■ 
ruination of Urine 
Tyson E X A M I N A T IO N 
OF 
U R I N E. THE SAME AUTHOR. 
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Practitioner. 1. 
BaleYeUow. 
Z 
lightYello w. 
3. 
Yellow. 
d. 
Reddish Yellow. 
5. 
Yellowish Red. 
6. 
Red. 
7. 
Brownish Red. 
8. 
Reddish drown. 
9. 
Brownish Black. 
FromSTa.tiiT'e 'byJfrJ'.Vbyel. 
VOGEL'S SCALE OF URINE TINTS. A GUIDE 
TO THE 
PRACTICAL EXAMINATION 
OF 
URINE. 
FOR THE USE OF PHYSICIANS AN4) STUDENTS. 
BY 
• JAMES M.D., 
Professor of General Pathology and Morbid Anatomy in the University of Pennsyl- 
vania; one of the Physicians to the Philadelphia Hospital; Pet low of the 
College of Physicians of Philadelphia, etc., etc., etc. 
FIFTH EDITION. 
REVISED AND CORRECTED. 
WITH COLORED PLATES AND WOOD ENGRAVINGS. 
PHILADELPHIA? 
P. BL AK 1ST ON, SON 
No. 1012 Walnut Street. 
1886. Entered according to Act of Congress, in the year 1885, by 
JAIME'S TYSON, M. D„ 
In the Office of the Librarian of Congress, at Washington, D. C. 
SHERMAN & CO., PRINTERS, 
PHILADELPHIA. PREFACE TO THE FIFTH EDITION. 
The exhaustion of a large edition of this manual in 
a short time has stimulated the author to further at- 
tempts to make it meet the wants of the student and 
practitioner. The fourth edition was just printing when 
the first announcements were made as to the new and 
delicate tests for albumin, which were, therefore, not 
included. This was perhaps fortunate, for whatever 
would have been published at that time must certainly 
have been erroneous. But in the large attention and 
discussion which they have received since then, they 
may be said to have nearly if not quite found their 
place, and the author, while endeavoring to estimate 
them correctly, has also sought to place them before 
the profession in a shape which will permit them to be 
further tested. 
The use of these tests has also increased the impor- 
tance of that class of proteids represented by peptones 
and mucin, as constituents of urine, and it has been 
found necessary to give place to a consideration of 
these, which in previous editions was not thought de- 
manded. 
These and some other additions have increased the 
number of pages in the volume, but it is hoped it has 
not been inconveniently enlarged thereby. 
1506, Spruce Street, Dec. 1st, 1885. LIST OF ILLUSTRATIONS. 
COLORED PLATES. 
Vogel's scale of urine tests, Frontispiece. 
Pigmented markings often found on glass slides, facing page 178 
FIG. PAGE 
1. Measuring-glasses for measuring urine, . . . .18 
2. Apparatus for determining specific gravity, .... 26 
3. Small urinometer, ........ 27 
4. Dr. Squibb's new urinometer and floating cylinder, . . 28 
5. Testing for albumin by nitric acid, . . . . .38 
6. Dr. Johnson's picro-saccharimeter, ..... 84 
7. To illustrate the application of indigo-carmine for the quan- 
titative determination of sugar, ..... 92 
8. Laurent's polarizing saccharimeter, . . . . . -95 
9. Dubosq's polarizing saccharimeter, ..... 97 
10. Crystals of nitrate of urea (from Beale), .... 143 . 
11. Burette stand with two forms of burette, .... 148 
12. Apparatus for estimation of urea by the hypobromite process, 152 
13. Green's measuring tube, ....... 152 
14. Prismatic crystals of sodium urate, spherules of ammonium 
urate, and amorphous urates, with octahedral crystals of 
oxalate of lime (Ranke), ...... 175 
15. Spiculated spherules of ammonium urate along with triple 
(ammonio-magnesian) phosphate and octahedral crystals 
of the oxalate of lime, . . . . . . .176 
16. More usual forms of uric acid crystals (after Harley), . . 180 
WOOD ENGRAVINGS. LIST OF ILLUSTRATIONS. 
X 
FIG. PAGE 
17. More unusual forms of uric acid crystals (after Harley), . 181 
18. Other unusual forms of uric acid, not unlike crystals of the 
triple phosphate of ammonium and magnesium. X 150, • 182 
19. Spherules and spiculated spherules of urate of ammonium 
(sodium?); amorphous granular urates, .... 184 
20. Prismatic crystals of sodium urate, spherules of ammonium 
urate, and amorphous urates with octahedral crystals of 
oxalate of lime (Ranke), ...... 185 
21. Dumb-bell and octahedral crystals of oxalate of lime, . . 187 
22. Crystals of triple phosphate (ammonio-magnesian phos- 
phate), . . . . . . . . . .192 
23. Stellate feathery crystals of triple phosphate, . . .193 
24. Crystalline and amorphous phosphate of lime, . . . 194 
25. Leucin spheres and tyrosin needles, ..... 196 
26. Cystin (after Harley), ........ 198 
27. Mucus- and pus-corpuscles before and after the addition of 
acetic acid, . . . . . . . . . 202 
28. Round epithelial cells from the convoluted tubules of the kid- 
ney found m urine from a case of acute nephritis. X 420, 206 
29. Epithelial cells from different parts of the genito-urinary 
tract, .......... 207 
30. Blood-disks, ......... 209 
31. Epithelial casts and compound granule-cells, . . . 210 
32. Blood-casts (after Whittaker), . . . . . .211 
33. Hyaline casts. X 210, .. . . . . . .212 
34. Hyaline and granular casts, ...... 213 
35. Waxy casts. X 150, ........ 214 
36. Oil-casts and fatty epithelium, . . . . . .215 
37. Mucus-casts (after Whittaker), ...... 216 
38. Human spermatozoids, . . . . . . .219 
39. Yeast fungus (after Harley), .. . . . . .221 TABLE OF CONTENTS. 
INTRODUCTION. 
PACE 
Secretion of Urine, . . . . . • . . .13 
Reagents and Apparatus Required for Examination of Urine, . 15 
Selectinga Specimen of Urine, ....... 18 
General Physical and Chemical Characters of the Urine, . . 19 
To Determine the Amount of Solid Matters in the Twenty-four 
hours' Urine, ......... 32 
PART I. 
Albumin and Tests therefor, ....... 34 
Quantitative Estimation of Albumin, ...... 51 
Other Proteids Found in Urine,....... 54 
Serum-globulin, Globulin or Paraglobulin, . . . . -54 
Mucin, ........... 55 
Peptone, '/"XiEON 6/' 58 
Hemialbumose or Propeptone, . f " 64 
Fibrin, f. . -65 
Sugars found in Urine, . . t. ' . . . . . 67 
Glucose, ..... ... . . -67 
Other Saccharine Substances Found in UriqjtJ' . . . .101 
Inosite, ....... vl . . . 101 
Fruit-sugar or Laevulose, ........ 102 
Sugar of Milk or Lactose, ........ 103 
Acetone and Acetone Producing Substances, .... 104 
Coloring Matters, ......... 109 
Normal Coloring Matters, . . . . . .110 
Abnormal Coloring Matters, . . . . . .119 
Biliary Acids, . . . . . . . . . • 133 
Leucin and Tyrosin, . . . . . . . . -139 
Fatty Matters, .......... 141 
Urea, 142 
Uric Acid, .......... 157 
Urates, 159 XII 
TABLE OF CONTENTS. 
PAGE 
Chlorides,. .......... 161 
Phosphates, . . . . . . . . . .164 
Sulphates, . . . . . 169 
PART II. 
Urinary Deposits, . . . . . . . . .172 
Unorganized Sediments, . . . . . . . .179 
Uric Acid. . . . . . . . . .179 
Uric Acid Compounds, ....... 183 
Oxalate of Lime, . . . • . . . . . 187 
Earthy Phosphates, . . . . . . .191 
Carbonate of Lime, . . . . . . .195 
Leucin and Tyrosin, . . . . . . .195 
Cystin, . . . . . . . . . . 197 
Organized Sediments, . . . . . . . ■ >99 
Mucus and Pus, . . . . . . . .199 
Epithelium, ......... 205 
Blood-corpuscles, . . . . . . . . 208 
Tube-casts, . . . . . . . . .210 
Spermatozoids, . . . . . . . . 218 
Fungi, . . . . . . . . . .219 
The Elements of Morbid Growths, ..... 222 
Entozoa, ......... 222 
The Preservation of Organized LTrinary Sediments for 
Subsequent Examination, ...... 223 
Differential Diagnosis of Renal Diseases, ..... 224 
Urinary Calculi, . . . . . . . . .231 
To Determine the Composition of Calculi, .... 232 
PART III. 
Mode of Recording an Examination, ..... 236 
Tables for Reducing the Metric System into the English and 
versa, and for Converting Degrees Centigrade to 
degrees Fahrenheit and vice versa, ..... 238 
Index, ........... 241 
APPENDIX. PRACTICAL 
EXAMINATION OF THE URINE. 
INTRODUCTION. 
SECRETION OF URINE. 
The theory which explains the secretion of urine most 
consistently with the facts, is one which, while it makes the 
process partly physical, requires also something of the na- 
ture of elaboration in the office of the kidney. Nothing 
can be more attractive at first thought than the theory of 
Ludwig, according to whom the process is a purely physical 
one-partly a filtration and partly a diffusion or osmosis. 
He correctly states that in the capillaries of the Malpighian 
body the blood pressure is relatively greater on account 
of the resistance to the exit of the blood through the efferent 
vessel. As the result of this, a filtration of the watery con- 
stituents of the blood, with some dissolved salts, takes place 
into the Malpighian capsule. Thus the blood is greatly 
thickened when it reaches the second capillary network em- 
bracing the convoluted tubules, into which has passed the 
thin aqueous filtrate from the Malpighian bodies. Here are 
the essential elements of a complete osmometer-an animal 14 
PRACTICAL EXAMINATION OF THE URINE. 
membrane formed by the thin wall of the capillary and the 
delicate basement membrane of the tubule, with a dense 
fluid, the blood, on one side, and a thin saline solution on 
the other. An interchange now takes place, as the result 
of which a current sets in, of the water from the tubules to 
the blood, and of the products of regressive metamorphosis, 
urea, etc., and salts, to the tubules, concentrating the fluid 
in the latter, making it, in a word, urine; while the albu- 
minous constituents of the blood are retained in it because 
of their well-known indisposition to osmosis. 
The objection formerly made to the physical nature of 
the act of secretion of urine, on the ground that we cannot 
by this method account for the formation of an acid fluid 
from an alkaline one, no longer holds, since Dr. Ralfe, of 
London, has shown this to be quite possible. Into one 
limb of a small U-shaped tube, fitted with a membranous 
diaphragm at the bend, he introduced an alkaline solution 
of sodium bicarbonate, and into the other limb a solution 
of neutral sodium phosphate. He then passed a weak elec- 
tric current through the solutions. In a short time the fluid 
in the limb connected with the positive pole became acid 
from the formation of acid sodium phosphate, while the 
fluid in the limb connected with the negative pole increased 
in alkalinity. The changes are represented by the follow- 
ing formula: 
Sodium 
bicarbonate. 
Neutral sodium 
phosphate. 
Sodium 
carbonate. 
Acid sodium 
phosphate. 
One important fact, however, remains unaccounted for 
by this theory, beautifully simple as it is. This is, that if 
NaHCO3 + Na2HPO4 = Na2CO3 + Na2HPO4.* 
* Medical News and Library, October, 1871, from London Lancet, 
July 4, 1871. REAGENTS AND APPARATUS REQUIRED. 
15 
the tubules are stripped of their epithelium, as they often 
are in disease, urea and other products of regressive meta- 
morphosis are no longer so freely removed, but accumulate 
in the blood, producing the phenomena of the condition 
known as urcemia. We must therefore admit some elabo- 
rating action on the part of the epithelium, as originally 
suggested by Bowman. Doubtless, however, a part of the 
act is physical-a process of transudation or filtration, and 
of diffusion or osmosis. 
The recent experimental researches of Heidenhain* have 
settled the question in favor of an active elaborating office 
on the part of the epithelium of the kidney. Heidenhain 
injected into the blood of animals, indigo-carmine, a sub- 
stance which is promptly separated by the kidneys. He 
removed these organs at suitable intervals after the operation 
and examined them minutely. In no instance did he find 
any of the indigo-carmine in the Malpighian capsules, but the 
cells lining the convoluted tubules and the looped tubes of 
Henle were filled with it, as was also the lumen of the tubes 
if the animal was killed sufficiently long after the injection. 
Similar experiments with urate of sodium showed that it is 
secreted at the same place and in the same manner. 
REAGENTS AND APPARATUS REQUIRED FOR QUALITATIVE 
AND APPROXIMATE ANALYSIS.f 
It is not a matter of very great importance in what form 
of bottle reagents are kept. They should hold enough- 
four ounces is a convenient quantity-and be provided with 
* Max Schultze's Archiv, vol. x., 1874, p. 1, and Pfliiger's Archiv, 
vol. ix., 1874, p. 1. 
f All reagents and apparatus suitable for urinalysis may be obtained 
of Bullock & Crenshaw, 528 Arch Street, Philadelphia. 16 
PRACTICAL EXAMINATION OF THE URINE. 
ground-glass stoppers for the acids, but the alkalies are 
better kept in bottles with rubber stoppers. Those re- 
quired are as follows : 
1. Pure colorless nitric acid (HNO3). 
2. Nitroso-nitric acid, the brown fuming nitrous acid of commerce, 
-nitric acid containing nitrogen tetroxide (HNOa T N2O4 or 
NO2). 
3. Pure hydrochloric acid (HC1). 
4. Pure colorless sulphuric acid (H2SO4). 
5. Pure acetic acid (C2H4O2). 
6. Liquor potassae, U. S. P. The sp. gr. is 1065, and it contains .058 
of potassium hydroxide (HKO). 
7. Solution of caustic potash, or caustic soda, 1 part to 2 of distilled 
water, sp. gr. 1330 -|-, to be spoken of in the text as the " stronger 
solution of potash." It is the tetzkalilauge (or aetznatronlauge, 
if soda) of the German Pharmacopoeia, and contains from .30 to 
.31 of the hydrate of potassium (of of sodium). 
8. Solution of sodium carbonate, 1 part water and 2 parts of the crys- 
tallized salt. 
9. Solution of barium chloride, 4 parts crystallized barium chloride, 
16 of distilled water, and I of hydrochloric acid. 
10. Liquor ammoniae, U. S. P. 
11. The magnesian fluid, containing of magnesium sulphate and pure 
ammonium chloride, each 1 part, distilled water 8 parts, and 
pure liquor ammoniae 1 part. 
12. Solution of copper sulphate, say I gram to 30 c.c., or 15 grs. to 
13. Pavy's or Fehling's copper solutions,made as directed under volu- 
metric analysis for sugar. 
14. Solution of silver nitrate, 1 part to 8 of distilled water. 
15. Solution of neutral lead acetate (sugar of lead), 1 part to 4 of dis- 
tilled water. 
16. Solution of basic lead acetate, 1 part to 4 of distilled water. 
17. Distilled water, a liter or a quart. 
18. Alcohol, 95 per cent., a half a liter or a pint. 
Other solutions as required. REAGENTS AND APPARATUS REQUIRED. 
17 
A note and drawing-book. 
1 dozen test-tubes, assorted sizes, some narrow. Some test tubes with 
bases, so that they may stand on a shelf or table, are convenient 
and desirable; see Fig. 5. Some tubes should be graduated in 
divisions of a centimeter and fractions thereof. They may be 
used as fluid measures, and to determine the proportion of a 
sediment, or of albumin after its precipitation by heat. 
Test tube rack and drainer. 
4 conical glasses. (Observe that there is not a convexity at the bottom, 
and the edge should be ground so that they may be covered 
with ground glass covers and thus made air-tight.) 
2 or 3 smooth wineglasses, with broad bottoms, of the kind sometimes 
known as " collamore " wineglasses. 
Red and blue litmus paper; filtering paper. 
Urinometer and urinometer glass. 
4 ground-glass covers, assorted sizes. 
Spirit-lamp. 
3 porcelain capsules. 
6 beaker-glasses, small and medium sizes. 
6 watch-glasses. 
3 glass funnels, assorted sizes. 
1 long narrow funnel tube 12 inches long and 1 inch wide, for filtering 
through animal charcoal. 
Glass stirring-rods and plain glass pipettes. 
1 large receiving-glass to measure twenty-four hours' urine, with capa- 
city of 2000 cubic centimeters or more. 
I graduated measuring-glass holding 500 c.c. 
1 wash-bottle with distilled water. 
1 retort stand; water-bath. 
1 or 2 sheet-iron tripods with wire gauze to cover. 
1 100-minim pipette; 1 volume pipette for 5 c.c., another for 10 c.c. 
Platinum spoon. 
Blowpipe. 
Swabs for cleaning test-tubes, etc. 
A microscope with two object-glasses, a | or | inch, and a I inch or 
inch; stage micrometer; camera lucida for drawing; glass slides, 
thin covers, shallow cells ; test-bottles with capillary stoppers. 
Apparatus. 18 
PRACTICAL EXAMINATION OF THE URINE. 
For volumetric analysis are required in addition : 
A full set of volume pipettes, 5, 10, 15, 20, 30, 50 c.c. 
1 dropping pipette holding 1 c.c., graduated in and fractions 
thereof. 
2 burettes of 50 c.c. capacity ; burette stand. 
A half-liter flask. 
Volumetric solutions as directed under Volumetric Analysis. 
If the solutions are made by the student himself, as they may 
be, he should be provided with a balance which will turn with 
a milligram, or with of a grain if the English system is used. 
SELECTING A SPECIMEN OF URINE. 
In obtaining a specimen of urine for examination, it 
should, as far as possible, be a part of the whole twenty- 
four hours' urine, as the specific 
gravity, reaction, and other properties 
are well known to vary during the 
twenty-four hours, and the only ac- 
curate method is, therefore, to take a 
part of the total. When this is not 
possible, circumstances determine the 
selection. Thus, when a small quan- 
tity of albumin is present in urine, it 
is often increased after a meal, and 
sometimes when there is no trace 
apparent in the morning urine, a 
little will be detectable after a meal. 
The same is true of sugar. The phy- 
sician must therefore exercise his judg- 
ment in the selection of a specimen. 
In Fig. 1 are represented forms of glass vessels used for 
measuring large quantities of urine. 
Fig. i. PHYSICAL AND CHEMICAL CHARACTERS. 
19 
GENERAL PHYSICAL AND CHEMICAL CHARACTERS OF THE 
URINE. 
Normal urine may be described as a transparent, aqueous 
fluid, of a pale lemon-yellow hue, acid reaction, specific 
gravity of about 1020 when passed in the average quantity 
of 1500 cubic centimeters (50 ounces) in the twenty-four 
hours, and possessing an odor which can only be indicated 
as "characteristic" or "urinous." The odor is sometimes 
spoken of as "aromatic." 
Each one of these characters is, however, liable to some 
variation within the limits of health, as well as in disease, 
and with these variations we should be thoroughly familiar 
before interpreting a given specimen. 
I. As to Transparency.-This, although quite a con- 
stant, can scarcely be considered an essential character of 
normal urine, while, on the other hand, it by no means fol- 
lows that because a given specimen of urine is transparent, 
it is therefore normal. 
Causes of Diminished Transparency.-Dimin- 
ished transparency may be due to one of three causes. 
1. Even urine which is apparently perfectly transparent 
when passed, commonly exhibits, a few minutes after stand- 
ing, floating somewhere between the top and bottom, a faint 
cloud, which is composed of mucus derived from the genito- 
urinary tract. In the urine of females this cloud is apt to 
be more distinctly visible, in consequence of a larger amount 
of epithelium from the vagina and adjacent mucous surfaces 
in this sex. There is nothing abnormal in the presence of 
such an amount of mucus as is covered by the above descrip- 
tion. The effect of alkalies, heat, and strong acids is to 
leave the appearance unchanged, but acetic acid may pro- 
duce a slight increase of the opacity by coagulating the 
mucin. 20 
PRACTICAL EXAMINATION OF THE URINE. 
2. Normal acid urine may be partially opaque at the mo- 
ment when passed, by reason of the presence of the earthy 
phosphates of calcium and magnesium. These, shortly after 
passing, begin to subside, and within half an hour, present 
an appearance not unlike that of mucus,-that of a floccu- 
lent mass floating somewhere between the top and bottom 
of the vessel. But still later, generally within an hour, they 
have approached the bottom and become a sediment, cloudy, 
and bulky, leaving a transparent supernatant fluid. 
To test the nature of such sediment we add a few drops 
of any acid, as nitric, which will cause its prompt disap- 
pearance if it be an earthy phosphate, while the application 
of heat will increase it, such increase being also rapidly 
dissipated by the action of acid. 
The more or less constant presence of the earthy phos- 
phates above mentioned cannot be considered abnormal. 
Requiring an acid urine to keep them in solution, a dimi- 
nution ot the degree of acidity may result in their precipi- 
tation, which is further increased by an alkaline reaction. 
Such diminished acidity and substitution of alkalinity 
always takes place during digestion, and the deposit is 
therefore commonly observed at such time. 
3. Urine is sometimes rendered turbid by the presence 
of the so-called mixed urates of sodium, potassium, calcium, 
and magnesium. The most frequent cause of this precipi- 
tation in normal urine is a reduction in the temperature of 
the urine after being passed. Although highly soluble in 
water at the temperature of the body, the urates are 
promptly precipitated from a cold urine, such as would 
prevail in a room without fire in winter. 
As in the case of earthy phosphates, such opacity soon 
diminishes by subsidence of the disseminated urates, which 
become a white or pink deposit, less bulky than that of PHYSICAL AND CHEMICAL CHARACTERS. 
21 
phosphates; urates are also apt to be precipitated on the 
side of the vessel. 
Io test the nature of this deposit we apply heat, which 
quickly causes the dissipation of urates, while a sediment 
of phosphates is increased by it. 
1. Pathologically, urine may be opaque or semi-opaque 
from abnormal degrees of the above conditions, or from the 
presence of pus, which also subsides with a rapidity in- 
versely as the quantity of mucus. If the latter is absent, 
or present ia small quantity, the subsidence is rapid ; if, 
on the other hand, it is large, subsidence is slow, often 
requiring several hours. The opacity of such urine is 
creased by the application of heat and acids, in consequence 
of the precipitation of the albumin which is always a con- 
stituent of liquor puris. 
2. The presence of fat in a state of minute subdivision, 
as in the so-called chylous urine, produces a degree of opac- 
ity ranging from mere cloudiness to absolute milkiness. In 
such urine the fatty matter is disposed to rise and form a 
whitish, creamy layer on top of a less turbid fluid. Such 
condition, not uncommon in tropical countries, is also 
sometimes met in temperate climates. 
II. As to Consistence.-In health, urine is never any- 
thing else but aqueous, that is, it drops and flows readily, 
like water. 
Pathologically, it often becomes viscid, glutinous, and 
separable into drops, with difficulty, or not at all. Such state 
may be due to the presence of an excess of pure mucus, or 
of a mixture of mucus and pus, and very frequently it is 
caused by the action upon pus of an alkalinity due to the 
presence of ammonium carbonate. This will be again 
alluded to. 
In the chylous urine above referred to, the presence of 22 
PRACTICAL EXAMINATION OF THE URINE. 
the molecular fat also increases the consistence of the 
urine. 
III. As to Color.-While normal urine may be char- 
acterized in general terms as pale-yellow, lemon-yellow, or 
amber-hued, there may be considerable variation in health. 
Due to the presence, in solution, of the normal coloring 
matters, the color is deeper or paler according to the pro- 
portion of water dissolving them. After copious libations 
of beer or water, the quantity of urine discharged being 
large, it is very pale. On the other hand, circumstances 
which diminish the proportion of water within the limits 
of health deepen the color. The complemental relation 
of the skin and kidneys is well known. Under the influence 
of warmth, therefore, when the skin is acting freely, the 
quantity of urine is smaller, and it is darker. In winter, 
the skin being less active, the quantity of urine is larger, 
and its color less deep. In persons from whom the respira- 
tory exhalation is greater, the urine is likewise less abun- 
dant, darker, and vice versa. 
Pathologically, the color of urine may be altered, ist, 
by increase or diminution of the normal coloring matters, 
or 2d, by the addition of abnormal ones. 
1. The former is generally due to a change in the pro- 
portion of the coloring matters to the watery constituent. 
Thus we have almost an absence of color in the copious 
urines of diabetes, hysteria, and convulsions, while we have 
a high color in the urine of fevers and febrile states, chiefly 
because the quantity of water is diminished, but in the latter 
instance also because of the addition of an abnormal color- 
ing matter known as uroerythrin. 
2. (a) The addition of abnormal coloring matters is seen 
in the instance just mentioned-fevers, in urines contain- 
ing blood or blood-coloring matters, and bile pigment; and PHYSICAL AND CHEMICAL CHARACTERS. 
23 
in the blue and brown urines of which instances have been 
reported. 
(IP) The urine is also colored after the ingestion of certain 
vegetable matters eliminated by the kidneys, as santonin, 
which imparts a yellow color. 
IV. The reaction of normal mixed urine, that is, the 
urine of the entire twenty-four hours, is always acid. And, 
generally, specimens of urine passed at any time of day 
exhibit this reaction, though there is a difference in its 
degree, while after a meal the urine may become neutral or 
even alkaline. 
The cause of this change in the reaction is still disputed. 
Roberts believes that it is due to an admixture with the 
blood of the elements of food, which are largely alkaline, 
and that the resulting increased alkalinity affects the reac- 
tion of the urine secreted. Bence Jones contended that it 
is the demand made on the blood for the elements of the 
acid gastric juice, which thus affects the reaction of the 
urine secreted during digestion. While neither explana- 
tion is altogether satisfactory, the former seems more likely 
to be correct. 
The cause of the acid reaction of the urine is usually 
said to be acid sodic phosphate, though it is probably also 
slightly contributed to by other acid constituents, as uric 
and hippuric acids, and, under certain circumstances, also 
by lactic and acetic acids. 
There is often observed in urine which has been standing 
for a short time, especially at a moderate temperature, an 
increased degree of acidity, which sometimes results in a 
decomposition of urates, and a precipitation, first of acid 
urates, and later of uric acid crystals. This has been as- 
cribed by Scherer to an acid fermentation, in which, the 
mucus acting as the ferment, lactic and acetic acids are 24 
PRACTICAL EXAMINATION OF THE URINE. 
formed by the decomposition of the coloring matters of 
the urine. This has not been altogether satisfactorily 
proven, while the increased acidity is by no means constant. 
It is certain, however, that acid urine which has stood 
for some time, and more rapidly in hot weather, acquires 
an ammoniacal odor, and becomes alkaline in its reaction; 
attending this change of reaction is a semi-opacity with a 
precipitation of a white amorphous and crystalline sedi- 
ment, and often also with the formation of an iridescent 
pellicle on the surface. The cause of these changes has 
been well determined, and has already been alluded to. 
Through the action of mucus, and other organic matters, 
acting in their decomposition as a ferment, the urea is con- 
verted into ammonium carbonate by the addition of two 
equivalents of water. Thus: 
CH4N2O + 2H2O = (NH4)2CO3, 
which gives the odor of ammonia and the alkaline reaction. 
The opacity and deposits are due to the precipitation of 
the crystalline triple phosphate of ammonium and mag- 
nesium, the amorphous phosphate of lime, urate of ammo- 
nium, and to living vegetable organisms known as bacteria. 
The alkalinity thus resulting from the presence of volatile 
alkali (ammonia) is easily distinguished from that due to 
fixed alkali (potash or soda). On drying the test-paper, 
which has been rendered blue by volatile alkali, the blue 
color disappears, and the paper resumes its original red or 
violet tint; if due to fixed alkali the blue remains after 
desiccation. 
V. The specific gravity, as stated, may be put down at 
1020 for an average amount of 1500 c.c. (50 oz.) in the 
twenty-four hours. But as this amount is by no means fixed, 
while the amount of solid matter remains about the same, PHYSICAL AND CHEMICAL CHARACTERS. 
25 
the specific gravity must vary accordingly. When the skin 
is not acting, from the action of cold or other cause, and 
after copious use of water and diuretics, the specific gravity 
may descend to 1010, and even lower, within the limits of 
health. But, where perspiration is copious, or a drain of 
water from the economy takes place through some other 
channel, the urine becomes concentrated, and may be 1025 
or higher in specific gravity. 
Pathologically, the specific gravity of urine is increased 
or diminished, but to be entirely reliable, conclusions should 
be based upon observations made on the entire quantity 
passed in the twenty-four hours. The specific gravity is 
increased in diabetes mellitus, where it sometimes reaches 
1050. A specific gravity of more than 1028, if it attend a 
copious urine, should excite suspicion of diabetes, and calls 
for sugar tests. In one instance which came under my 
observation, a specific gravity of 1010, in a specimen of 
albuminous urine, was attended by the evident presence 
of sugar, easily shown by all the tests,* proving that it is 
not safe to infer from a low specific gravity alone the absence 
of sugar. 
The specific gravity is also increased in the first stage of 
acute fevers, in consequence of the increased amount of 
solid matters excreted; and in the first stage of acute 
Bright's disease, from the presence of blood, the higher 
specific gravity of the latter raising that of the mixed fluid. 
The specific gravity is diminished in hysterical and spas- 
modic hydruria, though here it attends a proportionate in- 
crease of water, and is not of much practical significance. 
* The first edition of this book noted that I had not met sugar in 
urine with a lower specific gravity than 1020, but as my experience 
grew I found it in urines of less weight, until in 1881 I met the in- 
stance referred to in the text. 26 
PRACTICAL EXAMINATION OF THE URINE. 
In all forms of Bright's disease, except the stage of acute 
nephritis referred to, and in the condition known as cyan- 
otic induration of the kidney, which often attends heart 
disease, there is a tendency to lowering of specific gravity 
owing to the diminished proportion of urea. Particularly is 
such reduction of specific gravity significant when it attends 
a diminished quantity of urine. In a general way, the 
Fig. 2. 
(From Harley.) 
presence of albumen and sugar being eliminated, variations 
in the specific gravity of urine point to variations in the 
amount of urea present; lower specific gravity of mixed urine 
generally means less urea. 
To determine specific gravity the so-called urinometer 
is almost invariably used, and though less accurate than the 
picnometer (e, Fig. 2) and balance, is still sufficiently so PHYSICAL AND CHEMICAL CHARACTERS. 
27 
when carefully constructed. Every urinometer should first 
be tested with distilled water at 6o° F. (15.540 C.), into 
which it should sink to the mark o, or 1000. In its gradua- 
tion the lines indicating the degrees should 
gradually approach each other as the bulb is 
reached, because allowance must be made for 
the weight of the stem above water. 
The English-made uri nometers, about five 
inches long (Fig. 2, c), are generally accu- 
rate, but the short German instruments (three 
inches) are very convenient for small quanti- 
ties of urine. In the little urinometer of Hel- 
ler (Fig. 3), in which the "sink" consists of 
leaden shot, the graduation of Baume is retained, where 
one degree corresponds with seven of the ordinary scale. 
Thus 1001 == 1007, 1002 = 1014, and so on. Especial 
care should be taken in testing these instruments, as a slight 
variation in them indicates a large one by the ordinary scale. 
The writer has in his possession an instrument of this kind 
which recorded the specific gravity of a given specimen of 
urine 1004, that is, 1028 by the ordinary scale, of which 
the specific gravity by a long tried English instrument was 
found to be 1019. And on testing the former with distilled 
water it was found to sink, not to 1000, but to 1001 +, 
proving its inaccuracy. More recently a urinometer is 
imported from Germany even slightly shorter than the 
original of Heller, in which the ordinary scale is retained 
on an ivory stem within the tube, and the " sink" contains 
mercury instead of shot. It is apparently altogether more 
carefully made, and I have generally found it accurate. 
Dr. E. R. Squibb, of Brooklyn, N. Y., has recently sug- 
gested a small urinometer standardized for 250 C., or 770 
F., a temperature much more easily attained than 6o° F., 
Fig. 3. 28 
PRACTICAL EXAMINATION OF THE URINE. 
and at three points, 1000, 1030, and 1060, with the varia- 
tions marked, whence corrections are easily made. The 
glass jar supplied with it is also fluted or indented, and in 
this way the instrument is kept from clinging to the side of 
the glass. This object is further secured by making the 
air-chamber a double cone, base to base, as seen in a, Fig. 4, 
instead of a cylinder as in e. In this way, also, there is ob- 
tained a single point of contact between the urinometer and 
Fig. 4. 
Squibb's Urinometer and jar, the latter shown also in section at b. 
the jar. Finally, the instrument is provided with a thermo- 
meter to secure greater accuracy, but as .004, if water be 
put at 1000, is the maximum error which can occur at any 
temperature at which urine can be tested, it is not a serious 
matter. This is certainly the most accurate urinometer I 
have seen; and, by reason of the fluting of the glass, a smaller 
amount of urine is required than in the ordinary perfectly 
cylindrical jar. PHYSICAL AND CHEMICAL CHARACTERS. 
29 
The cylindrical glass vessel usually supplied with the 
urinometer, or a sufficiently large test-tube, should be about 
three-fourths filled, the urinometer introduced, and when at 
rest the specific gravity read off. The cylinder or test-tube 
should not be too small in relation to the urinometer, lest, 
in consequence of the capillary attraction between the latter 
and the walls of the cylinder, the urinometer should not 
sink as low as it ought. For the same reason the urinometer 
should not be allowed to impinge against one side of the 
glass. All these difficulties are provided against in Squibb's 
urinometer. The scale should be read from above, not 
below the fluid. 
If the quantity of urine be too small sufficiently to 
fill the cylinder, it may be diluted with a quantity of distilled 
water sufficient to fill the cylinder to the required height. 
From the sp. gr. of this mixture may be calculated that of 
the urine. Thus: suppose it is necessary to add four times as 
much water as urine to enable us to use the urinometer, that 
is, to make five volumes, and the specific gravity of the 
mixed fluid is 1004, then that of the urine would be 1000 
+ (4 X 5)= 1020. Although the principle of this method 
is correct, and the results must be, if the data are, the 
urinometers in use are not usually so nicely graduated that 
absolute accuracy in reading is secured : while any error in 
reading is multiplied by the number of volumes used. Hence 
it is desirable to use this method as rarely as possible, espe- 
cially with urines of low specific gravity. 
VI. Quantity.-The average amount of urine in the 
twenty-four hours is usually put down at 1500 c.c., or about 
50 fluidounces. I am inclined to think this is a little more 
than the average; perhaps it would be more nearly correct 
to say between 40 and 50 ounces, or 1200 to 1500 c.c. But 30 
PRACTICAL EXAMINATION OF THE URINE. 
enough has already been said to allow the inference that 
there is also much variation within the limits of health. All 
that has been said of color and specific gravity in this respect 
is true of the quantity of urine, though in an inverse ratio. 
That is, in health diminished intensity of color and dimin- 
ished specific gravity correspond with increased quantity of 
urine. It is with regard to quantity that the complemental 
relation so well known to exist between the skin and kidneys 
most palpably shows itself, the increased activity of the 
former causing diminished water separation by the latter, 
and vice versa. In deranged conditions, it is the absence 
of this relation of color and specific gravity to quantity 
which gives significance to either. 
Pathologically, the quantity of urine is increased in 
diabetes, and hysterical and convulsive conditions; in the 
former with increased specific gravity, and in the latter 
with diminished. In cardiac hypertrophy, in common with 
all conditions which cause increased blood-pressure, includ- 
ing ingestion of large amounts of water, the peripheral 
action of cold, etc., there is an increase of water, and a 
corresponding reduction in specific gravity and color. 
In all forms of Bright's disease, except the cirrhotic 
and lardaceous kidneys, there is a tendency to diminished 
secretion of urine. Towards the fatal termination, how- 
ever, it is diminished even in these affections. Any marked 
diminution of urine in these diseases, particularly if it be 
attended by a low specific gravity, which means diminished 
urea, becomes a grave symptom. 
In acute fevers and inflammatory affections, the quantity 
of urine is very constantly diminished until convalescence 
sets in, when there is generally observed a marked increase, 
which, in common with the profuse perspiration often ob- PHYSICAL AND CHEMICAL CHARACTERS. 
31 
served at the same time, was long ago characterized by the 
word " critical." 
VII. Odor.-Of the odor, little more can be said than that, 
in health, it is "peculiar " or " characteristic. It is by some 
spoken of as "aromatic." There is, however, appreciable 
difference in its intensity, as most have observed in their 
own cases. Concentrated urines always exhibit what is 
described in common language as a " strong odor." This 
is, undoubtedly, due to urea, though the characteristic odor 
of urine is not ascribed to urea, but rather to the minute quan- 
tities of phenylic, taurylic, and damoluric acids found in it. 
Urine which has been standing exposed in warm weather 
acquires an odor which is at once putrescent and ammoni- 
acal, the former from decomposition of mucus and other 
organic matters, the latter from the ammonium carbonate 
derived from the urea. The former is predominant when a 
large amount of organic matter is present, and is often 
observed in destructive disease of the kidney or its pelvis, 
and especially of the bladder. 
The odor of urine is very promptly influenced by that of 
substances separated by the kidney from the blood, illus- 
trated by the well-known odor of violets in the urine of 
persons taking turpentine. The odor of cubebs, copaiba, 
and sandalwood oil is promptly communicated to the urine 
of persons taking them. So, too, the use of certain vege- 
table foods promptly influences the odor of the urine. 
Among these asparagus is conspicuous. 
Pathologically, except the increased intensity of the 
characteristic odor of concentrated urines, the putridity 
alluded to, and sweetish and fruity smell which often attends 
the presence of sugar in the urine, there seem to be no 
modifications of the "characteristic" odor of urine. 32 
PRACTICAL EXAMINATION OF THE URINE. 
TO DETERMINE THE AMOUNT OF SOLIDS IN THE TWENTY- 
FOUR HOURS* URINE. 
Knowing the quantity of urine passed in the twenty-four 
hours, and its specific gravity, an approximation to the 
quantity of solid matters, and thence that of water, may be 
readily obtained by multiplying the last two figures of the 
specific gravity by the coefficient of Trapp-which is 2- 
or that of Haeser, 2.33. This will give approximately 
the number of grams of solid matters in the 1000 c.c. 
(33.8 f. oz.). 
Thus, suppose the twenty-four hours' urine to be 1200 
c.c. and the specific gravity to be 1022, then, using Haeser's 
coefficient, 
22 X 2.33 = 51.26 grams in 1000 c.c. 
But the total quantity of urine in twenty-four hours is 
1200 c.c., therefore it will contain more than 1000 c.c. 
contain. Hence, 
IOOO : I2OO : : 51 26 : x= S1- 1200 = 61 .51 grms, (948.09 grs.) 
1000 
Now, estimating the twenty-four hours' urine at 1500 c.c., 
the normal amount of solid matters is about 70 grams 
(1080.1 grs.), showing that, in this instance, rather less 
than the normal quantity was separated. In this manner, 
valuable information, bearing upon diagnosis and progno- 
sis, may be obtained in a few seconds. The most striking 
variations are observed in diabetes and Bright's disease. In 
the former the solids are increased by the addition of sugar, 
in the latter they are diminished by loss of urea. 
While this method of arriving at the solids is not suffi- 
ciently accurate for scientific use, it answers for ordinary 
clinical purposes. PART I. 
THE DIFFERENT CONSTITUENTS OF URINE IN 
HEALTH AND DISEASE. 
In the examination of a specimen of urine, the following 
are the steps which will be found most convenient in actual 
practice. Observe- 
I. The quantity passed in twenty-four hours. 
II. Color and transparency. 
III. Odor. 
IV. Reaction. 
V. Specific gravity. 
VI. Presence or absence of sediment, its quantity, and 
characters. 
In all cases, whether the sediment be appreciable or not, a 
portion of the fluid should be set aside in a conical glass 
vessel for twelve hours, in order to collect it for microscopical 
examination. The remaining or supernatant fluid, filtered if 
necessary, should then be further examined for certain organic 
and inorganic constituents. 
Organic Constituents. 
VII. Presence or absence of albumin and other proteid 
substances. 
VIII. Presence or absence of the different varieties of sugar. 34 
PRACTICAL EXAMINATION OF THE URINE. 
IX. Other saccharine substances. 
X. Presence or absence of acetone and diacetic acid. 
Abnormal. 
Normal. 
a-r ■ 
XI. Coloring matters. 
XII. The biliary acids. 
XIII. Leucin and tyrosin. 
XIV. Fatty matters. 
XV. Urea. 
XVI. Uric acid. 
XVII. Urates. 
Inorganic Constituents. 
XVIII. Chlorides. 
XIX. Phosphates. 
a. Earthy phosphates. 
b. Alkaline " 
XX. Sulphates. 
Examination of Sediment Microscopically and Chemically. 
I. Unorganized deposits, including crystals and amor- 
phous deposits. 
II. Organized deposits, including anatomical elements, 
such as tube-casts, epithelium, pus, blood-corpuscles, etc. 
III. Other morphological elements, as fungi, granular 
matter, extraneous substances, etc. 
Nos. I, II, III, IV, V, VI, require no further explanation 
than is involved in the consideration of the "general phy- 
sical and chemical characters." 
Organic Constituents. 
VII. Albumin and other Proteids. 
Albumin. 
The albumin, usually found in urine, is serum-albumin. 
It and serum-globulin are precipitated from their solutions ORGANIC CONSTITUENTS. 
35 
at a temperature of 730 to 750 C. (163.40 to 167° F.). 
This is true of no other of the proteids which occur in 
urine. Other agencies, however, also throw down serum- 
albumin, and become equally delicate tests for it, although 
less reliable, because of their precipitating other substances. 
In all instances, where the urine used for testing is not 
perfectly clear, it should be filtered before applying the 
tests. This may be done in a few minutes by means of fil- 
tering-paper and a funnel. 
(a) The Test by Heat. 
A test-tube is filled to % to its depth with perfectly 
clear urine, to which, if it be not distinctly acid in reaction, 
a drop or two of acetic acid is added-only enough to 
make it clearly acid-and the fluid boiled over a spirit- 
lamp. If an opacity result, the slightest degree of which 
becomes visible in a clear urine held in a good light, it is 
due either to albumin or earthy phosphates. If the latter, 
it promptly disappears on the addition of a few drops of 
nitric acid ; if albumin, it is permanent. If further confir- 
mation is desired, to the boiling urine quickly add half as 
much of the stronger potash solution (7, p. 16), when the 
albumin is dissolved, and the earthy phosphates again sepa- 
rate in flocculi. 
A very good way is to fill the test-tube nearly full of clear 
urine, and apply the heat only to the upper part, when a 
resulting diminished transparency can be very easily recog- 
nized on comparing the two portions of the tube. 
It sometimes happens, even when the precipitate obtained 
by boiling is albumin, that the addition of two or 'three 
drops ofacid will be followed by a partial disappearance of the 36 
PRACTICAL EXAMINATION OF THE URINE. 
opacity, but, if a few more drops be added, the full amount 
is again thrown down. We should, therefore, continue the 
addition of the nitric acid until 15 or 20 drops have been 
used. On the other hand, should the quantity of albumin 
be very small, too much acid will dissolve it. 
If the urine has not been filtered, and is opaque from the 
presence of amorphous urates, the first effect of the appli- 
cation of heat is to clear up the fluid, and, as the tempera- 
ture is increased, the albumin, if present, is precipitated. 
Acetic acid is preferred to nitric for acidulating the 
urine, because not only is it true that a small quantity of albu- 
min is dissolved by a large amount of nitric acid, but also 
that, if a drop or two of nitric acid be added to a specimen 
of albuminous urine so as to render it distinctly acid, it may' 
happen on boiling the urine that no precipitate whatever will 
appear, although much albumin is present. This is because 
the serum-albumin has been converted into acid-albumin or 
syntonin, which is not coagulated by heat. In like manner 
and for the same reason, albuminous urine boiled in a test- 
tube in which a drop of nitric acid happens to be present 
may fail to precipitate its albumin. The same thing may 
happen when urine is very highly acid from the natural 
causes of its acidity, although this is rare. Acetic acid, 
also, may produce a soluble acid-albumin, not precipitable 
by heat if too much is used. Hence a drop or two only 
should be added. Whatever be its source, the acid-albumin 
may be readily reconverted into serum-albumin by the ad- 
dition of a drop of liquor potassae. 
It is also to be remembered that two or three drops of 
nitric acid may be added to a specimen of cold albuminous 
urine, and although a little cloud of albumin may follow 
the entrance of each drop into the urine, it will be quickly ORGANIC CONSTITUENTS. 
37 
redissolved, and on the application of heat no precipitate 
may take place. If nitric acid is used in this way it should 
be added in considerable excess, yet short of an amount 
sufficient to dissolve the albumin. 
It also occasionally happens, when acetic acid is added to 
urine naturally acid, and at the same time albuminous, that 
the albumin is at first only partially precipitated on the appli- 
cation of heat, there being a mere opalescence when the 
quantity of albumin may equal one-half the bulk of urine 
tested. After waiting a little while, however, the full 
amount of albumin is thrown down. 
