobromite test, which is most readily performed with Dr.\\nDoremus s ureometer. A fresh solution of sodium hypobromite\\nis necessary for testing, as the solution does not keep well This\\nis best obtained as follows Have on hand a quarter- or half-", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0412.jp2"}, "413": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 311\\npound bottle of bromine, and, after once opened with care, set it\\naside for use. Next prepare a solution of sodium hydroxid\\n(caustic sodium) by dissolving 3 ounces of caustic sodium (in\\nsticks) in 8 ounces of distilled water, which may also be kept\\non hand for use. In preparing the solution of sodium hj^po-\\nbromite for testing, pour 10 cubic centimetres of the caustic-\\nsodium solution into a graduated glass, and with the pipette\\n(furnished with the ureometer) take up 1 cubic centimetre of\\nbromine 1 and mix thoroughly with the caustic-sodium solution;\\nnext add an equal volume of water, and, after thoroughl}\\nmixing until the solution becomes transparent, fill the bulb\\nof the ureometer with the solution, and incline the instru-\\nment until the hypobromite solution fills the long arm. Xext\\nthoroughly cleanse the pipette, and take up 1 cubic centimetre\\nof the urine and slowly discharge it into the hypobromite solu-\\ntion, in such position that tiie disengaged nitrogen-gas will all\\nascend the long arm of the instrument, where it is measured.\\nAs soon as the urea is all decomposed, as indicated by no further\\nascending of bubbles, read off the quantity as indicated by the\\namount of nitrogen-gas marked on the long arm of the instru-\\nment. Each number represents the fractions of a gramme of\\nurea per cubic centimetre of urine, of which 0.02 is the normal\\nproportion. If preferred, these ureometers are furnished with a\\nscale indicating the number of grains of urea per ounce of\\nurine instead of grammes per cubic centimetre. 2\\nThe normal quantity of urea is about 512 grains in twenty^\\nfour hours for a man of 145 pounds weight, upon a mixed diet\\nand moderate amount of exercise. This gives an approximate\\nproportion of 10 grains of urea per ounce of urine, the whole\\nquantity of the urine being 50 ounces. It will be necessary to\\nmake an allowance of about 25 or 30 per cent, from this standard\\nin order to cover variations caused by differences in weight, age,\\ndiet, and exercise. If, therefore, the gross quantity of urea sink\\nbelow 350 grains (7 grains per ounce), there is reason to appre-\\n1 Avoid inhaling the strong vapor of the bromine, which is very irritating to\\nthe air-passages.\\n2 These instruments are furnished by Eimer Amend, 205 and 211 Third\\nAvenue, New York, at moderate cost.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0413.jp2"}, "414": {"fulltext": "372 APPENDIX.\\nbend the presence of some organic disease of the kidneys.\\nShould the deficiency be still more marked, the quantity of urea\\ndiminishing to 250 or 200 grains (5 grains per ounce), it fur-\\nnishes strong evidence of diseased kidneys. On the other hand,\\na normal amount of urea in the urine, coupled with the absence\\nof albumin therefrom, strongly indicates that the kidneys are\\nhealthy. Certain it is that no very advanced renal disease can\\nbe present under such circumstances.\\nMicroscopical Examination.\\nA microscopical examination of the urine is often required\\nof the medical examiner in cases of applications for heavy\\namounts of insurance. In addition to this, in cases in which a\\nchemical examination of the urine has not been conclusive, a\\nmicroscopical investigation should be made. It is not proposed\\nto here enter into the technique of microscopy, which every one\\nhas access to in the numerous works especially devoted to the\\nsubject. A few general suggestions in reference to the special\\nsubject herein considered may, however, be of use.\\nThe urine for microscopical examination should in all cases be\\nfreshly voided, and it is better to have it somewhat concentrated\\nby directing the applicant to abstain from the use of fluids for a\\nfew hours previous to voiding the urine for examination. Where\\npracticable, the sediment is preferably obtained by the centrifu-\\ngal method. Should the centrifugal apparatus not be available,\\nproceed by adding 10 grains of resorcin, chloral hydrate, or\\nsalicylic acid to the urine, in a conical glass, to preserve it from\\nchange, and, after covering the glass, stand it aside for from\\ntwenty-four to forty-eight hours, until the sediment subsides.\\nThen take up from 4 to 6 drops of the sediment, by means of a\\nnipple pipette, from the bottom of the deposit, and place them\\nin a shallow cell cover the cell with a cover-glass, take up the\\noverflow of urine with the torn edge of a piece of blotting-\\npaper, place the slide under the microscope, and examine delib-\\nerately with a one-fourth-inch objective, avoiding too brilliant\\nillumination of the field, since too much light tends to render\\nhyaline casts invisible, as they are feebly refractive. Careful\\nsearch should be made over at least two slides prepared as above", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0414.jp2"}, "415": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 373\\ndirected, noting the presence and relative number of pus- or\\nblood- corpuscles, but more especially the presence, number, and\\ncharacters of any renal casts. If no pathological products be\\nfound after examination of two slides, the evidence ma} be\\nconsidered conclusive in the negative.\\nPyuria.