+£f*?r,*",^1"'Hi*iH .t..!..'l'i''*':-^;'*.'' %JrT"ri'• ............' lOjk........^„.'a«u4i^y 440 V 1/ | ^fe .era QT3^t)^c^Qfr)OtxQ,s^£yoQ^l:^eeie^ Surgeon General's Office ]:• i ■ yccfri N „,!■£ ^ MANUALS BLOOD AND URINE. ON THE BLOOD AND URINE. BY JOHN WILLIAM GRIFFITH, M.D., F.L.S., &r. G. OWEN REES, M.D., F.R.S., F.G.S., &c\ AND ALFRED MARKWICK, M.D., &c. IN ONE VOLUME. PHILADELPHIA: LEA k BLANCHAUD. 1848. est mi ADVERTISEMENT. The three works embraced in this volume, were published in London separately; but the immediate connection and im- portance of the subjects treated, have induced the American Publishers to embody them in a volume suitable for reference and preservation. Philadelphia, Maul, 1S48. s PRACTICAL MANUAL, * CONTAINING A DESCRIPTION OF THE GENERAL, CHEMICAL AND MICROSCOPICAL v CHAEACTERS OF THE BLOOD, SECRETIONS OF THE HUMAN BODY, AS WELL AS OF THEIR COMPONENTS, INCLUDING BOTH THEIR HEALTHY AND DISEASED STATES; WITH THE BEST METHODS OF SEPARATING AND ESTIMATING THEIR INGREDIENTS ; ALSO, A SUCCINCT ACCOUNT OF THE VARIOUS CONCRETIONS OCCASIONALLY FOUND IN THE BODY AND FORMING CALCULI. „\ / JOHN WILLIAM GRIFFITH', M.D., F.L.S., &c *V? PHILADELPHIA: LEA &~B LANCHARD. 1848. TO G O L D I N G BIRD, A.M., M.D., F.L.S., ASSISTANT PHYSICIAN TO GUY'S HOSPITAL, &c. &c, AS A SLIGHT TESTIMONY OF RESPECT AND GRATITUDE ! ROM HIS OBLIGED AND SINCERE FRIEND, THE AUTHOPv. PREFACE. This Manual is intended to assist the practitioner or student in medicine in discovering the deviations from health, and their nature in the blood and the various secretions of the body. An outline of the mode of analysing the different products, suffi- cient for practical purposes, is also subjoined, so as to make it a complete practical manual. The several branches of this subject have lately received a large share of attention, particu- larly from the German and French authors : and treatises somewhat analogous to this have appeared in those languages. The absence of such a one in this country has induced me to undertake the filling up of this deficiency. Much has also lately been done in the application of organic chemistry to the explanation of the phenomena of healthy and morbid actions. But I have avoided any notice of these views, as in many cases they are quite theoretical, and in the majority not Avell esta- blished. The use of the modern microscope is revealing to us the true structure of bodies in health, and their alterations in disease, with their true relations to their vital products, secre- tions. And as recourse to the microscope often abbreviates chemical experiments, and enables us to ascertain the chemical nature of very minute portions of matter, I have added an ac- count, with figures of the microscopical characters of each sub- stance. In some cases, where I have not had opportunities, or at least insufficient ones, of testing their accuracy, or where I do not feel authorised in assenting to the correctness of their observations, I have borrowed the statements of former authors, Vlll rind have given their names as authorities. Further informa- tion on these subjects and all their branches may be obtained from the writings of Becquerel, Berzelius, Bird, Christison, Liebig, Prout, Rayer, Rees, Sinion, Turner, Vigla, Vogel, and Willis, to whom in some instances I am much indebted. I have also to acknowledge the kind assistance offered me on several occasions by W. Francis, Esq. It is to be wished that the facility I trust this Manual will afford those anxious to prose- cutc this most interesting branch of medical inquiry, in exa- mining and appreciating morbid states of the various secretions, may enable us shortly to arrive at some more satisfactory con- clusions respecting the pathological relations of these fluids. 9 St. John's Square, April, 1343. PART I. CONTAINING THE GENERAL, CHEMICAL, AND MICROSCOPICAL CHARACTERS OF THE UBINE AND ITS DEPOSITS, BOTH IN HEALTH AND DISEASE, AS ALSO THOSE OF VESICAL CALCULI. INTRODUCTION. To those unaccustomed to chemico-mieroscopical examina- tions the following observations will save much trouble and vexation. 1. The specific gravity of urine is taken either by the Uri- nometer or the Specific Gravity bottle; if the former be used we should bear in mind that its indications are never so correct as those of the bottle, although quite sufficiently so for ordinary purposes ; and moreover, those instruments sold at the shops should always be carefully tested as regards accuracy, by com- parison with some standard instrument or the bottle. II. In testing the acidity of urine use thin blue, and for alka- linity slightly reddened litmus paper. I have repeatedly seen urine considered neutral from neglect of attention to the former circumstance when it was decidedly acid. III. Be sure your tests are pure, otherwise in operating on small quantities, you will be extremely puzzled at some of your results. The purity of your tests will be sufficient, provided they stand the examination required by the London Pharma- copoeia. Oxalate of ammonia, not mentioned there, should be entirely dissipated by heat; and all that is precipitated from its solution by chloride of barium should dissolve in nitric acid. IV. The best mode of microscopically examining urinary sediments is this :—Allow the urine to stand ; decant the su- pernatant fluid; pour the remainder into a watch-glass; draw off the small quantity of fluid remaining after a short repose by means of a pipette, and then it can be conveniently viewed under the field of the microscope. In most cases an achro- 12 matic half-inch object-glass will be quite sufficient for the dis- cernment and distinction of these deposits ; but some few re- quire one-eighth of an inch, as the pus and mucus globules, lithate of ammonia, and oxalate of lime. In urine, as is very frequently the case, where there is much lithate of ammonia mixed with the sediment, warm it gently in a watch-glass, then the supernatant liquid containing the lithate in solution can be removed by the pipette, and any insoluble sediment distinctly perceived. When we use the high powers of the microscope, we must not view sediments in a watch-glass, but, having ob- tained them moist in the watch-glass as above, pour this on to the middle of a glass slip, then drop a small square of thin glass over it; thus we have the object perfectly flat, the mois- ture is prevented from condensing on the object-glass, and there is no risk of scratching the latter. V. It is often required for the sake of comparison to pre- serve these sediments : this may be done either moist or dry. Those only are preserved moist which are very transparent, as the oxalate of lime, globular lithate, pus, blood, &c. ; the rest may be preserved in Canada balsam. "Whenever you intend to preserve any deposit, be sure first to wash it well with dis- tilled water, to free it from the gummy deliquescent matter Avith which it is combined in the urine. If to be preserved in bal- sam, allow it to dry on a glass slide ; then hold some Canada balsam on the end of a stick over a spirit-lamp at some distance from the flame,* so that it shall gently melt; just as it has melted and is on the point of dropping from the stick, hold under it the previously gently Avarmed glass slip lying on Avhich is the deposit; in this manner so much of the balsam may be dropped on the glass as is sufficient to cover the deposit: Avhile it is still Avarm, drop on the surface of the balsam a slip of thin glass, also previously warmed, press this gently, alloAv the whole to become hard, and the specimen is permanently pre- * If this be not attended to bubbles will be formed and the speci- men spoiled. 13 served. All the objects for examination by polarized light are beautifully prepared in this manner. Those to be kept moist, are Avashed carefully, placed on a glass slip, and a drop or two of Aveak spirit, water saturated Avith creasote, or Godby's fluid,* used without heat in the same manner as the balsam. As soon as all the fluid not confined between the two glasses has been carefully Aviped aAvay, surround the thin glass at its edges Avith gold size thickened with lamp-black (this may be dropped around the edges of the glass with the end of a pen,) and allow it to dry; thus Ave have the specimen permanently preserved in a cell. Some objects require to be preserved in syrup ; a strong syrup should be made mixed with a little gum, this should be kept for some time, and then used Avifhout heat in the same Avay as the balsam. Salts and pus, Avith other organic globules occasionally present, may be Ave 11 preserved in this way. VI. I shall now give an abstract account of the ordinary modes of procedure in the analytical examination of the urine, the minute details will be found in other parts of this Avork. When we wish to examine any specimen of urine, it is very important that some of its characters should be ascertained as soon as possible after it has passed; this is particularly the case with those specimens which contain excess of urea or mucus, as alkalinity occurs so soon in some of these cases, in the secretion which is acid at the time it is passed, as to be without care a source of error. Those containing excess of acid keep better. The first point then is to note its acidity (II.) The amount may be estimated by neutralizing the free acid by a dilute solution of ammonia, the quantity of the solution re- quired, and Avhose strength is previously known, will indicate the proportion of acid. We noAV set it aside and allow the sedimentary portions to subside. Then having noticed the ap- parent characters of the sediment, pour off the upper clear * This is composed of bay-salt, one ounce ; alum, half an ounce; corrosive sublimate, one grain ; distilled Avater, half a pint. 14 portions (should the upper part not be clear it can be filtered.) We next notice the colour of the urine, and also take its spe- cific gravity. <*.. The sedimentary portion must be examined microscopically (vide IV.) and then chemically. We have now obtained some idea of its constituents; the peculiar ap- pearances of the organized portions can be compared Avith the figures in the Plates (PI. I. and II.,) and if there be any doubt about their composition, they can be examined chemically. /3. Should the sp. gr. of the urine be above or about 1030, we may suspect the presence of either sugar or excess of urea. The former may be ascertained by setting aside a portion in a Avarm place; the production of the peculiar vegetable organi- zations, forming the Avhite poAvdery surface, will readily decide this question (33.) The excess of urea may be also readily detected (11.) Should its sp. gr. be low, if the colour is pale and the urine clear, most probably the quantity is in- creased, and the solid contents diminished; if it be not clear but muddy and dull, albumen may be suspected, the presence of which is readily detected by ascertaining that the urine is acid and then boiling (19.) In all cases Avhere we are about to analyse the urine quantitatively, a small portion should be ex- amined previously, so that Ave may become acquainted Avith the predominating ingredients. Should the urine contain much mucus, this may be throAvn down by acetic acid or alcohol; by its being thus coagulated the fluid portion passes readily through the filter. In ordinary cases of filtration, Avhere the fluid is not loaded with insoluble portions, Ave may use filters whose weight is previously known, and the residue after combustion is very minute, and also previously known. Supposing then we have disposed of the deposits, and the filtered liquor is clear, if it contain albumen this is first esti- mated by boiling a proper quantity. The albumen thus co- agulated is collected on a filter, washed (the washings must be added to the filtered liquor,) and dried in a water bath. The weight of the dried albumen, minus the weight of the filter, gives us the absolute quantity of the former which the boiled 15 portion of the urine contained. When Ave require to be very accurate, or operate on very small quantities, the albumen must be boiled in alcohol or aether previous to desiccation, so as to separate fatty matter. The filtered albuminous liquor, as Avell as the Avashinors, or when no albumen is present, the original liquid is evaporated to dryness on the water-bath; the weight of the residue + the weight of the albumen Avhen present is the amount of solid constituents. Should this residue contain any fatty matter, this can be separated by boiling aether; the weight of this aethereal extract -f that obtained from the albu- men gives us the Avhole amount of fatty matter. Sometimes the aether dissolves, besides fat, other matters, as salts, &c; these are separated by Avashing Avith Avater. The extract Avhich has been treated Avith aether is then acted upon by al- cohol, sp. gr. -830; this dissolves the urea, colouring matter, suo-ar ^Avhen present,) alcoholic extract, metallic chlorides (sodium, potassium,) and sal-ammoniac, Avith the lactates. The filtered solution, together with the alcohol used for washing, is then e\-aporated to dryness. The Aveight of the residue gives the weight of all the above-named compounds. «. The urea is estimated by adding nitric or oxalic acid to its concentrated so- lution. /3. If sugar be present, this is either allowed to crys- tallize, or its quantity is estimated by fermentation. (33.) y. The fixed salts are estimated in quantity by incinerating the extract; the ash contains chloride of sodium, chloride of potassium as such, and the lactic salts Avith fixed bases as car- bonates (14.) The sal-ammoniac and volatile lactates have dis- appeared. The separation of those organic matters soluble in alcohol from those insoluble in that liquid is not ordinarily ne- cessary, the mode recommended in (14.) is sufficiently accurate. Another mode is, using a separate portion to calculate the urea (this portion ought to be more considerable than the one Ave are about to mention; the latter may be very small, pro- vided Ave have a delicate balance.) Evaporate, weigh, digest Avith alcohol, (-830,) and filter; lithic acid and the phosphates remain as a residue (these can be readily separated by the 16 solubility of the former in liquor potassas.) The alcoholic so- lution is evaporated, dissolved in a considerable quantity of water, and boiled with caustic lime, until the urea is completely decomposed. The lime is precipitated by oxalic acid; the ex- tract contains lactic acid, lactates, muriate of ammonia, and al- coholic extract, Avhose amount can be estimated by the filtra- tion and evaporation of the liquid. VII. The evaporations in all these cases should be performed in a steam-bath, or in some cases a water-bath may be used, but a high temperature should be carefully avoided. VIII. All incinerations should be performed in a porcelain or platinum capsule ; and whenever any liquid is to be filtered, the filter must be previously moistened Avith distilled Avater. IX. All reactions in Avhich colour is produced are best ob- served in Avhite, eartheuAvare, glazed, evaporating dishes or capsules. X. A freezing mixture is readily made either by mixing powdered nitrate#of ammonia and Avater in equal Aveights: or equal parts of nitre and sal-ammoniac powdered and added to four parts of water ; or pounded ice and common salt. Having now given Avhat Avill be sufficient on the general methods of examination, I will proceed to minuter details. GENERAL, CHEMICAL, AND MICROSCOPICAL CHAEACTERS OF THE URINE, &c. 1. The function of the kidneys is to separate from the blood by their selecting power certain compounds which are of no further use in the animal economy, and the reten- tion of which in the blood acts as a virulent poison to the system. These corapounds dissolved in water and forming the urine are very numerous, and of very different natures; some undoubtedly exist in the blood, Avhilst the detection of others eludes our strictest chemical investigations, con- sequently we must believe that they do not exist in that fluid. 2. The quantity of urine passed daily varies greatly ac- cording to circumstances. In health the most important of these is the state of the skin; the state of the liver is also intimately associated Avith that of the kidney, and conse- quently of the urine. The normal quantity may be con- sidered as between 30 and 40 ounces. The amount will be diminished if the secretion of the skin be much increased by active exercise, Avarmth, or sAveating from any cause; and much increased if the functions of the skin be impeded or suspended; in cold atmospheres, after copious draughts nf fluid, &c. 2 18 3. The odour when first passed is somewhat aromatic, but this disappears on cooling, Avhen it is replaced by one peculiar to that fluid. 4. Urine is always acid in health ; this acidity most probably depends upon the presence of acid salts. It does not, as was supposed, contain any super-salts of lime.* 5. Its specific gravity varies greatly in health, and is in an inverse ratio to its quantity. It may be said to vary from 1015 to 1025; the average throughout the day would be rather less than 1020. If the specific gravity be higher, an increased amount of solids need not be necessarily inferred,! because the quantity of the fluid may be di- minished ; nor if the sp. gr. be much diminished, is a dimi- nution of solids passed a necessary consequence, because the amount of the fluid may be increased ; so that in estimating the value of the sp. gr. we must pay particular attention to the quantity. Three varieties of urine may be distin- guished,— 1st, that passed after drink, and which is ex- ceedingly low in sp. gr., Urina Potus; 2d, that Avhich occurs after the completion of digestion, Urina Chyli, this is usually of the highest sp. gr. of any; 3d, that Avhich is passed in the morning, and is secreted from the blood, con- sequently not immediately affected by ingesta; this is the Urina Sanguinis. This may be considered as the pure renal secretion, and is that Avhich should generally be examined as indicating the state of the system. 6. The quantity of solid materials passed during the 24 hours varies according to the sp. gr.; it is on an average, in health, 2\ oz.4 the amount in any specimen of urine Avhose sp. gr. is knoAvn may be found out by reference to the following table :§— * Thomson, Animal Chemistry, 1843. j I allude to the quantity per diem, not the absolute quantity under examination. M " * Christison. § Becquerel. 19 Sp. gr. at 50° F. Solids* Sp. gr. at 50° F. Solids. 1001 1-65 1016 26-40 1002 3-30 1017 28-05 1003 4-95 1018 29-70 1004 6-60 1019 31-35 1005 8-25 1020 33-00 1006 9-90 1021 34-65 1007 11-53 1022 36-30 1008 13-20 1023 37-95 1009 14-85 1024 39-60 1010 16-50 1025 41-25 1011 18-15 1026 42-90 1012 19-80 1027 44-55 1013 21-45 1028 46-20 1014 23-10 1029 47-85 1015 24-75 1030 49.50 7. Urine is generally of an amber tint. The colouring matter varies much in its intensity, but it cannot be separated in a state of purity. The brown organic matter which gives the colour to inspissated urine and seems to be the source of its peculiar odour, has recently been examined, and has yielded a broAvn, fusible, resinous mass, having a strong odour of castoreum when dry, and a urinous smell when boiled Avith Avater.f The colouring matter is usually much increased in quantity when excess of lithic acid is present. Dr. Prout considers that there are two colouring principles in urine which are intimately related to each other, and which by their properties seem to indicate that they are related to lithic acid on the one hand, and some modification of that of the bile on the other. The colouring matter of the bile resembles lithic acid in assuming a purple tint by nitric acid. Polarized light when transmitted through healthy urine does not, when analyzed, develope any colour, nor is any notable change produced. 8. When healthy urine is first passed it is not quite trans- parent, but by repose it becomes so, and a very delicate cloud falls to the bottom of the containing vessel; this is mucus mixed with a few epithelial scales. Some have de- nied that there is any deposit in healthy urine, but by care- ful examination this is found invariably present. It may be * In 1000 parts. t Scharling. 20 collected by filtering the urine, when it remains on the filter as a transparent colourless mass, of a shining appearance when dry. Chem. prop.—It is readily soluble in nitric and acetic acids* and in liquor potassse ; the acid solutions are pre- cipitated by solution of ferrocyanide of potassium. It is not coagulated by boiling. It is insoluble in sulphuric acid. It contains albumen in some unknoAvn state of combination, as it is not coagulated by boiling or nitric acid, although it is precipitated by galvanic electricity and ferrocyanide of potassium. Mucus often exists in great excess in urine. In mild cases the ordinary mucous cloud is merely increased in quantity and retains the same appearance, except that upon careful examination Ave find very delicate opaque threads floating in it; these are composed almost entirely of the pe- culiar globules. When hoAvever it is more abundant it be- comes much firmer, and often forms large gelatinous stringy masses, which can be drawn out in ropes. When present it soon causes the urine to putrefy. It does not render it coagulable by heat, although often so by acetic acid; more- over it does not give evidence of free albumen. The pre- sence of mucus in the urine acts as a ferment, for after its separation it may be preserved a much longer time without decomposition. Microscop. characters.—It is almost entirely composed of amorphous, extremely minute granular particles ; sometimes we have one or two mucous globules similar to those of pus, and here and there an epithelial scale or two, but it is nearly all amorphous. 9. There is another deposit Avhich often exists in urine and is quite consistent with health : this is the lithate of am- monia. When healthy urine is placed under the receiver of an air-pump with sulphuric acid, and the atmospheric pressure is removed, a copious amorphous precipitate of this substance occurs; also when the quantity of urine is much diminished and the temperature reduced, this compound tails. It may be readily known from all others by its solu- * When the secretion of mucus is much increased it is 0nlv partially soluble in acetic acid. on|y 21 bility by boiling in water or urine, and its entire dissipation at a red heat; but for its minute characters vide (15.) I. Having thus noticed the general properties of the healthy secretion and its deposits, we will now examine its chemical constituents in health, with the means of separating and estimating them.* 10. The quantitative analysis of the urine which have been made are comparatively feAV, and that of Berzelius, which was made many years ago and has appeared in every work relating to the subject since, is almost the only pub- lished one which has been minutely carried out. But for practical purposes they are not required to be carried to the extent adopted by that illustrious chemist. The following may be taken as a type of what is quite sufficient for ordi- nary practical purposes:— 1. Water 2. Urea 3. Lithic acid 4. Fixed salts 5. Ammoniacal salts and organic matters. 972- 12- 0-398 6-918 8-6f ► = 1000 grs. The fixed salts are chloride of sodium, sulphates of soda and potash, phosphate of soda, magnesia and lime: thus— Chlorine......0-502 Sulphuric acid Phosphoric acid Soda Lime Magnesia Potash 0-855 0-317 \> 5-244 6-918 The organic matters and ammoniacal salts are lactic acid, lactate of ammonia, osraazone, animal extractive soluble in water only, muriate and phosphate of ammonia. * An excess of these constituting disease is noticed under each head. f Becquerel. 22 11. Urea.—This ingredient enters most largely into the composition of the urine, and to it many of its most im- portant properties are due. It is supposed to be generated in the human body during the destructive assimilation of the gelatinous tissues. It is formed in the blood, and the presence of the kidney is not necessary to its formation. Chem. prop.—When pure it is perfectly colourless ; neither acid nor alkaline ; crystallizes in the form of very delicate and silky four-sided prisms. It combines with, but does not neutralize acids. It is soluble in its own weight of cold Avater and in every proportion of hot; in 4| parts of cold and 2 of boiling alcohol, and it separates from the hot alcoholic solution on cooling. It is almost insoluble in sulphuric aether, forms crystalline compounds with nitric and oxalic acids, and is entirely dissipated by heat. It is composed of C2 O2 H4 N2. It is one of the few organic compounds which can be artificially prepared, and can be obtained thus :*—Mix 28 parts of dry ferrocyanide of po- tassium with 14 of peroxide of manganese in poAvder, and make the mixture as intimate as possible. Heat this on an iron "plate over a charcoal fire to a dull red heat; it must be well stirred while cooling. When cold digest it repeatedly in cold water, and mix the solution with 20^ parts of sul- phate of ammonia. The first concentrated liquid obtained by washing the residuum should be set aside, and the sul- phate of ammonia dissolved in the succeeding weak liquids. A copious precipitate of sulphate of potash falls. The supernatant liquor is decanted off and evaporated over the water-bath. More sulphate of potash falls, Avhich is sepa- rated, and this is repeated as long as the sulphate continues to form. The liquid is noAv evaporated to dryness, and the solid residue is digested in boiling alcohol of 80 or 90 per cent. The urea is dissolved. It crystallizes as the solu- tion cools or is evaporated.f A concentrated aqueous solution of urea is not precipi- * Although the description of such details as those necessary for the preparation of urea may appear contrary to what is expected in a practical manual, the artificial production of this compound is so highly interesting, and the process so readily conducted, that I am sure it will not be out of place here. f Liebig and Wohler. 23 tated by nitrate of silver, bichloride of mercury, alcohol, infusion of galls, nor alkalies. By the aid of the microscope Ave may ascertain the pre- sence of a very minute proportion of urea. Evaporate its aqueous or alcoholic solution ; then add a little nitric or oxalic acid ; delicate silky crystals of nitrate of oxalate of urea occur. This evaporation should be performed on a glass slide, and the subsequent crystallization examined by the microscope. The state of combination in Avhich urea exists in the urine is not satisfactorily ascertained. MM. Cap and Henry stated that it existed combined Avith lactic acid ; but others, on repeating their experiments, instead of obtaining lactate of urea, have obtained the urea pure, Avhich most probably Cap and Henry have mistaken for the lactate.* Moreover, M. Pelouze has proved that no such compound as lactate of urea exists. Its strong aqueous solution is not decomposed by ebulli- tion, whilst the diluted solution decomposes very rapidly, and is converted into carbonate of ammonia.f As it is so very soluble and readily decomposed, we generally estimate it in combination with nitric or oxalic acid. Its impure crystals can be best decolourized by a little permanganate of potash,^ which destroys the colouring matter and has little action upon urea; an excess of the salt is removed by alcohol, which converts it into peroxide of manganese. It often exists in excess, sometimes Avith increase in the quan- tity of the urine, when that fluid is pale ; it is always in excess when the quantity of urine is diminished and its sp. gr. high, and in combination with excess of lithic acid and the lithates. a. When an equal volume of nitric acid is added to a portion of urine in a Avatch-glass, if there be no excess of urea present no crystallization takes place ; but if there be * Turner's Chemistry by Liebig and Gregory; and Chemical Gazette, No. 3, December, 1842. f M. Vogel found that the relative proportion of urea was not diminished in urine by keeping for six weeks, nor by boiling for three hours and a half, but this is certainly not commonly the case.— Ankilung zum Gebrauch des Mikroskopes, Leipzig, 1841. X Turner's Chemistry by Liebig and Gregory. 24 excess, a brownish-yellow crystalline* compound is formed; this is the nitrate of urea. Its appearance is preceded by the formation of some bubbles, and in acid urine these bubbles are generally more numerous the larger the quantity of urea present, so that its presence in excess may generally be foretold. Its crystallization sometimes takes place in a feAv minutes, sometimes it requires a lapse of several hours. This is a very rough method of detecting an excess of urea, and in making use of it we must carefully notice the tem- perature, because the higher this is, the less likely will the crystallization be to take place, and vice versa. b. To estimate its quantity more accurately proceed thus: I. Evaporate the urine to dryness over a steam-bath; moisten this extract with water, and pour strong alcohol on it. Evaporate this to dryness with a very Ioav heat; dis- solve it in a small quantity of water, and add nitric acid; then place the compound in ice or a freezing mixture. Throw it then on a filter, and wash it with ice-cold water, gently press and dry it. By then subtracting the previously knoAvn Aveight of the filter from that of the dried filter con- taining the nitrate of urea, we ascertain the amount of the latter, and on subtracting the proportional of nitric acid from this, Ave obtain the weight of the urea present. Nitrate of urea is composed of 52-63 nitric acid + 4737 urea in 100 parts. II. Evaporate a given weight of urine over the open stearn-bath to dryness; boil successive portions of alcohol on the dry residue until nothing more is taken up ; mix the liquors; evaporate to the consistence of an extract; redis- solve in a small quantity of lukewarm Avater; add oxalic acid to this solution until no more becomes dissolved on heating the liquid to 122° F. Allow the liquor to cool • a crystalline deposit of oxalate of urea occurs ; collect this on a filter and wash it with a small quantity of weak solution of oxalic acid. This last, as well as the mother-liquor, must be evaporated to procure any crystals which may exist in them ; the crystals must then be dried in bibulous paper • then redissolve them in water, and neutralize the oxalic * These crystals appear when perfect as rhomboidal tables somP- times having the angles truncated. (Vide PI. II. figs. 37 and 38>) 25 acid with carbonate of lime; filter and well wash the pre- cipitate. Evaporate the filtered liquors and the Avashings over the open steam-bath, and weigh the extract.* This should be entirely soluble in anhydrous alcohol; if not, the weight of the residue must be deducted from that of the extract; we thus get the Aveight of the urea. Or Ave may calculate the amount of urea by deducing its weight from that of the undecomposed oxalate, which is in general the best mode. Oxalate of urea is composed of oxalic acid, 37-436 " " " " urea " 62-564 100-OOf III. Or nitric acid may be used instead of the oxalic, and the nitrate of urea decomposed by carbonate of baryta, in- stead of carbonate of lime. c. To extract the urea in diabetic urine:—Expose a given quantity of urine, mixed with some yeast, to the tempera- ture of 80°, in a graduated glass jar inverted over a mer- curial bath; we thus get rid of the sugar by fermentation, and can proceed as below (d): the quantity of sugar present is also indicated at the same time (33.) d. To estimate the urea in albuminous urine:—Evaporate the urine to dryness in an open steam-bath, treat the residue with boiling alcohol. Evaporate the alcoholic solution and redissolve the extract in distilled water; concentrate this to a syrup, then mix it Avith half its bulk of pure nitric acid. Place it in a freezing-mixture : the crystallized nitrate is then produced. The supernatant liquid is then poured off, the crystals Avashed Avith ice-cold water and dried in the open steam-bath. We may then calculate the amount of urea by abstracting the equivalent of nitric acid from the weight of the crystalline nitrate. e. For the peculiar effect of the presence of urea in alter- ing the ordinary form of the crystals of chloride of sodium, see (13.) * These evaporations must not be hurried ; if they are, no depen- dence can be placed upon the results. p Berzelius. 26 12. Lithic Acid exists in the urine combined with am- monia. This compound is deposited from healthy urine under certain circumstances. (9.) a. Chem. characters.—It is soluble in 10,000 parts of cold Avater, the solution feebly reddens litmus. When pure it is white, but is always coloured when existing as a urinary deposit; insoluble in alcohol and aether; soluble in liquor potassae and strong sulphuric acid, from the latter of which it is precipitated by Avater; sparingly soluble in the alkaline carbonates;* rather more soluble in strong hydrochloric acid than in water; soluble in both diluted and strong nitric acid, equal volumes of gaseous carbonic acid and nitrogen being given off. After evaporating the nitric solution a red extract is left, which becomes of a beautiful purple by the addition of ammonia. This is the purpurate of ammonia, purpurine, or murexide, and is the characteristic of the presence of this acid. Murexide is but slightly soluble in cold water, but colours it of a fine purple; it dissolves in Avater at 158°, and crystallizes on cooling; it is insoluble in alcohol and aether. Urea is formed by the distillation of lithic acid. The crystals of lithic acid are of a yelloAvish brown colour; the colouring matter is related to that of the bile, as, like it, it becomes of a purple colour by the action of nitric acid. The composition of lithic acid is CI0 N4 H4 06. b. Microscop. characters.—It is always crystalline. As occurring in urine the crystals are always coloured. Their varieties of form are almost endless ; the most common only Avill be noticed. The crystals are either separate or com- bined into clusters. When separate, the outlines are either rhomboidal, square, or rectangular, and all their varieties appear to me to be clearly explained by assuming them as derived from the right rhombic prism. The most perfect and the largest crystals generally approach nearest to this form. In many cases this prism is very much flattened, so as without great care to be mistaken for a rectangular plate. A cube of lithic acid I have never seen, although I have sometimes been sho\vn Avhat Avas considered one i. e. a crystal wi* a square surface; the other surfaces were not seen in these cases, but only imagined. In many cases we * Lithic acid is most soluble in carbonate of lithia (1 to 40 27 find the prisms of tolerable length, as in PI. I. fig. 1; of course here the rectangular outline of the crystal, as it lies on its side, is very distinct (but by moistening any speci- mens we are examining with Avater, and then adding a little aether or spirit, currents are produced which cause the crys- tals to turn over continually and in every direction, so that a full vieAv of every surface is obtained.) In other cases the prisms are extremely short, so as to lie upon one of their flat extremities; here of course the rhomboidal base only is seen, as in. PI. I. fig. 2. In many cases, especially where the acid has been precipitated by the addition of muriatic or nitric acid, the crystals possess a curious hour- glass internal structure; the relations of this are difficult to comprehend. In some cases the two obtuse angles of the rhombic prism are replaced by tAvo semicircular facets, as in PI. I. figs. 3 and 4. A very curious modification of form is seen in the lithic acid obtained from the guano, or the excrement of serpents; in these Ave find the crystals are ex- tremely thin, possess the hour-glass internal structure, and are apparently nothing more than delicate tables ; but by vieAving them Avhen turning over, Ave can distinctly see that they are the same rhombic prisms very much flattened. In many cases, where the containing urine has been very acid, the crystals are striated, as in PI. I. fig. 13 /3; but in others Ave find this without any such acidity. The aigrettes and other combinations we so frequently meet with seem irre- gularly or more hurriedly formed, although sometimes Ave find them in the urine mixed with the ordinary rhomboids (see PL I. figs. 9 and 12.) When Ave add a feAv drops of any- acid to urine the lithate of ammonia contained in it is de- composed; the acid added appropriating the ammonia, whilst the lithic acid falls in crystals (PI. I. fig. 1.) This is the ordinary mode of ascertaining the amount of lithic acid present in urine ; for this purpose use muriatic or acetic acid, as nitric acid dissolves trie lithic acid. c. Urine containing a deposit of lithic acid is generally minus* its proper quantity in solution; some acid furnished by the system decomposing the lithate of ammonia in its * In the majority of cases of lithic acid gravel the amount of that compound deposited very much exceeds that ever naturally contained in the urine. 28 passage to the bladder. This is sometimes lactic acid, sometimes phosphoric, and sometimes sulphuric. The crystals of lithic acid, Avhen examined by polarized light, develope splendid colours ; the pure do so beautifully. This is sufficient to show that cubes of this substance can- not exist, inasmuch as it does not belong to the cubic system. d. Calculi composed of lithic acid are generally smooth, or having broadish tubercles ; of a brownish-yelloAv colour, with their layers concentrically arranged ; and are readily distinguished by their entire volatility by heat ;* insolubility in water; formation of murexide Avith nitric acid and sub- sequent evaporation; solubility in liquor potassae; and re- precipitation in a pure crystallized state by the subsequent addition of an acid. 13. The fixed salts are chloride of sodium, sulphates of soda and potash, phosphate of soda, magnesia and lime. For ordinary purposes these may be estimated together; they constitute the residue of the incineration of the extract arising from the evaporation of any given Aveight of urine. They are composed of salts soluble and those insoluble in water. The former are alkaline, the latter earthy salts. A portion of silica has usually been considered as present in urine, but the quantity is so minute, if really existing in health, that it is not worth noticing; it would remain in combination with the earthy phosphates. Should you re- quire to separate the alkaline salts proceed thus:—Divide their solution in water into two parts ; acidulate one of these with nitric acid; then precipitate the contained sulphuric acid by nitrate of baryta; the sulphate of baryta falls as a white precpitatef (the other salts of baryta would be dis- solved by the nitric acid should they form in the solution;) this is collected on a filter, washed, and dried; it is then weighed and by deducting the weight of the barvta we am- J Amorphus and granular. 29 monia, a precipitate of phosphate of baryta* falls ; this must be collected and dried on a filter; by abstracting the Aveight of the baryta Ave obtain the Aveight of the phosphoric acid. (Vide Table.) The second portion is used to determine the quantity of muriatic acid present. Acidulate this with nitric acid. (This dissolves the phosphate of silver or the sulphate, should any be formed.) On the addition of solution of nitrate of silver, an insoluble curdy chloride is formed,! Avhich must be collected on a filter, Avell washed, and then fused. From the Aveight of this Ave abstract the Aveight of the silver, Avhen Ave obtain the Aveight of the chlorine pre- sent. (Vide Table.) To ascertain the Aveight of the bases we must add the correct proportions requisite fomeutral combination. The sulphuric acid must be divided between potash and soda ; the phosphoric and muriatic acids are in combination with soda only. Table shoAving the composition of the various salts men- tioned above.! Phosphate of baryta Sulphate of baryta . Sulphate of potash Chloride of silver . Chloride of sodium Phosphate of soda . Sulphate of soda . (Baryta 68 20 -f acid'31-80 = 100 (Baryta 6563 -f acid 34-37 = 100 Potash 54-07 + acid 45-93 = 100 Silver 75-33 + acid 24-67 = 100 Sodium 39-66 + acid 60-34 = 100 Soda 46-70 + acid 59-30 = 100 Soda 43-82 -f acid 56-18 = 100<§ Common salt ordinarily crystallizes in cubes; a peculiar structure is apparent in many of these crystals Avhich gives very much the appearance of octahedra (PI. II. fig. 28.) When common salt is sloAvly evaporated from its solution in urine it crystallizes in octahedra, tetrahedra, and in irre- gular hexagonal plates, &c. (PI. II. fig. 29.) These latter might be confounded with cystine ; but they are readily soluble in water, which cystine is not; and they are not destroyed by a red beat, which cystine is; moreover, we rarely or never see an equilateral hexagonal plate as in cys- * Idem, f Idem. % In the anhydrous state. $ Berzelins. 30 tine. The effect of polarized light would in some instances assist us. When common salt is crystallized rapidly by evaporation from a solution containing urea, delicate foliaceous crystals are produced, among Avhich the form of the dagger is pre- dominant. This has been proposed as a test of the pre- sence of urea, and may perhaps in some cases be useful. (PI. II. figs. 30 and 31.) The* presence of soda in any residue of incineration is readily indicated by the blowpipe.* The ash is moistened Avith distilled Avater, and placed in a loop or small coil of pla- tinum wire ; by directing the point of the inner flame against this, the outer flame becomes tinged intensely yellow. Potash is recognised by its concentrated watery solution being precipitated by an excess of tartaric acid, forming a crystalline bitartrate. When examined by the microscope this appears in the form of rhomboidal colourless tables,! sometimes perfect, but ordinarily with truncation of the acute angles ; or a spirituous solution of chloride of plati- num gives a yellow precipitate, Avhich appears under the microscope composed of aggregations of small prismatic crystals.| Both these reagents hoAvever give certain evi- dences of the presence of potash only Avhen the substances suspected to contain it are incinerated ; for concentrated ammoniacal solutions produce similar precipitates Avith these reagents. By the blowpipe the salts of potash jield. a voilet tinge to the flame. The mode of separating the magnesia and lime in the earthy phosphates is this:—Dissolve in dilute hydrochloric acid, nearly neutralize by ammonia, Avarm gently, and then add slight excess of oxalate of ammonia ; an insoluble pre- cipitate of oxalate of lime falls ; this appears under the mi- croscope either in amorphous granular masses of a dull colour, or when the formation is slower, small brilliant oc- tahedral crystals (PI. II. fig. 26.) The subsequent addition * The antimonite and antimoniate of potassa have been recom- mended as tests for soda forming a white crystalline precipitate ?n us solutions; no free acid must be present. K'^ipuaie in f Vogel. 1 have always obtained the bitartrate from urine in the prismatic, not tabular form. ln :ne t U. These have appeared to me as very minute octahedra. 31 of ammonia precipitates the phosphate of magnesia.* This assumes the form given in PI. I. fig. 18. If we wish to obtain the amount of sulphuric acid present in any product we are examining, it may be done by acidulating as above with nitric acid, and the subsequent addition of nitrate of baryta. The amount of phosphoric acid may be estimated in the residue of earthy phosphates, by dissolving these in dilute nitric acid,! nearly neutralizing by ammonia, and then adding solution of nitrate of silver, when the yel- low phosphate is precipitated. This phosphate of silver is composed of 82-99 parts of oxide of silver -f- 17-01 parts of phosphoric acid in 100. 14. The Lactates, Ammoniacal Salts, and organic matter with them cannot be completely separated ; and for practical purposes they are best estimated together. There is most probably free lactic acid in the healthy urine. We obtain the weight of these matters in an analysis thus: — Evaporate a given Aveight of urine over the steam-bath to dryness, weigh the residue. Then incinerate and decar- bonize this residue ; again weigh ; Ave then know the weight of the destructible portions of the extract; if from this we extract the weight of the urea and lithic acid we shall have the desired weight. The state in which lactic acid exists in the urine is un- certain. It is soluble in water and alcohol, as are most of its salts. No precipitate is occasioned in its solution, or in that of its salts, by acids or alkalies. Neither lactic acid nor its salts, which occur in the body with alkaline bases, are precipitated by chloride of calcium, chloride of barium, nitrate of silver (although the latter solution becomes trou- bled after some time in consequence of the silver being re- * Or the following method, which is perhaps better, may be used :—Dissolve the two in hydrochloric acid ; then add to the solu- tion, first, sulphuric acid, and then sufficient alcohol to form a weak spirituous solution. The sulphate of lime falls as a precipitate; this is washed with diluted alcohol, and separated by filtration; then drive the alcohol off in vapour by a continued gentle heat, after which precipitate the phosphate of magnesia, in the bibasic form, by ammonia. | Acetic acid may be used, but on no account muriatic acid, as this would form an insoluble white chloride, which would quite ob- scure the yelloAV phosphate. 32 duced,) nor by bichloride of mercury. When chloride of iron is added to a solution of a neutral lactate, or to lactic acid saturated by ammonia, the solution does not assume a blood-red colour, nor is oxide of iron immediately precipi- tated by an excess of ammonia ; but after some time a tur- bidness and gradually a precipitate of oxide of iron falls.* In very dilute solutions of lactic acid this occurs immedi- ately. When lactates Avith fixed bases are heated to red- ness, the base remains in the ash as a carbonate. Composition, C6 H5 Os -f aq. In the ordinary state lactic acid occurs as a deliquescent liquid, but by sublimation it may be obtained in crystalline rhomboidal tables.! It is distinguished from the volatile acids by its not pass- ing over in distillation ; also chloride of iron added Avhen the solution is supersaturated Avith ammonia, does not im- mediately yield a precipitate of oxide of iron. This last property distinguishes it from the mineral acids. The lac- tates are more difficultly recognised. We may conclude them to be present Avhen the alcoholic extract, (previously supposing it to be free from salts of volatile or fatty acids) which is acid, or at least not alkaline, after incineration, and being moistened with distilled Avater, is distinctly alkaline (renders red litmus blue.) This means can only be adopted when lactic acid is combined Avith fixed bases. Microscop. characters.—As it ordinarily exists in the liquid state it presents no particles which can be microscopically recognised, but when crystallized it forms rhomboidal tables.J 15. Lithate of Ammonia exists in solution in all healthy urine (9.) It lias been before noticed as sometimes being precipitated in health, when the quantity of water is not sufficient to retain it in solution. We now notice it as an abnormal ingredient, i. e. where it continues to be secreted in excess. It is the chief component of the lateritious sedi- ments. Its colour varies from a perfect white to a beautiful pink. * Vogel. wate™8 S"bUmate is comPose when by heating it to between 500° and 600° it would be sublimed in acicular crystals Prus- Becquerel. 41 sian blue would be readily recognised by boiling it in so- lution of potash, Avhen, upon the subsequent addition of a solution of perchloride of iron, the blue colouring reappears ; this is not the case with indigo. b. A blue colouring principle termed cyanourine has been also found in the urine. This is turned red by acids, and on neutralizing the acid by an alkali the original blue tint is restored. Caustic potash has little or no effect on it.* Various articles taken into the stomach alter the colour of the urine, such as madder, beet-root, rhubarb, &c. In some cases the red colour produced by some of these has been mistaken for blood. They would be readily distin- guished by the absence of the peculiar effects of boiling; (17) in these cases the colour is not destroyed by heat; moreover, by adding liquor potassae to such urine, a green colour is produced; this is destroyed on neutralizing the alkali by an acid, and the original tint reappears. c. The various shades of colour produced when the urine is loaded with the lithates have already been noticed ; (15 a) sometimes the quantity of colouring matter combined with the lithate of ammonia is so great as to make the urine ap- pear almost black. A peculiar black substance has also been noticed, Avhich became developed after the urine had been passed, and has been denominated melanic acid ; but it is so rare as hardly to require mention. 24. Many dietetic articles also impregnate the urinl? with their odoriferous principles; some of these become altered in their passage through the system. Essential oils, bal- sams, onions, asparagus, coffee, &c, can be detected in this manner. The ready communication of the odoriferous particles of food to the urine would indicate mal-assimi- lation. Oil of turpentine communicates a powerful odour of violets to this secretion. 