Furthermore, serum albumin is converted by the con- 
tinued action of an alkali into alkali albumin, which is also 
not coagulated by heat. This may occur in highly alkaline 
urines. But the alkali-albumin is promptly converted into 
serum-albumin by the addition of a drop or two of dilute 
acid. 
Mehu* calls attention to the fact that urine charged with 
oxalate of lime becomes slightly turbid when heated, even 
after all the lime possible has been filtered out, and that the 
turbidity thus produced is not removed by the addition of 
a few drops of concentrated acetic acid. I have never en- 
countered this source of error. 
(b) The Nitric Acid Test. 
This is best applied according to Heller's method. Upon 
a convenient quantity of pure, colorless nitric acid in a 
small test-tube (one of those with a foot, seen in Fig. 5, is 
* L'Urine, Normale et Pathologique, Paris, 1880, p. 326, 38 
PRACTICAL EXAMINATION OF THE URINE. 
most suitable), allow to trickle from a pipette down the side 
of the inclined glass an equal amount of clear urine, which 
will thus overlie the acid. If albumin is present, there 
appears at the point of contact, between the urine and 
Fig. 5. 
Testing for albumin by nitric acid. 
nitric acid, a sharp white band or zone of varying thickness, 
according to the quantity of albumin present. 
The urine may be put into the glass first, if preferred, 
and the acid may then be allowed to pass down the side 
and under the urine. The result is the same, but I think 
the former is somewhat more easily practiced. ORGANIC CONSTITUENTS. 
39 
When nitric acid is allowed to underlie normal urine, 
there appears between the urine and the acid a brown ring 
which grows in intensity on standing, and is due to the 
action of the acid on the coloring matters. In consequence 
of this fact, when the urine is highly charged with coloring 
matters, as it often is in fever cases, the albumin precipi- 
tated at the same place is similarly tinted. If there is 
much indican present in the urine, a rose-red or violet tint 
may be communicated to the albumin ; if much blood- 
coloring matter, a brownish-red, and if undecomposed 
biliary coloring matters, a green hue. 
Precautions.-I. Much difficulty is often experienced in causing the 
urine to flow from the pipette with sufficient slowness-that is, it will 
either not flow at all, or the finger, in the effort to cause it to flow, is 
raised so much as to permit a sudden fall of the urine into the acid, 
which interferes with the success of the test. This difficulty is readily 
overcome by rotating the pipette, covered by the end of the index-finger, 
between the middle finger and the thumb, whereby the flow may be 
easily controlled ; the process is further facilitated if the upper end of 
the pipette is slightly roughened. 
2. A somewhat similar white zone is formed by the action of nitric 
acid on the mixed urates if present in excess, by which the more insol- 
uble acid urates are thrown down. This zone might be mistaken for 
that of albumin, but the acid urates begin to appear not so much at 
the border between the urine and acid as higher up ; nor does the zone 
on its upper surface remain so sharply defined, but while under exami- 
nation is seen to diffuse itself into the urine above. Further, this layer, 
if caused by urates, is easily dissipated on the application of heat, 
although some care is necessary in this application lest in ebullition the 
ring be commingled with the entire mass of fluid and thus lost to view, 
although not actually dissolved. After some hours have elapsed these 
amorphous acid urates are completely decomposed by a further action 
of the nitric acid, and uric acid is then deposited as a characteristic 
crystalline sediment. Further difficulty arises where, as is occasionally 40 
PRACTICAL EXAMINATION OF THE URINE. 
the case in very severe cases of fever, a small quantity of albumin co- 
exists with an excess of acid urates. In these cases the urine is of 
high specific gravity, and the line of albumin, lying immediately on the 
acid, may be obscured by the broader band and cloud of urates. The 
difficulty from this source is diminished if the urine is diluted with two 
or three parts of water, while if the method laid down on page 47 is 
carefully followed out, a mistake is scarcely possible. 
It should be added that Thudichum considers that the " cloud " of 
acid urates here referred to is not urates, but hydrate of uric acid.* 
3. This method of performing the nitric acid test operates equally 
well with serum-albumin, acid-albumin, and alkali-albumin, and 
therefore obviates the possibility of the source of error referred to on 
page 36, originally pointed out by Bence Jones-first, that, if albumi- 
nous urine be acidified by a small quantity of acid, as a drop or two, 
no precipitation of albumin takes place; also, that arising from the 
addition of too large a quantity, as an equal bulk, of acid, when the 
mixture may in like manner remain perfectly clear. Roberts says he 
has known the latter fallacy to cause the concealment of albumin in 
urine for months, in a case of Bright's disease. 
4. Occasionally, also, it happens that a urine is so highly concen- 
trated-so highly charged with urea-that the simple addition of nitric 
acid causes a precipitation of crystals of nitrate of urea. But these are 
readily distinguished from albumin by their solubility on the applica- 
tion of heat, and by their appearance under the microscope, which 
exhibits them made up of six-sided rhombic tablets. Such urine is al- 
ways of high specific gravity, while albuminous urine, except in cases 
of acute Bright's disease, is apt to be of low specific gravity. 
5. If carbonic acid be abundantly present in urine, either free or com- 
bined with ammonium, as after the alkaline fermentation, or with 
sodium or potassium, during the administration of alkaline carbonates 
or salts of the vegetable acids, the addition of an acid liberates it with 
effervescence. Under ordinary circumstances, this does not interfere 
with the test; but if the quantity of carbonate of ammonium be very 
* Thudichum, J. L. W., Pathology of the Urine, 2d edition, Lon- 
don, 1877, P- 377- ORGANIC CONSTITUENTS. 
41 
large, as is the case with some old urines, and the quantity of albumin 
small, the effervescence is so great as to make the nitric acid test 
impossible; while the amount of acetic acid required to secure an 
acidity sufficient to permit the use of the heat test may be so great as 
to completely hold in solution the small quantity of albumin. Such 
difficulty is further increased by the fact that these alkaline urines are 
always more or less cloudy, from the presence of amorphous phosphates 
and of bacteria, and cannot be cleared up by ordinary filtration. 
Under these circumstances the following method recommended by 
Hoffmann and Ultzmann must be pursued. Add to the urine about 
a fourth part of its volume of liquor potassae, warm the mixture, and 
filter. If the filtrate is still not quite clear, add one or two drops of 
the magnesian fluid (II, p. 16), warm again and filter. The fluid is 
then always clear and transparent, and albumin, if present, may be 
revealed by Heller's nitric acid test, or by the cautious addition of acetic 
acid. 
6. Occasionally, after the administration of turpentine or balsam 
copaibae, resinous matters are found in the urine. These are precipi- 
tated by nitric acid in the shape of a yellowish-white cloud, which is, 
however, redissolved on the addition of alcohol. 
Other Tests for Albumin. 
It has long been known that other agents besides heat and 
nitric acid coagulate albumin. Since the appearance of the 
last edition of this manual, some of these have claimed a 
large amount of attention, and been found to be extremely 
delicate tests; some more delicate even than the heat test ap- 
plied in the most careful manner, and very much more delicate 
than the nitric acid test. An objection, however, which holds 
against the most delicate of these tests is, that they precipu 
tate other substances besides albumin, and although these 
substances are generally distinguishable from albumin by the 
aid of certain precautions or additional steps, it dare not be 
said that the reliability of the tests is not weakened thereby. 42 
PRACTICAL EXAMINATION OF THE URINE. 
As the result of a careful study of these tests based upon 
experiment and clinical application, I have come to the 
conclusion that, for the present at least, it is safer to rely 
upon them in conjunction with the heat and acid tests, with 
a view to confirming or extending results attained by the 
latter. Such use is, however, of the greatest importance; 
and I shall, therefore, now consider the most delicate of 
them, including the method of their application, and the 
precautions to be observed in rendering them reliable. Those 
I deem most worthy of consideration are in the order in 
which I have found them most delicate: Picric acid, so- 
dium tungstate with citric acid, potassio-mercuric iodide,* 
ferrocyanide of potassium, and Dr. Roberts's acid brine 
solution. 
Picric Acid.-This has its ablest and most enthusiastic 
exponent in Dr. George Johnson, of London, who says, 
"there is no known substance occurring in either normal 
or abnormal urine, except albumen, which gives a precipi- 
tate with picric acid insoluble by the subsequent application 
of heat.j- 
An ounce of water at 6o° F. retains in solution 5.3 grains 
of the dry acid. A saturated solution may be made by dis- 
solving 6 or 7 grains of the powder in an ounce of 
boiling distilled or rain water. A portion of the acid will 
* The first three named of these agents are so nearly equal in deli- 
cacy that one arranges them in any order at some risk, and I must 
confess to not invariably having found them delicate in the order 
named. The experiments of Dr. George Oliver, of London, show that 
any one of these used in solution by the contact method, will precipitate 
I part of albumin in 20,000 of urine 
J Johnson, Albumen and Sugar Testing, London, 1884, p. 11. ORGANIC CONSTITUENTS. 
43 
crystallize out on cooling, leaving a transparent yellow 
supernatant liquid. Such a solution has a specific gravity 
of 1005. 
Dr. Johnson's mode of applying the test for the detec- 
tion of a very minute trace of albumin is as follows: Into 
a test-tube six inches long pour a four-inch column of urine; 
then, holding the tube in a slanting position, pour gently 
an inch of the picric acid solution on the surface of the 
urine, where, in consequence of its low specific gravity, it 
mixes only with the upper layer of the urine. As far as 
the yellow color of the picric acid solution extends, the 
coagulated albumin renders the liquid turbid, contrasting 
with the transparent urine below. For the action of the test, 
there must be an actual mixture, and not a mere surface 
contact. When, in consequence of the scantiness of the 
albumin, the turbidity is very slight, the application of heat 
to the upper part of the turbid column increases it. Then, 
if the tube be placed in a stand, the coagulated albumin 
will gradually subside, and, in the course of an hour or 
so, forms a delicate, horizontal film at the junction of the 
colored and unstained stratum of urine. 
No previous acidulation of the urine is required, as the 
picric acid accomplishes this, if needed. 
Precautions.-I. The urine to be tested should be perfectly clear, 
and if not clear when obtained should be rendered so by filtration, or 
the processes described on p. 41. 
2. Urates, peptones, vegetable alkaloids, as quinine, morphia, etc., 
are all precipitated by picric acid solution at the point of contact, but 
are promptly redissolved by a degree of heat much lower than that of 
the boiling-point. Quinine promptly appears in the urine after the ad- 
ministration of ten grains of this drug. 44 
PRACTICAL EXAMINATION OF THE URINE. 
Dr. Oliver correctly claims that the addition of citric 
acid in the proportion of two drachms to an ounce of the 
picric solution makes a reagent which gives a more distinct 
reaction than the plain picric acid solution; but Dr. John- 
son says that this is because the citric acid precipitates also 
the mucin which exists in all urines. 
Dr. Johnson also considers that mucin is not precipitated 
from urine by picric acid, but in this view he is not sustained 
by others. 
Sodium Tungstate with Citric Acid.-This solu- 
tion is made by mixing equal parts of a saturated solution of 
sodium tungstate (i to 4) and a saturated solution of citric 
acid (join 6). It has a specific gravity of 1214, and is best 
used by the overlaying method. It is a test of extreme 
delicacy, precipitating 1 part of albumin in 20,000 of urine, 
and has the advantage over picric acid of not precipitating 
quinine from its solution, but, like the picric acid, precipi- 
tates acid urates, peptones, and mucin, which are also 
promptly dissipated by heat. 
The Potassio-Mercuric Iodide.-This test was sug- 
gested by M. Charles Tanret, of Paris, and is regarded by 
Dr. Oliver as the most sensitive test known, discovering, like 
the picric acid and sodium tungstate, 1 part of albumin in 
20,000 of urine. In my own experiments, however, I have 
several times failed with the mercuric iodide when I suc- 
ceeded both with picric acid and sodium tungstate. I am 
inclined to believe that the age of the preparation and the 
mode of compounding it have something to do with the 
results. 
The solution is prepared by M. Tanret as follows: Bi- 
chloride of mercury, 1.35 grams; iodide of potassium, 3.32 
grams; acetic acid, 20 cubic centimeters; distilled water, ORGANIC CONSTITUENTS. 
45 
enough to make 1000 cubic centimeters. The resulting re- 
agent is the double iodide of mercury and potassium, the 
chloride of potassium being without effect. It is also a 
heavy fluid, having a specific gravity of 1040 + , and is 
used by the contact method. The urine requires no pre- 
vious acidulation. 
It coagulates the same substances as picric acid, which 
are likewise dissipated by heat, or the addition of alcohol. 
On cooling they reappear. With regard to mucin, however, 
Dr. Oliver says it is not dissipated by heat if a large excess 
of the reagent be employed, the mercuric salt apparently 
preventing solution. 
Ferrocyanide of Potassium.-This test, used in sat- 
urated solution, while less delicate than any of the three pre- 
viously considered, detecting, according to Dr. Oliver, but 
1 part of albumin in 10,000 of urine, has the advantage over 
them of not precipitating mucin, peptones, or the alkaloids, 
but it may throw down acid urates. It is fully as delicate as 
nitric acid, but less so than heat. It requires for its opera- 
tion that the urine shall be acid. 
Dr. Roberts's Acidulated Brine Solution.-This 
solution, which consists of a pint of a saturated solution of 
common salt to which is added an ounce of hydrochloric 
acid, and the whole filtered, is about equal in delicacy to 
nitric acid, but much less so than heat. 
It has a high specific gravity, and is used by the contact 
method. It has the great advantage over nitric acid in 
that it is less caustic and corrosive, and therefore much 
pleasanter to work with, while equally delicate. 
Albumin Test Papers.-All of these reagents, except 
the acid brine solution, may be used in the shape of the test- 
papers suggested by Dr. Oliver, which are more especially 46 
PRACTICAL EXAMINATION OF THE URINE. 
useful for bedside testing, although Dr. Oliver claims for 
them some advantages over the solutions even when used 
in the laboratory.* 
Most recently,f Dr. Oliver has rejected all of the albu- 
min papers except the "mercuric" and " ferrocyanic," and 
recommends their use as follows: 
A mercuric or ferrocyanic, and a citric acid paper are 
dropped into the test-tube, and water added to 60 minims. 
After gentle agitation for half a minute or so, the test-papers 
are removed, and the transparent solution is ready for the 
testing. 
The pipette containing the suspected urine is held in a 
vertical position over the tube, and the urine is delivered in 
drops. If four drops of urine added to the mercuric solu- 
tion, and six to the ferrocyanic,| do not produce a trace of 
milkiness when the contents of the tube are viewed against 
a dark background, it may safely be inferred that if albu- 
min is present it is in so small a quantity that nitric acid, 
applied after the contact method for one minute, will not 
discover it. If a slight milkiness is apparent, it will rep- 
resent a trace of albumin detectable by nitric acid. 
If there is no response, the dropping should be continued, 
and, if instead of four drops of the mercuric and six of the 
ferrocyanic solution there be required 10 of the former and 
* The different forms of test-papers suggested by Dr. Oliver, origi- 
nally made for him by Wilson & Son of Harrogate, London, are now 
furnished by Parke, Davis & Co., of Detroit, Mich., as are also, in a 
single case with the test-papers, the suitably graduated test-tubes. 
f Bedside Urine-Testing, London, 1885. 
| The ferrocyanic solution should be allowed a minute in which to 
develop the reaction from a trace of albumin. ORGANIC CONSTITUENTS. 
47 
15 of the latter to produce an appreciable opacity, it will 
indicate a quantity which can readily be shown by heat and 
acidulation. If 20 of the former and 30 of the latter are 
required, it indicates a trace of albumin which can be 
shown only by careful acidulation and subsequent boiling. 
In the case of the mercuric test, if a reaction occurs, 
the solution should be boiled so as to prove the presence or 
absence of one of the diffusible proteids, peptone, or hemi- 
albumose. If the opacity is unaffected by heat, or is in- 
tensified by it, it is caused by albumin, but if it is dimin- 
ished or entirely removed, presumptive evidence is afforded 
of the presence of a peptoid body, either alone or in con- 
junction with albumin. The mercuric test, supplemented 
by heat, may be said, therefore, to provide a fuller knowl- 
edge of the proteids which may appear in the urine than 
the ferrocyanic, which precipitates albumin only. 
Remarks on Testing for Small Quantities of Albumin. 
The Author's Method. 
To determine the presence of albumin in urine when it is 
abundantly present is usually a very simple matter. The 
application of heat will throw down albumin even from an 
alkaline solution, if the latter is highly charged with it, 
while the addition of a few drops of acid removesail possi- 
bility of error. But it is well known that small quantities 
of albumin, the significance of which in diagnosis and 
prognosis is sometimes greater than that of large amounts, 
often escape detection ; while large quantities are sometimes 
obscured in consequence of peculiarities of combination 
between albumin and acids, and albumin and alkalies, 
resulting in the formation of the so-called acid- and alkali- 48 
PRACTICAL EXAMINATION OF THE URINE. 
albumins. It is with a view to pointing out the way to 
avoid such errors that the following paragraphs are written. 
Under all ordinary circumstances by far the most strik- 
ing test for small quantities of albumin is that form of the 
nitric acid test described as Heller's (p. 37), and in the 
majority of cases, this test, carefully carried out, even in the 
hands of the inexperienced, will exhibit the presence of 
albumin when it would have been overlooked in the ordi- 
nary mode of application of the heat and nitric acid test. 
But it is not so delicate a test as the latter applied in the 
manner to be described.* 
Many who have tested urine for albumin by the ordinary 
heat and acid test will have observed that after boiling the 
clear urine and adding a few drops of nitric acid, the 
resulting fluid will be apparently clear; but upon setting 
aside the urine thus treated, say for twelve hours, or until 
the next morning, there will sometimes be found a small 
deposit. Supposing the urine before testing to have been 
carefully filtered, this deposit is either, 1st, acid urates; 2d, 
uric acid; 3d, nitrate of urea; 4th, albumin. The first 
arise from a partial decomposition of the neutral urates by 
the nitric acid added ; the second by a further action of the 
acid upon the acid urates, and a resulting complete separa- 
tion of the uric acid from the sodium, potassium, etc., with 
which it was combined ; the third is found only when the 
urine happens to be highly concentrated and contains an 
unusual proportion of urea. The second and third have 
well-known forms of crystallization by which they can be 
* See a paper by the author, " Notes on Albuminuria," in the Pro- 
ceedings of the Medical Society of the State of Pennsylvania for i83i, 
p. 644. ORGANIC CONSTITUENTS. 
49 
easily recognized under the microscope, but the acid urates 
and albumin are both amorphous and cannot therefore be 
thus distinguished. All, however, except albumin, disap- 
pear, on the reapplication of heat. In all instances, there- 
fore, urine which has been tried by heat and nitric acid, in 
which, after cooling and standing from six to twelve hours, 
a sediment is present, should be boiled again ; and if the 
sediment is not dissolved after such ebullition, it is albu- 
min. 
My own method, therefore, of examining a specimen of 
urine for albumin is invariably as follows: 
I. Unless perfectly clear, it is first filtered, and if not 
rendered clear by filtration, it is clarified by strong alkalies, 
or the magnesian fluid, according to the directions on page 
41. A portion of the filtered fluid is then taken, and, if not 
acid, it is cautiously acidulated, and then boiled, being care- 
fully watched in a good light for detection of the least dimi- 
nution of transparency. A drop or two of nitric acid is 
then added, and if a turbidity which has ensued upon the 
action of the heat disappears, it is caused by phosphates of 
lime and magnesium, and not albumin. The addition of 
the nitric acid should be cautiously continued until a 
decided excess is added-15 to 30 drops-but not more, 
lest a small amount of albumin present be redissolved by the 
excess of acid. If any degree of turbidity remains it is 
caused by albumin, and- the test may end here-although 
it is well to put the tube aside, in order that the albumin 
may subside and be approximately estimated. If, however, 
there is the least doubt about the presence of albumin, the 
tube must be set away, carefully protected from dust, for 
six to twelve hours, in order that any appreciable sediment 
may subside, and be subsequently again tried with heat. 50 
PRACTICAL EXAMINATION OF THE URINE. 
II. A test-tube is now filled to the depth of half an inch 
with colorless nitric acid. About as much urine is then 
allowed to fall gently upon it in the manner described on 
page 38, and the point of junction of the two fluids care- 
fully examined for the white line. This is best observed by 
holding the tube against a dark ground, produced by a book, 
pamphlet, or coat sleeve, so that the light may fall obliquely 
upon the line of junction of the two fluids, while at the 
same time it is seen against the dark ground. 
When this double test is carefully applied as above 
described, it is scarcely possible to err with regard to the 
presence of albumin. Where it is abundantly present, it is, 
of course, unnecessary to use either the modified heat and 
acid test or the Heller's test, although the latter is always 
useful in that it affords one means of approximately estimat- 
ing the amount of albumin.* 
* The following observation by Dr. C. E. Brown-Sequard, in the 
first number of his Archives of Scientific and Practical Medicine 
(1873), illustrates some of the difficulties occasionally encountered in 
this ordinarily very simple process of testing for albumin: " If we first 
test, by heat, urine containing albumin (after having ascertained that 
it is naturally acid), we may not find the least precipitate; and if we 
add nitric acid to it after it has boiled and become somewhat cold, we 
may yet not find precipitation of albumin. But if we boil a second 
time that now acidified urine, the solidification of albumin quickly 
takes place, and a precipitate soon appears." 
He further says : " In three cases in which the microscope showed 
tubular casts in the urine, the albumin contained by this fluid was so 
modified bv the heat that if the urine (which was naturally acid) was 
boiled first, the addition of nitric acid in small or in large quantity at 
a low temperature or at the degree of boiling produced no solidification 
of that proteid substance. But when I added either a small or a large 
quantity of nitric acid to the fresh unboiled urine and then boiled it, ORGANIC CONSTITUENTS. 
51 
Quantitative Estimation of Albumin. 
Gravimetric Method.-It is a matter of extreme im- 
portance in the course of Bright's disease that we should be 
able to compare the quantity of albumin contained in the 
urine from day to day. The only accurate method is by 
precipitation by acetic acid and boiling, separation by fil- 
tration, drying, and weighing by delicately accurate bal- 
ances, the weight of the filter having been previously deter- 
mined. This, however, involves too much time for the busy 
practitioner, and we must fall back on one of the approxi- 
mative methods. 
Approximate Estimation with Boiling.-The 
easiest of these is to boil a given quantity of urine in a test- 
tube, add a few drops of nitric acid, and set aside for at 
least twelve hours-shaking the urine once or twice in this 
period in order to secure a uniform subdivision and pre- 
cipitation of the particles of albumin. The proportion of 
bulk occupied-one-fourth, one-eighth, a trace, etc.,-is 
used to indicate the quantity of albumin. Greater accuracy 
is obtained by previously filtering the urine of urates, epi- 
thelium, or extraneous matter, which might unduly increase 
the bulk of deposit on standing. 
the ordinary coagulation took place, and after some time of rest, the 
ordinary precipitate appeared. It is evident, therefore, that there is 
sometimes in the urine a kind of albumin which loses its coagulability 
by boiling." 
The lesson from these facts is that it would seem necessary to apply 
the heat and acid tests both ways, that is, the acid should first be added 
to the urine and the mixture then boiled, as well as that the urine 
should be first boiled and the acid then added. I believe, however, if 
the method above described is carefully carried out, albumin cannot 
be overlooked. 52 
PRACTICAL EXAMINATION OF THE URINE. 
Approximate Estimation with Nitric Acid.- 
More definite but perhaps scarcely more accurate is the ap- 
proximate quantitative estimation by means of Heller's nitric 
acid method as given by Hoffmann and Ultzmann. Accord- 
ing to this, if the white zone of albumin has the depth of from 
2 to 3 mm. (-jJj to | inch), is delicate and faintly white in 
color, has no granular appearance, and appears clearly de- 
fined, only when placed against a dark background, the 
quantity is less than per cent., usually per cent. If the 
zone is 4 to 6 mm. to inch) in depth, granular, white, 
opaque, and perceptible without a dark background, the 
quantity is considerable, j to per cent. If, however, the 
zone of albumin appears granular and flocculent, and sinks 
in more or less lumpy masses to the bottom, and when by 
stirring the albumin by means of a glass rod the mixture 
assumes the consistence and appearance of sour cream, then 
the quantity is very large, i to 2 per cent. 
Oliver's Approximate Method.-A better quantita- 
tive method is that recently suggested by Dr. Oliver. It con- 
sists in precipitating all the albumin from a given quantity 
of urine by a mercuric test-paper, and comparing the result- 
ing diminished transparency with that produced by coagu- 
lating the albumin from a standard solution containing 
of 1 per cent, of albumin. This degree of opacity is imitated 
by a piece of ground glass. The test is applied as follows: 
Into a flattened test-tube, graduated to 200 minims, in 
10 minim divisions, are poured 20 minims of urine, and 
a potassio-mercuric iodide test-paper is dropped into the 
tube. It is then well shaken and the resulting turbidity is 
tested by placing behind the tube a card on which lines of 
various degrees of thickness are printed. If the opacity is 
such as to obscure the lines completely, water is to be freely ORGANIC CONSTITUENTS. 
53 
added, say to 60 minims in all, the tube again shaken, and 
the test made with the card. If the opacity is still greater 
than that of the standard ground glass, as determined by 
placing the ruled card behind each, water is to be cau- 
tiously added, io minims at a time, until the opacity of the 
mixture corresponds exactly with that of the standard 
ground glass. A comparison between the known value of 
the precipitant test-paper and the number of times the 
urine has been diluted, furnishes the proportions of albu- 
min. Thus the value of the mercuric papers being per 
cent., five dilutions would be .5 per cent., six, .6 per cent., 
and so on. 
When the lines on the card can be read at once, with- 
out any dilution, the quantity of albumin is below per 
cent. 
The Proportion of Albumin Found in Urine.- 
There is much carelessness of expression among physicians in 
speaking of the quantity of albumin found inagiven specimen 
of urine. Thus we often read that a specimen contains 25 
per cent., or even 50 per cent., of albumen. The propor- 
tion in bulk is of course intended, but no indication given 
that this is what is meant. In point of fact 3 or 4 per cent, 
is probably the maximum amount of albumin which urine 
can contain, since blood-serum only contains about 5 per 
cent., and 2 per cent, albuminuria is a very large one. A 
half per cent, is much more common, and many albumi- 
nuric urines contain nfuch less than a half per cent, of the 
proteid. 
It is not unusual also to over-estimate the amount of albu- 
min passed in the 24 hours, and thence the drain upon the 
system. Suppose, for example, the percentage of albumin 
by weight is .5 of 1 per cent., and the quantity of urine is 54 
PRACTICAL EXAMINATION OF THE URINE. 
50 ounces in the 24 hours, then, there being 480 grains in 
an ounce, 480 X .005 x 50 = 100 grains, the amount of daily- 
discharge, or less than one-quarter of an ounce. Supposing 
there be 2 per cent., which is a very large amount of albu- 
min, and 40 ounces of urine. Then 480 X .02 X 40 = 360 
grains, or three-fourths of an ounce. Of such a loss Senator 
well says that half a pound of beef will more than make up 
the loss of a week. 
Other Proteids Found in Urine. 
It has long been recognized that modifications of albu- 
min occur in urine, either alone or in association with albu- 
min, but since the introduction of the delicate tests, more 
attention has been paid the subject. Among the most con- 
stant of these is: 
Serum-Globulin, Globulin, or Paraglobulin.- 
Globulin is almost always associated with serum-albumin, 
from which it may be separated by the addition, to satura- 
tion, of magnesium sulphate. The precipitate is filtered off, 
and washed in hot water until the sulphate is quite removed. 
The filtrate contains the serum-albumin. 
Globulin is also separated by diluting the urine, after filtra- 
tion, until the specific gravity is 1003 or 1002. Occasionally 
a cloudiness appears immediately, due to the separation of 
some of the globulin. But it is completely separated by 
passing a stream of carbonic acid through the dilute fluid, 
for from 2 to 4 hours. In from 24 to 48 hours the globulin 
falls to the bottom as a milk-white flocculent substance. 
The supernatant fluid contains the albumin. Should the 
urine be neutral or alkaline, it must be rendered slightly 
acid by a few drops of dilute acetic acid. 
This test is based upon the fact, that paraglobulin is held ORGANIC CONSTITUENTS. 
55 
in solution by the sodium chloride, and other neutral salts 
always present in the urine. When urines are largely di- 
luted with moderately pure water, the percentage of neutral 
salts is so reduced that the globulin falls out of solution. 
Dr. Roberts* suggests the following simple modification 
of the test: Fill a urine-glass or test-tube with water, and 
let fall into it a succession of drops of albuminous urine. 
In many cases, each drop as it falls is followed by a milky 
train, and when a sufficient number of drops has been 
added, the water assumes throughout an opalescent appear- 
ance, as if a few drops of milk had been added to it. The 
addition of acetic acid causes the opalescence to disappear ; 
for globulin is soluble in concentrated acetic acid, and also 
in a i per cent, solution of hydrochloric acid. From its 
solution in common salt it is completely separated on heat- 
ing. 
Occurrence.-Not only does globulin accompany se- 
rum-albumin in most instances, but it sometimes exceeds it 
decidedly, although the proportion in the blood is much 
less, being to serum-albumin as i to 1.5. It may even occur, 
although very rarely, without serum-albumin. According to 
Senator, it is most abundant in the urine of lardaceous dis- 
ease of the kidney. It also occurs in acute nephritis, in the 
hyperaemia of cantharides poisoning, and in albuminuria 
associated with deranged digestion. 
Mucin.-This proteid, abundant in urine which has 
passed over irritated urinary passages, is said to be present 
to some extent in all urines. It is precipitated by alcohol, 
* Discussion on Albuminuria before the Glasgow Pathological and 
Clinical Society, p. 17. Reprinted from the Glasgow Medical Jour- 
nal, 1884. 56 
PRACTICAL EXAMINATION OF THE URINE. 
by dilute mineral acids, and by all vegetable acids except, 
according to Dr. Johnson, picric acid. But Dr. Oliver does 
not even except picric acid, and fears that in all of his 
earlier observations with this acid, he mistook mucin for a 
trace of albumin.* 
To Test for Mucin.-The tests usually employed for 
mucin are citric and acetic acids and by the contact method, 
the acid being introduced first. Just above the point of 
contact a cloud-like coagulum gradually makes its appear- 
ance, contrasting with the opaque white coagulum of albu- 
min. When albumin and mucin are both present, the latter 
appears at the upper part of the column of urine, while the 
albumin is confined to the point of contact between the two 
fluids. It differs from the somewhat similar white deposit 
of acid urates in that it is not dissipated by heat. 
The Mucin Reaction of Normal Urine.-Accord- 
ing to Dr. Oliver even when a normal urine is thus treated 
by citric acid, there appears in the course of several 
minutes, along the plane of contact of the two fluids, a deli- 
cate whitish zone which becomes gradually more pro- 
nounced, and which is mucin. This reaction concentrated 
by the contact method becomes, when diffused throughout 
the urine, either totally inappreciable, or appreciable only 
in the slightest degree. This may be studied by adding a 
citric acid test paper to 60 minims of transparent urine. If 
mucin is present in larger quantity than usual, a slight 
milkiness appears. 
If, however, to the normal urine, acidified by citric acid, 
a mercuric test paper be added, a delicate haze may be 
* On Bedside Urine Testing. Third edition, London, 1885, p. Ill, 
note. ORGANIC CONSTITUENTS. 
57 
detected on holding the urine to the light, and on a dark 
background. This haziness, according to Dr. Oliver, disap- 
pears on applying heat to near the boiling point, and reappears 
on cooling, to revanish on reheating. If, on the other hand, 
a solution of the potassio-mercuric iodide is used by the 
contact method, the opacity thus produced by mucin does 
not disappear when heat is applied.* If these observations 
are correct, heat removes all sources of error in testing for 
albumin with the potassio-mercuric iodide, when used in the 
shape of a test paper. This, therefore, Dr. Oliver regards 
as possessing a distinct clinical advantage over the solu- 
tion. 
* The student is earnestly recommended to study the reactions of 
mucin by impregnating normal urine with saliva as directed by Dr. Oli- 
ver. The clear saliva and a solution of salt, say 20 grains to the ounce, 
should be mixed in equal parts, and one drop of acetic acid, or a citric 
acid test paper, added to a 4-inch column, which should be thoroughly 
boiled, when the milkiness produced by a trace of albumin will appear. 
This highly muciparous solution is added to albumin-free urine, 1 to 1 
or 1 to 2 according as the observer may wish to charge it with mucin. 
In any case the urine will then become more highly muciparous than 
is likely to be met with in practice. Filtration may be omitted, being 
slow, if observation is checked by comparing the unheated fluid with 
that experimented with. A citric acid and a mercuric test paper, added 
to 60 minims, produces an opacity exactly like that produced by a 
small quantity of albumin, but it differs front it in completely vanishing 
when heated. The opacity returns as the temperature of the solution 
falls, and in the cold it greatly exceeds the original amount. Heat will 
again disperse it as before. If a trace of albumin be added to the 
mucin-charged urine, the test papers will produce an opacity which 
heat will clear up only to a certain degree, that which remains over 
being due to albumin. 58 
PRACTICAL EXAMINATION OF THE URINE. 
Peptone.-The frequent occurrence of peptone in urine 
has rendered it one of the most important of the possible 
constituents demanding attention. Much has been lately 
added to our knowledge of peptonuria, but it is possible 
that further changes will be made in such knowledge before 
it is complete. 
It is well known that peptone is a proteid substance 
which is the final result of gastric and pancreatic digestion. 
It may also be produced from albumin by the continued 
action of acids and alkalies, and it is said, also, by the 
decomposing action of bacteria, as well as the long-con- 
tinued operation of a temperature of 268° to 290° F. It 
differs from albumin and hemialbumose or propeptone in 
that it is not precipitated by heat or nitric acid, by acetic 
acid combined with chloride of sodium, or with cyanide of 
potassium. Like albumin and propeptone, it is precipitated 
by tannin, corrosive sublimate, phosphortungstic acid, Mil- 
lon's reagent, and by sodium tungstate, potassio-mercuric 
iodide and picric acid, the last three being among the 
recently suggested delicate tests for albumin ; but when 
precipitated by these reagents it is redissolved by heating. It 
is further characterized by the purple reaction its solutions 
strike with sodic hydrate and a little salt of copper. The 
sensitiveness of this so-called "biuret" reaction is increased 
by slight colorations of the fluid, and especially a yellow. 
So delicate is it that a solution as weak as 1 part in 1000 
responds promptly. This reaction is shared by propep- 
tone, while albumin produces only a blue coloration,- 
under no circumstances a red or violet. It has been sug- 
gested that peptone bears the same relation to albumin as 
grape sugar to starch-that is, that it is a hydrate of 
albumin. ORGANIC CONSTITUENTS. 
59 
Peptone is not present in healthy blood or normal urine, 
and even during digestion the portal vein contains but 
traces of it. Injected into the blood, it disappears from it 
very quickly, a certain proportion reappearing in the urine, 
while some is taken up by various organs of the body. 
These organs also appear to retain any small excess which 
may have been introduced into the blood from over-inges- 
tion of albuminous food. It would seem, therefore, that it 
is converted into albumin at the moment it is absorbed into 
the circulation, and is incapable of taking the place of al- 
bumin in the blood, although this has been alleged by Plosz, 
Maly, and Adamkiewicz. During health, too, the various 
organs of the body contain traces of it, and it is a constant 
constituent of pus, as was first shown by Hofmeister. 
Tests for Peptone.-The best tests for peptone are 
those which require some preliminary treatment of urine 
suspected to contain it. For these we are chiefly indebted 
to Hofmeister.* The simplest of these is the 
Phosphor-Tungstate Test.-(i) The urine is de- 
colorized and freed from mucin by treating say half a liter 
or about a pint with solution of neutral acetate of lead until 
a thick flocculent precipitate is produced, and then filtering. 
(2) To a portion of the filtrate add acetic acid and a few 
drops of a solution of ferrocyanide of potassium. Should 
there be a cloudiness or precipitate it is due to albumin, 
and the addition should be continued as long as a pre- 
cipitate occurs. The albumin must be removed by filtra- 
tion. 
(3) Add to a portion of the filtrate about one-fifth its 
* Zeitschrift fur Physiol. Chemie, 573. 60 
PRACTICAL EXAMINATION OF THE URINE. 
bulk of concentrated acetic acid, and then phosphortungstic 
acid acidulated with acetic acid.* If the fluid remains clear 
after standing some time, it does not contain peptone. 
Should, however, after the lapse of io minutes, a cloudiness 
appear, peptone is present. 
The Biuret Test.-Add to the entire filtrate, after 
treatment with acetate of lead, concentrated solution of 
tannic acid, so long as a precipitate takes place. Throw the 
latter, after 24 hours, on a filter, and wash it with water in 
which tannic acid and magnesium sulphate are dissolved. 
The precipitate is now thoroughly rubbed up in a capsule 
with saturated baryta water, and after the addition of a frag- 
ment of solid baryta, retained at a boiling temperature for 
a few minutes. If care is not taken to mix intimately 
the precipitate with the baryta, resinous masses form dur- 
ing the heating, which interfere with the proper -action of 
the baryta. After a few minutes the mixture is filtered, 
baryta water again added, and thoroughly shaken with it 
until the fluid filters off from the dark-colored precipitate, 
either colorless or slightly yellow. 
Or the filtrate may be treated with half a volume or its 
own bulk of concentrated hydrochloric acid, and then with 
an acid solution of phosphortungstic acid, until there is 
no longer a precipitate. The latter is then promptly filtered 
off, because if allowed to stand, there appears on the sur- 
face a second reddish precipitate, which interferes with the 
* The solution of phosphortungstic acid is made by adding to a 
boiling watery solution of tungstate of sodium, enough phosphoric 
acid to produce an acid reaction. After cooling, the fluid is to be 
made strongly acid with acetic or hydrochloric acid, and, after stand- 
ing one day, filtered. ORGANIC CONSTITUENTS. 
61 
subsequent demonstration of the peptone. The precipitate 
is washed on the filter with a solution of sulphuric acid, 
three to five per cent, strong, until the filtrate passes through 
colorless, then turned into a capsule, intimately mixed with 
baryta in substance, the mixture treated with a little water, 
and, after being warmed for a short time, filtered. If too 
strongly heated, a dark-hued filtrate is obtained, which is to 
be avoided. 
The second is both shorter and more delicate, 
detecting, according to Neubauer, peptone in solutions 
containing but . i gram to the liter, while the tannic acid 
method requires .15 to .2 gram. It is the one preferred by 
v. Jaksch, to whom we are indebted for so much of our 
knowledge of peptonuria and its clinical significance. 
In the filtrate thus obtained the " biuret " reaction is now 
sought by adding first liquor sodae or potassae until a decided 
alkalinity is produced, and then, drop by drop, a very weak 
solution of sulphate of copper. If a reddish color appears, 
the addition of the copper solution is to be continued until 
the reddish-violet has reached its greatest intensity. If no 
peptone is present the fluid becomes simply green or bluish- 
green. The simultaneous baryta-precipitate does not inter- 
fere with the test, as it rapidly subsides while the supernatant 
fluid retains the color. 
Ralfe's Test.-A rough test for peptone, which answers 
very well where a considerable quantity is present, may be 
made by placing a drachm, or 3.5 c.c., of urine in the bot- 
tom of a test-tube and gently overlaying it with an equal 
bulk of urine. At the point of contact a zone of phosphates 
forms, while above this, if peptones are present, a delicate 
rose-colored halo will float. Should the peptones be mixed 62 
PRACTICAL EXAMINATION OF THE URINE. 
with serum-albumin, the halo will be mauve, if only albumin 
is present, purple. 
Randolph's Test with Acid Mercuric Nitrate and 
Potassium Iodide.-This test, suggested by Dr. N. 
Archer Randolph, of Philadelphia, is based upon the fact, 
that if Millon's* reagent be added to an aqueous solution 
of iodide of potassium, a red precipitate of mercuric iodide 
results, but if peptone or bile acids are present, the precipi- 
tate is yellow. To 5 c.c. of urine, which must be cold and 
but faintly acid, add two drops of a saturated solution of 
iodide of potassium and then 3 or 4 drops of Millon's 
reagent, when, if peptones or bile acids are present, a yellow 
precipitate falls. Then the question as to whether it be bile 
acids or peptones must be settled by the tests for the former. 
Johnson's Picric Acid Test.-It is well known that 
peptones, like albumin, are precipitated by picric acid ; but, 
unlike albumin, the precipitate thus obtained is redissolved 
on heating. The same is true, however, of the acid urates 
and vegetable alkaloids, among which quinine and its allied 
derivatives are conspicuous. The sediment of urates is 
readily distinguishable from that of peptones by the micro- 
scope, the former being made up of large granules of urate 
of sodium and uric acid crystals, while freshly precipitated 
peptones appear quite homogeneous under the microscope ; 
but when, having been dissolved by heat, they are repre- 
cipitated on cooling slowly, they contain exceedingly 
minute granules, which exhibit very actively the dancing 
Brownian movement. If, however, the liquid be cooled 
suddenly, by plunging the test-tube in cold water, the pre- 
* To make Millon's reagent, dissolve quicksilver by the aid of 
warmth in common fuming nitric acid, and dilute with two volumes 
of water. ORGANIC CONSTITUENTS. 
63 
cipitate does not become granular until it has been allowed 
to stand for some hours. The difference between the fresh 
precipitate with the vegetable alkaloids and that of peptone, 
according to Johnson, is, that the former is finely granular, 
while the freshly precipitated peptones are homogeneous. 
The Clinical Significance of Peptonuria.-The 
instances in which peptonuria occurs are numerous. The 
best determined fact with regard to it is that discovered by 
Maixner, that it is always present when pus-corpuscles are 
disintegrating somewhere in the body, and in most of the 
diseased states in which it has been found, such a condition 
of affairs has been probable. It has been especially studied 
by Maixner, v. Jaksch, Fenomenow, and Pacancowski. 
Among the diseases in which it has been found may be 
named typhoid fever, variola, scarlatina, miliary tubercu- 
losis, erysipelas, acute arthritis, pulmonary tuberculosis, 
croupous pneumonia, purulent pleurisy, embolism, carci- 
noma of the gastro-intestinal tract and of the liver, catarrhal 
jaundice, parametritis, cerebral apoplexy, parotitis, abscess. 
Exception to the above explanation may have to be made 
in some cases of carcinoma of the gastro-intestinal tract, and 
cancer of the liver and uterus. In cancer of the stomach 
and small intestine, Maixner early ascribed the peptonuria 
to absorption by the ulcerated surfaces, of the peptone of 
digestion, but in cancer of the oesophagus, rectum, and 
uterus, we must have recourse to disintegration of new- 
formed tissue as the sole source. The almost invariable 
association of peptonuria with cancer of the liver, Pacancow- 
ski thinks, compels the conclusion that the liver in* health 
has something to do with the conversion of peptone into 
albumin, an office that in cancer is interfered with. 
Although Senator, Petri, and Poehl assert that albumin- 64 
PRACTICAL EXAMINATION OF THE URINE. 
uria and peptonuria coexist, Maixner, and more recently 
Pacancowski, fails to confirm this. The latter failed to find 
it in four cases of chronic nephritis, and one of acute. 
It has also been said that peptone may originate from 
the conversion of albumin by reason of a sort of fermenta- 
tive action of the cellular elements of urine, and that pep- 
tone may be a product of the decomposition of proteid 
matters by the agency of bacteria. 
Hemialbumose, or Propeptone. 
This substance is an intermediate product in the con- 
version of albumin into peptone, during gastric and pan- 
creatic digestion. It is, therefore, abundantly present along 
with albumin in the gastric and intestinal contents, and, 
unlike peptone, is also found in the blood during digestion. 
It was first found by Bence Jones in the urine in a case of 
osteomalacia, and later by Kiihne in another case of the 
same disease. 
Hemialbumose, like albumin, is insoluble in alcohol; 
sparingly soluble in cold water, but very easily in hot water, 
and water containing only traces of acids, alkalies, or salts. 
It is not, therefore, precipitated by heat from its watery 
solution, as is albumin, but if the solution be made strongly 
acid and concentrated salt solution be added thereto, hemial- 
bumose is precipitated. If the cloudy fluid be now heated, it 
becomes transparent, but again turbid on cooling. A further 
large addition ofsalt maintains the precipitate in spite of heat- 
ing. Hemialbumose is precipitated by pure nitric acid, but 
redissolved with the production of an intense yellow color on 
being heated, and reprecipitates on cooling. An excess of 
nitric acid redissolves the precipitate even in the cold, with 
the production of the same orange-red color. 65 
ORGANIC CONSTITUENTS. 
In these respects hemialbumose differs strikingly from 
both peptone and albumin. It is like peptone, in that it 
exhibits the biuret reaction with an alkali and salt of cop- 
per. Like albumin, it is precipitated by adding first acetic 
acid and then ferrocyanide of potassium ; also by phosphor- 
molybdanic, phosphorwolframic, tannic and picric acids, 
the precipitate, except that with picric acid, being undis- 
solved by warmth. 