\\nThe medical examiner will encounter but little difficulty in\\ndetecting the presence of pus in the urine of the applicant if it\\nbe present in an}^ notable quantity. Such urine is always more\\nor less cloudy when voided, and the turbiditj does not clear up\\nby the addition of an acid or the application of heat on the\\ncontrary, the cloudiness is rather increased by these agents. A\\nsediment, more or less pronounced, quickbv settles to the bottom\\nof the vessel, and if the urine be decanted from the sediment\\nand liquor potassae added to the latter, it thickens into a jell}\\nlike consistence, and becomes ropy and sticky, as will be\\nobserved in pouring it from the vessel. Should any doubts\\narise, however, as to the nature of this deposit, the microscope\\nwill readily reveal the presence of characteristic corpuscles,\\ndescribed in the text (page 182).\\nThe significance of pyuria may be very grave it can scarcely\\never be considered trivial, inasmuch as it points to bacterial\\ninfection of the urinary tract. In people beyond middle age it\\nis nearly always a serious matter, since in such people the resist-\\ning powers of the S}~stem against pj r ogenic germs are much\\ndiminished, and consequently the infection under such circum-\\nstances is more likely to extend than to subside. Moreover, the\\ncauses which most often provoke pyuria in elderly people are\\nof a permanent nature.\\nOn the other hand, pyuria in younger subjects is often the\\nindex of tubercular p} elitis, pyonephrosis, etc., which are not\\nonly, as a rule, incurable diseases, but often rapidly fatal ones.\\nPyuria in its least serious signification is the associate of\\nmild forms of cystitis in otherwise healthy subjects, and as\\nsuch it is usually soon recovered from, in young or even middle-\\naged subjects, under properly-directed treatment. On the\\nwhole, pyuria should be looked upon as more or less serious,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0415.jp2"}, "416": {"fulltext": "374 APPENDIX.\\nand the onl} safe course to pursue in these cases is to recommend\\ndelay of the application for a few weeks until it be determined\\nif the condition be a permanent one.\\nHEMATURIA.\\nApplication will scarcely be made for life-insurance if blood\\nbe present in the urine in sufficient amount to attract the atten-\\ntion of the applicant. Should such be the case, however, the\\nexaminer will not be likely to overlook cases of pronounced\\nhsematuria, as they will be apparent upon the most superficial\\ninspection of the urine. But the urine may become so highly\\ncolored from concentration as to conceal minute quantities of\\nblood; or, again, blood may be present in quantities so minute\\nthat it merely lends to the urine a deep shade of normal colora-\\ntion. Close inspection will usually distinguish the abnormal\\ntint due to blood, and upon standing the distinction will usually\\nbe more marked in the sediment. In cases of doubt, however,\\nthe microscope will readily detect the presence of the blood, in\\nquantities however minute it may be present.\\nThe examiner should always inquire for a history of attacks\\nof hsematuria, with the circumstances associated therewith. The\\nappearance of blood in the urine, occurring at irregular intervals,\\noften indicates the presence of gravel, or the beginning of such\\nstill more serious diseases as renal tuberculosis and cancer of\\nthe kidne}\\\\ If hematuria has appeared, inquiries should be\\nmade as to its character, the frequency of the attacks, as well as\\nits extent. Thus, if the blood appeared intimately mingled with\\nthe urine, of dark color, and without clots, it ma} 7 be concluded\\nthat its source was renal, and it would be presumptive evidence\\nof the presence of more or less serious disease. On the other\\nhand, if the blood appeared somewhat separate from the urine,\\nof a brighter and more arterial tint, and associated with small\\nclots, it ma} T be concluded that it originated from the lower\\nurinary tract, most likely the bladder, and further inquiry is\\nlikely to elicit symptoms of stone, villous growths, early tubercu-\\nlosis, or even malignant disease. Unless in the early stages of\\nthe conditions just named, the accompanying symptoms will be so\\npronounced that they could scarcely be overlooked. There is a", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0416.jp2"}, "417": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. 375\\nperiod, however, in the early stages of most of these diseases,\\nin which mild hematuria may he almost the only S} T mptom\\nobservable hence the importance of ascertaining its occurrence.\\nIt will be a safe rule for the medical examiner to consider a\\nsubject in danger of serious disease of the kidneys or bladder\\nwho presents a history of haematuria, unless five years have\\npassed since the last appearance of such attacks, the urine\\nremaining in the interval in all respects normal.\\nCalculi.\\nAn examination of the urinary organs cannot be considered\\ncomplete without inquiring for any attacks of renal colic or the\\npassage of calculi by the applicant. A number of such attacks\\nmay have occurred, and even small calculi ma}- exist and be in\\nprocess of growth in the kidneys without any evidence thereof\\nbeing present in the urine.\\nThe passage of renal calculus, however small, is usually at-\\ntended by symptoms of so marked and characteristic an order\\nthat it will be distinctly remembered by the applicant upon in-\\nterrogation. The sudden onset of pain in the side without any\\napparent cause; the intense suffering for some hours, in which\\nthe pain extends along the course of the ureter, often retracting\\nthe testicle on the affected side frequently accompanied by\\nnausea, vomiting, cold perspiration, and even some degree of\\ncollapse, and followed by sudden and complete relief. These\\nform a chain of phenomena so pronounced and distinctive that\\nthey are neither likely to be overlooked by the applicant nor\\nmisinterpreted by the medical examiner.