25. Salts in passing through the system are in some cases decomposed, in others they remain unchanged. Thus the tartrate, citrate, and acetate of soda or potash become con- verted into carbonates. The vegetable acids appear united with bases ; whilst the mineral salts pass through the sys- tem, and appear in the urine unchanged. * Braconnot. 42 Iodine, taken internally, appears in the urine as an iodide or an iodate,* and may be readily detected thus:—Add to the secretion a few drops of nitro-muriatic acid, or a so- lution of chlorine, and then a cold solution of starch ; the blue iodide of starch immediately appears. In some cases it is requisite to evaporate the urine to dryness, then to boil Avater on the residue ; this solution, tested in the same man- ner, produced the same effects. Quinine and mercury are said also to have been found in the urine. 26. Hippuric or Uro-Benzoic Acid appears in the urine Avhen benzoic acid has been taken internally ; it never exists in the healthy secretion. It is obtained on concentrating the urine by slow evaporation, and then adding muriatic acid, when it is precipitated in the crystalline form (PL II. fig. 40.) I have never been able to detect hippuric acid in the urine of children, although it is stated to exist there. I fear there is some mistake in this matter. Chem. char.—Uro-benzoic acid is soluble in 400 parts of cold, and in a small quantity of boiling Avater; soluble in alcohol, sparingly soluble in aether; dissolves without change in muriatic acid. Nitric acid converts it into ben- zoic acid. It j,s composed of C 18, N, H 9, 0 6. Microscop. char.—The crystals are long four-sided prisms, whose modifications are seen in PL II. fig. 40. It may be distinguished from benzoic acid by its crystal- line form. The latter crystallizes in aggregated hexagonal needles of pearly scales, and is soluble in 2 parts of sulphu- ric aether, Avhereas hippuric acid crystallizes in isolated four-sided prisms, and is very little soluble in aether. 27. Nitric Acid has been sometimes detected in the urine, and its action upon the lithic acid has been supposed to be the cause of the production of the purpuriate of am- monia or murexide, which colours the beautiful pink de- posits. It Avould be best thus detected:— Neutralize any free acid by potash; evaporate to dryness; dissolve the * Generally, if not always, as the latter ; inasmuch as on boilin* alcohol on the residue of evaporation the iodine is not removed. ° 43 residue in a small quantity of water; add a little sulphuric acid, and then a green crystal of protosulphate of iron. If nitric acid be present, it will be decomposed, and the re- sulting nitric oxide passing through the Avater containing the protosulphate in solution Avill cause the formation of a black deposit or cloud around the crystals. 28. Oxalic Acid Avhen added to urine forms an insoluble oxalate of lime, so that should it be present at any time it Avould unite with the lime always existing in urine, and form an insoluble compound. Should it be suspected to exist free, or as a soluble oxalate, it might be detected thus:—Add a solution of chloride of calcium to the sus- pected urine or solution ; if oxalic acid be present, an inso- luble precipitate would be formed; this would be distin- guished from the sulphate of lime by its solubility in nitric acid, and from the phosphate or tartrate, &c. by its insolu- bility in a small quantity of hydrochloric acid, Avhich these are; it is, however, soluble in considerable excess. Wohler has observed oxalate of lime in the urine after oxalic acid had been taken internally, and Donne has observed-that after eating sorrel the urine has become filled with crystals of the same compound. 29. Oxalate of Lime.—This in the form of a crystalline deposit is not nearly so rare as was formerly supposed ;* it is often combined with the lithates. a. Chem. char.—Insoluble in liquor potassse, also in acetic acid. When incinerated, carbonated and caustic lime are left. By boiling with excess of sulphuric acid the oxalic acid may be separated and recognised by its peculiar character, Avhich is the formation of a white precipitate, soluble in nitric, but not in a small quantity of muriatic acid (28). By boiling oxalate of lime in solution of carbonate of potassa double decomposition takes place, carbonate of lime is precipitated, and oxalate of potassa remains in solution. b. Microscop. char.—When present in the urine it occurs in crystals, whose form is a very flat octahedron. As they lie upon the field of the microscope they appear to hate a rectangular, or sometimes a square outline. When dry * This was first pointed out by Dr. Golding Bird. 44 they appear to have a smaller square placed within the larger, whose sides are opposite the angles of the latter; this arises from the lateral rays being refracted beyond or without the field of the microscope (PL II. fig. 22.) When moist they appear as in PL II. fig. 21. But their true form can only be shown by placing them, Avhen gently moistened in aether or spirit, and then examining them under the microscope. Sometimes they appear in the form of Avhat Dr. Bird has called dumb-bells (PL II. figs. 24, 25,) or sometimes a modification of them, Avhich I have found, as in PL II. fig. 24.* By polarized light the dumb-bells give the most splendid colours; Avhilst the octahedrons produce very little, sometimes no alteration. c. Urine containing oxalate of lime is extremely various in its characters ; sometimes it is very pale, at others loaded with lithates, and high-coloured. d. Calculi composed of oxalate of lime, or mulberry cal- culi, are invariably tubercular upon the surface, of a grayish- broAvn tint, very hard and dense ; sometimes the surface is covered with sparkling crystals of the same composition. When urate and oxalate of lime are combined, they may be conveniently separated by digesting the powdered calculus in a large proportion of dilute hydrochloric acid, Avhich dissolves the oxalate alone and unchanged; the lithic acid is precipitated, whilst the lime with Avhich it Avas united combines with the excess of hydrochloric acid. The liquid must be filtered to get rid of the lithic acid, and by saturating the clear fluid with ammonia, oxalate of lime is precipitated. The remainder of the lime resulting from the decomposed urate will subside on adding oxalate of ammonia.! Before the blowpipe oxalate of lime chars, and on continuing the heat a white ash is left; this is alkaline, and effervesces with acids. It may be shown to be lime by dissolving in a small quantity of dilute muriatic acid, and adding solution of oxalate of ammonia, when the insoluble oxalate is thrown doAvn. 30. Carbonate of Lime sometimes occurs as a urinary deposit always however as a secondary production, being formed from the decomposition of the calcareous salts by f Scharling. 45 the carbonate of ammonia resulting from the decomposed urea. A small quantity is occasionally found in urine loaded Avith phosphates; it is also found in calculi, chiefly mixed with other ingredients. It Avould be readily distin- guished by its solubility Avith effervescence in dilute muri- atic acid, the solution being precipitated by oxalate of am- monia. It has been said to be the cause of the precipitate formed in urine by heat not albuminous; this, however, I believe to be incorrect. Vide (16e.) 31. Cystic Oxide is of exceedingly rare occurrence, but is sometimes found as a urinary deposit, sometimes as a calculus. a. Chem. char.—It is soluble in dilute nitric, sulphuric, muriatic, oxalic, and phosphoric acids; and is insoluble in acetic, citric, and tartaric acids and alcohol; also soluble in ammonia and the caustic alkalies, and in the fixed alkaline carbonates; but not in the carbonate of ammonia. It is entirely dissipated by heat, giving off a characteristic odour. It is nearly soluble in Avater. By the spontaneous evapora- tion of its ammoniacal solution it may be obtained in crystals. Composition, C6 H6 N S5 04. b. Microscop. char.—Cystine generally crystallizes in delicate six-sided plates, sometimes in quadrilateral plates; sometimes the crystals are crenate at the margin, with a dark nucleus ; and often we can perceive irregular laminae on their surface. Their effect with polarized light is very various; some- times Ave have colour developed, but often none. c. Urine containing cystine has a greenish tinge, and an odour of sweet-briar. In putrefying this urine exhales sul- phuretted hydrogen. Cystine is precipitated from urine by the addition of acetic acid. d. Calculi composed of cystine are generally covered with smooth tubercles, and have a Avaxy appearance. When recent they are brown, but become gray or green by keeping. They have no concentric layers. 32. Pus is occasionally present in urine. When in large quantity and unaccompanied by mucus, or when mixed with blood, it may generally be supposed to be de- rived from an abscess; but when mucus is in excess, or 46 has preceded the pus, most probably it is derived from the urinary mucous membrane. When present in urine it renders that fluid albuminous, and gives a yellowish or greenish tinge to the sediment Avhich it composes ; it can easily be diffused through the urine by agitation, and would be readily distinguished from mucus by its want of tenacity or viscidity, and by the large number of globules which float in its albuminous liquid. Urine containing pus has little tendency to putrefy. When pus is acted upon by ammonia it becomes converted into a viscous gelatinous mass, which depends upon the union of the ammonia with the fatty matter of the pus. Microscop. char.—The peculiar globular granular particles can be readily perceived by a good microscope; they are several times larger than those of the blood, almost colour- less ; these characters would distinguish them Avhen in small quantity from those of blood, Avhich are entire, smooth, yellow, and flattened. When acted upon by acetic acid they leave distinct nuclei, which vary in number. Vide Part II. Blood and Pus. 33. Sugar.—The presence of sugar in the urine properly characterizes diabetes. The quantity of urine sometimes passed in this disease is almost incredible. It is usually pale in colour, higher sp. gr. than 1030, of a hay-like smell. If left in a warm place it becomes covered with a frothy white layer, as if its surface had been sprinkled with flour. This is quite characteristic, and when once seen cannot be mistaken. This white froth is composed of a number of minute vegetable organizations Avhich have been denominated Torulce; they occur in all fermenting liquids, and their growth is by some considered in relation to fermentation in the light of cause and effect.* They are figured in PL II. fig. 35: their development is very interest- ing. When first formed they are very minute spherical globules composed of two coats, and filled Avith a liquid containing in suspension a number of extremely minute granules; the globules enlarge, rise to the surface, and form the Avhite scum. Some of the internal granules also enlarge,, and become distinct nuclei. These continue ex- * Turpin. 47 panding, the primary globule becomes elongated, and one of the enlarged nuclei bursts through the envelopes of the maternal cell and appears as a bud; this enlarges, others increase in the same manner. As the globules enlarge they become elongated, finally forming long, slender, jointed vegetables, as in PL II. fig. 35. These contain several nuclei which are ready to bud out in the same manner as their parents have originally done. They seem to increase in tAvo distinct ways; one is the budding process above mentioned, the other is the division of the parent cell. It is first divided by the increase of two, three or more nuclei into as many separate parts. It then becomes contracted opposite the spaces between the continuous extremities of the internal young cells, finally forming distinct and inde- pendent plants, capable of further propagation in a similar manner. The quantity of urea present in diabetic urine was atone time considered to be less than natural, but this has since been proved to be incorrect by the experiments of Mr. MacGregor.* The mode of detecting it is described at (11 d.) The amount of sugar may be estimated by fer- mentation (id.;) each cubic inch of carbonic acid gas pro- duced corresponding to nearly one grain of sugar. It is almost impossible to separate the whole of the urea from the sugar and other animal matters. The sugar in a quan- titative analysis is most easily estimated in combination with the lactates and other animal matters. (14) Crystalline sugar can be thus obtained from diabetic urine :—Add to its solution of diacetate of lead ; filter; throAV down the lead by sulphuretted hydrogen ; filter again, and evaporate to a syrup; by boiling alcohol on this, and alloAV- ing it to evaporate spontaneously, crystals will be produced. In many cases it may be obtained merely by evaporating to dryness, &c, without using the acetate of lead. It is composed of C 12, H 14, 0 14. When heated with nitric acid oxalic acid is formed ; this may be recognised by its appropriate tests. (28) Diabetic sugar is identical in composition with that of grapes. Its crystalline form is represented in PL II. fig. 36. * MacGregor, Experimental Inquiry. 48 It is readily soluble in water and a mixture of alcohol and water, but little or not at all in absolute alcohol and aether. The quantity of solids in 1000 parts of diabetic urine of different specific gravities may be readily found from the folloAving Table. Sp. gr. at .'iOJ F. Solids. 1031 51-15 1032 52-80 1033 54-35 1034 56-00 1035 57-65 1036 59-30 1037 60-95 1038 62-60 1039 64-35 1040 66-00 Sp. gr. at 50° F. 1041 67-65 1042 69-30 1043 71-05 1044 72-70 1045 74-45 1046 76-10 1047 77*75 1048 79-40 1049 81-55 1050 83-20* The phenomena of circular polarization of light are deve- loped in diabetic as Avell as in albuminous urine. 34. Milk has occasionally been found in the urine; but I believe in all cases it has been purposely put into it. Urine under these circumstances is coagulated by acetic acid but riot by boiling. But by the peculiar globules which would be found in it, we should readily recognise the imposition. (PL II. fig. 32. Vide Part II. Milk.*) • 3T5-.?4NTHIC 0xide is of extremely rare occurrence. It is, I think, mostly considered as doubtfully existing as a body sui generis It would be distinguished by its dis- solving without effervescence in nitric acid, and its leaving a yellow residue on evaporation, not pink, as in lithic acid! (12 a) It cannot be crystallized. It is not precipitated from its solution in potassa on the addition of hydrochlorate of ammonia ; this is the case with lithic acid 36. Calculi have been found composed entirely of animal matter. Iheir chemical characters resemble those of fibrin and they are therefore called fibrinous calculi They £ semble yellow wax in colour and consistence. * * Simon. 49 Chem. char.—Insoluble in water, alcohol, and hydro- chloric acid. Soluble in caustic potash, and precipitated by muriatic acid. Soluble in acetic acid by heat, and this solution is precipitated by ferrocyanide of potassium. By the blow pipe they give out a smell of burnt horn, and leave a bulky charcoal. Composition of Xanthic Oxide, Cs -f Ng + 08 -f H2. / 37. After the urine has escaped from the bladder decom- position soon commences; this it has been previously men- tioned appears to be hastened by the presence of the mucus, as it may be preserved from decomposition for a greater space of time when this is removed. In Avarm weather a urine loaded with urea will become neutral and even alka- line in a few hours. This process is also much hastened when the mucus is in excess; these urines, if not alkaline at the time of passage from the bladder, very speedily be- come so. The first and most important change noticed is the decomposition of the urea; by uniting with the elements of the Avater present, it becomes converted into carbonate of ammonia ; a portion of the carbonic acid of this escapes; the ammonia unites with the phosphate of magnesia, form- ing the triple salt. This is ahvays present in a crystalline form in stale urine, adhering to the sides of the containing vessel. The phosphate of lime is partly precipitated in an amorphous form, and a portion of carbonate of lime is also formed. The urine often becomes much deepened in colour, and gradually opaque throughout. A scum inva- riably forms upon its surface, composed of a peculiar magma of animal matter,* covered with crystals of triple phosphate. It will be readily perceived from the above account how important it is to obtain the urine fresh and examine it at once; otherwise the patient may be treated as suffering from a phosphatic deposition, which is the consequence of decomposition only. 38. The early formation of a peculiar scum on the sur- face of urine has been adverted to as a sign of pregnancy. It has been observed by many that an opaque greasy-look- ing layer begins to form in the urine of pregnant women soon after it is passed; this often takes place whilst the * Consisting of very minute granular particles. 4 50 urine is still acid, but it very soon after becomes neutral, and then alkaline. As soon as the urine has become neu- tral this crust becomes covered with crystals of the neutral triple phosphate. This layer or scum has been denominated Kiestein. When it is acted upon by acetic acid the phos- phatic crystals are dissolved, and the animal matter is left; Avhen acted upon by ammonia the animal matter is dis- solved, and the crystals remain. To observe this appear- ance, about four or six ounces of perfectly fresh urine should be laid aside in a tall, moderately narrow glass vessel, and a paper cover laid over it, to exclude dust. It should then be placed in a tolerably Avarm atmosphere. The appear- ance denominated kiestein would be produced should a crust similar to that above described appear within a day or two. The crust I spoke of formerly as occurring in all urine could hardly be confounded with this, as it appears so much later in the urine. When examined microscopi- cally the crust of kiestein appears composed of very minute globules. When it has remained on the surface of the urine for a few days (this fluid often exhaling a peculiar cheesy odour) it breaks up and falls to the bottom. It has been stated that the quantity of the salts of lime in the urine of pregnancy is much diminished. I have ex- amined a very large number of urines of women during pregnancy, but I have not found this by any means correct. With the exception of the peculiar fermentation (?) Avhich produces the kiestein, and the peculiar cheese-like odour, there are no characteristics of the urine in pregnancy, and even these are not constant. 39. In many urines, particularly those Avhich have con- tained considerable excess of lithate of ammonia by being kept, a number of minute blackish globules appear. I have seen these in urine several times, but unfortunately have not recorded the effects of chemical reagents upon them to determine their nature. I satisfied myself that they were not lithate of ammonia, but I can say nothing more from my own experience. They are sketched from a preparation in my possession. (PL II. fig. 34.) The urine in these cases had assumed the peculiar deep brownish-red colour it gene- rally does by keeping. I.K1FFITJ1 OX HI.OOD & t'HINK VI aU /. k H ' ■* /•■ Fi*f 3 F.rj Pisj J-'$ 4 V A n n 1 a t||| />// 7. 7^ 1 fj /J Fia /J ]H3 p7 />/?p i /i 0-j ft / /■"'.'// -^ ) ,. M -Y W* «9 ^ \ . 4C ^ A 1 ^a><,/ >3 'M 3 &y> x-v Pin II AV./.-.'J ■?. 3 /ii/2« O n ^ *> «- ^ ■i o.- ■ J.. ' .a; oq0° J Fiq.33. \ 1/ yr :f .1 I / / J \ V"* 0 i,i/i.,rrsi„.7a/r r/u/« \ DESCRIPTION OF THE PLATES. The sketches are all made from preserved specimens in my own possession, except Avhen otherwise mentioned. The most common and most readily distinguished forms only are sketched, except Avhere there are some peculiarly interesting features in others. I may say the varieties of form assumed by these crystalline deposits are almost endless. PLATE I. Forms of Lithic Acid. Fig. 1. Form of the crystals of lithic acid as obtained by adding a few drops of an acid to urine. They possess a curious hour-glass internal structure; and their ex- tremities are not entire, but composed of small crys- talline needles. The rhomboidal form, Avhen viewed at the extremities, is represented in a. Magnified 90 diameters. 2. Ordinary form of lithic acid Avhen occurring naturalh' as a crystalline sediment. Internal nuclei are here apparent, and in some cases one or both the apices are prolonged into a beak-like form. 90 diameters. 3. Same deposit; here the obtuse angles are replaced by semicircular facets ; side vieAv. 90 diameters. 4. Same, lying on its face. 90 diameters. 5. The forms represented here are such as are obtained in precipitating a boiled solution of lithic acid or lithate of ammonia in solution of potash by an acid; this is very pure and colourless ; and the internal structure is beautifully developed by polnrized light. 150 diameters.. 52 Fig. 6. A modification of the same. 7. A natural form of lithic acid, frequently mistaken for the cubic. They are curiously nucleated, but their rhomboidal forms can be readily detected by exa- mining them in a watch-glass with aether, and &c. 90 diameters. 8. Aggregation of lithic acid prisms. 90 diameters, natu- ral. 9. Foliaceous crystalline forms of lithic acid, sometimes occurring in urine with the regular ordinary rhom- boids. In some cases they appear tied round the centre as Avith a string. 90 diameters. 10. Curiously nucleated form of lithic acid, the nucleus retaining the rhomboidal outline. 90 diameters. 11. The same as fig. 3, and having a rectangular nucleus. 12. Modification of fig. 9. 13. Prismatic forms of lithic acid. Here the rhombic prism is elongated, so that these crystals ahvays present a rectangular outline. The true form is dis- covered by moistening with aether, &c. The rhom- boidal outline may often be detected on their extremi- ties, as in ct, and they are often beautifully striated transversely, as in /3. 90 diameters. 14. Lithate of ammonia in the globular form; the needles are most probably in the state of superlithate; minute rhomboids of lithic acid mixed Avith it, and probably resulting from its ^rtial decomposition. Very rare. 300 diameters. 14.* This is the form of. lithate of soda. I have twice met Avith it, it approaches very near to my form of lithate of ammonia (fig. 14.,) but* is distinguished by the needles in the former being acute at the extremities, and in the latter obtuse. Forms of Phosphate?. 15. Various forms assumed by the neutral triple phosphate. A trilateral prism with truncated summits appears to be the predominating form. In some cases, one or two, and in others all the angles are replaced by facets. 90 diameters. 16. The same composed of aggregated prisms. This is by no means a common form. 300 diameters. 17. The form of neutral triple phosphate generally found when the urine containing it is acid. 90 diameters. 53 Fig. 18. Forms of bi- or sometimes called sesqui-basic triple phosphate. 600 diameters. 18.* Phosphate of lime after Simon.t Forms of Cystine. 19. These crystals are remarkable for their regular six- sided form, (a.,) always having traces of laminae on their surface («*.) In some cases their centres are occupied by black masses, as in b. Sometimes the whole crystal assumes this form. It then appears composed of an aggregate of minute needles. 90 di- ameters. 20. Cystine assuming the form of the rectangle. The effect of polarized light upon this is much more striking than upon the six-sided form. In some rare cases the cystine has assumed the form of a semicir- cular plate, shoAving beautifully the black cross Avhen examined by polarized light. PLATE II. Forms of Oxalate of Lime. 21. Ordinary form when moist. The outline appears rectangular or square. 300 diameters. Natural. 22. The same when dry. 23. The same viewed edgewise, as seen rolling over in spirit or aether. 24. Dumb-bell form of oxalate. 600 diameters. Natural. 25. The same lying on its side. These appear composed of very minute needles. 26. Represents the oxalate as precipitated from urine by oxalic acid or oxalate of ammonia. 300 diameters. 27. The same, only exceedingly small. 28, 29, 30, 31. Crystals of Chloride of Sodium. 28. Crystallized from distilled water. We have here a peculiar appearance which might very readily be mistaken for that of an octahedron. j- I have specimens of this. 54 Fig. 29. Slowly crystallized from urine. We have here forms somewhat resembling those of oxalate of lime and cystine; but there are no laminae to the hexagonal plates, as in cystine; nor are the sides equal, as in the latter; and the octahedron is not flattened, as in oxalate of lime. Moreover, the solubility of chloride of sodium in water Avould at once distinguish it from these two. The figures 30 and 31 are formed when common salt is crystallized rapidly from urine or a solution of urea. They appear generally crenate at the margin, some- times however quite entire, and of the form of a dag- ger. 90 diameters. 32. Globules of milk, characterized by their extreme variations in size, absence of nucleus, and spherical smooth surface. It appears to me quite absurd to talk of the "size" of milk-globules as definite, for they are of almost all sizes. 300 diameters. 33. Spermatic animalcules, with epithelial] scales and mucus globules,* found in urine containing semen. 300 diameters. 34. Black globules found in urine by keeping, mixed with crystals of triple phosphate. 35. " Torida Diabetica.'''' I do not knoAv of any charac- ters by Avhich this fungus can be distinguished from that found in milk or other saccharine liquids; in fact, I believe they are all the same. 300 diameters. 36. Crystals of diabetic sugar. 90 diameters. 37. Crystals of nitrate of urea. Impure, as ordinarily obtained by adding nitric, acid to concentrated urine, or that containing urea in excess. 90 diameters. 38. The same in a more pure and distinctly crystalline form. 90 diameters. 39. Crystals of oxalate of urea. 90 diameters. 40. Crystals of hippuric acid. 90 diameters. c. Perfect form (Ure.) «, b, b. Crystallized from alcohol. Some of these forms are not unlike those of nitrate1 and oxalate of urea, but the peculiar circumstances under which they are produced Avould readily distin- guish them. * From the prostate! PART II. CONTAINING the GENERAL, CHEMICAL, AND MICROSCOPICAL CHAEACTERS OF THE BLOOD, ETC., BOTH IN HEALTH AND DISEASE. PREFACE TO PART II. This Part forms the completion of the work. The proper- ties of the substances entering into the composition of the va- rious animal fluids are here entered into rather more fully than in the preceding Part, and their leading characteristics detailed. The results of the numerous analyses which have been made are but rarely noticed, my object being rather to show the manner in which such may be best made. The excellent work of Simon will however be found to supply this deficiency, for in the second volume the most important results which have been obtained in this branch of investigation are contained; and as a translation of it has been issued by the Sydenham Society, it is within the reach of all who are interested in the subject. Organic or ultimate analysis is not treated of, although it is frequently indispensable in the investigation of the nature of animal matters. This was expressly avoided, since distinct treatises have been published on it; and it is moreover usually considered to require too much time and too minute a know- ledge of chemical manipulation to come within the grasp of the medical practitioner. An Appendix is added, into which any discoveries or new processes of importance that have appeared since the publica- tion of the first Part, and which come within the limits of the Manual, are abstracted. It would be mere waste of time to attempt to detail the ad- vantages to be derived from a more extended examination of the properties of the components of the human body in its nor- mal state of health, and in its deviations from this condition. 58 The important light which has been thrown upon several points in physiology and pathology by the researches of modern che- mistry and microscopy are so striking, that to be alone ac- quainted with them is sufficient to ensure a due appreciation of their importance. To argue that such investigations are idle, merely because each new truth which is elicited is not imme- diately applicable to the elucidation of some point in the his- tory of a disease, or to the improved application of remedial means for its alleviation, is as absurd as unfortunately it is fre- quent. There is however one consolation in this matter, which is, that those who are the most ready to urge these views and to decry the utility of calling in the aid of the colla- teral sciences, are such as are least acquainted with their details. In conclusion, if by writing this little book I may at all con- tribute to excite an increased taste for the cultivation of the subjects of which it treats, I shall feel amply repaid for any trouble bestowed upon it. 9 St. John's Square, April, 1846. GENERAL, CHEMICAL, AND MICROSCOPICAL CHARACTERS OF THE BLOOD, &c. Before treating of the characters of the compound fluids, those proximate principles, &c. which are generally diffused through them will be described; those which are found in peculiar fluids only will be treated of Avith the fluids them- selves. I. PROTEINE COMPOUNDS. These substances consist of combinations of an organic principle with sulphur and phosphorus in various propor- tions ; the organic principle itself is called proteine. They exist in two states, a fluid and a solid. In the former they are coagulated by electricity; and after the addition of acetic acid, by solution of ferrocyanide of potassium. When in the coagulated or solid state, they are insoluble in water, alcohol and aether, partly soluble in acetic acid, en- tirely so in alkalies by heat, and on the addition of acetic acid to the alkaline solution the proteine is precipitated. When boiled Avith muriatic acid they gradually dissolve, assuming a lilac or bluish-purple tinge. When boiled with water, the base becomes oxidized. 60 1. Proteine does not occur in the solids or fluids of the body in an uncombined state. Chemical properties.—a. When carefully dried, it forms a broAvnish amber-coloured mass, which is hard, brittle, and may be readily pulverized ; it absorbs moisture from the air, but may be completely dried at 212° F.; Avhen im- mersed in water, this is absorbed, rendering the proteine ge- latinous, and forming semi-transparent flakes. It is insoluble in Avater, alcohol and aether. When heated, it does not fuse until decomposition commences ; it then swells up and evolves the ordinary products of decomposition of nitro- genous bodies. It leaATes no ash. By long-continued ebul- lition with water, it does not yield gelatine, but tAVO sub- stances which have been only recently discovered by the indefatigable Mulder. Proteine combines with acids and bases. It dissolves in acetic acid, and the solution is pre- cipitated by ferrocyanide of potassium f it is soluble in very dilute, but precipitated by strong acids,f except the acetic and phosphoric; tannic acid and potash likewise precipitate it from its solutions in acids. On ebullition with dilute sulphuric acid, it becomes coloured purplish-red; with nitric acid, yellow or orange; Avith muriatic, at first yellowish, then bluish-purple, and ultimately brownish or black. The presence of oxygen is requisite for the produc- tion of this change in colour, Avhich is a very characteristic phenomenon. Proteine dissolves in alkalies Avithout change; the resulting compounds are insoluble in alcohol. When boiled with excess of potash, carbonate and formiate of ammonia, leucine, protide and erythroprotide are formed. Proteine is composed per cent, of carbon, 55-22; hydro- gen, 6-99; nitrogen, 15-97; and oxygen, 21-82, giving the formula C*° H3° N* Ol2.| Its atomic Aveight is 436. b. Proteine maybe obtained by treating fibrine, albumen, caserne, or any substance containing it, with Avater, alcohol, aether and dilute muriatic acid§ in succession. It is then heated for some time to 120° in a moderately strong solution * This precipitate is composed of hydrocyanic acid, proteine and cyanide ot iron. t These are compounds of the acid with proteine. X Liebig assumes the formula C48 H3*5 N6 O14.* § These agents remove extractives, fat, salts, &c.' 61 of caustic potash.* Acetic acid is then added in the slightest possible excess; the precipitate is collected on a filter and Avashed with distilled water. c. Proteine forms two oxides:— «. The binoxide is left in an insoluble form after fibrine has been boiled with water for some hours; it is purified by ebullition with alcohol and aether, in which it is insoluble. It is soluble in the dilute mineral and acetic acids; ferro- cyanide of potassium precipitates it from the acid solution; it is also soluble in solution of potash and ammonia, and does not assume so deep a yelloAv colour from the action of nitric acid as proteine. It is composed of 1 atom of proteine 4- 2 atoms of oxgen, yielding carbon, 53-52; hydrogen, 7*17; nitrogen, 14*80; oxygen, 24-51 = Ci0 HJ0N5 Oli. p. The tritoxide is formed by boiling fibrine or albumen in water for many hours, precipitating by acetate of lead, neutralizing the solution Avith ammonia. The precipitates are collected on a filter, and the lead separated by sul- phuretted hydrogen ; on evaporating the solution, the tri- toxide remains. It is soluble in both hot and cold Avater and in alkalies, but is almost insoluble in alcohol and quite so in aether. It is precipitated by the mineral acids, bi- chloride of mercury, and both acetates of lead, but not by ferrocyanide of potassium. It is composed of 1 atom of proteine 4- 3 atoms of oxygen, yielding carbon, 51-38; hydrogen, 6-78 ; nitrogen, 15-01; oxygen, 26-82. d. With sulphuric acid, proteine forms a gelatinous com- pound, consisting of 1 atom of each constituent; it is called sulpho-proteic acid. When dry, it is yelloAv, insoluble in Avater, alcohol and aether, and forms compounds with metallic oxides. When a solution of proteine (albumen or caseine) in acetic acid is dropped into very dilute sulphuric acid, a flocculent precipitate of subsulphate of proteine is formed; it contains 2 atoms of proteine to 1 of acid. e. When acted upon by nitric acid, a yellow substance, * This removes the sulphur and phosphorus, forming sulphuretof potassium and phosphate of potash. 62 xantho-proteic acid, remains undissolved, whilst nitrate of ammonia, oxalic and saccharic acids are formed in the solution. It is composed of C34 H*4 N4 O12 +HO, and is insoluble in Avater, alcohol and aether. /. Proteine also forms compounds with alkalies and me- tallic oxides. g. When chlorine is passed through a solution of pro- teine, proteo-chlorous acid is precipitated in the form of white flakes; it consists of C40 H30 N5 0J2 + CIO3, and is dissolved by solution of ammonia. h. Protide is of a yellow colour, soluble in water and cold alcohol, but precipitated from its solution by basic acetate of lead, not by other metallic salts or tannic acid. Its composition is C13 H9 N 0*. i. Erythroprotide subsides from its alcoholic solution on cooling, is of a reddish colour, readily soluble in water and hot alcohol, and is precipitated by salts of lead and silver. Its composition is C13 H8 N/D5. k. There is no peculiarity in the microscopic appearance of proteine. 2. Albumen.—Some observations relating especially to the detection of albumen Avere made in Part I. p. 38. Chem. prop.—». Fluid.—In this form it is coagulated at 158° F., the temperature requiring to be more elevated as the amount of albumen in solution is less; free alkali or acid prevents its occurrence. Albumen is precipitated by the concentrated mineral acids,* alcohol, lactic acid, bichloride of mercury,f nitrate of silver, both acetates of lead,J alum, protosulphate of iron, chloride of tin,§ and tannic acid. Chromic acid causes a precipitate in a very dilute solution. * Phosphoric acid does not cause a precipitate, but metaphos- phoric acid does. f This is composed of albuminate of mercury, muriate of albu- men remaining in solution. The latter may be removed by Avashing with water. X Neutral acetate of lead throws down a part only of the albumen, the diacetate the whole. In the former case, some of the albumen combines with, and is retained in solution by, the acetic acid ; in the latter, the whole of the albumen combines with the excess of oxide of lead, neutral acetate of lead remaining in solution. Excess of the diacetate redissolves the precipitate. § Excess redissolves the precipitate. 63 Copious dilution with water also causes a precipitation of part of the albumen. jS. Coagulated.—In this state when dried it forms yellow- ish brittle masses, which when pulverized in a Avarm mor- tar becomes powerfully electrical, adhering strongly to the pestle; in cold water it sAvells, and a very small portion appears to dissolve.* It is insoluble in alcohol and aether, and is incinerated with difficulty, leaving an ash containing phosphate of lime. It swells into a jelly in acetic acid, and is finally soluble in water, especially when heated. Sul- phuric and nitric acids behave to it as to proteine. It completely neutralizes alkalies. The quantity of ash left on incineration varies from 1*3 to 11 per cent. In addi- tion to the principal constituent, phosphate of lime, it also contains a trace of phosphate of magnesia with chloride of sodium and carbonate of soda. It is composed of carbon 54-84; hydrogen, 7-09; nitro- gen, 15-83; oxygen, 21-23; phosphorus, 0-33; and sul- phur, 0-68; or proteine, 10 atoms + S2, P.f y. Albumen enters into combination Avith acids and alka- lies. When solutions of metallic salts are added to it, a compound of the acid and albumen remains in solution, and may be washed aAvay, whilst the metallic oxide combined with another portion remains insoluble. It was formerly supposed that albumen is dissolved in animal fluids by the free or carbonated soda and salts always existing in them; the experiments of Wurtz have however shown that this is not the case, at least in some instances. h To separate pure albumen, add muriatic acid to an albuminous solution until no further precipitate is occa- sioned, Avash aAvay the supernatent liquid with very dilute muriatic acid, dissolve the precipitate in cold Avater, and throw down the albumen with carbonate of ammonia, col- lect it on a filter, wash, dry and separate all fat by boiling alcohol and aether; or boil an albuminous liquid, taking care that any free alkali is neutralized, filter, wash and dry the precipitate, then digest it in dilute muriatic acid, and subsequently treat it with alcohol and aether. In quantita- * 7 parts in 1000 (Chevreul.) \ The albumen of eugs contains a single atom only of sulphur thus agreeing with fibrine in composition. 64 tive analysis it may be estimated as the insoluble residue of the digestion of water, aether and alcohol on the dried extract, separation from the earthy phosphates, &c, being effected by incineration. e. Albumen, when long boiled with Avater, yields tritoxide of proteine, a portion of unaltered albumen remaining undis- solved. It thus differs from fibrine in the tritoxide being formed at once, without the intervention of the binoxide. If an albuminous solution be heated in an atmosphere of oxygen, a scum is formed on its surface. Microscopical characters.—See Part I. p. 39. 3. Globuline.—This substance, which occurs in the blood and crystalline lens, is undoubtedly a proteine com- pound, resembling albumen very closely in its properties. Chem. prop.—». It is precipitated from its solution by alcohol; the precipitate is insoluble in water, but is partly soluble in boiling wreak alcohol, partly separating as the solution cools. It is precipitated from its solution in an alkali by acetic acid, but not from the blood, when freed as perfectly as possible from albumen. A scum forms upon its surface on ebullition. When solid, it is but little acted upon by alcohol; acetic acid with heat partly dissolves it. In most other respects it agrees Avith albumen in its properties.* It is insoluble in alcohol acidified with sulphuric acid. According to Mul- der's analysis, it is composed of 15 atoms of proteine + S.f /3. It may be obtained by decomposing the sulphate with finely poAvdered marble, then dissolving the substance in boiling spirit; (0*915) on cooling it subsides. 4. Fibrine, like albumen, exists in two states, a fluid and a solid. *. Fluid.—We have but little opportunity of examining fibrine in its naturally fluid state, for as soon as it is re- moved from the living vessels it commences to solidify. The addition of salts, as sulphate or carbonate of soda, &c, will however prevent this. It is perhaps beyond the limits of this manual to enter into the question, whether the fibrine is really dissolved in the blood and other fluids, or * For some further observations on this substance, see " Medical Gazette," vol. xxxvi. p. 184. t Mulder found the per-centage of sulphur. = 0-272. 65 whether it exists in a semi-fluid state or suspended in the form of minute particles, the cohering of Avhich causes the apparent coagulation. I have no doubt that the former view is correct; for although minute granules can always be detected in fibrinous and other animal fluids, if a drop of the latter be placed under the microscope prior to coagu- lation, the fibres or masses of fibrine Avbich are subsequently seen to form are far more considerable than could possibly have resulted from the union of the scattered granules. p. Solid.—In this state, fibrine is almost entirely insolu- ble in water, alcohol and aether. WThen dried and free from fat, it forms a yellowish opaque mass ; if at all trans- parent, it still contains fat. It is difficultly incinerated, leaving an ash consisting of about 0-6-0-8 per cent.; this is composed of phosphate of lime, a little phosphate of magnesia, and sometimes a little silica; but it contains neither iron, alkali, nor carbonate of lime. Muriatic acid Avith heat colours it of an indigo-blue colour. It is much more readily acted upon by acetic acid than albumen. It becomes yellow with nitric acid. Alkalies saturate it as perfectly as albumen. Peroxide of hydrogen added to moist fibrine is decomposed, oxygen being evolved and Avater formed ; this does not occur however if the fibrine has been boiled with Avater or digested Avith alcohol; it also happens, in a greater or less degree, with many organic tissues which contain no fibrine. NotAvithstanding the similarity betAveen the two, it does not occur with albu- men.* Fibrine usually contains about 2-4 per cent, of fat. It is composed of 10 atoms of proteine S + P, yielding carbon, 54-56 ; hydrogen, 690; nitrogen, 15-72 ; oxygen, 22-13; sulphur, 0-36; and phosphorus,. 0-33 per cent. When boiled it is first transformed into binoxide, and subsequently into tritoxide of proteine. y. Fibrine is most readily obtained by stirring blood im- mediately after its withdrawal from a vessel with a glass rod; the clot is thoroughly Avashed with water, being oc- casionally pressed until it is completely colourless; it is then dried, powdered and exhausted Avith aether. J1. The means of distinguishing fibrine from albumen are * Berzelius. 5 66 unsatisfactory. When fluid, the spontaneous coagulation of the former is decisive, although its non-occurrence does not afford positive proof of its absence. When solid, the best characters are the more bluish colour formed with muriatic acid and the greater action of acetic acid. The cohesion of fibrine varies greatly; sometimes it forms a firm fibrous clot, at other times an almost diffluent granular mass. e. Microscop. char.—Fibrine exhibits tAvo microscopic forms; one undistinguishablefrom albumen, the other com- posed of delicate fibres crossing in various directions. The latter is readily seen in fibrine separated from blood by stirring, or in a drop of blood coagulating under the micro- scope. 5. Caseine.—This substance varies somewhat *in its properties according to the source from Avhich it is derived. «. Fluid.—It is precipitated by the mineral, acetic and lactic acids,* but the precipitate is soluble on the addition of excess; it is also precipitated by alcohol, chloride of calcium, both acetates of lead, chloride of tin and chromic acid. When boiled, it is not coagulated, but a scum forms upon its surface ; this does not occur however Avithout access of oxygen, as for instance in an atmosphere of carbonic acid. It is coagulated by rennet Avhen sugar of milk is present, but not otherAvise ; the coagulation is really effected by the lactic acid formed from the decomposition of the sugar. iEther coagulates the caseine in cow's milk, but not that in the human fluid. Ferrocyanide of potassium causes a precipitate in the acetic solution of caseine. Rochleder states that caseine is nearly insoluble in water, that the soluble caseine in milk is combined Avith potash, soda or lime, and that its coagulation is nothing more than a separation of caseine, resulting from the combination of the acid with the base of the caseine compound. This is however very improbable ; otherwise, sufficient of any acid * These precipitates are usually stated to be compounds of the caseine with the acid. M. Rochleder however did not find any ma- is decomposed and its acid removed pound 67 to neutralize the alkali present should precipitate the whole of the caseine, which is not the case. &. Solid.—4n this state it is yelloAA'ish, swells in water, but does not dissolve in it, nor in alcohol and aether. Acetic acid dissolves it, especially with heat. It is acted upon by mineral acids like albumen. Alkalies dissolve and decompose it Avhen concentrated. When incinerated, it leaves an ash containing carbonate and phosphate of lime ; of the latter about 6 per cent, in the caseine which has not been treated with acids. y. The caseine of human milk differs principally from that of the cow in its greater solubility in water, the less perfect precipitation by acids, especially dilute sulphuric, muriatic and lactic. Caseine, like albumen, forms tAvo compounds with metallic salts, one soluble and the other insoluble. Caseine is composed of 10 atoms of proteine 4- 1 of S. The absence of phosphorus is a remarkable peculiarity; it yielded carbon, 54-96; hydrogen, 7-15; nitrogen, 15-80; oxygen, 21-73 ; and sulphur, 0-36. £. Caseine may be obtained by adding sulphuric acid to skimmed milk, washing the coagulum with water, and de- composing the sulphate with carbonate of lime or lead; the soluble caseine thus obtained however generally contains some of the base used. The lead may be separated by sulphuretted hydrogen. Or the precipitate with sulphuric or acetic acid may be boiled repeatedly and in a consider- able quantity of water, washed, dried, and the fat removed by aether. j. Microscop. char.—Caseine is composed of minute granules, aggregated as in albumen to form flakes or masses of various sizes, but not possessing any characteristic form or appearance. 6. Kkratine is the name applied by Simon to the pecu- liar animal substance constituting horn, the epidermis, epi- thelium, nails, hair, &c. Recent experiments have shown that this substance is, in some cases at least, a compound of proteine and its oxides ; but as its properties are tolerably definite, the name may be conveniently retained. Chem. prop.—It is colourless Avhen pure, insoluble in water, both hot and cold, al?o in aether and alcohol. It is 68 soluble in liquor potassce, partially so in ammonia; also soluble in sulphuric acid, imperfectly so in nitric acid, being at the same time coloured yellow. Acetic acid dis- solves merely a trace; ferrocyanide of potassium causes little or no precipitate in the solution. By dissolving hair in potash, rendering the solution as slightly acid as possible, a precipitate of proteine falls; on adding more acid, binoxide of proteine is precipitated. It is not known Avhether the same occurs with all the keratine corapounds. When boiled with muriatic acid, the solution becomes reddish- brown. When incinerated, keratine leaves the same earthy and alkaline salts as albumen or fibrine. In the hair, in addi- tion to these, phosphate of magnesia, silica, and oxides of iron and manganese have been found. The hair, Avhich has received more attention than any other keratine com- pound, contains sulphur and a very minute quantity of phosphorus. In preparing hair for analysis, it cannot be digested with alcohol or aether, as these agents act upon the sulphur it contains; consequently the state in Avhich the last substance is contained in it must differ from that of the sulphur in albumen, fibrine or caseine, as in these it is not removed by either aether or alcohol. Keratine in the hair is composed of C40 H33 N6 OS15 giving carbon, 51-529; hydrogen, 6-687 ; nitrogen, 17-936; sulphur and oxygen, 23-848 per cent. The sulphur averages 5 per cent. Microscop. char.—The appearances presented by the different varieties of keratine relate principally to the ex- tent of its organization ; there is nothing characteristic in the substance itself. The structures formed of it, as far as they come within the limits of this manual, will be de- scribed with the fluids in which they occur. For descrip- tions of the remainder, Mr. Paget's " Report,"* or Henle's " General Anatomy nf may be consulted. • \ " ?ep,°rt °/rlhe Res,llts obtained by the Use of the Microscope in the btudy of Human Anatomy," Brit, and Foreign Med. Review July 1842. t "Allgemeine Anatomie," von J. Henle, one of the volumes of summering s "Anatomie." 