To test the presence of Hemialbumose, the albu- 
min must first be removed. This is accomplished by acidify- 
ing the urine with a few drops of acetic acid, adding about 
one-sixth its volume of concentrated salt solution, boiling, and 
filtering off the precipitate. Albumin and globulin remain 
upon the filter. The filtrate is then allowed to cool, and if a 
turbidity arises or is produced by the further addition of salt 
solution, which disappears by heating, and reappears with 
cold, propeptone is present. If desired, the precipitate can 
be filtered off the filtrate, redissolved in a little water, and 
reprecipitated by acetic acid and ferrocyanide of potassium. 
Hemialbumose is removed from fluids by adding acetate 
of iron and boiling, or by boiling with hydrated lead oxide. 
Fibrin. 
Fibrin is found in the urine when there are haemorrhages 
from the genito-urinary passages, and in intense inflammation 
of these passages and of the kidneys; also in a condition of 
fibrinuria which occurs in the Isle of France; finally, in 
chylous urine fibrin is present. 
Recognition.-It is recognized by its spontaneous 
coagulation, the product of which is, however, not to be 
confounded with mucus, or the glairy substance formed by 
the action of ammonium carbonate on pus; also by its 
fibrillar structure as shown by the microscope. 66 
PRACTICAL EXAMINATION OF THE URINE. 
Coagula may be filtered out from urine by means of mus- 
lin, and washed with water to free them from urinary constit- 
uents. If insoluble in dilute alkalies and in 5 to 10 per 
cent, solution of sodium chloride, they are fibrin. 
Proteids found in the Urine Contrasted. 
The following paragraphs, from the latest edition of Neubauer,* con- 
trasting the characteristic properties of the proteids which may occur 
in urine, will aid the student in acquiring the necessary knowledge: 
Albumin, hemialbumose and peptone are soluble in water; globulin 
is not. This insolubility in water globulin shares with protein (which, 
however, does not occur in urine), and both albuminoid substances are 
soluble in alkalies and acids, forming with the acids and alkalies soluble 
binary combinations, behaving to the alkalies as acids and to acids as 
bases. They are soluble also in basic salts (phosphates and car- 
bonates of the alkalies), since they take away from these salts the bases. 
The combination of protein with a base is called an albuminate, that 
of protein with an acid, acid-albumin. No special term is applied to the 
combinations of globulin with bases or with acids. 
If the acid be withdrawn from an acid-albumin in solution, by neu- 
tralization with an alkali, the insoluble protein is liberated, and falls as 
a precipitate. The same thing happens when a dissolved albuminate 
is neutralized by an acid. The term precipitable albumin has been 
suggested for protein, and since globulin, at least under certain cir- 
cumstances, gives the same reaction, so may the same term be extended 
to it. 
Globulin is distinguished from protein in that the former is soluble 
in neutral salts (the neutrally reacting salts of the alkalies and alkaline 
earths, as common salt and nitrate of potash) ; protein is not soluble in 
these. 
Hemialbumose, although soluble in water, is even more easily soluble 
than globulin in alkalies and acids, as well as in neutral salts. On the 
other hand, neither alkalies, acids, nor neutral salts have any influence 
upon the solubility of albumin and peptone, already soluble in water. 
These two albuminous substances are, however, distinguished from 
* Wiesbaden, 1881, p. 114. ORGANIC CONSTITUENTS. 
67 
each other, in that albumin is easily converted into precipitable albumin, 
while peptone is not. 
Fibrin, finally, is soluble neither in water, like albumin, hemialbu- 
mose, and peptone, nor in dilute cold acids or alkalies, like precipitable 
albumin, nor in salt solutions like globulin. 
Mucin, like precipitable albumin, is not soluble in water, but is in 
alkalies and strong mineral acids; on the other hand, it is not soluble in 
dilute mineral acids, nor in concentrated organic acids. 
Haemoglobin and methaemoglobin are recognizable by their color. 
VIII. Sugars found in Urine. 
Glucose, C6H12O6. 
While the assertion of Briicke and Bence Jones that glucose 
is present to a slight degree, even in normal urine, has been 
quite generally accepted, and has apparently been confirmed 
by the more recent researches of Dr. Pavy,* of London, it 
has been contradicted by Seegen, and very careful investi- 
gations by my colleague, Professor Wormley, confirm the 
results of Seegen.f It does not follow, however, that in- 
stances may not occur, in which small quantities of sugar, 
barely, if at all, recognizable by the ordinary tests, are 
present in urine, and that these have no clinical significance. 
Of the large number of tests for the detection of sugar, 
only those will be given which have borne the trial of expe- 
rience, and it is suggested that for practical purposes the 
student should select some one of these and accustom him- 
self to its use, and to the modifications in results to which 
all are more or less subject. I am confident that much of 
the difference of opinion as to the value of the different 
tests is due to the unequal experience of different observers 
* Pavy, Points Connected with Diabetes, London, 1879. 
f Seegen, Der Diabetes Mellitus, 2 Aufl., s. 224. 68 
PRACTICAL EXAMINATION OF THE URINE. 
with a particular test. Mistakes are less likely to be 
made by a beginner with a freshly made Fehling's solu- 
tion than with Trommer's test. It is necessary, however, 
to be familiar with more than one test, because cases of 
doubt constantly arise where the evidence of one is insuffi- 
cient. (See especially remarks on qualitative testing, p. 98.) 
Specific Gravity and Quantity.-The specific grav- 
ity alone, when 1030 or more, affords a presumption of the 
presence of sugar, and if at the same time the urine is very 
pale, and far exceeds 1500 c.c. (50 fluidounces) in twenty- 
four hours, the probabilities are much increased. These 
facts at least call for the use of other tests to determine the 
question. (See note on p. 25.) 
Moore's or Heller's Test. 
Moore's test depends upon the fact that glucose or grape- 
sugar, with which diabetic sugar is identical, becomes oxi- 
dized when boiled in contact with caustic alkali, taking the 
oxygen from the atmosphere. 
To a small quantity of urine in a test-tube, add half as 
much liquor potassae, or liquor sodae, and boil. If glucose is 
present, a yellowish-brown color soon makes its appearance, 
which becomes more intense as the boiling is continued, 
and which will be the deeper the larger the proportion of 
sugar, becoming finally almost black if the quantity is 
large. The coloration is due to the formation, first, of 
glucic and finally of melassic acid, both of which remain in 
solution. The flaky precipitate which is observed after the 
addition of the alkali, and is increased on the application 
of heat, consists of the earthy phosphates, which, if very 
abundant, may be filtered off before the heat is applied. 
If now to the colored fluid a few drops of nitric acid be ORGANIC CONSTITUENTS. 
69 
added, the brown coloration disappears, and the odor of car- 
amel or of burnt molasses is developed. 
For the successful operation of Moore's test there should 
be at least .3 per cent, of sugar in the urine, or grains 
to the fluidounce. 
Precautions.-I. Albumin if present should be removed by boil- 
ing and filtration. 
2. Solutions of soda and potash are liable to become impregnated 
with lead, either from being kept in flint-glass bottles or from the glazed 
earthenware vessels in which, during preparation, they are evaporated. 
Such contamination always causes the production of a brown and black 
color when boiled with organic matter containing sulphur, due to the 
formation of sulphuret of lead. This error may be avoided by first 
ascertaining the purity of the alkaline solutions, and afterwards keeping 
them in green-glass bottles. 
3. All high-colored urines darken slightly when boiled with liquor 
potassae. A high color is, however, rare with diabetic urines. Should 
it be present, the coloring matter may be precipitated by solution of 
acetate (sugar) of lead, or by filtering through animal charcoal. The 
former throws down a small quantity of the sugar, and the latter retains 
a little. 
4. The coloring matters of bile in urine, either when pure or decom- 
posed (that is, when they respond neither to Gmelin's nor Heller's test), 
produce a brown color with liquor potassae or sodae without the appli- 
cation of heat. 
5. Bodeker found in the urine of an adult a substance which he calls 
alkapton, which with strong solutions of alkali produces a brown dis- 
coloration from above downward. This, according to him, also reduces 
the salts of copper, but does not affect the bismuth salts. 
An approximate quantitative analysis may be made 
by Moore's test. As a result of trial, Vogel has ascertained 
that solutions of grape-sugar, when boiled with half their bulk 
of liquor potassae, exhibit the following changes of color: 
a 1 per cent, solution becomes canary-yellow, a 2 per cent. 70 
PRACTICAL EXAMINATION OF THE URINE. 
solution a dark amber, a 5 per cent, a dark Jamaica rum, 
and a 10 per cent, a dark black-brown and opaque, while 
all solutions of a less percentage are more or less trans- 
parent. 
The Copper Tests. 
The copper tests depend upon the power which grape- 
sugar possesses of reducing the oxide of copper and other 
metallic oxides, as silver, gold, etc., to a lower state of oxi- 
dation. In Trommer's test the oxide of copper is set free 
at the time of its application by liquor potassae or sodae, in 
excess. 
Trommer's Test.-1. A drop or two of a (preferably 
weak-say 1 to 30) solution of cupric sulphate is added to 
4 or 5 c.c. of the suspected urine, and then an equal bulk 
of liquor potassae or sodae. On first adding the alkali there 
is immediately liberated, in addition to the earthy phos- 
phates, a blue precipitate of hydrated cupric protoxide, 
which, if sugar is present, is redissolved on agitating the mix- 
ture, producing a beautiful blue transparent liquid. If, on 
the other hand, there is no sugar, the fluid will not be 
thus blue after agitation, but exhibit a turbid greenish, hue. 
This, however, is not alone relied upon, but the mixture is 
boiled for a few seconds, and if sugar is present, a copious 
yellow precipitate of hydrated cupric suboxide takes place. 
This subsequently loses its water and becomes the red sub- 
oxide which falls to the bottom or sides of the test-tube, to 
which it often closely adheres. 
The precise reaction is not known. 
2. A second similarly prepared mixture of these ingredi- 
ents should be made and set aside without the addition of 
heat, for from six to twenty-four hours. If sugar is present ORGANIC CONSTITUENTS. 
71 
a similar precipitate of suboxide of copper will take place. 
If the reaction is at all doubtful it is important that this 
check-test should be made, since, as Neubauer points out, 
most of the other organic substances which reduce the salts 
of copper do so only when heated or after long boiling. 
Precautions.- I. Albumin must always be removed, as it interferes 
with the reduction of the cupric oxide. 
2. Too much of the solution of cupric sulphate or too strong a solu- 
tion should not be used, because the prolonged boiling of any urine 
with an excess of copper will produce a yellow or greenish-yellow 
color, which may not appear until the mixture cools off. Just enough 
copper should be added to produce a distinctly blue color. 
3. While the fluid must be made to boil for perhaps half a minute, 
the precipitate should take place without prolonged boiling, as a re- 
duction by other organic substances is induced by prolonged boiling. 
4. The flocculent precipitate of earthy phosphates should not be 
mistaken for the suboxide of copper; it is either transparent or of a 
pale greenish hue. On the other hand, a mere change of color is not 
sufficient. Strictly normal urine almost always has a decolorizing effect. 
There must be an actual yellow or red precipitate. If it be desired to 
eliminate altogether any error due to the precipitation of the earthy 
phosphates, it may be done by adding the potash solution, and filtering 
before adding the copper. 
5. As already stated, cupric protoxide is sometimes reduced by other 
organic matters found in urine, especially uric acid, by hippuric acid, 
the urates, hypoxanthin, mucus, indican, etc. On the other hand, a 
small amount of sugar may be present in urine and fail to reduce the 
oxide in the presence of certain other substances. Dr. Beale* has 
shown that ammonium chloride, ammonium urate, and other ammoniacal 
compounds have this latter effect; and not only albumin but organic 
substances generally, including creatin, creatinin, pepsin, peptones, uri- 
nary coloring matters, etc., act similarly. Recently Dr. George Hay,J 
* Kidney Diseases and Urinary Deposits, p. 246. 
f Philadelphia Medical Times, vol. vii., 1877, and vol. viii., 1878, 
p. 28. 72 
PRACTICAL EXAMINATION OF THE URINE. 
of Pittsburgh, Pa., has reaffirmed some of these sources of error. When 
these partial reductions occur, a yellowish-green precipitate results. 
Attention should be paid to the specific gravity, to the fact that a pre- 
cipitate of the phosphates always takes place which must not be mis- 
taken for the suboxide, and the disappearance of the blue color and the 
substitution of a yellowish tinge is also not to be mistaken for a pre- 
cipitate. A yellow precipitate, however, does indicate a partial re- 
duction either by some other organic substance or by the sugar itself, 
and demands that the urine should be subjected to the bismuth or fer- 
mentation test, or, if absolute accuracy is required, to the lead process 
described on page 98. 
When proper precautions are observed, reliable results 
may be expected with Trommer's test with saccharine urines 
containing of 1 per cent. 
Other Copper Test Solutions-Fehling's, and Pavy's Fluid. 
It has been stated that when an alkali is added to a solu- 
tion of sulphate of copper an abundant precipitate of hy- 
drated cupric protoxide is thrown down. This is not 
dissolved by any excess of alkali added, but if some organic 
matter is added or is present, an excess of alkali dissolves 
the protoxide. It is for this reason that if sugar happens 
to be present in a suspected fluid to which these have been 
added, the precipitated protoxide is dissolved and a clear 
blue fluid results. 
These facts enable us to construct a fluid which will hold 
the protoxide of copper in solution; but, in selecting an 
organic substance, one must be chosen which will not 
reduce the oxide of copper as does sugar, else it will make 
our test inoperative. Such a substance is tartaric acid, 
which is usually employed. 
Of the numerous copper solutions employed, only Fehl- 
ing's, and Dr. Pavy's modification of it, are given, since 
these are most convenient in practice, and serve also for ORGANIC CONSTITUENTS. 
73 
quantitative estimation. The one or the other maybeused,as 
it is preferred to work with the English or the metric system. 
Fehling's Solution.-34.639 grams pure crystallized 
sulphate of copper are dissolved in 200 grams distilled 
water; 173 grams chemically pure crystallized neutral sodic 
tartrate are dissolved in 500 or 600 grams solution of caustic 
soda of specific gravity 1.12, and into this basic solution 
the copper solution is poured, a little at a time. The clear 
mixed fluid is diluted to 1 liter. 
10 c.c. of this solution will be reduced by .05 gram, or 
50 milligrams, of diabetic sugar. If the copper solution is 
to be kept some time, it is absolutely essential that it 
should be placed in smaller bottles holding 40-80 grams, 
sealed, and kept in the cellar. 
Pavy's Solution consists of- 
Cupric sulphate, 320 grains. 
Neutral potassic tartrate, 640 grains. 
Caustic potash, 1280 grains. 
Distilled water, 20 fluidounces. 
The solution is made in the same manner as Fehling's, 
and 100 minims correspond to % grain of grape-sugar, the 
formula for grape-sugar being here taken C6HUO7, while by 
Fehling it is taken C6H1SO6.* 
These solutions serve equally well for qualitative and volu- 
metric testing, but if it is simply desired to have a solution 
for the former purpose, it may be made by pounding to- 
gether 5 grains (.324 gram) cupric sulphate, 10 grains (.648 
gram) neutral potassic tartrate, and dissolving in 2 drachms 
(7.4 c.c.) liquor potassae. The usual blue fluid results. 
* This should be remembered, as, in consequence of it, the same 
urine in the hands of different observers would yield slighly different 
results, according as one or the other solution is used. 74 
PRACTICAL EXAMINATION OF THE URINE. 
To Use Fehling's and Pavy's Solutions for Quali- 
tative Testing.- The same precautions laid down for the 
use of Trommer's test are to be observed, for the Fehling's 
and Pavy's solutions are simple modifications of Trommer's 
test and subject to the same sources of error. 
In using either of the above solutions for qualitative test- 
ing, a small quantity, say i c.c., should be placed in a test- 
tube, and diluted with about four times its bulk of water. The 
mixture should then be boiled for a few seconds. If the solu- 
tion remains clear on this boiling, add immediately the sus- 
pected urine drop by drop. If sugar is present in any 
quantity, the first few drops will usually cause the yellow 
precipitate; but the dropping may be continued if no pre- 
cipitate occurs, reapplying the heat occasionally, until an 
equal volume of the urine has been added. If no precipi- 
tate occurs, sugar is absent, clinically speaking. 
If a precipitate occurs on boiling the test fluid alone, a 
new supply must be obtained, or a little more soda or 
potash may be added, the fluid filtered, when it is again 
fit for use. The precipitate referred to is a suboxide of 
copper, the result of a reduction of the protoxide, which 
sometimes occurs when Fehling's or Pavy's solution is 
kept for some time. It is said to be due to racemic acid, 
into which tartaric acid is convertible on exposure. Under 
the influence of heat this acid oxidizes at the expense of the 
protoxide of copper, and the suboxide is precipitated ; 
hence the necessity of boiling a solution, before adding the 
suspected fluid. I have sometimes noted that boiling a 
spoiled undiluted Fehling's solution does not reduce the 
copper, while from the diluted solution, when boiled, the 
suboxide is thrown down ; so that boiling a diluted Fehling's 
solution becomes a more delicate test of its quality than ORGANIC CONSTITUENTS. 
75 
boiling the undiluted solution. All possibility of such 
source of error may be avoided by keeping the solution of 
copper separate from that of the potassic tartrate in the 
caustic soda solution, and mixing them at the moment they 
are required for use, in the proportion of one part of the 
former, three of the latter, and two of water. 
It will be noted that in the use of Fehling's and Pavy's 
copper solutions an excess of the test fluid is always used, 
while in the method described as Trommer's, the effect of 
adding too much may be to produce a yellow sediment and 
coloration on boiling with any urine, especially on cool- 
ing. It occasionally happens, also, when Fehling's solu- 
tion is used, that no leaction occurs until considerable 
urine has been added and the mixture cools down after 
the boiling, when a yellowness or milkiness makes its 
appearance. Dr. Roberts* believes this reaction due to 
sugar. But this is at least doubtful, for I have known it to 
occur in urine which, when treated by the lead process 
presently to be described, was found to be without a trace 
of sugar. It may be due to sugar, but it is as likely to be 
due to uric acid or some other of the reducing substances 
contained in urine. In such a case the only way to settle 
the question is to resort to the lead process described on p. 
98. But this may be said, that the quantity of sugar which 
could occasion such a reaction is of no clinical significance. 
Filtering through animal charcoal is a less troublesome 
expedient than the lead process. This gives a perfectly 
clear fluid to work with, but in such filtration a small quan- 
tity of sugar is retained by the charcoal and must be washed 
out with distilled water. Again, it is almost impossible to 
* Urinary and Renal Diseases, Amer, ed., 1879, p. 190. 76 
PRACTICAL EXAMINATION OF THE URINE. 
obtain charcoal sufficiently free from impurities, even when 
specially prepared for the purpose. 
Quantitative Analysis by Fehling's or Pavy's 
Solutions. Volumetric Process.-The simplest 
method of analysis by Fehling's or Pavy's solution, and one 
which may be used in the consulting room as easily as the 
laboratory, is the following: One cubic centimeter of 
Fehling's solution is diluted in a large test-tube with four 
cubic centimeters of distilled water, and boiled as described 
for qualitative testing. Its purity being thus ascertained, 
ny cubic centimeter of the suspected urine is added from a 
suitably graduated pipette. Heat is then reapplied, the pre- 
cipitate watched, and then another cubic centimeter added, 
the heat again reapplied until it is found, after proper sub- 
sidence, that all the blue color is removed from the cubic 
centimeter of Fehling's solution. If in doing this, i c.c. of 
urine has been added, it will have contained just half of 
i per cent, of sugar. If more than i c.c., it will have 
contained less than a half, but more than one-quarter per 
cent. If exactly 2 c.c. are used, it will have contained 
exactly one-quarter per cent. If, on the other hand, but 
half a cubic centimeter is used, it will have contained 1 
per cent., one-quarter of a cubic centimeter, 2 per cent, 
and so on. 
If the proportion of sugar is large, as indicated by the 
specific gravity or qualitative test, the urine should be 
diluted with a definite proportion of water, and this re- 
garded in the estimation. 
If it is desired to determine the quantity in English 
measures, Pavy's solution maybe used instead of Fehling's, 
and 100 minims measured off into the test-tube, diluted 
with four times its bulk of water, and boiled as before. ORGANIC CONSTITUENTS. 
77 
Then the urine, diluted if necessary, is allowed to fall into 
the liquid, drop by drop, the heat being constantly renewed, 
until all the blue color has disappeared; and when this has 
happened the quantity of urine used will have contained 
just half a grain of sugar. 
If it is preferred, the urine may be dropped from a burette 
into either solution contained in a capsule and so arranged 
that it may be kept hot. 
Cupric Test Pellets.-These were first suggested by 
Dr. Pavy at a meeting of the Clinical Society of London, 
in January, 1880, and were first made in this country by 
Mr. McKelway, of Philadelphia, at the suggestion of Dr. 
Joseph Neff.* These pellets contain the elements of Feh- 
ling's solution in solid form, and are very neatly made in 
the shape of a compressed pill. As made by Mr. McKelway, 
each pellet when dissolved in distilled water represents 5 
milligrams of diabetic sugar, and they may be used for 
approximate quantitative as well as qualitative testing. 
To use them, dissolve one in a small quantity of water 
in a test-tube and boil the solution. The purity of 
the pellet is thus tested, for if it has spoiled, the cupric 
oxide is reduced spontaneously. If the solution remains 
clear, the urine is added drop by drop, the temperature 
being kept up, and if sugar is present the usual precipitate 
occurs. The quantity of urine which just removes the blue 
color of the solution in which one pellet is dissolved con- 
tains 5 milligrams of sugar. 
These pellets are very convenient to carry, but in my 
experience they are liable to become unfit for use sooner 
* New York Medical Record, March 23, 188c. 78 
PRACTICAL EXAMINATION OF THE URINE. 
than a Fehling's solution, and unless very carefully made 
they keep but a short time. 
Cupric Test Paper.-Dr. Oliver has also constructed 
a cupric test paper with tartrate of Cuprammonium, this 
salt being selected as the only one which is permanent on 
exposure to the air, and the only one that is stable when 
boiled with an alkaline carbonate as well as with a caustic 
alkali. 
The test paper is a compound one, consisting of one 
charged with the reagent and the other with carbonate of 
sodium, the two being united by a thin layer of rubber. 
To use.-i. Drop a test paper into 60 minims of soft or 
distilled water. 2. Boil for a few seconds until the water 
assumes a greenish tint. 3. Remove the papers. 4. 
Reboil the solution, and then add one drop of the sus- 
pected urine. 5. If glucose be present, reduction will take 
place without further application of heat, though, if pre- 
ferred, the boiling may be continued and the reaction 
hastened. In any case, if the solution remains transparent 
for a quarter of a minute, heat should be applied to the 
boiling point for one minute. If then no opacity what- 
ever appears, it may be safely inferred that glucose is not 
present in pathological amount. 
The Fermentation Test. 
An excellent test for the presence of sugar is the fermenta- 
tion test, but being somewhat troublesome, it is less suitable 
for the practitioner as an every-day test. The most con- 
venient method of its application is as follows: A small 
quantity of ordinary baker's or brewer's yeast (about a 
fluidrachm, or 3 to 4 c.c.) is added to about 4 ounces of urine 
in a 6-ounce vial, which is lightly corked and subjected to a ORGANIC CONSTITUENTS. 
79 
temperature of 15-250 C. (59-77° F.). If sugar is present 
evidences of fermentation will present themselves generally 
within twelve hours, by the formation of carbonic acid 
gas, which passes off, leaving the fluid lighter and reduced 
in specific gravity in proportion to the quantity of sugar 
present. 
Dr. Roberts has ascertained that urine containing less 
than 0.5 per cent, or grains to the ounce, yields no sign 
to the fermentation test. It is, therefore, even less sen- 
sitive than Moore's test. 
Dr. Roberts has made use of this fact of the lowering of 
the specific gravity in devising a quantitative method. 
He has shown by careful experiments that every " degree " 
in specific gravity lost in fermentation corresponds to one 
grain of sugar per fluidounce. Thus, if before fermentation 
the specific gravity of a given specimen is 1050, and after 
fermentation it is 1020, it will have contained 30 grains to 
the fluidounce. The method recommended by Dr Roberts 
is as follows: Four ounces of the saccharine urine are put 
in a 12-ounce bottle, and a lump of German yeast,* as large 
as a small walnut, is added. The bottle is then covered 
with a nicked cork to permit the escape of the carbonic 
acid, and set aside on a mantlepiece or other warm place. 
Beside it is placed a tightly-corked 4-ounce vial, filled with 
the same urine, but without any yeast. In eighteen to 
twenty-four hours fermentation will be complete, and the 
scum cleared off or subsided. The specific gravity of the 
decanted fermented urine is then taken; at the same time, 
that of the unfermented urine, and a comparison made. 
While some time is required to complete the fermenta- 
* The so-called Vienna yeast, now well known in this country, is the 
same thing. But the ordinary liquid yeast answers as well. 80 
PRACTICAL EXAMINATION OF THE URINE. 
tion, yet, as Dr. Roberts says, the preparation can be made 
by the patient himself or friends, and each day, when the 
physician makes his visit, he has only to make the com- 
parison. 
. Bolger's Bismuth Test. 
This consists in adding to urine an equal volume of liquor 
potassae or sodae, then a pinch of the ordinary subnitrate of 
bismuth, shaking and boiling for a couple of minutes. The 
sugar possesses the power of reducing the salts of bismuth, 
and, if sugar is present, the black metallic bismuth will 
shortly be deposited on the side of the test-tube. If the 
quantity of sugar is small, the bismuth will assume a grayish 
hue; hence, when this is the case, a very small amount of 
bismuth should be used in making the test. 
This is a brilliant test, and except albumin or other sub- 
stance containing sulphur, nothing but sugar is supposed to 
reduce bismuth salts. To meet this, especial care must be 
taken to remove the albumin before applying the bismuth 
test, or we may use 
Briicke's Modification of the Bismuth Test.*- 
Professor Briicke finds that while Bbtger's bismuth test has 
many advantages over Trommer's test, it may lead, under 
certain conditions, to false results, since sulphur occasion- 
ally present in the urine will cause a black precipitate of 
sulphide of bismuth; hence he recommends the use of 
Frohn'sf reagent to remove the disturbing elements, as fol- 
* Proceedings of American Pharmaceutical Association, 1877, p. 287. 
Also Hoffmann and Ultzmann, Analysis of Urine, American translation. 
New York, 1879, p. 93. 
j- 1.5 gram freshly precipitated basic bismuth nitrate is mixed with 20 
grams water and heated to boiling; then 7 grams iodide of potassium 
and 20 drops of hydrochloric acid are added. The reagent is orange-red, ORGANIC CONSTITUENTS. 
81 
lows: take equal quantities of water and urine in two test- 
tubes; to the first add hydrochloric acid until a drop of the 
Frohn's reagent no longer produces a cloudiness. In this 
way we ascertain approximately how much HC1 must be 
added to the urine. Acidify the urine with such quantity; 
treat it with the reagent and filter. The filtrate, which 
should not now become cloudy on adding HC1 or the 
reagent, is boiled for a few minutes with an excess of a 
concentrated solution of caustic soda or potash, as in 
Bbtger's test; if a gray or black color results, or such a pre- 
cipitate is formed, the presence of sugar is proven beyond a 
doubt. 
Dudley's Modification of the Bismuth Test.- 
With solutions of glucose Professor William L. Dudley, of 
Cincinnati, 'found the following modification quite as deli- 
cate as Fehling's or Trommer's copper test.* 
Dissolve subnitrate of bismuth in the least possible quan- 
tity of chemically pure nitric acid, and add to it an equal 
amount of acetic acid of ordinary strength ; dilute to eight 
or ten times its volume, and filter if necessary. To the 
solution to be tested add sufficient sodium hydrate to render 
it strongly alkaline, then add a drop or two of the bismuth 
solution; heat to boiling and continue the boiling for a short 
time (twenty to thirty seconds). If sugar is present, the 
white flocculent precipitate which formed on the addition 
of the bismuth solution to the alkaline liquid will become 
gray or black. The depth of color of the precipitate de- 
pends on the amount of sugar present. If the amount of 
sugar be very small the gray or black precipitate forms 
slowly, and it is necessary to allow it to stand for some 
* American Chemical Journal, vol. 2, No. 1. 82 
PRACTICAL EXAMINATION OF THE URINE. 
time (ten or fifteen minutes). This reduction occurs in 
the cold after standing quietly for twenty-four to forty-eight 
hours. 
The bismuth solution will remain unaltered, and can be 
diluted to any degree without the precipitation of the bis- 
muth. If albumin is present it must be removed before 
applying the test for sugar. 
The Picric Acid and Potash Test. 
This test, originally suggested in 1865 by C. D. Braun,* 
and revived by Dr. George Johnsonf in 1882, is based upon 
the fact that grape-sugar, when boiled with picric acid and 
potash, reduces the yellow picric acid to the deep red pic- 
ramic acid, the depth of color depending upon the amount 
of sugar present. 
For qualitative testing, to a fluidrachm of the sus- 
pected urine, add 40 minims of a saturated solution of picric 
acid, and half a drachm of liquor potassae. If albumin is pres- 
ent, a turbidity will develop, on the addition of picric acid, 
and thus the presence of this substance recognized ; but it 
does not interfere with the test. Boil the mixture, and if 
sugar is present, a dark mahogany-red color will be produced. 
If normal urine be treated in the same way, a somewhat 
darker hue is also developed, but not nearly so marked as 
when sugar is present. 
Or the test may be applied, especially at the bedside, in 
the following manner: 
Into a test-tube, graduated up to three drachms, is put about 
* Ueber die Umwandlung der Pikrinsaure in PikraminsSure, und 
fiber die Nachweisung der Trauben-Zucker.-Zeitschrift fur Chimie, 
1865. 
j- Lancet, November 18th, 1882. ORGANIC CONSTITUENTS. 
83 
one-third of a grain of picric acid-as much as can be car- 
ried on the point of a penknife ; then add half a drachm of 
water ; the acid is dissolved in the water by the heat of a 
lamp. Now, add half a drachm of urine, and the presence 
of albumin is ascertained ; next add a grain lump of caus- 
tic potash, and boil the liquid for a few seconds, and the 
dark coloration appears. 
For quantitative testing Dr. Johnson directs a stan- 
dard solution made by boiling together a fluidrachm of a 
solution of grape-sugar of the strength of one grain to the 
fluidounce, half a drachm of liquor potassae, and forty min- 
ims of a saturated solution of picric acid, the whole 
increased to four drachms with distilled water. The mix- 
ture is conveniently made in a large test-tube, which should 
be marked at four drachms. The liquid is kept boiling for 
sixty seconds, during which its pale-yellow becomes a beau- 
tiful claret-red. It is cooled by cautiously immersing the 
tube in cold water, and if the level of the liquid is not that 
of the four-drachm mark, it is raised to it by adding distilled 
water. The color, thus obtained, is that which results from 
the decomposition of 40 minims of a saturated solution of 
picric acid by a grain of sugar to the ounce, four times 
diluted, or one-quarter of a grain of sugar to the ounce. 
The color of this solution is, however, not permanent, and 
Dr. Johnson imitates it with a solution of ferric acetate 
made by mixing thoroughly Jj of solution of perchloride of 
iron, sp. gr. 1.44; Jiv of solution of acetate of ammonia; 
Jiv of glacial acetic acid, sp. gr. 1065 ; adding Jj of liquor 
ammoniae, and diluting with distilled water up to The 
ingredients are all of the strength of the British Pharmaco- 
poeia. This solution, corresponding to a quarter of a grain 
of sugar to the ounce, retains its color unchanged, at least 
when kept in the dark, and is used for comparison. 84 
PRACTICAL EXAMINATION OF THE URINE. 
In testing for sugar, treat a fluidrachm of urine as 
indicated for qualitative testing, and di- 
lute the mixture with distilled water, up 
to four fluidrachms.* Raise the liquid to 
the boiling point and keep it boiling for 
sixty seconds. Cool the liquid by care- 
fully immersing in cold water, and if 
below the four-drachm mark it is to be 
again raised to it by the addition of 
distilled water. A comparison is then 
made between the resulting fluid and 
the standard solution by means of the 
picro-saccharometer devised by Dr. 
Johnson and figured in the margin. 
The stoppered tube on the left con- 
tains the standard solution. Into the 
graduated tube on the right, having 
the same diameter as the standard tube, 
the boiled mixture is to be introduced. 
Should the two agree precisely in color, 
the suspected urine will have contained 
one grain of sugar to the ounce. If, 
on the other hand, the mixture requires 
to be diluted in order to make it cor- 
respond with the standard solution, 
this should be done with distilled 
water, and if enough must be added 
to raise the level of the fluid, say 
from the 10-division mark, at which 
it stood, to the 20-mark, the quantity of sugar would 
Fig. 6. 
* The test-tube, which should be a large one, may be conveniently 
marked at four fluidrachms. ORGANIC CONSTITUENTS. 
85 
be two grains; if to 40, four grains; to 45, four and a half 
grains.* 
In making an analysis, the picric acid must be added in 
proportion to the amount of sugar. If the proportion of 
sugar be as high as six grains per ounce, a drachm of the 
picric acid solution will be required. If it is higher than this, 
the urine should be diluted with distilled water in a definite 
proportion before commencing the analysis, and the dilu- 
tion borne in mind in making the calculation. When the 
urine has been diluted ten times, the figures on the sac- 
charometer indicate the number of grains per ounce. Thus, 
when the ten-times diluted urine, after boiling with picric 
acid and potash, is further diluted from 10 divisions to 35, 
to obtain the standard color, the amount of sugar is 35 
grains to the ounce.f We may reduce the amount of sugar 
per ounce to the proportion per cent, by a simple propor- 
tion, in which the first term is 455.7 grs., the weight of an 
ounce of water at o° Cent.4 100 the second term, and the 
* A more exact comparison of the saccharine liquid with the standard 
can be made by pouring into a flat-bottomed colorless tube, about six 
inches long and an inch in diameter, as much of the standard as will 
form a column of liquid about an inch in height, and an exactly equal 
column of the saccharine liquid in a precisely similar tube. Looking 
down on the surface of a white porcelain slab or white paper through 
both tubes, at once a slight difference in tint is easily recognized ; and 
if the liquid to be analyzed be found darker than the standard, it is re- 
turned to the saccharometer and diluted until the two fluids are found 
to be identical, when the final reading is made. 
j- Distilled or clear rain-water should be used, because the turbidity 
resulting from the action of potash on the salts of lime interferes with 
the exact estimation of the depth of color. 
| This is the weight of the ounce of distilled water according to 
the United States Pharmacopoeia. The English fluidounce weighs 
437-5 grains. 86 
PRACTICAL EXAMINATION OF THE URINE. 
quantity of sugar per ounce the third. Thus, if there 
be 20 grs. of sugar to the ounce, then as 455.7 : 100 : : 
20 : 4.3. 
It has been said that when normal urine is treated with 
pierid acid, potash, and heat, a slight coloration also takes 
place, which Dr. Johnson estimates as about equal to the 
change which would be produced by a solution of glucose 
containing 0.5 to 0.7 grains to the fluidounce. Dr. John- 
son does not claim that normal urine contains an amount 
of sugar sufficient to produce this reaction, but thinks it 
may be some allied substance. 
Dr. Johnson, after much experimental research made 
in association with his son, G. Stillingfleet Johnson, claims 
that this method is "asaccurate as any other," and that for 
the estimation of sugar in the urine it is even more accu- 
rate than either Fehling's or Pavy's process, because the 
picric acid is not acted on by uric acid or urates, which 
reduce the oxide of copper. He also claims that the method 
by the picro-saccharometer is more speedy than any other, 
the materials and apparatus inexpensive, and not liable to 
undergo rapid change. 
The Indigo-carmine Test. 
When a solution of indigo-carmine alkalized by sodium 
carbonate, is boiled and kept heated, the blue color remains, 
but when a drop of a solution of glucose, or saccharine urine 
is added to the hot solution, a beautiful play of colors occurs, 
terminating in pale yellow. Mulder first suggested this reac- 
tion as a test for sugar. Dr. Oliver has revived it for both 
qualitative and quantitative analysis. The indigo-carmine 
solution is not available, because when the carmine and ORGANIC CONSTITUENTS. 
87 
sodium carbonate are present in solution the fluid un- 
dergoes a gradual change, the indigo-blue color gradually 
passing into a pale green. Nor is it convenient to keep 
the solutions separate. 
Dr. Oliver has, however, constructed a stable test-paper, 
charged with a definite quantity of the two reagents, in- 
digo-carmine and sodium carbonate; while increased sen- 
sitiveness is produced by the use of an additional paper 
charged with sodium carbonate. 
In Testing.-i. One of the carmine test-papers should 
be dropped into a half-inch test-tube, and then water should 
be poured in to the amount of 60 minims. 
2. Heat is applied, the tube being gently shaken, and 
boiling kept up for a second or two. The solution will 
then be quite blue, and, if the water added was soft or dis- 
tilled, it will be perfectly transparent. Any turbidity 
observed will arise from the use of hard water, in which 
case a sodium-carbonate paper should be dropped into the 
solution. The test-paper may now be removed or allowed 
to remain. 
3. Not more than one drop of the suspected urine is 
let fall into the tube from the pipette held in an upright 
position. 
4. The contents of the tube are again boiled for a few 
seconds; then the tube should be raised an inch or two 
above the flame, and held without shaking while the so- 
lution is kept quite hot, but without ebullition, for exactly 
one minute. If glucose is present " in abnormal amount," 
says Dr. Oliver, "the soft rich blue will be seen, first of all, 
to darken into violet; then, according to the quantity of 
sugar, there will appear in succession purple, red, reddish- 88 
PRACTICAL EXAMINATION OF THE URINE. 
yellow, and finally straw-yellow." When the last color has 
developed, agitation will cause the return of purple and 
violet, and finally of the original blue. 
The time required for the reaction to commence, after 
boiling, varies inversely with the amount of glucose present. 
When the latter is large-over 20 grs. to the ounce-it will 
amount only to a few seconds. When small-say from 2 
to 3 grs. to the ounce-it may require from 30 to 60 sec- 
onds. If the urine contains less than a grain to the 
ounce, the color of the solution at the end of one minute 
will be unchanged. 
Precautions.-I. Care should be taken during the heating not to 
shake the tube, or to keep up active ebullition. 
2. While keeping the contents of the tube hot, it should not be held 
between the eye and the sky, for then the early color changes may 
escape detection. The tube should be kept below the eye level, and 
its contents viewed by the reflected light of some bright object-as a 
sheet of white paper propped up an inch or two beyond the tube. 
The test is as available by artificial as by daylight. 
3. Any caustic alkali, as liquor potassae or sodse, will discharge the 
blue color of carmine. Hence, care should be taken not to use a test- 
tube containing a trace of either of these substances or of Fehling's 
solution or the alkaline picric solution, lest a deceptive reaction occurs. 
No amount of agitation will restore the blue removed by these agents. 
Dr. Oliver, comparing the results of experiments with the 
indigo-carmine and Fehling's solution, found that whenever 
one drop was submitted to the indigo test and the presence 
of sugar shown, confirmation was invariably provided by 
Fehling's solution used in the ordinary way. On the other 
hand, whenever one drop of urine gave no reaction with 
the indigo, Fehling's solution also gave negative results. ORGANIC CONSTITUENTS. 
89 
In further experimental testings, Dr. Oliver found that 
none of the ordinary constituents of urine affect the carmine 
test, but all the free acids of the urine, uric, oxalic, lactic, 
etc., reduce Fehling's solution. Of substances apt to appear 
in urine in disease, albumin, peptone, pus, mucus, blood, 
bile, leucin, tyrosin do not react with either test; nor does 
one drop of ammoniacal or decomposing albuminous urine, 
or weak solution of ammonium sulphide ;* but dextrin and 
milk-sugar as well as glucose reduce both. Inosit reacts 
with the carmine, and turns Fehling's solution green-a 
green precipitate falling, leaving the supernatant fluid blue, 
which, however, becomes green on reheating. 
Of medicinal agents likely to find their way into the urine, 
iron sulphate, gallic and tannic acid alone react with car- 
mine, as do they, also, with Fehling's solution. 
Comparative experiments by Oliver with picric acid and 
potash showed that whenever the indigo-carmine test-paper 
afforded a reaction, a correspondent reaction was obtained 
with the potash solution. 
Application of the Indigo-Carmine Test for 
Quantitative Determinations of Glucose.-Dr. 
Oliver has also applied his test to quantitative analysis by 
the following method :f 
The directions for the qualitative testing are to be followed, but with 
more care in certain particulars. 
1. The water to bp used should be distilled or soft. 
2. The quantity of water to be added should not exceed the 6oTtJJ 
mark on the half-inch test-tube. A wider tube than this should not 
be used. 
* Even a weak solution of ammonium sulphide will reduce Fehl- 
ing's solution. 
f Bedside Urine Testing, 3d Edition, London, 1885, p. 183. 90 
PRACTICAL EXAMINATION OF THE URINE. 
3. Twenty minims of the urine to be examined are shaken with a 
carbonate-of-sodium paper in the larger test-tube, which is then set aside. 
4. The observer should select, if possible, daylight; and he should 
place some light-colored object close behind the tube, so that he may 
view the color changes distinctly by a bright reflected light. The dis- 
appearance of red is, however, perhaps most easily detected by hold- 
ing the tube against the sky. 
5. Before the testing is begun the observer lays before him his 
watch-a centre seconds is by far the best for the purpose. Time is 
to be accurately estimated by the seconds hand. 
6. Immediately after the paper-which is allowed to remain-has 
been boiled, when the carmine has well passed into solution, and 
when the liquid is quite hot, one drop-not more-of the urine in the 
larger test-tube is delivered from the pipette held vertically,* and the 
exact time by the seconds hand of the watch is noted. 
7. The solution is then well boiled up for about 10 seconds, and 
the tube is raised a few inches above the flame, and is very steadily 
held in that position; but on the slightest ebullition occurring, it is 
raised still higher. The prevention of simmering during the course of 
the heating is a most important precaution towards obtaining reliable 
comparative results. The slightest shaking of the tube-especially 
towards the end of the reaction-should be avoided. 
8. If the complete reduction, indicated by pale yellow, is not 
effected within two minutes, the heating is kept up for the whole of 
this period. 
The carbonate-of-sodium paper should on no account be used along 
with the carmine test-paper, which is complete in itself. 
* Dr. Oliver is aware that a drop is a somewhat variable quantity, 
but he thinks it preferable-in handiness and practicability-to the 
minim, the accurate measurement of which requires well-trained and 
reliable eyes and fingers; and the variability of the drop, when dis- 
charged from the pipette held in a vertical position, is not so great as 
to disturb the conclusions of the text. Those who prefer a more precise 
method will find it convenient to take ion£ of the urine, and make up 
with water to add a carbonate-of-sodium paper, and use at 
each testing. ORGANIC CONSTITUENTS. 
91 
From the time of dropping in the urine the observer should specially 
note the color of the solution at the close of 
(a) Thirty seconds. 
(£) One minute. 
(c) Two minutes. (See diagram, p. 92.) 
Quantitative data.-The quantitative information to be derived 
from the test-paper is obtained from submitting to it the urine (1) un- 
diluted, and (2) definitely diluted. 
I. The Urine Undiluted. 
The data provided fall into two sections; according as the reaction 
is complete or incomplete at the expiration of the period prescribed 
for heating-two minutes. 
(a) The reaction is incomplete.-When the final color change-pale 
yellow-is not developed, there are less than 5 grains of sugar to the 
ounce, or under 1 per cent. 
Any vestige of red tingeing the yellow can be distinctly seen when 
the tube is held without any shaking about an inch before a piece of 
white paper; on, however, placing it immediately against the latter, a 
trace of red may still be detected-to remove this requires not less 
than 10 grains to the ounce. 
When sugar is present in smaller quantity than 5 grains to the ounce, 
the color of the solution at the end of the heating for two minutes 
represents definite quantities. 
Color. Grains to the ounce. 
Violet* = about 1. 
Purple* = " 2. 
Red = " 3. 
Reddish-yellow = " 4. 
If violet does not appear within half a minute, there are less than 2 
grains of glucose to the ounce. 
If the solution, however, retains its blueness for twenty or thirty 
* The casual observer is apt to confound violet with purple; but the 
colors are quite distinct-the former having blue, and the latter red, as 
the predominating hue. 92 
PRACTICAL EXAMINATION OF THE URINE. 
seconds, and then during the course of the first minute becomes violet 
and purple, the quantity of sugar is about 2 grains to the ounce: but 
if the violet appears at the close of the boiling up for ten seconds, there 
are at least from 4 to 6 grains to the ounce. 
(£) The reaction is complete.-The time required for the full de- 
velopment of all the colors is determined by the amount of sugar. 
When straw-yellow is reached in 
y2 minute, there are about 35 grains or more. 
1 " " " " 10 " 
2 << « « « 5 << 
Fig. 7. 