\\nA man may have one or more such attacks, and the s} T mp-\\ntoms may permanently disappear without calculus lodging and\\ndeveloping into calculous disease. Such cases are termed spon-\\ntaneous recovery but it is not safe to class cases in this\\ncategory until at least five years have passed since the last\\nattack, the urine remaining constantly free from pus and blood.\\nUnder the latter circumstances it may be concluded that the con-\\nditions whicli favored the formation of calculi have passed away.\\nIf, on the other hand, attacks have been frequent, and especially\\nif there have been recent attacks, it may be concluded that the", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0417.jp2"}, "418": {"fulltext": "376 APPENDIX.\\nconditions favorable for the development of calculous disease\\nin the urinary tract still continue, and such cases cannot be\\nsafely recommended for life-insurance.\\nFrom the sum of these considerations the following rules\\nmay be formulated, as a concise guide in conducting examina-\\ntions of the urine and reaching conclusive data as to the con-\\ndition of the kidneys and urinary organs in life-insurance\\nRules.\\n1. Secure a freshly-voided sample of urine for examination,\\npreferably after food and exercise, and be certain that the urine\\nexamined has been voided by the applicant.\\nIf the examination result in any doubts as to the true con-\\nditions present, procure a sample of a mixture of the whole\\ntwenty-four hours product of the kidneys, and also another\\nfreshly-voided sample of the urine examine both of these sepa-\\nrately and compare carefully the results.\\n2. Carefully observe first the phj-sical characters of the urine,\\nmore especially (a) The appearance. If cloudy, ascertain the\\ncause, whether due to phosphates, urates, pus, blood, etc. The\\ncolor, whether light (water}-) like hydruria,or greenish (diabetic-\\nlike), or normal straw-yellow, (b) The specific gravity. If 1025\\nor above, search for sugar. If below 1020 search for albumin,\\nand also ascertain the total amount of urea, (c) The chemical\\nreaction. If very sharply acid (possibly diabetic, rheumatic, or\\ngouty conditions are present). If alkaline from fixed alkali\\n(probably debility, dyspepsia or fasting, or vegetable diet). If\\nammoniacal (cystitis is suggested).\\n3. Examine next for albumin with the ferrocyanic test as\\ndirected. Do not ignore the presence of albumin, however mi-\\nnute the quantity may be. If in any doubt as to the presence of\\nminute traces, take two perfectly-clean test-tubes half full of the\\nsuspected urine. To one apply the ferrocyanic test, but to the\\nother add no reagent whatever. Stand the two side by side in\\na good light for ten minutes. If they remain alike, albumin is\\nabsent if faint opacity occur in the one with the test, albumin\\nis present.\\n4. Examine next for sugar with Haines s test as directed,", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0418.jp2"}, "419": {"fulltext": "EXAMINATION OF URINE FOR LIFE-INSURANCE. :;7 7\\nBoil 1 drachm of this test; add 8 or 10 drops of the urine, no\\nmore; boil again half a minute. If sugar be present, a yellow\\nor yellowish-red precipitate will appear. If no such precipitate\\nappear, sugar is absent. If a gray or whitish precipitate occur,\\nit is caused b} T earthy phosphates, and not sugar. If any doubts\\narise as to the presence of sugar by the copper test, appeal to\\nthe phenyl-lrydrazin test for confirmation.\\n5. An estimation should next be made of the quantity of\\nurea in the urine with the Doremus ureometer, but especially if\\nthe specific gravity of the urine be materially reduced. Should\\nthe proportion of urea be 25 per cent, below normal, or lower,\\nestimate the whole excretion of urea for twent3 -four hours, and\\nif below 300 grains report the fact to the home office.\\n6. In cases in which a microscopical examination of the urine\\nis requested by the company, carefully report the following feat-\\nures of the urinary sediment (a) The presence, quantity, and\\nfeatures of pus- or blood- corpuscles, i.e., whether well preserved\\nor partly broken down. (6) The presence, number, and charac-\\nters of any renal casts, especially noting their size, whether clear\\nor granulated, and if an} epithelium or blood-corpuscles are\\nseen attached to the casts.\\n7. Inquire for a history of attacks of renal colic (passage of\\ncalculi) or haematuria. Report the number and special features\\nof such attacks, especially the severity and length of time they\\nmay have continued, and the date of the last attack.\\n25", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0419.jp2"}, "420": {"fulltext": "APPENDIX B.\\nREAGENTS AND APPARATUS FOR QUALITATIVE\\nAND DETERMINATE URANALYS1S.\\nAll liquid-reagent bottles should be made of the purest glass\\nand fitted with carefully-ground glass stoppers. The four-ounce\\nbottles furnished by Whitall, Tatum Co., of Philadelphia,\\nare the best for the purpose. The glass from which these bottles\\nare made is free from lead or other impurities, and, as a double\\ncheck in laboratory work, each bottle has the name of the con-\\ntained reagent upon it in raised-glass letters with ground tops,\\nand the chemical symbol of the reagent below and separate from\\nthe lettering. An additional advantage of such bottles is the\\ngreat facility with which they can be cleaned and kept in order.