69 II. GELATINOUS COMPOUNDS. These substances occur extensively in the human body. They s\vell and become transparent in cold water, dissolve in boiling Avater; and if the solution be not too dilute, con- crete into a jelly on cooling. They are precipitated by chlorine, tannic acid, many earthy and metallic salts, and chloride of platinum, but not by electricity. They are especially distinguished from the proteine compounds by the addition of ferrocyanide of potassium after acetic acid causing no precipitate, by the action of hot water, and their not being precipitated from their solution by acids. Chevreul found that a certain quantity of tendon, dried at 212°, yielded the same Aveight of gelatine dried at the same temperature ; so that it probably exists already formed in the structures. 7. Gelatine occurs in the bones, skin, serous mem- branes, cellular tissue, tendons, ligaments and ossified car- tilages. et. Its solution is precipitated by bichloride of mercury, little or not at all by either acetate of lead, copiously by tannic acid, alcohol and chlorine, but not by acids, aether, protosulphate of iron, alum, chloride of calcium, nor alka- lies ;* protochloride of tin causes a very slight precipitate. When solid and dried, it is nearly colourless, horny, and does not exhibit any electrical phenomena on trituration. In cold water it swells, forming a plastic mass; in hot water it dissolves, the solution solidifying on cooling. It is inso- luble in alcohol and aether. When incinerated it puffs up, and leaves an ash consisting of phosphate of lime. It is composed of C13 H10 N2 O5, yielding carbon, 15-39; hydrogen, 6-64; nitrogen, 18-34; and oxygen, 25-10. /3. To separate gelatine, the substance containing it must be soaked in water, frequently squeezed, and well washed on a linen bag; the softened moist mass is heated to 120°; it then becomes fluid, and must be filtered ; the albuminous * Alkalies sometimes throw down a slight precipitate of phosphate of lime. 70 and mucus portions are thus separated. In preparing gela- tine from bones, the carbonate and phosphate of lime should be previously removed by digestion in dilute muriatic acid. y. If gelatine be boiled with excess of caustic potash until ammonia ceases to be developed, leucine and sugar are formed. To separate them, the solution is saturated with sulphuric acid, evaporated to dryness, and alcohol boiled on the residue. The alcoholic solution is then eva- porated, and the leucine extracted from the residue by cold alcohol. <3\ Leucine, which we have previously noticed in the action of potash upon proteine,* crystallizes in scales resembling cholesterine. It is anhydrous, readily soluble in water and alcohol, but not in aether. It is not precipitated from its solution by any reagent except pernitrate of mercury.f It is composed of C! 2 H'r NO4. i. Gelatine sugar (glycicolle) crystallizes in rhombic prisms, is readily soluble in water, difficultly so in alcohol, and not at all in aether. It gives off no water at 230°. In combination with oxide of lead, it is composed of Cs H7 N2 0s. In the crystallized state it contains 2 atoms of water. £. On ebullition with nitric acid, gelatine yields oxalic, saccharic and artificial tannic acids, as also a fat resembling stearine. Leucine and gelatine sugar are also formed by the action of sulphuric acid on gelatine ; and the latter like- Ayise by boiling hippuric acid with muriatic acid for some time. *. The microscopic appearance of gelatine is not charac- teristic. 8. Chondrine.—x. This gelatinous substance is princi- pally obtained from the cornea and the permanent cartilages, as those of the nose, the ears and the trachea, as also from the cartilages of the joints and the ribs. It differs in its properties from gelatine. Its solution is precipitated by acetic and the mineral acids, both acetates of lead, alcohol, * It is also formed by fusing potash with caseine. t Lehmann. 71 protosulphate of iron, chromic acid, alum,* chlorine, chlo- ride of tin, tannic acid,protonitrate of mercury* and nitrate of 'silver.* It is not precipitated by alkalies, aether, chlo- ride of calcium, ferrocyanide of potassium, nor bichloride of mercury. It is but little soluble in cold Avater. When dried, it is transparent and shining. It does not become electrical when poAvdered. It consists of C320 H260 N40 O140 S, or per cent, car- bon, 49-96; hydrogen, 663; nitrogen, 14-44; oxygen, 28-59 ; and sulphur, 0-38. Mulder regards it as a com- pound of 20 atoms of chondrine free from sulphur (C16 H.13 N2 O7,) combined with 1 atom of sulphur. When incinerated, it leaves an ash (about 4 per cent.,) consisting principally of phosphate of lime. /3. Chondrine differs principally from gelatine in the action of acids, the acetates of lead, and the solubility of most of its precipitates in excess of the reagents. y. It may be obtained from cartilages nearly in the same manner as gelatine from bones, by digesting them, when cut up into small pieces, with water for some time ; they are then boiled Avith Avater, but for a much longer period than in obtaining gelatine. The chondrine is next preci- pitated by strong alcohol, the mixture set aside, the alcohol poured off, and the chondrine again dissolved in water. iron . ) 78-2867 78-5050 0-2832 02200 6-7252 69950 05155 12-6313 0-1855 0-1637 0-7837 Seroline nu,,J Phosphorized fat °'1610i Cholesterine . 13-4150 009 0-62 [ Saponified fat (Extractives.) 01757 0-0897 $ Phosphate <■ Iron 0-0020 0-0476 0-0089 0-1025 0-6200 0-0344 0-0553 100-0000 Total ash . 0-7097 If this precipitate be white, too little iron has been used. 120 Denis, in ten experiments, found the mean amount of saline matter in 100 parts of blood = 1-11. Nasse obtained 0-7942 percent, of inorganic constituents from the entire blood ; these were composed of— f Phosphates . . . 0-0823] Alkaline and J Sulphates .... 0-0202 i„fifi^9 , soluble salts] Carbonates . . . 0-0957 j U,t>t"'ana [Chloride of sodium 0-4690j f Sulphuric acid . . 0-0052] Insoluble J Phosphoric acid . . 00201 I 0-1270 = 0-7942 substances j Lime.....0-0183 j per cent. { Peroxide of iron . . 0-0834 J Becquerel and Rodier obtained— Alkaline salts..........0-56, and Insoluble ) Earthy phosphates . 0-033 ) 0-089 = 0-649 substances } Iron......0*056 ) total per cent. On ultimate analysis healthy blood yielded,—carbon, 51-96; hydrogen, 7-25; nitrogen, 1507; oxygen, 21-30; deducting the ash, C 54-19, H 7-48, N 15-72, and O 22-31. The dried corpuscles contain about 5 per cent, of haema- tine; the haematine contains about 10 per cent, of oxide of iron. The amount of fat in our typical analysis is too great, the average being 0-2 or 0-3 per cent.* The total amount of saline matters is about 1-0 per cent., that of oxide of iron about 0-06-0-07 per cent. The following may be regarded as the average composi- tion of serum:— Water..............90600 Albumen.............7-900 Extractives, fat and soda........0-599 Alkaline chlorides..........0-600 ) Carbonate, phosphate and sulphate of soda . . 0*210 > 0*901 Carbonate and phosphate of lime and magnesia 0*091 ) 100-000 The fatty matter of the blood requires a few remarks; it * I inadvertently stated in the Med. Gaz. that the amount of fat iu blood averages 2 per cent. It should be 2 parts in 1000. 121 has not however been sufficiently examined totenable us to speak positively as to its nature. It is separated by ex- hausting the dried and powdered blood with Avater, again drying, and boiling alcohol on the residue. The alcoholic solution should be filtered whilst boiling-hot; on cooling, it deposits seroline. After separating this, on evaporating the alcoholic solution, four fatty matters are found in the extract. When the latter is acted upon by cold alcohol (0'833,) a crystalline fat remains undissolved; this is the phosphorized fat, and somewhat resembles Fremy's cerebric acid. The alcoholic solution on spontaneous evaporation deposits cholesterine ; and after separating this, on further evaporation a mixture of margaric and oleic acids with the potash soaps of these acids is left. Lecanu found in the serum only cholesterine, seroline, margaric and oleic acids, but no phosphorized fat. The fat extracted from fibrine by aether is crystalline when cold, reddens litmus, and is soluble in cold alcohol, leaving an alkaline ash on incineration ; thus it appears, partly at least, to consist of an acid soap.* In addition to the ordinary constituents of the blood which Ave have just detailed, others are occasionally present, even in the healthy fluid. 60. Sugar is one of these. It has been found by Mr. McGregor, and recently by Dr. Buchanan, that blood, even from an apparently healthy individual, ferments Avith yeast; this has also been found to occur in diabetic blood. It would be more satisfactory Avere more positive means adopted to test the presence of sugar in this fluid; as by procuring the sugar in the solid form, or the application of Trommer's or Pettenkofer's tests; the production of car- bonic acid, cannot be received as evidence without the growth of the torula (Pt. I. p. 46,) as carbonic acid is evolved from the blood under other conditions. In applying the fermentation test, the serum should be evaporated to dryness, and the residue treated with boiling water. The solution is then treated with a little yeast, and set aside in a warm place ; if sugar be present, the evolution of gas and the formation of the white froth occur. * Berzelius. 122 Trommer-te test depends upon the power possessed by sugar, of reducing the suboxide of copper to the protoxide. It is this:— Add a little solution of sulphate of copper to the suspected liquid, then solution of potash in slight excess, and boil the mixture. The oxide of copper at first precipitated is redis- solved by the excess of potash, the liquid becoming deep blue ; and if sugar be present, on the application of the heat an orange-red precipitate of suboxide of copper falls; if no sugar be present, the precipitate is almost black. As potash at a boiling temperature frequently causes a dark colour with organic matters, which may obscure the distinct appearance of the reaction, the folloAving method of apply- ing this principle is preferable (Cappezuoli's test:)—Add solution of potash to that of sulphate of copper in a test- tube, wash the blue precipitate with water, add it to the suspected liquid, and then enough potash to render the mixture distinctly alkaline. Set the whole aside in a tall glass vessel, no heat being applied. At the end of a few hours, if sugar be present, the blue precipitate is changed in colour, at first upon its surface, finally throughout the whole mass, assuming a canary-yellow tint; this is suc- ceeded by a red one, the protoxide of copper being reduced. This is a beautiful test; the only objection is that it cannot be applied immediately. The solution may be prepared for its application, either as described above, or by evaporation to dryness, exhaust- ing the residue with boiling alcohol (not strong,) again evaporating to dryness, and treating with Avater. 61. Bilic Acid and Biliary Colouring Matter.— These t\vo substances appear to occur separately, although mixed in the bile, and we now* fortunately possess means of recognising each. It is doubtful whether bilic acid occurs in the blood, but there is no doubt regarding the occurrence of the colouring matter. In the healthy fluid neither can be detected. The colouring matter is recognised by the peculiar greenish-yelloAV colour Avhich it imparts to the fluid, as also by the reaction of nitric acid, which causes it to pass through a series of tints, in Avhich green and red predominate. If the fluid be albuminous, the albumen, when precipitated by 123 nitric acid, assumes a green colour. Bilic acid its recog- nised by its reactions Avith sulphuric acid and cane-sugar (Pettenkofer's test.) The liquid, or an aqueous solution of the solid suspected to contain it, is treated guttatim Avith two-thirds of its volume of sulphuric acid in a test-tube. From 2 to 5 drops of syrup (1 part sugar to 4-5 water) are then added, and the mixture shaken. The addition of the acid at first precipitates the bilic acid, which is subsequently redissolved, and speedily a beautiful deep reddish-violet colour is produced. In using this excellent test, the tem- perature of the mixture must be kept beloAV 144° F.; too much sugar must not be added; the sulphuric acid must be free from sulphurous acid, and albumen must be previously removed by ebullition. In some cases, especially where the amount of bilic acid is small, an excess of the acid may- be requisite. To remove the bilic acid and colouring matter, the fluid should be evaporated to dryness, exhausted with strong alcohol, again evaporated to dryness, and the residue dis- solved in a small quantity of Avater. This test acts equally Avell Avith grape-sugar. If properly applied it does not appear liable to fallacy. Albuminous solutions, when Arery concentrated, produced a similar re- action. If too much syrup be added, the mixture becomes broAvn from the formation of humus. A certain amount of heat is necessary, or at least facilitates the reaction. 62. Urea.—In all probability urea exists in the blood in minute quantity, although it cannot be satisfactorily detected. The fact of the extractives of blood causing chloride of sodium to crystallize in octahedra and to form the peculiar dagger-like crystals (Part I. figs. 30 and 31,) cannot be considered as sufficient to decide this point. Some of the crystalline arborizations of muriate of ammonia so nearly resemble those of chloride of sodium crystallized from a solution of urea, that they can hardly be distinguished. In certain diseased conditions there is no doubt of its occur- rence*. To detect urea in the blood, or in any fluid, evapo- rate it to dryness in a steam or water-bath, exhaust the residue with strong alcohol, again eA'aporate, dissolve the residue in a small quantity of water, immerse the mixture in ice-cold Avater, or in a freezing mixture, and add slight 124 excess of nitric acid. The compound whrch separates (and one nearly always does so, Avhether urea is present or not) must then be examined with the microscope. Two sub- stances are generally to be found, viz. globules of oleic acid, or rather a mixture of oleic and margaric acids, and oblique rhomboids of nitrate of soda; if urea be present, it may be distinguished by its characteristic form (PI. II. fig. 38.) It is seldom however that it can be recognised at the stage of the process; if not, the liquid should be digested with excess of carbonate of baryta, then gently evaporated to dryness, exhausted with strong alcohol, again evaporated and treated with the acid in the cold as before; if urea be present, its form may then be recognised ; the appearances generally presented are figured in PI. IV. fig. 20. The crystals of the nitrate of soda, as found under these circum- stances, are figured in PI. IV. fig. 21. It is well not to use oxalic acid to separate the urea in this process, as it crys- tallizes itself in the cold, and may give rise to confusion; moreover, the extracts should be thoroughly exhausted with alcohol, as the amount of urea is generally not large, and the evaporations should be performed very carefully and slowly. 63. Milky Blood.—The occasional occurrence of either an entire milkiness of the serum, or the formation of a creamy scum on its surface by repose, has been noticed in several diseases. It has been lately shown to be almost a constant occurrence in the blood withdraAvn a few hours after a meal. The milkiness is caused by an immense number of exceedingly minute granules, resembling in ap- pearance those Avhich form the molecular base of the chyle. They are of two totally distinct kinds, one being soluble in aether, the other unaffected by it. When the milkiness is caused by the former, on agitating the serum with aether it entirely disappears, the serum becoming clear ; in the latter case the aether floats on the surface, acquiring a yellowish colour from the solution of fatty matter, the lower portion retaining its peculiar aspect. The former substance is probably analogous to the molecular base of the chyle (vide Chyle, p. 129.) Dr. R. D. Thomson found the latter quite insoluble in both aether and alcohol, but soluble in 125 caustic potash. It contained sulphur. He concluded that it most probably consisted of a proteine compound. Dr. Buchanan found that it might be removed by adding salt to the solution, filtering and washing. In one case the blood has been found milky and acid from the presence of acid fatty salts. I had an opportunity lately of examining some milky blood which had been withdrawn from a gouty patient. It was uniformly Avhite, from the presence of an immense number of minute granules or molecules. These were separated by solution of chloride of sodium. When dried and treated with aether, they yielded some fatty mat- ter. On ebullition wTith muriatic acid, the characteristic reddish colour of proteine Avas produced, and a large num- ber of oily globules, which solidified on cooling,* floated on the liquid. These Avere composed of a fatty acid. The substance Avas in but small quantity, and I have not yet completed its examination. It decidedly contained no sulphur. 64. Pus is an occasional abnormal ingredient of blood. Donne has proposed the action of ammonia as a test of its presence. If healthy blood be mixed with ammonia, the colour becomes someAvhat brighter, and the mixture is rendered clear; when containing pus, it becomes gela- tinous, the firmness and quantity of the jelly being propor- tional to the quantity of pus present. This may be a useful test in some cases, but should not alone be relied upon. The microscope may be much more safely trusted. In using this instrument, care must be taken not to mistake the proper chyle-corpuscles (Chyle, p. 129,) or the colourless corpuscles of the blood, for those of pus; the red cor- puscles also occasionally present a granular appearance, not very unlike that of globules of pus. The latter may be distinguished from the former by their spherical form, larger size, whitish colour, and yielding nuclei Avith acetic acid ; whilst the former are yellowish, flattened, and dis- solved by acetic acid, leaving no nuclei. The colourless corpuscles of the blood much resemble those of pus, but are smaller and more finely granulated on the surface. The proper chyle-corpuscles are also smaller than those of pus, and occur but rarely. % 126 Pus, when mixed with blood, appears in the serum either in the form of the mucous urinary deposit or in flakes.* (160) 65. Buffy Coat.—The appearance of this remarkable formation is well knoAvn. Its ordinary physical properties do not differ from those of fibrine. When freed from the serum by kneading in cold Avater, and then boiled with water, it yielded 14-2 per cent, of tritoxide of proteine and 85-8 per cent, of binoxide. On organic analysis it yielded— C 52-53-52-95, H 6-9-7*04, N 15*51, 0 25-06-24-5. Hence it is composed of a mixture of the bin- and tritoxides of proteine. The cause of its formation cannot be ex- plained. Jt has been observed that if blood be draAvn into two separate cups, one of Avhich contains oil, the latter ex- hibits the buffy coat, whilst the former does not. It is unknoAvn whether the buffy coat is ever composed of fibrine ; w-hen produced under the conditions just described, its composition is also unknown. We have already shoAvn that the oxygen of the air has an undoubted influence upon the corpuscles especially. Noav supposing from any cause (and several have been pro- posed) that the corpuscles in blood which is about to form the buffy coat subside more rapidly, or that the cohesion of the red particles occurring sooner in buffy than in healthy blood squeezes out the Liquor sanguinis, Avhich is thus ex- posed to the air during the coagulation, we can imagine Iioav it might occur that in healthy blood during coagulation the fibrine is defended by the corpuscles from the action of the oxygen ; Avhilst in the buffy blood this is not the case, and the fibrine is exposed to the free action of the air, and might form the oxides of proteine. This view Avould be confirmed should the buffy coat formed under oil be found composed of fibrine. These arguments are merely pro- posed to draw particular attention to the point, and hence to cause the institution of more experiments. I have not noticed Mulder's views on this subject, inasmuch as they do not appear to me at all satisfactory, and he seems to speculate on this matter much more than his experiments (entitle him to do. * Geadiin. * 127 The microscopic appearances of blood Avhich is about to form a buffy coat are well marked. The formation of the net work perceptible to the naked eye, Avhich in healthy blood does not occur until the lapse of about a minute, may be perceived in buffy blood immediately after its removal from the vessel. Moreover, the fibres formed by the appo- sition of the sides of the red corpuscles under the micro- scope are immediately visible; hence buffy blood differs essentially from the healthy fluid, and the formation of the buffy coat may thus be foretold. Buffy blood contains a larger number of colourless cor- puscles than the healthy fluid ; but the relation these have to the oxides of proteine is notknoAvn. In consequence of the formation of the net Avork or sponge Avhich Ave have just mentioned, before the solidification of the fibrine, its con- traction is uninterrupted by the latter, and the Liquor san- guinis with the colourless corpuscles are squeezed out of the sponge and rise to the surface ; so that if Ave examine a drop from the surface of the blood immediately after it has been drawn into a cup, Ave find a few colourless cor- puscles, as well as the net Avork of coloured corpuscles; a little later, the latter having sunk, are nearly absent, a few only being detectable, the colourless corpuscles being much more abundant; at a still later period, these having sunk, almost disappear, the solidified fibrine alone being present. 66. Concretions are occasionally found in the cavities of the heart, which have formed during life. They are composed of fibrine, containing the red corpuscles diffused through them, and, as in the ordinary clot, these are most abundant in the most dependent portion. In the interior of these masses pus is stated to have been found ; but, from the observations of Mr. Gulliver, the semifluid matter ap- pears to consist merely of disintegrated pultaceous fibrine; it contains few, if any corpuscles resembling true pus. No- thing is known of its chemical nature. When examined microscopically, it exhibits an immense number of very minute granules with a few lymph (?) corpuscles. It is more prone to putrefaction than pus. 67. Chyle.—This fluid is so difficult to procure that our knowledge of it is not very satisfactory. It can hardly be- come an object of pathological examination. It is a neu- 128 tral milky fluid of about 1021-4 spec, grav., and varying in its properties according to the part of the lacteal system from which it is withdrawn. Soon after its removal from the vessels it coagulates like blood ; the coagulum is red- dish Avhen viewed in a mass; this redness is said to be in- creased by exposure to the air; when examined in small quantity it is not perceptible. Its appearance also varies according to the contents of the alimentary canal at the time of the death of the subject from which it is obtained. If a full meal had been taken a few hours prior to death, and especially if this contained fat, the chyle is perfectly milky; but if digestion Avas not going on, it resembles lymph in its composition. The milkiness depends upon the presence of a peculiar molecular base. It is entirely re- moved by aether. The reddish colour depends upon the presence of blood-corpuscles. When allo\ved to repose, the molecular base partly forms a creamy scum on the sur- face, but the Avhole fluid does not become clear. The minute granules, constituting the molecular base, are not changed by the action of the salts, caustic alkalies, nor acetic and muriatic acids. They are instantly dissolved by aether, the chyle becoming transparent, except a small quan- tity of a light brown or whitish matter, which forms*a nearly pellucid substratum, sinking towards the bottom of the test- tube, but never entirely reaching it.* The fatty matter of the chyle leaves an alkaline ash, and contains no phosphorus. Chyle (obtained from the thoracic duct) yielded on analysis— Water ...... 90-48 Albumen, with traces of fibrine . . . 7*08 t, . .- ( Aqueous .... 2*56 Extractives I .? , ,. n wn ( Alcoholic .... 0o2 Alkaline chloride, carbonate and sulphate, Avith traces ) » ., of phosphate and oxide of iron . . . ) Fatty matters ..... 0-92 100-OOf The differential characters of chyle and blood are as fob » Gulliver. f Dr. Rees. 129 jow:—The partial or complete absence of the red colour; the Ioav specific gravity; the less distinctly alkaline reac- tion ; the later and more imperfect coagulation; the less number of its corpuscles; their different appearance; the greater amount of fatty matter, but less amount of solids; the imperfect formation of its albumen, which more nearly resembles caseine than the albumen of the blood, and of its fibrine, which more nearly approaches albumen ; the free, not saponified state of its fat; its great richness in extrac- tives, diminished quantity of soluble salts; its iron being contained in the serum, instead of the corpuscles; and its greater richness in carbon and poorness in nitrogen than arterial blood.* Sugar has been found in the chyle, and it would be extremely interesting to knoAV whether urea is ever present or not. Microscop. char.—Before the chyle has passed through the mesenteric glands, it is of a milk-Avhite colour; this is owing to the presence of, «, an immense number of minute granules, of the —l-----— th of an inch in diameter (the molecular base ;) it also contains /3, some free oil-globules ; after having passed through the mesenteric glands, it con- tains, y, the proper (?) chyle-corpuscles \\ these are round- ish granulated bodies, some larger and some smaller than the blood-corpuscles, and closely resembling the lymph- globules; <^, a few coloured corpuscles of the blood are oc- casionally present. When treated with aether, the * and /3 particles are dissolved, the proper chyle-corpuscles being- unaffected. The latter are scarcely affected by acetic acid, nor do they generally yield any distinct nuclei with it> although tAvo or three are sometimes seen4 Chyle may be analysed much in the same manner as the blood; more dif- ficulty is however experienced in separating the fibrine, the texture of which is extremely loose and diffluent. 68. Lymph.—We have even less accurate knowledge of this fluid than of the chyle. It is of a pale yellowish colour, and coagulates in about 10 minutes. The coagulum is gelatinous. It is alkaline, and contains about 3-5 per cent. of solids. It contains much more water than the chyle. * Nasse. f These are surely nothing more than lymph-corpuscles. X Gulliver. 9 130 Gmelin found human lymph composed of— Water ...... Fibrine ...... Albumen ...... Chloride of sodium, free alkali, phosphate of soda, and a substance resembling ptyaline Extractives and soda .... Marchand found 1-544 per cent, of inorganic constituents. In microscopic appearance lymph resembles blood which is deprived of the red corpuscles, but it appears to contain a larger number of the colourless globules. Lymph may be analysed in the same manner as the chyle or serum of the blood. 69. Saliva.—The saliva, as voided from the mouth, is a mixed fluid, consisting of the secretion of the salivary glands with the mucus of the mouth. When alloAved to repose, it separates into two layers; the upper is clear, colourless, and somewhat mucous; the lower consists of the same liquid, containing an opaque matter in suspension. If the saliva be agitated with Avater, the mucus is diffused through the liquid, and by repose completely subsides. It has a specific gravity of 1005-8, and appears to be alkaline Avhen food is taken, at other times acid. When diluted with Avater, it is precipitated by nitrate of silver, both acetates of lead, bichloride of mercury and tannic acid ; perchloride of iron causes the liquid to assume a deep red colour, from the formation of sulpbocyanide of iron. A milkiness is caused in saliva Avhen mixed with water and filtered by acetic, nitric and muriatic acids; ferrocyanide of potassium causes a precipitate in the muriatic solution. Alum also causes a precipitate, but neither this nor the acetic precipitate is soluble in excess of the precipitant. When boiled a very slight opalescence is caused in its aqueous solution. Berzelius obtained 0-717 per cent, of solid residue from saliva by evaporation. Spirit removes alkaline chlorides, albuminate of soda and extractive from it. The portion insoluble in alcohol is slightly alkaline; when neutralized Avith acetic acid, evaporated and treated with alcohol, ace- tate of soda is removed. The undissolved residue consists of mucus and ptyaline. 96-10 0-250(?) 2 750 0*210 0690 131 70. Ptyaline somewhat resembles tritoxide of proteine in its characters, but differs from it in some essential points. It is insoluble in alcohol and aether, being precipitated from its aqueous solution by the former, but not by mineral acids, acetic or tannic acids, neither acetate of lead nor bichloride of mercury. It is neutral, and leaves an alkaline ash on incineration. Ptyaline may be procured by treating the mixture of that substance Avith mucus, spoken of above, Avith cold water; the ptyaline is dissolved, the mucus remains. Or, fresh saliva should be neutralized Avith acetic acid, and then evaporated in a water-bath ; the residue is first treated with alcohol and then with spirits; the residue is dissolved in water, and treated with chloride of calcium and ammonia, to precipi- tate the sulphuric and phosphoric acids; the solution is then neutralized with muriatic acid, evaporated to dryness, and the chlorides extracted with alcohol.* Ptyaline is stated to have been found in vomited fluids, dropsical effusions, &c. Berzelius found saliva constituted of— Water .... 99*29 Ptyaline .... 0 29 Mucus .... 0 14 Extractive and alkali 0 09 Chloride of sodium 0*17 Free soda .... 0-02 10000 Chloride of calcium, alkaline carbonate, phosphate and sul- phate, muriate of ammonia, with phosphate and carbonate of lime and a phosphorized fat, have also been detected in it. Simon found 0052 per cent, of fat. Tiedemann and Gmelin found 0-25 per cent, of ash, consisting of 0*203 alkaline and 0*047 earthy salts. Saliva contains an exceed- ingly small quantity of a substance precipitable by acetic, nitric and muriatic acid, as also by ebullition. This appears to consist of albumen with mucus. The presence of sulphocyanogen in the saliva was clearly shown by Tiedemann and Gmelin thus:—Dried saliva was exhausted with alcohol, the latter removed by distillation, the residue mixed with concentrated phosphoric acid, and * Lehmann. 132 the mixture distilled to dryness in a water-bath ; the dis- tilled fluid was reddened by a neutral salt of iron. When a portion of the distillate was treated with a mixture of pro- tosulphate of iron and sulphate of copper, a white precipi- tate was produced, Avhich possessed the property of redden- ing an acid solution of perchloride of iron. Finally, a mixture of solution of chloride of barium, chromate of pot- ash and muriatic acid (which is clear, and contains chlorine abundantly.) when added to and digested with the distillate, became turbid, and gradually deposited sulphate of baryta, formed at the expense of the sulphocyanic acid in the dis- tillate.* The white precipitate spoken of above is 2CuCy2S; the sulphocyanide of copper, CuCy2S, is soluble in water, but is reduced by the protosalt of iron to the sulphocyanuret 2CuCy2S. Acetic acid is volatile, but does not cause a deep red colouring in solutions of iron except when previ- ously neutralized by an alkali; moreover, it does not cause the white precipitate with the solution of iron and copper. The red colour of the sulphocyanuret of iron is destroyed by bichloride of mercury ; that of the acetate is not so. The meconate and formiate of iron are also of a similar colour to that of the sulphocyanuret; they are however readily distin- guished by the bichloride of mercury, which does not destroy their colour. That produced by the addition of chloride of iron to the human saliva is destroyed on the addition of the bichloride. Microscop. app.—This differs but little from that of mucus. Four kinds of corpuscles are recognisable:—*, the minute granules found in all animal fluids; jS, mucous globules; these are larger than those in pus, generally yielding a sin- gle large nucleus with acetic acid, sometimes not, and being much more slowly acted upon than those of pus; y, epithe- lial scales ; and «^, occasionally a globule or two of oil. In all probability, the whole of these are, save the last, derived from the mucous membrane. The /3 globules exhibit moving molecules in their interior. • The pathological alterations of the saliva relate to its acidity or alkalinity, the alteration in properties of its nor- mal constituents, and the addition of foreign ones. The detection of its acidity needs no notice, except that * Berzelius. 133 the paper should be of the most sensitive kind, dahlia-paper prepared Avithout the addition of either acid or alkali; the amount of acid may be estimated according to 117. The proportion of its constituents may be determined by a pro- cess similar to that used in the analysis of the serum of the blood. The principal foreign matters, and those which should be sought for, are fat, 21 /;rV\""' A^-- ~Fu>. /J A;:Ay. yta L,t/, .■/■ ry,;,:.urr/,,/-' GRIFFITH OX BLOOD &I7RTXK. Plate ■/. ® S .(A,-, '0.3®- 5)® $>«; i? ^y> t • '"«, 9' '♦ * A V, -©,.SA ®(S),.',®' IV.r.jS J afyy^ ) ' r> ® ■ v ©y ,"v'a > 'A..■■* ?>>. ?/. ^A'^a /f? H T^y ^A' Tio. b AM :AA a:' w [ a a y \ / /%.?-/ 'll pL J ~- h ' ».%.'&m Fia. 2J .* * J J J X Fid 27 r,<, 16 .-% W$t J "?2y /$>« <-* «^=A n . At W \ IM. of T SineZair. J'Tiil" DESCRIPTION OF PLATE III. Fiff. 1. Margarine from human fat. a and b, minute branched needles; c, tufts composed of needles more rapidly formed; d, drops of oleine. 150 diameters. 2. Stearine. It is rarely found to exhibit any distinctly crystalline form; that figured however sometimes occurs. 3. Also margarine, more highly magnified, a, tufts com- posed of ramified needles; b, the same, more highly magnified. 4. Sebacic acid, a, prismatic form ; b, thin plates; c. minute tufts; d, the same, more highly magnified. These forms are found in the acid crystallized for the first time from a hot aqueous solution of the products of distillation of a fat containing oleine; e, the same, recrystallized and pure, exceedingly thin elongated laminae. ."). Margaric acid. 150 diameters. These crystals some- what resemble those of margarine. (». Stearic acid. 150 diameters. 7. Oleine. 8. Cholesterine. Thin rhomboidal plates, the angles oc- casionally truncated. 0. Muriate of ammonia. The form a approaches very near the dagger-shaped crystal of chloride of sodium and urea. 10. Lactate of zinc. 11. Acetate of zinc. These are very thin plates. 12. Carbonate of lime. See p. 100, note. 13. Ammonio-phosphate of soda from urine by evaporation. After Simon. 12 178 DESCRIPTION OF PLATE IV. Fig. 14. Blood, a andb, coloured corpuscles ; a, as ordinarily seen; b, lateral view, when turning over; c, colour- less corpuscles; (/, after treatment with acetic acid, exhibiting nuclei. 15. Blood during coagulation; the coloured corpuscles forming areolar spaces by the adhesion of their plane surfaces, the colourless corpuscles remaining distinct. 16. Blood before coagulation commences. Seen Avith a much lower power than in 14. 17. Oxalate of soda, a, dumb-bell form;' b, prisms; c, tufts. 18. Epithelial scales and mucous corpuscles. 19. Mucus (nasal.) a, epithelium ; b, mucous corpuscles ; c, granular matter; d, fibrous appearance. Less highly magnified than in the last figure. 20. Nitrate of urea, crystallized from blood in Bright's disease. 21. Nitrate of soda, from an aqueous solution of the alco- holic extract of blood. 22. Tartrate of lime. 23. Milk-sugar, a, tufts (after Vogel;) b, prisms. 24. Benzoic acid, a, by sublimation ; b, by crystallization. From coav's urine. 25. Corpuscles of pus. a, ordinary; b, after the addition of acetic acid. 26. Fatty globules from the colostrum, somewhat resembling the globular masses in sour milk. 27. Bitartrate of potash. 28. Allantoin. 29. Semen, containing crystals of phosphate of lime. INDEX. *** The figures to which the Rornai Acetic acid, properties of, ^5; distinction from lactic acid, 86; quantitative Ana- lysis. 86 Acroleine, 82 Albumen, in urine, fallacies in detecting, i. 38; of fluid, 62; coagulated, 63; cause of its solution, 63; compounds of, with acids, 03; compounds of, with alkalies, 63; to obtain, 63; distinction of, from fibrine, 65 Allantoic fluid, 158 Allantoin, 158 Alumina, properties of, 90; separation from phosphates, 96 Ammonia, detection of, i. 31, note; pro- perties of, 94; quantitative estimation of, 94 Ammoniacal salts in urine, i. 31 Amniotic fluid, 1.58 Analysis of blood, 114 Andral and Gavarret's process for ana- lysing blood, 144 Antimoniate and antimonite of potash, tests for soda, i. 30, note Arterial blood, characters of, 113 Atomic weights, to determine, 102 Be lie acid, properties of, &7 Berzelius, process for the analysis of blood, 11.5 Rile in urine, i. 37; in blood, 1-22; pro- perties of, 137; crystallized, 138; quan- titative analysis of, 145 —, colouring matters and properties of, 140 I character is affixed refer to Tart I. Biliary calculi. 146 Biliary sugnr, 138 Bilic acid. 137; in blood, presence of, 122: detection of, 145 Biline, 13-t, 141 Bilifellinic acid, 142 Bilifulvic acid, 141 1 Bilifulvine, 140 Biliverdine, 140 Bmotide of proteine, 01; in the buffy coat, 126 Blood, in urine, i. 37; general properties of, 104; coagulation of, 104; corpuscles of, 105; microscopic characters of, 105; extractives of, binoxide of proteine in, 111; during coagulation, microscopic ap- pearance of. 111; cause of arterial and venous colour of, 112; arterial, distin- guishing characters of, 113; in health, composition of, 113, 119: menstrual, characters of, 113; portal, characters of, 113; analysis of, 114; coagulated, analy- sis of, U6; analysis of, 119; constituents of, 113; ultimate analysis of, 120; fatty matter of, 121; biliary colouring matter in, 122; bilic acid in, 122; detection of urea in, 123; milky, 124; pus in, 125; buffy coat of, 126 Brain, fluids from the serous membrane of, 161 Buffy coat of blood, 120; ultimate analysis of, 120 Butyric acid, 77 Butyrine, 80 12* 180 Calculi, urinary, i. 28, 33, 36, 44, 45, 48; salivary, 133; biliary, 146; intestinal, . 150 Cappezuoli's test for sugar, 122 Capric acid, 151 Caproic acid, 151 Capryllic acid. 152 Carbonates, alkaline, in the blond, 110 Carbonate of lime in urine, i. 44 Carbonic acid, detection of, 92 Caseine, general properties of, 66; diffe- rence between thai of human and that of animals, 67 Cerumen, 356 Chloride of sodium, crystalline forms of, i. 29 Choleic acid, 144 Cholepyrrhine, 140 Cholesterine, 81 f holesteric acid, 81 Cholic acid, 144 Cholinic acid, 143 Choloidic acid, 144 Chondrine, 70; distinction between gela- tine and, 71 Chyle, properties of 127; composition of, 128; molecular base of, 128 Chylous urine, i. 40 Coagulated blood, analysis of, 110 Coagulation of the blood, 104; microscopy of, 111 Colour, arterial, of blood, cause of, 112 ------, venous, of blood, cause of, 112 Colouring matter of the bile in blood, 122 ----------matters, vegetable, in urine, i. 41 Colostrum, 155 Concretions in the heart, composition of, 127 Copper, detection of, 97; occurrence of, in biliaiv calculi, 147 Corpiir-cies. of the blood, properties and composition of, 109; of the chyle, 128; of milk, 154; of pus, 163; of mucus, 100 Cyanourine, i. 41 Cystic oxide, in urine, i. 45; calculi, i. 45 Diabetic sugar, Dyslysine, 143 47 Elaic acid. See Oleic acid. Elaine. See Oleine. Erythroprotide, 62 Evaporations, method of performing, i. 16 Excrement, 147 Extractive matters, 72 Faeces, 147 Fatty acids, 74 Fatty matters, 73; in urine, i. 40; general properties of, 74; products of destructive distillation of, 74; separation of, 74; to obtain the fusing-points of, 74; analysis of, 83 Fellinic acid, 142 Fibrine fluid, 64; solid, 64; distinction of, from albumen, 65; of blood, 106; fatty matter of, 120 Fibrinous calculi, i. 49 Figuier's process for analysing blood, 115 Fluorine, determination of, 92 Formic acid, properties of, 87 Freezing mixture, method of making, i. 16 Fusing-points of fatty matters, table of, 74; method of ascertaining, 75 Gastric juice, properties of, 133 Gelatine, 69; sugar of, 69; action of alka- lies upon, 70; action of nitric acid upon, 71; distinction from chondrine. 72 --------of elastic tissues, 71; distinction from gelatine, chondrine, &c, 72 Gelatinous compounds, 69 Globuline, chemical and microscopical characters of, 64; of blood, 100 Glycerine, 81; products of, on destructive distillation, i-2; to obtain, 83 Glycicolle, 70 Haemapbeine, 110 Hasmatine, properties of, 107, and compo- sition of, 107; condition of the iron in, 107; method of obtaining, 10f; propor- tion of iron in, 107 Hair. 68 Heart, concretions in, composition of, 127 Hippuric acid, in urine, i. 42; distinction from benzoic acid, i. 43 Hydrocele, fluids of, 162 Hydro, nic acid, detection of, 86 Hydrofluoric acid, detection and estima- tion, of 92 Incineration of animal matters, how best performed, i. 16, ii. 118 Indigo, detection of, in urine, i. 40 Intestinal fluid, 130 Iodine in the urine, i. 42 Iron, oxide, detection of, 96 ----, quantitative determination. 96; sepa- ration from the earthy phosphates, 96 Keratine 67 Kiestein, i. 50 Kreatine, 73 Lactic acid, properties and composition of, i. 31, ii. 84; detection of, i. 32, ii. 83; distinction from acetic acid, 85 Lactates in urine, i. 31, Appendix, 4 Lead, detection of, 97 Leucine, 70 Lime, detection and estimation of, 'Jo; separation of, from magnesia, 9i"; basic phosphate of, 98; neutral phosphate of, phosphates of, 98 Liqunr sanguinis, 104 Lithate of ammonia, occurrence of, in the urine of health, i. 20; in disease, i. 32: 181 ehemical and microscopical characters of, i. 33; calculi of, i. 33 Lithate of soda and lime, i. 34 Lithic acid, chemical and microscopical properties of, i. 20; state of, in urine, i. 26; action of polarized light upon, i. 28; calculi, i. 28 Logarithms, use of, in analytical calcula- tions, 103 Ludwig on the extractives of the blood, 72 Lymph^ composition and properties of, 129 —----globules in blood, 105 Magnesia, properties of, 95; separation of, from lime, 95; phosphates of, 95. 99 -------and lime, separation of the phos- phates of, i. 30 Manganese, oxide of, detection of, 97 Margaric acid, 75 Margarine, 79 Melanic acid, i. 41 Menstrual blood, characters of, 113 Mercurv in the urine, i. 42 Milk, 150; in urine, i. 4-; sugar of, 152; constituents of, J53; analysis of, 154; composition of, 154; microscopical cha- racters of, 154 Milky blood, 124 Molecular base of the chyle, 129; in blood, 106 Mucus, 159; vesical, i. 16; biliary, 160; in- testinal, 148; nasal, 159; in disease, 159 Muriatic acid, detection of, i. 29, ii. 89; separation from muriate of ammonia, 90 Neutral fats, 78 Nitric acid in urine, i. 42 1 • -'' Odoriferous substances occurring in urine, 41 Oil, globules of, in blood, 100 Oleic acid, 76 Oleine, 80 Oleo-albuminous urine, i. 39 Ovarian fluids, 161 Oxalate of lime, calculi, i. 44 ---------------, in urine, 43 Oxalic acid, properties of, 88; in urine, i. 43 Oxaluric acid, properties of, 88 Pancreatic fluid, 136 Pepsine, 135 Peritonaeum, fluids secreted by, 162 Perspiration, 157 Phosphates, earthy, existing in urine, i. 34; distinction from albumen, i. 36; calculi composed of, i. 36; analysis of, 96; com- position of, 98 Phosphate of lime in urine, chemical and microscopical characters of, i. 35; sepa- ration from phosphate of magnesia, i. 30, ii. 95. Phosphates of magnesia, 99 Phosphate of silver, composition of, i. 31 Phosphoglvceric acid, 78 Phosphoric acid, in urine, i. 28; properties of, 91; estimation of, 91 Phosphorized fat, existence of, in blood, 108 Phosphorus, detection of, 90; estimation of, 90 Picromel, 141 Platinum, ammonio-chloride of, test for potash, i. 30 Pleura, fluids secreted by, 163 Polarized light, action of, upon healthy urine, i. 19. Portal blood, characters of, 113 Potash, detection of, i. 29, ii. 93; quantita- tive separation from soda, 93 Potash, bitartrate of, i. 30 Proteine, chemical and microscopical pro- perties of, 59; compounds, 59; binoxide of, 61; composition of, 60; tritoxide of, 61; compounds of metallic oxides with, 62 Proteochlorous acid, 02 Protide, 62 Prussian blue in urine, i. 40 Ptyaline, 131 Pus, 163; in urine, i. 45; in blood, 125 Pyine, 163 Quinine in the urine, i. 42 Saliva, properties and composition of, 130 Salts, decomposition of, in passing through the system, i. 41 Sebacic acid, 78 Semen, 155; in urine, i. 40 Seroline, properties of, 108 Serous membranes, secretions of, 161 Serum of blood, properties of. 110; analysis of, 118; composition of, 121 Silica, in urine, i. 28; properties of, 92 Simon's process for the analysis of blood, 117 j Soaps, preparation of, 83; properties of, 83 Soda, detection of, i. 30 Spermatine, 150 Spermatozoa, detection of, 156 Stearic acid, 75 Stearine, 78 Subsulphate of proteine, 61 Sugar, in urine, i. 46; in blood, 121; detec- tion of, 122 Sugar of milk, 152; of urine, j. 46 Sulphocyanogen, occurrence of, in the saliva, 131; Appendix; quantitative ana- lysis of, Appendix Sulphoglycerale of lime, .-.2 Sulphoglyceric acid, 82 Sulpho-proteic acid, 01 Sulphur, detection of, 88; quantitative separation of, 89 Table, of salts, 101; of fusing-points of fats, 74; of fusing-points of mixtures of margaric and oleic acids, 76, of composi- tion of solids in urine, i. 18, and Ap- pendix Tartaric acid, properties of, 83 Tartar of the teeth, composition of, 13J Taurine, 143 Tearp, 156 182 Tests, purity of, i. 1.5 Titanic acid, detection of, 9? Torula in urine, i. 46 Triple phosphate, chemical and micro- scopical characters of, i. 35 Tritoxide of proteine in the buffy coat, 126 Trommer's test for sugar, 122 Tubercles, 161 Urea, formation of, in the body, i. 22; chemical and microscopical characters, i. 22; artificial preparation of, i. 23; state of its existence in urine, i. 23; de- tection of excess of, i. 23; nitrate of, composition of, i. 24; in diabetic urine, to estimate, i. 25; interference of, with the form of the crystals of chloride of sodium, i. 25; in albuminous urine, to estimate, i. 25, oxalate of, i. 25; occur- rence and detection of, in blood, 123; composition of, percent., Appendix Urate of ammonia, i. 34 Trie acid, i. 26; calculi of, i. 28 Urina ciiyli, i. 18; potus, i. 18; sanguinis, i. 18 Urinary deposit, method of examining mi- croscopically, i. 11; method of preserving i. 18 Urine, specific gravity of, i. 18, Appendix; acidity of, i. II, 13; general process for the analysis of, i. 13; estimation of albu- men in, i. 15; quantity of, i. 17; odour of, i. 18; colouring matter of, i. 19; and Appendix; solids contained in, i. 18, Appendix; mucus of the, in health, i. 19; fixed salts of, i. 28; separation of alka- line salts in. i. 2-<; phosphoric acid in, estimation, i. 29; phenomena of, on spontaneous decomposition, i. 49; of pregnancy, i. 49 Vaccinic acid, 1.52 Xanthic oxide in urine, i. 48 Xantho-proteic acid, 62 Zieger, 151 THE END, ANALYSIS BLOOD AND URINE, HEALTH AND DISEASE; THE TREATMENT OF URINARY DISEASES. y » G. OWEN REES,' M.D. F.R.S. F.G.S. &c. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, PRINCIPAL MEDICAL OFFICER TO THE PENTONVILLE PRISON, ASSISTANT PHYSICIAN TO GUY'S HOSPITAL, AND PHYSICIAN TO THE CALEDONIAN ASYLUM. FROM THE SECOND LONDON EDITION. PHILADELPHIA: LEA & BLANCHARD. 