The observer should carefully note the rapidity of the reaction in the 
course of the first minute. If at the close of the first half of it the solu- 
tion is reddish, the quantity will be less than 35 grains to the ounce; 
but if it is pale yellow, the amount will be larger than this. If at the 
termination of the minute a red tinge is still apparent, the proportion 
will be under 10 grains to the ounce, or below 2 per cent. ORGANIC CONSTITUENTS. 
93 
2. The Urine definitely Diluted. 
When the reaction with the undiluted urine is completed within one 
minute, only a general conception of the quantity of sugar is provided 
by the test-paper. But the information thus obtained is a useful pre- 
liminary to the acquirement of a more definite idea of the amount, 
which can be attained by the further testing of the urine methodically 
diluted. 
The principle of the procedure is to take a measured portion of the 
saccharine urine (2otiJ) and to dilute by the same volume (2ott£) of 
water at a time, until at last it is found, that at the conclusion of the 
heating for the definite period of one minute, the color developed is no 
longer pale yellow, but has a distinctly red tinge; the approximate 
amount of sugar is then arrived at, by multiplying the number of times 
the volume of the urine was increased on the previous dilution by io 
grs. to the ounce. In this way, when urines are found to contain more 
than this amount of sugar, they are uniformly reduced to it; and the 
dilution is continued until it is clear the limit has been overstepped-a 
reddish hue remained at the close of the procedure. 
On returning the urine contained in the pipette to the large test-tube 
into which 2OtiJ were delivered (see p. 90), the observer adds the 
same measure of water. If, however, on testing the undiluted urine 
he found the yellow to appear at the end of half a minute, he may at 
once dilute the urine to three times its volume (second dilution), other- 
wise he will only add 2ottjt of water, and retest. If at the termination 
of the minute the yellow still appears, the contents of the pipette are 
returned to the test-tube holding the diluted urine, and a further addi- 
tion of of water is made. The testing is repeated; but, when it 
is evident the complete reduction of the blue carmine is not accom- 
plished at the expiration of the minute, the procedure is at an end. 
On putting this method into practice under the guidance of Fehling's 
quantitative determination, Dr. Oliver finds, that when the testing by the 
carmine paper affords a reddish-yellow tint, the value of the last dilu- 
tion should be counted as 5 grains; which amount should be added to 
the 10-grain values of the previous dilutions; but, when the final trial 
provides a more decided red color, the calculation should only include 
the previous dilutions. For example : a urine containing according to 
Fehling 7 p. c. of sugar, or about 36 grains to the ounce, on the second 94 
PRACTICAL EXAMINATION OF THE URINE. 
dilution, gave, at the expiration of the minute, a reddish-yellow reaction ; 
therefore, the amount was (3 X 10) -4-5=35 grains to the ounce. Another 
urine, shown hy Fehling to contain 6 p. c. of sugar, or about 31 grains to 
the ounce, just reduced the carmine on the second dilution, but on the 
third it failed in doing so, and the solution, on being heated for the 
minute, merely acquired a redness that could not be mistaken for yel- 
low ; the calculation was, therefore, 3 X 10 - 3° grains to the ounce. 
The determination of sugar by this method does not usually require 
more than three test-papers in all (often two will suffice), and the ex- 
penditure of more time than five minutes. 
Dr. Oliver's conclusions are as follows: 
1. The indigo-carmine test-paper enables the clinical observer to 
discriminate between the glucose charges of different saccharine urines 
in the course of the mere qualitative testing. 
2. It furnishes definite, though only approximative, quantitative 
data; sufficient, however, for most of the clinical requirements of the 
practitioner. 
3. The method proposed for its quantitative use exacts but a small 
expenditure of time-only a few minutes-and merely that careful at- 
tention to a few essential details, and the ordinary skill in observing 
and manipulating, which it is rightly presumed that most medical men 
possess. 
Polarimetry. 
The most accurate, as well as the most convenient and 
the quickest of the methods for the qualitative or quanti- 
tative determination of glucose, when all the appliances are 
at hand, is by polarimetry. The costliness of the apparatus, 
however, will always be in the way of its common use. 
The process is based upon the fact, that glucose rotates 
polarized light towards the right, and the proportion of 
sugar in solution is determined by the degree of deviation 
noted. The best instrument probably is the shadow ap- 
paratus of Laurent, figured in the text. Light is admitted 
through a Nicol's prism or polarizer in the tube RB, and falls 
on another prism, the analyzer in the eye-piece OH. ORGANIC CONSTITUENTS. 
95 
The Laurent Shadow Polarizing Saccharimeter. 
Fig. 8. 96 
PRACTICAL EXAMINATION OF THE URINE. 
In using the instrument the two prisms are so adjusted by 
means of the screw F which moves the analyzer that no light 
passes through it. This is attained when the field is uniformly 
illuminated on both sides. The vernier should then read 
o. The suspected urine, freed from albumin, if this 
should be present, is treated with a solution of basic ace- 
tate of lead in the proportion of io to 100 of urine, and 
filtered. A tube of known length is then filled with the 
mixture, and placed in position between the two prisms. 
Immediately light passes through the analyzer in OH, and 
this must be again turned by means of the screw F until 
the light is again stopped and the field is uniformly illumi- 
nated. The angle is now read off on the dial-plate C. The 
magnitude of the angle is in direct proportion to the length 
of the tube and the quantity of sugar in solution, and as we 
know the specific rotary power [<z]D of the substance in solu- 
tion, we can from these data compute the quantity of sugar. 
For if a represent the angle of deviation, and x the weight 
in grams of the sugar contained in i c.c. of urine, then 
x = r ia .. If now the angle read off be 50, the specific 
rotary power of glucose being 4-57.6, and the length of tube 
200 mm., then x = -- - .424. To this result should 
' 57-6X2 
be added to allow for the 10 c.c. of lead solution* used, 
and the sugar in 1 c.c. will be .477 grams. 
More recently Laurent has further improved his apparatus, 
so that an ordinary gas-flame may be used. A new vernier 
like that at C, Fig. 9, is interposed between the analyzer in 
OH and the dial-plate C, Fig. 8, and we have simply to 
* The urine may also be clarified by filtering through animal char- 
coal, in which event, of course, no allowance of this kind need be made. ORGANIC CONSTITUENTS. 
97 
multiply the reading increased by /q (allowance for the 
lead solution) by the figures .2051, a factor arrived at by 
experiment as that which multiplied by the reading gives 
Improved Apparatus of Dubosq. 
Fig, 9. 
the percentage when a tube 200 millimeters long is used. 
Thus, suppose the reading to be 24.9, then 24.9 4- 2.49 = 
27.39, and 27.39 x .2051 - 5.61 per cent. 98 
PRACTICAL EXAMINATION OF THE URINE. 
Dubosq has also devised a polarizing saccharimeter, on 
the graduated vernier of which may at once be read the per- 
centage of sugar. He has contrived two forms of instru- 
ment, one of which, although less expensive, is at the same 
time less accurate and more troublesome, requiring an 
arrangement for monochromatic light. It is, however, still 
sufficiently accurate for clinical but not for strictly scientific 
purposes. The second form is strictly accurate and requires 
no special arrangement for monochromatic light, but is much 
more costly. It is represented in Fig. 9. The method of 
using is the same as for the Laurent.* 
Remarks on the Qualitative Testing of Urine suspected to 
contain Sugar. 
There has been more criticism of the methods employed 
in testing urine for sugar, and the results obtained from 
them, than is justified. It arises partly from the fact that 
the chemist and the clinical physician view the subject from 
different standpoints. The former makes his experiments 
with test-fluids upon pure aqueous solutions of sugar, the 
latter upon a fluid containing numerous other organic con- 
stituents, more than one of which is capable of influencing 
certain test-solutions, though it may be in a less degree than 
sugar. Let us suppose the chemist to have made solutions 
of grape-sugar of different strengths which he is testing with 
Fehling's solution diluted in the manner indicated on p. 
74. He tests weaker and weaker solutions, and finally 
reachesone by which the test-fluid is just decolorized, while 
pure water will have no such effect. The chemist knows 
that it is sugar which thus reacts, because he has nothing 
* All forms of polarizing saccharimeters are furnished by J. W. 
Queen & Co., Philadelphia. ORGANIC CONSTITUENTS. 
99 
but the test-fluid, sugar, and water in combination. But it 
is very different with the clinician who tests urine suspected 
to contain sugar. There is no urine which will not decol- 
orize a Fehling's solution sufficiently dilute, when it is 
boiled with it. Yet no one can claim that it is sugar which 
produces the decoloration when there may be several or- 
ganic substances in the urine which can produce this effect. 
On the other hand, no one can deny that it is sugar, be- 
cause a very small amount of sugar will do the same thing. 
Further, it is easy to show that a quantity of sugar so small 
that it cannot be detected in urine can be readily detected 
in water, though it is also true that minute traces of sugar 
can be extracted from urine by certain processes, one of 
which will be detailed below. But these processes are not 
often available for the practical physician, noris it necessary 
that they should be. For such amounts of sugar have no 
more clinical significance than has the normal proportion 
of urea in a specimen. It is only tangible amounts of sugar 
which are significant, and these are ordinarily recognizable 
by any one of the tests named, practiced with due precaution. 
With all tests, there are certain very evident reactions 
and certain doubtful ones, and to interpret these last, expe- 
rience must often be relied upon. 
Exact Qualitative Method of Testing for Glucose-the Lead 
Process. 
While any one of the methods just detailed suffices, if 
carefully used, to determine qualitatively, with sufficient 
accuracy for clinical purposes, the presence of sugar in a 
given specimen of suspected urine, it sometimes happens, 
especially in watching the course of a case of diabetes mel- 
litus under treatment, that the physician desires to know 100 
PRACTICAL EXAMINATION OF THE URINE. 
with absolute certainty whether there is even a trace of 
sugar present. This can be done by the following method, 
which is a modification of the one originally proposed by 
Briicke, and used by Pavy to demonstrate the presence of 
sugar in normal urine : 
Take 50 c.c. of urine and add 60 c.c. of a 10 per cent, 
solution of neutral acetate of lead. The precipitate which 
takes place includes sulphuric and phosphoric acids, and 
part of the uric acid and chlorine, while the sugar remains 
in solution. Separate the precipitate on a filter, and treat 
the filtrate with an excess of ammonia. A further precipi- 
tate occurs, which contains the sugar in combination with 
the plumbic acetate. 
This precipitate is then collected and washed, great care 
being taken to remove all the ammonia, which is best 
effected by repeating several times the subsidence and de- 
cantation before throwing the precipitate on the filter; after 
which water is passed through until red litmus paper is no 
longer turned blue by the filtrate.* 
The precipitate, suspended in about 100 c.c. of water, is 
placed in a suitable apparatus and decomposed by passing 
through it a stream of sulphuretted hydrogen as long as a 
precipitate is produced. Filtration is then performed and 
the excess of sulphuretted hydrogen expelled by heat. The 
filtrate, a colorless fluid, is then evaporated over a water- 
bath to a volume equal to that of the original urine oper- 
ated upon, that is, 50 c.c. 
Dr. Pavy recommends the testing of the fluid thus ob- 
tained by the Fehling's solution, but Prof. Wbrmley has 
* Dr. Pavy cautions against washing with hot water. Although it 
expedites the process, there is danger of breaking up the combination be- 
tween the plumbic oxide and the sugar, thereby losing some of the latter. organic constituents. 
101 
discovered that it still contains uric acid which is capable of 
producing a neat reaction with the cupric test. This uric acid 
he removes by simply allowing the fluid to stand twenty- 
four hours or longer, at the end of which time a consider- 
able sediment of uric acid has fallen to the bottom of the 
vessel; and it is this acid which produces the reaction in 
urine in the hands of Brticke, Bence Jones, and Pavy, and 
ascribed by them to sugar. When the uric acid is wholly 
removed from normal urine, no reaction occurs; but if the 
slightest trace of sugar is present, it occurs, and the sugar 
is detected. 
IX. Other Saccharine Substances. 
Inosite. 
Inosite or muscle sugar is sometimes found in the 
albuminuria of nephritis as well as in diabetes mellitus, 
and in the latter disease it has been found occasion- 
ally to substitute glucose, especially during convalescence ; 
also in phthisis, the syphilitic cachexia, and in typhus fever. 
Gallois examined the urine of 102 patients for inosite and 
found it in seven only; five times in 30 cases of diabetes 
along with sugar in variable quantity, and twice in 25 cases 
of albuminuria. 
Recognition.-Inosite is obtained from urine as follows: After 
any albumin that may be present is removed, the urine is treated with 
neutral acetate of lead, until completely precipitated. It is then fil- 
tered, and the warmed filtrate treated with basic acetate of lead so 
long as a precipitate arises. It is better, however, to concentrate the 
urine to one-fourth its bulk over a water-bath before precipitation. The 
lead precipitate which contains the inosite combined with the lead 
oxide is collected after twelve hours, washed, suspended in water and 
decomposed with sulphuretted hydrogen. Out of the filtrate there is 
separated, after standing some time, a small quantity of uric acid. This 
is filtered out, the fluid concentrated as far as possible and treated while 102 
PRACTICAL EXAMINATION OF THE URINE. 
boiling with three to four times its volume of alcohol. If there arises 
a heavy precipitate adhering to the bottom of the glass, the hot alco- 
holic solution is simply poured off. But if a flocculent non-adhesive 
precipitate occurs, the hot solution is filtered through a hot funnel and 
allowed to cool. If, at the end of 24 hours, groups of inosite crystals 
appear, they are separated and washed with a little cool alcohol. 
In this case it is advisable, in order that there may be no loss of 
inosite, to dissolve the precipitate obtained by the addition of hot alcohol 
in as small a quantity as possible of hot water, and precipitate a second 
time with three or four times its volume of hot water. If no crystals 
separate, ether is added to the clear, cold alcoholic filtrate, until, on 
shaking thoroughly, a milky cloudiness appears, and then the fluid is 
permitted to stand in the cold 24 hours. If not too small amount of 
ether is added (an excess does no harm), all the inosite present is pre- 
cipitated in pearl-like shiny plates. 
Inosite differs from cane-sugar in not undergoing vinous 
fermentation when treated with yeast, although its solutions 
readily take on the lactic fermentation when brought in 
contact with putrefying cheese. It does not reduce cupric 
tartrate in solution with potassic hydrate, but changes it to 
an olive-green, and after a while a flocculent precipitate 
falls, and the supernatant fluid becomes blue, but on again 
heating the solution the olive-green color is redeveloped. 
This reaction is sometimes observed in treating urine with 
Fehling's solution as was originally pointed out by Dr. Ralfe, 
and it has been suggested by Dr. Oliver that it may be due 
to inosite. Should this be true, inosite would appear to be 
less rare than has been heretofore supposed, but it is doubt- 
ful whether a reaction so indistinctive should be allowed 
much stress as compared with the exact chemical process 
above described. 
Fruit-sugar, or Lcevulose. 
Fruit-sugar sometimes occurs in urine accompanying dia- ORGANIC CONSTITUENTS. 
103 
betic sugar. It is characterized by being non-crystallizable, 
and turning the plane of polarized light to the left instead 
of to the right. The specific rotary power diminishes as the 
temperature rises, while that of grape-sugar is independent. 
It is -108.3 at °° C-, "99-44 at z4° ? "97-1 at I7-5°5 
-52.5 at 87.2°, according to Tuchschmied. It reduces the 
salts of copper as does glucose, but in a less degree. 
Recognition.-Since laevulose is always associated with 
glucose when it occurs in urine, and both reduce the salts 
of copper, it is only by their opposite action on polarized 
light that they can be distinguished. If, therefore, a sugar- 
holding urine deflects polarized light strongly to the left, 
or if, after allowing for the fact that normal urine turns it 
to the left 10, and that this property is increased by the 
ingestion of large doses of benzol, phenol, bromo- and 
nitro-benzol, chloral, and camphor, polarized light is not 
deflected at all, we may conclude that laevulose is present. 
It is to be remembered, also, that these substances also 
reduce copper salts. Other substances turning polarized 
light to the left must also be excluded. 
Sugar of Milk, or Lactose. C12H22On4-H2O. 
Lactose is sometimes found in small quantity in the 
urine of nursing women and females of animals. Dr. Ralfe 
refers to a case under his observation in the London Hos- 
pital, of a young married woman, aged 29, who was suckling 
an infant and suffering with debility and frequent micturi- 
tion, whose urine contained as much as 3 per cent, of sugar. 
This occurred in three successive confinements, there being 
no sugar during pregnancy. 
Lactose is characterized by crystallizing in white, or 
colorless, four-sided prisms with acuminated ends bounded 104 
PRACTICAL EXAMINATION OF THE URINE. 
by four triangles, by its turning polarized light to the right 
with a rotating power of 4-59-3°, varying also with thedegree 
of concentration; while that of grape-sugar is 4-57-3° 1 by 
the fact that it reduces the salts of copper as does grape- 
sugar, and that it does not undergo the alcoholic fermenta- 
tion with yeast. The fungi which convert milk-sugar into 
alcohol are cleft fungi. On the other hand, the lactic acid 
and butyric acid fermentation are readily entered upon. 
Recognition.-A very strong reducing power and an 
otherwise inexplicable deflection to the right suggest milk- 
sugar. Especially is this suspicion justified if the urine is that 
of a nursing woman. It can be recognized with certainty only 
by isolating it from the urine, for the details of which the 
student is referred to the works on physiological chemistry 
by Gorup-Besanez or Hoppe-Seyler, or the elaborate trea- 
tise on urine analysis by Neubauer and Vogel or Salkowski. 
X. Acetone and Acetone-producing Substances; 
Diacetone. 
Often closely, although not necessarily, associated with 
glycosuria, are those conditions of the urine which respond 
to the tests for acetone. 
Acetone. 
When small quantities of acetone are present in urine, it 
can only be recognized after distillation of the urine, but 
if considerable in amount, its presence may be shown by- 
Legal's Test.-A few crystals of sodium nitroprusside 
are dissolved in a little water in a test-tube to obtain a fresh 
solution. Add a few drops of this to three or four cubic 
centimeters of the urine to be tested. A red color ensues, 
whether the urine contains acetone or not. This, however, 
rapidly fades, but if 20 or 30 drops of acetic acid be now ORGANIC CONSTITUENTS. 
105 
added, there appears, after some seconds, if acetone is 
present, an intense deep purple color, following the course 
of the drops of acid. 
To show the presence of very small quantities of acetone 
the distillate must be used, and to this may be applied- 
Lieben's Iodoform Test.-To a portion of the distil- 
late add a small quantity of liquor potassae, then a few drops 
of a solution of iodine and iodide of potassium. If acetone is 
present a yellow precipitate of iodoform is produced at 
once. Should alcohol happen to be present in the distillate, 
the reaction takes place also, but more slowly, but with 
acetone it is immediate. 
The latter source of error may be altogether avoided by 
the modification suggested by Gunning, who uses ammo- 
nium hydrate and tincture of iodine. With these, alcohol 
causes no precipitate, while acetone does produce one of 
iodoform in addition to iodine, which falls as a black sedi- 
ment, even though there be no acetone. The precipitated 
iodine is soon redissolved if the urine contains much ace- 
tone; if it contains but little, the iodoform crystals may 
be seen in 24 or 48 hours, resting in a thin layer upon the 
black precipitate of iodine. 
Where considerable acetone is present, Lieben's test may 
be used, as suggested by Dr. Ralph, as follows: 
About a drachm of liquor potassae. containing 20 grains 
of iodide of potassium, is placed in a test-tube and boiled. 
A drachm of the suspected urine is then carefully floated 
on the surface. When the latter comes in contact with the 
hot alkaline solution, a ring of phosphates is formed, and, 
after a few minutes, if acetone or its allies are present, the 
ring will become yellow and studded with yellow points of 106 
PRACTICAL EXAMINATION OF THE URINE. 
iodoform. These in turn will sink through the ring of 
phosphates and be deposited in the bottom of the tube. 
This mode of applying the test is subject to error, due 
to the fact that lactic acid and ethyl alcohol, both of which 
are found in urine, act similarly. 
Hence it is safest to work with the distillate. 
The Indigo Reaction of Baeyer and Drewsen. 
-Heat a few crystals of nitro-benzaldehyde until dissolved. 
Allow the solution to cool, when the aldehyde separates as a 
white cloud. Then add the suspected fluid (preferably its 
distillate), and make the mixture distinctly alkaline with 
dilute caustic soda. If acetone is present, there appears, first 
a yellow, then a green color, followed by an indigo-blue, 
in the course of ten minutes. If only traces of acetone are 
present, the yellow fluid is shaken with a few drops of chlo- 
roform, when a distinct blue coloration of the chloroform 
takes place. 
By this method acetone can be easily detected in a dilu- 
tion of i part to 2500, if the distillate is used. Even with 
undistilled urine, by the aid of chloroform, it can be de- 
tected if present in the proportion of 1 to 1000. 
Pyroracemic acid, aldehyde, and acetophenon are the 
only other substances producing the indigo reaction, and 
these have not, as yet, been found in urine. 
Diacetic acid is characterized by striking a Bordeaux-red 
color with a solution of the chloride of iron, and urine con- 
taining it in sufficient quantity responds similarly. Other 
substances, however, strike the same reaction, as the salts 
of formic and acetic acids; also carbolic and salicylic acids; 
decomposition-products of antipyrin, kairin, and thallin. 
Diacetic acid also responds to the various tests for acetone. 
Diacetic Acid. ORGANIC CONSTITUENTS. 
107 
The chloride of iron test, as is practiced by v. Jaksch, 
is as follows : To urine, as fresh as possible,* are added a 
few drops of a solution of chloride of iron. If a precipi- 
tation of phosphates takes place, it is removed by filtration, 
and the filtrate again treated with the chloride of iron. In 
case a Bordeaux-red color is produced, a portion of the urine 
is boiled. Another portion of the fresh urine is acidulated 
with sulphuric acid and shaken with ether. If the reaction 
in the boiled urine occurs but slightly, or not at all, if, after 
twenty-four hours, the red color produced by testing the 
ethereal extract grows pale, and if, operating on the distil- 
late, the urine is found rich in acetone, we have, then, to 
do, according to v. Jaksch, with diacetic acid. 
Clinical Significance of Acetone and Diacetic 
Acid.-We are indebted to v. Jakschf for most of our 
knowledge of the difference in the clinical significance of 
these two substances, which were formerly thought to be of 
identical import. 
Acetone is found in cases whose course is usually favor- 
able, and may have little or no significance. Diaceturia, 
on the other hand, is a most dangerous complication. 
Acetonuria seems to be the result of continued high tem- 
perature, or at least accompanies diseases attended with such 
temperature, and a diminution of temperature is followed 
by a fall in the quantity of acetone, while a redevelopment 
of high temperature is followed by an increase in acetone. 
* It is exceedingly important that the urine should be fresh, or de- 
composition prevented, because diacetic acid is so quickly converted 
into acetone. 
f Acetonurie und Diaceturie, Berlin, 1885. For a very careful 
presentation of the results of v. Jaksch's observations on this subject, 
see a paper by Dr. J. P. C. Griffith, in the Philadelphia Medical News, 
for October 3, 1885. 108 
PRACTICAL EXAMINATION OF THE URINE. 
Acetonuria often accompanies diabetes, but is not neces- 
sarily associated with it or with glycosuria, and while the 
development of acetonuria in diabetes is sometimes accom- 
panied by very unpleasant symptoms, as headache, loss of 
appetite, and deranged digestion, all of short duration, it is 
otherwise of little significance except as a possible precursor 
of the diaceturia which sometimes succeeds it. 
Among other diseases with which acetone has been found 
associated are carcinoma, inanition, and cerebral psychoses 
accompanied by mental excitement. 
There is also a condition, a sort of auto-intoxication, or 
" acetonaemia," sui generis, in which the acetone would seem 
to be solely responsible for a set of symptoms in which rest- 
lessness, excitement, and delirium are the most conspicu- 
ous, and which may either pass away entirely, or terminate 
in coma and death. 
On the other hand, what is commonly known as diabetic 
coma, according to v. Jaksch, is the result, not of acetone 
in the blood, but of diacetic acid, although he admits that 
it is often preceded by a long-continued acetonuria. It 
is commonly observed in cases of far-advanced diabetes. 
There is added to the usual feeling of weakness and de- 
pression drowsiness which may deepen into coma or pass 
away, the diaceturia continuing. As a rule, there is no 
relation between the amount of sugar and diacetic acid 
eliminated, although a sudden diminution of glycosuria is 
sometimes followed by the appearance of a large amount of 
diacetic acid, coma and death. 
Diaceturia also sometimes accompanies mental diseases 
with excitement, and has been noted in inanition and car- 
cinoma, so that a coma carcinomatosum has been described, ORGANIC CONSTITUENTS. 
109 
similar to that of diabetes. It is to be remembered, how- 
ever, that symptoms of diabetic coma may occur without 
either acetonuria or diaceturia. V. Jaksch proposes to do 
away with the term "diabetic coma" and substitute "coma 
diaceticum" for all of those cases of coma, from whatever 
remote cause, accompanied by diaceturia. 
Finally, there appears also to be an auto-intoxication or 
" diaceticaemia" from diacetic acid, manifested by vomit- 
ing, dyspnoea, and jactitation, which soon terminates in coma 
and death, unattended by any other discoverable grave 
disease. This condition, very grave, but rare in adults, is 
said by v. Jaksch, to be much more frequent in children 
and correspondingly less serious. In such cases the child 
feels weak, has a thickly coated tongue, often slight con- 
junctival catarrh, sometimes vomiting, usually constipation, 
and very little or no fever. In two or three days, all of 
these symptoms, together with the diaceturia, disappear. 
In other cases nervous symptoms are more marked. V. 
Jaksch believes that all of these, as well as a certain number 
of other convulsive attacks in children, are the result of 
auto-intoxication with diacetic acid. 
It is evident that our knowledge of these substances, ace- 
tone and diacetic acid, as well as that of the symptoms 
developed by their presence, is not yet definite; but the state- 
ments just made may be considered as representing as defi- 
nitely as possible our present information. 
XI. Coloring Matters. 
The pathological significance of all the coloring matters 
has not as yet been determined. Many of them are, how- 110 
PRACTICAL EXAMINATION OF THE URINE. 
ever, of such importance that their consideration commands 
interest next to that of the proteids and sugars. 
I. Normal Coloring Matters. 
Notwithstanding the very considerable study which 
has been given to this subject of late years, there is still 
much confusion in regard to the normal coloring matters. 
The two as to the existence of which, as separate proxi- 
mate principles, there is most satisfactory evidence are 
urobilin and urine-indican, the latter being the uroxan- 
thin of Heller. 
Thudichum* makes a single coloring matter which he 
calls urochrome. To this matter, according to Thudichum, 
the urine owes the whole or greater part of its yellow color, 
while numerous other coloring matters, including the urrho- 
din of Heller, Scherer's urohaematin, and the urohaematin 
of Harley, he considers mixtures of the products of decom- 
position of this yellow pigment. 
The urohaematin of Scherer and that of Harley are prob- 
ably identical, Schererf admitting that urohaematin con- 
tains iron, and approving of the use of the term by Harley 
for his coloring matter. The urophain of Heller is prob- 
ably the same thing. It will at any rate here be so con- 
sidered. Finally, all of these are probably modifica- 
tions, due to different methods of treating urine, of the 
substance known as urobilin, now generally acknowledged 
* Thudichum, A Treatise on the Pathology of the Urine, 2d edition, 
London,1877. 
f Harley, The Urine and its Derangements, Philadelphia, 1872, 
from London edition, 1871. ORGANIC CONSTITUENTS. 
111 
to be the most important coloring matter of the urine. 
Upon the presence of indican (Heller's uroxanthin) in 
most normal urines, all are agreed, although Thudichum pre- 
fers not to consider it a coloring matter, but a chromogen or 
color generator. For the present I shall retain it among 
the normal coloring matters, treating therefore chiefly of 
two, viz. : 
1. Urobilin (Jaffe), hydrobilirubin of Maly, and its modi- 
fications ; urohcematin of Harley and Scherer; urophain of 
Heller. 
2. Urine-indican or the uroxanthin of Heller; to 
which will be added a short account of the urochrome of 
Thudichum. 
i. Urobilin-Hydrobilirubin- Urophain- Urohcematin. 
Urobilin, first extracted by Jaffe, and further studied by 
Maly, is believed to be the bilirubin or normal coloring 
matter of the bile-itself the haematin of the blood reduced 
by the action of the bile acids-altered after passing into 
the small intestine, by absorbing water and hydrogen-in 
a word, reduced bilirubin. Hence Maly names it hydro- 
bilirubin. The reaction may be expressed as follows: 
2(CltH„N,0,) + H2O + H, = C„H.,N,O, 
Bilirubin. Urobilin. 
As such it is reabsorbed and excreted by the kidneys. Its 
direct descent from the blood is thus established. Ob- 
tained most readily from high-colored fever urines by pro- 
cesses described in the larger works on urinalysis, it is a 
brown resinous mass, easily soluble in water, but more 
readily in alcohol, ether, and chloroform. It gives no play 
of colors with nitric acid. Its concentrated solutions are 112 
PRACTICAL EXAMINATION OF THE URINE. 
brown ; more diluted they are yellow, and still more, rose- 
red. When concentrated they exhibit peculiar spectro- 
scopic properties and a beautiful green fluorescence by 
reflected light. The spectrum is a dark absorption band be- 
tween Fraunhofer's lines b and F. Both properties become 
more distinct by the addition of solution of ammonia and 
a drop of chloride of calcium, while the fluorescence ceases 
on adding hydrochloric acid, and the absorption band re- 
cedes towards F, and becomes more indistinct. 
Jaffe has inferred from the absence of these peculiar reac- 
tions of urobilin in fresh urine that urobilin is not at first 
present, but is preceded by a chromogen, which is converted 
into urobilin on exposure, by absorbing oxygen. 
Test for Urobilin or Hydrobilirubin.-Add ammo- 
nia until distinctly alkaline, filter, and to the filtrate add a 
little chloride of zinc solution. The appearance of a green 
fluorescence and the characteristic absorption band indicates 
the presence of a considerable amount of bilirubin. 
It is especially abundant in the high-colored urine of fever 
cases, heart and liver diseases, and after sweating. 
Heller's test for urophain is as follows: About 2 c.c. 
(32.4 minims) of colorless sulphuric acid are poured into a 
small beaker-glass, or, better, a " collamore " wineglass (p. 
17), and upon it in a fine stream, from a height of about 
four inches, twice as much urine is allowed to fall. The 
urine mingles intimately with the sulphuric acid, and 
in normal urine, of which the specific gravity is 1020 and 
the quantity 1500 c.c. in the twenty-four hours, produces a 
deep garnet-red coloration. 
If the coloring matter is increased, the coloration is no 
longer garnet-red, but is black and opaque; whereas, if the ORGANIC CONSTITUENTS. 
113 
coloring matter is diminished, the mixture appears pale 
garnet-red and transparent. 
Precautions.-Unfortunately, other conditions than that of in- 
creased amount of coloring matter produce the increased intensity of 
the urophain reaction. Thus diabetic urine produces the same dark 
opacity through carbonization of the sugar by the sulphuric acid. In 
like manner, urine containing blood, biliary coloring matters, and 
uroerythrin (an abnormal coloring matter), gives the same reaction 
with sulphuric acid. Before relying, therefore, upon this reaction, the 
above substances must be carefully excluded. 
Dr. Harley's test for urohaematin is as follows: 
Dilute the twenty-four hours' urine with water till it 
measures 60 ounces (1800 c.c.), or if the quantity exceeds 
60 ounces, concentrate it to this amount; then to about 2 
drachms (7.4 c.c.) of it, in a test-tube, add half a drachm 
(1.8 c.c.) of pure nitric acid, and allow the mixture to 
stand for some minutes. If the quantity of urohaematin is 
normal, the mixture will alter but slightly in tint; whereas, 
if there be an excess, it will become pink, red, crimson, or 
purple, according to the amount present. Heating the 
mixture hastens the change in color, but it is better to do 
this experiment in the cold, and, if necessary, allow plenty 
of time for the change to take place. 
The acid is added to liberate the coloring matter, which 
may be so thoroughly concealed that a pale urine often con- 
tains a large amount of urohcematin. 
Harley gives a second method, also easy of application, for 
determining an excess of urohaematin in cases of destructive 
diseases of the blood. Boil 4 ounces (120 c.c.) of urine, 
and add nitric acid to set the coloring matter free. When 
cool, put the urine in a six-ounce bottle along with an ounce 114 
PRACTICAL EXAMINATION OF THE URINE. 
of ether. Cork the bottle, thoroughly shake it, and place 
aside for twenty-four hours. At the end of that time the 
ether will be found to be like a red, tremulous jelly. Such 
a case, however, he admits to be a bad one. He further 
says that "in some of the worst cases of urohaematuria the 
urine is neutral, or even alkaline, and the Jons et origo malt 
is to be looked for in the spinal cord." 
Dr. Harley, apparently with good reason, considers that 
urohaematin arises from the disintegration of red blood 
corpuscles, and that it fluctuates, therefore, with the rate of 
destruction of these. 
Urochrome of Thudichum.-Thudichum terms the 
substance, to which he considers the whole or greater part 
of the yellow color of the urine is due, urochrome. It is 
an alkaloid, but not of pronounced basic properties. It 
has been isolated, but not finally analyzed. Its principal 
characteristic is that on chemolysis with acids it is split up 
into several bodies of smaller atomic weight, one of which 
-uromelanin-seems to be derived from the coloring in- 
gredient of the blood. Urochrome does not show any 
specific absorption band before the spectroscope when 
strongly acidified, but by chemolysis probably gives rise to 
two or three substances having distinct spectrum phenomena 
which greatly aid in their diagnosis. It is not the chro- 
mogen of urobilin. 
Thudichum gives (<?/. rzZ) several methods of isolating 
urochrome, the briefest of which consists in precipitating 
fresh urine with neutral and basic lead acetate, decompos- 
ing the precipitate with sulphuric acid, and precipitating 
the urochrome and some xanthin-like body from the fil- 
trate by phosphomolybdic acid. ORGANIC CONSTITUENTS. 
115 
2. Urine-indican-Uroxanthin of Heller-Indigogen of 
Thudichum. 
Indican, C52H62N2O34, or uroxanthin, is itself a color- 
less substance, separable from urine in the shape of a clear 
brown syrup, easily soluble in water, alcohol, and ether. It 
has a bitter taste, and is easily converted by treatment with 
acids under warmth into indigo-blue (the uroglaucin of 
Heller), a red coloring matter (urrhodin of Heller), said 
by Kletzinsky to be identical with indigo red; but this is 
denied by Thudichum. Formerly one of these products 
was said to be indigo-gluein, a saccharine substance which 
is said to respond to Trommer's test, but not to the fermen- 
tation test. This is now denied. According to Thudichum, 
urrhodin is the result of chemolysis by acids of a separate 
chromogen which he calls urrhodinogen. Uroxanthin or 
urine-indican was formerly thought to be identical with 
plant-indican, but more recent investigations tend to show 
a difference 
Heller's test is performed as follows: 4 c.c. or f5j 
of pure hydrochloric acid are poured into a smooth wine- 
or a small beaker-glass, and into the same while stirring 10 
to 20 drops of urine are dropped. Under normal condi- 
tions indican is present in urine in so small quantity that 
the acid to which the urine is added is colored pale yellowish- 
red. If indican is present in larger amount, the colora- 
tion is violet or blue. The more abundant the indican the 
more rapid does the violet or blue coloration take place, 
and often 1 to 2 drops of urine are sufficient to color 
or 4 c.c. hydrochloric acid. The blue color does not 
always make its appearance immediately. It is well then 
to wait 10 or 15 minutes, but the reaction which appears 116 
PRACTICAL EXAMINATION OF THE URINE. 
after such an interval indicates but a small quantity of indi- 
can. The addition of 2 or 3 drops of pure nitric acid 
makes the test more delicate, and small amounts of indican 
are thus recognized. If it is desired to test urine contain- 
ing the biliary coloring matters for indican, the former 
must be precipitated by solution of lead acetate and filtered 
out. 
Jaffe's method is more striking in its results, and is 
even approximately quantitative. To 10 or 15 c.c. (2.7 or 
3.24 fj) of urine in a large test-tube add an equal amount 
of fuming hydrochloric acid, and then, with constant shak- 
ing, a saturated solution of calcic hypochlorite (chloride of 
lime) drop by drop, until the greatest intensity of the blue 
color is reached. This is then shaken with chloroform, 
which readily dissolves the freshly formed indigo, and 
separates from the aqueous solution as a blue fluid, the color 
being more or less deep according to the amount of indican 
present. In pale urines, often very rich in indican, this 
method will serve to determine its amount with sufficient 
accuracy for clinical purposes. Dark urines, whose other 
coloring matters are also decomposed by hydrochloric acid 
and calcic hypochlorite, should first be decolorized by a 
solution of basic acetate of lead, avoiding a great ex- 
cess of the latter, when, if indican is present, a good indigo 
extract can be obtained in this way. 
Precaution.-Albumin must always be separated before 
performing this analysis, as well as Heller's test, as it devel- 
ops a blue color with hydrochloric acid after standing a long 
time. 
Clinical Significance of Indican in the Urine.- 
Normal urine, according to Jaffe, contains 4.5 to 19.5 mil- 
ligrams in 1500 c.c., or about 6.6 in 1000 c.c. It is in- ORGANIC CONSTITUENTS. 
117 
creased by a meat diet, in obstructive diseases of the bowel, 
in pyelitis, diseases of the spinal cord and its membranes, 
and especially derangements of the entire central and peri- 
pheral nervous system, in urina spastica, after coitus and in 
hot weather, probably from concentration of the urine. It 
is also especially abundant in the urine secreted during the 
reaction from cholera (Wyss). 
It has been found by Neftel in cases of cancer of the 
liver; and its presence in large quantities, in persons affected 
with malignant tumors, he considered pathognomonic of 
cancer of the liver; by Hoppe-Seyler, in a case of melanotic 
c.incer of the orbit. Jaffe finds indican increased in all 
diseases attended by intestinal obstruction, cancer of the 
stomach, lymphoma and lympho-sarcoma in the abdomen, 
purulent peritonitis, certain forms of diarrhoea, and in 
various diseases where the latter is a symptom. Rosenstein 
found indican increased eleven to twelve times in Addison's 
disease. 
I found it markedly increased in two cases of cirrhosis of 
the liver confirmed by post-mortem examination, and in 
one of evident malignant disease of some abominal organ, 
probably the liver; but the diagnosis was not certain and 
there was no autopsy. M. Robin has recently announced 
that he considers the presence of indican a valuable diag- 
nostic sign in typhoid fever.* 
From these facts it is evident that it is difficult to associate 
it pathognomonically with any disease. But recent physio- 
logical observations afford a rational explanation for its 
increase, which is strikingly confirmed by the clinical ob- 
servations above noted. Indican is increased when a sub- 
* Philadelphia Medical Times, October 22, 1881, p. 63. 118 
PRACTICAL EXAMINATION OF THE URINE. 
stance known as indol (C8H9N), first discovered by Baeyer, 
is introduced into the blood. It was found by Kiihne 
(Virchow's Archiv, vol. xxxix.) that during the artificial 
fermentation of albumin in the presence of minced pan- 
creas, indol was produced. Jaffe suggested that the indol 
thus produced during digestion is absorbed and converted 
in the blood into urine-indican. Now it is supposed that in 
ordinary normal intestinal digestion very little indol is 
produced ; but wherever digestion is interfered with or de- 
layed, as is evidently likely to be the case in almost all of 
the conditions above instanced, more is produced, absorbed, 
oxidized, and excreted as indican, thus accounting for its 
presence in increased amount under the circumstances. 
Dr. Harley believes that all the various colored urine- 
pigments are but different grades of oxidation of urohaema- 
tin,* and thus accounts for the various cases of blue, green, 
brown, and black urines which have been at different times 
reported, a most important fact with regard to which is that 
they never exhibit these colors at the moment the urine is 
passed, but acquire them after exposure to the air or the 
action of chemical reagents. He considers these changes 
which occur in urohaematin out of the body are primarily due 
to its constitution in the body having been altered by disease. 
He admits, however, in common with others, that some 
portion of the coloring matter of the urine comes from the 
food, chiefly vegetable food. J 
* Op. citat, p. no. 
f Op. citat., p. IOI, ad fin. 
My friend Dr. S. Weir Mitchell has called attention to a pecu- 
liar greenish or yellowish-green coloration exhibited by the urine of 
those who are upon a diet of skimmed milk alone. This coloration is ORGANIC CONSTITUENTS. 
119 
II. Abnormal Coloring Matters. 
Under abnormal coloring matters are included those 
which never enter into the composition of normal urine, 
whether found elsewhere in the body or not. 
They include (a) the coloring matters of blood, haemoglobin 
or oxyhaemoglobin, methaemoglobin, and haematin. Haem- 
atin is a deoxygenated haemoglobin, into which and a co- 
agulated albuminous substance the latter is converted by 
the action of heat. Methaemoglobin is an intermediate 
condition, approaching, however, nearer to haematin, and 
gives the same absorption band, in the yellow of the spec- 
trum between Fraunhofer's lines C and D, but nearer to D, 
while haemoglobin gives one band in the yellow and one in 
the green between D and E. 
In fresh urine containing blood-coloring matters the pre- 
vailing one is haemoglobin ; but if a specimen of such urine 
be treated by sulphuret of ammonium, it becomes reduced 
haemoglobin by loss of its oxygen. Of this, the spectrum 
gives a single broad band between the lines D and E. Shak- 
ing with oxygen or atmospheric air again restores the reduced 
haemoglobin to oxyhaemoglobin. 
(b) The uroerythrin of Heller. 
(c) Vegetable coloring matters. 
(d) Biliary coloring matters. 
(a) The Coloring Matters of the Blood, Hcemoglobin, 
Methcemoglobin and Hcematin. 
These substances can enter the urine either by direct trans 
probably such as would be expected when the coloring matter derived 
from the haemoglobin of the red blood-corpuscles is uninfluenced by 
coloring matters contained in food, but it is a subject which requires to 
be investigated. 120 
PRACTICAL EXAMINATION OF THE URINE. 
udation, or arise from the dissolution of blood-corpuscles 
themselves, which have entered the urine in different ways. 
They may be present in the urine in very small quantities 
without being accompanied by albumen, as was first shown 
by Dr. F. A. Mahomed.* 
The color of the urine is different according as it con- 
tains more haemoglobin or methaemoglobin, the former 
being brighter, the latter darker, brownish-red.' Haemor- 
rhages from the larger vessels produce more haemoglobin ; 
capillary haemorrhages, on the other hand, more methaemo- 
globin. Heller proposes to account for the difference by 
the fact that in the haemorrhages which take place from the 
capillaries in renal disease, the blood is much more slowly 
and more intimately commingled with the urine, and there- 
fore longer retained with it at the normal temperature of 
the body. Temperature, the presence of carbonic acid, 
and the absence of oxygen, may favor the change of haemo- 
globin to methaemoglobin. 
Detection of Blood- Coloring Matters. 
1. Mahomed's Test for Small Quantities of Hcemo- 
globin Unaccompanied by Albumen.- Dr. Mahomed (op. 
citP) directs as follows: One end of a small slip of white 
blotting-paper is dipped in the urine and dried over the 
flame of a spirit-lamp; by this means the dilute solution of 
the crystalloid is concentrated by evaporation; two drops 
of the tincture of guaiacum are then dropped on the paper, 
and, after a minute or so, allowed for the spirit to evaporate, 
* Transactions of the Royal Medico-Chirurgical Society of London, 
vol. Ivii., 1874, p. 196. ORGANIC CONSTITUENTS. 
121 
a single drop of ozonic ether* is let fall in the centre of the 
guaiacum stain. A blue color appears if haemoglobin is 
present. Some time, perhaps a quarter of an hour, will 
elapse before the reaction becomes visible, especially if it 
be slight; when it appears it is not permanent; it will 
begin to fade in a few hours, and will have disappeared in 
a day or two. 
The advantage of this test lies in the fact that the physi- 
cian can carry a few slips of blotting-paper in his pocket- 
book, dip one in the urine during his visit, allow it to dry, 
and make the test at home. 
Dr. Stevenson's modification of Dr. Mahomed's 
test, acknowledged by the latter to be far more brilliant, is 
as follows: To a drop or two of urine in a small test-tube 
add one drop of the tincture of guaiacum and a few drops 
of ozonized ether ; agitate and allow the ether to collect at 
the top, forming an upper layer of fluid. If haemoglobin 
be present the ether carries up with it the blue color that is 
produced, leaving the urine colorless below. In this method 
the blotting-paper, which is somehow the source of fallacy, 
is not required. 
Precautions.-Saliva, nasal mucus, and a salt of iodine (as happens 
when the patient is taking iodide of potassium) all strike a blue color 
with tincture of guaiacum, some without and some after the addition of 
ozonic ether. 
Clinical Application.-By this test, according to Dr. 