\\nFor efficient laboratory work the following list of reagents and\\napparatus should be kept in stock but for the general prac-\\ntitioner, who only does the main essentials of urinary testing,\\nthe list from 1 to 14 and from 34 to 42 and 66 to 75, inclusive,\\nwill answer his purposes very well\\nLiquid Reagents.\\n1. Nitric Acid, C. P. (HN0 3\\n2. Hydrochloric Acid, C. P. (HC1).\\n3. Acetic Acid (C 2 H 4 2\\n4. Potassium Hydroxid (KOH).\\n5. Sodium Hydroxid [(NaOH), 40 per-cent. solution].\\n6. Bromine (I -pound bottle).\\n7. Sat. Sol. Sodium Chloride.\\n8. Alcohol (95 per cent.).\\n9. Glycerin (C. P.; free from lead),\\n10. Aquae Destill.\\n11. Sol. Potassium Ferrocyanide (1 in 20).\\n12. Sol. Baric Chloride (4 oz. baric-chloride crystals, 16 oz. distilled\\nwater, 1 oz. hydrochloric acid).\\n(378)", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0420.jp2"}, "421": {"fulltext": "REAGENTS AND APPARATUS. 37 9\\n13. Magnesium Mixture (magnesium sulphate, ammonium chloride, aa gj\\ndistilled water, gviij liquor ammonia, 3J).\\n14. Sol. Silver Nitrate [(standard aqueous solution, 1 in 8), 5 j to 5J.].\\n15. Strong Ammonia (U. S. P. sp. gr., 0.90).\\n16. Nitrous Acid (HN0 2\\n17. Sulphuric Acid (H 2 S0 4\\n18. Sol. Potass. Ferrocyanide [1 in 10 (for quantitative determination\\nof albumin, Purdy s method)].\\n19. Millon s Reagent.\\n20. Sol. Ferric Chloride (Fe 2 Cl 6\\n21. Sol. Calcic Chloride (CaCl 2\\n22. Sol. Potassio-mercuric Iodide [(Tanret s test) Potass, iodidi, 3.32\\ngrammes hyd. bichloridi, 1.35 grammes distilled water, to 100\\ncubic centimetres. (Dissolve the two salts separately, mix, and\\nmake up to 100 cubic centimetres with distilled water.)].\\n23. Sol. Plumbic Acetate [(Pb0 2 [C 2 H 3 0] 2 1 part lead acetate to 4\\nparts distilled water].\\n24. Sol. Basic Plumbic Acetate [(Pb 2 C 2 H 3 2 2PbO); 1 part basic lead\\nacetate to 4 parts distilled water].\\n25. Hydrogen Dioxide (Oakland Chemical Company).\\n26. Sat. Sol. Ammonium Chloride.\\n27. Sat. Sol. Ammonium Sulphate.\\n28. Sat. Sol. Baric Nitrate.\\n29. Cupric-Sulphate Sol.\\n30. Sodium Nitroprusside (2-per-cent. solution).\\n31. Tinct. Guaiaci.\\n32. Turpentine.\\n33. Uranium Nitrate (5-per-cent. solution).\\nSolid Reagents.\\n34. Potassium Ferrocyanide (C. P).\\n35. Cupric Sulphate (C. P.).\\n36. Sodium Hydroxid (purified by alcohol).\\n37. Potassium Hydroxid (jmrified by alcohol).\\n38. Phenyl-hydrazin Hydrochlorate.\\n39. Sodium Acetate.\\n40. Sodium Chloride (C. P.).\\n41. Ferric Chloride.\\n42. Picric Acid.\\n43. Sulphanilic Acid.\\n44. Barium Chloride (crystals).\\n45. Sodium Carbonate (C. P.).\\n46. Magnesium Sulphate (C. P.),\\n47. Sodium Nitrite.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0421.jp2"}, "422": {"fulltext": "380 APPENDIX.\\n48. Plumbic Acetate.\\n49. Basic Plumbic Acetate.\\n50. Ammonium Chloride.\\n51. Ammonium Sulphate.\\n52. Citric Acid.\\n53. Hydrarg. Bichloridi.\\n54. Potassium Iodidi.\\n55. Barium Nitrate (crystals).\\n56. Uranium Nitrate.\\n57. Ammonium Nitrate.\\n58. Barium Hydrate.\\n59. Calcium Carbonate.\\n60. Oxalic Acid.\\n61. Potassium Bichromate.\\n62. Potassium Chlorate.\\n63. Potassium Permanganate.\\n64. Resorcin.\\n65. Tannin.\\nApparatus.\\n66. Test-tubes. Several sizes. Some with bases so that they will stand\\non a table or shelf. Some should be graduated for the purpose of\\napproximate bulk determinations.\\n67. Spirit-lamp and Bunsen burner.\\n68. Urinometer (preferably Squibb s).\\n69. Test-tube rack and brush.\\n70. Graduate glasses, one for 100 cubic centimetres measurement and\\none for 500 cubic centimetres.\\n71. Doremus s ureometer.\\n72. Nipple pipettes.\\n73. Litmus-paper (blue and red) and Swedish filtering-paper (two sizes).\\n74. Glass funnels (two sizes).\\n75. An accurate thermometer.\\n76. Set of porcelain capsules.\\n77. Set of beaker glasses.\\n78. Long funnel for filtering through animal charcoal.\\n79. Glass rods.\\n80. Retort-stand with water-bath.\\n81. Platinum spoon and foil.\\n82. Blow-pipe.\\n83. Burettes graduated in fractions of a cubic centimetre also in minims.\\n84. Volume pipettes (set from 5 to 50 cubic centimetres).\\n85. A litre flask.\\n86. An accurate scale, turning at of a grain.", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0422.jp2"}, "423": {"fulltext": "REAGENTS AND APPARATUS. 381\\n87. A good centrifuge capable of 2000 revolutions per minute, with 12\\nto 14 inches from tip to tip of tubes when in motion, and armed\\nwith both sediment and percentage tubes of capacity of at least\\n15 cubic centimetres each.\\n88. Microscope with J -inch and 1-inch objectives, glass slides, covers.\\nshallow cells, etc.\\nFor the purpose of recording the results of urinary analysis\\nsome systematic form of blank should be employed, both to ex-\\npedite and systematize work, as well as to preserve the results\\nin the form of a permanent record. These blanks may be kept\\nin separate sheets or bound in book-form, or, better still, both.\\nIn the latter case the original analysis may be recorded in the\\nvolume as a permanent record, and a copy may be furnished the\\npatient on one of the separate sheets or slips. For practical\\nclinical purposes the record of analysis should have prominently\\nin view the leading or more important features of the urine,\\nnormal and abnormal, to which suggestive headings should be\\nadded for those features less commonly met with, and those of\\nminor importance or significance. Any attempt at compre-\\nhensive analysis of the urine must include quantitative as well\\nas qualitative data. The blank form on the succeeding page\\n(Xo. 1, Regular Form) will answer most of the usual require-\\nments for both qualitative and quantitative data. It aims at a\\nreasonable measure of completeness without unnecessary elab-\\noration. In case only qualitative data are worked out. the\\nmore simple form on the succeeding page will be found useful\\n(Xo. 2, Special Form).", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0423.jp2"}, "424": {"fulltext": "ANALYSIS OF URINE.