1848. TO RICHARD BRIGHT, M.D., F.R.S., &C. &C. PHYSICIAN EXTRAORDINARY TO THE QUEEN, CONSULTING PHYSICIAN TO GUY'S HOSPITAL, PRESIDENT OF THE HUN- TERIAN SOCIETY, ETC. ETC. 4 My Dear Sir, It would have been a pleasure to me to dedicate this work to you, if only to mark my admiration for those dis- coveries which make your name as a philosopher familiar to the practitioners of medicine throughout the civilised world. I have, however, an additional gratification in availing myself of this opportunity of expressing my grati- tude for the kind encouragement received from you when, as a mere boy, I first entered on the study of pathological chemistry. The confidence you have reposed in my re- sults and observations, at more advanced periods of my professional career, I shall ever regard as a flattering as- surance that my time has not been ill spent; and though well aware that I have effected very little by my labours, still, had it not been for your friendly aid and council, that little must inevitably have been far less than it is. That your kind wTord and noble example have not pro- duced a better result is felt with regret, by Yours, gratefully and attached, G. OWEN REES. 59, Guildford Street, Russell Square, October 1, 1845. B • PREFACE TO THE FIRST EDITION. The increased desire for a more intimate acquaintance with animal chemistry, which has lately been evinced by the medical profession, induces me to present this little work to public notice. The more philosophical methods of investigation at present adopted to ascertain the diseased conditions of the living system have forced a new branch of inquiry upon the attention of the student; while the further advanced labours in the medical profession feel the necessity of informing themselves on a subject which becomes important (to them at least) were it only as a shield against the exposure which might occur from the more perfect knowledge of a rising generation. It has been my object in this work, to exhibit a concise view of those plans of analysis which may be performed simply, usefully, and at a small expense ; requiring for their execution care and patience rather than skill and per- fection in manipulation. VI PREFACE TO THE FIRST EDITION. I have avoided as much as possible those formal methods of description which have frequently disheartened the be- ginner from even reading a process, much more putting it to practice. If any such feeling be entertained by my readers, let me assure them that it is the reading, and reading only, that perplexes them ; and that when once they have commenced the practice of the process, all con- fusion will pass away, and the facts become clearly and firmly impressed upon their minds. If the study of this volume should in any way tend to increase the number of those who occupy their leisure hours with the study of animal analysis, as applied to disease, I shall be more than repaid for my slight labours; for I shall feel that I have assisted in directing attention to a subject which, in all probability, is no less rich in discovery than it is neglected and uninvestigated by the great body of the medical profession. PREFACE TO THE SECOND EDITION. This second edition is constructed on the plan of the first, with the addition of an essay on the treatment of urinary diseases. Considerable alterations have been rendered ne- cessary by the advances made in animal chemistry since the first edition was published; but I have avoided, as much as possible, entering into scientific details as foreign to the purpose of the work, which must not be regarded as an elaborated treatise on the blood and urine in all their re- lations, but simply as a work on proximate animal analysis. Substances of rare occurrence in the blood and urine in disease, or which exist as mere traces, and are not well ex- amined or ascertained in the healthy fluids, are here only slightly noticed; and, for information of a more extended kind, the reader is referred to the works of Berzelius, Lecanu, Denis, Becquerel, and Simon. From the latter auther I have made extracts in the Appendix relating to the analysis of the blood. My object has been throughout simply to supply to the Viii PREFACE TO THE SECOND EDITION. medical practitioner the means of analysing blood and urine, and thus to assist him to comprehend and appreciate with more defined ideas the experiments of those animal chemists whose results may have reference to the important subject of humoral pathology. I have added a microscopical description, and drawings, to that part of the work treating of urinary deposits. REESE ON BLOOD a-URLNK >c y*{y- £ g fo" - §c Zilh. ofTSinAair DESCRIPTION OF MICROSCOPICAL FIGURES REPRESENTED ON THE PLATE. 1. Monobasic ammoniaco-magnesian phosphate in prismatic crys- tals; the forms derived from the right rectangular prism, ob- served generally in neutral or slightly acid urine, sometimes also in slightly alkaline urine. 2. Bi-basic ammoniaco-magnesian phosphate, formed in specimens of urine which are strongly alkaline. 3. Lithic acid in various forms, prismatic, rhomboidal, and lozenge-shaped. t. Lithate of magnesia in prismatic crystals. "When occurring in groups or tufts this is often mistaken for lithate of lime, but may be distinguished by the crystals being truncated, while those of lithate of lime have an acicular form. 5. Lithates of ammonia and other bases. 6. Lithate of lime in tufts and acicular crystals. T. Cystine in hexagonal plates. 3. Hippuric acid in four-sided prisms. 9. Oxalate of lime in octahedral crystals and other forms.* 10. Pus corpuscles. 11. Epithelium. 12. Mucous corpuscles, with tubes of albuminous matter; first de- scribed by Simon as existing in albuminous urine. 13. Milk corpuscles. 14. Seminal animalculae, occasionally observed in the urine, some- times in connection with traces of albumen. 15. Torulae, observed in diabetic urine during fermentation. 16. Blood corpuscles. The largest and lined figure represents one of the fibrinous corpuscles as seen in the blood. The red corpuscles are represented thicker than when viewed floating in liquor sanguinis, having undergone endosmodic change by contact with the urine. * As described by Dr. Bird. CONTENTS. Pa?e Introduction - - - - - 1X_- Physical Structure of the Blood - - - - 17 Analysis of the Blood in Health - - - - 21 Qualitative Account of the Constituents of healthy Blood - 31 Blood in Disease - - - - - - 35 Analysis of Blood containing Urea - - - - 36 Bile - - - - 38 Cholesterine - - - 39 Sugar - - - - 40 Analysis of the Urine in Health - - - - 43 Urine in Disease - - - - _ - 55 Urinary Deposits - - - - - - 55 Action of Re-agents on Urine - - - - - 62 Extraneous Principles in Urine - - - - 65 Analysis of Urine containing Albumen - - - 66 Sugar - - - - 69 Analysis of Urinary Calculi - - - - - 72 On the Treatment of the Lithic Acid Deposits - - 91 the Phosphatic - - - - 102 the Oxalate of Lime - - - 111 Albuminuria - - - - 116 Chylo-serous Urine - - - 126 Diabetes - - - - 12? Excess and Deficiency of Urea - 134, 135 Appendix ..---- Fatty Matters of Blood - Varying Constitution of Blood in Health and Disease Organic Acids of Urine - - - - - 149 Alkaline Salts of the Urine - - - - 150 Albuminous Urine - - - - - 151 Tests of the Presence of Albumen in the Urine - - 152 Colouring Matter of Pink Deposits - 162 Distinction of Ordinary Deposits - - - - 162 Accidental Matters in the Urine - - - - 163 Urine in Diabetes - - - - - 163 Kiestein - - - - - - - 164 Chylous Urine - - - - - - 165 138 140 INTRODUCTION. Before I enter on the description of processes, I feel it necessary to offer a few observations on the cautions to be ob- served in the more important steps of manipulation. It may also be proper to describe the uses of one or two contrivances to which analytical chemistry is pre-eminently indebted, and without which it is difficult to conceive how any degree of per- fection could have been attained in the prosecution of analysis. I shall proceed at once, therefore, to a description of the follow- ing operations, viz. Evaporation, Filtration, and Incineration; concluding with a few observations on the precautions which are necessary in weighing fluids and solids. Evaporation. This may be performed at different degrees of heat; and the greatest care should be taken to choose a sui- table temperature. Thus, if urine be experimented upon, it is impossible to use a continued heat of 212° Fahrenheit, without risking the loss of a portion, at least, of the urea, which is one of its most important constituents. When the serum of blood is experimented upon, a heat of 212° is absolutely necessary, for the purpose of rendering the albumen entirely insoluble in boiling water ; indeed, it has been stated, that a heat of 225° is necessary for that purpose ; but this is not the fact, as will be found on experiment, particularly if the serum be thoroughly dried, and then treated, while warm, with water at 212°. Filtration.—Considerable care is requisite in performing this operation ; fine white bibulous paper should be used, and the filter washed with distilled water before it is applied to the 10 INTRODUCTION. purposes of analysis. After the fluid we are operating upon may have passed through the filter, it often becomes necessary to perform many ablutions of the filter, in order to wash out from the paper all the fluid for analysis : these washings, are of course, to be added to the first-filtered liquor, and evapo- rated with it in continuing the examination. When pouring from any vessel into a filter, the lip of such vessel should be kept perfectly dry, otherwise the fluid may, after passing the lip, run backwards to the bottom of the vessel, and thus be lost. Another excellent method of avoiding this evil, consists in applying the side of a glass rod, moistened with distilled water, to the lip of the vessel, and pointing it upon the filter. These may seem trifling circumstances to dilate upon, but per- sons who are accustomed to manipulation are well aware of the value of such remarks to the uninitiated. Incineration.—Constant attention is necessary in this pro- cess, and much tact requisite in placing the crucible in proper positions in order to expedite the dissipation of the carbonace- ous matter. The crucible should be somewhat shallow, and of the form of a dish or flat capsule. It should be placed on the top of the flame of the circular-wicked spirit lamp, and with a slight inclination towards one side : this position favours the constant fresh access of air, and assists in dissipating the carbon. The crucible should, of course, be opened immediately that the animal matter is charred ; but a loose cover ought to be placed upon it before the salts begin to fuse (as sometimes happens,) in order to prevent the loss which may take place by decrepitation. The crucible is to be managed by a small pair of forceps with scissor handles, similar to the dressing-forceps used by surgeons. //eighing.—There is, perhaps, no operation in chemistry which demands so much attention as that of weighing : for the substances to be weighed are frequently of a destructive nature, and the balance is more easily injured than any other of the requisites of a laboratory. In weighing animal matters, both INTRODUCTION. 11 solid and fluid, there is continual danger of moistening the balance-dishes, and thus interfering with the accuracy of the result. To the student in animal chemistry, I would advise the use of a balance, capable of turning to one-fiftieth of a grain. This should be mounted in a balance lantern, and kept in a dry room. Accuracy is greatly-ensured by the habit of weighing by counterpoise, which is by balancing the substance to be weighed, with dry powdered sand [or any other convenient powder); and then, on removing this substance, whose weight is to be ascertained and counterpoising the sand in the balance with the weights, the most accurate result is obtained; for the number of grains, or parts of a grain required, must be identical in weight with the substance removed, before they can pro- duce the same effect, of precisely balancing the sand. By this method all that is wanted in the balance is a suitable degree of delicacy. The necessity for an equality of length in the scale- arms (which is very difficult to procure) is thus obviated, though it is absolutely necessary to the perfect determination of weight by the common method. The weight of fluids for analysis may be taken by two methods, viz. by balancing them in a bottle the weight of which has been previously ascertained; or by weighing the vessel and fluid together, and then noting the diminution of weight which occurs, when the fluid for analysis is poured out. The former method possesses the advantage of yielding a fixed quantity; for we can pour into the weighed vessel exactly the weight of fluid we wish: but it is necessary always to wash out the weighing vessel with distilled water* after the weighed fluid is poured out, in order to remove the adherent portions in the bottle, which, of course, were taken into account when the weight was ascertained. By the second method we avoid the necessity of washing out the weighing bottle ; for the * These washings must, of course, be added to the fluid for ana- lysis, and evaporated with it in pursuing the analysis. 12 INTRODUCTION. wreight we note is just that of the fluid poured out: but then we lose the means of procuring any fixed quantity of fluid which we may desire. This, however, is no great disadvan- tage, since we can always calculate the proportional quantities in any number of parts we may choose. The former method may sometimes be adopted, the weighing being performed in a dtsh which may serve also for the evaporation, thus doing away with the necessity of removing the fluid from one vessel to another. The weight of solid animal matters should be taken in an accurately balanced watch-glass, placed upon a curl of paper, which prevents its slipping from the operator ; an in- convenience occasionally very distressing during manipulation, but which may be easily obviated by this simple expedient. Before quitting this subject, I must urge upon the reader the propriety of noting with the greatest care the result of every weighing performed during an analysis. I shall now proceed to describe the contrivances adopted for procuring that degree of heat which may be requisite for the purposes we have in view, and shall notice some chemical im- plements eminently useful in the prosecution of animal analysis. Water-bath.—This may be divided into two kinds, viz. the fresh and salt water-bath. The former is formed by floating a dish in water, which is kept at a boiling temperature by means of a lamp or any other steady source of heat. Fluids placed in this floating dish are kept at a temperature approaching that of boiling water; that is, somewhat below 212° Fahrenheit. The salt water-bath is formed in the same manner, excepting that the evaporating dish is floated in a saturated solution of common salt instead of fresh spring water, by which means we can procure a heat of 225° Fahrenheit. Steam-bath.—This may be divided also into two kinds, viz- the open and closed. The former is eminently useful in the examination of fluids suspected to contain easily destructible animal principles, and is the one which should always be used, if admissible, in preference to any other sort of bath. It is formed by placing a dish over the steam issuing from a vessel INTRODUCTION. 13 in which water is kept at a boiling heat; care being taken that the evaporating dish do not touch the vessel of water in any part, but be supported over it by means of a small wooden rack. In this way we obtain a constant heat, which is far below that of boiling water. The closed steam-bath differs from the open, in being formed by a dish which perfectly closes the vessel from which the steam is issuing. It affords a very variable heat, which frequently approaches 212° Fahrenheit. The freshwater-bath is generally to be preferred.* Circular-wicked Spirit Lamp.—This is a somewhat dan- gerous piece of apparatus in the hands of the beginner. Many of the lamps sold for the purpose of burning spirit, are so con- structed as to allow of the reservoir becoming heated and the spirit consequently boiling within so short a time after the wick has been lighted, that we cannot well obtain a sufficiently con- tinued heat for our purposes. From the experience I have had in the use of this instrument, I am inclined, on all occa- sions when the application of a long continued heat is neces- sary, to prefer an open fire to a lamp, even when of the best construction. When an open fire is used our platinum crucible must be placed within a larger one of clay. In this manner wre can very easily effect incineration and dissipate carbon from burned animal matters in the process of obtaining fixed salts, and our platinum vessel is kept perfectly clean, being protected from the fuel by the large day crucible. In choosing a spirit lamp the great object should be to select that form which shows the least possible connection between the reservoir and the circular wick, and the connection existing should be formed as much as possible of glass or other badly conducting material. ♦There is an excellent arrangement for the water or steam bath, made of brown earthenware, sold at the chemical apparatus warehouses. 14 INTRODUCTION. I have now to make a few remarks on the necessity of em- ploying pure- re-agents. Unless this be carefully attended to, we shall frequently find ourselves in most unpleasant difficul- ties. I would recommend that no one should use any of his solutions until he has tested their purity for himself. We fre- quently find that the distilled water of the shops becomes cloudy on the addition of a k\v drops of the solution of nitrate of silver (indicating the presence of a chloride ;) this ought not to be the case, and such water should be discarded as unfit for use. The ordinary hydrochloric acid of the shops always contains iron in solution, and is frequently admixed with sulphuric acid, as is also the case with the common nitric acid. These acids should never be used as re-agents in their officinal condition, but always procured (in their perfecdy colourless form) from some well-known operative chemist. The sulphuric acid of the shops contains sulphate of lead in solution, which is easily detected by diluting the acid, when that substance becomes precipitated. Arsenic has likewise been detected in some specimens of this acid, which may be accounted for, by the fact, that a vast quantity of sulphuric acid is made with sulphur procured from arsenical pyrites. In several specimens of sulphuric acid lately examined, I detected arsenic in amount equal to from 20 to 30 grains in the pint. In some instances I detected the presence of selenium in small quantity. The officinal liquor potassae should never be used as a re- agent, for it frequently contains lime. Were I to proceed to show the reasons for avoiding the purchase of officinally prepared solutions, I should far exceed the intentions of this work ; I will, therefore, at once conclude, by earnestly entreating the beginner to exercise extreme caution in the selection of reagents. j\ly reason for especially noticing the impurities of distilled water, the mineral acids, and the liquor potassa?, is that these are the most likely to be purchased as officinally prepared. INTRODUCTION. 15 I subjoin a list of chemicals, which will be found sufficient for most purposes, in prosecuting the proximate analysis of animal bodies. Pure sulphuric acid, ) hydrochloric acid, I <-,. . . . y Strong. nitric acid, acetic acid, J These acids should also be kept in a dilute form. One part of strong acid to nine of v^-ater is a convenient mixture. Solution of caustic potassa. ----- ammonia. ----- carbonate of potassa. ----- oxalate of ammonia. ----- bichloride of mercury. ----- acetate of lead. ----- di-acetate of lead. ----- alum. ----■ ferro-cyanuret of potassa. ----- tartaric acid. ----- nitrate of silver. ----- chloride of barium. Tincture of galls. Sulphuret of iron.* Litmus paper, both blue and reddened,! * For procuring a stream of sulphuretted hydrogen gas:—This is done by placing the powdered sulphuret in a large phial, and adding sulphuric acid, diluted with three times its bulk of water. The gas which escapes can be conducted to the bottom of the fluid which we wish to act upon, by means of a glass tube, bent twice at right angles; one leg of which must be inserted air-tight into the cork of the phial; and the other (which must be sufficiently long) made to pass to the bottom of the vessel holding the liquid to be subjected to the action of the gas. j" Reddened litmus paper, if well prepared, is an extremely deli- cate test of alkali, far more so than turmeric paper, which, however, should also be used, as the effect produced upon it by animal solu- tions (if compared with their effect on reddened litmus) affords a rough, but frequently a useful, test of the degree of alkalinity. 16 INTRODUCTION. Turmeric paper. Alcohol—specific gravity *833. Rectified ether. The following instruments of analysis, will now render our laboratory pretty complete:— A platinum crucible, capable of holding about half a fluid ounce. Platinum foil. ---- wire. Test tubes and stand. Watch-glasses. A blow pipe. Glass rods. A spirit lamp. Test glasses. Forceps. A pair of scissors. Bone spatulas. Steel spatulas. Glass funnels. Wedgewood dishes of various sizes to contain from a quarter to half an ounce. German China-ware dishes and capsules. Lamp rack and dish stands. ON THE ANALYSIS OF THE BLOOD AND UEINE. ON THE BLOOD. As it is impossible for the student thoroughly to under- stand the principles on which the methods for analysing the blood are founded, or to possess a clear and well defined view of the application of chemistry to the advancement of humoral pathology, unless he become acquainted with the minute physical structure of the blood, I shall, in the first place, proceed to a description of that fluid as it circulates in the vessels, and point out, by reference to its minute anatomy as shown under the microscope, what those parts of its history are requiring the assistance of chemistry for their further development. The student will Ihus be ena- bled more completely to understand the nature of the changes occurring during coagulation, and more fully to appreciate the extent to which physical actions occurring in the blood, after removal from the body, and over which we have no control, are capable of affecting the positive value of our results. He will also be able to appreciate the exact point at which chemical methods of analysis should commence, and beyond which physical division can no longer be practised ; and, I trust, will thus be impressed with the absolute ne- cessity of possessing an accurate knowledge of the physical 2 18 PHYSICAL STRUCTURE OF THE BLOOD. structure of the blood before he can hope to enter upon its chemistry with advantage. The blood as it circulates through the vascular system, may be described as made up of a fluid holding in suspen- sion a number of minute organised bodies of a red colour, which so thickly pervade the suspending fluid as to give it to the unassisted eye the appearance of a homogeneous red solution. There are, existing in the blood, besides these red corpuscles, a smaller number of colourless bodies of a different organization, and known by the name of fibrinous corpuscles. In addition to. these, we also occasionally re- mark granules of various sizes thinly scattered through the blood, and,'wh-ich seem to appear in greater numbers a short time after a meal, and at a period when the flow of chyle into the blood has taken place freely. When the blood coagulates, the fluid in which the corpuscles float, and which has been called liquor sanguinis, becomes disinte- grated, a solid matter depositing frorrj it, known under the name of fibrin, while its fluid portion, containing the albu- minous and' saline matters in solution, forms serum. The fibrin as it separates becomes mixed up with the red cor- puscles, and1 the two together make up the mass known as crassamentura, which floats in serum, as is seen in-coagu- lated Wood. The white bodies which I have described as floating with the red corpuscles in the liquor sanguinis, are entangled-with these latter in the fibrin during coagulation: thus the serum is nothing else than a cleas solution of ani- mal matters and salts. When blood is about to. coagulate, it is always observed, that before the deposition of fibrin from the.liquor sanguinis commences, the corpuscles float- ing in the blood begin to subside-, and leave a thin, stratum of liquor sanguinis, on the surface. If this be removed by carefully skimming the bloody we obtain pure liquor san- guinis of a pale straw colour, which, when set aside, will separate into fibrin and serum. It was by thus skimming inflamed blood, that Hewson first succeeded in.obtaining a fluid capable of coagulation ; but he did not carry out this observation on healthy-blood, and it was left for-Dfc Babing- ton to prove, that healthy blood as it circulates, is made up of a homogeneous flui^ contaifling floating corpuscles, and tp this fluid, whieb be prcv^d to be a solution PHYSICAL STRUCTURE OF THE BLOOD. 19 of fibrin in serum, Dr. Babington gave the name of liquor sanguinis.* When examining the blood, then, under the microscope, we must bear in mind, that, when freshly drawn from a puncture, it is composed of corpuscles floating in a homo- geneous fluid, but that if coagulation be allowed to take place-, we have the corpuscles floating in serum, or, in other words, in liquor sanguinis deprived of its fibrin, a condition which will materially interfere with the natural appearance of the corpuscles, for; reasons which will be at once apparent when the physical properties of those bodies have been described. The anatomy of the red corpuscles has formed a subject for conjecture and experioren-t among physiologists for a number of years, and a great diversity of opinion has ex- isted as to their true nature. Some have believed them solid bodies, while others, on the contrary, have believed them of taore complex vesicular structure. We are now, however, enabled to speak positively as to their nature, their vesicular structure having been put beyond doubt by late experiments, which have shown that endosmodic cur- rents can be induced through their membrane, and that the corpuscles, as seen under the microscope, can either be emptied or filled accordingly as we mix with the blood so- lutions of a specific gravity higher or lower than that of the liquor sanguinis, in which the corpuscles floated in the na- tural statcf Now it has not only been proved that the red corpuscle possesses a membrane or envelope, but also that this envelope encloses a red fluid, and this being the case, it follows that the specific gravity of the- enclosed red fluid must be identical with that of the liquor sanguinis, in which the corpuscle floats, such being.the inevitable result of stasis when a permeable- membrane separates fluids. With this knowledge let us now reflect on the change which will take place when the blood coagulates. The liquor sanguinis, in whieb the red corpuscles float, deposits rts fibrin, and becomes.thus converted into serum. Having * Med. Chirurgi Trans. f Vide Guy's, Hospital Reports, No*.,xiii. Rees and Lane on Anatomy, &c 20 PHYSICAL STRUCTURE OF THE BLOOD. lost part of its solid contents, it now possesses a less spe- cific gravity, and the fluid within the corpuscles, since it retains its normal specific gravity, is heavier than the se- rum in which the corpuscle floats, and consequently an interchange of fluid through the membrane will take place, In this way we find the corpuscle becomes filled by serum, to an extent which frequently renders its thickness half as great again as it is observed in blood before coagulation, for the reason that in accordance with the endosmodic laws, the lighter fluid without has entered the corpuscle in larger proportion than its heavier contained fluid could pass away. In this manner a portion of the serum, which in the natural state assisted in forming the liquid in which the corpuscles floated, has entered those bodies; and in our analysis of blood after coagulation, we possess no means of separating this serum from the corpuscle ; it is, in fact, always retained permanently. After the description I have now given of the physical structure and qualities of the red corpuscle, I trust the stu- dent will be prepared to consider the difficulties we have to encounter in accomplishing an analysis of coagulated blood, such as shall be perfect in all its parts. I have stated that there are colourless bodies existing in the blood, which are to be seen under the microscope, and are known by the name of fibrinous corpuscles. It maybe well to mention that these do not possess the vesicular cha- racter so strikingly shown by the red corpuscles, but that they are soft solids, the physical structure of which in no way interferes with the perfection of analysis, whereas we have seen that the endosmodic action set up during coagu- lation by the red corpuscles becomes a serious obstacle to our obtaining an absolutely correct analysis of the entire blood. I shall now proceed to describe the method era- ployed for ascertaining the proportion of fibrin, red corpus- cles, and serum contained in the blood. My reason for commencing thus is, that I may gradually introduce the student from the simpler into the more intri- cate processes. I have, therefore, preferred to introduce this simple quantitative examination as a commencement to the more complicated qualitative analysis which follows, and which, in strict propriety, should "have preceded. It ANALYSIS OF BLOOD. 21 will be found, however, that this slight sacrifice of order is of the greatest utility to the student. Before noticing the qualitative examination of the various matters entering into the composition of blood, our object will be to describe, in as concise a manner as possible, the most approved pro- cesses for making the quantitative analysis of the serum, both in health and disease. ON THE ANALYSIS OF THE BLOOD IN HEALTH. Determination of the Proportion of Water, solid Matters of Serum, Fibnn, and Red Corpuscles* The blood intended for analysis is to be collected in three vessels, one of these being a platinum capsule, capable of * Several methods of effecting the separation of these three con- stituents of the blood have been proposed by chemists, and there are objections to all, in so far as absolute correctness is concerned. The process I have adopted I believe to be the best in medical inquiries, as it allows of the estimation of the corpuscles with greater precision than most others. The method recently proposed by Simon for the analysis of the entire blood possesses one great disadvantage: for the nuclei and capsules of the corpuscles are by him estimated as albumen, a defect which must render his results unsatisfactory to the pathologist, since a correct appreciation of the proportion of the corpuscles in their integral state is absolutely necessary to a clear understanding of many of the charges occurring in blood during the progress of disease. Simon has shown, however, that no very great discrepancies are to be observed between his results and those of other chemists. The method I now describe, which nearly ap- proaches to that lately employed by Andral and Gavarret in then- researches, is by far the most perfect with which I am acquainted. Many objections have been raised against it, of which the following only is deserving of notice. In the estimation of the proportion of serum and corpuscles, all the water of the blood is presumed to exist as a constituent of serum, and the corpuscles are assumed to be solids, whose moisture is entirely owing to the fluid in which they float, whereas in reality they are organised bodies containing, as a constituent, a fluid of a red colour, which is quite distinct from serum in its chemical relations. If we more minutely consider this plan of analysis in relation to the structure of the corpuscles, we shall ob- serve, however, that it is capable of giving results far nearer to the truth than might at first be imagined. It must be remembered that 22 ANALYSIS OF BLOOD. containing half a fluid ounce; the other two must be glass vessels, each of the capacity of six fluid ounces, and one of which should be a bottle or flask fitted with a glass stopper. The weights of the capsule and glasses in a perfectly dry state must be correctly ascertained, and, if possible, en- graved upon them. From two to three fluid drams of blood are to be received into the platinum capsule, and from four to six into each of the glass vessels. Ten or twelve pieces of lead, each about a quarter the size of a sixpenny piece, and the weight of which has been previously ascertained, are to be imme- diately put into the glass vessel provided with a stopper, and then shaken up with the blood, agitation being con- tinued for ten or twelve minutes. By this action, the fibrin is made to coagulate around the lead. The bottle, with its contents, is now weighed, in order to ascertain the weight of blood operated on, which is at once done by subtracting the weight of the lead and bottle from the whole weight shown by the balance. The bottle is now to be emptied into a saucer, and the fibrin collected, washed with distilled water, dried, and weighed. This gives the weight of fibrin contained in the portion of blood operated on. The blood received in the other glass vessel is to be set aside to coagulate, in order to afford a clear serum for analysis. The blood received into the platinum capsule is now to be weighed in that vessel, the weight of the cap- sule being subtracted from the whole weight shown by the balance, giving the true weight of blood. The capsule is next to be removed to a water bath, and the blood dried until it ceases to lose weight by further application of heat. The capsule containing the dry matter is now to be wiped dry and weighed, and the weight obtained subtracted from that of the capsule and blood taken at the commencement there is a constant endosmodic interchange of position taking place between the contents of the corpuscle and the liquor sanguinis, in which it floats, varying with the entrance and exit of water from the circulation ; and that consequently the contents of the corpuscle will always be in part composed of those constituents of the blood which form the liquor sanguinis, and of which serum constitutes the greater part. ANALYSIS OF BLOOD. 23 of the analysis. This gives us the weight of water con- tained in the portion of blood operated on.* By subtracting the weight of the capsule from the weight shown by the balance, we also obtain the proportion of dry matter in the blood. We have now ascertained the proportion of the following ingredients of the blood ; viz. Water, Solid matters, and Fibrin. Now these results having Deen obtained on portions of blood differing in weight, our next step consists in reducing them, in order to ascertain the relative proportions of the ingredients contained in 1000 parts of blood. Having done this by the rule ef proportion, we next subtract the weight of the fibrin (as adjusted to 1000 parts) from that of the solid matters of blood, of which of course it formed a part. We thus ascertain the weights of Water, Fibrin, and Blood corpuscles and solid matter of serum mixed ; the two latter ingredients making up the remaining solid matters of blood. The weight of the blood corpuscles and serum mixed together being known, it is obvious that if we ascertain the weight of either one of them, we shall be able to determine the weight of the other, by subtraction from the mixed weights. It is thus that we obtain the weight of the cor- puscles by determining that of the solids of serum, which is done as follows. One hundred grains of serum, taken from the glass vessel which was set aside for coagulation of the contained blood are to be evaporated in a dish over a water bath until weight is no longer lost by further applica- tion of heat. The proportion of solid matter and water in * In thus using a small quantity of blood expressly to ascertain the proportion of water, we ensure exactness; for though we operate on a small weio-ht, we do not move it from the capsule, or subject it to loss before weighing, and its small bulk ensures perfect drying over the water bath. 24 ANALYSIS OF BLOOD. the serum is thus ascertained.* Now we have already noted a weight of water in our analysis, as contained in 1000 parts of blood, and the solid matters of serum con- tained in the dry matters of blood will bear a proportion to that water. This proportion we have now determined by our experiment on 100 parts of serum. WTe now, therefore, merely have to m^ke the calculation for the proportion of solid matters of serum indicated by the water in our analysis for 1000 parts of blood; and thus having ascertained the weight, we can also obtain that of the corpuscles by sub- tracting it from the known wreight of the two together.f * The process in detail is the same as that for determining the proportion of» water and solid matter in the blood, and may be per- formed in the balanced platinum capsule. f The method of ascertaining the proportions of red particles, fibrin, and solids of serum here detailed, is only applicable when we can obtain blood before coagulation. When this cannot be managed it is best to use the method of Berzelius, which, though generally found to produce an over estimate of fibrin, still does not do so to any very material extent. The steps of the process are as follows :— The weight of the whole quantity of blood operated on being noted, the proportion of water and solid matter in the serum is first ascertained by evaporating a known weight of that fluid to dryness in a salt-water bath; the loss of weight indicating the proportion of water, and the residuum the proportion of solid matter existing in the serum. These proportions being observed, the next step consists in dividing the crassamentum into two portions of equal weight; one of which is used to ascertain the proportion of fibrin, and the other the proportion of red particles, as follows:— Treatment of first Portion.—The mass is to be cut into pieces as minutely as is possible, without losing any appreciable quantity of matter, care being taken that its precise weight be ascertained before comminution. The mass is now to be placed on a filter, with a stream of distilled or rain water so adapted that a constant supply be afforded to wash away the red particles and serum contained in the interstices of the clots. This process occupies some time, and may occasionally be assisted by careful pressure, exercised by the thumb and finger. In this manner the fibrin becomes freed from its ad- mixture, and its weight is to be taken, after careful desiccation over a water bath. Second Portion of Crassamentum.—The. second portion is to be weighed, and then thoroughly dried over a salt-water bath. It is now again to be carefully weighed, the loss of weight indicating the proportion of water combined with the coagulum; but since all the water of the crassamentum may be considered to exist in combination as serum, we have to subtract from the weight of this solid residuum, ANALYSIS OF BLOOD. 25 I shall next proceed to describe the manner of analysing the serum, by separating its various constituents, which is all that is now necessary to a perfect examination of the blood. On the Analysis of healthy Serum.—Serum, the fluid part of the blood, which separates from the fibrin and red cor- puscles on coagulation, contains the following constituents; viz. Water. Albumen. Extractive matter, soluble in water and alcohol. Albumen, combined with soda. Crystalline fatty matter. Animal oily matter. Chlorides of potassium and sodium. Alkaline, carbonate, phosphate, and sulphate. Earthy phosphate and carbonate. Subphosphate of iron. Oxide of iron. The process for making the quantitative analysis of the serum is as follows:— The portion destined for analysis is first to be carefully weighed in a balanced china-ware capsule: 200 grains is frequently used by chemists; but if the operator can afford to wait the requisite time for the evaporations, I shpuld recommend that he use 1000 grains in his experiments. The weight of the serum being noted, it is now necessary to evaporate it to dryness over a'water bath, and then, on a quantity of solid matter proportional to the quantity of water, and which belongs to the serum, and not to the crassamentum. This is at once done; since the proportions of solid matter and water which compose the serum are ascertained at the commencement of the pro- cess. After this subtraction, it is obvious we have remaining the proportion of fibrin and red particles in admixture; but as the weight of the fibrin was obtained singly from the first portion of crassamen- tum operated on, we have only to subtract its weight, to ascertain the proportion of red particles. In this way we obtain the proportion of the fibrin and red particles: the deficit, of course, consists of serum; and the proportion of water and solid matter contained in this fluid being already ascertained, we can declare the weights of the water, solid matter of serum, fibrin, and red particles contained in any given specimen of blood. 26 ANALYSIS OF BLOOD. ascertaining the weight of the dry extract, and subtracting it from that of the serum, we.obtain the proportion of water contained in the specimen. The dry extract is next to be carefully broken up in the evaporating dish,* and then treated with boiling distilled ■water; care being taken that the heat be kept to 212 Fahrenheit at the moment of admixture, as otherwise the albumen is liable to assume a gelatinous form, which greatly interferes with the process. The quantity of water first added should be equal to about four times the bulk of the extract, and should serve to detach it from the sides of the evaporating dish : it then may be allowed to digest for a quarter of an hour, when it is to be thrown on a filter, which has previously been washed with hot distilled water, and allowed to drain. The contents of the filter are now again to be treated with boiling water, which is to be added by small quantities ; a small portion of the liquor which passes through being Occasionally tested with a solution of nitrate of silver, as it is necessary to continue the washings with boiling distilled water until the re-agent above men- tioned ceases to be affected by the percolating fluid. We in this way procure a residue b, and a filtered solution A. a, the solution, is now to be evaporated to dryness, the result weighed, and its weight noted. The next step con- sists in adding to the dry mass about four times its bulk of hot alcohol, which should be allowed to digest for ten or twelve minutes. This first portion serves to place the ex- tract on a filter, and wh^n the filtration is finished, two portions of hot alcohol, each equal in bulk to half the first, are successively to be allowed to wash the residue which will be observed on the filter; thus we have formed a clear solution c, and a second residue d. c. This clear solution on evaporation yields the animal extractive or osmazome, soluble in water and alcohol; this is to be dried over a water bath, and its weight ascertained. From this datum we may likewise obtain the weight of the * This must be done by the aid of scissors, a spatula, a sharp knife; and the capsule should be placed on a dark-coloured sheet of glazed paper, in order that any portion of matter projected from it may be at once seen, and replaced. ANALYSIS of blood. 27 albumen combined with soda ; which is done by subtracting the weight of the osmazome from the weight of the solid matter of the solution a. d. This second residue is entirely soluble in distilled water, and consists of albumen combined with soda. Its weight may be ascertained directly, or inferred as above mentioned in process c. b. This residue is to be dried and weighed ; successive portions of alcohol are now boiled on the mass until they no longer deposit stearine on cooling; these alcoholic wash- ings are to be added together, and evaporated over a steam bath. The residue b is to be again dried and weighed, which will afford the proportion of albumen. The dried fatty matters may now be washed with cold alcohol, which dissolves the oily and leaves the crystalline fat; these may next be separately dried and weighed, to ascertain their proportion. The following processes are now necessary, in order to render the analysis complete, by the determination of the proportion of alkaline and earthy salts. With this view, we must first incinerate the albumen, and keep the residue at a red heat in a platinum crucible over a circular-wicked lamp until all carbonaceous matter is dissipated; the weight of the residuum indicates the proportion of earthy salts with an occasional trace of iron : this weight must be subtracted from the original weight of the albumen (obtained by process b,) in order to arrive at the exact proportion of that animal principle. The proportion of alkaline salts may next be ascertained by incinerating the watery and alcoholic extracts obtained by processes c and d. The extracts must be separately in- cinerated, and the weight of salts in each be subtracted from the weight of the respective extracts, in order to as- certain the real weight of animal matter in each. It will be observed, that the determination of the pro- portion of salts is a necessary step in order to ascertain the true amount of the animal matters. The following results of two analyses, made by M. Le- canu, will serve to show the quantitative constitution of healthy serum:— 28 analysis of blood. Water - 906 00 901*00 Albumen - - - - 8-00 81*20 Organic matter, soluble in ) 1*69 2*05 water and alcohol ) Albumen combined with soda 2*10 2-55 Crystalline fatty matter 1*20 2*10 Oily ditto - 1*00 1*30 Chlorides of potassium and -\ sodium - - - ( 8*10 7*32 Alkaline phosphate, sul-1 phate, and carbonate 3 Earthy phosphate and car- ~) bonate, with phosphate > 091 0.87 of iron y Loss - 1*00 1*61 1000*00 100000 For those who cannot spare time to mak# an analysis as above, it may be well to mention the formula, as under, in accordance with which an analysis may be very easily effected: — Water - Albumen, with earthy salts and phosphate of iron* Animal extractives! Fatty matters! - Alkaline salts ... I will now describe the method of proving the presence of the several salts above enumerated, as constituents of serum, beginning with the alkaline salts. These may be proved to be such by dissolving them, as obtained by in- cinerating the extractives, in a small quantity of distilled wrater, and then adding a few drops of a solution of carbo- nate of potassa to a portion of the saline fluid. The carbo- nate has the power of precipitating both metallic and earthy salts from their solutions, provided no excess of acid be * Avoiding the incineration of the albumen. + Avoiding the separation by alcohol. \. Avoiding the separation of the crystalline fat from the oily matter. ANALYSIS of blood. 29 present. It will be now observed, that the liquor remains unaltered by the addition of the re-agent; and we may therefore at once conclude that all the salts present are al- kaline. To a second portion of the solution we may add an excess of tartaric acid, and set it aside for a few hours, when a crystalline precipitate will be procured, consisting of the bitartrate of potassa ; thus indicating the presence of that base. A portion of the fused salts is now to be ex- posed to the inner flame of the blowpipe on a platinum wire, when the outer flame will become coloured yellow, in a very marked degree ; proving that soda likewise exists in the salts. Having now shown the nature of the bases, we will pro- ceed to examine the acids with which they are combined: —1st. Let a portion of the dry salts be treated with a drop of moderately dilute acetic acid, when an effervescence en- sues ; proving the carbonic acid to be present.* To a third portion of the solution of salts add a few drops of the solution of chloride of barium, which will occasion a dense precipitate, owing to the alkaline carbonate pre- sent. This precipitate must now be dissolved by a slight excess of pure hydrochloric acid, and the solution set aside, when a white precipitate of sulphate of baryta will appear, proving the presence of the sulphuric acid.f A fourth portion of the solution is now to be rendered acid by a very slight excess of pure nitric acid, and then tested with a solution of nitrate of silver, which will occa- sion immediately a white precipitate, consisting of the chlo- * Enderlin denies the existence of a carbonate in the ashes of blood ; and it is true, that if we incinerate the serum and crassa- mentum together, we obtain an ash which does not effervesce on the addition of acids. If we incinerate serum alone, however, we ob- tain an ash w hich effervesces strongly on the addition of acids. The explanation of the above apparent anomaly consists in the fact that the phosphorised fats contained in the clot produce during combus- tion a sufficient quantity of phosphoric acid to decompose the carbo- nate formed from the decomposed lactates and albuminate of the serum. ~ t If the whole of the precipitate be not dissolved by the excess ol hydrochloric acid, we may also conclude that the solution contains a sulphate. 30 ANALYSIS OF BLOOD. ride of silver; proving the presence of the hydrochloric acid. This precipitate may now be allowed to subside in the acid liquor, which is to be poured off" into another tube, and to be carefully neutralised with ammonia. A yellow precipitate will then appear, which before was dissolved by the excess of acid. This precipitate consists of phosphate of silver, and may be further identified by allowing it to remain in the tube exposed to light for a few hours, when it will be found perfectly blaekened; thus the phosphoric acid is shown to be present. We will now proceed to the examination of the earthy and metallic salts: these will be found insoluble in water; an acid must therefore be used to dissolve them, which easily effects the purpose. The dilute nitric acid, perfectly pure, is to be preferred.; care being taken to use little more than is absolutely necessary to effect the solution. It will be observed, that when the acid is added, effervescence occurs, occasioned by the escape of carbonic acid. The phosphoric acid may now be show.n to be present, by the addition of afew drops of the-solution of nitrate of silver to a portion of the acid fluid, and then neutralising the excess of nitric acid with pure ammonia ;* when the yellow phos- phate of. silver will.be precipitated. The existence of this acid may also be demonstrated before the blowpipe, by subjecting a portion, of the dry salts to theaation of the inner, flame, having' previously moistened them with strong sulphuric acid, when the outer flame will assume a fine green colour. Having now experimented upon the acids, we will pro- ceed to the examination of the bases.. To a-portion of the acid solution add a sufficiency of ammonia nearly to neu- tralise it, and then let it be tested with theferro-prussiate of potassa, when a precipitate of prussian blue or ferro-se£- * Great care must be taken.that too great a quantity of nitric acid be not added in performing the solution of the salts; for in that case, the great excess of nitrate of. ammonia (which is formed on the ad- dition of the ammonia) tends to hold the phosphate of silver in so- lution. This fact of the solubi ity of the phosphate in ammoniacal salt will probably account for the frequent disagreements of chemists as to the existencaof phosphates in some animal matters. CONSTITUENTS OF BLOOD. 