Mahomed, infinitesimal traces of haemoglobin can be de- 
* Ozonic ether may be obtained in Philadelphia, of L. Wolf, apothe- 
cary, northwest corner Twelfth and Chestnut Streets. Both it and the 
tincture of guaiacum should be freshly prepared. 122 
PRACTICAL EXAMINATION OF THE URINE. 
tected in urine which to the naked eye, the microscope, the 
spectroscope, and even to the nitric acid test for albumin, 
affords no indication whatever of abnormality. Indeed, 
the presence of albumin in any quantity interferes with the 
test, and it is in the prealbutninuric stages of scarlatina, or 
just after it has disappeared, and where there is a high state 
of vascular tension, that it is serviceable. It will respond 
in chronic albuminuria also, where minute traces of blood 
are present. Where the response precedes the appearance 
of albuminuria, it fades when the albumin becomes copious, 
and reappears again as it diminishes or after it disappears. 
The most useful application of the test, if Dr. Mahomed's 
views are sustained, will be in the prealbuminuric stage of 
scarlatina, where it will give us information of a state of 
affairs in the kidney previous to actual inflammation of the 
organ, when a brisk purge or copious sweat may avert more 
serious mischief. In cases of albuminuria produced by in- 
tense fever and due to venous congestion, as in enteric 
fever, pneumonia, and sometimes in the febrile stage of 
scarlatina, when the fever is intense and the albuminuria 
only slight, no reaction showing the transudation of the 
haemoglobin can be obtained. 
2. The presence of haemoglobinuria as distinguished 
from haematuria is determined by the absence of blood 
disks and the presence of a smaller quantity of albumin, 
derived from the decomposition of the haemoglobin. When 
a solution of haemoglobin is heated in a test-tube it breaks 
up into a coagulated albuminous substance, haematin and 
methaemoglobin. The former is precipitated, not in flakes 
which quickly coalesce and form a large white bulky precipi- 
tate, as does coagulated serum-albumin, but forms a small, 
brownish, coherent coagulum which floats upon the surface. ORGANIC CONSTITUENTS. 
123 
The color may be removed from the washed coagulum by 
boiling with alcohol containing sulphuric acid, the fluid 
becoming tinted reddish to reddish-brown, and given the 
spectrum of haematuria. Again, the color of such urine, 
although dark red in bulk, is yellowish and more trans- 
parent in thin layers than urine containing blood-cor- 
puscles. It is of lower specific gravity than such blood, 
and deposits a less copious sediment. 
It must not be concluded, that, because blood-cor- 
puscles are absent from a given specimen of urine con- 
taining haemoglobin, they have never been present; for 
they are sometimes rapidly dissolved, especially in alkaline 
urine. In such event we must depend upon the smaller 
amount of albumin just alluded to as characteristic of simple 
haemoglobinuria, and the smaller sediment. The urine con- 
taining the dissolved corpuscles is more apt to be alkaline 
while the urine of haemoglobin is acid in reaction. Should 
there be a transudation of serum at the same time with the 
haemoglobin it would of course be impossible to distinguish 
the two. 
3. Heller's test for haematin is as follows: Precipi- 
tate from urine in a test-tube the earthy phosphates by 
caustic potash and gentle heat, over a flame. The earthy 
phosphates carry with them, as they sink, the blood-coloring 
matters, and appear, therefore, not white as in normal 
urine, but blood-red. When the quantity of coloring matter 
in urine is very small, the earthy phosphates appear dichroic. 
If the urine is already alkaline, and no precipitate of earthy 
phosphate appears on the addition of liquor potassae and 
heat, a precipitate can be artificially produced by the addi- 
tion of one or two drops of the magnesian fluid, which, 124 
PRACTICAL EXAMINATION OF THE URINE. 
with the application of heat, carries down the coloring 
matters; whence it is possible 
To Prepare Haemin Crystals.-If the precipitated 
earthy phosphates are filtered out and placed on an object- 
glass, and carefully warmed until the phosphates are com- 
pletely dry, Teichmann's haemin crystals can be produced 
therefrom. For this purpose a minute granule of common 
salt is carried on the point of a knife to the dried haematin 
and earthy phosphate, and thoroughly mixed with it. Any 
excess of salt is then removed, the mixture is covered with 
a thin glass cover, a hair interposed, and a drop or two of 
glacial acetic acid allowed to pass under. The slide is then 
carefully warmed until bubbles begin to make their appear- 
ance. After cooling, haemin crystals can be seen by aid of 
the microscope. These, though often very small and in- 
completely crystallized, are easily recognizable by an ampli- 
fication of 300 diameters. They are chemically hydro- 
chlorate of haematin. 
Precautions.-Care must, however, be taken to apply only a gentle 
heat in precipitating the earthy phosphates with caustic potash solution, 
and to filter quickly, lest the haematin may be decomposed. 
It sometimes happens, also, that vesicles develop under the thin glass 
cover, after the addition of acetic acid, even before heat has been 
applied. These are carbonic acid. They should be allowed to pass 
away, and the slide then warmed until the formation of vesicles, that is, 
to the boiling-point of acetic acid. 
4. Test for Haematin by Precipitation of Albu- 
min, etc.-The blood-coloring matters in urine may also 
be demonstrated by coagulating the albumin by boiling, 
filtering off the brown coagulum, drying, and treating it 
with alcohol containing sulphuric acid. This alcoholic ORGANIC CONSTITUENTS. 
125 
solution contains the haematin, and if the alcohol be evap- 
orated, haemin crystals can be obtained from the residue in 
the manner above described. 
5. Struve's Test.-Treat a few cubic centimetres of 
urine with a little sodic or ammonic hydrate, then with a 
solution of tannin and with acetic acid until a distinct acid 
reaction obtains. If blood is present there occurs a dis- 
tinctly colored precipitate of tannate of haematin. After 
washing and drying, haemin crystals may be obtained from 
this precipitate in the manner already described. 
6. Alemen's Test.-Afewc.c. of tincture of guaiacum 
are shaken up with an equal volume of oil of turpentine 
until an emulsion results, and to this, urine is added drop 
by drop. If the urine be normal the resin of guaiac is 
quickly precipitated as a white, dirty-yellow or green pre- 
cipitate. If the blood-coloring matters are present the 
resin is colored a more or less intense blue, often almost 
indigo-blue. 
These tests of course do not admit the distinction be- 
tween haemoglobin, methaemoglobin, and haematin. 
Occurrence.-Haemoglobinuria, that is the direct pas- 
sage into the urine from the blood, of the coloring matters 
unaccompanied by the corpuscular element, occurs in cer- 
tain general diseases, as scurvy, purpura, scarlatina, pro- 
found malarial poisoning, etc. Haematuric or bloody urine 
results from the above and from a variety of other causes 
which require no special mention. ' 
Melanin is sometimes found in the urine of persons 
having melanotic cancer or sarcoma. It is deposited from 
urine in the shape of granular particles. These are soluble 
in liquor potassae, and their solution is decolorized by 126 
PRACTICAL EXAMINATION OF THE URINE. 
passing chlorine through it. Melanin differs from carbon 
in being soluble in potash, while carbon is not. 
(b) Uroerythrin. 
Heller ascribes the well-known dark reddish-yellow or 
"high " color of all fever urines to the presence of a sub- 
stance which he calls uroerythrin, as well as to an increase 
of the normal coloring matters. Except that it contains 
iron, little else that is certain is known with regard to uro- 
erythin. To it he ascribes the reddish color which so often 
characterizes the deposits of urates known as " lateritious;" 
if the supernatant urine in such cases be treated with solu- 
tion of neutral acetate of lead, the precipitate presents a 
similar "rosy red " or " flesh color," which he attributes 
to the same substance. It is doubtless a modified haematin, 
being found especially in diseases where there is evident 
blood dyscrasia, as in low fevers, septic conditions, etc. 
It so far at least corresponds with the urohaematin of Har- 
ley that it is a measure of the destruction of the blood-cor- 
puscles, though it will be remembered that the urohaematin 
of Harley is looked upon as a normal constituent of urine 
which may be abnormally increased, while uroerythrin, 
although a modified haematin, is still not considered iden- 
tical by its discoverer. 
Neubauer includes uroerythrin among the normal color- 
ing matters, while Hoffmann and Ultzmann, following 
Heller, treat it as abnormal. 
Detection.-Uroerythrin is known to be present by its 
pink coloration of the " lateritious " sediment, or by its 
precipitation by solution of neutral acetate of lead. Too 
much lead solution must not be added lest the precipitate 
be too abundant, and the coloring matter rendered less dis- ORGANIC CONSTITUENTS. 
127 
tinct by its being disseminated over a large amount of de- 
posit. If the urine contains haematin or the coloring 
matter of blood, it must be first removed. 
Precautions.-I. The froth of a urine highly charged withuroery- 
thrin may appear yellow, as that of urine containing biliary coloring 
matter, hut the precipitate of the latter by acetate of lead is also yellow 
and not pink, as is uroerythrin. 
2. The earthy phosphates which are precipitated on heating the 
urine with caustic potash are " dirty-gray " when the urine contains uro- 
erythrin, while in urine containing haematin they are " blood-red " or 
dichoric. The absence of albumin from the urine, the gray coloration 
of the earthy phosphates, and the red precipitate with solutions of lead, 
serve as points in the differential diagnosis between uroerythrin and the 
coloring matter of the blood. 
Clinical Significance.-Uroerythrin is found in the 
urine in all febrile affections, however slight; also, it is 
said, in pyaemia, diseases of the liver, and lead colic. All 
urine, according to Heller, which contains uroerythrin 
must be abnormal. 
(c) Vegetable Coloring Matters. 
The coloring matter of plants, especially chrysophanic 
acid, found in rhubarb and senna leaves, contributes to 
alkaline urine a reddish-yellow to a deep-red color. It can 
be recognized by the fact that the red alkaline urine on 
adding an acid becomes yellow, and on the addition of an 
excess of ammonia again takes on the red color. 
Precautious.-Such precipitation by heat and potash solution might 
possibly be taken for blood-coloring matters. But the absence of albu- 
min from the urine, the production of the red color by addition of an 
excess of ammonia, and its paling on the further addition of an excess 
of acid, serve to distinguish this vegetable coloring matter from blood- 
coloring matter and uroerythrin. 128 
PRACTICAL EXAMINATION OF THE URINE. 
Numerous other vegetable matters color the urine, among 
which santonin is conspicuous for the bright yellow color 
it produces in acid urine, while the staining of linen by it 
closely resembles that of biliary coloring matter. Dr. W. 
G. Smith {Dublin Quarterly Journal of Medical Science, 
November, 1870) has investigated the subject, and found 
that the addition of alkali causes the development of a fine 
cherry-red or crimson color, according to the amount of 
santonin present; but it will be observed that this reaction 
is that of the vegetable-coloring matters generally, as above 
described. 
Madder, indigo, gamboge, rhubarb, logwood, carrots, 
whortleberries, etc., give to urine more or less of their 
peculiar color. 
Salicylic acid when administered in sufficient doses gives 
a smoky hue to the urine, and the urine strikes a blue color 
when a few drops of a solution of ferric chloride are added. 
Carbolic acid introduced into the system in sufficient 
quantity causes a dark and even black discoloration of urine. 
(d) Biliary Coloring Matters-The Detection of Bile 
in tne Urine. 
The biliary coloring matters are chiefly bilirubin 
(C]6H18N2O3), biliverdin (C16H20N2O5), and bilifuscin 
(C16H22N2O6), the last two being derivatives by oxidation of 
the former. The last is found as such in herbivorous bile, 
and bilifuscin can be obtained from human gall-stones. 
None of these give any spectrum unless acted upon by re- 
agents. We have seen that urobilin, the normal coloring 
matter of urine, is bilirubin altered by taking up, while in 
the small intestine, water and hydrogen, as the result of 
which it acquires the spectrum described on page in. ORGANIC CONSTITUENTS. 
129 
From the intestine it is absorbed, and excreted by the kid- 
neys as the normal coloring matter of urine. 
When bile is abundantly present in urine, the yellow 
color of the fluid, and especially of the froth or foam pro- 
duced by shaking, is sufficient to excite suspicion. Further, 
if a piece of filtering-paper or apiece of linen be moistened 
with such urine, it retains a permanent yellow color on 
drying. 
The only positive proof of the presence of the coloring 
matters of bile in the urine is found in Gmelin's or Heller's 
test for the unaltered coloring matters. 
Gmelin's nitrous acid test is performed in two ways : 
First. A quantity of urine is placed in a test-tube, and a 
small quantity of fuming nitric acid (nitrous acid of com- 
merce) is allowed to pass carefully down the sides of the 
test-tube to underlie the urine, as described in Heller's 
test for albumin. If biliary coloring matters are present, 
at the point of union between the urine and the acid will 
very soon be seen a set of colors which, if typical, should 
be green, blue, violet red and yellow, or yellowish-green 
again, in the order named from above downward. Often, 
however, one or more colors are wanting. The green is 
most constant, and the first green indispensable to prove the 
presence of bile ; but violet, shading into red and yellow, is 
also very constantly seen. The other colors may be pro- 
duced by other coloring matters, especially indican. 
Second. Equally satisfactory is the test if a few drops of 
the urine are placed upon a porcelain plate, and as much 
of the fuming acid is placed adjacent and allowed gradu- 
ally to approach the urine. The same play of colors 
occurs. 130 
PRACTICAL EXAMINATION OF THE URINE. 
E. Fleischl's Test.*-A modification of Gmelin's 
test, by which it is made more delicate. Instead of having 
impure nitric acid added in such a way that it will form a 
separate layer at the bottom, the urine should be thoroughly 
mixed with pure nitric acid, or, still better, with a con- 
centrated solution of the nitrate of sodium, and then con- 
centrated sulphuric acid should be carefully added so as to 
form a separate layer at the bottom. The play of colors 
forms at the junction of the urine and the sulphuric acid, 
the green appearing first above the acid, but rising gradu- 
ally and giving place to the blue, violet-blue, and yellow. 
The advantage of this modification is that the pigment is 
not oxidized so rapidly, and therefore the color is not 
changed so quickly, remaining often half an hour or longer. 
Heller's Test for Bile Pigment.-Pour into a test- 
tube about 6 c.c. (1.6 f3)of pure hydrochloric acid, and add 
to it, drop by drop, just sufficient urine to distinctly color it. 
The two are mixed and " underlaid" as before with pure 
nitric acid, and at the point of contact between the mixture 
and the colorless nitric acid a handsome play of colors 
appears. If the "underlaid" nitric acid is now stirred 
with a glass rod, the set of colors which were superimposed 
upon one another now appear alongside of each other in 
the entire mixture, and should be studied by transmitted 
light. Heller further says, if the hydrochloric acid on 
addition of the biliary urine is colored reddish-yellow, the 
coloring matter is bilirubin; on the other hand, if it is 
colored green it is biliverdin. 
If the amount of coloring matter is very small, a large 
quantity of urine should be shaken with chloroform ; the 
* Boston Med. and Surg. Journal, Jan. 13, 1876, from Centralblatt 
fur die Medicinischen Wissenschaften, 1875, No. 34. ORGANIC CONSTITUENTS. 
131 
chloroform allowed to separate at the bottom of the vessel 
in large drops. The yellow-colored chloroform is then 
removed by means of a pipette, washed with distilled 
water, and poured into a beaker-glass containing hydro- 
chloric acid. The yellow drops of chloroform sink to the 
bottom. If now, while diligently shaking the glass, nitric 
acid is added, the changes of color can be distinctly ob- 
served in the chloroform. In consequence of the slower 
action of the acid upon the coloring matters dissolved in 
the urine and the consequent slower transition of colors, 
this method is peculiarly adapted for demonstration. 
Precautions. - I. With neither test should too dark-hued a urine 
be employed. Very dark urines should first be diluted with water. 
2. Should albumin be present, the opaque zone at the point of con- 
tact between the urine and acid imbibes the coloring matters and ex- 
hibits a green coloration; so that the test is in no way interfered 
with. 
3. Urine ricA in indican may, however, deceive, forming at the 
point of contact a blue layer of indigo, which, along with the yellow 
urine, in reflected light, may appear green. In these doubtful cases the 
chloroform modification of the test should be used, or the urine may be 
precipitated with solution of acetate of lead, and the filtrate examined 
for indican. 
4. The earthy phosphates, precipitated from biliary urine by liquor 
potassas and heat, exhibit a brown coloration. 
Ultzmann's Test.-Add to 10 c.c. of urine 3 or 4 c.c. 
of pure caustic potash solution (1 part of KOH to 3 of 
H2O), then shake and add an excess of pure hydrochloric 
acid. The mixture assumes a beautiful emerald-green color. 
Marechalt's Test.-Upon a specimen of urine in a 
test-tube allow a few drops of tincture of iodine to fall care- 
fully. If biliary pigments are present a green color ap- 132 
PRACTICAL EXAMINATION OF THE URINE. 
pears at the point of contact between the two fluids, and 
remains for some time, even twenty-four hours. In this test 
the possibility of confounding indican is said to be excluded. 
Test for Decomposed Biliary Coloring Matters. 
-Should the urine contain only altered biliary coloring 
matters, which respond to neither Gmelin's nor Heller's 
test, Hoffman and Ultzmann recommend the following: 
A piece of white linen or filtering-paper is immersed in 
the suspected urine, and allowed to dry, when it will appear 
colored brown. A further confirmation that the decom- 
posed coloring matters are present will be found in a low 
specific gravity and a dark urophain reaction.* If, more- 
over, the urine be treated with liquor potassae and heat, to 
precipitate the earthy phosphates, it becomes darker than 
before and the phosphates are precipitated brown. 
Bile-pigments have a property of adhering to precipitates 
much more tenaciously than other pigments, and therefore 
sometimes cannot be detected in fluid urine when they 
may be in precipitates. Hence Dr. J. F. Tarchanoff (Cen- 
tralblattfii.r die Medicinischen Wissenschaften, 1875, No. 6) 
recommends, in order to separate with certainty the biliary 
from the urinary pigments, precipitating the urine with 
milk of lime, freeing from excess of lime by a current of 
carbonic acid gas, allowing the whole to stand a few hours, 
filtering, and washing the precipitate with water. The 
bile-pigments are contained in the precipitate, while the 
indican, haemoglobin, and methaemoglobin are in the fil- 
trate. The precipitate is then dissolved in acetic acid and 
tested by Gmelin's test. 
* It should be remembered that this dark urophain reaction is also 
produced by sugar and blood-coloring matters. These causes should, 
therefore, be eliminated. ORGANIC CONSTITUENTS. 
133 
In addition to urobilin the normal coloring matter of urine, directly 
derived by oxidation from bilirubin the normal coloring matter of fresh 
human bile, the latter substance and other derivatives from it are found 
in the urine when from any cause bile is reabsorbed. No attempt has 
been here made to separate these from each other, and the tests given 
are those for bilirubin and its combined derivatives, whatever they 
may be. Indeed I do not know that any of these except urobilin has 
been recognized in urine as a distinct coloring matter, unless it be the one 
last discovered by Stokvis,*-and apparently not yet named,-as a sec- 
ondary product in most cases of the oxidation of biliary coloring matter, 
whereby Gmelin's reaction is produced. This same substance Mac- 
Munnj- believes he has found in the urine, by the aid of the spectro- 
scope, in certain cases of rheumatic fever, pregnancy, thoracic aneurism, 
cirrhosis of the liver, and cancer of the pylorus. It is indicated by an 
absorption band, which occurs on the red side of the band of urobilin. 
In testing for it, the liquid is to be precipitated with lead acetate, 
excess of lead removed by oxalic acid, and the filtrate concentrated 
and boiled with alkalis and a reducing agent. If no reduction takes 
place, and if the other tests for biliary coloring matters have given a 
negative result, their absence may be inferred. 
XII. The Biliary Acids. 
From a perusal of almost all of the text-books on physi- 
ology, and even of numerous manuals on the examination 
of urine, the student is led to suppose that the detection of 
bile acids, if present in urine, by means of what is called 
Pettenkofer's test, is one of the easiest possible. This is, 
however, far from being the case, and the fact is that such 
detection by the direct application of the elements of Petten- 
kofer's test in urine, or any other animal fluid, is practically 
impossible, even if the bile acids are present in considerable 
amount. Nor have any of the modifications of Petten- 
* N. Rep. Pharm., xxi., 123; Watt's Dictionary, 2d Supp., 1875. 
f Spectroscope in Medicine, London, 1880, p. 168. 134 
PRACTICAL EXAMINATION OF THE URINE. 
kofer's test, recently announced as clinically available, 
proved such in my hands, even where the elements of bile 
have been added to the urine, except where inspissated ox- 
bile has been used. The results of a complete investigation 
of this subject in its practical bearings will be found in a 
clinical lecture by the writer, in the Philadelphia Medical 
Times for July 5, 1873, "On a Case of Jaundice, with Re- 
marks on the Availability of Pettenkofer's Test," to which 
the reader is referred. In these experiments the simplest 
method of obtaining the biliary acids was found to be as 
follows: Six or eight ounces (180-240 c.c.) of the sus- 
pected urine are evaporated to dryness over a water-bath. 
The residue thus obtained is treated with an excess of ab- 
solute alcohol, filtered, and the filtrate treated with an ex- 
cess of ether (12 to 24 times its bulk), by which the bile- 
acids, if present, are precipitated. These are then removed 
by filtration and redissolved in distilled water. The solu- 
tion is then decolorized by passing through animal charcoal 
and the resulting colorless fluid tried by Pettenkofer's test 
as follows: A single drop of a 20 per cent, solution of 
cane-sugar (simple syrup of the Pharmacopoeia is many 
times too strong) is then added to a drachm or two (3.7- 
7.4 c.c.) in a test-tube or porcelain capsule. Sulphuric 
acid is then added drop by drop, while the test-tube is kept 
in a vessel of cold water, to prevent too great a rise in tem- 
perature, which should not exceed 5o°-7o° C. (i22°-i58° 
F.). As the quantity added approaches a bulk equal to 
that of the fluid to be tested, a beautiful cherry-red or pur- 
ple-violet color should make its appearance. So soon as a 
yellow color appears, then the sulphuric acid is acting on 
the sugar, and the cherry-red can no longer be looked for. 
This carbonizing of the sugar is obviated by keeping the 
temperature down to the degree mentioned. ORGANIC CONSTITUENTS. 
135 
Even this method involves more time than is often avail- 
able to the active practitioner, but there is none more simple, 
and there is really rarely any necessity for any other than 
the color test, for the presence of the biliary acids, although 
undoubtedly occurring, is very rare, and the circumstances 
under which they occur are illy determined. It is not true, 
as was once supposed, that they are always present in the 
urine in cases of jaundice from obstruction and consequent 
reabsorption of bile (hepatogenous jaundice), and absent in 
cases of jaundice from dissolution of the blood (haematoge- 
nous jaundice), else would the determination of their pres- 
ence be of real value in diagnosis. The only circumstances 
under which they are undoubtedly present in the urine are 
rapidly destructive diseases of the liver, as acute yellow 
atrophy and phosphorus poisoning. On the other hand, 
traces of the bile acids are said to be present in normal 
urine, Dragendorf having found 7 to 8 grains in 100 litres.* 
The bile acids yield a spectrum, which MacMunn has in- 
vestigated. It gives a band outside D, and a broad band at E. 
Dr. Oliver's New Peptone Test for the Bile- 
Acids.-This is founded upon the physiological fact that 
when the products of gastric digestion, peptone and para- 
peptone, which leave the stomach in an acid solution, meet 
with the bile, they are thrown down in a tenacious layer 
over the entire mucous membrane of the duodenum. So, 
too, albuminous urine or urine charged with peptone is pre- 
cipitated by a solution of bile salts or of their derivative, 
cholate of sodium. Hence acidified albuminous urine be- 
comes a test for bile salts, but an acidulated antiseptic 
* The presence of bile-acids in normal urine is also asserted by Dr. 
Oliver, this assertion being based on experience with his new peptone 
test considered in the ensuing section. 136 
PRACTICAL EXAMINATION OF THE URINE. 
solution of peptone is a readier and more delicate reagent. 
Such a solution is made by Dr. Oliver as follows : 
Pulverized peptone (Savory and Moore), .... gr. xxx. 
Salicylic acid,gr. iv. 
Acetic acid,njjxxx. 
Distilled water,to f ?viii. 
Perfect transparency is secured by repeated filtration. 
Application.-The urine should be perfectly clear, rendered 
so by filtration if necessary, boiled and filtered if bloody, 
rendered normally acid if alkaline, and finally reduced to a 
specific gravity of 1008. Twenty minims should then be 
run into 60 minims of the test solution, and if the proportion 
of bile salts is normal or subnormal there is no immediate 
reaction, but in a little while there is a mere tinge of milki- 
ness. If, however, the bile salts are present in excess, a 
distinct milkiness promptly appears, becoming more intense 
in a minute or two, the degree of opacity being directly 
proportionate to the amount of bile derivatives. 
On agitation, the opalescence diminishes and perhaps 
finally vanishes, but is restored on adding more of the test 
solution. The precipitate differs from all other urinary 
precipitates induced by an acidified reagent, in dissolving 
completely on adding a drop or two of acetic acid or a 
citric acid test-paper, and by diminishing but not disappear- 
ing when boiled, but the opacity is not affected by such a 
degree of warmth as is sufficient to dissolve urates. Further 
an insufficiency, as well as an excess of acid, interferes with 
the reaction, as also does an excess of proteids, or of the 
salts themselves. Hence the importance of securing the 
proper proportions as in Dr. Oliver's formula, and of di- 
luting the urine to be operated upon to a specific gravity of 
1008. By the dilution is also secured such a solution of the ORGANIC CONSTITUENTS. 
137 
urates as avoids their precipitation and also any error conse- 
quent thereon. The reduction in specific gravity also ob- 
viates another source of error, in that concentrated urines 
often simulate an excess, while urines of low specific gravity, 
though affording a reaction similar to normal urines, may 
actually contain more than the normal amount of bile salts. 
The test may be used in the contact method, by running 
the solution over the urine reduced in specific gravity to 
1008. If the bile salts are present in normal amount or 
less, there is again no immediate response, but in the course 
of a minute, a delicate thread-like line makes its appearance, 
which may increase slightly. If the bile salts are abnor- 
mally increased an immediate reaction takes place. 
This test, according to Dr. Oliver, is so delicate that 
there can readily be detected one part of bile salts in at 
least 18,000 to 20,000 parts of a solution of chloride of 
sodium. So far, he has been unable to find any other con- 
stituent of urine which reacts similarly, and, although it 
is true that a concentrated solution of chloride of sodium 
in the presence of an acid will precipitate a proteid, exper- 
iment shows that when the peptone solution is run upon a 
solution of salt of any specific gravity below 1050, no pre- 
cipitation takes place. Hence there can be no error from 
this source in urine. 
Mucin may be eliminated as a source of error, because 
this substance in acid solution is not precipitated by adding 
more acid, and when it is thrown down in urine of acid 
reaction, it is highly probable that the acid is not the reagent 
producing it, but merely supplies the requisite degree of 
acidity to enable the precipitant already present to operate, 
and in that event, the mucin would only indicate the pres- 
ence of bile salts. 138 
PRACTICAL EXAMINATION OF THE URINE. 
Quantitative Estimation.-This is based upon a per- 
manent standard of opacity provided by mixing together, 
in equal proportions, the test solution and normal urine 
reduced to the specific gravity of 1008. 
To 60 minims of the test solution add the suspected urine 
reduced to a specific gravity of 1008, usually 10 to 20 
minims at a time, allowing a minute to elapse after each 
addition, until the opacity induced is exactly equal to or 
slightly exceeds that of the standard, the tubes being held 
to the light, shaded by a dark background, such as a coat- 
sleeve. 
If 50 or 60 minims bring up the opacity to that of the 
standard, the proportion of bile salts does not exceed the 
normal amount. Any smaller quantity required, indicates 
an excess, while the smaller the amount needed, the larger 
the proportion of bile salts present. 
Dr. Oliver has constructed a table showing the percent- 
age of increase indicated by a varying number of drops : 
Minims. 
I 
or 
Drops. 
2 
Percentage of Increase on 
the Normal Standard. 
6,000 
2 
or 
4 
= 
3,ooo 
3 
or 
6 
= 
2,000 
4 
or 
8 
= 
1,500 
5 
or 
IO 
- 
1,200 
IO 
or 
20 
= 
600 
15 
or 
3° 
= 
400 
20 
or 
4° 
= 
300 
25 
or 
So 
= 
240 
30 
or 
6o 
= 
100 
35 
or 
70 
= 
83 
40 
or 
So 
= 
66 
45 
or 
90 
= 
50 ORGANIC CONSTITUENTS. 
139 
An increase beyond 700 per cent, over the normal is rarely 
met, although Dr. Oliver mentions an instance of non- 
jaundiced urine which showed an increase of over 1500 per 
cent., which afforded at once a beautiful reaction with 
Pettenkofer's test. 
Peptone Test Paper.-Dr. Oliver has also constructed 
a peptone test paper which he considers permanent and 
reliable, and best used as follows: 
The peptone paper with half a citric paper is dropped 
into 60 minims water in a test-tube or wineglass. After the 
lapse of a minute the solution is slightly agitated, and on 
being set aside for another minute is ready for use. 
The solution thus prepared is taken up by the pipette 
and carefully run over the transparent urine. If bile salts 
are present in larger amount than the normal average, an 
immediate reaction is observed as a pearly-white thread or 
band. In urine in which there is no such excess, a deli- 
cate zone may appear, but only in the course of one or two 
minutes. 
XIII. Leucin (C6H13NO2) and Tyrosin (C9HuNO3). 
Leucin and tyrosin, products of a retrograde metamor- 
phosis of nitrogenous substances, are found physiologically 
only in certain fetid secretions, as those of the axilla and 
between the toes, but can be produced by chemical means 
from some glands, as the liver, pancreas, and spleen, where 
they also occur in certain pathological states. They are 
found in urine, chiefly in rapidly destructive diseases of 
the liver, as acute yellow atrophy or phosphorus poison- 
ing, but occasionally also in typhus and small-pox. They 
always accompany a large amount of biliary coloring matter 
and the presence of albumin. When at all abundant, as 140 
PRACTICAL EXAMINATION OF THE URINE. 
they generally are in acute yellow atrophy, they are de- 
posited from urine and are found in the sediment, the 
former in the shape of centrically marked spheres, arranged 
in warty masses, or druses, the latter in needles. (Fig. 25.) 
Schultzen has shown* that in animals poisoned by phos- 
phorus, " urea disappears from the urine, and is replaced 
by leucin and tyrosin, which in the healthy organism, are 
converted into urea." A similar substitution takes place 
in cases of acute atrophy of the liver, the retained urea 
accounting for the convulsive attacks which usually precede 
death in these cases. 
Detection.-If the crystals, to be more fully described in 
treating of sediments, do not present themselves in the 
spontaneous deposit of such cases, the evaporation of a 
small quantity of the urine will generally promptly display 
them. 
If they are not sufficiently abundant to be thus demon- 
strated, the method of Frerichs must be pursued to separate 
them. A large amount of urine is precipitated with basic 
acetate of lead, filtered, the excess of lead removed from 
the filtrate by sulphuretted hydrogen, and the clear fluid 
evaporated over a water-bath to a small volume. In 
twenty-four hours tyrosin needles will be found to have 
crystallized out, but leucin spheres will not appear until 
later, because of the great solubility of the leucin.f 
* Boston Medical and Surgical Journal, July 23, 1874, from Zeit- 
schrift fur Biologie, viii., 124, and Berliner klin. Wochenscbrift, 1872, 
p. 417. 
f Leucin and tyrosin are more fully treated by the writer in the 
American Journal of the Medical Sciences for January, 1872. The 
above is believed to be sufficient for practical purposes. ORGANIC CONSTITUENTS. 
141 
XIV. Fatty Matters. 
That a trace of fat exists dissolved in normal urine has 
been shown by Schunk; while the list of reported cases in 
which fat is present in abnormal quantity is gradually in- 
creasing. In such cases are, of course, not included those 
in which fatty epithelium, fatty casts, and free oil drops 
are present, as the result of chronic Bright's disease; nor 
those in which fatty epithelium from the bladder or vagina 
occurs. 
The oil may be present in urine in a state of minute sub- 
division into small drops and molecules as in the so-called 
chylous urine, or in the form of clear fluid oil. In the 
former instance the admixture probably results from the 
leakage of a lymph vessel into some part of the urinary 
tract. In the latter its source has been, in one instance* 
at least, traced to an abscess in the left lumbar region com- 
municating with the left ureter; and such possible source 
should always be remembered. It is not impossible also 
that it may come directly from the kidney in cases of cystic 
cheesy degeneration of that organ, instances of which I 
have seen where there has been considerable free oil with 
compound granule cells and cholesterin plates among the 
cheesy matter. Dr. Robertsf refers to three cases in which 
pure yellow oil was present in the urine, in two during the 
administration of cod-liver oil, and in the third during the 
use of an emulsion. Dr. reported three cases 
of heart disease in which free oil globules were suspended 
through the urine. 
* Dr. E. W. Cushing, in Boston Medical and Surgical Journal, vol. 
104, 1880, p. 242. 
f Urinary and Renal Diseases, Am. ed., 1879, p. 125. 
J British Medical Journal, May 22, 1858. 142 
PRACTICAL EXAMINATION OF THE URINE. 
Fat has been found in the urine from cases of calculous 
disease of the pancreas, and in one case referred to by Dr. 
George W. Johnston,* fat made its appearance in the urine 
one month before it was detected in the alvine dejecta, and 
in such quantity as to float, when cool, in greasy flakes on 
the surface. 
The presence of cholesterin in the urine is also a possible 
but very rare occurrence, and may be conceived to occur 
in such a case of cheesy cystic kidney above alluded to. The 
only well-authenticated case I have ever seen reported is that 
given by Dr. Roberts, f Dr. Beale has shown that choles- 
terin may be obtained by treating large quantities of urine 
from cases of chronic Bright's disease, but this is a different 
matter from its being contained in urine in the free state. 
XV. Urea (CN2H4O). 
Urea is the chief organic constituent of the urine and 
the index of nitrogenous excretion. Its quantity fluctuates 
with changes in the quantity and composition of ingesta, 
and with the rapidity of tissue metamorphosis in health and 
disease. A range of from 20 to 40 grams (308.6 to 617.2 
grains), at least, must be admitted in adults. 
Detection and Estimation.-Theodor of urinehighly 
charged with urea may be said to be characteristic, but cir- 
tain evidence of its presence can only be obtained by treat- 
ing the solution suspected to contain it with nitric or oxalic 
acid. Though crystallizing itself in glistening needles, it 
* Inaugural thesis for the degree of Doctor of Medicine in the 
University of Pennsylvania, 1882. Published in the American Jour, 
of the Med. Sciences, Oct., 1883, of which see p. 427. 
f Op. citat., p. 125. ORGANIC CONSTITUENTS. 
143 
is too soluble to permit of easy detection by its own form. 
If it be desired to detect its presence in a suspected fluid, 
a drop or two is placed upon a glass slide, a drop of nitric 
acid added, the slide carefully warmed over a spirit-lamp, 
and placed aside to crystallize. If urea is present, the 
microscope will reveal, singly or in strata, six-sided and 
quadrilateral plates of nitrate of urea (Fig. 10). The crystals 
Fig. io. 
Crystals of nitrate of urea. (After Beale.) 
have acute angles measuring about 82°, and are so charac- 
teristic as to be easily recognizable ; they often overlap 
each other like the shingles of a roof. 
Solution of oxalic acid produces similar but less regular 
crystals of oxalate of urea. 
In ordinary normal urine, this crystallization does not 
take place unless the urine is concentrated by evaporation. 
But in some urines highly charged with urea, it is simply 
necessary to add nitric acid to produce the crystals, and 
thus is arrived at a rough quantitative estimation for urea. 144 
PRACTICAL EXAMINATION OF THE URINE. 
As urea is by far the most abundant solid constituent of 
the urine, it follows that the specific gravity may become a 
means of approximately estimating its amount, especially 
when there is no sugar present, if the quantity of albumin 
is small and that of the chlorides is normal. A specimen 
of urine neither albuminous nor saccharine, containing a 
normal proportion of chlorides, and having a specific 
gravity of 1020-4 to a quantity of 1500 c.c. (50 oz.) in 
twenty-four hours, may be taken as a standard normal 
specimen containing 2 per cent, to per cent, of urea. 
These conditions being observed, a higher specific gravity 
would indicate an increased proportion of urea, and a 
lower, diminished proportion. Under these circumstances, 
a specific gravity of 1014 indicates about 1 per cent, of 
urea, and of 1028 to 1030 about 3 per cent. 
But the chlorides fluctuate markedly in some diseases, 
and by far the largest proportion of urines in which a 
knowledge of the amount of urea is important contain 
albumin. Next to urea, supposing albumin and sugar ab- 
sent, the chlorides most affect the specific gravity, being 
separated to the amount of 10 to 16 grams (154 to 247 
grains), or to 1 per cent, in the twenty-four hours. If 
these are totally absent, as they often are in pneumonia and 
other febrile diseases, accompanied by an increase in the 
elimination of urea, then must a specific gravity of 1020 
indicate more than per cent, of urea, or, if the per- 
centage of chlorides replaced by urea be added, 3% per 
cent. This is on the supposition, of course, that the re- 
maining constituents, uric acid, creatinin, phosphates, sul- 
phates, etc., have little influence on the specific gravity- 
which is the fact. 
If albumin is present in small quantity, not exceeding T20 ORGANIC CONSTITUENTS. 
145 
per cent., it has little effect, and it can be thrown out of 
the question. If, however, the albumin be more abundant, 
i to 2 per cent., it must first be removed by coagulation 
and filtration, and the approximate estimation be made 
from the specific gravity of the filtrate after cooling. Care 
must of course be taken to wash the coagulum by further 
addition of water until the quantity of fluid originally 
operated with is restored. After such removal of albumin, 
if not before, the specific gravity will generally be found 
lower than in health, showing-what volumetric analysis has 
determined more precisely-that in chronic albuminuria, 
at least, the quantity of urea is generally diminished. 
Where sugar is present, the percentage of urea is also 
generally less, though with increased specific gravity, while 
the large total quantity of urine in the twenty-four hours 
may show an increase in the total urea for the day. There 
is no way of allowing here for the specific gravity due to 
the presence of sugar, and the only way to arrive at a 
knowledge of the amount of urea is by volumetric analysis. 
Volumetric Analysis for Urea. 
Under any circumstances, when an accurate estimation 
of urea is required, we must have recourse to volumetric 
analysis. Several methods of volumetric analysis for urea 
have been suggested, of which that of Liebig, with the 
nitrate of mercury solution, seems most to combine accuracy 
and convenience. Davy's method, with the sodium hypo- 
chlorite and pure mercury, is, in some respects, more 
simple, but it is also more liable to error, and really takes 
more time for its completion, while Liebig's process is car- 
ried out with surprising celerity, after even a little experi- 
ence, not more than fifteen minutes being required to 146 
PRACTICAL EXAMINATION OF THE URINE. 
complete it if the solutions are at hand. Liebig's process is 
based upon the fact that urea produces a precipitate with 
mercuric nitrate. 
The following test-solutions are required : 
1. The baryta solution, consisting of one volume of cold 
saturated solution of barium nitrate with two volumes of 
cold saturated solution of caustic baryta (barium hydrate). 
2. A saturated solution of sodium carbonate. 
3. A standard solution of mercuric nitrate of such strength 
that 1 c.c. is precisely equivalent to .010 gram, or 10 milli- 
grams, of urea. 
To Prepare the Standard Solution of Mercuric Nitrate.- 
1. Dissolve 71.48 grams of pure mercury or 77.2 grams of theoxide 
of mercury in nitric acid by the aid of heat. The acid fluid is 
concentrated by evaporating over a water-bath to a syrupy consist- 
ence, and then diluted with distilled water to a volume somewhat 
less than a liter. If on dilution a white precipitate of basic ni- 
trate of mercury fall, allow it to settle, and decant the clear liquid. 
Then add to the residue a few drops of nitric acid to dissolve the 
precipitate. Add the solution thus obtained to the former de- 
canted liquid, and dilute to exactly one liter. The solution 
requires to be graduated by 
2. The Standard Solution of Urea.-Two grams of pure urea 
should now be dissolved in 100 c.c. of distilled water, of which 
10 c.c. will then contain 0.2 gram or 200 milligrams. 
Ten c.c. of the standard solution, containing 200 milligrams of 
urea, are now placed in a beaker-glass. A burette is then filled 
to o with the solution of mercuric nitrate (taking care that the 
lower edge of the meniscus which forms the upper surface of the 
liquid corresponds with the arrow on the burette), which is then 
allowed to drop into the beaker, where it will quickly form a 
dense precipitate. When the precipitation seems about complete, 
a drop of the fluid containing it is allowed to fall on a drop of the 
solution of sodium carbonate, of which several are previously 
ready on a piece of glass on a dark ground. If the urea is not 
completely precipitated, no change of color takes place. The ORGANIC CONSTITUENTS. 
147 
cautious addition of the mercuric nitrate is continued, also the 
process of testing with the Na2CO3, until finally a yellow color 
appears. This proves that the mercuric nitrate has been added in 
excess,-consumed all the urea in combination and left some mer- 
curic nitrate to react with the sodic carbonate, which it does by 
forming sodic nitrate and the yellow oxide of mercury. 
If now the mercuric solution is correct it will require exactly 
20 c.c. of it to precipitate the whole of the urea in the io c.c. of 
the standard solution of urea, and enough more to react with the 
sodium carbonate. If the yellow coloration does not occur under 
these circumstances, there has been some impurity in the mercury 
compound employed, or some error in making up the solution. 
Process.-Take 40 c.c. urine and 20 c.c of the baryta 
solution, and throw them into a beaker-glass. By this 
means the phosphates, sulphates, and carbonates are pre- 
cipitated. They are removed by filtration through a dry 
filter, and if the filtrate happen not to be quite clear, it 
may be passed through a second time.* 
While this is taking place, the burette is filled to o with 
the mercuric nitrate solution, and 15 c.c. of the filtrate from 
the mixed baryta fluid and urine, containing of course 10 
c.c. of pure urine, are measured off into a small beaker-glass. 
Into this the mercuric nitrate solution is allowed to fall from 
the burette, first, a number of cubic centimeters approaching 
the last two figures of the specific gravity (that is, if the spe- 
cific gravity is 1017, drop say 15 c.c.) before testing with the 
sodium solution. If no yellow coloration appears on such 
testing, then proceed cautiously, adding a fractional part of 
* If the filtrate is not alkaline, the precipitation of the phosphates and 
sulphates may not have been complete. This may be determined by 
adding a drop or two of the baryta mixture to the filtrate, when, if a 
precipitate appears, a fresh quantity of urine must be taken, and a larger 
proportion of the baryta solution added. 148 
PRACTICAL EXAMINATION OF THE URINE. 
a cubic centimeter at a time, and testing with the Na2CO3 
until the yellow coloration is obtained. When that point 
Fig. ii. 
Burette stand with two forms of burette, 
is reached, read off the number of cubic centimeters em- 
ployed.* The number of cubic centimeters of mercury 
* The tinge of yellow at which we cease the titration must of course 
be the same as that at which in originally standardizing the nitrate of 
mercury solution the titration was stopped. It is evident that ceasing 
the titration, now at a slight tinge and again at a marked yellow colora- 
tion, must give rise to an error, which practice will soon teach the 
student to avoid. ORGANIC CONSTITUENTS. 
149 
solution thus used, minus 2, multiplied by .010 gram, gives 
the amount of urea in fractions of a gram contained in 10 
c.c. of the urine, when the latter is of average composition, 
-that is, when it contains no abnormal constituent, and 
the amount of chlorides is nearly normal. 
Corrections Explained.-The two cubic centimeters 
are first subtracted because it takes about this quantity of the 
reagent to convert the chloride of sodium into the nitrate, and 
until this combination is complete, the combination with 
the urea does not begin. Hence this amount must first be 
subtracted. 
If, however, the chlorides are not of average amount, but dimin- 
ished or increased, and we wish to be accurate, we must first esti- 
mate the amount of chlorides calculated as NaCl in 10 c.c. of the 
urine, by the process to be explained under chlorides, and from a 
fresh quantity of urine remove the whole of the chlorides by a 
standard solution of silver nitrate. For this purpose a solution of 
nitrate of silver is required of such strength that I c.c. will pre- 
cipitate 10 milligrams sodium chloride. 29.059 grams of fused 
nitrate of silver, dissolved in distilled water and diluted to a liter, 
will be such a fluid. 
In 10 c.c. of the original urine we determine with the nitrate of 
silver solution the chloride of sodium by the method for the deter- 
mination of the chlorides, p. 162. Suppose there are required for 
this 17.5 c.c. of the silver solution, this indicates 175 milligrams 
sodium chloride. 
Take now 30 c.c. (containing 20 c.c. of urine) of the filtrate 
from the mixture of baryta fluid and urine, add a drop of nitric 
acid, and then 17.5 X 2 c.c. = 35 c.c. of the nitrate of silver solu- 
tion. This will precipitate all the chlorides, which should be 
removed by filtration, and the filtrate may be now estimated for 
urea. It is important always to bear in mind the exact amount 
of urine operated with after adding the nitrate of silver solution to 
a mixture of baryta solution and urine, of which only two-thirds 
are urine. Thus, if 35 c.c. of the silver solution are added to 30 150 
PRACTICAL EXAMINATION OF THE URINE. 
c.c. of the filtered mixture of urine and baryta fluid, of the result- 
ing 65 c.c. only 20 would be urine minus the chlorine, or out of 
32.5 c.c. 10 would be urine minus the chlorine. 