\\n(NO. 1. REGULAR FORM.)\\nCASE\\nCHEMICAL EXAMINATION.\\nSPECIMEN Total 24 hours c.c. ounces.\\nTRANSPARENCY\\nCOLOR Vogel s scale).\\nSPECIFIC GRAVITY at 15 U. (Westphal balance).\\nCHEMICAL REACTION\\n(Heat test, Purdy s method)\\nALBUMIN (Ferrocyanide test)\\n(Tanret s test)\\nNUCLEO-ALBUMIN (Mucin)\\nr (Copper test)\\nSUGAR\\n((Phenyl-hydrazin test).\\nACETONE\\nDIACETIC ACID\\nINDICAN\\nBILE\\nHEMOGLOBIN\\nDIAZO REACTION\\nQUANTITATIVE ESTIMATIONS.\\nVolumetric\\nPercentage.\\nGravimetric\\nPercentage.\\nGrains\\nper\\nFluidounce.\\nAmount in 24 Hours.\\nGrammes.\\nGrains.\\nUREA (Knop-Hoefner method)\\nACIDITY (Expressed as oxalic acid)\\nSUGAR\\nALBUMIN\\nCHLORIDES\\nPHOSPHATES\\nSULPHATES\\nSEDIMENT\\n(382)", "height": "5098", "width": "3051", "jp2-path": "practicaluran00purd_0424.jp2"}, "425": {"fulltext": "date\\ncasts\\nMICROSCOPIC EXAMINATION.\\nNUMBER OF SLIDES EXAMINED\\nORGANIZED SEDIMENT.\\nEpithelial Finely Granular\\nNarrow Hyaline Dark Granular\\n.Medium Hyaline Bloody\\nBroad Hyaline Amyloid\\nFALSE CASTS (Cylindroids of Thomas.)\\nSmall Round\\nSpindle Form\\nPavement Form\\nPUS SPERMATOZOA\\nBLOOD-CORPUSCLES OTHER PRODUCTS\\nURIC ACID\\nCALCIUM OXALATE\\nUNORGANIZED SEDIMENT.\\nCRYSTALLINE.\\nTRIPLE PHOSPHATE\\nOTHER FORMS\\nURATES\\nPHOSPHATES\\nOTHER FORMS\\nAMORPHOUS.\\nMICRO-ORGANISMS.\\nREMARKS.\\nREACTION.\\nNegative. Decided.\\nVery faint. Strong.\\nFaint. Very strong.\\nTERMS USED.\\nEXPRESSING\\nQUANTITY.\\nAbsent. Moderate amount.\\nLarge amount.\\nTraces.\\nSmall amount\\nExcessive amount.\\nNUMBER.\\nNone. Moderate number.\\nVery few. Numerous.\\nFew. Very numerous.\\n(383)", "height": "5098", "width": "3051", "jp2-path": "practicaluran00purd_0425.jp2"}, "426": {"fulltext": "ANALYSIS OF URINE.\\niNo. 2. Special form.)\\ncase.\\nCHEMICAL EXAMINATION.\\nSPECIMEN\\nTRANSPARENCY\\nCOLOR\\n..Vogel s scale.)\\nCHEMICAL REACTION\\nSPECIFIC GRAVITY\\nUREA Percentage\\nHeat test (Purdy s method)\\nALBUMIN Ferrocyanide test\\nTanret s test\\nat 15\u00c2\u00b0 C. Westphal balance).\\nGrains per fluidounce.\\nNUCLEO-ALBUMIN (Mucin)\\nCopper test\\nSUGAR\\nPhenyl-hydrazin test..\\nACETONE\\nDIACETONE\\nINDICAN\\nBILE\\nH/CMOGLOBIN\\nDIAZO TEST (Ehiiich s)\\nOTHER PRODUCTS\\n(384)", "height": "5102", "width": "3051", "jp2-path": "practicaluran00purd_0426.jp2"}, "427": {"fulltext": "Date\\ncasts J\\nMICROSCOPIC EXAMINATION.\\nNUMBER OF SLIDES EXAMINED\\nORGANIZED SEDIMENT.\\nr Epithelial Finely Granular\\nNarrow Hyaline Dark Granular\\nMedium Hyaline Bloody\\nBroad Hyaline Amyloid\\nFALSE CASTS (Cylindroids of Thomas\\nSmall Round\\nEPITHELIA Spindle Form\\nPavement Form\\nPUS SPERMATOZOA\\nBLOOD-CORPUSCLES OTHER PRODUCTS\\nURIC ACID\\nCALCIUM OXALATE.\\nURATES-\\nPHOSPHATES\\nOTHER FORMS\\nUNORGANIZED SEDIMENT.\\nCRYSTALLINE.\\nTRIPLE PHOSPHATE\\nOTHER FORMS-\\nAMORPHOUS.\\nMICRO-ORGANISMS.\\nREMARKS.\\nREACTION.\\nNegative. Decided.\\nVery faint. Strong.\\nFaint. Very strong.\\nTERMS USED.\\nEXPRESSING\\nQUANTITY.\\nAbsent. Moderate amount.\\nTraces. Large amount.\\nSmall amount. Excessive amount.\\nNUMBER.\\nNone. Moderate nrnnbe\\nVery few. Numerous.\\nFew. Verv numerous.\\n(385)", "height": "5102", "width": "3051", "jp2-path": "practicaluran00purd_0427.jp2"}, "428": {"fulltext": "INDEX.\\nAbnormal urine, 67\\nAcetonuria, 123\\nAcidity of the urine, estimation of, 20\\nAcute atrophy of liver, 351\\nbronchitis, 358\\ndiffuse nephritis, 275\\ngout, 353\\ninfectious diseases, 343\\ninterstitial nephritis, 322\\npleurisy, 358\\nrheumatism, 352\\nAlbumin in the urine, 67\\nbiuret test for, 78\\ncauses of, 6S\\ncolor reactions of, 78\\ndetermination of, 81-84\\nEsbach s method for quantitative es-\\ntimation of, 82\\ngravimetric method for quantitative\\nestimation of, 81\\nPurdy s centrifugal method for quan-\\ntitative estimation of, 80\\nquantitative estimation of, 80\\nsignificance of, 68\\nTanret s titration method for quanti-\\ntative estimation of, 83\\ntests for, 71-79\\nAlbuminuria, 67\\nclinical significance of, 68\\nin life-insurance, 366\\nAlbumosuria, 84\\ndetection of, 85\\nsignificance of, 85\\nAllantoin in urine, 36\\nAmmonio-magnesium phosphate in the\\nurine, 166\\nammonio-magnesium-phosphate cal-\\nculi, 248\\nAmphoteric reaction, 20\\nAmyloid disease of kidneys, 287\\nAnalysis, centrifugal, 63\\nprocess of, 64\\nof calculi, 252\\nAnatomical sediments in urine, 178\\nbacteria, 203\\nblood, 178\\ncylindroids, 197\\nechinococci, 212\\nepithelium, 185\\nfragments of tumors, 202\\npus, 182\\nrenal casts, 189\\nspermatozoa, 200\\nvermes, 208\\n(386)\\nAnatomy of bladder, 266\\nof kidney, 260\\nof renal pelvis, 265\\nof ureters, 265\\nAnimal gum in urine, 48\\nAppendix, 361\\nAromatic substances in urine, 39\\nArticular diseases, 352\\nBacterial casts in urine, 192\\nBacteriuria, 203\\nBile-acids in urine, 127\\ndetection of, 129\\nBile-pigments in urine, 130\\nsignificance and detection of, 131\\nBladder, benign growths of, 338\\ninflammation of, 329\\nmalignant disease of, 337\\nstone in, 333\\ntuberculosis of, 335\\nBlood, in the urine, 178\\ncasts in urine, 190\\nBronchitis, the urine in, 358\\nCalcium- carbonate gravel, 249\\noxalate calculi, 246\\nsediments, 162\\nphosphate calculi, 247\\nCalculi, 241\\nammonio-magnesium phosphate, 248\\nanalysis of, 252\\ncalcium- carbonate, 249\\noxalate, 246\\nphosphate, 248\\ncystin, 246\\ndifferentiation of, 250\\nfatty, 249\\nindigo, 249\\nmixed phosphatic, 248\\nprostatic, 249\\nrelations to life-insurance, 375\\nuratic, 245\\nuric acid, 243\\nCancer, renal, 297\\nvesical, 337\\nCane-sugar in urine, 121\\nCarbohydrates in urine, 48-49\\nCarbonates of normal urine, 62\\nCarbonic acid in urine, 63\\nCasts, 189, 232\\ndiagnosis of, 233\\nfalse, 234\\nsearch for, 198", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0428.jp2"}, "429": {"fulltext": "INDEX.