31 quicyanuret of iron will collect in the solution.* Many minutes are sometimes required, howTever, before this effect is produced. In order to demonstrate the presence of the earthy phosphates, the acid solution must be neutralised with ammonia, when the peculiar gelatinous appearance of the precipitate will sufficiently characterise its nature. QUALITATIVE ACCOUNT OF THE CONSTITUENTS OF THE HEALTHY BLOOD. Fibrin—Albumen—> Glbbulin. The blood is principally composed of proteine com- pounds, which are in combination with certain salts, fatty matterSj and water, neeessary either as solvents to the more important principles, or as assistants in the process of nu- trition. The more important proteine compounds which we meet with in analysis are fibrin and albumen,! formed by the union of proteine with sulphur and phosphorus in varying proportion. To these most chemists add another, to which they give the name of globulin. This body is a constituent of the corpuscles—the white part of the corpus- cles—and is made up of the nuclei and membranes which contained the red colouring fluid. It is estimated as a part of the corpuscles in the method of analysis I have detailed. The ashes of globulin have been erroneously stated to con- tain iron; this only happens when colouring matter has become mixed with k, for I have proved that the whole of iron contained in the blood exists in the red colouring * Iron exists as a mere trace in serum, and when found its pre- sence is probably owing to accidental admixture with a ;>,Tiall num- ber of blood corpuscles. f The ultimate constitution of these hodies has been stated as follows:— Fibrin. Albumen. Proteine. . . . 10 atoms 10 atoms. Sulphur . . .. L 2 Phosphorus . . 1 1 The proportions of phosphorus and sulphur, however, cannot be relied upon. Proteine itself is constituted as follows :—- C„H„N. 0I4. "1 32 CONSTITUENTS OF BLOOD. principle, and that the white matter of the corpuscles, when pure, yields a white ash.* The general chemical qualities of fibrin and albumen are almost identical, and the re-actions of the white matter of the corpuscles, so far as it has been examined, are of the same character. These principles are soluble in alkaline solutions, and precipitable when so dissolved on neutrali- sation with acids. They are rendered gelatinous, and dis- solved by strong acetic acid. Ferrocyanuret of potassium precipitates the acetic solu- tion. Strong hydrochloric acid boiled on solid fibrin or al- bumen assumes a fine purple tinge. The ashes of fibrin, albumen, and globulin, when pure, are perfectly white, and composed principally of phosphate of lime. Albumen when in solution is precipitated on the application of a heat equal to about 160° Fahrenheit. It is coagulated also by the addition of— Nitric acid, Solution of bichloride of mercury, and ferrocyanuret of potassium, provided a few drops of acetic acid be previously added. Several metallic and earthy salts also precipitate albumen from some soluble forms of combination. Hcematosine. The red corpuscles of the blood, if collected in serum by washing the clot in that fluid, removing the coarser parts, and then allowing them to subside, may be made to yield haoraatosine free from globulin, by the following process:— The supernatant serum is to be poured off as nearly as pos- sible without disturbing the corpuscles ; a solution of com- mon salt is next to be added, being of the same specific gravity as the decanted serum (about 1*029,) and the cor- puscles having been agitated and washed in this fluid, are again to be allowed to subside, by which means they are freed from adhering albumen. Subsidence being complete, the next step consists in pouring away the saline solution, and throwing the subsided corpuscles into a vessel of dis- * Vide Guy's Hospital Reports, April, 1843,-p. 323. CONSTITUENTS OF BLOOD. 33 tilled water, which burst the corpuscles by rapid endos- mosis, causing the burst vesicles to fall in the fluid together with the nuclei, while the red colouring matter dissolves in the water. The mixture is now to be placed on a filter, when the solution of hgematosine will pass through, leaving behind the nuclei and membranes of the corpuscles. This solution, if evaporated, yields the red colouring matter in a state nearly approaching to purity. In this condition it will be found greatly to resemble albumen and fibrin in its re-actions with acids and alkalies. It yields, however, an ash rich in iron.* If we digest ether on dried blood, we obtain not only the fatty matters that we extract from serum, but in addition a fatty principle or principles containing phosphorus. The ethereal solution is clear, transparent, and of a yellowish colour. By spontaneous evaporation it leaves a reddish- brown residue, of the consistence of turpentine, which is formed of two very distinct substances; one being oily, and the other of a crystalline, fatty texture. These may be separated by cold alcohol, which dissolves the oily matter, leaving the crystalline matter unchanged.f This crystalline, fatty matter is now to be dissolved in boiling alcohol, which deposits it on cooling in scales re- sembling mother of pearl; it is without odour or taste, solu- ble in cold ether and boiling alcohol, and insoluble in a solution of caustic potassa; when decomposed by heat, it leaves a residue, containing phosphoric acid ; it has a great similarity to cholesterine in appearance. The oily matter is now to be procured by the evaporation of the cold alcoholic solution. It is insoluble in cold and hot water; alcohol and ether dissolve it readily, assuming, at the same time, a yellow colour. It dissolves when gently heated in a solution of potassa; and if it be decom- posed from iA alkaline solution by hydrochloric acid, the fatty acidi are formed. * Two colouring matters, called haemaphaein and hsemacyanin, have been described by teimon and Sanson as constituents of healthy blood. The former is evidently altered, haematosine existing id minute quantity in serum. Of the latter 1 know nothing. f Berzelius seems to consider a part of the fatty matters as pecu- liar to the fibrin. 3 34 CONSTITUENTS OF BLOOD. Besides these fatty matters, we occasionally find choles- terine (a fatty matter supposed to be peculiar to the bile) mentioned as a constituent of blood ; and I have reason to believe it occasionally is present. Boudet mentions a fatty matter, to which he gives the name of serolin. His defi- nition of this substance indicates properties nearly identical with those of the crystalline fat of the blood; it is, however, less soluble in hot alcohol of *833, and fuses at a lower tem- perature than cholesterine, with which it also shows some characters in common. Animal Extractives. In the analysis of serum two extractive matters have been noticed, one soluble in alcohol and water, the other soluble in water only. The former of these is called the alcoholic, the latter the aqueous extractive. The alcoholic extractive is of a yellow colour, and deli- quescent. Its properties are as follows:—It is soluble in water and alcohol; precipitable of a brown colour by in- fusion of galls; precipitable by the di-acetate of lead, the precipitate being soluble in an excess of that re-agent. This substance is wThat Berzelius once considered as lactate of soda, mixed with peculiar organic matter. It is the osmazome of some chemists. Lecanu says that it does not give out the odour of meat when boiled, which is the case with osmazome, and therefore thinks that the latter, as ob- tained by former chemists, consisted of this extractive mat- ter, mixed with a portion of the fats, which would produce the odour in question. This is, indeed, more than proba- ble ; since in most of the processes for obtaining osmazome no mention is made of any previous ethereal digestion, which would he necessary for the extraction of the fatty matters. The aqueous extractive, when dry, forms a mass which Berzelius has considered as a result of the action of hot water on albumen. Lecanu, however, considers it to be a combination of albumen and soda, which is more than probable, as its solution in water gives a precipitate with acetic acid, resembling albumen in its gelatinous state; and BLOOD IN DISEASE. 35 as the same body may be procured without the use of hot water, it is plain that the action of that fluid is not necessary to its existence. OF THE BLOOD IN DISEASE. The analysis of the blood has been so little studied by the medical profession until of late years, that we have but few observations to direct us regarding its diseased con- dition. The advance of animal chemistry has but just begun to produce those improvements in our pathological knowledge which have been long anticipated, and is gradually silencing those who argue against the utility of chemical investigations as applied to medicine. The blood may be called diseased, either when any of its constituents become unusually abundant, or when a diminution of these proximate elements is observed. The more interesting deviation from health consists, however, in the existence of principles in the blood which are entirely foreign to its healthy constitution, and belong especially to the secretions or excretions of the body. A knowledge of the processes for the analysis of healthy blood will, of course, suffice to enable the experimenter very easily to analyse those specimens in which disease has either in- creased or lessened the proportion of any of the constituents. The substances foreign to healthy blood, and which chemis- try has served to demonstrate as existing in the diseased condition of that fluid, are few in number, but yet the presence of each will require either a modification of the method of analysis or increased care and attention as to the degree of heat to be employed during the operations. Many observations have now been made in reference to the effects of disease in destroying the normal proportions of the principles of the blood: the most prominent among these changes are those in which the proportions of fatty matter and water become disturbed. The principles intro- duced into the blood by disease,, aad which will be espe- 36 BLOOD IN DISEASE. cially noticed, are urea, colouring matter of bile, choleste- rine, and sugar. Examination of Blood supposed to contain Urea. 1. Let a portion of serum be accurately weighed, and then evaporated to dryness over an open steam-bath.* 2. A quantity of distilled water (amounting to about one ounce for each 200 grains of serum used for experiment) is to be heated to 200° Fahrenheit, and then poured on the dry extract, which must be previously broken up with a sharp spatula. A digestion over the steam-bath for about half an hour is now to be performed; the loss of water by evaporation being supplied occasionally by the experimenter. 3. The digested fluid is to be filtered, and the residue on the filter washed with distilled water (the washings being added to the original liquor.) The whole of the fil- tered liquor is nowr to be evaporated to dryness over an open steam-bath, and the residue of the evaporation digested, with absolute alcohol,f at a gentle heat, for half an hour; care being taken that the loss by evaporation do not materially diminish the bulk of the fluid. 4. A second filtration is now to be performed, and the filtered fluid must again be evaporated to dryness, and then dissolved in a small portion of lukewarm distilled water. We thus procure an aqueous solution of urea, combined with animal extractive ; to this solution (previously evapo- rated to the consistence of a thin syrup) we now add a few drops of nitric acid, which causes an effervescence. This mixture must be set aside to crystallize. 5. Should crystals appear, of the peculiarly characteristic appearance of nitrate of urea, we may conclude that urea is present: indeed, if crystals exist at all after the foregoing * By using an open steam-bath, we are always certain of keeping the matter of experiment at a heat considerably below 212° Fahren- heit, which is absolutely necessary in these experiments, since urea in dilute solution becomes gradually destroyed if kept at the tempera- ture of boiling water. t About eight times the bulk of the solid extract for digestion. BLOOD IN DISEASE. 37 process, they must be nitrate of urea ; since no principle of the blood that can possibly exist in the last-tested fluid pos- sesses the property of becoming less soluble by the addition of nitric acid. 6. Crystals being formed in the liquor*, we may now pro- ceed to ascertain the proportion of urea. For this purpose we must first allow some time to elapse, in order that the deposition of crystals may be perfectly accomplished.f When such is the case, the supernatant liquor must be poured off"; which, with the assistance of a small glass rod (to retain any very minute crystals) may be perfectly ef- fected. The acid crystals remaining are now to be care- fully dried over the open steam-bath and then weighed ; from their weight we may infer the proportion of urea pre- sent, since we know the composition of nitrate of urea to be— Urea - - 52*63 Nitric acid - - 47*37 100-00 If it be required to ascertain the relative proportion of the other ingredients of the blood containing urea, it will be right to make a separate analysis for that purpose ; since the use of the open stearn-bath and distilled water at 200° Fahrenheit will materially interfere with the determination of the quantity of albumen. I feel convinced that the wish to ascertain all by a single analysis has frequently been the cause of failure in the detection of urea when it existed in blood. * It will always be observed in specimens where urea exists, that, long before any material diminution occurs in the bulk of the fluid (which has been mixed with nitric acid,) a crop of crystals ap- pears. f This must be determined by the discretion of the operator, as it is impossible to lay down rules on such a subject; when any diffi- culty occurs, it is well to have recourse to the use of a freezing mixture, as recommended in the process for separating urea from the urine. 38 BLOOD IN DISEASE. Examination of Blood containing colouring Matter of Bile.* The best account which has yet been given of this dis- eased condition of the serum is by Lecanu, who satisfac- torily proves that in jaundice the vital current is strongly impregnated writh those matters, which in the healthy state are peculiar to the secretion of the liver. This able che- mist has established, that in cases of jaundice the blood contains the following principles foreign to its healthy con- stitution :— 1. A combination of albumen and soda, scarcely at all soluble in water. 2. An orange-yellow colouring principle. 3. A blue colouring principle. These colouring principles have been demonstrated to exist in the bile by M. Chevreul. The examination of the serum of icteric blood is per- formed as follows: — The serum is diluted with a considerable excess of al- cohol, which renders it turbid, and precipitates a quantity of flocculi. These are collected on a filter, and washed re- peatedly with cold alcohol. This filtered alcoholic solu- tion is of a yellow colour, and possesses an alkaline re-ac- tion ; it yields a dark yellow coloured residue on evapora- tion, which has a saltish disagreeable taste. It is delique- scent, and almost entirely soluble in ether. The portion insoluble in the last-named menstruum is granular, and of a salt taste, without bitterness. It contains, besides salts, an extractive matter, soluble in alcohol, and another or- ganic matter, such as is met with in healthy blood. The ethereal solution is now left to spontaneous evapo- ration, when a considerable orange-yellow residue is ob- tained, which contains crystals of the crystalline fatty mat- ter of the blood. These crystals may be separated by warm * It is probable that bile exists in serum in its perfect state; but the colouring matter is that part which gives evidence of its presence, and therefore it is to the determination of this substance (to which the name of biliphsein has been given) that the attention of chemists has been principally directed. BLOOD IN DISEASE. 39 alcohol, which also extracts an oily matter, of a beautiful deep yellow colour.* The albumen which has been precipitated is now to be treated with boiling alcohol, which assumes a dark green tint, and by cooling deposits crystals of fatty matter. The liquor, when cold, is to be filtered, and then evapo- rated over a water-bath. During the evaporation, it retains its original tint for some time ; but when the alcohol is nearly dissipated, the green colour disappears, and a yel- low tint is observable, while at the same time a portion of brownish matter deposits on the sides of the vessel. This brown deposit may be washed with cold alcohol, to free it from the other matters ; when it will be found very soluble in boiling alcohol, and capable of producing a fine blue colour when dissolved in that liquid. It is remarkable that exposure to the rays of the sun destroys this colour. The yellow serum of jaundice may be very easily tested for bile by the addition of nitric acid, which changes the colour to a delicate green after the lapse of a few minutes. This is a very simple method, and no less easy than it is satisfactory, and void of fallacy. The jaundiced serum is thus described by Lecanu :—It possesses a sickly taste; it is of a saffron colour, which passes to a canary yellow on being diluted with water; it froths by agitation, and turns syrup of violets to a fine green colour.f No method is at present known of separating the biliary matters quantitatively from serum. Examination of Blood containing Cholesterine. This principle is very easily discovered when it exists in blood; and many instances are on record, in which it has * This has been lately shown by Braconnot to consist of the yellow matter of bile in combination with an oily matter. f See, in reference to this subject, Chevreul, Diction, des Sciences Naturelles, vol. xlvii. p. 198. Lassaigne, Journal de Uu- mie Medicale, Juin, 1826, pp. 264. 267. Examen Chimique du Saner dans l'Ictere, et Considerations sur cette Liqueur. Deyeux, Considerations Chimiques et Medicales sur le Sang des Ictenques. Collard et Martigny, Analyse Chimique du Sang dune remme morte icterique, &c. &c. 40 BLOOD IN DISEASE. been detected in icteric serum. The late researches of P. S. Denis have convinced him that cholesterine is not a con- stituent of healthy blood ;* others believe it to exist in the healthy blood, Boudet among the number. However this may be, it is pretty certain that an increased proportion is occasionally present in disease. WThen serum is suspected to contain cholesterine, it should first be evaporated to dry- ness over a water-bath, and the dry residue digested with ether for several hours. The ethereal solution may now be decanted, and allowed to evaporate spontaneously. The residue consists of the fatty matters of blood combined with cholesterine. These are to be well washed with cold alcohol, which extracts the oily matter of the blood, leaving the crystal- line fatty matter and cholesterine. This latter may now be removed with the point of a penknife, or any fine instru- ment, as its crystals are very obvious and easily distinguish- able.! Examination of Blood containing Sugar. Sugar has been detected in the serum of diabetic blood. The best method of determining its presence is that which has been lately proposed by Dr. Bence Jones, who recom- mends that the serum be first dried, and then that hot w7ater be thrown on the powdered extract, by which means the albumen is separated, while the sugar and other constituents of the serum become dissolved. The filtered liquor may now be tested by Trommer's test as follows :—A few drops of a solution of sulphate of copper are to be added to the suspected fluid, so as to give it a pale blue tint. A solution of caustic potassa is next used to precipitate the copper salt; this being done, an excess of the potassa is to be added, in order that the hydrated oxyde of copper precipitated * Recherches Experimentales sur le Sang Humain considere a l'Etat sain. Par P. S. Denis. f There is some difficulty in otherwise separating these two sub- stances ; for the crystalline fatty matter, like cholesterine, is insoluble in alkaline lixivia, and is very similar to that principle in all its re- actions. Cholesterine, however, yields an ash having a strong al- kaline re-action, which is not the case with that derived from the crystalline fatty matter of the blood. BLOOD IN DISEASE. 41 may be redissolved in the alkaline menstruum. The solu- tion will now assume a fine blue colour. Heat to a boil- ing temperature is next applied, when, if sugar be present, the oxyde of copper is thrown down as a precipitate of a reddish-brown colour, owing to the deoxydising action of the diabetic sugar on the oxyde of copper, which, were that principle not present, would assume a dark-brown tint on precipitation. We know7 of no method at present of accurately ascer- taining the proportion of sugar in diabetic blood. The following process will yield sugar tolerably pure ; but does not enable us to determine its weight with pre- cision. The blood is to be evaporated to dryness over a water- bath, the dried mass comminuted and digested several hours in boiling water. The aqueous solution is to be filtered off, evaporated to dryness, and the dried residuum digested in alcohol of sp. 0*825. The alcoholic solution is to be filtered, evaporated to dryness, and treated with rectified ether, which dissolves out fatty matter, and some urea, leaving behind sugar, osmazome, and chloride of so- dium. This mass on being dissolved in alcohol, and the solution allowed to evaporate spontaneously, affords a crop of mixed crystals, principally composed of alkaline, chlo- ride, and diabetic sugar. These may be separated by care- ful manipulation. I have succeeded by the mechanical use of alcohol of low specific gravity, in effecting this by agi- tation, with a near approach to accuracy ; for the chloride sinks before the crystals of sugar, and thus allows of the latter being poured off partly dissolved in the fluid. The following is an analysis I made of diabetic serum obtained from a patient, the specific gravity of whose urine was 1048:— 42 BLOOD IN DISEASE. WTater ----- 908*50 Albumen (yielding traces of phosphate } of lime and oxyde of iron, on incine- > 80*35 ration) " " " ) Fatty matters - 0*95 Diabetic sugar - - - - 1*80 Animal extractive, soluble in alcohol, urea 2*20 Albuminate of soda - 0*80 Alkaline chloride, with traces of phosphate ) Alkaline carbonate, and trace of sulphate, > 4*40 the results of incineration - ) Loss ----- i-oo 1000*00 I should wish the proportion of diabetic sugar given here to be considered merely in the light of an approximation, as it is impossible to separate it completely from impurity; and the loss sustained during manipulation must be con- siderable. ( 43 ) ON THE URINE. I shall commence this subject by describing each con- stituent of the urine, and shall then proceed to give an ac- count of the method used for the performance of the quan- titative analysis. In considering the urine in disease, I shall, first, treat of the urinary deposits; and, secondly, of those diseased conditions of the fluid which do not neces- sarily cause any sediment or turbidity. The examination by reagents will be noticed ; and then a particular account given of the method for the quantitative analysis of certain forms of unhealthy urine. OF THE URINE IN HEALTH. The urine in health has been stated by Berzelius to con- tain, besides water, the following substances as ingredients; each of which will be separately noticed:— Urea. Free lactic acid.* Lactate of ammonia. Osmazome. Animal extractive (soluble in water only.) Lithic acid. Vesical mucus. Sulphate of potash. Sulphate of soda. Phosphate of soda. Phosphate of ammonia. Chloride of sodium. Hydrochlorate of ammonia. Phosphates of lime and magnesia. Silica. * Liebig denies the existence of lactic acid as a constituent of urine, and adds hippuric acid as present in healthy urine. He seems to think that the substance mistaken by Berzelius for lactic acid was a nitrogenous resinoid body produced during evaporation together with acetic acid. 44 CONSTITUENTS OF URINE. Urea.* The following process is, perhaps, the best for procuring this principle in a separate form :— Evaporate urine to the consistence of a strong syrup, and then add pure concentrated nitric acid, until the whole mass becomes more or less solid. The crystalline matter which is now produced consists of nitrate of urea. This must be washed from adherent impurities by ice-cold water, and then pressed between folds of bibulous paper to dry. These crystals are now to be dissolved in lukewarm distilled water, and neutralised with carbonate of barytes. This mixture is to be evaporated to dryness, and alcohol boiled on the dried mass. In this way the urea may be extracted from the barytic salt. It may be obtained in colourless crystals, by digesting the alcoholic solution with animal charcoal, then filtering, and allowing the urea to crystallise by spontaneous evaporation. The chemical properties of urea are as follows:— When heated on platinum foil it fuses; and if the heat be urged is decomposed, yielding fumes of carbonate of ammonia. It is very soluble in cold water, but more so in warm. It gives out a great degree of cold when dissolved in any considerable quantity. The concentrated solution in water will bear a heat of 212°, without decomposition; but in dilute solution it quickly decomposes at that temperature. Alcohol of specific gravity 0*816 dissolves a fifth of its weight of urea at 60° Fahrenheit; when boiling it dissolves nearly its own weight. It is slightly soluble in ether. The caustic alkalies de- compose urea into carbonate of ammonia. The nitric oxalic acids combine with urea, forming salts, * This important constituent of the urine has been supposed by some to form during evaporation. Mons. Cap and Henry believe it to exist in the form of lactate. It is neither formed by evaporation, nor present as lactate, however, for I have succeeded in separating it without evaporation, and that too in a pure state, by agitating urine with the common rectified ether of the shops, and evaporating the ethereal solution which separates above. CONSTITUENTS OF URINE. 45 more or less insoluble. The crystallization with nitric acid forms one of its best distinctive characters. Urea possesses neither an acid nor alkaline reaction : its crystalline form is that of a four-sided prism, exceedingly delicate, and silky in texture. Lactic Acid. The lactic acid was first stated to exist in the urine by Berzelius, who extracted it by the following process:— A portion of urine was evaporated to dryness, and alco- hol of specific gravity 0*833 boiled on the solid residuum. The alcoholic solution was now evaporated, and the mass dissolved in water. The watery solution was then boiled with a considerable quantity of hydrate of lime, till all ammoniacal fumes (from decomposing urea) were dissipated; the hydrate of lime now became coloured yellow, owing to the decomposition of animal matter. The colourless solution was filtered, dried, and then treated with alcohol of specific gravity *845. Equal parts of strong sulphuric acid and water were now added, gutta- tirn, to the alcoholic solution, until sulphate of lime no longer precipitated; the clear liquor being decanted was next treated with carbonate of lead, recently precipitated,) and was then filtered and evaporated to dryness. The residue was treated with oxide of lead and a little water, by which means the lactic acid w7as converted into a sub-salt of considerable insolubility. This was collected, washed with water, and then decomposed by sulphuretted hydrogen.* Thus, sulphuret of lead subsided, leaving the lactic acid free in the supernatant liquor, which, by evapo- ration, yielded it in the form of an acid yellow syrup, ex- ceedingly deliquescent, and incapable of being thoroughly dried by heat. Its chemical properties are the following:— * This is done by suspending the precipitate in distilled water, and allowing a jet of sulphuretted hydrogen to pass through the liquid to saturation. 46 CONSTITUENTS OF URINE. It gives out an acrid odour* when heated, and leaves a porous charcoal if the heat be continued. Alcohol dis- solves it in all proportions. It is nearly insoluble in ether. Its salts are all of a gummy and uncrystallizable nature, excepting the lactates of zinc and magnesia, which have been obtained in a crystalline form. When lactic acid is added to a strong solution of the acetates of magnesia or oxide of zinc, the lactates of those bases are precipitated. Osmazome. This is a term used to signify an animal extract, soluble both in water and alcohol. Such exists in the urine, and may be procured by digesting alcohol of specific gravity •833 on an extract of urine; and after crystallizing the urea from the alcoholic solution (by means of nitric acid,) separating the uncrystallizable matter, and neutralising it with carbonate of baryta: the mass must then be dried, and alcohol will now extract the osmazome from the barytic salts, f Its chemical properties are as follows:— When heated it swells much, and leaves a copious alka- line carbonaceous mass4 It reddens litmus paper. Neither chloride of mercury, nor the acetate of lead, is capable of precipitating its watery solution.§ Both acid and alkaline solutions are incapable of effecting any precipitation of this extract from its solution in water. Protochloride of tin, nitrate of silver, and di-acetate of lead, produce precipitates. It may be well to mention, that if anhydrous alcohol be digested on this osmazome, it is capable of being divided into twTo portions*, the one soluble and the other insoluble in that fluid. The property of being precipitated by the diacetate of * Not unlike that of the tartrates. X This will not be quite pure, but sufficiently so to exhibit its properties. X It contains an alkaline lactate. § If these salts produce a precipitate, it is because alcohol has been used of higher specific gravity than 0*833. CONSTITUENTS OF URINE. 47 lead, nitrate of silver, and protochloride of tin belongs peculiarly to that part of the extractive matter which is soluble in anhydrous alcohol. Animal Extractive (soluble in Water only.) This matter may be procured by dissolving in water an extract of urine which has been digested with alcohol of specific gravity 0-833. By the resolution we separate any vesical mucus, lithic acid, earthy phosphate, or silica, which may be contained in the mass. The solution is now pre- cipitated with acetate of baryta, in order to rid it of sul- phuric acid. The sulphate of baryta is collected on a filter, and the filtered liquor neutralized with ammonia, and then again precipitated with the acetate, which now causes a precipitate of phosphate of baryta.* This is to be collected, and the filtered liquor evaporated, in order to drive off' the ammonia ; or what is better, it may be neutralized by acetic acid. Neutral acetate of lead is now added to the solution, which causes a copious precipitate. This must be collected and washed, and then decomposed by sulphuretted hydro- gen, which precipitates sulphuret of lead, and leaves the animal extractive in solution, which may be obtained by evaporation. This extractive is, however, but part of that meant to be understood as the " animal extractive soluble in water only," so often mentioned in analyses. The re- mainder of it may be procured by precipitating the liquor (in which the precipitate by neutral acetate of lead subsides,) by means of the di-acetate of lead; then collecting the pre- cipitate, decomposing it as before by sulphuretted hydrogen, and procuring the extractive from the clear liquor. It roust be remembered that each of these extractives have peculiar properties; perhaps dependent on the processes used to obtain them. There is also a portion of animal extractive left unprecipitated by the di-acetate of lead. It is easily obtained from the liquor by ridding the solution of any lead * Both these precipitates produced by acetate of baryta contain animal matter, which in the latter case is in very considerable pro- portion. 48 CONSTITUENTS OF URINE. which may exist in it by means of sulphuretted hydrogen, filtering, and then evaporating to dryness. It is a mixture of these three peculiar extractives which constitutes the "animal extractive soluble in water only" of Berzelius. The properties of the extractive matter precipitated by the neutral acetate of lead are the following:— It is of a browmish colour, translucid, and does not deli- quesce ; has no taste, and scarcely affects litmus paper. Its solution is rendered cloudy by bi-chloride of mercury, and more so by the proto-chloride of tin. The extractive precipitable by the di-acetate of lead has the following properties:— It is of a yellowish-brown colour, has a slightly bitter taste, and does not deliquesce. The watery solution of this extract is of a deep yellow tint. It is not precipitable by the solution of bi-chloride of mercury, but the proto-chloride of tin, the di-acetate of lead, and nitrate of silver, precipitate it of a dark-brown colour. The third extractive which was precipitated neither by the acetate nor di-acetate of lead, possesses the following characters:— It is of a yellow colour. Solutions of bi-chloride of mer- cury, proto-chloride of tin, and nitrate of silver precipitate its aqueous solution. The precipitate produced by the last of these reagents is of a dirty yellowish-red colour.* Lithic Acid. This acid may be procured from the urine by the addition of a few drops of strong hydro-chloric acid, which, after the lapse of some hours, produces a reddish crystalline pre- cipitate of lithic acid. The red colour is caused by an ad- mixture of colouring matter of urine ; for pure lithic acid is perfectly white. It may be obtained in a pure state from the red crystals by dissolving them in caustic potash, and * For further examination of these extractive matters, see the ar- ticle by Berzelius in his Traite de Chimie, vol. vii. p. 380. Sur lea Matieres indeterminees dans l'Urine. CONSTITUENTS OF URINE. 49 then precipitating the solution by the addition of hydro- chloric acid. The precipitate may now be collected, and washed on a filter. For the chemical properties of lithic acid, see the article on the analysis of urinary calculi. Vesical Mucus. This substance always exists in healthy urine, but is scarcely to be observed when in normal proportion. It may be procured from urine by throwing it on a filter im- mediately after evacuation, when we may collect it in trans- parent colourless flocculi, which, if allowed to dry on the filter, possesses a shining appearance. The addition of water, however, immediately restores the original form of the flocculi. It possesses the following chemical proper- ties:— The acetic and nitric acids dissolve it readily, and the solution is precipitated by the ferro-cyanuret of potassium. Caustic potash dissolves it, and ammoniacal fumes are produced. It does not dissolve in sulphuric acid. When mucus exists in considerable quantity in urine, it may be easily recognised by its glairy tenacious appearance. It never, therefore, can be mistaken for pus; but when small quantities of both are present, we are occasionally at a loss to determine the truth by chemical means, and are obliged to have recourse to the microscope. When pus is present in urine with mucus, we sometimes find it lying on the latter, and possessing a yellower tint; it is also opaque, whereas mucus is more or less transparent. Salts. These consist of alkaline sulphates, chlorides and phos- phates, the earthy phosphates, and silica. They may all be procured for examination by incinerating the urine, if we except the hydro-chlorate of ammonia, which becomes dis- sipated by calcination, and must be procured by a separate process. * I shall first notice the manner of extracting this 4 50 CONSTITUENTS OF URINE. last-mentioned salt, and then proceed to a general descrip- tion of the remainder. To extract the hydro-chlorate of ammonia, a portion of urine must be exposed during several days, by which pro- cess we find a crystallization of various salts to occur at the bottom of the vessel. These consist principally of the chloride of sodium, hydro-chlorate of ammonia, and ammo- niaco-phosphate of soda, mixed with earthy phosphates. These crystals may now be collected on bibulous paper, the cubes extracted from the other crystals, and dissolved in distilled wTater; from which they may be re-crystallized, in order to rid them of adhering animal matter.* These crystals may be recognised as hydro-chlorate of ammonia by the following characters :— When heated with potash, vapours of ammonia are evolved, to be recognised as such by their odour, as well as by forming a milk-white vapour if mingled with those of hydro-chloric acid. The crystals are volatile, and easily sublimed. The solution is precipitated by the addition of nitrate of silver. The other alkaline salts which may be obtained by in- cinerating dried urine are separated from the earthy phos- phates and silica by being dissolved in water; the residuum can be left for after-examination. The solution may now be shown to contain chlorides, phosphates, and sulphates, by the addition of solutions of nitrate of silver and nitrate of baryta to separate portions of the liquor. The nitrate of silver will throw down a copious white precipitate, which will be in part only soluble in pure nitric acid; thus showing the insoluble chloride of silver and more soluble phosphate. If the chloride be allowed to subside in the acid solution, and the clear supernatant liquid be then poured off, we shall find that on neutralizing the nitric acid present by the cautious addition of caustic am- monia, we can reproduce the precipitate of phosphate of silver, possessing its characteristic yellow colour. It now remains to show the presence of sulphuric acid, * The chloride of sodium crystallizes from the urine in octahe- drons, owing to the existence of urea in the solution. We avoid that chloride by selecting the cubes. CONSTITUENTS OF URINE. 51 which is done by adding a solution of nitrate of baryta to a second portion of the liquid; when a copious white pre- cipitate occurs, consisting of sulphate of baryta, which will be found insoluble in strong nitric acid. Having thus proved the salts to contain the above acids, we must next show the nature of their bases. This may be done by adding a solution of carbonate of potash to a por- tion of their solution, when we shall find no precipitate to occur; a fact that shows we are operating on alkaline salts. We may now direct our attention to the residuum, which was insoluble in water, consisting of earthy phosphates and silica.* The phosphates, consisting of phosphate of magnesia and lime, may be separated from the other insoluble ingredient by digestion with dilute nitric acid, which readily dissolves the phosphates. This solution may be tested for lime with oxalate of ammonia (the liquor having previously been nearly neutralised by caustic ammonia,) when a precipitate of oxalate of lime occurs: this takes some time collecting, and it is well to boil it briskly and leave it to cool gradually. When the precipitate has quite subsided, if the clear liquor be poured off, and then rendered alkaline with ammonia, we procure after some time a crystalline precipitate of the ammoniaco-magnesian phosphate: thus we ascertain that magnesia and lime are the earthy bases. If a considerable quantity of urine has been subjected to experiment, we now have a residue which consists of silica, f This is easily recognised by being insoluble in strong aqua regia, and forming a perfectly transparent and colour- less glass with soda before the blowpipe. Having now become acquainted with the reactions of the various constituents of the healthy urine, we are prepared to enter on the consideration of its quantitative analysis; a * It must be observed, that in order to procure any quantity of this residue, it is necessary to employ a large bulk of urine for evapora- tion. f This has been said to contain traces of filiate of lime; but con- firmation is necessary on this point; indeed, there must be great. difficulty in proving the presence of a fluate when it exists as a trace, and that, too, in combination with silica. 52 ANALYSIS OF URINE. subject which, carried to its fullest extent, may be regarded as one of the most difficult undertakings of the chemist. ON THE QUANTITATIVE ANALYSIS OF HEALTHY URINE. It is not my intention to enter deeply into the quantitative analysis of the urine, but rather to give the process to that extent which is requisite for medical inquiry. I do not scruple to assert, that up to the present time, our knowledge of animal chemstry is far from adequate to exhibit in a separate form all the various constituents of a fluid so com- plex and destructible as the urine. The laborious re- searches of the much respected Berzelius served but to convince him of the futility of an attempt of the kind, and he concludes the description of a tedious process with the following remark : " Cette marche serait celle a suivre dans l'analyse de Purine, telle qu'on peut l'executer actuellement. Un temps viendra, sans doute ou elle paraitra forte impar- faite." The following is the quantitative analysis of the urine, as performed by Berzelius:— Water - Urea - - - - Free lactic acid ... Lactate of ammonia Osmazome ... Extractive, soluble in water only - Lithic acid ... Vesical mucus ... Sulphate of potash - Sulphate of soda - Phosphate of soda - Biphosphate of ammonia Chloride of sodium- Hydrochlorate of ammonia - Phosphate of lime and magnesia Silica - This form of analysis involves many troublesome pro- cesses for the separation of matters at present unimportant - 933*00 - 30*10 1714 1*00 0*32 371 3*16 2*94 1*65 4*45 1*50 100 003 ANALYSIS OF URINE. 53 to the consideration of medical inquirers. I shall therefore adopt a modification of the above which will be found both simple and satisfactory. The form is as follows:— Water ... Urea - - - - Free lactic acid Lactate of ammonia - Osmazome - Animal extractive, soluble in - water only Ammoniacal salts Alkaline sulphates Chloride of sodium Phosphate of soda Earthy phosphates and silica - Lithic acid - - - Vesical mucus By this form of analysis we omit the determination of the proportions of lithic acid and ammoniacal salts : the former exists in the healthy urine in the proportion of l-10th per cent., and the latter also in slight proportion. The pro portion of lithic acid may be easily ascertained by using a portion of urine for the express purpose; as the addition of acid determines its precipitation after a few hours have elapsed, and it can then be collected on a filter, washed with distilled water, and weighed.* The process for fulfilling the formula is as follows, two portions of urine of 1000 grains each being requisite for that purpose. First Portion.—This is evaporated over a steam-bath to dryness, and the weight of the residue noted ; which being subtracted from the original weight (1000 grains) will give the proportion of water present. Alcohol, specific gravity •833, is now to be boiled on the dry extract in separate quantities, until no further action is exerted by it. By this * Hydrochloric acid should be used for precipitating the lithic acid, in the proportion of about 1 dram to 1 pint of urine, which must be evaporated to half its bulk before the addition of the acid. 54 ANALYSIS OF URINE. means we obtain an impure solution of urea, which is to be purified as follows:—An extract is first made from the al- coholic solution, and then it is re-dissolved in lukewarm distilled water ; to this solution oxalic acid is to be added, until no more becomes dissolved on heating the liquid to 200° Fahrenheit. When the liquor cools, a deposit of crystals of oxalate of urea occurs, which are impure and dark- coloured ; these are collected on a filter, and washed with a very small quantity of distilled water. This water, together with the mother-liquor, is evaporated to procure any more crystals which may exist in the solution ; care being taken, if the liquors be not acid, that more oxalic acid is added to them at a heat of 200° Fahrenheit, when we shall obtain a fresh quantity of crystals on cooling. These crystals, being collected together, are dried between folds of bibulous paper, then redissolved in water, and neutralised with car- bonate of lime; the liquor is filtered, and the precipitate well washed. The filtered liquor and washings, being a solution of urea, are then evaporated to dryness over a steam-bath, and the extract weighed. Anhydrous alcohol should dissolve the whole of this ; and if there be any por- tion insoluble in that menstruum, its weight must be de- ducted from that of the weighed extract, and thus we ascer- tain the exact weight of the urea. The residue which resisted the action of alcohol *833 is now to be treated with water, which leaves an insoluble residue, consisting of vesical mucus, lithic acid, earthy phosphate, and silica; this residue is to be dried and weighed ; the weight being noted, the mass is to be incine- rated in a platinum capsule. The result of the incineration is silica and earthy phosphates, the weight of which may now be taken. The loss of weight by incineration will indicate the pro- portion of lithic acid and vesical mucus. We have now ascertained from the first portion of urine the proportion of the water, urea, lithic acid and vesical mucus, earthy phosphates, and silica.* It remains for us * It may be remarked, that if any very notable proportion of these two latter is observed, their separate weights may be taken by ex- tracting the phosphates with dilute muriatic acid, and weighing the remaining silica. This, with the previous knowledge of the mixed weights, enables us to determine the weight of each. URINARY DEPOSITS. 55 to determine the weight of the alkaline salts and various animal extractives ; this is done with the second portion of urine. Second Portion.—These 1000 grains are to be evaporated to dryness over a steam-bath, and the weight of the dry ex- tract again ascertained, in order to assure ourselves of the correctness of our former experiment. The extract is now carefully incinerated and decarbonised in a platinum cruci- ble: the weight of the result being taken, and then sub- tracted from that of the dry extract, gives us the weight of the animal extractives, &c. &c, plus that of the urea, vesi- cal mucus, and lithic acid ; but the proportion of these latter being already ascertained, we have but to deduct their weight to ascertain that of the extractives. The weight of the result of incineration, minus that of the earthy phosphates and silica, is the weight of the alka- line salts. Thus we have fulfilled the formula, which may, if required, be further extended by ascertaining the propor- tion of each of the alkaline salts.* ON THE ANALYSIS OF URINE IN DISEASE. The analysis of urine in disease has been practised with far more advantage and success than that of the blood in its unhealthy condition. This, doubtless, is owing to the more frequent opportunities offered to the physician for in- specting the urine, and also to the more obvious marks of disease presented by that fluid. The most frequently ob- served variation from health is that of the existence of a deposit, which is generally produced on the fluid becoming cool after evacuation, but is sometimes voided with the urine in a precipitated state. I shall first notice the chemi- cal constitution of these deposits. Analysis of Urinary Deposits. Most of these deposits are precisely similar in constitu- tion to urinary calculi, and therefore the same rules are ap- plicable to their analysis. Some of the urinary deposits have been arranged accord- * Vide Appendix. 56 URINARY DEPOSITS. ing to their colour by Dr. Prout; who notices the following varieties:— ' Lithate of ammonia. Yellowish or nut-brown sedi- ment. - - - Reddish-brown or lateriti ous sediments. Pink sediments Colouring matter of urine. Earthy phosphates and li- thate of soda. [ Alkaline lithate. | Colouring matter of urine. <{ Alkaline purpurate.