If the case be one of inflammation, as pneumonia, where there 
is a total or almost total absence of chlorides, they may be thrown 
out of the question altogether. 
Further Corrections.-If the number of cubic centimeters of 
mercury solution added to 15 c.c. of the mixture of urine and 
baryta fluid exceeds 30-that is, if the amount of urea in the un- 
mixed urine exceeds 3 per cent.-we must, for the number of c.c. 
of the mercurial solution required above 30, add half the number 
of cubic centimeters of water to the urine mixture and make a 
second titration. Thus, suppose 36 c.c. are required on the first 
titration, the excess is 6 c.c., therefore 3 c.c. of water must be 
added to the mixture before making the second titration. 
If the unmixed urine contains less than 3 per cent, of urea, then 
for every 4 c.c. of the test solution used below 30 there should be 
deducted I c.c. from the entire number of cubic centimeters of the 
mercurial solution used. 
These corrections are rendered necessary by the fact that in 
standardizing the reagent it was mixed with just half its volume 
of the urea solution, conditions which we have (in regard to dilu- 
tion) when 10 c.c. of urine containing 3 percent, of urea are mixed 
with 5 c.c. baryta mixture and 30 c.c. of the mercury solution. 
Hence, any excess of reagent employed above 30 c.c. for 15 c.c. 
of the urine mixture should be diluted with half its volume of 
water to reduce such excess to the same degree of dilution as was 
present in standardizing the reagent. So, on the other hand, if 
less than 30 c c. of the reagent are required, that employed will 
be under greater dilution than was present in standardizing the 
reagents; hence, the reduction mentioned above. 
Estimation of Urea by the Hypobromite Process. 
-The principle on which this process is based-that urea, 
when brought into contact with hypochlorite of calcium, is 
decomposed into nitrogen, carbonic anhydride and water ORGANIC CONSTITUENTS. 
151 
-was suggested many years ago by Davy,* and at the same 
time by LeConte.f In 1874, Messrs. Russell and West£ 
again directed attention to the subject, substituting an alka- 
line solution of hypobromite of sodium and caustic soda, 
which yields similar products; the carbonic anhydride 
being absorbed by the caustic alkali. The following is the 
reaction: 
CON2H4 + 3(NaBrO) = 3(NaBr) + CO2 + 2H2O + N2; 
the volume of nitrogen disengaged being the measure of the 
urea. 
Many forms of apparatus have been suggested by different 
experimenters, all based upon the assumption that one gram 
of urea contains 372 c.c. nitrogen, measured at o° C. and 
760 mm. barometric pressure ; or that each c.c. of nitrogen 
evolved, measured under the conditions stated, represents 
.002688 gram urea. 
The simple apparatus figured is that in use in the chemical 
laboratory of the University of Pennsylvania. It consists, 
1st, of a wide-mouthed bottle or mixing vessel, B, and a 
test-tube, C, of about 10 c.c. capacity. 2d, of a taller 
vessel, A, to contain water, into which is immersed an 
elongated bell-glass or burette, graduated in cubic centi- 
meters. To the upper open end of the burette a piece of 
rubber tubing is attached, connecting it with the glass- 
tube passing through the rubber stopper to the mixing- 
vessel B. 
The alkaline hypobromite solution used is made by 
* Philosoph. Mag., 1854, p. 345. 
f Comtes Rendus, xlvii., 237. 
J Journal of the Chemical Society (London), August, 1874. 152 
PRACTICAL EXAMINATION OF THE URINE. 
dissolving 100 grams of caustic soda in 250 c.c. of water, 
and adding 25 c.c. of bromine to the solution thus pro- 
duced. 
2NaH0 + Br2 = NaBr 4- H2O + NaBrO. 
Process.-Introduce into the test-tube, C, 5 c.c. urine, and 
into the mixing-vessel 15 c.c. of the hypobromite solution, being 
Fig. 12. 
careful not to mix the two fluids. The apparatus is then accurately 
closed, and when there is no longer any change in the height of 
the column within the graduated tube, this is so adjusted that the 
surface of the contained liquid coincides with that in the cylinder ORGANIC CONSTITUENTS. 
153 
This point, the temperature, and in exact experiments the barome- 
tric pressure being noted, the mixing-tube is then inclined so as 
to allow the urine to mix with the hypobromite solution. Effer- 
vescence immediately sets in, and as it proceeds, the measuring- 
tube is gradually raised to relieve the disengaged nitrogen of the 
increased pressure. The mixing-vessel is then shaken a few 
times, and when the reaction appears complete, the apparatus is 
left for a few minutes until it has acquired the temperature of the 
room in which the operation has been performed. The water 
within and without the tube is again levelled, and the cubic cen- 
timeters displaced by the gas read off. Thus, suppose 10 cubic 
centimeters have been read off. Then 5 c.c. urine contain 
.00268 X 10 =.02688 grm.; whence can be calculated either the 
percentage or the twenty-four hours' quantity. 
In experiments made by Messrs. West and Russell, Mr. 
Richard Apjohn, Dr. Dupre, Dr. M. Simpson, Mr. C. 
O'Keefe, and others, with solutions containing known 
quantities of urea, astonishingly accurate results were ob- 
tained, quite sufficiently so for clinical purposes. 
M. Depaine (Journ. de Pharm. Auv., 1877) recom- 
mends that 4.5 per cent, be deducted from the total amount 
of urea found, to eliminate the error caused by the simul- 
taneous decomposition of uric acid and creatinin. 
Fig. 13 represents a very convenient, simple and com- 
paratively inexpensive apparatus, devised for this mode of 
analysis by Dr. William H. Greene,* of Philadelphia. It 
consists of a small glass flask and measuring-tube in one 
piece, the flask being made with rather a heavy base to 
secure stability. 
To use, the apparatus is completely filled with the hypobromite 
solution and placed on a plate intended to receive the liquid, which 
overflows during the analysis. By the aid of a pipette, of which the 
* First described in the Philadelphia Medical Tinies for January 12, 
1884, p. 278. 154 
PRACTICAL EXAMINATION OF THE URINE. 
end is so bent that it may pass to the centre of the flask, a measured 
quantity of urine-one, two, or the desired number of cubic centime- 
ters-is introduced and the decomposition takes place as the liquids 
mix. The opening of the pipette must be so small that only three or 
four cubic centimeters run out per minute. 
When the desired quantity of urine has been decomposed, a rather 
wide funnel-shaped tube is adapted to the opening in the flask, and 
Fig. 13. 
filled with the hypobromite solution until the liquid is at the same level 
in the funnel-tube and the measuring-tube. The volume of gas is then 
read and the calculation made. Or an aqueous solution of one centi- 
gram of urea may be introduced and the increase in the volume of 
nitrogen compared with the volume yielded by the urine. 
Precautions.-Care must be taken that no urine is allowed to flow 
from the pipette until its end is well in the flask. 
The results thus obtained are sufficiently exact for clini- 
cal purposes, and as much so as can be desired for all 
excepting the most precise physiological researches. ORGANIC CONSTITUENTS. 
155 
A similar apparatus has been suggested by Dr. Charles A. 
Doremus, figured p. 598, Medical News, May 30, 1885, 
and furnished by Eisner & Amend, of New York city. 
It is generally acknowledged that not quite all the nitrogen of the 
urea in a given solution is liberated by the hypobromite process, but 
authorities are not all agreed as to the quantity retained. M. Leconte 
(Chem. Gaz., 1858) obtained .92 ; Foster announced {fourn. Chem. 
Soc., March, 1879) that .92 was obtained; Russell and West obtained 
.94; others secure a larger proportion, as much as .95; others a still 
different proportion. Mehu (Journ. Chem. Soc., Nov., 1879), admit- 
ting that about .08 of nitrogen is retained, first suggested that this 
deficiency is overcome if a solution of either cane or grape sugar is 
mixed with the urine and hypobromite solution, the small amount 
of nitrogen otherwise retained being now liberated. But a little later 
Esbach (Journ. Cheni. Soc., December, 1879) and M. Jay {Bui. Soc. 
Chim., 1880) announced that a solution of glucose alone mixed with 
the hypobromite solution evolves a gas. Fauconnier (Bui. Soc. Chi- 
mique, February, 1880) then announced that with a solution of glu- 
cose, the theoretical quantity of nitrogen is evolved from urea solutions 
by the hypobromite, but with a solution of cane sugar only .94. Again, 
Jay's experiments {Ibid.) go to show that if a solution of glucose is 
mixed with the hypobromite and urea solution, no additional gas is 
evolved in the short time allotted to an ordinary titration, while with 
cane-sugar solutions an appreciable amount is evolved. But as it is 
practically impossible to obtain pure glucose, it resolves itself into this, 
that neither of these solutions should be mixed with the hypobromite 
solution and urine. My colleague, Professor Wormley, in some recent 
experiments in connection with this subject, has made an important 
observation, jvhich may serve to explain some of the discrepancies 
above alluded to. He finds that on mixing solutions of sugar and 
hypobromite a large amount of heat is evolved, as much as 8.9° C. or 
160 F. with cane sugar and 14.50 C. or 26.2° F. with grape sugar. 
This, causing an expansion of the gas, would permit a larger amount 
of nitrogen to be read off. 156 
PRACTICAL EXAMINATION OF THE URINE. 
Fowler's Hypochlorite Process for Urea.*-This 
method is based upon the fact that there is a difference in 
the specific gravity of urine before and after the decompo- 
sition of its urea by the hypochlorites; and that such dif- 
ference bears a definite relation to the quantity of urea 
present. Dr. Fowler found that every degree of density 
lost corresponds to .77 of 1 per cent., or about grains 
per fluidounce. The hypochlorite solution employed is 
Squibb's solution of chlorinated soda, or Labarraque's solu- 
tion, of which seven parts will destroy the urea in one part 
of urine, unless the amount is very large, in which event 
the urine should be diluted by an equal bulk of water, and 
the result multiplied by 2. 
Process.-1st. Add to 1 volume of the urine 7 volumes 
of the hypochlorite solution. Effervescence due to the 
liberation of nitrogen will immediately take place. Shake 
the jar containing the mixture occasionally, and stand it 
aside for two hours, when the urea wrill have been decom- 
posed. Now take the specific gravity of the quiescent fluid. 
2d. Ascertain the specific gravity of the mixed urine and 
hypochlorite solution before decomposition. To do this, 
multiply the specific gravity of the pure hypochlorite solu- 
tion by 7, add this to the specific gravity of the pure urine 
and divide by 8. The result is the specific gravity of the 
mixed fluid. From this subtract the specific gravity of the 
quiescent mixture after decomposition of the urea, multiply 
the difference by .77, and the result is the percentage of 
urea. 
* Fowler, Prize Essay to the Alumni Association of the College of 
Physicians and Surgeons, New York. Published in the New York 
Medical Journal, July, 1877. ORGANIC CONSTITUENTS. 
157 
As changes of temperature affect the specific gravity and 
volume of liquids, the hypochlorite solution and urine 
should be mixed and the jar set aside along with a bottle 
of the urine and the hypochlorite solution in the same 
place, subject to the same temperature. When decompo- 
sition is complete, the specific gravities can be taken and 
the calculation made. 
Example.-Suppose the specific gravity of the urine is 
1010, and that of the hypochlorite solution 1045, that of 
the mixed fluid will be 
1045 X 7 + 1010 
-- '-! - 1040. 
8 
Now suppose the specific gravity of the decomposed fluid is 
1038, then (1040-1038) X -77 = 1.54, the percentage of 
urea. 
This very simple and easy process has been found quite 
accurate, and is not interfered with by sugar or albumin. 
XVI. Uric Acid (C5H4N4O3). 
When uric acid is spoken of as a constituent of normal 
urine, it is never to its free state that allusion is made, but 
to its combinations, chiefly with potassium, sodium, and 
ammonium, but also with calcium and magnesium, usually 
known as mixed urates. Uric acid itself is so extremely 
insoluble (one part requiring 14,000 of cold and 1800 of 
hot water to dissolve it) that it is immediately precipitated 
on being freed of its bases. In quantity it is found rang- 
ing .4 to .8 gram (6.17 to 12.34 grs.) in the twenty-four 
hours, in health varying pari passu with urea, of which it is 
a stage short in oxidation. 
Detection by the Microscope.-Its presence as such 
is recognized by the microscopic peculiarities of its crystals, 158 
PRACTICAL EXAMINATION OF THE URINE. 
which in their typical form may be said to be " lozenge- 
shaped," or, as best described by the Germans, "whet- 
stone-shaped." They are, moreover, always colored yel- 
lowish-red, being with their salts the only urinary deposits 
thus stained, so that when a sediment is seen of which the 
elements are thus colored, it may, without hesitation, be 
put down as composed of uric acid or its combinations. 
More will be said of these crystals in treating of sediments, 
where their discussion more properly belongs. 
The Murexid Test.-The murexid test for uric acid 
and its combinations is one of extreme beauty. A small por- 
tion of sediment, or the residue after evaporation, is placed 
on a porcelain plate or piece of platinum, a drop or two of 
nitric acid added to dissolve it, and the solution carefully 
evaporated over a spirit-lamp flame. When dry, a drop or 
two of liquor ammonias is added, when there promptly ap- 
pears a beautiful purple color, which will gradually diffuse 
itself as the ammonia spreads. The murexid reaction is 
believed to depend upon alloxan, alloxantin, and ammonia, 
which arise under the action of the hot nitric acid. 
This reaction is also said to occur with tyrosin, hypoxan- 
thin, and xanthoglobulin, and Schiff accordingly recom- 
mends the- 
Carbonate of Silver Test for Uric Acid.-This is 
very delicate, and is most conveniently applied as recom- 
mended by Harley. Dissolve a little uric acid in a solution 
of sodium or potassium carbonate, place a drop or two of the 
solution on paper, and add a solution of nitrate of silver. 
A distinct gray stain promptly occurring indicates the pres- 
ence of uric acid. Neither of the tests, however, discrimi- 
nates between uric acid and urates. The microscope most 
easily does this. ORGANIC CONSTITUENTS. 
159 
Quantitative Estimation of Uric Acid.-To 200 
c.c. add 20 c.c. of hydrochloric or nitric acid, and set aside 
in a cool place, as a cellar, for twenty-four hours. At the end 
of that time the uric acid crystals, highly colored, will be 
found adhering to the sides and at the bottom of the beaker. 
Collect the uric acid on a weighed filter, wash thoroughly 
with distilled water. Dry the filter and uric acid at a tem- 
perature of ioo° C. (2120 F.), weigh, and the weight of the 
two, minus the weight of the filter, will be the weight of the 
uric acid in 200 c.c., except the small portion retained in 
the acid and washings. Neubauer advises to add to the 
result 0.0038 gram uric acid for every 100 c.c. of these 
fluids. 
XVII. Urates. 
It has already been said that in health, practically all the 
uric acid of the urine is held in combination with potas- 
sium, ammonium, sodium, calcium and magnesium, of 
which, according to Bence Jones, those with potassium and 
ammonium are most abundant. These are very soluble 
compounds at the temperature of the body, but are precipi- 
tated in amorphous granules when the temperature of the 
urine is lowered, as in winter weather. 
Their physiological and pathological significance de- 
pends altogether upon the uric acid they contain, but there 
are some points of reaction with which the student should 
be quite familiar. These grow out of the fact that uric acid 
is a bibasic acid, forming neutral and acid salts, and that 
the acid salts are much less soluble than the neutral, requir- 
ing 124 parts of boiling and 1120 parts of cold water for 
their solution. They form, therefore, the bulk of urate de- 
posits, while urates, which remain in solution after such 160 
PRACTICAL EXAMINATION OF THE URINE. 
reduction of temperature as constantly takes place in an 
apartment, must be, if not neutral, at least less acid than 
those which form the sediment. And a solution remaining 
for some time clear under such circumstances must contain 
urates of sodium, etc., with a large proportion of the alka- 
line base. 
The practical application of this fact is seen in this, that 
when an acid is added to such solution of neutral urate, by 
seizing upon a portion of the base, it leaves an acid urate 
of sodium, which, in consequence of its relative insolubility, 
is promptly precipitated in a finely granular form, produc- 
ing a decided opacity. Now, this is precisely what often 
happens in the nitric acid test for albumin. The urine is 
highly charged with neutral urates which are held in solu- 
tion. Nitric acid is added, and down goes a precipitate, 
not crystalline, but amorphous, which is composed of acid 
urate of sodium. And if Heller's method is followed, an 
opaque zone is formed at the point of contact between the 
acid and urine, which may be mistaken for albumin, but 
which, besides presenting certain visual characters of its 
own, which have been described, p. 39, is readily soluble 
by heat. If urine presenting this reaction with acid be 
allowed to stand for some time, the milky opacity gradually 
passes away, and is substituted by a very small crystalline 
sediment of uric acid. By longer action of the acid the 
remainder of the base is entirely withdrawn, leaving the 
free acid, which is deposited in crystals. It has already 
been stated that this precipitate by nitric acid is considered 
by Thudichum to be not acid urates, but hydrated uric acid. 
The remaining organic constituents of urine, creatinin, 
xanthin, hippuric acid, oxalic acid, lactic acid, and phenylic INORGANIC CONSTITUENTS. 
161 
acid, having little practical significance as such, require only 
to be mentioned in this connection. 
Mucus and the crystalline combination of oxalic acid 
with lime will be further considered in treating of sedi- 
ments. 
Hippuric Acid is interesting in forming one of the most 
striking connecting links between the urine of carnivora, 
omnivora, and herbivora, replacing in the last the uric acid 
of the first, while in man, who consumes a mixed diet, we 
have both uric acid and hippuric, that is, an intermediate 
state. But while hippuric acid is increased in man by a 
vegetable diet, it is not wholly absent with animal food. It 
is increased in diabetes, where also it almost replaces uric 
acid. If io grains benzoic acid be taken in the evening, 
the next morning crystals of hippuric acid will usually be 
found in the urine. The typical form of these is a four- 
sided prism, with two or four bevelled surfaces at its ends, 
but from this there are deviations. In the twenty-four 
hours' urine of man, .5 to 1 gram (7.7 to 15.4 grs.) is sep- 
arated. 
Inorganic Constituents. 
XVIII. The Chlorides. 
The chlorides found in the urine are chiefly those of 
sodium, with a small proportion of chloride of potassium 
and ammonium. 
In health the chlorides of the urine are almost an exact 
measure of the same substances taken in with the food, and 
amount to 10-16 grams (154.3 to 246.8 grs.) in the twenty- 
four hours. 
Detection and Approximate Estimation.-If a 
drop of urine be slowly evaporated on a glass slide, char- 162 
PRACTICAL EXAMINATION OF THE URINE. 
acteristic octahedral crystals and rhombic plates of a com- 
bination of urea and chlorine make their appearance, and 
may be examined by the microscope. But more available 
for detection and approximate estimation is 
The Nitrate of Silver Test.-Nitrate of silver in 
solution throws down both the phosphates and chlorides 
from the urine. But if a few drops of nitric acid be first 
added, the phosphates will be held in solution, and only 
the chlorides will fall as opaque white chloride of silver. 
From normal urine containing to i per cent, of chlo- 
rides, they are precipitated by a single drop of a solution of 
nitrate of silver, i part to 8, in cheesy lumps, which do not 
further divide themselves, or make the urine more milky 
by moving the glass about. If, however, the chlorides are 
diminished to Per cent- or less, the addition of a single 
drop of the silver solution no longer produces the white 
cheesy lumps, but a simple cloudiness, and the entire fluid 
appears equally milky. If, finally, there should be no precip- 
itate whatever, then the chlorides are totally absent. 
The presence of albumin in moderate amount does not 
interfere with the test, but if abundant it must be removed. 
Clinical Significance.-The chlorides are diminished 
in all febrile conditions, whether of local or general origin. 
Especially is this the case where there are any exudations, 
solid or fluid, by which they seem to be eliminated. In 
acute pneumonia, where they are often totally absent from 
the urine, they appear abundantly in the saliva. In this 
affection, and indeed in all acute diseases, their disappear- 
ance from the urine indicates an increment in the disease, 
and their reappearance an improvement. In pneumonia a 
decline in the disease may often be detected through their 
return before physical or any other signs point to improve- INORGANIC CONSTITUENTS. 
163 
inent. Hence a daily trial of the urine for them becomes 
important. 
Volumetric Process for the Chlorides. 
The volumetric process employed may be that of Liebig 
with solution of mercuric nitrate, or Mohr's with silver 
nitrate. 
Mohr's nitrate of silver method is preferred by 
Neubauer,* because Liebig's method, if not very exactly 
carried out, gives incorrect results. There are required- 
1. A cold saturated solution of neutral chromate of 
potassium. 
2. A solution of nitrate of silver, such that i c.c. = io 
milligrams NaCl. This is made by dissolving 29.075 grams 
pure fused nitrate of silver in distilled water and diluting 
to a liter. 
Process.-Put 10 c.c. of the urine into a platinum cru- 
cible, dissolve in it 1 or 2 grams potassium nitrate, free from 
chlorides, and evaporate the whole slowly to dryness. 
Expose the remainder first to a gentle and afterwards to a 
strong heat until the carbon is completely oxidized, and 
the residue a white molten saline mass. The entire white 
mass is then dissolved in a little water, placed in a beaker- 
glass, and the platinum capsule washed off into it with the 
wash-bottle. Dilute nitric acid is then carefully dropped 
into the alkaline fluid until it is faintly acid, a small pinch of 
calcium carbonate is introduced to make it neutral, and the 
excess of lime filtered off. To the mixture 2 or 3 drops of 
the potassium chromate solution are now added, and the 
silver solution allowed to flow in from the burette while 
stirring the mixture, until a distinct red color remains. The 
color continues canary-yellow until all the chlorides are 
* Neubauer and Vogel, Analyse des Harns, vi. Aufl., 1872, p. 1869. 164 
PRACTICAL EXAMINATION OF THE URINE. 
decomposed. As each drop falls into the urine, it must be 
carefully watched for the least tinge of red surrounding the 
precipitate of chloride of silver; the very next drop after 
the complete decomposition of the chlorides gives a per- 
manent red color, due to the presence of silver chromate. 
The number of cubic centimeters consumed X .010 gram 
will give the amount of chlorides, estimated as NaCl, in 10 
c.c. urine, whence the total is calculated. 
XIX. Phosphates. 
The phosphates of the urine are composed partly of earthy 
and partly of alkaline phosphates. The former are insol- 
uble in water, but soluble in acids; they are held in solution 
in acid urine by free carbonic acid, and are precipitable 
from it by alkalies. The alkaline phosphates are soluble in 
water, and are not precipitated from solution by alkalies. 
(a) The earthy phosphates are phosphates of calcium 
and magnesium, and are contained in urine in but small 
quantities-1 to 1.5 gram (15.43 to 23.14 grains) in twenty- 
four hours. The proportion of calcium to the magnesian 
phosphate is as 33 to 67. 
Detection and Approximate Estimation.-The 
presence of the earthy phosphates is shown by adding any 
alkali, as caustic ammonia or potash. 
Their quantity may be approximately estimated in the 
following simple way, directed by Hoffmann and Ultzmann. 
A test-tube, 16 centimeters (6.2992 inches) long and 2 
centimeters (.787 inch) wide, is filled one-third with clear 
or filtered urine, to which a few drops of caustic ammonia 
or caustic potash solution are added, and warmed gently 
over a spirit-lamp until the earthy phosphates begin to sep- 
arate in flakes. It is then placed aside for ten or fifteen INORGANIC CONSTITUENTS. 
165 
minutes for them to subside. If the layer of sediment is 
one centimeter (.3937 inch) high, the earthy phosphates are 
present in normal amount; if they occupy 2 to 3 centime- 
ters (.787 to 1.181 inch), they are increased; if, on the 
other hand, only a few flakes are visible, the earthy phos- 
phates are diminished. 
Further, in normal urine the earthy phosphates are precip- 
itated white, but if the urine contains abnormal coloring 
matter, they fall variously colored. If the urine contains 
blood-coloring matter, the earthy phosphates appear blood- 
red or dichroic ; if there be present vegetable coloring mat- 
ters, as rhubarb, senna, etc., they are colored rosy-red to 
blood-red, and by the biliary coloring matters yellowish- 
brown, and by uroerythrin, gray. 
The earthy phosphates are deposited from alkaline urine, 
and a most important precaution must here be observed not 
to make such a deposit for an excess of phosphates. The 
phosphates may really be diminished, and yet, in conse- 
quence of the reaction of the urine, a copious deposit may 
be present. The possible precipitation of earthy phosphates 
by heat alone, as a source of error in testing for albumin, 
has already been alluded to. This frequently occurs, and 
is best explained on the supposition of Dr. Brett that the 
earthy phosphates are held in solution in urine by carbonic 
acid, which, being dissipated by heat, allows the phosphates 
to fall. It should be further stated, however, that Dr. Owen 
Rees believes the phosphates are held in solution by am- 
monium chloride, which would also be dissipated by heat. 
Dr. Bence Jones attributed this precipitation to a neutral- 
ization of the excess of free acid in the urine by an alkali 
or free sodium phosphate. 
Clinical Significance.-The earthy phosphates are in- 166 
PRACTICAL EXAMINATION OF THE URINE. 
creased in the urine by diseases of the bones, especially if 
extensive, as in osteomalacia and rickets, in chronic rheu- 
matoid arthritis, in diseases of the nerve-centres, and after 
great mental strain ; but especially are the earthy phos- 
phates increased by the food and drink, some contending 
that all variations in the earthy phosphates are due to this 
cause. In renal diseases, on the other hand, the phosphates 
are said to be diminished. Earthy phosphates are often 
found deposited in conditions of dyspepsia and overwork, 
but this may generally be traced to changes in the reaction 
of the urine. 
(<£) The alkaline phosphates, soluble in water and not 
precipitated by ammonia or alkalies, form the chief bulk of 
the phosphates, averaging, according to Breed, 4 grams 
(61.72 grains) in the twenty-four hours, though Neubauer, 
by volumetric analysis, has seldom found more than two 
grams (30.86 grains) in this period. Four grams correspond 
to two grams phosphoric acid. They are almost wholly 
made up of acid sodium phosphate, with possible traces of 
potassium phosphate. The acid sodium phosphate was be- 
lieved by Liebig to be the cause of the acid reaction of the 
urine. 
Approximate Estimation of Alkaline Phosphates. 
-Accurately to estimate the alkaline phosphates, it is 
necessary, first, to remove the earthy phosphates, which is 
easily done by precipitating them with ammonia and filter- 
ing them out. For approximate estimation, however, this 
is not necessary, since they are in the first place present in 
comparatively small quantity, and, secondly, do not vary 
much in disease. Practically, therefore, they are disre- 
garded, and to-a suitable quantity of urine placed in a 
beaker-glass about one-third as much of the magnesian INORGANIC CONSTITUENTS. 
167 
fluid (p. 16) is added. All of the phosphates are thrown 
down in the shape of a snow-white deposit composed chiefly 
of ammonio-magnesian phosphate and amorphous phosphate 
of lime. If the entire fluid present a milk-like cloudy ap- 
pearance, the alkaline phosphates may be considered present 
in normal amount; if it is denser, more cream-like, there 
is an increase. If, on the other hand, the fluid is but 
slightly cloudy, transmitting light distinctly, the phosphates 
are diminished. 
Nitrate of Silver Test.-A solution of nitrate of silver 
added to urine throws down a yellow precipitate of phos- 
phate of silver, and chloride of silver. Both are soluble in 
ammonia, the silver phosphate also in nitric acid, but not 
the chloride. If, therefore, a few drops of ammonia be 
added, they will promptly disappear. If now nitric acid, 
just sufficient to neutralize the ammonia, be added, the 
precipitate will again appear; but the moment the nitric 
acid is present in excess, the silver phosphate is redissolved, 
but the chloride remains in suspension. If now enough 
ammonia be added again to neutralize the nitric acid, the 
phosphate of silver will again fall; but if an excess be added, 
the entire precipitate, including the chlorides, will be re- 
dissolved. 
Clinical Significance of Alkaline Phosphates.- 
The alkaline phosphates in the urine are influenced chiefly 
by the food, whence they are mainly derived ; phosphorus 
is also oxidized in the economy, and a small part of the 
phosphates is doubtless derived from the disintegration of 
nervous and muscular tissues. Any increased activity of 
vital processes, as inflammations and fevers, would, there- 
fore, favor their increase. 168 
PRACTICAL EXAMINATION OF THE URINE. 
Volumetric Process for Phosphoric Acid. 
This process is based upon the facts that, 
1. When a solution of phosphate acidulated with acetic 
acid is treated with a solution of nitrate or acetate of ura- 
nium, a precipitate falls which is composed of uranium 
phosphate. 
2. When a soluble salt of uranium is added to a solution 
of potassium ferrocyanide, a reddish-brown precipitate or 
color is developed. 
The solutions required aret 
1. A standard solution of sodium phosphate, made by 
dissolving 10.085 grams of well-crystallized sodium phos- 
phate (Na2HPO4 4- i2H.2O) in distilled water, and diluted 
to a liter; 50 c.c. then contain .1 gram P.2O5. 
2. Saturated solution of potassium ferrocyanide. 
3. Sodium acetate solution, made by dissolving 100 grams 
sodium acetate in 100 c.c. pure acetic acid, and diluting 
with distilled water to 1000 c.c. 
4. Solution of uranium acetate, such that 1 c.c. will cor- 
respond to .005 gram or 5 milligrams phosphoric acid. 
To prepare the Uranium Acetate Solution.-Dissolve 20.3 
grams of yellow uranic oxide in strong acetic acid previously diluted 
with distilled water to nearly a liter. To determine the strength of 
this solution, place 50 c.c. of the standard solution of sodium phos- 
phate in a beaker with 5 c.c. of the solution of sodium acetate, and 
heat in a water-bath to 90° to ioo° C. (1940 to 212° F.). The ura- 
nium solution is then allowed to run from a burette into the warm 
mixture until precipitation ceases. Then a drop of the mixture is 
carried by a glass rod into contact with a drop of the ferrocyanide 
of potassium solution on a white plate, or to a piece of the filter- 
ing-paper impregnated with it. If the reddish-brown of the ura- 
nium ferrocyanide does not appear, continue the cautious addition INORGANIC CONSTITUENTS. 
169 
of the uranium solution until the color responds to the test. The 
quantity used is then read off, being that which is sufficient to de- 
compose sodium phosphate corresponding to .1 gram of P2O5, 
whence is calculated the amount of distilled water to be added to 
make I c.c. correspond to .005 gram of phosphoric acid. 
Process.-Take 50 c.c. of urine, add 5 c.c. of the sodium 
acetate solution, and warm in a water-bath as above. Fill 
the burette with the uranium solution, and drop it into the 
mixture while warm, testing with the ferrocyanide solution. 
The number of cubic centimeters used multiplied by .005 
will give the phosphoric acid in the 50 c.c. of urine, whence 
calculate the quantity for the twenty-four hours. 
XX. Sulphates. 
The sulphates found in the urine are those of sodium and 
potassium, the former preponderating. The quantity in 
twenty-four hours is three to four grams (46.2910 61.72 
grains), corresponding to 2 grams (30.86) sulphuric acid. 
Detection and Approximate Estimation.-This is 
simple with any of the barium compounds, which throw down 
a white precipitate of barium sulphate. A little acid, as hy- 
drochloric, should previously be added, in order to hold in 
solution the barium phosphate, which is otherwise thrown 
down, or the acid may be previously added to a solution of 
barium chloride. 
If to a small quantity of urine in a beaker glass one-third 
as much of the acidulated solution of barium chloride (1 part 
to 8 plus a part hydrochloric acid) is added, and there 
occurs an opaque milky cloudiness, the proportion of sul- 
phates is normal; if the opacity is intense, and the whole 
mixture has the appearance and consistence of cream, the 170 
PRACTICAL EXAMINATION OF THE URINE. 
sulphates are increased ; if, on the other hand, there is only 
a slight cloudiness, so that light is still transmitted, the 
sulphates are diminished. 
Clinical Significance.-The sulphates are derived 
partly from the food and partly from the tissues, are in- 
creased by the introduction of sulphur compounds, sulphuric 
acid and its soluble combinations, by animal food, and by 
any causes producing increased rapidity of tissue change; 
as active exercise, the inhalation of oxygen, by febrile move- 
ments, and fevers. The greatest increase has been observed 
in meningitis, cerebritis, rheumatism, and affections of the 
muscular system. They are diminished in an exclusively 
vegetable diet. 
The Volumetric Process for Sulphuric Acid. 
This depends upon the principle that a solution of chlo- 
ride of barium will throw down a precipitate from a given 
quantity of urine, so long as any sulphuric acid is present; 
and further, that in thus treating a specimen of urine acidu- 
lated with HC1, a neutral point is reached at which the 
filtrate will show a slight opacity as well with the sulphuric 
acid as with the barium chloride solution. In such a fluid 
we are to suppose potassium chloride, barium chloride, 
and potassium sulphate balancing each other. If now either 
barium chloride or potassium sulphate is added, it itself is 
decomposed, and barium sulphate precipitated. 
The solutions required are- 
1. Solution of barium chloride so concentrated that i 
c.c. will precipitate exactly 12.25 milligrams H2SO4, or 10 
milligrams SO3 prepared by dissolving 30.5 grams dry crys- 
tallized chloride of barium, and diluted to a liter. 
2. Solution of potassium sulphate, such that 1 c.c. = INORGANIC CONSTITUENTS. 
171 
12.25 milligrams H2SO4, or 10 milligrams S03; prepared 
by dissolving 21.775 grams chemically pure powdered 
potassium sulphate, dried at ioo° C. (212° F.), and dilut- 
ing to a liter.' 
Process.-Place 100 c.c. urine, acidulated with 20 to 30 
drops hycrochloric acid, and heat it in a water-bath. When 
boiling, allow 5-8 c.c. of the barium solution to flow in 
from a burette. Remove the heat and allow the precipitate 
to subside. If the fluid becomes rapidly clear, allow another 
cubic centimeter or two of the barium solution to flow in, 
reapply the heat, and filter 10 to 12 drops of the urine into 
a small test-tube, add some of the barium solution, and 
observe whether there is a precipitate or not. If not, add 
to another portion a few drops of the potassium sulphate 
solution, by which we learn whether an excess of the 
barium solution has been added or not. If, however, the 
barium solution still produces a precipitate in the portion 
removed for testing, the latter is returned to the beaker, 
and more solution allowed to flow in, determining the 
quantity somewhat by the intensity of the reaction in the 
test-tube, and the process repeated until no precipitation 
takes place with the barium, and until a slight cloudiness 
takes place when adding the potassium sulphate to a por- 
tion of the filtered mixture. If the latter is an intense 
reaction, say at 12 c.c., then we know that the correct 
point is somewhere between 11 and 12, and the process 
is repeated as far as 11 c.c., when it is continued very 
cautiously, adding only fractions of a centimeter- 
until the right point is reached, whence the calculation is 
made as before. PART II. 
URINARY DEPOSITS. 
Preliminary Remarks-Secondary Deposits. 
It has already been said that strictly normal freshly 
passed urine, of acid reaction, contains no sediment what- 
ever, except the faint flocculi of mucus which gradually 
subside towards the bottom, and entangle a few mucus- 
corpuscles and an occasional epithelial cell. Should the 
urine, however, be alkaline, as is frequently the case three 
or four hours after a meal, it may be more or less cloudy at 
the moment it is passed, and quickly deposit a flocculent 
precipitate of earthy phosphates, which may occupy con- 
siderable bulk. They will be found by microscopic exami- 
nation to be made up of amorphous granules, and will 
quickly disappear on the addition of a few drops of any 
acid. 
But even urine which is strictly normal will, in the course 
of time, form deposits as the result of changed reaction. 
These deposits differ with the stages of such reaction, 
and should be perfectly understood by the student before 
he is ready to interpret any sediment arising from other 
causes. 
i. After normal urine, completely without sediment, has 
stood for a time, especially at a moderate temperature, URINARY DEPOSITS. 
173 
there is often observed a precipitate of amorphous granular 
matter, readily soluble by heat, which is made up of acid 
urates of potassium, sodium, and ammonium, with which 
urates of lime and magnesium are occasionally commingled. 
(See lower portion of Fig. 14.) A little later they are re- 
placed by rhombic crystals of uric acid, stained yellowish or 
yellowish-red. These are often associated with octahedral 
crystals of the oxalate of lime. 
The explanation given by Scherer of the occurrence of 
these deposits is that of the so-called acid fermentation, in 
which, through the agency of the mucus of the bladder, 
acting as a ferment, are formed out of the coloring-matters, 
lactic and acetic acids. These take away a part of the base 
from the neutral or alkaline urates, and produce first the 
more insoluble acid urates named above, which are de- 
posited ; later they combine with the remainder of the 
base also, and leave the crystalline uric acid sediment. 
As though favoring this so-called acid fermentation, there 
are also often found at this stage in urine spores of torula 
cerevisice-the yeast fungus; small, oval, transparent, struc- 
tureless cells, to be again referred to. Sufficient proof that 
such fermentation takes place is, however, wanting. 
A much more satisfactory explanation of the occurrence 
of these deposits has been offered by Voit and Hoffmann,* 
who attribute the decomposition of the basic urates to the 
acid phosphate of sodium, the excess of phosphoric acid 
playing the part of the acetic and lactic acid in the fermen- 
tation theory, and decomposing the alkaline urates in the 
same way and with the same results. They prove their 
* Neubauer and Vogel, Analyse des Harns, vi Aufl., 1872, p. 113, 
from Zeitschrift fiir Analyt. Chemie, Bd. 7, p. 397. 174 
PRACTICAL EXAMINATION OF THE URINE. 
position by an artificial production of the same results by 
adding a solution of acid phosphate of sodium to a solution 
of basic urates. The extent to which the reaction goes will 
depend upon the quantity of acid phosphate of sodium 
present and the length of time during which the reaction 
has been permitted to proceed. It is possible also for the 
latter to begin at the moment of secretion, and to continue 
in the bladder, causing deposits of acid urates and uric acid 
to appear as "gravel" or "sand" immediately after the 
urine is passed. Such a condition would be pathological. 
According to these authors, a more rapid action of the acid 
sodium phosphate produces an amorphous precipitate, and 
a slower separates the crystalline uric acid. The more rapid 
reaction may be induced by a more abundant separation of 
the acid sodium phosphate or a greater concentration of 
the urine. 
In the course of these changes, also, the acidity of the 
urine is diminished, and it may become neutral and even 
alkaline before the phenomena of the next stage to be 
described-the alkaline fermentation-set in. 
2. After a still longer but variable period, which is 
shorter in warm weather and longer in cold, we have the 
so-called alkaline fermentation, which is a real fermentation. 
This, in which decomposing mucus is also thought by some 
to be the ferment, is ascribed by Tieghen* to the action of 
a little torula, structureless and without a cell-wall, which 
multiplies by budding, not at the surface, but within the 
urine or at the bottom of the vessel, where it with the de- 
posited salts forms a white sediment. In this fermentation 
* Neubauer and Vogel, Analyse des Harns, vi Auflage, 1872, pp. 
110 and 130. URINARY DEPOSITS. 
175 
we have the urea converted into carbonate of ammonium, 
as already explained, by the addition of two equivalents of 
Fig. 14. 
Prismatic crystals of sodium urate, spherules of ammonium urate, and amorphous 
urates, with octahedral crystals of oxalate of lime (Ranke.) 
water.* As the result of this conversion, the urine is ren- 
dered highly alkaline, and a further change in the character 
* An explanation of the delay which sometimes occurs in the ap- 
pearance of these phenomena is based on the recognition of the multi- 
plication of these spores as the cause of the fermentation. If infusoria 
are simultaneously developed, the urea is more slowly converted, and 
if the surface of the urine happens to be covered with other plant vege- 
tation (mildew), as is sometimes the case, the urine may remain acid 
for months in consequence of the interference with the access of oxygen, 
on the presence of which the spore is dependent for its growth and 
multiplication. 176 
PRACTICAL EXAMINATION OF THE URINE. 
of the sediment takes place. At the very beginning of the 
reaction, when the urine may still be neutral or even weakly 
alkaline, the uric acid crystals begin to dissolve and to 
change their form so as to become more or less unrecogniz- 
able, while on their fragments may often be seen to adhere 
prismatic crystals of urate of sodium and dark spheres of 
urate of ammonium (Fig. 15). As the reaction becomes 
alkaline, the uric acid altogether disappears, and the field 
becomes crowded with granules of amorphous phosphate of 
lime, beautiful triangular prisms, (" coffin-lid " shaped crys- 
Fig. 15. 
Spiculated spherules of ammonium urate along with triple (ammonio-magnesian) 
phosphate and octahedral crystals of the oxalate of lime. (Ranke.) 
tals) and their modifications, of the triple phosphate of 
ammonium and magnesium, and opaque black balls of urate 
of ammonium often beset with spiculae (Fig. 15); the 
spores referred to are also often present, while millions of 
bacteria vibrate slowly along, or form granular aggregations 
about a fragment of organic matter, and an occasional infu- URINARY DEPOSITS. 
177 
sorium darts across the field of view with magnified celerity. 
Commonly, however, the intermediate stage is Jost sight of, 
and the stage just described is the only one seen in the alka- 
line fermentation. Such urine has an ammoniacal and pu- 
trescent odor, is cloudy from the suspended phosphate of 
lime and bacteria, and exhibits to the naked eye an abun- 
dant white deposit. 
Either of the above set of changes may take place within 
the body, that is, in the pelvis of the kidney or in the 
bladder, and as such form pathological conditions which 
are constantly met with in practice, the first in the condi- 
tion of uric acid gravel or calculus, with its incident suffer- 
ing, and the second in the phenomena of irritation and 
inflammation, more particularly of the bladder, due to ob- 
struction by stone, stricture, or malignant disease. It also 
seems to be a matter of modern observation that the germs 
of the fungi above alluded to, which appear to have a very 
close relation to the phenomena described, either as cause 
or effect, may be introduced from without by the use of im- 
perfectly cleansed catheters, sounds, or similar instruments. 
With this preliminary knowledge of the rationale of the 
causation of a large proportion of urinary deposits, we are 
ready to take up their detailed consideration, previous to 
which, however, allusion must be made to- 
Extraneous Substances found in Urine. 
These are very various, and include indeed all substances 
which are liable to get into vessels containing urine. The 
most common among these are fibres of cotton and linen, hair 
of blankets, worsted, wool, human hair, cats' hair, splinters 
of wood, oil-globules, starch-corpuscles, tea-leaves, bread- 
crumbs, etc. With the microscopical appearances of all 178 
PRACTICAL EXAMINATION OF THE URINE. 
these the student should familiarize himself before he begins 
the examination of urinary sediments. 
Scratches and marks in the glass slides may also con- 
fuse, if not mislead, the beginner, and, if they become filled 
with coloring matters are more likely to do so. Such error 
was, for a long time, occasioned by the pigmented markings 
often found in glass slides, which were so long and so often 
described by observers as pigment flakes. They are little 
depressions or scratches in the glass which have become 
filled with oxide of iron used in the polishing of the glass, 
and can be better appreciated by a study of the annexed 
plate than by any description. Their true character was 
first pointed out by Dr. J. G. Richardson, of this city. 
Classification of Urinary Deposits. 
Efforts have been made to classify sediments on different 
bases, that is, on the ground of their external naked-eye 
characters as to bulk, color, weight, etc. ; again with regard 
to their nature and origin, whether organized or unorgan- 
ized, crystalline or amorphous; and finally as to the reac- 
tion of the urine in which they are found. 
The simplest division is into unorganized and organized. 
A further division of these groups into crystalline and 
amorphous seems to separate groups which are naturally 
associated, and is therefore omitted. 
Unorganized. 
I. Uric acid (crystalline). 
a. Acid sodium urate (amorphous, occa- 
sionally crystalline). 
b. Acid potassium urate (amorphous). 
c. Acid calcium urate (amorphous). 
d. Acid ammonium urate (crystalline). 
II. Uric acid com- 
pounds.  179 
URINARY DEPOSITS. 
III. Oxalate of lime (crystalline). 
a. Ammonio-magnesian phosphate 
(crystalline). 
b. Calcium phosphate (amorphous 
and crystalline). 
IV. Earthy phosphates. 
V. Carbonate of lime (crystalline). 
VI. Leucin and tyrosin (crystalline). 
VII. Cystin (crystalline). 
Organized. 
I. Mucus and pus. 
II. Epithelium. 
III. Blood. 
IV. Casts. 
V. Spermatozoids. 
VI. Fungi and infusoria. 
VII. Elements of morbid growths. 
VIII. Entozoa. 
Unorganized Sediments. 
Occurrence.-Uric acid presents itself as a sediment of 
small bulk, sinking to the bottom, but sometimes also ad- 
hering to the side of the glass. The individual crystals are 
often large enough to be seen by the naked eye, and in their 
aggregation frequently form masses so large as to be char- 
acterized by the terms "sand," "gravel," "red-pepper 
grains." This latter term is based upon the red or yellowish- 
red coloration which uric acid crystals in urine exhibit. 