\\n387\\nCentrifugal analysis of urine, 63\\nauthor s method, 64\\nfor chlorides, 64\\nfor phosphates, 65\\nfor sulphates, 65\\nCentrifugal sedimentation of urine, 148\\nCentrifuge, the author s electric, 149\\nChanges in urine on standing, 5\\nChemical reaction of urine, 14\\nChemical sediments in urine, 156\\ncystin, 170\\nfat, 176\\nleucin and ty rosin, 172\\nmelanin, 175\\noxalates, 152\\nphosphates, 166\\nurates, 159\\nuric acid, 156\\nChlorides in the urine, 50\\nCholera, urine in, 346\\nCholuria, 127\\nChronic diffuse nephritis, 279\\ninterstitial nephritis, 282\\nChyluria, 308\\nclinical features of, 311\\nurine in, 308\\nCirrhosis of kidney, 282\\nof liver, 350\\nClinical symptoms of acute diffuse\\nnephritis, 278\\nof acute interstitial nephritis, 323\\nof acute renal hyperemia, 27:2\\nof amyloid kidneys, 290\\nof calculus and gravel, 250\\nof cancer of the bladder, 338\\nof chronic diffuse nephritis, 2S2\\nof chronic interstitial nephritis, 2S6\\nof chyluria, 311\\nof cystic disease of kidneys, 291\\nof cystitis, 322\\nof diabetes insipidus, 312\\nof diabetes mellitus, 314\\nof hemoglobinuria, 308\\nof hydronephrosis, 319\\nof movable kidney, 328\\nof passive renal hyperemia, 274\\nof pyelitis, 326\\nof pyonephrosis, 321\\nof renal calculus, 301\\nof renal cancer, 298\\nof renal embolism, 303\\nof renal tuberculosis, 296\\nCollection of urine for analysis, G\\nColor of urine, 7\\nComposition of normal urine, 4-21\\nConsistence of urine, 12\\nCreatin and creatinin in urine, 37\\nCylindroids in the urine, 197\\nCystic disease of kidney, 291\\nCystin calculus, 246\\nCvstinuria, 170\\nCystitis, 329\\nDecompositional changes in urine, 5\\nDetection of acetone in urine, 124\\nof albumin in urine, 71\\nof albumose in urine, 85\\nof allantoin in urine, 37\\nof bile-acids in urine, 129\\nof bile-pigments in urine, 131\\nof cane-sugar in urine, 121\\nof carbonates in urine, 62\\nof chlorides in urine, 51\\nof creatin and creatinin in urine, 38\\nof diacetone in urine, 126\\nof fibrin in urine, 96\\nof globulin in urine, 90\\nof glycuronic acid in urine, 121\\nof haemoglobin in urine, 94\\nof hippuric acid in urine, 40\\nof indoxyl potassium sulphate in\\nurine, 44\\nof inosite in urine, 119\\nof lactose in urine, 118\\nof levulose in urine, 118\\nof mucin in urine, 50, 98\\nof normal urobilin in urine, 46\\nof oxybutyric acid in urine, 136\\nof peptone in urine, 88\\nof phenol potassium sulphate in\\nurine, 43\\nof phosphates in urine, 57\\nof sugar in urine, 101\\nof sulphates in urine, 59\\nof urea, 24\\nof uric acid, 32\\nof xanthin, 36\\nDetermination of albumin in urine, SI\\nof allantoin in urine, 37\\nof bile-acids in urine, 130\\nof carbonates in urine, 62\\nof chlorides, total, in urine, 52\\ncentrifugal method, 64\\nof creatinin in urine, 38\\nof globulin in urine, 90\\nof hippuric acid in urine, 40\\nof phenol potassium sulphate in\\nurine, 43\\nof phosphates, total, in urine, 58\\ncentrifugal method, 65\\nof sugar in the urine, 107\\nof sulphates, total, in urine, 59\\ncentrifugal method, 65\\nof urea, 24\\nof uric acid, 33\\nDeutero-albumose in the urine, 86\\nDiabetes insipidus, 311\\nsymptoms of, 312\\nurine in, 311\\nDiabetes mellitus, 312\\nsymptoms of, 314\\nurine in, 313\\nDiacetic acid in urine, 125\\ndetection of, 126\\nDiaceturia, 125", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0429.jp2"}, "430": {"fulltext": "388\\nINDEX.\\nDiaceturia, significance of, 126\\nDiagnosis of acute diffuse nephritis, 275\\nof acute interstitial nephritis, 322\\nof acute renal hyperemia, 271\\nof amyloid kidneys, 286\\nof benign growths in bladder, 338\\nof cholera, 346\\nof chronic diffuse nephritis, 279\\ninterstitial nephritis, 282\\nof chyluria, 308\\nof cystic disease of kidneys, 291\\nof diabetes insipidus, 311\\nof diabetes mellitus, 312\\nof hemoglobinuria, 306\\nof hydronephrosis, 318\\nof passive renal hyperaemia, 273\\nof pulmonary tuberculosis, 353\\nof pyelitis, 323\\nof pyonephrosis, 320\\nof renal calculus, 299\\ncancer, 297\\nembolism, 303\\nmisplacements, 326\\ntuberculosis, 294\\nof uraemia, 303\\nof vesical cancer, 337\\ninflammation, 329\\nstone, 333\\ntuberculosis, 335\\nDiastase in the urine, 49\\nDiazo reaction in urine, 134\\nDiffuse nephritis, acute, 275\\nchronic, 279\\nDigestive system, urine in diseases of,\\n359\\nDiphtheria, urine in, 348\\nDiseases of liver, urine in, 350\\nof nervous system, urine in, 354\\nof respiratory organs, urine in, 355\\nDistoma haematobium in urine, 208\\nEchinococci in urine, 212\\nEpilepsy, urine in, 354\\nEpithelial casts, 191\\nEpithelium in urine, 185\\nsignificance of, 188\\nEthereal sulphates in urine, 41\\nExamination of urine for life-insur-\\nance, 361\\nFatty acids in urine, 48\\ncasts in urine, 194\\nconcretions in urine, 249\\ndeposits in urine, 176\\nFerments in the urine, 49\\nFibrinuria, 95\\nFilaria sanguinis hominis, 210\\nFragments of growths in urine, 202\\nGases in urine, 63\\nGlobulinuria, 89\\nsignificance of, 89\\nGlycero-phosphoric acid in urine, 48\\nGlycogen in the urine, 122\\nGlycosuria, 99\\nsignificance of, 100\\nGlycuronic acid in urine, 120\\nsignificance of, 121\\nGout, acute, urine in, 353\\nGranular casts, 192\\nGravel, ammonio magnesium phos-\\nphate, 248\\nanalysis of, 253\\ncalcium- carbonate, 249\\noxalate, 246\\nphosphate, 248\\ncystin, 246\\ndifferentiation, clinical, 250\\nfatty concretions, 