* j Occasionally, earthy pilos- is phates. ( Lithate of ammonia. I Purpurate of ammonia. These consist, for the most part, of lithic acid, in com- bination with a base. There exists, however, the free li- thic acid ; as, _. , ... .. { Lithic acid. Red crystalline sediment j Colouring matter of urine. We have next to notice the phosphatic sediments, which are mostly of a dead-white colour, j C Triple phosphate. Amorphous sediment - < Phosphate of lime, in vari- ( able proportion. _ ... , .. ) Triple, or ammoniaco-mag- Crystallised sediment - J nesian phosphate . We must add to these the oxalate of lime deposit, the deposits of red corpuscles, of pus, mucus, bile, and cys- tine. I shall proceed to notice the plan to be adopted in the analysis of these deposits, commencing with— * Dr. Prout still adheres to the old name for this colouring mat- ter. It appears, however, from the researches of Liebig, that the purpurate of ammonia is not a salt, but a distinct principle, to which he gives the name of murexid. The purpuric acid of Prout is called murexan by Liebig. X I have occasionally met with the lithates of as pure a white as the phosphates. This is by no means common, however. URINARY DEPOSITS. 57 Yellowish or Kid-brown Sediment,* Consistidg of Lithate of ammonia. Lithate of soda.f Earthy phosphates.:): Colouring matter of urine. The deposit is to be boiled in distilled water, which ex- tracts the lithate of ammonia and lithate of soda, leaving the earthy phosphates§ For the examination of the earthy phosphates, see the article on the analysis of phosphates in healthy urine, page 52. The aqueous solution is to be evaporated to dryness, and a portion of the mass treated with nitric acid ; which, with the assistance of heat, yields on drying the purple tinge characteristic of lithic acid, which is increased on the ad- dition of ammonia: thus we prove the presence of lithic acid. A second portion of the dried mass is mixed with caustic lime on platinum foil; when vapours of ammonia will be observed, known by their odour, and by affording a white vapour when mingled with fumes of hydrochloric acid : thus ammonia is detected. A third portion of the mass is heated to redness on pla- tinum foil; when a residue is obtained, possessing an alka- line re-action, and dissolving in distilled water, thus show- ing the presence of fixed alkali. This is proved to be soda by directing the tip of the inner flame of the blowpipe upon it; when the outer flame becomes coloured yellow, which is not the case with either potash or lithia. Before finish- ing the notice of this deposit, I must state that I have oc- casionally detected lithate of lime in it. This was proved to be present by the solubility of the deposit in warm dilute nitric acid, and the detection of caustic and carbonated lime as a result of incineration.—N. B. No effervescence * Lithates of lime and magnesia often occur in the nut-brown de- posit, in small proportion. f This is almost always in small proportion. X The phosphate of lime exists in this deposit. § This holds the colouring matter in combination. 58 URINARY DEPOSITS. was produced by the addition of hydrochloric acid to the deposit previous to incineration. No oxalate of lime was present, to whose decomposition the carbonate of lime (of incineration) might be attributed. Reddish-brown or Lateritious Sediment, Said to consist of Alkaline lithate. Colouring matter of urine. Alkaline purpurate. Earthy phosphate (occasional.) The deposit is first to be boiled in a considerable quan- tity of distilled water, which leaves undissolved any earthy phosphate which may be present. The lithate and colour- ing matter are held in solution. The presence of the lithate may be proved as in the first described deposit, the presence of soda being particularly sought for. Pink Sediment, Said to consist of Lithate of ammonia, coloured by Purpurate of ammonia. The existence of lithate of ammonia in this deposit is to be proved in the way described above for the examination of the yellowish sediments. For an account of the colour- ing matter, see Appendix. Red Crystalline Sediment, Consisting of Lithic acid, Colouring matter of urine. This deposit may be proved to consist of lithic acid, by yielding all the re-actions mentioned in the article on the examination of lithic acid calculi. The colouring matter may be separated by boiling the sediment in distilled water. URINARY DEPOSITS. 59 Amorphous Sediment, Consisting of Ammoniaco-magnesian phosphate. Phosphate of lime. This sediment may by known by the following chemical characters:— It is insoluble in water. It readily dissolves in the dilute acids, from which it is precipitated on the addition of ammonia. It yields ammoniacal fumes, when treated with caustic potash. Its solution in acid, if it be first nearly neutralised with ammonia, yields a white precipitate of oxalate of lime when tested with a solution of oxalate of ammonia ; and if after the subsidence of this precipitate we pour off the clear liquor, and test it with ammonia, we shall perceive, after some time has elapsed, a crystalline precipitate of triple phosphate to occur in the liquor: thus we prove lime and magnesia to be present. The phosphoric acid is shown to exist in the solution by the re-actions of nitrate of silver. See p. 50.* Crystallised Sediment, Consisting of Ammoniaco-magnesian phosphate. This dissolves in acids, and is precipitated from its acid solution by the addition of ammonia, like the preceding de- posit; but does not yield a precipitate on the addition of oxalate of ammonia to the nearly neutralised solution in acid, in consequence of having no lime in its constitution. This is its best distinguishing characteristic. As with the preceding sediment, ammonia is evolved when it is treated with caustic potash. Oxalate of Lime Sediment. This deposit may be known by the following characters: viz. * This amorphous sediment frequently simulates pus in appear- ance ; but may be easily distinguished, the latter being dissipated be- fore the blowpipe. 60 URINARY DEPOSITS. It is insoluble in water and warm dilute nitric acid. When heated before the blowpipe on platinum foil, it leaves a residue of carbonate of lime, which may be known as such by its insolubility in water, solubility wTith effervescence in dilute acids, and precipitation from this solution by oxa- late of ammonia.* Red Corpuscles. This sediment, when present in small proportion, requires the use of the microscope for detection ; when in large pro- portion, it can never be mistaken, on account of its pecu- liar colour. It may sometimes be identified by the pro- perty it possesses of becoming of a very bright red colour, when treated with a concentrated solution of chloride of sodium. The deep porter colour occasionally observed in urine may frequently be traced to the existence of red cor- puscles in suspension. The existence of pus and mucus as a deposit in urine is of very common occurrence. I have before stated, that when in small proportion it becomes a matter of difficulty to discriminate, and we are obliged to use the microscope in order satisfactorily to determine their presence.! Biliary Sediment. This frequently remains on the filter through which jaundiced urine has passed. It consists of the yellow co- louring matter of bile. Its properties are as follow:— It is insoluble in water. It dissolves readily in caustic potash. When dilute muriatic acid is thrown on it, a fine green colour is produced. The addition of strong nitric acid produces a red colour. * These three experiments can be made in a watch-glass or small test tube, without removing the result of the blowpipe experiment, which may be a very minute quantity. First, the water is added, which has no solvent action ; secondly, the addition of acid to this water causes effervescence and solution ; and thirdly, the addition of oxalate of ammonia throws down a precipitate. f When pus is present in quantity, it frequently simulates the phosphates, but may be distinguished by the addition of caustic po- tassa in solution, when, if pus be present, the whole mass of deposit becomes mucoid and tenacious. This excellent test was proposed by Dr. Babington. URINARY DEPOSITS. 61 Cystine. This deposit may be known by the following properties:— It dissolves in caustic ammonia, and is precipitated from this solution by acetic acid. It is insoluble in alcohol, water, and solution of car- bonate of ammonia. It is soluble in the nitric and hydrochloric acids. It is soluble in the caustic fixed alkalies, and in their carbonates. Braconnot gave the name of Cyanourine to a colouring matter he detected in the urine. It has not been observed in connection with any particular form of disease. It tinged the whole urine of a blue colour. The following are its characters, according to Bracon- not:— It is tasteless, void of odour, darker than prussian blue, and in a very finely divided powder. When heated, it yields carbonate of ammonia and em- pyreumatic oil. It is slightly soluble in water and boiling alcohol. This alcoholic solution is green, and on cooling, it deposits a dark blue powder, having a crystalline appearance. This powder is dissolved by the acids, and is thus turned to a red colour. Its solution in dilute sulphuric acid yields a fine carmine colour on evaporation to dryness; and this residue is ren- dered brown by solution in water, but resumes its carmine tint on evaporation to dryness. When the red acid solutions of this colouring matter are neutralised with alkali, the original blue colour is restored, and a precipitate produced. Caustic potash acted but little on this blue colouring principle, and carbonate of potash had not the slightest effect upon it.* Other sediments have been described of a black colour by Drs. Marcet and Prout. These, however, are very rare. * This blue urine was most probably caused by the presence of some vegetable colouring matter, more or less modified by passing through the kidney. 62 URINE IN DISEASE. Prussian blue has also been observed as a precipitate in urine, but always, I believe, in cases in which iron, in some form, had been exhibited internally.* ON THOSE DISEASED CONDITIONS OF URINE NOT NECESSARILY CAUSING SEDIMENTARY DEPOSITS. There are such considerable variations occurring in the proportions of the ingredients of urine voided at different periods of the day, that it is exceedingly difficult to draw a determinate line, as to what shall be considered a healthy or morbid proportion of any single constituent of the fluid. There are, however, excessive cases of variation which claim our attention. If it be the wish of the physician to note such deviations of proportion, he can accomplish his object by making the quantitative analysis as for healthy urine. When, however, the secretion becomes admixed with matters foreign to its healthy constitution, we must employ a method of quantitative analysis very different from that applicable to healthy urine. I shall proceed to describe the examination of urine by re-agents, both for the detection of an excess of any ingre- dient, or for the discovery of any principle not met with in healthy urine. There are many medicines and vegetable colouring mat- ters that are to be detected in the urine of those who may be using such, either medicinally or as articles of diet; and as these are apt to perplex the inquirer in his observations on the diseased or even healthy fluid, I shall append to the examination by re-agents a short account of such re-actions as are displayed by various matters foreign to urine in a pure state. I shall, lastly, notice the quantitative analysis of diseased urine. ON THE USE OF RE-AGENTS IN THE EXAMINATION OF URINE. Mtric Acid.—l. This re-agent is exceedingly useful in the discovery of albumen. If a few drops be added to * The microscopical figures of the urinary sediments are ffiven at the commencement of the work. URINE IN DISEASE. 63 urine containing that principle, we have a precipitate pro- duced of a dead white colour. 2. This re-agent is also used to discover whether the urine contain lithic acid ; but some hours are generally necessary for the production of this precipitate, which, if it fall in small quantity, is found adherent to the sides of the vessel used for experiment.* 3. The colouring matter of the bile (which exists in solu- tion as well as in the form of a sediment) is precipitated from the urine by this re-agent: the precipitate is of a green colour ; but if an excess of nitric acid be added, it is quickly changed to a dingy red, and, finally, to a brown.f 4. When any great excess of urea exists in the urine, it is easily detected by placing a portion of the fluid in a watch- glass, and adding to it an equal bulk of nitric acid, which (if urea be present in a large proportion) will produce a speedy crystallisation of nitrate of urea. This test was first introduced by Prout, but it requires care in its application ; because the heat of the atmosphere, being subject to varia- tion, will cause an equal variation in the time required for crystallisation, even in identical specimens of urine. Prout states, that when the specific gravity of urine is above 1*025 or 1*030, this crystallisation is frequently ob- served: but it is certain that a much higher specific gravity may exist without the urine possessing the property of be- coming crystallised with nitric acid before evaporation; for Berzelius examined a specimen of urine of specific gravity 1*030, which, even when evaporated to three-fourths its original bulk, failed to yield crystals on the addition of nitric acid. This test requires attention to the atmospheric * In some fevers, the addition of nitric acid to the urine produces a large prec pitate of lithic acid, and that of so white a colour that it closely simulates albumen. It may be distinguished, however, by being produced equally by the addition of hydrochloric acid, which is not the case with albumen. t This re-action does not take effect unless a considerable propor- tion of colouring matter be present. If it be required to detect minutpr proportions, we must evaporate the urine to dryness, and boil anhydrous alcohol on the extract. This alcoholic solution con- tains the colouring matter; and by evaporation we can procure it, and then detect its presence by nitric acid, as above described. 64 URINE IN DISEASE. temperature; and also a practical knowledge of the effects produced upon healthy urine by nitric acid, an equal bulk of the latter being always used in testing. Solution of Caustic Ammonia.—The proportion of earthy phosphates may be ascertained by the addition of this re- agent. A white precipitate is formed, which may be col- lected and washed on a filter with distilled water. The precipitate consists of phosphate of lime and magnesia with ammonia. Solution of Ferrocyanuret of Potassium.—This is a very delicate test of albumen in urine; but always requires the previous addition of a few drops of pure acetic acid. Solution of Alum causes a white precipitate in urine con- taining albumen.* Hydrochloric Acid, like nitric acid, precipitates the lithic acid from urine, as also the colouring matter of bile; and is rather to be preferred, since it is less likely to exert a solvent action on the lithic acid, and likewise preserves the characteristic green colour of the biliary matter, which the nitric acid soon changes to brown, if any excess of the acid be present. Turmeric Paper changes from yellow to brown if mois- tened with alkaline urine, acid fluid exerting no re-action upon it. Litmus Paper (blue.)—This is used to test the urine for acidity, being changed to a red colour if moistened with an acid specimen. Alkaline urine has no re-action on this paper. Solution of caustic potash, boiled with an equal bulk of urine, is an excellent test for the presence of sugar, render- ing the mixture of a dark rich brown colour if that principle be present. This test was proposed by Mr. Moore. * If albuminous urine be boiled, we have coagulation produced, which is very significant of the presence of albumen : but nitric acid should be used as a test in conjunction with ebullition; for the earthy phosphates are sometimes precipitated by boiling, and become a source of fallacy. It has often occurred to me, to prove the phos- phates present when the precipitate procured by boiling was con- sidered albuminous. URINE IN DISEASE. 65 EXTRANEOUS PRINCIPLES IN URINE. The urine frequently presents the various odours and colours of vegetable matters which have been taken into the stomach; and the examiner must be on his guard against being deceived by such appearances. Thus, I have known a patient on the point of being treated for haematuria, when the urine falling under my observation, I discovered the red coloration to proceed from the presence of a vege- table matter. On inquiry, the patient stated that he had been eating a salad, of which beetroot was an ingredient, during the last eight or ten days of his medical friend's visits. I have also had occasion to observe the production of a deep brownish colour in the urine when vegetable infusions have been administered as medicines. This is almost always the case when the pyrola umbellata has been ex- hibited. These vegetable colouring matters are at once distin- guished by adding a solution of caustic potash to the tinctured urine, when a green colour is produced, which is destroyed on super-saturating the alkali with an acid, the original tint being restored.* Tannin, which exists in many vegetable matters used as remedial agents, is capable of entering the urine. In this case we find the fluid strikes a dark colour with per-salts of iron. Mercury has been said to exist in the urine of those who use frictions with mercurial ointments. This observation was made by Cantu, who obtained metallic globules from a sediment. I had occasion to examine the urine of a person who was salivated from large doses of calomel, but could not discover any traceof mercury in it. Arsenic and antimony have also been detected by Orfila in the urine of poisoned persons. Iodine always exists in the urine of those who take it in- * In a case of poisoning by sumach, which lately came under my notice at Guy's Hospital, I found the urine highly impregnated with vegetable colouring matter. 66 URINE IN DISEASE. ternally. I detected it in the urine of an individual who had taken only one grain of the remedy, and that in three separate doses of one third of a grain each. The process for the detection of iodine in urine is the following :— A portion of the suspected fluid is evaporated to dryness over a water-bath, and the residue re-dissolved in a small quantity of distilled water. This solution must be filtered, and treated with about one eighth part of strong sulphuric acid. If a solution of starch now be added to the liquor, we shall observe a fine blue colour if iodine be present. This colour is sometimes to be heightened by the careful addition of chlorine water, guttatim. Iodine is frequently to be detected in urine, simply by mixing that fluid with the above-mentioned pro- portion of strong sulphuric acid, and then suspending over the containing vessel a piece of bibulous paper, which has had a solution of starch dried upon it. In this way the fumes rise, and, combining with the starch, form the deep blue so characteristic of iodine in a free state.* Tartaric, Citric, and Malic Acids have been observed in the urine in combination with lime ; they then exist as a deposit. The method of distinguishing these will be given in the Appendix. Having now noticed the method of detecting the presence of various matters which are foreign to the healthy urine, I shall proceed to describe the means best adapted for per- forming the quantitative analysis of two very common forms of diseased urine, viz. the albuminous and saccharine. QUANTITATIVE ANALYSIS OF ALBUMINOUS URINE. It is requisite in this examination to use a distinct portion of urine, in order to ascertain the quantity of urea which may be present. In this form of diseased urine we fre- quently find that principle in an exceedingly minute pro- portion, and it is consequently very liable to escape obser- * I once digested alcohol on an extract of urine containing iodine in combination; but the alcoholic solution which I procured yielded no evidence of that body, when tested as above. This seems to show that in the urine the salt containing iodine is not an iodide, but probably an iodate. URINE IN DISEASE. 67 vation. The urine for analysis is therefore divided into two portions, of equal weight. First Portion.—This is accurately weighed, and then evaporated to dryness over an open steam-bath, and the re- sidue treated with boiling alcohol, specific gravity 0*833. The alcoholic solution is now to be evaporated, and the ex- tract so obtained redissolved in distilled water. This aqueous solution is concentrated until it assumes the consistence of a syrup. It is then to be mixed with half its bulk of pure nitric acid, and placed in a freezing mix- ture capable of lowering the temperature to 32° Fahren- heit.* By this means we produce a crystallisation of the nitrate of urea, and we can then abstract the crystals, which are to be treated as described in the article on the analysis of diseased blood, page 36., in order to ascertain the pro- portion of urea. Second Portion.—This is to be weighed, and then eva- porated to dryness ; the weight of the extract being ascer- tained, we are enabled to determine the proportion of water by subtracting the weight of extract from the original weight of the fluid. This extract is now to be treated with boiling distilled water, and the mass thrown on a filter; the inso- luble portion (consisting of albumen, lithic acid, earthy phosphate, and vesical mucus) is to be washed with warm distilled water, until that fluid exerts no further solvent action. This may be ascertained by occasionally testing the percolating fluid with nitrate of silver, which, if it do not affect the liquid, shows that the washings have been suffi- cient.! ^ e thus procure a filtered liquor a, and a resi- due B. a. The filtered liquor is evaporated to dryness and weigh- ed ; its weight being ascertained, it is next incinerated in a platinum capsule, over a circular-wicked lamp, until all the organic matter is dissipated. The weight of the decar- * Such a freezing mixture is easily made, by keeping a mixture in readiness composed of equal weights of nitre and sal ammoniac ; two and a half ounces of which, when mixed with one fourth of a pint of water, produce the effect required. f The extract should be quite dry before we add the boiling water, otherwise a portion of albumen will always remain in the filtered solution. 68 URINE IN DISEASE. bonized salts may now be taken; and by subtracting thisfrom the weight of the extract from the filtered liquor, we obtain the weight of ammoniacal salts, animal extractive, and urea together: but as the weight of the latter is already known, we can, by subtracting, determine the exact weight of the animal extractive and ammoniacal salts. Thus, we have already ascertained the proportions of Water - Urea - - - - - Animal extractives, lactic acid, and ammoni- ) acal salts ) Alkaline sulphates, phosphates, and chlo- ) rides S In order to finish the formula, we must now determine the proportions of albumen, lithic acid, and earthy phos- phates, which is performed with the residue b. The mass is removed from the filter, and its proportion deduced from our previous knowledge of the weight of the extract of urine, and also the weight of the matters con- tained in the filtered solution : by subtracting the latter from the former, we obtain the weight of the residue b as a re- sult. Nitric acid, diluted with about six times its bulk of water, is now poured on the albuminous mass, and gentle heat applied for about fifteen seconds. The acid must then be poured off', evaporated to dryness*, and incinerated; the weight of the result now indicates the proportion of earthy phospate, which, if subtracted from the weight of the al- buminous mass, gives us the weight of the albumen and li- thic acid together. By this process then we have executed the following formula :— . * Lithic acid, if present, can be detected during this evaporation by its re-action with nitric acid. It is not always to be satisfactorily discovered in these cases of albuminous urine. I have always in these examinations obtained an especial result for determining the proportion of the lithic acid by using for the purpose a portion of urine deprived of its albumen by boiling, then evaporating to a quar- ter's bulk, and adding hydrochloric acid as a precipitant, which throws down the lithic acid after a few hours. URINE IN DISEASE. 69 Water - Urea - Animal extractives, lactic acid, and ammo- ) niacal salts - - - j Albumen, with lithic acid and vesical j mucus - - - - \ Alkaline sulphate, phosphate, and chlo- ) ride - - - \ Earthy phosphate* - - - - QUANTITATIVE ANALYSIS OF URINE CONTAINING SUGAR. The great difficulty to be overcome in this examination is that of determining the proportion of urea ; for the sugar with which it is admixed completely prevents the crystal- lization on the addition of nitric acid. There seems little doubt that many specimens of diabetic urine have been stated to contain no urea, when that principle has been present in considerable quantity. Mr. Kane made some ex- periments on this subject, from which he concluded that urea is voided by diabetic patients in the same quantity per diem as by healthy individuals. His method of detection was by plunging the fluid, mixed with nitric acid, into a freezing mixture, formed with ice and common salt; at this temperature a crystallization of nitrate of urea occurred. In this examination it is best to divide the urine into three portions of equal weight. First Portion.—This, after being weighed, is evaporated to dryness over a steam-bath; the dry residue is then to be treated with boiling alcohol, specific gravity -833 until it exerts no further solvent action. This alcoholic solution, after filtration, is evaporated to dryness, and then re-dissolved in distilled water. The aqueous solution is now evaporated to the consistence of a thin syrup, and plunged into a freezing mixture,! where it * There is a variety of urine called by Prout chylo-serous urine. It contains a large quantity of fats in suspension. This urine may be cleared of fatty matter by agitation with ether, and then examined for other ingredients in the same manner as albuminous urine. f That of ice and common salt is better for this experiment than the nitre and sal ammoniac before mentioned ; but if ice cannot be procured, the salts must be substituted. For further account of this urine vide Appendix. 70 URINE IN DISEASE. is to be mixed with its own bulk of a solution in equal parts of pure nitric acid and water. Crystallization will now occur if urea be present; and in this way it may be presumed that we can remove nearly the whole of the prin- ciple. It is, however, but fair to mention in our analysis, that a portion of urea probably exists in combination with the diabetic sugar. The nitrate of urea obtained as above must be treated in the same manner as that from healthy urine, in order to ascertain the proportion of urea present. Second Portion.—This must be carefully weighed, and then evaporated to dryness; in this way we can ascertain the weight of w7ater and solid extract. The extract is now to be treated with boiling water, which dissolves nearly the whole, leaving only a small residue of vesical mucus and earthy phosphate. The weight of this residue being taken, we can by in- cineration determine the proportion of the phosphate (as a result) and vesical mucus (as the loss by incineration.) The aqueous solution is now to be evaporated to dryness, and the weight of the extract taken.* This mass is to be incinerated and decarbonised in a platinum crucible, when the weight of the residue is that of the salts, and the loss of weight by incineration minus that of the urea gives exactly the proportion of animal ex- tractives, lactic acid, lactate of ammonia, and sugar. Thus, we can fulfil the following formula :— Water - Urea - - - - - Animal extractive, lactic acid, lactate of am- ) monia, and diabetic sugar, with probably a > small portion of urea in admixture - y c u r • • .- ^ Alkaline,sulphate,phos- ) Salts of incineration < u * ui ■ 1 ? ( phate, chloride ) Earthy phosphate - tt • i ( With perhaps a trace ) Vesical mucus { fri(. -A > ( of lithic acid - ) Third Portion.—This is to be used for the purpose of determining the weight of sugar present, which is done by * This weight might be deduced ; but in all these experiments we can scarcely weigh too often. URINE IN DISEASE. 71 pouring it into a retort in admixture with a small proportion of yeast, and placing the nozzle of the retort under an in- verted and graduated jar filled with mercury. In this manner we can collect the carbonic acid produced by the fermentation of the sugar, and may estimate its quantity at a grain for every cubic inch of gas produced. This mode of calculating will be found sufficiently accurate for all practical purposes. The weight of the sugar being ascertained, we may now subtract it from the other matters soluble in alcohol, with which it is mentioned in the formula, and it may be entered as a separate constituent in the analysis. ( 72 ) ANALYSIS OF URINARY CALCULI. The examination of urinary calculi is very easily per- formed. We may divide the substances entering into their composition into two classes. Firstly, those whose texture and composition become destroyed by a red heat; and, secondly, those capable of resisting heat, and whose composition remains unaltered after the action of that agent. The first class contains the following substances : viz. Lithic acid. Lithate of ammonia. Oxalic acid (existing as oxalate.) Albuminous animal matter. Dried blood. Cystine, or cystic oxide. Xanthic oxide. Fibrinous calculus. Ammonia (separated from phosphate of magnesia.) The second class is not quite so numerous; containing as follows:— Phosphate of lime. Phosphate of magnesia. Carbonate.of soda (resulting from heating the lithate.) Carbonate of lime. Carbonate of lime, mixed with caustic lime (resulting from the decomposition of oxalate and lithate of lime by heat.) Silica. We sometimes find that lithic acid exists in combination with magnesia, but this is generally in an exceedingly small proportion. I have therefore abstained from men- tioning it in the list of constituents. I shall now proceed to describe the properties of each constituent, in the order observed in the list, commencing with the lithic acid. I shall then go through each step in ANALYSIS OF CALCULI. 73 the analysis of a calculus compounded of all the substances ordinarily contained in urinary concretions. CLASS I.--THOSE CONSTITUENTS OF URINARY CALCULI WTHICH ARE DESTRUCTIBLE BY A RED HEAT. Lithic Acid. This form of calculus is more commonly met with than any other ; it is generally of a yellowish-brown colour, and smooth on the surface : the brown coloration is owing to an admixture of animal matter, since the lithic acid, when pure, is perfectly white.* WTe usually find that calculi of this description are formed of very distinct concentric layers. Lithate of ammonia, soda, or potash occur, mixed with this form of concretion; and the lithate of lime has also been observed. The following are the chemical properties of lithic acid:— It is insoluble in water. It is easily soluble in a solution of caustic potassa, and is precipitated from this menstruum by the addition of an acid, in a granular and colourless state. It is dissolved by nitric acid with effervescence ; and, by careful evaporation to dryness, yields a red or rather pink colour,f which becomes of a fine violet tint when ammonia is dropped on it, or even when it is subjected to the action of strong ammoniacal fumes. This reaction of ammonia is very useful, inasmuch as it prevents the yellow stain which many animal matters produce with nitric acid from being mistaken for the re-action of lithic acid. In the former case, the ammonia increases the yellow tinge to an orange colour, which is very distinct from the violet tint of mu- rexid. Before the blowpipe this substance emits a fetid smell of burnt horn, mixed with an odour approaching to that of hydrocyanic acid. * It has been said that lithic acid never occurs in its pure state in urinary calculi. This is what we should expect; but I once met with a calculus, the nucleus of which was composed of colourless lithic acid. f Owing to the formation of murexid. b 74 ANALYSIS OF CALCULI. Lithate of Ammonia. This substance has several times been observed forming whole calculi; these, however, are generally small; they are of a clay colour, with a smooth external surface. Their fracture is more earthy than that of the lithic acid variety. Though it is very rarely that we meet with a calculus formed entirely of lithate of ammonia, yet a large majority of calculi contain that lithate in small proportions. Its properties are as follows :— It is very soluble in boiling water, but much less so in that fluid when cold. It is soluble in the solutions of alkaline carbonates. WTith nitric acid it reacts in the same manner as lithic acid. When suddenly heated on platina foil, it crepitates strongly. When treated with potash, it yields vapours of ammonia. The solubility of this substance in boiling water and solutions of alkaline carbonates sufficiently distinguishes it from the lithic acid. Oxalic Acid. This acid always exists as oxalate in urinary concretions; and the oxalate of lime is the only combination that has yet been detected in them. Calculi composed of oxalate of lime, either entirely or in great part, are of very frequent occurrence, and form the variety known by the name of the mulberry calculus, in consequence of its tuberculated exte- rior, presenting the appearance of that fruit. These calculi are generally of a dark brown colour. When sawn through and polished on the internal surface, we perceive an internal arrangement much resembling that of the fortification-agate, owing to a succession of conformable deposits taking place on the originally tuberculated surface. The chemical pro- perties of oxalate of lime are as follows:— It is insoluble in cold nitric and hydrochloric acids, but dissolves when boiled with these acids in a concentrated state ; by long digestion, however, in cold hydrochloric acid, the powdered calculus becomes dissolved. ANALYSIS OF CALCULI. 75 When boiled wTith a solution of carbonate of potash, it becomes decomposed, forming carbonate of lime and oxa- late of potash. Before the blowpipe, on platinum foil, this calculus be- comes charred, emits a fetid smell (caused by decomposing animal matter ;) and if the heat be continued, a white ash remains, possessing an alkaline reaction, and capable of effervescing with the acids, owing to the formation of a portion of carbonate of lime, varying in quantity according to the heat employed for calcination: the alkaline reaction above mentioned is attributable to the presence of caustic lime. This variety of calculus is easily distinguishable by the fact of its effervescing in dilute acids after calcination, and its insolubility and refractory character, previous to the ap- plication of heat. We occasionally meet with a form of the oxalate of lime calculus, the external surface of which is perfectly smooth and polished. These calculi are very small ; seldom more than half the size of an almond, of an oval form, and known as the hemp-seed calculus. I have examined but one spe- cimen of this variety of concretion. Calculi occasionally occur, having their surfaces stud- ded with octahedral crystals of oxalate of lime. I first pub- lished an account of such a calculus with a description of the crystals, in the Guy's Hospital Reports for October, 1837. Dr. Bird has since described octahedral crystals of oxalate of lime as occurring in the urine—these insoluble octahedra had been before noticed by Vigla, but not de- scribed as the oxalate. Albuminous Animal Matter and dried Blood. The former of these is constantly present, in greater or less proportion, in every kind of calculus. It exists in con- siderable quantity in calculi composed of lithic acid or the phosphates. It has been a matter of doubt whether the deeper tints of colour observed in calculi be not owing to some form of animal matter distinct from dried blood, and though it is not very easy to form an opinion by the examination of 76 ANALYSIS OF CALCULI. these matters, as presented to us in calculi, I feel pretty con- fident that blood is the only colouring matter capable of producing the deep tints observed in many varieties of calculus. There is also a peculiarity of colour, which a practised eye immediately seems to recognise as the appearance put on by blood coagulated by heat; and I would beg the reader, on the first opportunity, to boil some diluted serum with red particles in admixture, when he will find that, ac- cording to the quantity of red particles present, he can pro- duce modifications of colour exactly resembling those ob- served in the varieties of dark-coloured calculi. To this we may add, that from some calculi possessing such a co- lour, we can extract haematosine from the external layers. The albuminous animal matter contained in calculi has the following characters:— It is insoluble both in cold and boiling water. When treated with a solution of caustic potassa it dis- solves, but may be precipitated from this alkaline menstruum by means of hydrochloric acid. It produces a fine yellow colour when boiled with nitric acid, and yields all the well- known re-actions of albumen. Cystine, or Cystic Oxide. We are indebted to Wollaston for the discovery of this substance. It is of rare occurrence in the human species, but is frequently met with in the dog. The larger kind (of which there is a beautiful specimen in the museum of Guy's Hospital) is semi-crystalline, and not unlike stearine in ap- pearance ; there is a slight greenish tinge, and a radiated texture of a very peculiar character, observable throughout its section. The smaller kind (as those met with in the dog) are not distinctly crystalline, but solid and compact, and frequently want the greenish tinge peculiar to the larger and apparently more completely formed variety. Wollas- ton's reason for giving the name of cystic oxide to this sub- stance was, that he considered it peculiar to the bladder. This, however, is not the case; for it has been observed in the kidney by Dr. Marcet. Dr. W. chose to call it an ox- ide, because it resembled some few of that class of sub- ANALYSIS OF CALCULI. 77 stances in being soluble in both acids and alkalies, the term cystine is however more appropriate. Cystine exists in calculi in a perfectly pure form ; the only compound calcu- lus, containing cystine as a constituent, is contained in the collection of Guy's Hospital. It may be procured in crystals, by allowing its solution in caustic ammonia to evaporate spontaneously. We can then observe the crystalline form to be that of flattened hexagonal prisms. Its chemical properties are as fol- lows:— It dissolves in dilute nitric, hydrochloric, sulphuric, oxa- lic, and phosphoric acids ; but will not combine with the tartaric, acetic, or citric acids. It is dissolved by caustic ammonia; but not by the car- bonate of that alkali. The fixed caustic alkalies, as also their carbonates, readily dissolve it. When nitric acid is evaporated on cystine, a dark-brown colour is produced. It is insoluble in alcohol; and water exerts but a feeble solvent action. If it is wished to precipitate cystine from its solution in acids, the carbonate of ammonia is best for that purpose ; if from its solution in alkalies, the acetic acid is the best we can employ. The following method of proving the presence of cys- tine has'been proposed by Liebig:—Dissolve the calculous matter in caustic potassa, then add a solution of acetate of lead in such proportion that the oxide of lead shall not pre- cipitate, but be retained in solution by the excess of po- tassa. This liquor becomes black when boiled if cystine is present,—a re-action dependent on the presence of sul- phur in the cystine. Before the "blowpipe it is consumed, yielding a very pe- culiar fetid smell. Cystine may easily be distinguished from the other com- ponents of calculi, by its being soluble in dilute hydro- chloric acid, and also in the solution of carbonate of potash. Its very peculiar odour, when heated on platinum foil be- fore the blowpipe, forms likewise a good distinguishing characteristic. 78 ANALYSIS OF CALCULI. Xanthic Oxide. This calculus was first observed by Dr. Marcet, and has since been noticed by other chemists. When reading the re-actions described by Dr. M., we recognise many of the characters of lithic acid. The action of nitric acid on xan- thic oxide is what I have more than once had occasion to observe in lithic acid calculi containing much albuminous matter.* Stromeyer found this substance in a calculus. The chemical characters described by Marcet as peculiar to this substance accord pretty completely with those of lithic acid, except in its affording a yellow colour when heated with nitric acid ; which colour becomes changed to a red- dish tint on being treated w*ith potash. Before the blowpipe this calculus decrepitates, and is said to give out a peculiar odour, unlike that of cystine or lithic acid; it leaves a slight ash when perfectly incine- rated. Professors Wohler and Liebig have lately examined a specimen of this calculus. It is stated to differ from lithic acid in not yielding urea by ignition in a close tube, and by dissolving in nitric acid without evolution of gas.f Fibrinous Calculus. It has been before mentioned that every species of cal- culus (except, perhaps, that composed of cystine) contains an animal matter of an albuminoid character. The calcu- lus now under consideration appears, however, to consist entirely of this substance. * In the seventh volume of the Traitede Chimie of Berzelius we find the following passage concerning the re-actions of the xanthic oxide:—"Sans vouloir pretendre que l'oxide xantique etait simple- ment de l'acide urique, ou de I'urate ammonique, avec une matiere animale qui modifiat la couleur de la dissolution nitrique evaporee, il parait cependant qu'on ne pourra avec une entiere certitude le con- siderer comme une matiere particuliere, que quand il aura ete re- trouve et analyse de nouveau." f A small fragment of the calculus examined by Liebeg and Wohler lias been presented to the museum of Guy's Hospital by Dr. Willis. ANALYSIS OF CALCULI. 79 It was first noticed by Dr. Marcet, and its chemical char- acters resemble those of fibrin. This calculus is said to approach yellow wax, both in colour and consistence ; its structure being fibrous, and somewhat elastic. Its re-actions are as follows :— It is insoluble in water, alcohol, and hydrochloric acid. When treated with a solution of caustic potash it dissolves, and may be precipitated from this solution by the addition of acid. It dissolves in acetic acid by the assistance of heat; and this solution, like .that of fibrin, may be precipitated by the solution of ferrocyanuret of potassium. It is dissolved with difficulty by nitric acid. Before the blowpipe it gives out the smell of burnt horn, and leaves a bulky charcoal. Ammonia ('separated from Phosphate of Magnesia.) It is very easy to determine whether ammonia be present in any specimen of calculous matter submitted to our no- tice ; but the greatest care is requisite before wTe can deter- mine whether that ammonia proceeds from the presence of the triple phosphate of ammonia and magnesia, or from the lithate of ammonia : this can often be accomplished by determining the absence of one of these bodies by other tests than those dependent on the presence of the volatile alkali. If ammonia can now be proved to exist, it shows the presence of the other constituent; but further than this the testing for ammonia is a useless step in the analysis of calculi. When we separate the lithate of ammonia by means of boiling water, the ammoniacal test is, however, valid as a proof of the nature of the two substances so se- parated. Before, therefore, we can be sure that any ammonia which may be detected proceeds from the triple magnesian phos- phate, it is necessary to wash the portion used for perform- ing this test with a considerable excess of boiling distilled water, till the liquor ceases to yield the re-actions of lithic acid. The testing for ammonia is performed as follows:— A small portion of the calculus is placed on a piece of 80 ANALYSIS OF CALCULI. platinum foil, and treated with carbonate of potash in a concentrated solution. Vapours of carbonate of ammonia are now evolved, which may be detected by their well- known odour; but the best method of proving their pre- sence is by holding over them a rod which has been dipped in fuming hydrochloric acid, when fumes of hydrochlorate of ammonia will be distinctly visible. It is frequently re- commended to use caustic potash instead of the carbonate in this experiment; but the former is very liable to form ammoniacal fumes by its peculiar action on a great variety of animal matters, and therefore is not so distinctive as the carbonated alkali. CLASS II.—THOSE CONSTITUENTS OF URINARY CALCULI CAPA- BLE OF RESISTING THE ACTION OF HEAT. Phosphate of Lime. This substance but rarely exists as the sole ingredient of a calculus ; when it does so, the concretion is always very smooth and polished on the surface, and very distinctly laminated. It is generally of a pale-brown colour. Four- croy and Vauquelin doubt much whether it ever occurs unmixed with the triple phosphate. The phosphate of lime is a very frequent ingredient in compounded calculi; and when united to the triple phosphate in considerable propor- tion, it forms the fusible calculus, so called from its easy fusibility before the blowpipe. The chemical properties of the phosphate of lime calculus are the following:— It is soluble in the dilute mineral acids, and precipitable from this solution on the addition of ammonia.* Its acid solution, when nearly neutralised by ammonia, and then tested with oxalate of ammonia, gives a precipitate of oxalate of lime. Before the blowpipe it blackens, and leaves a copious white residue, if the heat be continued. It requires a very intense degree of heat for fusion. * This precipitate is in a gelatinous form, and very characteristic of the earthy phosphates. ANALYSIS OF CALCULI. 81 This form of calculus is best distinguished by its negative properties. Thus, it is known from the triple phosphate by not yielding ammoniacal fumes when treated with potash ; and from the fusible calculus by the great difficulty experi- enced in even rounding the edges of its fracture with the blowpipe flame. Phosphate of Magnesia (resulting from the triple Phosphate.) This salt, which remains as the result of heating the triple phosphate, \ras for a long time confounded with the phos- phate of limeT It possesses the following chemical charac- ters:— It readily dissolves in the acids: even cold dilute acetic acid acts powerfully on it. It cannot easily be fused by a blowpipe heat.. When oxalate of ammonia is added to its solution in acid, no precipitate is observable, which serves to distin- guish it from the phosphate of lime. When these earthy salts occur together, they may be separated by a method which will be described in the process for the analysis of mixed calculi. Carbonate of Soda (resulting from heating the Lithate.) It may be known by its solubility in water, and alkaline re-action, as also by effervescing with acids: it occurs but in very minute proportion in urinary calculi; but the lithate forms the great bulk of gouty concretions occurring about the smaller joints, and it is also found very generally in the urinary deposits of rheumatic subjects. The car- bonate of soda may be known from that of potash by its colouring the flame of the blowpipe of a fine yellow hue. Carbonate of Lime. This substance sometimes occurs as an ingredient of mixed calculi; but I do not know of any well-authenticated case in which it has been shown to exist alone as the con- stituent of a calculus from the human subject. W'hen car- bonate of lime is tested in a calculus, we must always 6 82 ANALYSIS OF CALCULI. make our examination before any incinerating process has been had recourse to ; for by such a step we run the risk of forming a carbonate of lime (which did not originally exist in the calculus) by the decomposition of any oxalate or lithate of lime which may be present in the concretion. Since, however, neither oxalate or lithate of lime produce effervescence with acids, there is no danger of confusion when tests are applied prior to calcination. If, then, calculous matter produces an effervescence on the addition of cold dilute hydrochloric acid, we may con- clude that a carbonate is present. The chemical properties of the carbonate Irre the follow- ins:—. It effervesces when moistened with cold dilute hydro- chloric acid. The solution in acids is precipitated on the addition of oxalate of ammonia ; care being taken previously nearly to neutralise the acid liquor. It is insoluble in water. Carbonate of Lime mixed with Caustic Lime (resulting from the Decomposition of Oxalate of Lime by Heat]) It may always be known that this substance is the result of incinerating the oxalate of lime, if we find the matter subjected to examination capable of effervescing, only after incineration.