They are found perfect only in acid urine, often at the 
end of the so-called acid fermentation, in urine concen- 
trated from any cause, and where there is a pathological 
increase in the production of uric acid due to imperfect 
oxidation or assimilation. 
Recognition.-The typical shapes of a uric acid crystal 
may be said to be a four-sided rhomb and six-sided plate. 
But it is comparatively seldom that the typical forms are 
observed, the latter shape being somewhat rare, and the 
I. Uric Acid. 180 
PRACTICAL EXAMINATION OF THE URINE. 
angles of the former being generally so rounded off that 
the crystals assume an ovoid or "whetstone" shape, of 
very different sizes, some being mere points with powers of 
200 to 300 diameters, while others are large enough to be 
seen by the naked eye. Further shapes are those of sections 
of a barrel, envelope, spear, fan, of a comb with teeth on 
two sides, quadrilateral prisms with terminal planes, dumb- 
bells, and even other forms. What are commonly called 
Fig. 16. 
More usual forms of uric acid crystals. (After Harley.) 
" dumb-bells " of uric acid may be rather compared to a tuft 
of hay constricted at its middle. These varied forms practice 
soon teaches one to recognize, even though they may de- 
viate much from the typical shape. Uric acid crystals, as 
mentioned, are almost invariably colored, and can generally 
thus be distinguished from other deposits. Dr. Beale* 
* Kidney Diseases and Urinary Deposits, Philadelphia, 1869, p. 371. URINARY DEPOSITS. 
181 
states that two or three instances have come under his no- 
tice in which they were not colored. Uric acid crystals are 
met singly, but very commonly they are aggregated, form- 
ing beautiful rosettes and other shapes of aggregation 
Fig. 17. 
More unusual forms of uric acid crystals. (After Haney.) 
of such size as to be easily visible to the naked eye,-as the 
" red-pepper grains" already alluded to,-and give pain 
in their transit through the ureter. 
Fig. 16 exhibits the more usual varieties of uric acid, and 
Figs. 17 and 18 some of the rarer forms. 
Tests for Uric Acid.-Whenever a crystalline deposit 
is of doubtful character and suspected to be uric acid, if the 
latter it will respond as follows : 
1. Insoluble in cold or hot water, it will readily dissolve 
in the alkalies, soda, potash, or ammonia. If then the 182 
PRACTICAL EXAMINATION OF THE URINE. 
alkaline solution be treated with an excess of acetic acid, 
in a few hours typical whetstone shaped forms will crystal- 
lize out. 
2. Or the sediment may be placed on a glass slide, and 
treated with the murexid test, as described on page 158. 
Fig. 18. 
Other unusual forms of uric acid, not unlike crystals of the triple phosphate of 
ammonium and magnesium. X 150. 
The dumb-bell crystals of uric acid, occasionally met with, 
may be distinguished from the dumb-bell crystals of the 
oxalate of lime by the characteristic shape already referred 
to, by their larger size, their darker color, and their solu- 
bility in alkalies. URINARY DEPOSITS. 
183 
II. Uric Acid Compounds. 
(<z) Sodium urate, mainly amorphous, is sometimes crys- 
talline. It always forms a part, and, according to Bence 
Jones, a predominant part, in the pulverulent, heavy, 
variously tinted, and generally bulky deposit of the mixed 
urates known as "brickdust" or " lateritious " sediment. 
The degree of coloration of this sediment depends upon 
that of the coloration of the urine whence it falls. From 
pale urine of low specific gravity, 1010 to 1014, an al- 
most white sediment separates, falling very slowly, and 
producing, therefore, an opaque cloudy appearance in 
suspension, but readily disappearing on the application 
of heat; from urine of an amber color, and specific 
gravity of about 1018, the urates deposited are fawn- 
colored ; and from high-colored urine of higher specific 
gravity, we have the true red "brickdust" sediment. 
The sediment is found in acid urine, or urine in which 
the acid fermentation has only commenced, and has not 
been operating so long as completely to remove the base 
and cause the crystalline uric acid to be deposited. It 
is found also in urine concentrated from any cause, or 
where it has cooled down considerably below 370 C. 
F.), or where there is defective oxidation or assimi- 
lation, as in fevers. 
Recognition.-By far most frequently do we find sodium 
urate in fine amorphous granules, by their shape in no wise 
distinguishable from other fine granular matters, requiring, 
therefore, the chemical tests for their discrimination. The 
adhesion of these fine granules to partially coagulated 
shreds of mucus sometimes gives rise to an appearance re- 
sembling finely granular casts (see Fig. 20), which is readily 
detected by the experienced, but which may mislead the 184 
PRACTICAL EXAMINATION Of THE URINE. 
beginner. The careful application of heat, or the addition 
of a drop of acetic acid, will promptly dissipate the illusion. 
These granules of sodium urate also assume a larger size, and 
become little spherules, sometimes provided with spicules, 
which are considered by some (G. Bird, Beale) to be spicules 
of uric acid. (See Fig. 19, from Beale, Kidney Diseases.} 
Other spherules are provided with projecting and curved 
processes, and are believed by Hassall (second edition, page 
75) and Thudichum (second edition, page 81) to be com- 
posed of sodium urate throughout. That the spines were 
also urate of sodium, Thudichum considered evidenced by 
their solubility in water. A modified form of the latter are 
Fig. 19. 
Spherules and spiculated spherules of urate of ammonium (sodium?); amor- 
phous granular urates. 
probably the irregularly star-shaped crystals in Dr. Beale's 
Fig. no, from the urine of a patient suffering with peri- 
tonitis. But all of these forms of spherules with straight 
and incurved processes (thorn-apple shapes) are put down 
by the German observers (Neubauer and Vogel, Hoffmann 
and Ultzmann) as crystalline forms of urate of ammonium, 
in which I am inclined to concur, at least with regard to 
those which are found at the stage of reaction intermediate 
between the acid and alkaline fermentations, or, perhaps, 
rather at the beginning of the latter, when ammonia makes 
its appearance, and is accompanied by the ammonio- URINARY DEPOSITS. 
185 
magnesian phosphate. But any spherules which occur early 
in the acid reaction, or before it is possible for any am- 
monia to be present, are probably sodium urate. 
The sodium urate is also rarely found in dumb-bells, which 
are also striated and broad at the extremities like those of 
uric acid, but less disposed than the latter to break up at the 
Fig. 20. 
Prismatic crystals of acid sodium urate, spherules of ammonium urate, and amor- 
phous urates with octahedral crystals of oxalate of lime. (Ranke.) 
extremities into individual acicles (Atlas of Hoffmann and 
Ultzmann, Taf. IX). One-half of one of these dumb-bells, 
viewed from above, would be fan-shaped. 
Under the same circumstances, at the end of the acid and 
at the beginning of the alkaline fermentation, do we also 
have the true prismatic crystals of acid sodium urate ar- 
ranged in star-like masses (Fig. 20). 186 
PRACTICAL EXAMINATION OF THE URINE. 
(£) Acid potassium urate is also amorphous, very soluble, 
and occurs under the same circumstances as sodium urate, 
as a constituent of the mixed urates. 
(c) Acid calcium urate occurs very seldom, and in small 
quantity, as a white amorphous powder, along with the 
mixed urates. It is with difficulty soluble in water, and 
known to have lime for its base, by leaving a residue of 
calcium carbonate after incineration. 
(<Z) Acid Ammonium Urate.-This is found, along with 
amorphous earthy phosphates and crystals of the triple 
phosphates of ammonium and magnesium, in urine in 
which the alkaline fermentation has commenced. It is the 
only urate found in alkaline urine. 
Recognition of Ammonium Urate.-It is crystalline, and 
presents itself in the shape of smooth and characteristic 
"thorn-apple" spherules (Figs. 19 and 20), which serve 
easily to distinguish it. The spherules are soluble in hot 
water, and dissolve in hydrochloric or other acid with the 
evolution of uric acid crystals. Liquor potassae, added to 
them, evolves the odor of ammonia, and they give the 
murexid reaction with nitric acid and ammonia. 
Tests for Acid Urates.-Though the acid urates are 
much more insoluble than the neutral urates remaining in 
solution, requiring 124 parts of boiling water and 1150 of 
cold, they readily dissolve on the application of heat to the 
slide or test-tube containing them. They are dissolved also 
by the alkalies, liquor potassae or sodae. Treated with 
nitric, hydrochloric, or acetic acid (the diluted are better 
on account of their slower action), they dissolve, with the 
subsequent crystallization of uric acid. They also respond 
to the murexid test. URINARY DEPOSITS. 
187 
III. Oxalate of Lime. 
Occurrence.-The oxalate of lime crystals are most 
frequently met in acid urine, often therefore alongside of 
crystals of uric acid, but they may also be met in alkaline 
urine, along with crystals of the triple phosphate. They are 
particularly abundant in the urine after a meal of rhubarb 
plant, after the use of tomatoes and other vegetables contain- 
ing oxalic acid. There are no means by which the presence 
of oxalate of lime may be foretold before a microscopic 
examination of the urine is made. The first edition of this 
book contained the following: "It never formsa deposit 
appreciable to the naked eye, and most commonly the crys- 
tals do not descend to the bottom of the glass, but are caught 
as it were by the flocculi of mucus which float towards the 
bottom, rather than occupy it.'' Later and repeated obser- 
vations have convinced me that in many instances the whole 
of this cloud-like mass, so much resembling mucus, is made 
up of oxalate of lime. 
F ig. 21. 
(After Harley.) 
Recognition.-Two forms of calcium oxalate crystals are 
met, the octahedra and the dumb-bell crystals. The appear- 
ance of the former is somewhat different according as they PRACTICAL EXAMINATION OF THE URINE. 
188 
are seen in the longer diameter or in the shorter. They 
may be said to be made up of two four-sided pyramids, 
placed base to base, and when viewed in the longer diam- 
eter may readily be detected as such by the microscope. 
When seen in the opposite direction, their characteristic 
appearance is that of a square, crossed obliquely by two 
bright lines, and if the crystal be very small, it will appear 
as a square with a bright point in the centre-a character- 
istic appearance by which one may soon learn to detect 
them, even when they are very small. They are often seen 
in aggregations of three, four, or more, closely adherent, 
and forming as it were microscopic calculi. 
The dumb-bells, very much more rarely met with, are 
highly characteristic; and although we have spoken of 
dumb-bells of uric acid and of ammonium urate, neither of 
the latter presents the typical dumb bell appearance like 
those of the oxalate of lime. In addition to these are found 
allied forms, circular and oval shapes, with darker or 
brighter centres, and some with partial concavities at the 
sides, as though passing over into dumb-bells. Dumb-bells 
are also met aggregated, forming microscopic calculi, which 
go far to explain the incipient formation of calculi. 
Chemical Characters.-The form of crystals of oxalate 
of lime is so characteristic that there is seldom occasion to 
make use of the chemical tests to determine them. The only 
crystals which at all resemble them are certain forms of the 
triple phosphate. These are small crystals, modifications 
of the typical triangular prism, with its bevelled ends, in 
which the body of the prism is exceedingly short, as if it 
were almost left out, so that the two inclined triangular ends 
closely approach each other, and form a crystal like that of 
the octahedron of oxalate of lime. Their nature may, how- URINARY DEPOSITS. 
189 
ever, be suspected by the shape of the larger crystals around 
them, for they never occur alone. Moreover, they are 
promptly dissolved by acetic acid, while the oxalate of lime 
is totally insoluble in this acid. The octahedra are highly 
insoluble in water, in alkalies, and in the vegetable acids, 
including acetic, but are soluble in the mineral acids. The 
dumb-bells, after the prolonged action of acetic acid, yield 
their crystalline matter, leaving a frame-work, which main- 
tains the original shape of the crystal. This in fact explains, 
perhaps, the shape of the crystal. It has been shown by 
Mr. Rainey and others that the presence of organic matter, 
as mucus, interferes with the crystallization in the regular 
manner. The dumb-bells of oxalate of lime can readily 
be distinguished from the dumb-bells of uric acid or urates 
by the solubility of the latter in alkalies. 
The acid phosphate of sodium, according to Neubauer,* 
possesses a power of solution over the oxalate of lime, often 
holding it in solution, and he gives a method by which the 
latter may be obtained from solution in the urine by its 
agency, as follows: 400 c.c. to 600 c.c. (13.3 to 20 f%) of 
the urine to be tested are treated with solution of chloride 
of calcium, supersaturated with ammonia, and the precipitate 
dissolved in acetic acid. After twenty-four hours, the 
precipitate then occurring, which nearly always contains 
uric acid, is placed on a filter, washed with water, and a few 
drops of hydrochloric acid poured upon it. The latter dis- 
solves out the oxalate of lime present, and leaves the uric 
acid on the filter. The filtrate is then diluted in a test-tube 
with 15 c.c. (2.83 fj) of water, and overlaid most carefully, 
by means of a pipette, with very dilute ammonia in sufficient 
quantity. At rest, the two fluids gradually mingle, and 
* Neubauer and Vogel, op. citat., p. 174. 190 
PRACTICAL EXAMINATION OF THE URINE. 
after twenty-four hours the oxalate of lime present will have 
collected at the bottom, and octahedra of great beauty may 
be studied with the microscope. 
Neubauer says he has many times, in this manner, obtained 
considerable quantities of oxalate of lime, where there was 
previously no deposit whatever. He has, however, in other 
instances, with normal urine obtained negative results, so 
that he is unable to decide whether the oxalate of lime 
should be considered a normal or abnormal constituent of 
urine. 
Sources of Oxalate of Lime in the Urine.-There 
is no doubt that oxalic acid is, at times at least, secreted by 
the kidneys, and meeting immediately the lime salts, for 
which it has a strong affinity, forms the crystals we are 
considering; for both octahedra and dumb-bells are not in- 
frequently found in the uriniferous tubules of the kidney, 
and even in tube-casts. Schunck has attempted to show 
that the oxalate of lime is formed during the decomposition 
of urine from the oxalate of ammonium, but Neubauer says 
the oxalate of ammonium is converted into carbonate of 
ammonium. Others, as Owen Rees, Aldrige of Dublin, 
Wohler, and Frerichs, allege that oxalate of lime is derived 
from a decomposition of uric acid and urates. Their ex- 
periments would seem to show this, and it is undoubtedly 
the case that deposits of oxalate often make their appearance 
in urine some time after it has been passed. Two sources 
must, therefore, be admitted, one within the organism and 
one without. 
Clinical Significance.-There is no disease with which 
the oxalate of lime is particularly associated, nor can de- 
posits of it be considered indicative of derangement. 
Abundant deposits of oxalate of lime are found in the urine URINARY DEPOSITS. 
191 
of persons who are typically healthy. On the other hand, 
it is apt to occur where there is malassimilation, and hence 
dyspeptics are often found having oxalates in their urine, 
as a result rather than a cause of the affection from which 
they suffer. 
When there are symptoms of renal calculus descending 
from the pelvis of the kidney, and oxalates are found in the 
urine, especially if they form the aggregations referred to, 
the latter may afford explanation of the nature of the stone. 
Unfortunately, too often there is no sediment whatever 
attending the descent of a calculus, and we must, therefore, 
determine its nature without such aid, or remain in igno- 
rance. A careful examination should, however, always be 
made of the urine in nephritic colic, as valuable information 
is at times at least furnished by it, especially in the uric acid 
lithiasis, where uric acid sediment is often found. 
Occurrence.-These deposits are found only in feebly 
acid or alkaline urine, and are the more abundant the more 
advanced is the stage of alkaline fermentation. They ap- 
pear to the naked eye as bulky opaque white deposits, un- 
less they are accompanied by blood, which then more or 
less tinges them. The urine itself is apt to be turbid from 
the presence of amorphous phosphate of lime in suspension, 
to have an ammoniacal and sometimes a fetid odor, though 
not necessarily. They are especially abundant in the urine 
of all irritative affections of the bladder, and often attend 
diseases of the spinal cord, because of paralysis of the blad- 
der and consequent retention of urine. The earthy phos- 
phates are the triple phosphate or ammonio-magnesian 
phosphate and the phosphate of lime. 
IV. Earthy Phosphates. 192 
PRACTICAL EXAMINATION OF THE URINE. 
(a) The ammonio-magnesian phosphate (MgNH4 
PO46H2O), or triple phosphate, is a crystalline deposit, of 
which the typical form is a triangular prism (Fig. 22) with 
bevelled ends, very characteristic and easily recognized. 
In addition to this, there is an infinite variety of modifi- 
cations, with one or more corners removed, the body of the 
Fig. 22. 
(After Harley.) 
crystals variously shortened, etc. Among these forms are 
the small crystals already referred to as being possibly mis- 
taken for the oxalate of lime. There are also sometimes 
found beautiful star-shaped feathery (Fig. 23) crystals of 
triple phosphate, which gradually undergo conversion into 
the prisms, and between these two there are many interme- 
diate forms. 
(z5) Phosphate of Lime (amorphous Ca3(PO4)2, crys- 
talline CaHPOj.-Phosphate of lime is most frequently URINARY DEPOSITS. 
193 
found amorphous under the same circumstances under which 
the triple phosphate occurs. It is, however, frequently de- 
posited from normal urine by which it is held in solution 
during the acid reaction by the acid phosphate of sodium, 
or carbonic acid, or by both. At any rate let the acid re- 
action be wanting, as it is three or four hours after a meal, 
Fig. 23. 
(After Hailey.) 
and a copious deposit of calcium phosphate often takes 
place, and is increased by boiling. In other instances, a 
urine may be acid in its reaction, and the boiling, appar- 
ently by driving off the carbonic acid, will cause the phos- 
phates to go down. These deposits have more than once 
been spoken of as possible sources of error in testing for 
albumin, but they promptly disappear on the addition of 
acids. The color of the phosphate of lime alone is not 194 
PRACTICAL EXAMINATION OF THE URINE. 
snow-white, as is that of the triple phosphate, but rather 
yellowish. 
Not unfrequently we meet in urinary deposits crystalline 
phosphate of lime (Fig. 24), which occurs sometimes alone 
and sometimes along with the triple phosphate. It is also 
Fig. 24. 
Crystalline and amorphous phosphate of lime. 
met in urine of a weak acid reaction, but strongly disposed 
to take on the alkaline fermentation. The occurrence of 
crystalline phosphate of lime seems peculiar to certain in- 
dividuals, and Hoffmann and Ultzmann have met persons 
perfectly healthy who, in the summer months, have almost 
daily deposits of crystalline phosphate of lime. They are 
frequently associated with octahedra of the oxalate of lime. URINARY DEPOSITS. 
195 
Recognition.-The isolated crystals of phosphate of lime 
may be said to be wedge-shaped or even conical, from which 
form there are, however, variations. But their characteristic 
feature is in their arrangement, which is that of a circular 
rosette, in which the apices of the numerous crystals form- 
ing it all point to the centre. Phosphate of lime is also 
found in the shape of spherules or even dumb-bells. The 
latter are said by Dr. Beale {Kidney Diseases and Urinary 
Deposits, p. 357) to be deposited in decomposing mucus, 
not only from the urinary tract, but from other surfaces, as 
the gall-bladder. Dr. Beale figures such dumb-bells in his 
Plate XXI, Figs. 116 and 118. 
Chemical Characters.-All of the phosphates are 
dissolved by acids, but are insoluble by alkalies and heat, 
whereas the uric acid salts are dissolved by both these agen 
cies. The small triple phosphate crystals, which resemble 
those of oxalate of lime, dissolve quickly in acetic acid, 
while the octahedra are untouched by it. Uric acid itself 
could scarcely ever be confounded with phosphates, occur- 
ring, as it does, in urine of different reaction ; but if it were 
necessary to discriminate them, the former are dissolved 
by alkalies, the latter not. Moreover, the murexid test will 
not respond to phosphates, but will to uric acid. 
V. Carbonate of Lime 
is a very rare deposit in human urine, but is found abun- 
dantly in horse's urine. When present, it occurs in small 
spheres, and is detected by its effervescence with acetic 
acid. 
VI. Leucin and Tyrosin. 
Occurrence.-These crystalline deposits are only found 
in urine which is loaded with biliary coloring matters, 196 
PRACTICAL EXAMINATION OF THE URINE. 
since they attend only grave destructive diseases of the 
liver, especially acute yellow atrophy and phosphorus 
poisoning. 
Recognition.-If suspected in urine presenting the 
above characters, it may be slightly evaporated, when the 
crystals will be deposited if present. 
Leucin presents itself in the shape of more or less yellow- 
tinged, highly refracting spheres, which may at first sight 
be taken for oil-drops. A little study will show them re- 
Fig. 25. 
fracting light not quite so strongly, i. e., not possessing 
quite so wide a dark border; and by suitable illumination 
many of them will be found marked with radiating and 
concentric striae. The spherules further exhibit a peculiar 
disposition to aggregate, appearing partially to merge where 
two edges come together. 
Chemical Characters.-Leucin spheres, unlike oil- 
globules, are insoluble in ether, and further are soluble in 
Leucin spheres and tyrusin needles. URINARY DEPOSITS. 
197 
caustic alkalies, but not in cold mineral acids. Spherules 
of sodium urate resemble somewhat leucin spheres. The 
former are, however, soluble on being warmed, and may 
also be recognized sometimes by the development of spines 
on their surface. 
Tyrosin is found in the shape of very fine needles ar- 
ranged in tufts or " 5-/z<?<sz/'"-like collections, often crossing 
each other and intersecting at their constricted central por- 
tions (Fig. 25). 
Chemical Characters.-Tyrosin may be recognized 
by Hoffmann's test. A suspected deposit is boiled in an ex- 
cess of water. To the boiling fluid a few drops of a solution 
of mercuric nitrate are added, and there arises a red precipi- 
tate, while the supernatant fluid is colored red to purple- 
red. 
VII. Cystin (C3H7NSO2). 
Occurrence and Recognition.-Cystin is a rare uri- 
nary sediment. Crystalline, forming a whitish or dirty 
yellowish-gray deposit, which on microscopic examination 
is found to be made up of regular six-sided tablets of dif- 
ferent sizes, often so arranged that one of smaller size is 
superimposed on one of larger, and this upon a still larger, 
and so on ; but it also occurs in irregular masses (Fig. 26). 
It is usually met in a pale urine, both acid and alkaline, 
developing in decomposition the odor of sulphuretted hy- 
drogen, as well as that of ammonia, the former doubtless 
derived from the sulphur contained in the cystin. Is occurs 
as a separate urinary deposit as well as accompanying cystin 
calculus, which seems sometimes to be hereditary. 
Chemical Characters.-It is soluble in ammonia, and, 
upon spontaneous evaporation of the ammoniacal solution, 198 
PRACTICAL EXAMINATION OF THE URINE. 
the six-sided crystals reappear, showing that it is simply dis- 
solved in the ammonia, and not in chemical combination 
with it. Now if the six-sided crystals of uric acid, which 
so closely resemble it, and which often accompany it, are 
dissolved in ammonia, and the solution allowed to evapo- 
rate, there would be formed ammonium urate, and, on 
evaporation of the solution, this ammonium urate would 
remain as an amorphous residue. Cystin is also insoluble 
in boiling water, in strong acetic and very weak hydro- 
chloric acids; but it is readily soluble in oxalic and strong 
Fig. 26. 
Cystin, (After Harley.) 
mineral acids. It is soluble in potash and insoluble in 
solution of carbonate of ammonium, and therefore may be 
precipitated from an acid urine by the alkaline fermenta- 
tion ; under these circumstances it would be accompanied 
by amorphous phosphate of lime and crystalline phosphate 
of ammonium and magnesium, with neither of which is it 
likely to be confounded. In a mixed deposit containing 
six-sided crystals, the lime and triple phosphate may be dis- 
solved out with acetic acid, while the plates of cystin will 
remain. They may then be treated with ammonia, as above, 
to distinguish them from uric acid. 
Cystin contains 26 per cent, of sulphur. URINARY DEPOSITS. 
199 
Organized Sediments. 
I. Mucus and Pus. 
Mucus must be present in considerable amount to be 
recognized by its own properties, since it is so transparent 
and similar to urine in its refractive index. It is visible 
partly through the accidental morphological constituents 
which it more or less constantly holds in suspension. These 
are the so-called mucus-corpuscles and epithelium from all 
parts of the genito-urinary tract, as well as crystals of the 
oxalate of lime, granules of sodium urate, and even crystals 
of uric acid. In strictly normal urine the first two would 
alone be present, and in very minute quantity. Mucus, 
when present in normal amount, appears as a delicate cloud, 
often barely visible, floating towards the bottom rather than 
at the bottom of the vessel. 
By the action of acetic acid, the mucin, an element of 
mucus which is comparable to albumin, though not coagu- 
lable by heat, is precipitated in the shape of delicate fibril- 
lated bands, which are sometimes tortuous, and again appear 
as delicate threads, known as mucin threads. If a little 
iodine and iodide of potassium be added to the acetic acid, 
they are made even more distinct. Tartaric acid and very 
dilute solutions of the mineral acids have the same effect, 
while an excess of the same will redissolve the precipitate; 
so, too, the mineral acids will dissolve the coagulum of 
acetic acid, while an excess of the latter will not dissolve it. 
These coagula may sometimes be found in urine to which no 
acids have been added, being probably produced by the 
action of the acids developed in the acid fermentation. 
Under these circumstances they are particularly apt to be 
studded with granular urates, which may cause them to be 200 
PRACTICAL EXAMINATION OF THE URINE. 
mistaken for granular tube-casts; but they are generally 
very much narrower than the latter, and the addition of a 
little warmth, hydrochloric acid, or alkali will quickly dis- 
solve the granules (see Fig. 20). 
As the result of irritation of any part of the genito-urinary 
tract, mucus is increased in quantity, when it assumes a 
thicker, more ropy character, and becomes more or less 
opaque; but even here the opacity is largely due to the 
increased proportion of cellular elements. Under these 
circumstances, the opaque clouds of mucus are often enor- 
mously increased, and with them the adherent epithelial 
cells from the seat of irritation. When thus in excess, 
mucus is apt to pervade more or less the entire mass of the 
urine rather than sink to the bottom, giving the entire fluid, 
therefore, a glairy character. Mucus, however, seldom be- 
comes very abundant without being attended by pus, as the 
causes producing them are but differences of degree. So 
long, however, as urine containing mucus is without albu- 
min, so long may pus be said to be absent, as mucus itself 
contains no albumin, while pus does. 
The Mucus- and Pus-corpuscles.-The mucus-cor- 
puscle, as it appears in urine, is a small, granular, spherical 
or nearly spherical cell, rather larger than a blood-corpuscle, 
that is, .008 to .010 millimeter to °f an inch) 
in diameter, containing one or more nuclei. In a healthy 
condition of mucous membrane, a mucus-corpuscle, however 
it originates, is nothing more nor less than a young epithelial 
cell which has reached the surface before it has attained the 
characters of such cell in its development. As such, there- 
fore, we must not too closely restrict its size, for who 
shall say where the mucus-corpuscle terminates and where 
the epithelial cell begins? As such a young cell, without URINARY DEPOSITS. 
201 
morbid impression, simply arrested in its normal develop- 
ment, a single nucleus is more common than it is in thepus- 
corpuscle, of which the multiple nucleus may be said to be 
more characteristic. But here the difference ceases. For 
the pus-corpuscle, when young (that is, not the subject of 
fatty degeneration), is a cell exhibiting the same characters, 
and may be defined in the same way. The fact being that 
when a cell exhibiting the above characters, with one or 
multiple nuclei, is found upon a non-suppurating surface, it 
is called a mucus-corpuscle, while the same cell on a sup- 
purating surface would be called a pus-corpuscle. Thus, 
while the two are physiologically distinct, they are anatomi- 
cally the same, the physiological difference being in this, 
that a pus-corpuscle is a cell too rapidly produced to be 
allowed to develop into the normal tissue of the part, while 
the mucus-corpuscle is, as it were, only accidentally arrested 
in its development. The same resemblance which exists 
between these bodies exists between them and the white 
corpuscles of the blood, and to the whole class of cells to 
which the term leucocyte or white cell is conveniently 
applied. 
The Action of Reagents.-The mono-nucleated 
mucus-corpuscle, which may be considered an older mucus- 
corpuscle, or young epithelial cell thrown off at a later 
period, usually exhibits its single nucleus distinctly, without 
the addition of a reagent; but the majority of leucocytes 
have not their nuclei visible until acted upon by certain 
reagents, of which two acting similarly most interest us. 
These are water and dilute acetic acid. 
i. Action of Water.-When water is added to the pus- 
or mucus-corpuscle, its first effect is to cause the latter to 
swell up, sometimes to twice the original size, next to become 202 
PRACTICAL EXAMINATION OF THE URINE. 
smooth, the granules gradually disappearing, while the 
nuclei come out with great distinctness. Finally, after 
some time the body of the cell becomes almost, and then 
quite invisible, while the nuclei remain some time longer. 
The circumstances under which the corpuscle exists in urine 
are not quite identical, because in it we have a solution of 
organic and inorganic matters considerably denser than 
water, having a sp. gr. 1015 to 1025, and while the action 
is somewhat similar, it is very much slower; and if the spe- 
Fig. 27. 
Mucus- and pus-corpuscles before and after the addition of acetic acid. 
cific gravity of the urine should be very high, exceeding 
that of the fluid in the cell, there might be no effect, or a 
contrary one, i. e., a shrinkage of the cell from an exos- 
mosis of its contents. 
2. Acetic Acid.-The action of dilute (20 per cent.) 
acetic acid is identical with that of water, except that it is 
very much more rapid, and the stage of distinct nuclei is 
reached much sooner. 
3. The caustic alkalies have a rapidly solvent effect 
upon these corpuscles, destroying their morphological iden- 
tity, and converting them into a gelatinous adherent mass. 
Characters of Urine containing Pus.-Urine, con- 
taining pus, deposits an opaque white sediment, which sinks 
rapidly to the bottom, so long as the reaction is acid and 
there is no mucus present. Such urine, when shaken up, URINARY DEPOSITS. 
203 
becomes more or less opaque, according to the amount of 
pus which it contains. The opacity, as well as the deposit, 
often resembles that due to the pale granular urates, from 
which both are distinguished by the disappearance of the 
latter on the application of heat, while purulent urine de- 
posits albumin under the same circumstances. To a less 
degree does urine containing pus resemble that containing 
amorphous phosphate of lime; but the latter is dissipated 
by acids, while acids also precipitate the albumin from pus, 
and the microscope reveals hundreds of the granular cells 
already described as pus-cells, in many of which the nuclei 
are already displayed in consequence of the action of water. 
Donne's test for pus is based upon the reaction re- 
ferred to between the alkalies and pus. It consists in the 
addition of liquor potassse to the suspected deposit, after 
the supernatant .urine is poured off. If the deposit is pus, 
it is promptly converted into a viscid, gelatinous substance 
resembling mucus, which adheres to the bottom of the test- 
tube, often permitting its inversion without falling out, and 
which, when it is forced to flow, does so in a continuous 
mass, as the albumen runs out of a broken egg. If a portion 
of this glairy mass be examined under the microscope, the 
pus-corpuscles will be found to have been destroyed, 
rather, converted into the substance itself. If the action 
has not been very long, or the proportion of alkali to the pus 
is small, the nuclei of the corpuscles may still be found as 
black dots in the mass, or a certain proportion of the cor- 
puscles may preserve their integrity. 
Changes in Urine containing Pus.-On this same 
reaction is based a most important change which urine con- 
taining pus undergoes after the alkaline fermentation has set 
in. Through the agency of the carbonate of ammonium 204 
PRACTICAL EXAMINATION OF THE URINE. 
generated, precisely the same change is wrought, and the 
urine contains a deposit so closely adhering to the bottom of 
the bottle that it is impossible to remove it with a pipette. 
It must be remembered that this is not mucus, although it so 
closely resembles it, and although microscopic examination 
may show the total absence of pus-corpuscles. These have 
been dissolved by the alkali. Care should be taken, there- 
fore, to determine the reaction of the urine before a mucoid 
deposit is decided upon, and if it is alkaline, another of acid 
reaction should be obtained. The glairy product referred 
to will be found dotted with glistening points, which, on 
microscopic examination, prove to be crystals of triple 
phosphate, while the supernatant fluid will be found to con- 
tain albumin, which is wanting in deposits of pure mucus. 
Frequently, in diseases of the bladder, these changes take 
place within the organ, forming a gelatinous mass, which 
plugs up the urethra and makes it almost impossible to 
evacuate the bladder, thus greatly increasing the suffering 
of the patient. In such cases the only remedy is to wash 
out the bladder with weak acid solutions, and having 
cleansed it, keep it so by their daily use. Even when acid 
at the time of being passed, these urines become rapidly 
alkaline afterwards. 
Sources of Pus in the Urine.-Pus in the urine may 
come from any part of the genito-urinary tract. When 
descending from the pelvis of the kidney, as it often does, 
where there is impacted calculus, it is less apt to be mingled 
with mucus, the urine retains its normal reaction, and the 
pus is, therefore, readily miscible with the urine, and as 
promptly deposited from it. When coming from the blad- 
der, if the urine is not already alkaline, it is apt to become 
so very quickly, and we have then the phenomena described URINARY DEPOSITS. 
205 
as incident to the alkaline fermentation, taking place soon 
after the urine is passed, if not in the bladder itself. 
In diseases of the prostate are apt to be found long plugs 
of mucus, which, appearing to the naked eye like fine 
threads, upon microscopic examination are found made up 
of aggregated pus-corpuscles, in which are sometimes found 
the larger round, or nearly round, nucleated cells peculiar 
to this seat. Similar plugs are found in the pus from gonor- 
rhoea, and it is said also that in this affection the mucus- 
corpuscles are distinguished from those derived from the 
bladder by their larger size, their "glass-like clearness" 
and diminished granulation. If there be no gonorrhoea, 
these plugs or threads point almost pathognomonically to 
inflammation or irritation of the prostate. 
In females, pus is apt to obtain in the urine from leucor- 
rhoea or other purulent discharge from the vagina. This 
should not be forgotten. 
II. Epithelium. 
Epithelium from all parts of the genito-urinary tract is 
found in the urine, but it is not very often that we are ena- 
bled to locate its site beyond the bladder and vagina, partly 
because of the comparatively slight differences in the epi- 
thelium from different locations, and partly because macera- 
tion in the urine renders such feeble distinctive points even 
less marked. 
Three varieties of epithelium may, however, be distin- 
guished in urine with tolerable ease: ist, round cells; 2d, 
cylindrical or conical and spindle cells ; and 3d, squamous 
cells. 
(a) Round epithelial cells (Fig. 28, and a, Fig. 29) 
arise from the uriniferous tubules, particularly in their con- 206 
PRACTICAL EXAMINATION OF THE URINE. 
voluted portion, from the deeper layers of the mucous mem- 
brane of the pelvis of the kidney, from the bladder, and from 
the male urethra. Some of these cells, originally somewhat 
flattened by pressure, swell up in the urine and become 
nearly round (Fig. 28). They are distinguished from pus- 
and mucus-corpuscles by their larger size and their single 
nucleus, which is distinct without the use of reagents, while 
the multiple nucleus of the pus-cell requires the use of acetic 
acid to exhibit it. There is no way of distinguishing the 
source of these cells more precisely than as stated above, 
Fig. 28. 
Round epithelial cells from the convoluted tubules of the kidney, found in urine 
from a case of acute nephritis. X 42°- The cells A, E and H are slightly more 
granular than in health, and C contains a few oil-drops. 
except that if the urine be albuminous, and there is evidence 
of renal disease, it may be right to infer them to come from 
the tubules of the kidney, or from the pelvis if there are 
symptoms of impacted calculus; otherwise from the urethra, 
the prostate, Cowper's or Littre's glands, but cells from the 
latter are rare. If the plugs already referred to, made up 
of pus-cells with a few larger, nearly round, and distinctly 
mononucleated cells united by mucus, are present, we may 
infer the round cells to be from the epithelium of the 
prostate. The round cells from the bladder are consider- URINARY DEPOSITS. 
207 
ably larger than those from other sources-twice the diam- 
eter of a pus-cell. 
(fi) Columnar or conical and spindle cells (£, Fig. 
29) are derived, the first from the superficial layers of the 
pelves of the kidneys, from the ureters and the urethra; the 
latter from the ureters and urethra. 
(fi) The flat epithelial cells (?, Fig. 29) arise from the 
bladder or the vagina. These are flat, but often thicker at 
Fig. 29. 
a, Round epithelium from bladder. 
b, Columnar epithelium from ureter and urethra. 
Columnar and squamous epithelium from deeper layers of epithelium of bladder, 
f*. Squamous epithelium from superficial layers of epithelium of vagina. 
the middle, contain a single nucleus, are irregularly poly- 
gonal in outline, and often folded on themselves either 
completely or partially. The epithelial cells of the blad- 
der (?) are not generally as large as those of the vagina (?), 208 
PRACTICAL EXAMINATION OF THE URINE. 
nor so flat; they are less apt to occur in layers or flakes, 
although also found thus. Frequently it is not safe to 
attempt to distinguish between the two. 
In acid urine these cells remain a considerable length of 
time, but in alkaline urine they are gradually destroyed, 
becoming at first swollen and more transparent. 
III. Blood-corpuscles. 
These get into the urine from the tubules and pelves of 
the kidneys, the bladder, the prostate, and from the uterus 
and vagina in their various physiological and pathological 
haemorrhages. They may be so abundant as to be easily 
distinguished in mass by the naked eye, or they may require 
the microscope for their detection. Urine containing blood 
in large amount is impressed with the red color of the latter, 
but containing the moderate amount most frequently en- 
countered in urine, it obtains a color depending on its 
reaction. If the urine is acid, it assumes a peculiar black- 
ish-brown color which has long been described as "smoke- 
hued," and which is so characteristic as to enable one who is 
at all experienced to decide at once as to the presence of 
blood. If, on the other hand, the urine is alkaline in 
reaction, it assumes the bright-red color of blood. Urine 
containing blood in any quantity appreciable to the naked eye 
is albuminous. 
If blood corpuscles are present in numbers sufficient to 
produce an appreciable deposit, they form a brownish-red 
pulverulent mass at the bottom of the vial, if they come from 
the kidneys or ureters. They are more apt to be found in 
coagula if they come from the bladder or urethra, though 
this latter is not necessarily the case; for, on the other 
hand, moulds of clotted blood are sometimes discharged 
from the ureters with all the agonies of nephritic colic. URINARY DEPOSITS. 
209 
Recognition of Blood-corpuscles.-Blood-corpus- 
cles are recognized under the microscope by the optical 
properties due to their biconcave centres. This is the 
reversal of light and shadow which they undergo in 
focussing, the centre and periphery alternating in bright- 
ness or shadow as the object-glass is approximated to 
the slide or removed from it. This, in connection 
with their evident biconcavity when seen on edge, and 
their yellowish color, will always serve to distinguish 
them, although the effects of long-continued maceration 
tend to interfere in different degrees with the distinctness 
Fig. 30. 
Blood-disks. 
of all of these features. If the urine is a dilute one, the 
corpuscles will swell up, become biconvex instead of bicon- 
cave, finally spherical, and the reversal of light and shadow 
no longer occurs, while the coloring matter is more or less 
dissolved out. Ultimately the corpuscle altogether disap- 
pears. If, on the other hand, the urine is highly concen- 
trated, the concavity becomes more marked and distinctive, 
while the corpuscle itself shrinks and becomes smaller, and 
soon acquires the crenated or horse-chestnut shape (Fig. 30). 
In an acid urine the blood-corpuscles maintain themselves 
for a long time, but in an ammoniacal urine they are soon 
dissolved, being soluble in alkalies. The haematocrystalline 
and haematin are then dissolved in the urine, and may be 
tested for as already directed. 210 
PRACTICAL EXAMINATION OF THE URINE. 
IV. Tube-casts. 
Tube-casts, or "epithelial cylinders" as they are some- 
times called, are moulds of the uriniferous tubules, produced 
by admission into the latter, by capillary rupture or other- 
wise, of a coagulable constituent of the blood, which there 
solidifies, and in this act entangles whatever it may have 
surrounded in its liquid state ; subsequently it contracts 
and slips out of the tubule into the pelvis of the kidney, 
whence it is carried to the bladder and voided with the 
urine. 
Fig. 31. 
It should be added, however, that at least two other views 
as to the mode of formation of casts are entertained, accord- 
ing to one of which the cast is a result of the disintegration 
and fusion of the epithelial lining of the tubules; and ac- 
cording to another, of a secretion from these same cells. 
That casts are sometimes formed according to the first, at 
least, of these two methods is not unlikely. 
The mechanism of the production of the different va- 
rieties of casts, on the supposition of an albuminoid exu- 
dation from the blood is very simple. Thus, suppose a 
tubule to be filled with detached and loosely attached 
Epithelial casts and compound granule-cells. URINARY DEPOSITS. 
211 
epithelium at the time the fibrin is poured into it. These 
elements are entangled, and, as the cast contracts, are car- 
ried out in the shape of an " epithelial" cast (Fig. 31). If 
the tubule should happen to have contained blood, the 
cast entangling it is called a " blood-cast" (Fig. 32). Casts 
containing even a few blood-corpuscles are also called 
blood-casts. The basis substance of blood-casts is most 
probably the fibrin of the blood. If the epithelium be 
firmly attached to the basement membrane of the tube, and 
Fig. 32. 
Blood-casts. (After Whittaker.) 
remain behind when the cast passes out, or if the tube be 
entirely bereft of epithelium, then is the cast a "hyaline" 
(Fig. 33) or structureless cast. In the former instance the 
cast is of smaller diameter, and in the latter of larger, the 
diameter in the latter being that of the former plus twice 
the thickness of an epithelial cell. Fig. 34, a, from Rind- 
fleisch, explains this sufficiently. From causes like these, 
as well as a subsequent contraction of the cast itself, the 
diameter of casts may vary considerably, ranging commonly' PRACTICAL EXAMINATION OF THE URINE. 
212 
from .01 to .05 mm. to in.). A cast is seldom 
completely hyaline, generally containing a few granules and 
one or two glistening oil-drops, but it is still called hyaline. 
Completely hyaline casts do, however, occur. A variety 
of hyaline cast, more solid in appearance, and resembling 
molten wax, is spoken of as a " waxy cast" (Fig. 35). Some 
hyaline casts are so delicate as to be overlooked unless the 
Fig. 33. 
Hyaline casts. X 2I°- 
light from the mirror illuminating the field of view be 
modified by shading with the hand or by manipulation of 
the mirror itself. If a cast contains granular matter, which 
is generally the granular debris of the degenerated epithelial 
lining of the tubule or of blood-corpuscles, it is called a 
"granular"*cast, and highly granular (Fig. 34, c), mod- 
erately granular, slightly or delicately granular, according to URINARY DEPOSITS. 
213 
the amount of granular matter present. When the material 
of granular casts is derived from broken-down blood- 
corpuscles,"the casts appear yellow or yellowish-red. Finally, 
if a cast is loaded with oil drops, either free or contained 
in epithelial cells, it is called an " oil-cast or fatty cast" 
(Fig. 36). 
Fig. 34. 
Hyaline and granular casts, illustrating the formation of the former at a. 
Casts of smaller diameter are sometimes found within 
those of larger, the material of the latter having been poured 
out around that of the former after it has undergone some 
contraction. This occurs usually with waxy or hyaline 
casts. In consequence of the mode of formation above 
referred to, hyaline and waxy casts vary considerably in 
diameter, some being as narrow as .025 millimeter 
of an inch) and even narrower, while others are as much as 
.05 millimeter ( of an inch) wide. There is no doubt 
that some of these are formed in the straight or collecting 
tubes near their openings on the papillae. To these a 
limited number of epithelial cells is sometimes attached. 214 
PRACTICAL EXAMINATION OF THE URINE. 
In addition to the epithelial casts above described, there 
are found in urine under the same circumstances moulds of 
the uriniferous tubules made up of simple aggregations of 
the epithelial cells themselves-simple exfoliations of the 
cellular contents of the tubule, which having increased by 
proliferation form a compact cellular mass. In addition to 
these are sometimes found epithelial casts in which the cells 
are seated on the outside or around the fibrinous mould. 
Fig. 35. 
Waxy casts. X 15°. 
Mucus-casts.-Casts are occasionally found which are 
apparently pure mucus-moulds of the uriniferous tubules (Fig. 
37). Unless covered by accidental elements, as granular 
urates or phosphate of lime, they are smooth, hyaline or 
gently fibrillated moulds, especially characterized by their 
great length, which is often enormous, in the course of 
which they divide and subdivide, diminishing in diameter 
as the division proceeds, showing positively that they come URINARY DEPOSITS. 
215 
from the kidney. Yet there is no albumin, or merely as 
much as could be accounted for by the presence of pus which 
sometimes attends them. For they are particularly apt to 
occur where there is irritation of the bladder, which is ap- 
parently extended through the ureters to the kidney. Under 
these circumstances they are frequently met. Dr. Beale 
says {Kidney Diseases, etc., p. 342) they are not infre- 
quently passed in cases where the urine has a very high 
Fig. 36. 
Oil-casts and fatty epithelium. 
specific gravity, 1030 or higher, containing an excess of 
urea and urates. 