249\\nindigo concretions, 249\\nmixed phosphatic, 248\\nprostatic concretions, 249\\nuratic, 245\\nuric acid, 243\\nxanthin, 247\\nHaematuria, 178\\nin life-insurance examinations, 374\\nsignificance of, 179\\nHaemoglobin in the urine, 92\\ndetection of, 94\\nHaemoglobinuria, 306\\nHetero-albumose, 86\\nHippuric acid in the urine, 39\\nHyaline casts, 194\\nHydronephrosis, 318\\nsymptoms of, 319\\nurine in, 219\\nHyperaemia, acute renal, 271\\nchronic renal, 273\\nHysteria, urine in, 354\\nIndigo concretions, 248\\nIndoxyl-potassium sulphate (indican),\\n43\\nIndoxyl-sulphuric acid, 132\\nInorganic constituents of urine, 50\\nInosite, 49\\nInosituria, 119\\nInterstitial nephritis, acute, 322\\nsymptoms of, 323\\nurine in, 322\\nchronic, 282\\nsymptoms of, 286\\nurine in, 283\\nIron in urine, 63\\nJaundice, urine in, 351\\nin acute yellow atrophy, 351\\nKidney, acute diffuse inflammation of,\\n275\\nacute interstitial inflammation of, 323\\namyloid disease of, 286", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0430.jp2"}, "431": {"fulltext": "INDEX.\\n389\\nKidney, anatomy of, 260\\ncalculus of, 299\\ncancer of, 297\\ncasts of, iu urine, 189\\nchronic diffuse inflammation of, 279\\nchronic interstitial inflammation of,\\n282\\ncystic disease of, 291\\nembolism of, 302\\nhydronephrosis of, 308\\nhyperemia, acute, 271\\npassive, 273\\nmovable, 326\\npyonephrosis, 320\\ntuberculosis of, 294\\nLactosuria, 118\\nLeucin deposits in urine, 172\\nsignificance of, 175\\nLeucomaines in urine, 136\\nLevulosuria, 117\\nLife-insurance, examination of urine\\nfor, 361\\nalbuminuria, relations of, 364\\ncalculi, relations of, 377\\ncollection of urine for, 363\\nhematuria, relations of, 374\\nmicroscopical examination of urine\\nfor, 372\\npyuria, relations of. 373\\nsugar in urine in 368\\nurea, 370\\nLipuria, 176\\nMelanuria, 175\\nsignificance of, 176\\nMeningitis, urine in, 354\\nMethod of testing for albumin, 79\\nsugar, 100\\nMicrococcus urea?, 204\\nMicroscope, 215\\ncare of the, 226\\ncoarse and fine adjustment of the, 216\\ndiaphragms of the, 216\\ndraw-tube of the, 218\\nillumination in the use of, 224\\nnose-piece of the, 218\\nobjectives of the, 216, 220\\nocular, or eye-piece, of the, 216\\nreflector of the, 216\\nsubstage condenser of the, 218\\nMicroscopical examination of urine for\\nlife-insurance, 372\\nMilk-sugar in urine, 48\\nMixed phosphatic gravel, 248\\nMovable kidney, 326\\nMucin, 97\\nMucinuria, abnormal, 97\\nnormal, 40\\nNephritis, acute diffuse, 275\\ninterstitial, 322\\nNephritis, chronic diffuse, 279\\ninterstitial, 282\\nNitrogen-gas in urine, 63\\nNon-pathogenic fungi in urine, 203\\nNormal urobilin, 45\\nNucleo-albumin, 97\\nOdor of the urine, 9\\nOrganic constituents of the urine, 21\\nallantoin, 36\\ncreatin and creatiniu, 37\\ndiastase, 49\\nethereal sulphates, 41\\nfatty acids, 48\\nferments, 49\\nglycero-phosphoric acid, 48\\nhippuric acid, 39\\nindoxyl-potassium sulphate (in-\\ndie an), 43\\ninosite, 49\\nmilk-sugar, 48\\nmucin, 49\\noxalic acid, 47\\npepsin, 49\\nphenol-potassium sulphate (car-\\nbolic acid), 42\\npigments, 45\\nrennet, 49\\nsuccinic acid, 48\\ntrypsin, 49\\nurea, 21\\nuric acid, 30\\nurochrom, 47\\nuroery thryn 47\\nxanthin, 36\\nOxalate-of-calcium sediments, 162\\nsignificance of, 164\\nOxalic acid in the urine, 47\\nOxybutyric acid in urine, 135\\nOxygen-gas in the urine, 63\\nPassive hyperemia of kidneys, 273\\nPathogenic fungi in the urine, 205\\nPelvis, renal, anatomy of, 265\\ncalculi in, 299\\ninflammation of, 323\\nPeptonuria, 86\\nsignificance of, 87\\nPhenol-potassium sulphate in urine\\n(carbolic acid), 42\\nPhosphates of normal urine, 55\\nPhosphatic sediments in urine, 166\\nsignificance of, 168\\nPhysical characters of urine, 7\\nPhysical examination of bladder, 270\\nof kidneys, 267\\nof ureters, 269\\nPigments of the urine, normal, 45\\nPleurisy, acute, urine in, 358\\nPneumonia, the urine in, 356\\nPrecipitation of urinary sediments, 147\\nby means of the centrifuge. 148", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0431.jp2"}, "432": {"fulltext": "J90\\nINDEX.\\nProstatic concretions, 249\\nProteids in the urine, 67\\ndifferential testing for, 91\\nProteoses in the urine, 84\\nPtomaines in the urine, 136\\nproperties of, 140\\nPulmonary tuberculosis, 355\\nurine in, 355\\nsymptoms of, 355\\nPus in the urine, 182\\nsignificance of, 184\\nPus-casts in the urine, 192\\nPyelitis, 323\\nPyonephrosis, 320\\nurine in, 320\\nsymptoms of, 321\\nPyrexia, simple, urine in, 341\\nPyuria, 182\\nsignificance of, 184\\niu life-insurance, 373\\nQuantitative tests for albumin, 81\\nfor allantoin, 37\\nfor bile-acids, 130\\nfor carbonates, 62\\nfor chlorides, 52\\ncentrifugal, 64\\nfor creatinin, 38\\nfor globulin, 90\\nfor hippuric acid, 40\\nfor phosphates, 58\\ncentrifugal, 65\\nfor sugar, 107\\nfor sulphates, 59\\ncentrifugal, 65\\nfor urea, 24\\nfor uric acid, 33\\nQuantity of urine, normal, 15\\nRenal calculus, 299\\nurine in, 300\\nsymptoms of, 301\\ncancer, 297\\nurine in, 297\\nsymptoms of, 298\\ncasts in urine, 189\\nembolism, 302\\nurine in, 302\\nsymptoms of, 303\\ntuberculosis, 294\\nurine in, 295\\nsymptoms of, 296\\nRennet in urine, 49\\nRheumatism, acute, urine in, 352\\nRules for examiners in life-insurance,\\n376\\nScarlatina, urine in, 345\\nSedimentation of urine, 147\\nSediments in the urine, 147\\nanatomical, bacteria, 203\\nblood, 178\\nSediments in the urine, anatomical,\\ncyiindroids, 197\\nechinococci, 212\\nepithelium, 185\\nfragments of growths, 202\\npus, 182\\nrenal casts, 189\\nspermatozoa, 200\\nvermes, 208\\nchemical, calcium oxalate, 162\\ncystin, 170\\nfatty, 176\\nleucin and ty rosin, 172\\nmelanin, 175\\noxalates, 162\\nphosphatic, 166\\nurates, 159\\nuric