* If a specimen of calculus matter effervesces both before and after incineration, then of course we may conclude that carbonate and oxalate of lime are both present; provided we have taken care to extract all the carbonate by means of dilute hydrochloric acid (which must be well washed from the calculous matter previous to performing the incinera- tion;) for the acid having removed all the carbonate, any * When lithate of lime exists in a calculus, we may have effer- vescence produced after incineration. When we have any suspi- cions, we should take care to employ a digestion with muriatic acid, previous to performing the calcination. When this precaution is used, we can be sure that any effervescence which may occur is caused by the decomposition of oxalate of lime. ANALYSIS OF CALCULI. 83 which may be detected after calcination must be regarded as a result of that process. Silica. This substance was twice detected by Vauquelin and Fourcroy during their laborious researches into the nature and composition of urinary concretions. Venables also re- ports the case of a woman who passed a calculus containing silica. It seems highly probable that this substance may exist in small proportion in most calculi; nor can we be surprised at its having been overlooked by those who examine the concretions; for, to do justice to such an in- vestigation, it would be necessary to sacrifice the greater portion of most calculi which is seldom permitted to the chemist, since such minute investigation has rarely been a desideratum with those who subject their specimens to his operations. Silica may be known by its perfect insolubility in water, and the concentrated mineral acids ; and likewise by its forming transparent colourless glass, when fused with car- bonate of soda on charcoal before the blowpipe. Having now separately noticed each constituent of uri- nary calculi, I shall proceed to describe the method for de- termining the composition of a compound calculus, con- taining all the ingredients which are ordinarily met with in such a concretion;" viz. Lithic acid. Lithate of ammonia. Lithate of soda. Lithate of Lime. Oxalate of lime. Ammoniaco-magnesian Forming the fusible cal- phosphate or triple I cuius, if the phosphate phosphate. [ of lime be in sufficient Phosphate of lime. J proportion. Carbonate of lime.f * Calculi for examination should always be sawn through the centre, in order to expose the layers to view. A portion of each of these layers must be used to form the powder for analysis. | Cystine, xanthic, and fibrinous oxide are here excluded, because 84 ANALYSIS OF CALCULI. The portion of calculus intended for examination must be reduced to a fine powrder, in a small agate mortar, and the powder divided into two parts. Treatment of first Part.—This is placed in a small glass flask, and distilled water boiled upon it for several minutes. The liquor is now to be poured off, and a few drops of it evaporated to dryness on a watch-glass ; when, if there be any residue, we must again treat the powder in the flask with a fresh portion of distilled water, which is to be boiled as before, and tested for a residue. This treatment is to be pursued until we no longer ex- tract any thing with boiling water.* Thus we procure an aqueous solution a, and a residue b. a. The aqueous solutions are to be added together, eva- porated to dryness, and the residue of the evaporation exa- mined as follows:— Lithic acid. A portion is placed on a watch-glass, and treated first with nitric acid and then with ammonia, as before described, when we shall procure the characteristic re-action of lithic acid (this residue of the aqueous solution consisting of the lithates.) Having now tested the acid, our attention must be directed to the bases. Ammonia. A small portion of the residue is placed on a watch-glass, and moistened with a solution of caustic potash, when am- moniacal vapours will be produced, known by their charac- teristic odour, and also by testing them with fumes of hy- drochloric acid, as before described. Soda. The remainder of the residue may now be carefully they never exist in any considerable quantity as components of cal- culi. Several other matters, which appear rarely and in small pro- portion, are also omitted; such are silica and hydrochlorate of am- monia; the latter first noticed by Dr. Yellowley, in the Philosophi- cal Transactions. * This soon happens, if we use each time a large bulk of water in proportion to the quantity of calculous matter. ANALYSIS OF CALCULI. 85 heated on platinum foil at a low heat, when it will char, and partly volatilise. The remainder (if any exist,) when perfectly decarbonised, will possess an alkaline re-action. When cold distilled water is digested on it, we shall find a portion becomes dissolved, and the liquor so formed not being precipitable by the solution of an alkaline carbonate, we at once recognise the dissolved matter as a fixed alkali. Lime. The matter which was not dissolved by the distilled water will be found to dissolve with effervescence in a drop of dilute hydrochloric acid, and to be precipitable from this acid on the addition of a solution of oxalate of ammonia: this precipitates lime.* The aqueous solution contained then,— Lithate of ammonia. ----■-----soda. ---------• lime. b. The calculous matter, insoluble in water, is now treated as follows:— Lithic acid. A small portion is tested for lithic acid, with nitric acid and ammonia. Carbonate of lime. A second portion is mixed with dilute hydrochloric acid; and if any effervescence occurs, we may conclude that car- bonate of lime is present. Oxalate of lime. The remaining matter insoluble in water is now to be di- gested in dilute hydrochloric acid, then incinerated and de- carbonised in a platinum capsule, over the spirit lamp: the residue when cold is tested with dilute acid; and if effer- * It must be observed, that this result of incineration on platinum foil is always minute, and great care is requisite in adding the water, to dissolve out the carbonate of soda, as well as in the addition of acid to the lime: a drop of dilute acid being quite enough for the latter purpose, and the same quantity of the test being quite sufficient as a precipitant for the lime. 86 ANALYSIS OF CALCULI. vescence ensue, we may be sure that oxalate of lime is a component of the calculus.* Treatment of second Part.—This is to be placed inapla- tinum capsule over the spirit lamp, and perfectly incinerated and decarbonised. Should carbonate of lime be present in this result of in- cineration (which of course is the case when the carbonate or oxalate of that earth exist in the calculus,) we must dis- solve the whole in dilute hydrochloric acid, and precipitate the solution with caustic ammonia, by which means we throw down the phosphates only which may exist in the li- quor. This precipitate is to be placed on a filter, and washed with cold distilled water; it must be dried, and then is ready for examination.!. Phosphates. A small portion is placed on the end of a platinum wire, which must previously be curled into a small noose, in order to hold more of the matter for experiment. The flame of the blowpipe must now be carefully directed on the mass ; when, if fusion occur quickly on urging the heat to incipient whiteness, we may conclude that wre are ope- rating an the phosphates of lime and magnesia in the pro- portions constituting the fusible calculus. If no fusion oc- cur, we must have recourse to other proof, in order to show that these two phosphates are present, which is often the case though they be not in the proportions necessary to form the fusible compound. This extra proof of their pre- sence may always be recurred to if we wish for any cor- roboration on the subject. The examination is as fol- lows :— * The reason for using a digestion with hydrochloric acid is to ex- tract all the carbonate of lime before incineration is performed: by which means we may be sure that any which appears after incine- ration is the result of decomposed oxalate. f If no carbonate or oxalate of lime exists in the calculus, then we may at once proceed with the examination of the result of incine- ration, without using the solution in hydrochloric acid and precipi- tation with ammonia, which is otherwise necessary in order to sepa- rate the phosphates. ANALYSIS OF CALCULI. 87 Phosphoric Acid. The incinerated or dried mass is to be dissolved in di- lute and pure nitric acid, and the solution divided into two portions. One is tested with nitrate of silver, which pro- duces a yellow precipitate on neutralising the excess of acid in the solution by the addition of an alkali. This precipi- tate is phosphate of silver, and thus we prove the presence of phosphoric acid. Lime. The second part of the solution is to be nearly neutralised with ammonia,* and then a solution of oxalate of ammonia added, which will precipitate lime after a short interval has elapsed. Magnesia. The precipitate (which is oxalate of lime) is allowed to subside, and the clear liquor poured off. This, when tested with caustic ammonia, will produce a crystalline precipi- tate of triple phosphate, if magnesia be present. It is very seldom that we have calculi presented for examination con- taining so many ingredients as the one here noticed. Very frequently we cannot extract any thing from the mass by means of boiling water, and then it may at once be con- cluded that the lithates are absent. Indeed, when we pro- cure a residue by evaporation from the boiling aqueous so- lution, we shall continually find that it consists of lithate of ammonia only, and is entirely volatilised when heated on platinum foil. Again, we but seldom encounter the car- bonate of lime in these researches, and this renders the de- termination of the oxalate of lime more simple and satis- factory. It is not at all uncommon to meet with calculi that are entirely dissipated on the application of heat. When this is the case, our examination is much simplified ; for we can exclude from the possible list of constituents the triple * The solution should, however, always be slightly acid, in order to preserve the magnesia in solution till the lime is precipitated, and the liquor should be well boiled, in order completely to get down the precipitate of oxalate of lime thrown down by the oxalate of am- monia. 88 ANALYSIS OF CALCULI. phosphate, phosphate of lime, oxalate and carbonate of lime: thus but few matters are left for our consideration. These destructible calculi consist for the most part of lithic acid, combined with more or less of the lithate of ammonia. When a calculus consists of the earthy phosphates, in a tolerably pure state, we find that it blackens before the blowpipe, owing to the presence of vesical mucus. When incinerating such a specimen, we cannot be sure but that this carbonisation is owing to the presence of lithic acid. The effect of the blowpipe, therefore, though of considera- ble assistance as a test, in cases where all the calculous in- gredients are volatile, cannot expedite our analysis if a residue be obtained after its incinerating action. I would advise those who analyse calculi to commence their examinations by incinerating a small portion on plati- num foil; when, if no residue be observed, they much simplify their labours—as they can be sure that no earthy or fixed alkaline salt exists in the concretion. It frequently happens that calculi are given to the che- mist for examination, consisting of different layers of con- siderable thickness, and it is required to know the consti- tution of each separate formation. When this is the case, it generally becomes necessary to examine a portion of each layer, accordiug to the process described above ; for though we may have examined a powder formed from triturating a portion of the layers, yet we cannot always determine which of these has yielded any one or more of the eonstituents of the whole calculus. In conclusion, I may observe, that when we are extract- ing portions for examination from the different layers of a calculus, it is very necessary to avoid turning over and shaking the sawn surface, in order to dislodge the fragment which w*e have detached ; for by so doing we are very likely to admix portions of the other layers if they happen to be friable, as is often the case. The best way of avoid- ing this source of error is to pick up the detached portion for examination, by means of a thin glass rod, moistened with distilled water, to which the calculus matter readily attaches itself, and can thus be removed for experiment. TREATMENT URINAKY DISEASES. ON THE TREATMENT OF URINARY DISEASES. In presenting the reader with the following essay on urinary diseases, my object has been to describe as concisely as possible the ordinary features of each class of affection, to enter upon a consideration of the most approved methods of treatment, and to add the results of my own experience on several parts of the subject. On some points of prac- tice I have been led to form opinions materially affecting treatment, and not entirely devoid of novelty. I therefore venture to hope, that this contribution to the literature of the subject may contain matter of interest, if not of advan- tage, to the reader. ON THE LITHIC DEPOSITS. Urine depositing the crystalline red gravel is generally of fine deep yellow colour, and contains an excess of acid. Its specific gravity will in most cases be found to exceed that of health, varying from 1022 to 1025, or even higher. When viewed under the microscope, this deposit presents a crystalline texture, and is seen under various forms. (Vide plate, figure 3.) It yields all the re-actions of lithic acid when chemically examined. (Vide p. 73.) 92 LITHIC DEPOSITS. The symptoms observed in those who suffer from the crystalline lithic acid deposit are occasionally of a very se- vere character, and are constantly brought before the atten- tion of practitioners as occurring among those members of every class of society who either from idleness or necessity fail to take the regular exercise indispensable to the preser- vation of health, and who at the same time may have the opportunity of indulging freely in animal food, either with or without the use of spirituous drinks. The tendency to the formation of lithic acid deposit is frequently marked by a liability to sharp lancinating pains affecting the extremi- ties, and by lumbar pains combined with a certain degree of irritation experienced during micturition. These symp- toms are seldom observed when the lateritious sediments composed of the lithates are being excreted by the patient, except of course when they occur in fever, rheumatism, or gouty disease, and not as constituting an unmixed variety of urinary affection. When transient but sharp pains are ex- perienced by the patient, and any complaint is made of scald- ing or irritation after micturition, while no other prominent symptom of constitutional disturbance is to be observed, we may very generally conclude that any deposit found in the urine will be composed of crystalline lithic acid, and not the lateritious sediment. The two causes of distress above alluded to constantly exist together as symptoms in- dicative of a tendency to lithic acid deposit, and that too when the general functions of the body are for the most part regularly discharged, and the general tone of the sys- tem preserved in a manner not to be observed in any other form of urinary disease attended with pain. It is true that such patients complain frequently of dys- peptic symptoms; but these for the most part are of trivial character, and by no means approaching the importance of those characterising the phosphate and oxalic forms of de- posit, in which we constantly observe an irritability and las- situde in connexion with dyspepsia which render the patient either unwilling or unable to enter upon the ordinary avo- cations of life, and, when obliged to use exertion from ne- cessity, injured and not benefitted by the effort. The lithic acid deposit either in the crystalline or agglu- tinated form is generally a disease of the middle or advan- LITHIC DEPOSITS. 93 ced stages of life, and when occurring in youth or infancy seldom fails to indicate a tendency to grave disease. The liability to calculus is frequently shown by the occurrence of lithic acid deposit in childhood, and a gouty tendency is often indicated in the same manner. In youth, the lithic acid deposit is sometimes observed in connexion with Mor- bus Brightii. I have known the lithic acid to exist in the urine of a child hereditarily predisposed to gout, and eventually lead to the formation of calculus in the bladder, which being passed by the urethra at an early period of its formation, thus for a short time relieved the sufferer. This patient, however, subsequently became the subject of gout in a se- vere form, but never afterwards experienced a return of calculous symptoms. As regards the formation of lithic acid calculi, it is chiefly at a more advanced age that the deposit is found in the urine in a form threatening their pro- duction. Thus the deposit, instead of appearing at the bottom of the chamber vessel as a crisp crystalline sand, is observed to assume a more rounded form, each little mass being more or less circular, and adhering occasionally to the bottom of the vessel even when the urine is shaken over it with some degree of rapidity. Dr. Prout has stated, as a general rule, that it is in middle life that the deposit of lithic acid assumes this concrete form, threatening calculus of the kidney or bladder. The crystalline lithic deposit, however, is not at all uncommon in middle life ; I have met with several such cases showing its presence. Where the concrete form exists, of course there will be an increased tendency to the formation of calculus. I never saw, however, the concrete lithic acid deposit in a child, and believe it rarely if ever to exist. In old age, a tendency to the excretion of very small rounded lithic acid calculi is sometimes observed. Dr. Prout has particularly noticed this condition of urinary disease, which appears connected, in general, with mischief in the urinary passages, and a tendency to the secretion of alkaline urine. Deposit of Lithates (Lateritious Deposits.) This form of deposit, formed of lithic acid in combination with ammonia, lime, magnesia, or soda, presents under the 94 LITHIC DEPOSITS. microscope the appearances described by figures 4, 5, and 6. (Vide plate.) Examined chemically, it yields the re- actions described at pages 84, and 85. If urine con- taining the lithates be heated the whole deposit is imme- diately dissolved. The colours assumed by the various lithates, when existing as deposits, are indicative of certain conditions of system, and they become thus valuable guides to treatment. When a dusky nut-brown colour occurs, we may very generally infer that little else than an ordinary dyspeptic attack has supervened, and if the urine be in other respects of normal character, no great anxiety need be entertained on the subject. There is not, however, the same security in those forms of lateritious deposit charac- terised by a white or dark purple colour. When urine de- positing the nut-brown sediment is not much above the normal specific gravity, (that is to say, not above from 1018 to 1022,) and when no evidence can be obtained of the presence of sugar, we shall seldom be wrong in attributing the attack to some accidental exposure or intemperance in diet; but it will sometimes happen, and that in cases in which other symptoms to countenance such a belief are en- tirely wanting, that traces of sugar can be detected in the urine, and then it becomes our duty carefully to investigate the case, and steadily to enforce treatment. It is not un- common for persons, who have passed lithates for years without the supervention of any disagreeable symptom, sud- denly to become the subjects of dyspepsia, attended with thirst, and then, on applying to their medical attendant, to doubt the possibility of any mischief having arisen from ne- glect of a symptom to which they have become, as it were, habituated ; nor is it uncommon to learn from them that they never feel so well as when excreting the deposit in large quantity. It is only when this form of deposit is associated with a saccharine condition of urine, that it becomes of im- portance as a disease, and it is always well to be sure of the absence of sugar in the secretion before we promise the pa- tient that certain and immediate relief, which we need seldom fail to afford in the uncomplicated form of dyspepsia, leading to the deposition of brown lithates as a sediment. Dr. Prout remarks, when treating of this subject, that the tendency to the deposit of lithic sediments is almost invariably connected LITHIC DEPOSITS. 95 with hasmotrophy of the kidney. Now it is true that we ob- serve the lithic acid in the crystalline form, and the lithates also, occasionally appearing in the urine of those who are the subjects of albuminuria ; but this is far from always the case, and again, the lithic acid and lithates are most decidedly found unconnected with a coagutable state of urine; so that I cannot well understand how the close connection spoken of by Dr. Prout can have presented itself to his mind, nor upon what grounds he has determined the presence of haj- motrophy in the cases to which he alludes. When the lithates deposit in the urine entirely devoid of colouring matter, and approach the white tint of the phosphates, it is not uncommon to observe dysuria as a symptom. I am far from considering with Dr. Prout, that this deposit is in- dicative of a tendency to deposit the phosphates, that is to say, if it be secreted pure, and entirely soluble in the urine when heated. The nut-brown deposit noticed above, I have, however, not uncommonly found alternating with the triple phosphate, which would tend to show that when these two deposits follow each other, the white lithates are not necessarily to be expected. The cause of this alternation of phosphatic with lithic deposit will be hereafter entered upon. The lithates, when excreted of a red or pink colour, are generally concomitants of a febrile condition, and dis- appear immediately the cause for constitutional disturbance (if it admit of remedy) is removed. In rheumatism and rheumatic gout, I have observed the red sediments to occur very frequently; and in a case of the kind recently under my care, I had an opportunity of witnessing their gradual change to a bright pink, while the urine assumed a dark purple colour, resembling that of murexid. In this case there had been long neglect of the bowels, and dyspepsia, while constipation formed an obstinate symptom throughout the course of the disease. In cases such as that above described, it is not uncom- mon to find old visceral derangement; and provided rheu- matism and gout do not appear as part of the disease, the appearance of the pink deposit must be regarded with anxiety. When, however, such symptoms are present we know they alone are occasionally capable of producing this urine with the pink deposits, and there is less cause to fear 96 LITHIC DEPOSITS. the existence of deep-seated disease affecting the liver or other chylopoietic organs. The red and pink sediments have been regarded as pe- culiar to fever, to the exclusion of the yellow amorphous sediment. I have observed the latter several times in typhus remittent. As a general rule, however, the red se- diments are produced by the febrile state. The treatment to which it is necessary to have recourse in these affections must vary according to the character as- sumed by each kind of deposit. When the red crystalline form of lithic acid is excreted, it has been very commonly supposed that the chief benefit we can derive is to be expected from the administration of alkaline remedies, which are known to correct the acid state of urine found in connection with this form of disease, and, moreover, to act as solvents on the deposit itself. It is a matter of fact that alkaline remedies will constantly cause the urine of patients suffering from the lithic acid deposit to become clear and transparent, and that the symp- toms of dysuria are generally relieved by the remedy; but I have seldom known this palliative treatment attended by any lasting benefit; and we must remember, that it should be our object to correct those general conditions of system on which the production of the unhealthy urine depends, rather than to afford a temporary benefit, by the use of means in themselves but ill calculated to effect the great object of all treatment. It is true that in those forms of deposit having a tendency to agglutinate, and therefore threatening the formation of calculi, the use of alkaline remedies may be necessary for a short period, and should be used in virtue of their me- chanical as well as chemical powers to rid the bladder and urinary passages of the irritation produced by adherence of the deposit; but it is not to the continuance of such treat- ment, that we are to look for relief even in this form of disease. It has probably been matter of experience with most of those who met with cases of red deposit, before the chemis- try of urine had received attention, that any remedy pos- sessing the power of invigorating the system, improving the appetite, and relieving the sense of fulness and tendency LITHIC DEPOSITS. 97 to sleep after meals, was capable of exerting a powerful controlling action over the excretion of lithic acid by the urine. The labours of animal chemists, however, produced so great a revolution in the minds of practitioners, that not- withstanding the force of prejudice (in our profession not generally so easily conquered,) the practitioners of our art almost universally adopted the opinions of those whose labours and results in the laboratory unfortunately assumed a complexion giving them an apparent right to dogmatise in physic; and the indiscriminate and mischievous use of alkaline remedies in cases of lithic disease is a prominent instance among the evils they were allowed to inflict. Apart from their use as mechanical agents acting through their solvent chemical power, I have good reason to dis- credit the production of benefit by their use, and they retard rather than expedite the good effects we can derive from the exhibition of other remedies. There are several forms of disease in which the elements of the urine appear to arrange themselves in an unusual manner; and the forma- tion of urinary deposit, not only in those cases of disease in which it is formed by a natural constituent of urine, but even when a material foreign to health appears, would seem sometimes to depend rather upon this tendency, than to the secretion of a positive excess of the constituent in the one case, or the production by the blood of some unusual body in the other. In such instances it is that we are generally at a loss to comprehend the causes in the action competent to the production of the effect upon the urine ; and though we may sometimes contrive, by the ingenious doubling and mingling of atoms, to extract a probable explanation by the transposition of elements, we are in no way assisted by this process to a better understanding either of the true nature of the disease or the plan of treatment best adapted to its cure. Although we derive but little assistance from chemis- try, so far as the treatment of this form of disease is con- cerned, we yet have present a certain set of symptoms indicative of general constitutional disturbance, by treating which the urinary mischief admits of being alleviated. The exhibition of mild aperients combined with altera- tives at night, and the use of vegetable tonics administered at intervals during the day, will generally be found of im- 98 LITHIC DEPOSITS. mediate efficacy in the cure of the disease in its early stages. When, however, the patient suffers from symptoms in- dicating a tendency to the formation of calculus, such as lumbar pains or sharp cutting sensations in the course of the ureters, it is well to combine our tonics with the liquor potassee, or bicarbonate of potash, in moderate doses. From fifteen to twenty minims of the former, or ten to fifteen grains of the latter, will generally be found sufficient in most cases. It is well, however, and more especially in hypochondriacal persons of low power, gradually to omit the use of alkali on the disappearance of the pains. This is best done by substituting small doses of magnesia for a few days, after which all alkaline remedies may be set aside. As regards the diet advisable in this form of disease, in early cases, there appears no objection to the use of any article known by experience to agree with the stomach of the patient. A careful regard to quantity is of course as valuable here as in every description of disease in which dyspepsia takes a prominent part. When long-continued inconvenience has been experienced from discharge of the lithic acid however, fish diet may be enjoined, with rest and perfect freedom from causes of irritation and anxiety during the hours of digestion. The use of wine is objectionable; and in all cases, how- ever mild, it is right to diminish the quantity to which the patient may have been accustomed, as an indispensable part of the treatment. Ripe fruits, which, from containing vegetable acids combined in excess with alkaline bases, yield alkaline carbonates to the blood and urine, are some- times of use in cases characterised by the cutting pains of gravel; but, like alkaline remedies in general, are more valuable in the removal of immediate symptoms than as adjuvants in effecting a permanent cure. In simple cases of lithic deposit they are not needed; and as they are fre- quently productive of much evil by causing increased dys- pepsia and much distress from flatus, it is generally better that they should be avoided. This same objection, and for the same reason, applies to acid wines and beer. When the patient passing lithic acid possesses a pulse indicative of power, I know of no better means of relief, and no better LITHIC DEPOSITS. 99 prophylactic when the attack has passed off, than that afforded by the use of the cold sponging-bath and friction of the skin. It is not every constitution, however, that is capable of bearing this somewhat severe method of render- ing the skin an active organ, and care is therefore requisite in prescribing such discipline. Whatever the tfeondition of the patient, however, as regards diathesis or constitution, we shall seldom do wrong in enjoining the daily use of the horse-hair gloves or flesh-brush, applied over the surface every morning. Steady exercise, always short of fatigue, is an important adjuvant in every form of lithic disease in its early stages. The increased exhalation thus obtained from the skin, of those nitrogenous ingredients of the blood which are constantly excreting from the nephritic and cuta- neous surfaces, will be found greatly to relieve the kidney, and produce urine less abounding in lithic acid. The general treatment of the sediments composed of lithates nearly corresponds with that required for the relief of the lithic acid form of deposit; viz. tonics and alter- atives, with the use of cutaneous friction. In persons who become the subjects of this deposit after excessive exertion or occasional irregularities of diet, the free use of cold bathing and frictions in the morning, as a habit, will constantly be found a most rapid means of ef- fecting a cure.* It would appear that weakly persons, in whom the cutaneous surface is inactive, convert the tissue wasted during exertion into a constituent of the urine, rather than into an excretion of the skin, and thus it is that, after exercise, some persons become liable to the deposit of lithates. The improvement of the general health by acid tonics and shower-baths is in such cases attended with im- mediate relief from urinary symptoms. It is not uncommon to find patients in whom, for days together, an alternation takes place by the excretion of phos- phatic deposits on the same day with the lithate of ammonia —the one forming the deposit of the night urine, the other * So complete is the influence of cutaneous friction on the urine of these cases, that I have known its omission followed by an im- mediate return of the deposit, which again disappeared on having recourse to the sponging-bath. 100 LITHIC DEPOSITS. that of the morning. This form of urinary affection is often observed in persons of advanced age, and is then generally attended with considerable irritation, and frequently com- plicated with disease of the bladder, prostate, and urinary passages. IThe phosphatic deposit is generally composed of the monobasic ammoniaco-magnesian salt, and the li- thates are of the nut-brown colour. In some cases the ex- planation of this condition would appear to consist in the fact, that during the day the skin is less actively engaged in excreting water than during the hours passed in bed, and that therefore more water appears with the evening urine, and thus the deposit of lithates is prevented, while the irritable mucous membrane of the urinary passages pours out an alkaline secretion in a sufficiently large quan- tity partially to neutralize the acid of the urine, and thus lead to a condition favourable to the crystallisation of the phosphatic salt. During the day there will, of course, be causes of irritation in action on the mucous membrane which do not exist during the night, and we therefore have the alkaline flux from that surface occurring in increased quantity in the day-time. When this alternation of phos- phates with lithates occurs in the urine of young persons, it is indicative of the phosphatic tendency, and generally co-exists with irritation of the gastric as well as urinary- mucous membrane. In severe dyspeptic cases characterised by the deposition of the lithates either of a lighter colour than usual or of a red tint, we sometimes observe, as mentioned before, that sugar can be detected in small quantity. The patient him- self will sometimes mention that he has observed a peculiar odour in his urine. These cases should be treated with the greatest care, and the patient fully informed of the danger to which he will subject himself by neglecting the rules of life and method of treatment enjoined by the medical ad- viser. In the general, we shall seldom do wrong to pre- scribe small doses of opium in these cases, in combination with ipecacuanha, at night, while the greatest possible bene- fit will be derived from the use of the hydrochloric acid in large dose. I have lately been induced, from the benefit derived from the use of this remedy, to make trial of its efficacy in confirmed diabetes, but have not yet had suffi- LITHIC DEPOSITS. 101 cient experience to speak confidently of its powers. Strict attention to the bowels and state of the liver, as shown by the stools, is very necessary in the treatment of this class of disease, which is frequently connected with visceral ob- struction. The pink deposit of lithates is so generally connected with rheumatic or gouty disease, or with organic visceral mischief, that the treatment necessary must vary with the peculiar character of each case, and the indications of the urine in no way allowed especially to influence us, either in the adaptation of means, or the selection of remedies. ( 102 ) ON THE PHOSPHATIC DEPOSITS. These deposits generally occur in urine possessing a specific gravity lower than that of health ; sometimes it is found slightly acid, but generally neutral or alkaline. When viewed under the microscope, these deposits assume peculiar definite forms, indicating their character. (Vide description of plate, figs. 1. and 2.) Examined chemically, they yield the re-actions described at p. 51. The forms of disease characterised by the deposit of the bibasic stellated salt of ammonia and magnesia do not always necessarily differ from those yielding the monobasic salt, the deposit showing itself either as one or the other, according as more or less alkali is developed in the urine. The stellated bibasic salt is, however, as a general rule, observed in the more advanced cases yielding alkaline urine, and is constantly present in the latter stages. The decomposition of urine containing the monobasic salt, owing to the generation of ammonia, frequently causes a deposit of the stellated crystals to occur in combination with phos- phate of lime. This is far from uncommon when, from long-continued exercise or a full meal, the patient passes urine of high specific gravity, that is to say, from 1028 to 1031, or even higher than this. We may divide the cases of alkaline urine into two classes; 1st, those depositing the crystalline sediment, and, 2dly, those depositing the amorphous white sediment. The first of these is the most frequently met with in young persons, while the last is generally indicative of confirmed mischief, and observed most frequently in old age in con- nection with disease of the bladder and prostate; it is also a sequela of calculous disease in every form, at the advanced period of life. Dr. Prout, in treating of these affections, has described a variety of disease as separable from the two above men- tioned, and as characterised by the secretion of the car- bonates of soda, potash, and ammonia. From the descrip- PHOSPHATIC deposits. 103 tion of this variety of urine, and the symptoms accompanying its excretion, it would seem to be produced as the result of that state of the urinary apparatus occurring in advanced stages of prostatic disease, when the ureters and kidneys have become involved, owing to the continuance of obstruc- tion by stricture. Thus in cases going on to suppurative disease of the kidney, the urine is voided of this character, which I believe to be entirely dependent on the state of the canals from the kidney to the urethra acting on the urine after secretion, rendering it ammoniacal and mixed with blood, and in no way to be connected with any peculiar constitutional condition influencing the secretion of the kid- ney. As regards the question of phosphatic deposits gene- rally, and the tendency to the alkaline character of the urine, I feel persuaded that in nearly all cases the real disease exists, not in the presence of any peculiarity on the part of the kidney as a secreting organ, but on a tendency to the production of alkaline fluid on the lining membrane of the whole, or a part, of the urinary apparatus. The treatment of these diseases, as founded on this view of their pathology, has led to such favourable results, that I am daily becoming more and more persuaded of the truth of the position. It has been far too much the fashion to regard the abnormal qualities of the urine as indicative of some general state of the system showing itself through the medium of the kidney, whereas it almost admits of demon- stration that the kidney frequently secretes urine possessing the qualities of health, with its acid re-action and other normal qualities, while it passes from the urethra foetid and ammoniacal. I do not here allude to cases of old bladder disease, or on that condition of the viscus observed in cases of spinal lesion, but to cases admitting of cure, and not necessarily characterised by any symptoms of cystitis. A young or middle-aged person becomes the subject of irrita- tion during the passage of urine, in connection with gastric symptoms, and aching irregular pains in the course of the ureters. His appearance is that which we are apt to de- scribe as indicative of a general want of tone, ami on examining his urine we find it either ammoniacal, neutral, or faintly acid, with a deposit of mucus and phosphates. If it be supposed that this depends on mal-secretion on the 104 PHOSPHATIC deposits. part of the kidney, knowing as we do that mineral acids will increase the acidity of healthy urine, nothing can be more reasonable than to supply these remedies for the cure of the patient; but if, on the contrary, no such mal-secretion is going on, and the urine only becomes alkaline after leaving the kidneys, and during its course through the passages, nothing can be required from the mineral acids. That, however, which remains to be done, in accordance with the pathological view I have advanced, is to act upon the urine in such a manner as to render it less irritating to the lining mucous membranes, and thus prevent the secre- tion of that alkaline flux which has been pouring out in quantity. It appeared to me that the use of alkaline reme- dies might be of advantange in these cases of alkaline urine, and, moreover, that if the alkali were administered in small doses so as only partially to neutralise the acid state of urine as secreted by the kidneyr, we might relieve the irritation of the mucous membranes, stop the excretion of alkaline matter, and have an acid urine excreted, the natural acidity having been only partially destroyed by our remedy. It may appear somewhat unaccountable to those who merely look to the chemical view of the matter that any one should expect to render alkaline urine acid by the administration of alkalies, but such was the treatment I adopted, and the result fully corroborated the correctness of the theory which suggested it as a crucial test. The first case I met with, and which afforded the symp- toms indicative of phosphatic disease, occurred in a gen- tleman of leuco-phlegmatic temperament, who had suffered much from despondency, and whose urine was generally alkaline and occasionally neutral. His appetite had given way ; his bowels were constipated ; and he had become the subject of shooting pains in the loins and down the ureters. There was no very great distress experienced in passing urine, nor was there frequent desire to do so at any period of night or day. The excretion was loaded with mucus mixed with the earthy phosphates. In.this case I exhibited the liquor potassa? in doses of twenty minims three times during the day, combined with hyoscyamus, in a mucilaginous vehicle. The result was, that my patient's urine became acid on the second day, and phosphatic deposits. 105 continued so till all his disagreeable urinary symptoms were removed. It was not of course necessary to continue the alkali beyond this point, as by its prolonged use it un- doubtedly would have eventually caused an alkaline urine to be secreted from the kidney. At this period of treatment, therefore, I had recourse to tonics containing an acid, a form of medicine which had been tried before the alkali was exhibited, and had produced so much irritation and so great an increase of the foetid odour of the urine without decreasing the deposit, that we were forced to abandon its use. It was found, however, that the acid could now be borne with advantage, and much good was obtained by its careful exhibition. The second case in which I had an opportunity of ma- king the same kind of observation occurred among the pa- tients at Guy's Hospital, in the person of a woman under the care of my friend and colleague, Dr. Babington, who kindly allowed me to prescribe for his case. This patient had been subject to fits from childhood, and was admitted into the Hospital for the cure of epilepsy. She, however, became suddenly seized with urinary symp- toms, experiencing difficulty in passing her urine, which was turbid, alkaline, and foetid if long retained. When I saw her she was stated to have suffered increased distress from the exhibition of acids, though there were no in- dications of bladder disease. The quantity of mucus voided was very considerable ; the sequel of this case, how- ever, as well as its history, sufficiently showed that the bladder was not materially involved. The acid remedies being laid aside, I ordered this person the liquor potassa? with tincture of hyoscyamus three times a day, and in a few days had the satisfaction of perceiving the urine passed to be of acid re-action, clear, and in every respect natural. I am not prepared to say that all cases characterised by the deposit of the earthy phosphates are pathologically identical wi^h those alluded to above ; but I am certain that in the greater number of cases in which alkaline and neutral urine exists, with mucus and phosphates as a de- posit, we shall find alkaline remedies of avail; and that if given in regulated dose we shall by their action obtain the excretion of an acid urine, showing that the cause of mis- 106 PHOSPHATIC DEPOSITS. chief is seated below the kidneys, but not necessarily in the bladder. In the mild form of disease in which we observe the triple phosphate as an occasional deposit, we shall often detect a general state of irritability, with gastric disturbance, which I believe is connected with a condition of the urinary mucous membrane resembling that so evidently produced upon the gastric surface, as shown by the tongue and state of the bowels. I am satisfied the urine is not secreted in an alkaline state in many of these cases, but that the deposits of phosphates occur occasionally in consequence of an alkaline discharge taking place from the mucous lining of the kidneys and ureters, just in the same manner as we know the mucous intestinal surface to be irregular in this respect, subjecting the patient one week to constipation and the next to diar- rhoea, of a mixed mucous and bilious character. Now, an alkaline state of the urine will account for the deposit of the phosphates contained in it; but it can in no way be regarded as a cause for their absolute increase in proportion, and when this takes place, very important changes must be going on in the economy. In mollifies ossium this increase occurs, and probably in other forms of disease; but the great multitude of cases met with in prac- tice are not of this kind, but are rather to be considered as instances in which no increase takes place in the positive proportion of the phosphates, but which, owing to the urine becoming alkaline or neutral, are characterised by the de- posit of those earthy salts which were before held in so- lution. Any one in health may assure himself that the normal proportion of earthy phosphates is sufficient to produce a copious deposit, by adding ammonia to his urine, and al- lowing the precipitate to subside. If it be remembered, when making this experiment, that an excretion of mucus frequently accompanies the deposit of phosphates, greatly increasing its apparent bulk, it will probably be a matter of surprise to the experimenter, that the phosphatic deposits occurring in disease are not even more voluminous than they are observed to be. The raucous membrane of the bladder has been supposed to secrete phosphate of lime in considerable quantity, and many circumstances connected PHOSPHATIC DEPOSITS. 107 with the history of calculous disorders would tend to sup- port such an opinion. With the knowledge, however, of the capability of the mucous surfaces to secrete an alkaline mucus, and the facility afforded for the deposit of phos- phatic salts from the urine in virtue of this property, great care is required before such an opinion can be generally adopted in the case of the urinary organs. There is an apparent analogy afforded here by the intestinal mucous surface, which is known not unfrequently to produce cal- culous matter, but these masses are of slow growth, and it is not easy to determine how much may depend upon the decomposition of the chylous and other fluids containing phosphates, by detention in the neighborhood of diseased portions of membrane. A reason which has been quoted for conceiving the concretions in both cases to depend on the secretion of earthy matter by the membrane itself, is, that a deficiency of the magnesian salt is observed in the urinary concretion, which could scarcely be expected were it derived from the urine, simply owing to the production of alkali by the membrane. These concretions, howeyer, really contain magnesia in considerable quantity. Carbonate of lime is sometimes found associated with phosphate adhering to the surface of mucus voided from the diseased membrane of the bladder in advanced cases, which may possibly be the result of decomposition of the urine, but the mucous membrane can scarcely be supposed to secrete a carbonate. On the whole, the probability is greatly in favour of such deposits being dependent on the decomposition of the fluids passing over the membranes, rather than on any power on the part of the surfaces them- selves to secrete earthy salts. There is a condition of urine to which I have directed at- tention in a former part of this work, in which we find that it deposits a precipitate of the earthy phosphates on the ap- plication of heat. This state of urine has been described as dependent on the presence of an excess of the earthy salts, whereas it is rather the result of a tendency on the part of the constituents of the urine to arrange themselves in a peculiar manner; the phosphates thus depositing not necessarily in- dicating their presence in excess. The unne may be acid or alkaline, and yet this deposit occur; in the former case, 108 PHOSPHATIC DEPOSITS. however, the deposit generally consists of the triple phos- phate. On considering generally the pathology of the phos- phatic deposits and the tendency to the secretion of alkaline urine, which is an almost constant concomitant, it would ap- pear that the general system, so far as is shown by the se- cretion of the kidney is rarely so seriously involved as has been supposed; that, in fact, the mucous surfaces are in- volved rather than the nervous structures, which has been assumed as a condition necessary to the existence of this class of affection. The facts, we observe, in the great ma- jority of cases are easily explained on the former suppo- sition, while, if we except some cases of paraplegia, little else than gratuitous assumption has been brought forward in support of the latter opinion. In the management of these cases, it is of the utmost im- portance to watch the urine as an index of the effect of the remedies employed, and when about to commence treatment, much is to be done by examining the excretion several times before any plan is determined upon. If the general symptoms observed are those of gastric irritation, and the urine deposits mucus with either an amorphous or crystal- line phosphatic sediment, we may conclude that alkaline remedies are indicated as the first part of the treatment, and that the kidney is not greatly in fault. The bicarbonates may be exhibited with advantage in such cases. If, on'the contrary, we observe a large amorphous deposit in conjunc- tion with blood and mucus, while the urine is extremely foetid, and incontinence exists as a symptom, we may con- clude that fatal disease is established, and the kidney in all probability is greatly involved in the mischief. Little remains to be done in such cases than to palliate the suf- ferings of the patient by attention to diet and regimen, while care is taken that any stricture existing is prevented exer- cising a pernicious influence by the constant use of the ca- theter. In the former class of cases, the use of alkalies should be discontinued immediately we percieve the urine to have become acid under their employment, and then alteratives, containing mild mercurials and ipecacuanha, with vegetable tonics, will generally complete the cure. It will be found in some few cases of recent origin, and of mild character, that the use of alkalies may be dispensed. PHOSPHATIC DEPOSITS. 