These casts are not identical with the bands of mucin 
already alluded to (p. 199), which are found in urine of 
highly acid reaction. The mucin bands are probably pre- 
cipitated by the acids, are often beset with granular urates, 
and might on this account be mistaken for casts. At the 
same time the mucus-cast is probably nothing but pure 
mucus. 216 
PRACTICAL EXAMINATION OF THE URINE. 
Casts of the Seminal Tubules are sometimes found 
in the urine, but their origin may be inferred from the 
presence of spermatozoids in them. 
To Prepare Urine for Examination for Casts.- 
The greatest caution should be exercised in examining urine 
for casts. They are often so sparsely present as to furnish no 
Fig. 37. 
Mucus-casts. (After Whittaker.) 
deposit appreciable to the naked eye, and yet may be found 
by careful microscopical examination. While it is not im- 
possible for non-albuminous urine to contain casts, yet I have 
never met them except in a few instances, where, albumin 
and casts having been present, in their gradual disappear- 
ance the signs of the presence of albumin disappeared before 
the last casts had been washed out. On the other hand the 
presence of albumin means casts in the vast majority of in- 
stances, and many times I am certain they are declared 
absent simply because they are not carefully sought. I URINARY DEPOSITS. 
217 
have, however, had cases under my observation in which the 
urine contained large amounts of albumin, and yet by the 
most searching examination no casts could be found. Not 
a single slide, however, should satisfy the examiner, but two 
or three should be carefully studied throughout their entire 
field. Nor is a plain slide sufficient. Urine should be 
examined in shallow cells, and as those of thin glass are 
generally too deep, the best are made with gum-damar or 
other suitable cement, by means of a turn-table and brush, 
since in this way they may be obtained sufficiently shallow 
to allow them to be penetrated by an ordinary one-fifth or 
one-fourth objective. After being made they should be put 
away for a month or more to thoroughly dry and harden, 
else they are washed off with the first cleaning of the slide. 
Most casts from their lightness subside slowly, and the 
more so because the urine is albuminous. As soon as re- 
ceived, therefore, the bottle of urine should be shaken up, 
poured into a conical glass, and carefully covered.* Al- 
though casts generally fall to the bottom in a short time, I 
have known twelve hours to elapse before one could be dis- 
covered, and therefore, whenever it is possible, urine should 
be allowed to stand for this time in a conical glass, and 
then examined. If the urine has already been standing 
some time, the supernatant fluid may be removed, and only 
the lower strata containing the sediment turned into the 
conical glass, and allowed further to subside. A pipette, 
made of a plain glass tube drawn nearly to a point, 
should then be carried to the bottom of the glass with the 
* It is desirable that the upper surface of the conical glass be ground 
that it may receive one of the ground glass covers referred to on p. 17. 
The urine is thus thoroughly protected from the action of the air, which 
favors decomposition and renders the examination unsatisfactory. 218 
PRACTICAL EXAMINATION OF THE URINE. 
index finger firmly pressed upon the distal end. When it 
has reached the bottom, the finger should be raised and 
immediately returned. In this manner only the lowest 
drops are obtained, which are most likely to contain the 
casts. A drop of this fluid is allowed to fall into one of the 
shallow cells, covered with a thin glass cover, and carefully 
examined with a one-fourth or one-fifth object-glass and the 
No. i eye-piece. If these precautions are taken, and two 
or three slides examined, castswill either be found, or they 
are absent. Only the beginner need be cautioned against 
linen and cotton fibre, hair, or portions of deal-wood. 
More likely are the mucin flakes and cast-like granular ag- 
gregations of inorganic and organic matter to mislead. 
V. Spermatozoids 
Frequently occur in the sediment of urine of healthy men. 
When abundant they form a slight flocculent cloud in the 
urine, but there is generally nothing in the appearance of 
urine whence their presence may be suspected. They 
require a power of 400 diameters (one-fifth object-glass 
with the No. 2 eye-piece) to show them well, when they 
may be recognized by the oval head or body and the deli- 
cate tail-like prolongation emanating from it. They do not 
exhibit the vibratile movement after entering the urine. 
Their recognition is most important in connection 
with medico-legal cases-cases of suspected rape. Their 
presence in vaginal mucus soon after coition, and in 
stains upon linen, is easy of demonstration. In the former 
case a drop of mucus from within the vagina is placed upon 
a slide, a drop of water added if necessary, covered with a 
thin cover, and examined with the microscope. In the 
latter a simple piece of the stained linen may be soaked in URINARY DEPOSITS. 
219 
water or artificial serum in a watch-glass for half an hour or 
an hour, and the sediment examined. Beale figures (Fig. 
Fig. 38, 
Human spermatozoids. 1. Magnified 350 diameters. 2. 800 diameters. 
a, viewed from the side ; b, from the front. 
74) some filaments of a vegetable nature resembling sper- 
matozoids. 
VI. Fungi. 
Most of the living organisms found in decomposing urine, 
formerly looked upon as of animal origin, are now acknowl- 
edged to be vegetable in their nature, and are generally fungi. 
The most frequent among these are bacteria, penicillium 
glaucum, and the yeast fungus. Sarcince are occasionally 
met with. 
1. Bacteria.-In the refined study which has of late years 
been given to the subject of fungi, a classification has been 
made of the minute objects which were formerly called 
monads and vibriones. They are a subdivision of Nageli's 220 
PRACTICAL EXAMINATION OF THE URINE. 
schyzomycetes or cleft fungi. They include, of Cohn's 
classification, a, the sphero-bacteria or micrococci, consisting 
of little trembling points uniform in size and proliferating 
rapidly in all putrid fluids including decomposing urine ; b, 
microbacteria, the staff-shaped or rod-bacteria, which ap- 
pear as minute lines approaching in length with moderate 
powers the diameter of a red blood-disk, but mere lines in 
breadth, sometimes at rest and sometimes vibrating across 
the field ; c, desmobacteria, or filamentous bacteria, including 
ist, a straight form, the bacillus, and 2d, a curved form, 
vibrio. Bacillus increases by transverse division, and often 
forms a long string called leptothrix, which may extend 
entirely across the field of view. It is not constricted 
at the joints like the moniliform threads sometimes 
formed by the globular bacteria. The first two occur 
either isolated or in the so-called zooglea form, consisting 
of jelly-like masses apparently held together by a gelatinous 
substance. The last often form swarms but never zooglea 
masses. 
The effect of the presence of bacteria in urine is to give 
it a cloudiness which can be only partially removed by fil- 
tration, the bacteria being so small that they pass through 
the pores of the filter. They may be entirely removed by 
the aid of the magnesian fluid (p. 16), gentle heat, and 
filtration. 
2. The yeast or sugar fungus (saccharomyces urince) 
consists, in the sporule-stage, of transparent oval cells, in 
their longer diameter about the size of a blood-disk, and of 
larger spherical cells, granular and nucleated. They are 
found in saccharine urine, and are probably identical with 
the ordinary yeast fungus (saccharomyces cerevisice). The 
former small oval cells are often arranged in rows of two, URINARY DEPOSITS. 
221 
three, or more, as seen in the figure (Fig. 39). According 
to Hassall, this is a fungus peculiar to saccharine urine, but 
the small oval cells of the sporule-stage at least cannot be 
distinguished from the similar stage of, 
Fig. 39. 
Yeast fungus. (After Harley.) 
3. Penicillium glaucum, which occurs in acid urine 
with or without albumin or sugar. The sporule-stage fur- 
nishes cells very similar to those of the yeast fungus, but later, 
penicillium, by the union of its cells, forms thalli or 
branches, which are characteristic. So, too, in the stage 
of aerial fructification, the penicillium multiplies by simple 
linear division of cells. 
4. The sarcina urinae is a fungus rarely met with. I have 
found it twice in fifteen years,.once in acid urine, a second 
time in urine of unknown reaction. Composed of cubes, 
it is capable of further separation into smaller cubes. It is 
similar to, but smaller than, the sarcina ventriculi Qi Goodsir. 
The germs of these fungi doubtless enter the urine, in the 
vast majority of instances, after it has passed from the 
bladder, one or the other form being developed according 
as its germs preponderate, or according to the properties the 
urine may possess. Decomposition seems essential to the 
presence of the bacteria, but not to the other forms. 222 
PRACTICAL EXAMINATION OF THE URINE. 
VII. The Elements of Morbid Growths. 
These are seldom met in the urine. Possibly cells may be 
found, and perhaps fragments of the growth may be broken 
off, and passed with the urine. The former may be suspected 
to be of morbid origin by their large size, their multi nuclear 
character, the large size of the nuclei, and diversity of the 
cell-forms. Spindle-cells, it must be remembered, may be 
derived from the ureter, urethra, and even the bladder, and 
must not, therefore, be considered abnormal. Indeed, every 
shape of cell may arise from the cells of the bladder during 
inflammation or irritation. 
Fragments of cancerous growths which get into the urine 
are generally from the villous kind, and may show the cap- 
illary vessels which make up the villus, with or without the 
epithelial covering. Fragments suitable for examination 
are sometimes withdrawn with the catheter. 
VIII. Entozoa. 
Entozoa are seldom found in the urine in this climate. 
Echinoccocus cysts, as well as their booklets, have been 
passed in two or three instances recorded. The eggs and 
ciliated embryos of Bilharzia hcematobia have been found 
by Dr. John Harley in three patients with the endemic 
haematuria of the Cape of Good Hope, and I had the 
privilege, through the kindness of Dr. S. W. Gross, of 
examining one of the slides containing ova, sent to this 
country. The parasite itself is found in the vesical, mesen- 
teric, and portal veins, causing haemorrhages into the intes- 
tines, bladder, ureters, and pelves of the kidney. The ova 
and parasite are figured by Beale, op. citat., p. 402. 
The filaria sanguinis hominis, the parasite which has 
recently been shown to have such an intimate association 
with chyluria, is sometimes found in urine. URINARY DEPOSITS. 
223 
Distoma hcematobium has been found in the bladder, 
ureters, and pelves of the kidney, especially in Egypt. 
The Preservation of Organized Urinary Sediments for Sub- 
sequent Examination. 
Crystalline urinary sediments are so easily obtained that 
there is no advantage in attempting their preservation, which 
is always difficult. Organized sediment, on the other hand, 
may be preserved tolerably unaltered in several fluids. One 
of the simplest and best of these is a mixture of glycerin 
and distilled water in such proportion as to secure the aver- 
age specific gravity of urine, about 1020, to which is added 
carbolic acid in the proportion of 1 part to 100. A weak 
solution of salicylic acid is also efficient, and Dr. W. W. 
Keen recommends a solution of chloral, ten grains to the 
ounce. Dr. Beale's naphtha and creasote solution is ef- 
ficient, but much more troublesome to prepare. 
Dr. E. S. Wood, of Boston, recommends very highly a 
filtered solution of acetate of potassium, specific gravity 
between 1050 and 1060, to which carbolic acid has been 
added in the proportion of 4 to 5 c.c. of the deliquesced 
crystal to one liter of the acetate solution. Instead of 
carbolic acid, salicylic acid may be added to saturation. 
When urine is to be transported in hot weather, or kept 
several days for any reason, a pinch of salicylic acid added 
to a four-ounce vial is generally sufficient to prevent decom- 
position, and in no way impairs the reactions or alters the 
sediments. 
To use any of these fluids, allow the sediment to subside 
in a conical glass, decant the supernatant fluid, replace the 
latter with the preservative, stir up the sediment, allow again 224 
PRACTICAL EXAMINATION OF THE URINE. 
to subside, again decant, and replace with a fresh portion 
of the preservative. Repeat this until the urine is thor- 
oughly replaced by the preservative. Then place the sedi- 
ment and preservative in a well-stopped ordinary vial, in 
which they may be kept for years without marked change ; 
or the sediment thus permeated by the preservative may be 
mounted in shallow cells over which a thin glass cover is 
cemented. 
DIFFERENTIAL DIAGNOSIS OF RENAL DISEASES. 
While it is quite impossible to determine with absolute 
certainty, by a mere examination of the urine, all of the 
different affections to which the kidneys are liable, there is, 
nevertheless, an association, more or less close, of signs with 
well determined conditions. With such association, it is 
important that we should be familiar, while we should as 
well recognize the fact that they are subject to variations 
and exceptions. If these facts are remembered, it is not 
likely that any one can be led far astray by observing the 
following : 
I. Acute Parenchymatous Nephritis (Acute Diffuse Neph- 
ritis ; Scarlatinal Nephritis ; Acute Tubal Nephritis').-The 
urine is scanty, dark, "smoke-hued," so long as it remains 
acid, but becomes red if alkalized. It is highly albuminous. 
Its specific gravity is not constant, but apt to be high-1025 
or above-not from an increase in urea, but from the presence 
of blood. It contains a variable but generally large amount 
of reddish-brown, pulverulent sediment, which, on micro- 
scopic examination, is found madeupof large epithelial casts, 
blood-casts, hyaline casts of large diameter, dark-red gran- DIAGNOSIS OF RENAL DISEASES. 
225 
ularcasts; also, numerous red blood-disks, and free cells from 
the uriniferous tubules, more or less round and nucleated, 
twice as wide as the blood-disks, cloudy, and more granular 
than in health, the granules often obscuring the nucleus. 
Crystals of uric acid are often present. The chlorides 
are first diminished, also the earthy phosphates. Hgematin, 
indican, and uric acid are increased. 
The patient is dropsical, much swollen about the face, and, 
if a child, has had scarlet fever, or, if an adult, has been 
exposed to rain, or has otherwise become wet while over- 
heated. 
The disease is acute nephritis, acute diffuse nephritis, scar- 
latinal nephritis, or acute Bright's disease, and the chances 
for recovery are many. 
II. Chronic Parenchymatous Nephritis (Tubal Nephritis; 
Chronic Diffuse Nephritis; Large White Kidney').-The 
urine is pale, and of low specific gravity, 1010-1015; its 
quantity, though variable, generally diminished. Albumin is 
diminished as compared with (I), but it is still abundant- 
one-quarter to one-half the bulk. The urine often deposits 
an appreciable white sediment, which by microscopic exami- 
nation is found made up of black, highly granular casts, 
hyaline casts, and casts containing fragments of epithelium ; 
also compound granule-cells (Fig. 31). Probably also there 
are casts containing a moderate quantity of oil, and per- 
haps also partially fatty cells. Waxy casts are also some- 
times found in this form of disease. The urea is diminished, 
the chlorides normal, pigment diminished. 
There is also oedema, more or less general, which may, 
however, subside, but the patient has a pale, almost charac- 
teristic waxy look. The symptoms have existed more than 
six weeks. 226 
PRACTICAL EXAMINATION OF THE URINE. 
The disease is probably the large white kidney, a chronic 
continuation of (I), known also as chronic tubal nephritis, 
and recovery, though possible, is much less likely to occur 
than with the acute form. 
At other times the sediment contains a large number of oil- 
casts filled with free oil, and oil contained in epithelial cells. 
There are numerous free fatty cells and free oil-globules. 
III. Secondary Contraction of the Kidney after Chronic 
Nephritis.-The disease has existed for more than a year, 
the urine is increased as compared with (II), and may be 
even increased as compared with health, and the specific 
gravity varies accordingly. The albumin is diminished, 
but may be considerable, or it may be very small in amount. 
The urine deposits a more scanty sediment, made up of 
broad casts, some dark granular and others waxy, together 
with a few narrow pale casts. Compound granule cells oc- 
cur, but are less numerous, and there may be some fatty 
epithelial cells, but the amount of oil, though distinctive, 
is not very large. The urea is much diminished. There is 
often some dropsy, less than in (I) and (II), but more than 
in (IV), and it may be .entirely absent. 
Here the large -white kidney has probably commenced to 
contract, and the resulting organ is also called the fatty and 
contracting kidney, to distinguish it from the next form, 
the chronically contracted kidney. One must be cautious 
about drawing too sharp a line between these (II) and (III). 
The prognosis as to recovery unfavorable, but the disease 
may last many years without inconveniencing the patient. 
IV. Interstitial Nephritis ( Chronically Contracted Kidney ; 
Granular Kidney; Red Granular Kidney; Cirrhotic Kid- 
ney?)-The urine is increased in amount, correspondingly 
pale, but, while micturition may be a little more frequent, it DIAGNOSIS OF RENAL DISEASES. 
227 
may not attract attention. The patient may have to rise once 
in the night. The specific gravity is generally diminished 
(1010-15), while the quantity of albumin is trifling, never 
exceeds one-quarter, and often is shown by a mere line of 
opacity in Heller's test. The urine deposits often no visible 
sediment, and at all times a trifling one. In this are found 
delicate hyaline and finely granular casts, often of small 
diameter. Some of these contain one or two glistening oil- 
drops, but very minute. Here are found the casts, which 
are at times almost invisible. The urea is generally slightly 
diminished. 
There is no dropsy. Hypertrophy of the left ventri- 
cle is constant, and there may be nausea and vomiting, 
especially in the morning, but there are often no obvious 
symptoms whatever connected with the disease. If any, 
the patient may complain of a weak, tired feeling, and this 
symptom should suggest an examination of the urine 
always. The disease may exist for years without the knowl- 
edge of the patient, who may or may not be subject to 
gout. Nausea is a common symptom in the advanced stages, 
and drowsiness a serious one. (The urine of gouty patients 
should be frequently examined.) 
The disease is interstitial nephritis, and its product the 
chronically contracted kidney. If exposure to cold and fa- 
tigue be avoided, the patient's life may be scarcely shortened, 
and yet he is constantly liable to attacks of uraemia, which 
may suddenly terminate his life. 
V. Lardaceous or Amyloid Degeneration of the Kidney.- 
The urine is increased in quantity, clear, of corresponding 
specific gravity (1007-1015), of a pale golden color, the 
color of a dilute urine only, contains at first little, but later 
considerable albumin, about one-fourth to one-half; urea is 228 
PRACTICAL EXAMINATION OF THE URINE. 
diminished. There is very little or no sediment visible. 
Casts are often wanting, and when present include the broad 
dark granular as well as the hyaline and waxy casts ; occa- 
sionally fatty casts are found ; the waxy are solid-looking, 
and sometimes give the characteristic red reaction of the 
amyloid substance when treated with a watery solution 
of iodine and iodide of potassium. Here hyaline and 
waxy casts of large diameter are found, and sometimes within 
these smaller casts. 
While the highly refracting waxy casts are not confined to 
albuminoid kidney, they always indicate chronic and deep- 
seated processes. 
At first there is no dropsy, but later it is sometimes per- 
sistent. Generally, however, except towards the termination 
of the case, it is amenable to treatment by rest and diuretics. 
The patient has an enlarged liver or spleen, sometimes 
obstinate diarrhoea ; he has had syphilis, or extensive dis- 
ease of the bones, or has phthisis. 
The disease is lardaceous degeneration of the kidney, and 
is incurable, though the patient may live many years. 
VI. Acute Active Hypercemia {Parenchymatous Degenera- 
tion of the Kidney ; " Cloudy Swelling" ).'■-Most frequently 
the sole symptom is albuminuria, the most careful examina- 
tion failing to discover casts; when casts are present, they 
are of the hyaline variety. There is, as a rule, no dropsy. 
The quantity of albumin (7'7 to bulk) is generally less 
than in tubal or parenchymatous inflammation or lardaceous 
degeneration. Such may sometimes be the albuminuria of 
pregnancy, or such grave diseases as diphtheria and acute 
febrile disorders. 
After death, the renal epithelia are often more or less 
enlarged, their contents cloudy. This condition differs DIAGNOSIS OF RENAL DISEASES. 
229 
from parenchymatous nephritis in the smaller extent and 
diminished intensity of the morbid process. It is probably 
due to the pernicious influence of some poison on the minute 
structure of the kidney, which may extend to all the tissues. 
Recovery is frequent. 
The disease is called by Niemeyer parenchymatous degen- 
eration. 
VII. Cyanotic Induration.-Cyanotic induration is a pe- 
culiar indurated form of kidney due to a simple hyperplasia 
of its interstitial tissue, the result of long-continued passive 
congestion. It is most frequently found accompanying 
valvular disease of the heart, and is characterized by a 
bluish color. 
In addition to the other symptoms of heart disease there 
is dropsy and often serous effusion in the great cavities. 
The urine is scanty, of high specific gravity, often 1030 
and above, there is usually a moderate amount of albumin, 
and a few small hyaline or faintly granular casts. 
The prognosis is unfavorable, but under favorable cir- 
cumstances the patient may improve and become more 
comfortable. 
The above is given as a general guide, and I would again 
refer to the fact that there are deviations from the condi- 
tions laid down. There are still many points quite disputed 
in the pathology of the kidney. Thus, the older German 
pathologists contended that there is a constant relation of 
succession between the acute parenchymatous nephritis, the 
chronic parenchymatous nephritis (large white kidney), 
and the contracting stage of the latter, making no distinc- 
tion between the cirrhotic kidney and the fatty and con- 
tracting kidney. And it is held by some to-day that all 230 
PRACTICAL EXAMINATION OF THE URINE. 
inflammations of the kidney are diffuse ; that is, there is no 
inflammation in which the epithelial tissue or the connective 
tissue alone is primarily involved, but that both always 
share the process from the beginning. 
One more fact must be mentioned in this connection, 
and this is that although the presence of fatty casts and fatty 
epithelium is an unfavorable symptom, yet it does not fol- 
low that such cases are necessarily fatal. I have, on more 
than one occasion, found oil-casts in the urine of patients, 
and yet have also found them to disappear altogether. The 
circumstances under which this has most frequently occur- 
red have been, ist, where there have been heart disease and 
kidney disease combined, and there has been some exacer- 
bation of one or both, when the albumin has increased, 
and oil-casts have made their appearance, which later 
totally disappeared ; 2d, where pregnancy has supervened 
on existing Bright's disease, and oil-casts have been present, 
which again disappeared after a successful labor. PART III. 
URINARY CALCULI. 
The qualitative analysis of gravel or calculus is much 
simpler than is generally supposed. There are but three 
varieties of calculus at all common, and therefore likely to 
demand analysis. These are (i) uric acid and its com- 
pounds, (2) oxalate of lime, and (3) the mixed phosphates. 
Calculi of xanthin and cystin occur, though very rarely. 
1. Uric acid calculi are the most common. They are 
either red or some shade of red, and usually smooth, but 
may be tuberculated. They leave a mere trace of residue 
after ignition. 
2. Oxalate of lime calculi are frequently met with. 
They are generally of a dark-brown or dark-gray color, and 
from their frequently tuberculated surface have been called 
mulberry calculi. They may, however, be smooth-hemp- 
seed calculi. Considerable residue remains after ignition. 
The calculus is soluble in mineral acids without effervescence. 
3. Calculi of the mixed phosphates, or fusible 
calculi, are composed of the phosphate of lime and of the 
triple phosphate of ammonium and magnesium. Phosphates 
make up the external layers of many calculi of various com- 
position, and may form entire calculi, but seldom constitute 
the nucleus alone, of a calculus. Mixed phosphatic calculi 
are white, exceedingly brittle, fuse in the blowpipe flame, 
and are soluble in acids, but insoluble in alkalies. PRACTICAL EXAMINATION OF THE URINE. 
232 
Other rarer forms of calculi are made up of carbonate of 
lime, of xanthin, cystin, and of urostealith. 
Few calculi of large size are of the same composition 
throughout, and when of any considerable size, these con- 
stituents are usually arranged in concentric layers about a 
nucleus. Oxalate of lime is the most frequent nucleus; 
uric acid may also serve as a nucleus, but phosphates, 
almost never. Small masses of organic matter, as blood- 
clots, frequently form nuclei, and may often be recognized 
by the odor of ammonia on ignition. Foreign bodies, as 
pieces of pencil or even glass, introduced into the bladder 
from without, may become nuclei. 
To Determine the Composition of Calculi Qualitatively * 
Previous to chemical treatment a calculus should be pow- 
dered, and in view of the fact that different layers are often 
of different composition, wherever the stone is of any size, it 
should be sawed or coarsely broken and a portion of each 
layer should be examined separately. 
Expose a portion of the powdered calculus on a piece of 
platinum foil or a platinum spoon to a dull red heat for a 
considerable time. Ndte whether there is a residue. 
A calculus which burns with very little or no fixed residue 
is composed either of uric acid or ammonium urate, of 
cystin, of xanthin, or of urostealith. If it does not burn 
completely it may contain uric acid and uric acid salts, 
phosphate of lime and phosphate of magnesium, the ammo- 
nio-magnesian phosphate, or oxalate of lime. 
* The processes here given are taken with some alterations and 
additions from the last edition of Thudichum's work on the " Pathol- 
ogy of the Urine." URINARY CALCULI. 
233 
A. There is a fixed residue. To a portion of the original 
powder apply the murexid test (p. 158). 
I. A purple color results : uric acid is present. 
Observe whether a portion of the calculus melts on 
being heated. 
a. It melts, and communicates- 
1. A strong yellow color to the flame of a spirit- 
lamp, or Bunsen burner : sodium urate. 
2. A violet color to the flame: potassium utate. 
b. It does not melt. Dissolve the residue after 
ignition in a little dilute HC1, add ammonia 
until alkaline, and then ammonium carbonate 
solution. 
1. A white precipitate falls: calcium urate. 
2. No precipitate. Add some hydric sodic 
phosphate solution ; a white crystalline 
precipitate falls: magnesium urate. 
II. No purple color results. 
Observe whether a portion of the calculus melts on 
being exposed to the blow-pipe flame. 
a. It melts (fusible calculus). Treat the residue with 
acetic acid; it dissolves. Add to the solution 
ammonia in excess; a white crystalline precipi- 
tate falls: ammonio-magnesium phosphate. In case 
the melted residue is insoluble in acetic acid, 
treat with HC1; it dissolves. Add to the solu- 
tion ammonia ; a white precipitate indicates cal- 
cium phosphate. Ammonio-magnesian phosphate 
and basic calcium phosphate ordinarily occur 
mixed in the same concretion. 
b. It does not melt. Moisten the residue with water, 
and test its reaction with litmus-paper ; it is not 234 
PRACTICAL EXAMINATION OF THE URINE. 
alkaline. Treat with HC1; it dissolves without 
effervescence. Add to the solution ammonia in 
excess; white precipitate; calcium phosphate. 
Calculi of pure calcium phosphate are rare, but 
may occur. 
Treat the calculus with acetic acid ; it does not 
dissolve. Treat the residue, after heating, with 
acetic acid ; it dissolves with effervescence : cal- 
cium oxalate* Treat the original calculus with 
acetic acid; it dissolves with effervescence: 
calcium carbonate. 
B. There is no fixed residue. Apply the murexid test (p. 
158). 
I. A purple color is developed. 
a. Mix a portion of the powdered calculus with a little 
lime, and moisten with a little water; ammonia 
is evolved, and a red litmus-paper suspended over 
the mass is turned blue : ammonium urate. 
b. No ammonia: uric acid. 
II. No purple color. 
a. But the nitric acid solution turns yellow as it is 
evaporated, and leaves a residue insoluble in po- 
tassium carbonate : xanthin. 
b. The nitric acid solution turns dark brown, and 
leaves a residue soluble in ammonia : cystin. 
c. The calculus, soft when fresh, dark-brown and 
brittle when dry, becomes softer again when 
warmed. Soluble in ether, the amorphous mass, 
* The calcium oxalate is converted by the heating into calcium 
carbonate, which dissolves with effervescence. If the heat be much 
higher then a dull red, the carbonate of lime is converted into quick- 
lime, which does not effervesce on adding an acid. URINARY CALCULI. 
235 
after evaporation of the ether, becomes violet on 
being heated. It dissolves in nitric acid, with 
slight evolution of gas and without change of 
color: urostealith. 
A coarser mode of analysis, but still sufficiently accurate 
for practical purposes in most instances, is the following: 
Powder a portion of the calculus and ignite upon a piece 
platinum foil. 
A. There is a fixed residue. To a portion of the powdered 
original calculus apply the murexid test (p. 158) : 
I. A purple color results. The stone is composed of 
uric acid or uric acid and its compounds. 
II. No purple color results. 
Observe whether a portion of the original calculus 
melts under the flame of the blowpipe. 
a. It melts (fusible calculus). The stone is the am- 
monio magnesianphosphate, containing, also, prob- 
ably, some phosphate of lime. 
b. It does not melt. (1) Treat some of the original cal- 
culus in powder with acetic acid. It does not 
dissolve. Treat the residue, after heating, with 
acetic acid. It dissolves with effervescence. The 
stone is oxalate of lime. 
(2) The powder of the original calculus dissolves 
with effervescence. The stone is calcium 
carbonate. 
B. There is no fixed residue. Apply the murexid test (p. 
158). 
I. A purple color results. The stone is uric acid or 
uric acid and its compounds. 
II. No purple color. (See II, p. 234.) APPENDIX. 
MODE OF RECORDING AN EXAMINATION. 
To systematize and facilitate the work of urine examina- 
tions, forms of record have been devised by those working 
in the subject. For ordinary use in hospital and private 
practice a modification of the form suggested by Heller 
recommends itself for its economy and convenience. 
The form may be printed, but as recommended by Heller, 
an ordinary half-sheet of letter-paper is folded in four, and 
marked in the manner indicated below : 
PHYSICAL PROPERTIES. 
Quantity taken in twenty-four hours. 
Color and reaction. 
Sp. gr., quantity and character of sediment. 
Uph. (Urophain). 
Ux. (Uroxanthin). 
+ 
U (Urea). 
U. (Uric acid). 
NORMAL CONSTITUENTS. 
Cl. (Chlorides). 
Eph. (Earthy phosphates). 
Alkaline phosphates. 
Sulphates. 
ABNORMAL CONSTITUENTS IN SOLUTION. 
SEDIMENT. 
CONCLUSION. RECORDING AN EXAMINATION. 
237 
Abbreviations for the important constituents are used as 
shown, the sign "-f-" for increased, the sign "- " for 
diminished, and the letter "n." for normal. Tor great in- 
crease or great diminution, "gr. + " and "gr.-" maybe 
used, and for slight increase or slight diminution, "si. 4- '' 
or "si. -." 
I have added another space for the opinion or diagnosis. 
Let us suppose an examination to have been made, with 
the following results. The word "indican," "ind.," is 
preferred for " uroxanthin," and substituted. 
PHYSICAL PROPERTIES. 
Quantity in twenty-four hours, 
Color, very pale yellow. 
Sp. gr., 1005. Sediment, mode 
500 c.c. 
Reaction, acid, 
rate, flocculent. 
NORMAL CONSTITUENTS. 
Uph. gr. - Cl. 
n. 
Ind. si. 4- Eph. 
- 
U I gr. - Aph. 
U J Sph. 
A 
ABNORMAL CONSTITUENTS IN SOLUTION. 
Albumin, 2 per cent. 
• SEDIMENT. 
Numerous oil-casts, free fatty cells, and free oil-globules. 
Diagnosis-Chronic Parenchymatous nephritis. 
Fatty kidney. 238 
APPENDIX. 
TABLES 
For Reducing the Metric or French System into the English, and vice 
versa, as far as required in Urinalysis. 
Grams to Grains. 
I 
= 
15.43 (+ .0022 
2 
= 
30.86 
3 
= 
46.29 
4 
= 
61.72 
5 
= 
77-15 
6 
= 
92-58 
7 
= 
108.01 
8 
= 
123-44 
9 
= 
138.87 
Cubic Centimeters to Minims. 
I 
= 
16.2 (+ .0293) 
2 
= 
32-4 
3 
= 
48.6 
4 
= 
64.8 
5 
= 
81.0 
6 
= 
97-2 
7 
= 
"3-4 
8 
= 
129.6 
9 
= 
145-8 
Cubic Centimeters to Fluidrachms. 
I 
= 
.27 (4- .0005) 
2 
= 
•54 
3 
= 
.81 
4 
- 
1.08 
5 
- 
i-35 
6 
= 
1.62 
7 
= 
1.89 
8 
- 
2.16 
9 
= 
2.43 
Grains to Milligrams. 
I = 64.8 (- .OOO425) 
2 = 120.6 
3 = 194-4 
4 ' = 259.2 
5 = 324.0 
6 = 388.8 
.7 = 453-6 
8 = 518.4 
9 = 583-2 
Minims to Cubic Centimeters. 
I = .0616 
2 = .1232 
3 = .1848 
4 = .2464 
5 = .3080 
6 = .3696 
7 = .4312 
8 = .4928 
9 = -5544 
Fluidrachms to Cubic Centimeters. 
I = 3-7 
2 = 7-4 
3 = 111 
4 = 14.8 
5 = 18.5 
6 = 22.2 
7 = 25.9 
8 = 29.6 
9 = 33-3 TABLES. 
239 
Liters to Fluidounces. 
I 
= 
33.8 (+ .on) 
2 
= 
67.6 
3 
= 
101.4 
4 
= 
135-2 
5 
= 
169.0 
6 
= 
202.8 
7 
= 
236.6 
8 
= 
270.4 
9 
= 
304.2 
Liters to Pints. 
I 
= 
2.1 (+ .013188) 
2 
= 
4-2 
3 
= 
63 
4 
= 
8.4 
5 
= 
10.5 
6 
= 
12.6 
7 
= 
14.7 
8 
= 
16.8 
9 
= 
18.9 
Inches to Millimeters. 
I 
= 
25.4 (4- .00005) 
2 
= 
50.8 
3 
= 
76.2 
4 
= 
101.6 
5 
= 
127.0 
6 
= 
I52-4 
7 
= 
177-8 
8 
= 
>93-2 
9 
= 
228.6 
Fluidounces to Cubic Centimeters. 
i = 3° (- -4238) 
2 = 60 
3=9° 
4 = 120 
5 =• 150 
6 =180 
7 . 210 
8 = 240 
9 = 270 
Pints to Liters. 
1 = -473 (+ -00022) 
2 = .946 
3 = 1-419 
4 = 1.892 
5 = 2.365 
6 = 2.838 
7 = 3-3II 
8 = 3784 
9 = 4-257 
Millimeters to Inches. 
1 = .03937 
2 = .07874 
3 - .11811 
4 - .15748 
5 = .19685 
6 = .23622 
7 = .27559 
8 = .3J496 
9 = -35433 240 
APPENDIX. 
Meters to Feet, 
I 
= 
3.28 
2 
= 
6.56 
3 
= 
9.84 
4 
= 
13.12 
5 
= 
16.40 
6 
- 
19.68 
7 
= 
22.96 
8 
= 
26.24 
9 
= 
29-52 
Feet to Meters. 
I 
= 
.3048 (4- .0000005) 
2 
= 
.6096 
3 
= 
.9144 
4 
= 
1.2192 
5 
= 
1.5240 
6 
- 
1.8288 
7 
= 
2.1336 
8 
= 
2.4348 
9 
= 
2.7432 
To Convert Degrees of Fahrenheit's Thermometer to Centigrade, and 
vice versa. 
Centigrade to Fahrenheit. 
I = 
1.8 
2 = 
3-6 
3 = 
5-4 
4 = 
7.2 
5 = 
9.0 
6 = . 
io.8 
7 = 
12 6 
8 = 
14.4 
9 = 
16.2 
Fahrenheit to Centigrade. 
I = 
•555 (+ -000555) 
2 
= 
I. I IO 
3 
= 
1.665 
4 
= 
2.220 
5 
= 
2-775 
6 
= 
3-330 
7 
= 
3-885 
8 
= 
4-440 
9 
= 
4-995 
To use this table, convert the given 
number of degrees Centigrade into de- 
grees Fahrenheit, and add 320. 
To use this table, subtract 320 from 
the given number of degrees Fah- 
renheit, and convert the remainder 
into degrees Centigrade. 
(From Dr. Craig's Decimal System.) INDEX. 
Acetone, 104 
clinical significance of, 107 
indigo test for, 106 
iodoform test for, 105 
Legal's test for, 104 
Acid fermentation of urine, 23, 173 
Acute nephritis, 224 
Albumin, author's method of testing for small quantities of, 47 
to detect, by acidulated solution of common salt, 45 
by ferrocyanide of potassium, 45 
by heat, 34 
by nitric acid, 35 
by picric acid, 42 
by potassio-mercuric iodide, 44 
by sodium tungstate, 44 
quantitative estimation of, 51 
quantity found in urine, 53 
remarks on testing for small quantities of, 47 
-test papers, 45 
Albuminoid degeneration of kidney, 227 
Alkaline fermentation of urine, 24, 174 
Alkapton, 69 
Ammonium urate, recognition, 186 
Amyloid kidney, 227 
Apparatus required for urine examination, 15 
Bacteria, 219 
Biliary acids, 133 
Oliver's new peptone test for, 135 
Oliver's peptone test-papers for testing for, 139 
Pcttenkofer's test for, 134 
quantitative estimation by Oliver's method, 138 242 
INDEX. 
Biliary coloring matters, 128 
decomposed, test for, 132 
Fleischl's modification of Gmelin's test, 130 
Gmelin's nitrous acid test for, 129 
Heller's test for, 130 
Marechalt's test, 131 
Ultzmann's test for, 131 
Blood, coloring matters of, in urine, 119 
Blood-corpuscles in urine, 208 
recognition of, 209 
Calculi, urinary, 231 
to determine composition of, 232 
Carbonate of lime, deposits of, 195 
Casts of the uriniferous tubules, 210 
Chlorides, 161 
clinical significance of, 162 
detection and approximate estimation of, 161 
Mohr's nitrate of silver volumetric process for, 163 
nitrate of silver test for, 162 
Cholesterin, 142 
Chylous urine, 21 
Coloring matters, 109 
abnormal, 119 
normal, no 
vegetable, 127 
Creatin, 160 
Creatinin, 160 
Cupric test-papers, 78 
-pellets, 77 
Cystin, chemical characters of, 197 
deposits, 198 
Deposits, urinary, organized, 199 
Diacetic acid, 106 
chloride of iron test for, 107 
clinical significance of, 107 
Dumb-bells of oxalate of lime, 188 INDEX. 
243 
Entozoa, 222 
Epithelium, 205 
Extraneous substances found in urine, 177 
Fat in urine, 21, 141 
Fehling's solution, 54 
Fibrin, 65 
Fruit-sugar, 102 
Fungi, 219 
Globulin, 54 
Glucose, 67 
approximate estimation by Moore's test, 69 
by Roberts' fermentation test, 79 
Bbtger's bismuth test for, 80 
Briicke's modification of the bismuth test for, 80 
copper tests for, 70 
Dudley's modification of the bismuth test for, 80 
Fehling's solution for testing and estimating, 73 
fermentation test for, 78 
indigo-carmine test for, 86 
lead process for, 99 
Moore's or Heller's test for, 68 
Pavy's solution for testing and estimating, 73 
picric acid test for, 82 
quantitative estimation by indigo-carmine, 89 
by picric acid, 83 
by polarimetry, 94 
to detect the presence of, by specific gravity and quantity, 68 
Trommer's test for, 70 
volumetric process for estimating, 76 
Gonorrhoea, pus from, 205 
Haematin, 119 
Alemen's test for, 125 
Heller's test for, 123 
Struve's test for, 125 
test for, by precipitation of albumin, etc., 124 244 
INDEX. 
Haematuria, 122 
Haemin crystals, to prepare, 124 
Haemoglobin, 119 
clinical application of Mahomed's test for, 121 
Mahomed's test for, 120 , 
Stevenson's modification of Mahomed's test for, 121 
Haemoglobinuria, 122 
Hemialbumose, 64 
test for, 65 
Hippuric acid, 161 
Hydrobilirubin, m 
test for, 112 
Indican or indigogen, 115 
clinical significance of, in urine, 116 
Heller's test for, 115 
Jaffe's test for, 116 
Inorganic constituents of urine, 161 
Inosite, 101 
Introduction, 13 
Kidney, acute inflammation of, 224 
hyperaemia of, 228 
albuminoid, 227 
amyloid, 227 
chronically contracted, 226 
fatty contracting, 226 
lardaceous, 227 
large white, 225 
Lactose, 103 
Laevulose, 102 
Lardaceous degeneration of the kidney, 227 
Lead process for testing for glucose, 99 
Leucin, 139 
as a urinary deposit, 195 
chemical characters of, 196 
detection of, 139 INDEX. 
245 
Lime, carbonate of, 195 
phosphate of, as a urinary sediment, 192 
chemical characters, 195 
recognition of, as a urinary sediment, 195 
Ludwig, theory of secretion of urine, 13 
Mahomed's method of testing for haemoglobin, 120 
Melanin, 125 
Methaemoglobin, 119 
Milk sugar, 103 
Morbid growths, elements of, in urine, 222 
Mucin, 55 
in normal urine, 56 
to test for, 56 
Mucus, 161, 199 
Mucus-casts, 214 
Mucus-corpuscles, 200 
Murexid test for uric acid, 158 
Nephritis, acute parenchymatous, 224 
chronic parenchymatous, 225 
interstitial, 226 
Nitric acid test, 37 
Octahedra of oxalate of lime, 187 
Odor of urine, 31 
Oil in urine, 21, 141 
Organic constituents of urine, 33 
Oxalate of lime, artificial formation of, 189 
chemical characters of, 188 
clinical significance of, 190 
deposits of, 187 
recognition of, 187 
sources of, in the urine, 190 
Paraglobulin, 54 
Penicillium glaucum, 221 246 
INDEX. 
Peptone, 58 
biuret test for, 60 
Johnson's test for, 62 
phosphor-tungstate test for, 59 
Ralfe's test for, 61 
Randolph's test for, 62 
Peptonuria, clinical significance of, 63 
Phosphate of lime, deposits of, 192 
their recognition, 195 
Phosphates, 164 
alkaline, approximate estimation of, 166 
clinical significance of, 167 
nitrate of silver test for, 167 
ammonio-magnesian, deposits of, 192 
earthy, 191 
as urinary sediments, 191 
chemical characters of, 195 
clinical significance of, 165 
detection and approximate estimation, 164 
of lime as a urinary sediment, 192 
recognition of, 195 
Phosphoric acid, volumetric process for, 168 
Picric acid test for albumin, 42 
Pigmented markings on glass slides, 178 
Polarizing saccharimeters, 94 
Propeptone, 64 
Proteids found in urine, 54 
contrasted, 66 
Pus, changes in urine containing, 203 
character of urine containing, 202 
-corpuscles, 151 
action of reagents, 201 
Donnfe's test for, 203 
sources of, in urine, 204 
Quantity of urine, 29 INDEX. 
247 
Reaction of urine, 23 
Reagents required for urine examination, 15 
Recording an examination, 236 
Remarks on testing for sugar, 98 
Renal diseases, differential diagnosis of, 224 
Sarcina, 221 
Sediments, organized, 199 
unorganized, 179 
Selecting a specimen of urine, 18 
Seminal tubules, casts of, 216 
Serutn-globulin, 54 
Solids in urine, 32 
Specific gravity of urine, 24 
variations in, 25 
to determine, 26 
for very small quantities of fluid, 29 
Spermatozoids, 218 
Sugar fungus, 220 
of milk, 103 
Sugars found in urine, 67. See Glucose. 
Sulphates, clinical significance of, 169 
detection and approximate estimation, 169 
Sulphuric acid, volumetric process for, 170 
Tables, 238 
Tube-casts, 210 
Tyrosin, 139, 195 
as a urinary deposit, 195, 197 
chemical characters of, 196 
detection of, 196 
Urates, 159 
acid, test for, 186 
deposits of, 183 
their test and recognition, 183, 186 
Urea, detection and estimation, 142 248 
INDEX. 
Urea, volumetric analysis for, by Fowler's process, 156 
by Liebig's method, 145 
by the hypobromite process, 150 
Uric acid, 157 
carbonate of silver test for, 158 
compounds of, 183 
their recognition, 183 
deposits of, 179 
recognition of, 179 
tests for, 181 
detection by microscope, 157 
murexid test for, 158 
quantitative estimation of, 159 
Urinary calculi, 231 
deposits, 172 
classification of, 178 
organized, 199 
rationale of production of certain forms, 173 
unorganized, 179 
Urine, acid fermentation of, 23, 172 
color of, and deviations therefrom, 22 
coloring matters of, 109 
consistence of, and deviations therefrom, 21 
extraneous substances found in, 172 
general physical and chemical characters of, 19 
inorganic constituents of, 161 
its transparency, and deviations therefrom, 19 
odor of, 31 
order of examination of, 33 
organic constituents of, 34 
quantity of, and variations, 29 
reaction of, 23 
secretion of, 14 
selecting specimen of, for examination, 18 
specific gravity of, 24 
to determine specific gravity of, 26 
to determine solid matters of, 32 INDEX. 
249 
Urine, to prepare for examination for casts, 216 
Urinometers, 27 
Urobilin, m 
test for, 112 
Urochrome ofThudichum, 114 
Uroerythrin in urine, 126 
clinical significance of, 127 
detection of, 126 
Uroglaucin, or indigo blue, 115 
Urohaematin, Harley's test for, 113 
Urophain, m 
Heller's test for, 112 
Uroxanthin, Heller's test for, 115 
Jaffe's test for, 116 
Urrhodin, or indigo-red, 115 
Vegetable coloring matters in urine, 127 
detection of, 127 
Xanthin, 160 
Yeast fungus, 220