acid, 156\\nSolids of the urine, 16\\nSpecific gravity of the urine, 12\\nSpermatozoa in urine, 200\\nsignificance of, 201\\nStone, in the bladder, 333\\nurine in, 334\\nsymptoms of, 334\\nin the kidney, 299\\nurine in, 300\\nsymptoms of, 301\\nSuccinic acid in the urine, 48\\nSugar in the urine, 99\\ndetection of, 101\\ndetermination of, 107\\nin life-insurance examinations, 368\\nSulphates in the urine, 59\\nTable for chlorides in the urine, 64\\nestimating amount of sugar in the\\nurine, 108\\nphosphates in the urine, 65\\nsulphates in the urine, 65\\nof reactions of proteids in the urine, 93\\nPurdy s quantitative method Tor\\nalbumin in urine (centrifugal),\\n80\\nTests, qualitative, for acetone, 124\\nfor albumin, 71\\nfor albumose, 85\\nfor allantoin, 37\\nfor bile-acids, 129\\nfor bile-pigments, 131\\nfor cane-sugar, 121\\nfor carbolic acid, 43\\nfor carbonates, 62\\nfor chlorides, 51\\nfor creatinin, 38\\nfor diacetic acid, 126\\nfor fibrin, 96\\nfor globulin, 90\\nfor glycuronic acid, 121\\nfor haemoglobin, 94\\nfor hippuric acid, 40\\nfor indican, 44", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0432.jp2"}, "433": {"fulltext": "INDEX.\\n391\\nTests, qualitative, for inosite, 119\\nfor lactose, 118\\nfor levulose. 118\\nfor mucin. 50, 96\\nfor normal urobilin. 46\\nfor oxy butyric acid, 136\\nfor peptone. SS\\nfor phosphates. 57\\nfor sulphates. 59\\nfor urea. 24\\nfor uric acid. 32\\nfor x an thin, 36\\nTests, quantitative, for albumin, SI\\nfor allantoic, 37\\nfor bile-acids. 130\\nfor bile-pigments, 131\\nfor carbonates. 62\\nfor chlorides, 52\\ncentrifugal, 64\\nfor creatinin, 38\\nfor globulin, 90\\nfor hippuric acid, 40\\nfor indie an, 44\\nfor phosphates, 58\\ncentrifugal, 65\\nfor sugar. 107\\nfor sulphates, 59\\ncentrifugal, 65\\nfor urea, 24\\nfor uric acid, 33\\nToxic properties of urine. 141\\nTransparency of urine, 11\\nTrypsin in the urine, 49\\nTuberculosis of bladder. 335\\nurine in, 335\\nsymptoms of. 336\\nTuberculosis of kidney. 295\\nurine in, 295\\nsymptoms of. 296\\nTuberculosis, pulmonary, urine in, 355\\nTumors, benign, of bladder. 33S\\nmalignant, of bladder. 337\\nof kidney. 297\\nTumors, fragments of. 202\\nTyphoid fever, urine in. 343\\nTyphus fever, urine in. 349\\nTyrosinuria, 172\\nsignificance of, 175\\nUraemia, 303\\nurine in, 303\\nUranalysis. qualitative and determi-\\nnate, reagents and apparatus\\nfor, 37S\\nUrea. 21\\nUric acid. 30\\nUrinary sediments, crystals in. 235\\nepittielia in, 235\\nexamination of. 229\\nmicro-organisms in, 237\\nmicroscopical search of, 232\\npus- and blood- corpuscles in. 236\\nUrine, in acute atrophy of liver, 351\\nin acute bronchitis. 35S\\nin acute diffuse nephritis, 275\\nin acute gout, 353\\nin acute interstitial nephritis. 321\\nin acute renal hyperemia, 272\\nin acute rheumatism. 352\\nin amyloid kidneys. 288\\nin benign growths of bladder,\\nin calculus of bladder, 334\\nin calculus of kidney. 306\\nin cancer of bladder! 337\\nin cancer of kidney. 297\\nin cholera, 346\\nin chronic diffuse nephritis. 279\\nin chronic interstitial nephritis. 2 S 3\\nin chyluria. 309\\nin cystic disease of kiduev. 292\\nin cystitis. 330\\nin diabetes insipidus. 311\\nin diabetes mellitus. 313\\nin diphtheria. 34S\\nin embolism of kidney. 3o2\\nin epilepsy, 3-54\\nin gout, acute, 353\\nin hemoglobinuria. 307\\nin hydronephrosis. 319\\nin hysteria, 354\\nin meningitis. 354\\nin movable kidney, 327\\nin passive renal hyperemia. 273\\nin pleurisy, acute, 35S\\nin pneumonia, 356\\nin pyelitis. 324\\nin pyonephrosis, 320\\nin renal tuberculosis, 295\\nin scarlatina. 345\\nin simple pyrexia. 341\\nin tuberculosis of bladder, 335\\nin tuberculosis, pulmonary, 355\\nin typhoid fever, 343\\nin typhus fever, 349\\nin variola, 346\\nin yellow fever. 349\\ninorganic constituents. 50\\ncarbonates. 62\\nchlorides, 50\\ngases. 63\\niron. 63\\nphosphates. 55\\nsulphates. 59\\norganic constituent?, 21\\nallantoin. 36\\nere a tin and creatinin, 37\\ndiastase. 49\\nethereal sulphates. 41\\nfatty acids. 48\\nferments. 49\\nglyeero-phosphoric acid. 4S\\nhippuric acid. 39\\nindoxvl-potassium sulphate (in-\\ndican).43", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0433.jp2"}, "434": {"fulltext": ":J92\\nINDEX.\\nUrine, organic constituents, inosite, 49\\nmilk sugar, 48\\nmucin, 49\\noxalic acid, 47\\npepsin, 49\\nphenol potassium sulphate (car-\\nbolic acid), 42\\npigments, 45\\nrennet, 49\\nsuccinic acid, 48\\ntrypsin, 49\\nurea, 21\\nuric acid, 30\\nurochrom, 47\\nuroerythryn, 47\\nxanthin, 36\\nphysical characters of, 7\\nchemical reaction, 14\\ncolor of, 7\\ncomposition of, 4\\nconsistence of, 12\\nodor of, 9\\nquantity of, 15\\nsolids of, 16\\nUrine, physical characters of, transpar-\\nency of, 11\\nUrobilin, normal, 45\\nUrochrom, 47\\nUroerythryn, 47\\nVariola, the urine in, 348\\nVermes, in the urine, 208\\ndistoma hsematobium, 208\\nechinococci, 212\\nfilaria sanguinis hominis, 210\\nstrongylus gigas, 213\\nVesical stone, 333\\nurine in, 334\\nsymptoms of, 334\\nVesical tuberculosis, 335\\nurine in, 335\\nsymptoms of, 336\\nXanthin, 36\\nconcretions of, in urine, 247\\nYellow atrophy of liver, acute, 351\\nYellow fever, urine in, 349", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0434.jp2"}, "435": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0435.jp2"}, "436": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0436.jp2"}, "437": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0437.jp2"}, "438": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0438.jp2"}, "439": {"fulltext": "", "height": "4895", "width": "3051", "jp2-path": "practicaluran00purd_0439.jp2"}, "440": {"fulltext": "", "height": "5320", "width": "3432", "jp2-path": "practicaluran00purd_0440.jp2"}}