109 with, and this is especially the case when the morobasic triple phosphate alone is secreted; but if any considerable irritation be observed, and mucus detected in abnormal pro- portion in the urine, it is always well to combine an alkali with our tonic remedy. As regards diet in this form of disease, we can say little more than enjoin general tempe- rance and the use of nutritious and easily digestible food, while all articles of diet either solid or fluid, known by ex- perience to produce flatulency, should be carefully avoided. I shall now say a few words on the treatment of that form of phosphatic disease so often set up during the formation of a calculus, and which, as the result of irritation of the mucous membrane of the bladder, is complicated with certain peculiar conditions of the urine. A knowledge of these conditions is absolutely necessary before we can form a correct prognosis, and the determination of the value of signs observed must often influence the conduct of the sur- geon in attempting the permanent cure of his patient by operation. Whatever may be the nature of the original deposit forming a calculus in the bladder, it constantly happens in irritable subjects that the urine becomes alkaline, while mucus and phosphates occur as a deposit. The blad- der next becomes further affected, and pus is poured out in addition to the mucus and phosphates; while owing to the excretion of this pus from the lining membrane of the blad- der, albumen may be detected dissolved in the urine. Now, an albuminous state of urine occurring independently of the presence of pus or blood, and showing itself day after day, is an indication of disease of the kidney, and if such disease could be discovered to exist, our prognosis would be very unfavourable; but if, on the contrary, we are able to trace the presence of the albumen dissolved in the urine to the existence of pus, our prognosis assumes a more favour- able character, and hopes may be reasonably entertained that on the extraction of the calculus the bladder will be re- lieved from irritation, and the urine assume its healthy qualities. Under these circnmstances it becomes of extreme importance to determine the absence of kidney disease; and we shall rarely fail to do so by attention to the following rule:—If the bladder alone be in fault, we shall always find that the quantity of albumen to be detected in the urine by 110 PHOSPHATIC DEPOSITS. the nitric acid test will bear a proportion to the quantity of purulent deposit, and the urine must be examined from day to day in order to determine this point. If, on the con- trary, the albumen to be detected does not undergo dimi- nution or increase in quantity proportionally with the puru- lent deposit, we may reasonably suspect the kidney to be in- volved. A case of calculus in the bladder lately occurred at Guy's Hospital, under the care of my colleague, Mr. Morgan, in which I was consulted, in consequence of the existence of albumen in the urine rendering the propriety of operating a matter of doubt. In this case pus, mucus, and phosphates were passed from the bladder; and by re- peated observation I assured myself that on favourable days, when but little pus appeared, a corresponding de- crease took place in the proportion of albumen in the urine. I therefore had no hesitation in expressing an opinion that the operation would benefit the patient, by relieving the bladder of that cause of irritation on which the pre- sence of albumen in the urine depended, and that in all probability the kidneys were unaffected. This patient underwent the operation, and recovered rapidly, his urine, after the healing of the wound, being no longer albuminous, which would not have been the case had he been affected with kidney disease. When relief from calculus symptoms cannot be obtained by operation, and phosphatic deposits become mechanically inconvenient, we shall generally find that the benefit which might at first view be hoped for from the solvent action of acid remedies cannot be obtained, inasmuch as the urinary mucous membrane only becomes the more irritated by their use, and the urine more loaded with mucus and phosphates. In such cases, alkalies in small dose are frequently of service, and much advantage has occasionally been gained by the dexterous use, on the part of the surgeon, of seda- tive injections made weakly acidulous by nitric acid. ( 111 ) ON THE OXALATE OF LIME DEPOSITS. Urine depositing the oxalate of lime often possesses a peculiar greenish-yellow colour. It is seldom of a specific gravity, varying greatly from that of health. Viewed under the microscope the deposit represents forms shown on the plate (fig. 9.) When examined chemically it yields the re-actions described at page 59. These crystalline forms would appear, according to the statements of Dr. Bird, to be of more common occurrence than was formerly supposed the case. The state of system on which the secretion of urine cha- racterised by the deposit of oxalate of lime depends is not well investigated. There appears some degree of proba- bility that it is connected with the formation of lithic acid in excess, and with that state of system in which a consi- derable portion of urea is secreted. This view has been advocated by Dr. Willis, and since adopted by others. Dr. Prout, however, states that he has known several instances in which the abuse of sugar led to the oxalic acid form of dyspepsia, and afterwards to the formation of calculus. The pathological chemistry of the subject is at present somewhat a matter of doubt, and it would almost appear that more than one source existed for the production of a tendency to this form of disease. Further and more cor- rect observations are needed into the physical condition of patients suffering from oxalate of lime deposit than any we yet possess. We find that chemistry is at no loss, how- ever, to devise theories for the transformation of several or- ganic principles into oxalic acid, and whether it be derived from sugar, urea, or lithic acid, we can make our formulas by abstracting or adding oxygen as the case may require. All this, however, must be looked upon as a display of inge- nuity on the part of the chemist, and we should wait till accurate and long-continued observation, conducted on the urine of patients, helps us to better evidence on which to found a conclusion. Unfortunately, the addition or sub- 112 OXALATE OF LIME DEPOSITS. traction of oxygen necessary to some of these theories has not been proved or even rendered probable, and no good reason has been given in most cases for transforming one proximate element rather than another for the formation of a diseased product. It is often the case that more than one proximate element would answer the purpose required, owing to their similarity of composition ; and the profusion with which chemists are in the habit of taking away or adding oxygen by as many atoms as may please them, still further lessens any difficulty that might at first appear to stand in the way of effecting an explanation. In connection, however, with the subject of oxalic acid, as produced in the urine, I have great pleasure in noticing a contribution to the pathology of oxalia disease by Dr. Aldridge of Dublin*, who so far differs from most other chemical theorists of the day that he has really rendered it more probable that oxalic acid is formed from lithic acid than from any other of the constituents of the urine. This gentleman has shown that lithic acid, by the addition of the elements of water, in varying proportion, may theoretically be converted into oxalate and carbonate of ammonia, hy- drocyanic and formic acids, according to the circumstances of decomposition, and further, by heating urine, and in some cases evaporating it, has succeeded in producing re- actions in the fluid indicative of the presence of the acids above named ; oxalate of lime depositing, while evidence of the hydrocyanic and formic acids could be obtained from the fluid. This is really a step in pathology, and has more prac- tical bearings than may at first sight appear evident. Now when urine is secreted by the healthy organism, we know that the constituents are so arranged, that the fluid possesses cer- tain definite qualities recognised as those indicative of health, and that when disease sets in, there is sometimes observed a tendency on the part of the constituent elements of the fluid to arrange themselves in a different manner to this, and that, too, without any very notable increase or decrease in the proportion of such elements being observed. Con- sidering the question in this point of view, and remembering that in Dr. Aldridge's experiments no re-agents were had * See Bird on Urinary Deposits, p. 160. OXALATE OF LIME DEPOSITS. 113 recourse to, and that ebullition alone produced oxalate of lime in healthy urine, which did not yield such crystals be- fore being boiled, we are justified in the belief that such a deposit may very easily form in the urine in certain states of system after secretion by the kidneys, and during its de- tention in the urinary tubes and bladder. It seems highly probable that in some cases which have been described, the oxalate of lime has been rather formed after the urine has been secreted, than as a result of the secreting process; and Dr. Aldridge's experiments point to the absolute ne- cessity of examining urine soon after excretion, and without applying heat, which tends to the formation of oxalate of lime even in healthy urine. The symptoms observed in those who suffer from the ox- alate of lime deposit are characteristic of general debility and irritation, not unlike those observed in the phosphatic form of disease ; with the exception, that the patient is liable to the more severe forms of hypochondriasis, and fre- quently to such an extent as to cause considerable anxiety on this account alone. This tendency to extreme depression indeed would seem to form a distinctive character of the complaint. The uneasiness experienced after taking food, so commonly felt in dyspepsia, is, in this disease, very fre- quently accompanied with distuj-Jaance of the circulatory system, attended with palpitation and dyspnoea. The bowels are often constipated while the tongue is coated and white. In advanced cases, however, we sometimes observe the tongue to be dry, clean, and glazed. When oxalate of lime calculi are forming we frequently observe a tendency to haemorrhage from the kidney, which accounts for the pe- culiar colour observed in this variety of concretion. In advanced cases of this disease Dr. Prout describes a peculiar tint of complexion, of which, however, I have never been able to satisfy myself, though I lately observed very much what he has described in a patient suffering from calculous symptoms, wriose urine, unfortunately, I had not an opportunity of examining, but whose history was by no means discordant with the existence of oxalate of lime in the urine. The treatment of this form of disease in the early stage is such as is applicable to all forms of dyspepsia. It is often 8 114 OXALATE OF LIME DEPOSITS. combined with symptoms of irritation and mental anxiety, which demand the use of sedatives in combination with alteratives ; but it is advisable, as much as possible, to avoid the use of the former. I have no doubt that much mischief has arisen from the indiscriminate use of sedatives for the cure of this disease, and that attention to diet, with the en- forcement of regular exercise, especially in the evening shortly before retiring to rest, would have answered every purpose, without enfeebling the system as by the use of hyoscyamus, conium, and such class of remedies. A fish diet is of the greatest service in this affection, nor is there any objection to the use of vegetables in moderation. Wine is very generally preferable to beer, which can seldom be taken by the patient without giving rise to distressing flatu- lency. In severe cases the use of frictions to the skin is advisable every morning, with the warm bath at intervals of three days ; but in slighter cases cold bathing and friction is of far more service, and will be found to assist and ex- pedite the cure in every case, as recovery advances. As regards the use of medicine, there is no doubt that in effecting the removal of the oxalate of lime deposit great benefit is frequently derived by following Dr. Prout's suggestion of prescribing acids ; but perhaps the most im- portant secret, in mild cases, consists in emptying the in- testinal canal, which will sometimes be found sufficient to remove the whole mischief. Attention to this point, com- bined with the administration of alteratives, and acid tonics, comprises nearly all that need be done in the general treat- ment of oxalate of lime deposit. The severer form of this affection is to be classed among the most obstinate of urinary diseases, and being liable to return upon the least exposure or intemperance, the patient often becomes a prey to the most complete despondency. In such cases calculi fre- quently form, and the phosphatic salts appear in the urine, which loses its acid re-action, while the state of the patient deters the surgeon from removing, by an operation, that which has now become an additional source of misery. In, this form of urine, the exhibition of alkaline remedies is of the greatest service. The liquor potassa? or bicarbonate of potash, in moderate dose, combined with hyoscyamus and mucilage, are to be preferred, while, if there be much irri- CYSTINE, ETC. 115 tation during the night, with frequent micturition, an opium suppository should be introduced, followed in the morning by a saline purgative. There is an ansemiated condition in these patients, which is greatly benefited by the administration of iron and salines; and when the more urgent symptoms can be subdued, it is always right to have recourse to such a plan of treatment. CYSTINE, ETC. The cases in which cystine has been detected as a con- stituent of the urine have been so few that sufficient oppor- tunity has not yet been afforded of investigating the pathology of the subject, and ascertaining the principles which should guide us in treatment. I shall not, therefore, enter here upon a description of the disease; and for the same reason, while considering treatment, refrain from noticing the subjects of xanthine and the fibrinous calculus. ( 116 ) ON ALBUMINURIA, OR THE MORBUS BRIGHTII. This disease has now been a matter of observation and experiment to the profession for many years, but un- fortunately so far as treatment is concerned, little advance has been made since the discovery of Dr. Bright was first announced to the public; and it is curious to reflect upon the fact, that, while in its milder or more recent forms it occa- sionally yields to the simplest remedies, yet in a somewhat more advanced stage every variety of means adopted for its cure has either failed or met with but partial success. We can, however, I believe in the present day, do more to lengthen life, and render it supportable by the application of remedies in the advanced stages than was formerly the case ; and our inability to perform cures must rather be at- tributed to the nature of the affection than the want of per- spicacity on the part of the profession. The researches of Dr. Bright, which pointed out the con- nection between this albuminous state of the urine and granular disease of the kidney, first attracted attention in connection with the subject of anasarca; but the further observations and publications of that discoverer subse- quently made us acquainted with other and more general states of system of the highest importance to pathology, as connected with the excretion of albumen with the urine. We may now, indeed, regard the state of kidney as asso- ciated with albuminous urine as indicative of a state of the fluids generally, tending to modify and complicate nearly every disease to which the patient may become liable, either from exposure or accident. Not only do we occasionally observe kidney disease and albuminuria, when no indica- tions of anasarca can be detected in the patient, but I have known some of the most fatal cases of apoplectic seizure to occur in those who exhibited scarcely any signs of oedema, showing that anasarca must be regarded only as an occa- sional and not necessary symptom of some general morbid derangement. Why the kidney should be more prone to ALBUMINURIA. 117 congestion or granular deposit than any other organ cannot be explained in the present state of our knowledge; but if We assume the blood as first implicated in the disease, this would seem a necessary step to prove, as all the other organs are supplied with the same blood. This is a diffi- culty; and yet that the kidney is originally involved scarcely seems consistent either with physiology or the history of the complaint. Thus, in the mild forms admit- ting of cure, we very often observe extreme degeneration of the blood, and the urine loaded with albumen, and yet in such intances the kidney can be but slightly diseased, for permanent recovery often takes place. The albuminous urine appears, therefore, in such cases to be connected rather with a degeneration of the fluids than a disease of the kidney, since that organ is almost certainly in merely a congested condition. The researches in morbid anatomy which have been pursued in connection with this subject seem clearly to point to the kidney as the first link in the chain of causation so far as the solids are concerned; and the lesions of heart and liver so often remarked in cases of albuminuria hold comparatively an unimportant place in the pathology of the affection. The changes effected in the kidney during the early stage have been noticed princi- pally in- acute cases, rapidly fatal from the supervention of some disease complicating an important organ. In such patients the kidney has shown extreme congestion, the cor- tical portion especially being distended, and appearing as though the cellular structure of the organ had become filled with extravasated blood, giving it a dark, chocolate-brown colour. The next change observed in the kidney in the course of this disease may be regarded as that indicative of the commencement of grave mischief, and threatening per- manent alteration of the structure of the organ. The corti- cal portion now becomes impregnated with an albuminous deposit, encroaching gradually at parts upon the tubular structure. At this stage the organ frequently varies from its natural size, becoming larger and softer, or smaller and harder; its colour also changes to a more yellow tinge, and white markings and dots appear on its surface, giving an appearance of mottling, which at once strikes the eye on tearing off the investing membrane. In the latter stages of 118 ALBUMINURIA. degeneration the kidneys become one mass of disease ; the tubular as well as cortical portion has become compressed by the morbid deposit; absorption of their natural structure seems to have taken place, and they are generally found compressed and hardened. When cut through, the natural structure seems to have become obliterated ; and the whole organs appear made up of a white albuminous matter, representing imperfectly, in some places, an approach to tubular arrangement. The kidney is now generally ob- served to present an irregular surface, the protuberances varying in size from mere papillary elevations to large rounded prominences, which give a lobulated form to the organ. When the investing membrane is torn off, we see the kidney of a light colour, with occasional dark spots or ecchymoses in streaks variegating its surface. The above are the principal appearances put on by the kidney, as the granular disease advances, and in every stage we observe the urine to contain albumen. The first question which might be expected from the pathologist who was for the first time made acquainted with the fact that this degeneration of the kidney was accompanied with the excretion of albumen by the kidney, would be an inquiry as to whether the proportion of this principle found in the urine bore any relation whatever to the stage of degenera- tion to which the kidney had advanced. This relation, however, is wanting; and we yet need a guide for de- termining, in many cases at least, at what stage the disease may have arrived when examining our patient. The proportion of albumen excreted is generally observed most abundant in early stages of this affection, and is some- times scanty in very advanced cases ; the reverse of this, however, is sometimes the case in these latter instances. In early cases the specific gravity of the urine is often but little changed from that of health ; but I have occasionally seen it as light as 1010 and 1012—a specific gravity which rather belongs to the latter periods of the disease. In the early stages the quantity of urine excreted is very variable, being sometimes much less than the healthy proportion, and at others equalling that amount. This, together with the fact that the specific gravity of health is sometimes main- tained, might lead to the supposition that the evacuatiion ALBUMINURIA. 119 of solids by the kidneys was going on to a natural extent; but Dr. Christison has shown that the preservation of the normal specific gravity is owing to the presence of albumen ; and that if we separate this principle we shall find evidence, from the decrease in the weight of the urine, that the daily discharge of the normal solid matters by the kidney is much less than that occurring in health. In the advanced stages of the disease the quantity of urine passed during the day- is very variable ; it occasionally possesses a very low spe- cific gravity, generally from 1010 to 1015, and the propor- tion of urea is greatly diminished. In one specimen I exa- mined no trace of lithic acid could be detected.* When a large proportion is passed, this low specific gravity always pertains; but sometimes when the skin has been active (a common occurrence in advanced cases,) the specific gravity of the urine will rise nearly to the normal standard, a pro- portional decrease occurring in the quantity excreted. In the later as well as early stages of this affection, the solid matter evacuated with the urine during the day is far below the proportion of health. When testing urine for albumen, we should never be contented with a single examination, as it has been observed free from albumen on some days, even in confirmed cases. The state of the blood in advanced stages of this disease is such as to render it unfit for the discharge of those func- tions necessary to the preservation of life, and it early be- comes materially degenerated. The three conditions most prominently shown by analysis are the deficient proportions of albumen and haernatosine, according to the stage of the disease, and the existence of urea in the blood, probably in conjunction with other principles found only in the urine in the healthy state of the system. This contamination of the blood by urea occurs in various other affections, and ap- pears common to every condition of body characterised by ischuria to any extent. Immediately that albumen commences passing from the kidney the blood begins to degenerate. Th© proportion of albumen becomes less, and the specific gravity of the li- * It has been considered as probable that in the course of this dis- ease the lithic acid or lithates may alternate with albumen in th© urine. Vide Med. Gaz. April 9, 1836. 120 ALBUMINURIA. quor sanguinis diminishes. As the disease advances, the proportion of blood corpuscles is observed to decrease, while not uncommonly the albumen approaches to its healthy proportion. The quantity of fibrin varies greatly, being generally, however, somewhat above the natural pro- portion, and becoming increased if any inflammatory action takes place in the course of the disease. Dr. Christison states that he has observed the albumen in the serum of some advanced cases to be above the healthy proportion. I have never yet observed this ; but more than once have known it approach the proportion of health. The highest specific gravity of serum observed by Dr. C. was 1031 in the advanced stage, and 1019 is mentioned by him as the lowest in the early stage. In the latter case, however, I once saw serum as low as 30157 Having now given a general sketch of the changes ob- served in the kidney and the degenerations of the blood and urine characteristic of this disease, I proceed to con- sider the causes and symptoms ; premising, that there is a difference observed in its duration and severity which ap- pears to authorise a division into the acute and chronic forms. When albuminuria sets in it is often to be traced to ex- posure to cold, or a damp and cold atmosphere, under cir- cumstances of depression and fatigue, sometimes, also, to intemperance, and, more especially, the use of ardent spirits. The type this disease may assume, as regards the acute and chronic forms, would appear to depend on the age, constitution, and habits of life of the patient. Thus in some we find such exposure followed by immediate and violent re-action, indicated by a hot skin and dry tongue, with a hard pulse, pain in the head, and severe thirst, while pain in the loins, and sometimes, but not always, ischuria, point to the kidney as the seat of mischief. The urine is high coloured, loaded with albumen, and occasionally- tinged with blood. The stomach is irritable, and vomiting not unfrequerrtly occurs, while partial oedema of the face, or complete anasarca, are the most common concomitants. * For physico-chemical experiments on the causes of deterioration of the blood in the Morbus Brightii, vide Guv's Hospital Reports, April, 1843. J ALBUMINURIA. 121 There is great liability to complication by serous inflamma- tion in this form of the disease ; and it is thus, in fatal cases, that life is most frequently destroyed. All symptoms which may be referred to the brain are to be carefully watched ; as coma and epileptico-apoplectic seizures will sometimes suddenly prove fatal.* W^hen by the early application of remedies this acute form of albuminuria is relieved, it ap- pears probable that complete and permanent cure is some- times effected ; but, again, in a large number of cases there is little doubt that such acute attack is followed, at no very distant interval, by the same set of symptoms assuming a more chronic type ; and that by repetitions of these attacks the patient sooner or later sinks. Mild cases of short duration, and generally admitting of permanent relief, are often observed after scarlatina in children, occasioning the anasarca so common as a sequel to that disease. As regards the chronic form of albuminuria, though we often find on interrogating our patients that they have before suffered from anasarca and other symptoms indica- tive of the previous occurrence of the acute disease, we as often meet with chronic symptoms as the first indicated by the patient; and these not unfrequently supervene in so masked a manner, and encroach so gradually on the com- fort of the individual, that a practised eye is necessary to detect the disease by the slight indications now afforded, and which, when the condition of the urine has been over- looked, have often passed for those of dyspepsia or inac- tivity of the liver. As regards the symptoms in this chronic form of the affection (though nearly identical in kind,) we have them present in a less marked degree than when characteristic of the acute disease. The pain in the loins is much less severe, and sometimes absent. Ischuria, as in the acute form, is not necessarily a symptom, and more commonly, as stated before, large quantities of urine are voided ; from 70 to 100 ounces per diem being no un- common discbarge. Anasarca is frequently wanting as a symptom, or only indicated by slight oedema of the face; * See Guy's Hospital Reports, No. 8. Dr. Addison on Dis- orders of the Brain connected with Disease of the Kidneys. 122 ALBUMINURIA. thus the under eyelids are occasionally swelled, and that only in the morning, and sometimes so slightly, that the pa- tient does not observe it. Dyspeptic ailments, with irri- tability of stomach, are often present; and when com- plained of as producing vomiting, may serve to guide us to the examination of the urine, and consequent detection of the true nature of the patient's disease. In this chronic form of the complaint it is often observed that the urine be- comes a source of irritation to the bladder, and the patient is distressed with frequent desire to make water, leaving his bed several times in the night for that purpose. This condition is not necessarily connected with a discharge of lithates or lithic acid, which are the common deposits in albuminuria, nor with any peculiarity of the excretion as yet ascertained. There are many complications attendant on this disease of the kidneys, dependent, in all probability, on the state of the blood, though we are at present unable to trace the manner in which it influences the solids, and much remains for experiment and observation. It may be well to remark, however, in connection with this subject, that the deficient proportion of albumen and haematosine, the one observed in the early and the other in the later stages of the disease, are as prominently marked in certain cases of leucorrhcea going On to chlorotic anaemia, as in the disease of which we are now treating; and that I have had occasion to prove the presence of urea in the blood, and that too in consider- able quantity, in a case of the mild form of albuminuria oc- curring after scarlatina, and which was rapidly cured. These facts would seem to show that the state of the blood in albuminuria requires further experiment. The organs most commonly implicated in albuminuria, in addition to the kidneys are the heart, the liver, and the brain ; and in examining cases it is of great importance to ascertain their conditions, so far as we are able, by physical signs, as well as by the evidence to be obtained from symptoms described by the patient. The state of the brain especially should be watched, as death is commonly occasioned by implication of that organ. In many cases, however, oedema of the glottis with more or less bronchitis, or sudden effusion into the pericardium, closes the disease. ALBUMINURIA. 123 The treatment of acute albuminuria differs materially from that adapted to the relief of the chronic form of the disease; and we frequently find that the simplest means are capable of working a permanent and rapid cure. This is remarkably the case in those instances of albuminuria and anasarca observed after scarlatina, in which mild purgatives and salines are generally found sufficient remedies. In other cases, however, the acute form of this disease is at- tended with violent symptoms requiring the active inter- ference of treatment for the preservation of life ; and this re- mark applies to some few cases of anasarca occurring after scarlatina, though these, for the most part, are mild in character. When acute albuminuria exists, I have always found the greatest benefit from treating the disease by the application of remedies affecting the skin. Of the various plans of treatment recommended, nearly all of which I have either seen practised or myself prescribed, I must confess that none ever impressed me so fully with a conviction of its beneficial effect as that which enforced the use of diapho- retic remedies as a principal means of obtaining relief. The favourable results which have been observed from the use of antimony I feel no hesitation in ascribing purely to its diaphoretic action, and further than this, am inclined to prefer, in most cases, the use of ipecacuanha, or of Dover's powder: the latter a formula in which the opium present assists us greatly in obtaining a ready action on the skin. The use of the warm bath every other day, with acetate of ammonia and Dover's powder, taken in draught twice during the twenty-four hours, if combined with the occa- sional administration of saline purgatives, will generally be found an excellent plan of affording relief in acute cases, unattended with any inflammatory complications. When, however, bronchitis or pneumonia are discovered to exist, we should have recourse to depletion with mercu- rials, but may still continue our diaphoretics as a part of the treatment. As regards depletion in the acute stage of albuminuria, all that we know of the state of the blood in the disease would lead to its disuse, as a remedy having a tendency to lead the case into the chronic form of the af- fection, by decreasing the proportion of red corpuscles in 124 ALBUMINURIA. the blood; and though I have occasionally observed be- nefit from the use of the lancet or cupping, I do not believe such treatment to possess any advantage over the diapho- retic plan ; and unless rendered an imperative measure by the presence of high inflammatory complications, experience has made me averse to its use in every form of this disease. The strong objection to the use of mercury expressed by- many writers on this subject, though it would appear justified by the results of some fewr cases which have been subjected to the mercurial influence, is not so strongly impressed upon my mind as to induce me altogether to reject it as a remedy in acute cases, even when no complications exist. It ap- pears to relieve the kidney greatly, but care must be used in its exhibition; and very small doses of mild mercurials are sufficient for the required purpose, as this mineral pro- duces its effects very rapidly in albuminuria, occasionally causing profuse ptyalism whcyi not more than two or three grains of calomel have been taken by the patient. In the more chronic form of albuminuria the employment of dia- phoretics is of almost as much importance as in the acute disease; but it now becomes necessary to avoid their use to such an extent as to produce a depressing effect on the system. Patients on whom we are inducing dia- phoresis, either by means of antimony, ipecacuanha, or any other medicine, should be constantly watched, and the remedy discontinued on the first signs of remission in the power of the pulse. The free use of purgatives is of the greatest importance when commencing the treatment of the chronic form of this disease, and is a most powerful means of lessening the pain- ful tension of the skin produced byanasarcous effusion, and often relieves the patient in a surprising manner from the dull sleepiness and tendency to coma, a cause for so much anxiety to the practitioner. The anremia existing in this chronic form of albuminuria is best treated by those reme- dies known to influence the blood, and to assist in restoring it to its healthy constitution. When the first distress expe- rienced by tense anasarca or pain in the loins is relieved by the use of diaphoretics and purgatives, the greatest benefit will accrue from the use of ferruginous medicines. The lactate of iron given three or four times a day in doses of ALBUMINURIA. 125 five grains, with columba or any mild tonic, I believe is better adapted to restore the patient than any medicine with which I am acquainted. As regards local treatment dtrected to the kidney, the use of counter irritation is greatly to be advised in cases of chronic albuminuria which are not very advanced. Setons or issues in the lumbar region I have known to assist in obtaining an early recovery. Much has been said con- cerning the propriety of administering diuretic forms of remedy in albuminuria, and it would appear desirable in most cases to avoid them ; indeed they will often be found to produce considerable distress when the pulse is hard, and the tendency to the excretion of large quantities of albumen is observed on examining the urine. In some advanced cases, however, I have seen digitalis in small dose combined with squills of service in relieving symptoms of ischuria and bronchitis ; as a general rule, my conviction is that they are better avoided. ( 126 ) CHYLO-SEROUS URINE. The chemical history of chylo-serous urine is given in the Appendix. I have seen but one case of this disease, which is of rare occurrence in our climate, and more frequently observed in warmer latitudes. The pathology of the affection is ex- ceedingly obscure, and is probably connected with the history of a subject as yet but imperfectly investigated; viz. the changes occurring in the circulation during the admis- sion of chyle. It is well ascertained that the disease may exist for many years without creating much distress. Ac- cording to an observation made by Dr. Prout, on the body of a patient who died of inflammation of the bowels while passing this kind of urine, it would appear that its presence is not necessarily connected with any appreciable organic lesion of the kidneys. No particular remedy or plan of treatment has exercised any special influence upon the disease, though benefit has been derived, as in most other cases, from carefully watching and treating symptoms. The obscure pathology of this affection, and its rare occurrence in this country, induce me to pass it with this slight notice, notwithstanding that its connection with the subject of sanguification affords an inviting field for hypo- thetical reasoning. ( 127 ) ON DIABETES. The urine passed in this form of disease contains sugar, and is of high specific gravity, being generally above 1030, and often as high as 1057. Dr. Prout states that he has seen it as low as 1015. It is but rarely, however, that it is observed even so low as 1025. Diabetic urine is of a pale straw colour, and clear, seldom depositing a sediment, and froths considerably when agitated. The quantity passed during the twenty-four hours is very great, varying how- ever from four to thirty pints; the latter is an excessively rare quantity, and we shall seldom observe excretion to half the amount. The odour of diabetic urine is peculiar, resembling that of hay, but of a more pungent character.* When a deposit occurs in diabetes, it will generally be found to consist of lithic acid, and its presence is considered by Dr. Prout as a favourable symptom. We also occa- sionally meet with caseous matter as an urinary deposit, and when present it induces rapid fermentation. The pro- portion of urea in diabetic urine is generally diminished; and in the course of the disease that principle is not always excreted in normal quantity, notwithstanding the large bulk of urine discharged daily, and we are occasionally able to detect it in the blood of the patient. The microscopic ap- pearance of the fungoid growth found diffused in diabetic urine is given on the Plate (fig. 15.) At the commencement of diabetes the train of symptoms are as follows:—General dyspeptic lassitude after food, and occasional gastrodymia are observed, notwithstanding that the appetite is good, and sometimes excessive. The bowels are constipated, the pulse irritable, and the tongue coated with a white mucus, which, when removed, leaves a glossy red appearance of the organ. Pain in the loins is often * In some aggravated cases of diabetes, the weight of egesta absolutely exceeds that of the ingesta, a fact first clearly pointed out by Mr. M'Gregor. 128 DIABETES. present, and the skin is dry, yielding a white scurf on the least friction ; the flow of urine is increased, and thirst is an early and prominent symptom. This disease is very insidious at the commencement, and its symptoms are not unfrequently overlooked as those of common dyspepsia, generally owing, I believe, to the time required by the patient to become aware of the increased flow of urine, which is that feature of the disease most likely to attract the attention of the practitioner to the true nature of the case. Of the two symptoms most prominently marked, viz. the thirst, and the increased flow of urine, I believe the former will, however, more frequently serve to assist our diagnosis than the latter, for the reason that it more prominently affects the comfort of the patient, and is therefore more likely to be related as a symptom. It cer- tainly has happened to myself to have had this urged upon my attention by patients, who made no allusion to diuresis until especial inquiries were directed to the point. The value of this indication cannot be too strongly impressed on the mind of the practitioner ; and whenever dyspepsia is attended with thirst, it is right to examine the urine parti- cularly. WThen diabetes is an advanced stage, emaciation becomes a very prominent symptom. The tongue presents a peculiar dry and red appearance, and is sometimes cleft in rugse, while aphthous inflammation affects the gums and mouth. The appetite is ravenous, and the breath possesses a peculiar odour, while the urine passed is in large quantity and of high specific gravity. There is also a general feeling of lassitude, and occasional giddiness, with a tendency to sleep during the day. The venereal appetite is frequently de- ficient. These symptoms increase, and death is most com- monly occasioned either by an attack of effusion on the brain, gradually ushered in by coma, or by the supervention of phthisis, a frequent complication of this disorder. Post-mortem examinations have shown little else in this disease than enlargement of the kidneys, and a peculiar appearance of the blood, with some few of the ordinary effects of debility. The general belief that diabetes is necessarily a fatal disease has in all probability arisen from the circumstance DIABETES. 129 that it was formerly seldom detected until far advanced, and beyond the reach of remedies. Attention having been of late, however, more actively directed to the general subject of urinary disease, cases are earlier detected and subjected to treatment; and it now occasionally happens that we meet with patients with a well authenticated and old diabetic history, who, on ex- amination, show no signs of diabetes, appearing to have been permanently cured, and who only apply to the medical man for complaints not necessarily connected with the original malady. I am now attending a case of this de- scription. The causes producing diabetes have been stated very variously by writers. Mercurial erythism and inherited taint, either scrofulous or directly diabetic, are quoted as predisposing to the disease ; but, with the exception of the latter, the causes noticed appear merely such as tend to the development of general debility. Among the exciting causes, Dr. Prout enumerates mental anxiety; and every one who has seen much of this disease will agree that mental distress is often a part of the past history of diabetic patients. In the present state of our knowledge, however, we are unable to trace this disease to any very especial cause. The observations which have been made on this disease in all its relations and in every stage have not yet been re- warded with success, so far as regards obtaining a know- ledge of its true nature. A near approach to this, however, has been made by Mr. M'Gregor; who, in several valuable communications laid before the profession, has shown that sugar is developed in diabetes during digestion, having succeeded in obtaining it from fluid vomited after a meal. This is a very valuable point to have decided; and it seems to prove that either the stomach or salivary glands must be seriously involved, since the food has only been subjected to the action of the secretions of these organs, when sugar admits of detection in considerable quantity. In connection with this subject, I now have to notice the observations of M. Mialhe, which are replete with interest so far as regards the formation of sugar in the stomach. M. Mialhe has proved that in the digestion of amylaceous and 9 130 DIABETES. saccharine ingesta the saliva takes a prominent part; and he has separated from that secretion a substance analogous to diastase, to which he gives the name of animal diastase. This (principle decomposes starch into dextrine, and re- quires a very short time for the purpose, as he proves by the blue colour of iodide of farina, not being produced when starch is submitted to the action of the diastase, and iodine is subsequently added. The importance of this dis- covery, with reference to the pathology of diabetes, will at once occur to every mind ; and if this constituent of the saliva is alone concerned in the digestion of amylaceous and saccharine ingesta, or in any wray necessary to the re- sult, it would seem that the disease should be investigated with relation to the condition of the salivary glands; a point of view in which it has never yet received the atten- tion of pathologists. M. Mialhe, in a paper on diabetes, has stated it as his belief, that saccharine and amylaceous principles are partly assimilated by an action consequent on admixture with the alkaline matters of the blood. It ap- pears, however, according to the experiments of MM. Ber- nard and Barreswil,* that if sugar is injected into the blood, it is passed as such by the kidneys ; while, if it first be subjected to the action of the gastric juice, it cannot be detected in the urine ; which shows that the alkali of the blood alone is insufficient to effect the transformation. It is pretty certain that the stomach of every animal during digestion contains saliva as well as gastric secretion; and it appears, therefore, very likely, that the diastase of the saliva effected the transformation in the experiments of MM. Bernard and Barreswil, and not the gastric juice. In taking this as a guide to the pathology of diabetes, we have as yet little but chemical evidence to assist us. It is clear, however, that sugar in diabetic cases is first formed in the stomach when amylaceous ingesta are taken; and, therefore, that either pepsin or salivary diastase fail in their action, or are not present to assist in digestion; and the ex- periments of M. Mialhe seem clearly to point to the action of saliva as the active means of effecting the transformations of health. * Comptes Rendus, Dec. 7, 1843, and April 15, 1844. DIABETES 131 It has often appeared to me that the importance of the saliva has been underrated. The large quantity secreted and poured into the stomach during a meal, and the ex- istence of a substance closely resembling, if not absolutely identical with, salivary matter in the chyle of animals, would seem to indicate that it plays some more important part in the economy than any with which we have yet become acquainted. The obscurity still involving the pa- thology of diabetes entitles every suggestion connected with it to the most attentive consideration of the practitioner; and the state of the salivary glands and their secretion will, I trust, before long, be fully investigated in this disease. There is a fact connected with the history of diabetes, which I have several times had occasion to observe; it is that on some days, and that too in advanced cases, the su<*ar is not to be detected in the urine, while the high specific gravity of the secretion is kept up by the presence of an enormous excess of urea taking as it were the place of the sugar. I believe this has been observed before by others. During some experiments I made on the use of oxalic acid in diabetes, I observed this alternation of urea and sugar to occur very frequently, and was inclined at the time to regard it as an effect of the remedy; but I have since known it to occur without any acid form of medicine having been prescribed. The treatment of diabetes proposed from time to time has varied greatly in character. It is true that for the most part it has agreed in the one particular, in consisting of means directed to the stomach; but still some of those remedies considered as the most efficacious have been such as in health greatly tend to the derangement of that organ. Amona the most powerful of these may be placed opium, which,°in combination with other medicines, is frequently of service in checking symptoms, and has occasionally been known so far to restore the patient as to justify a hope that permanent benefit had been obtained. As regards the sto- machic remedies, we find the alkalies and acids have both been fully tried; and the alkaline earth magnesia is still highly prized, as of service in this disease, by many expe- rienced practitioners. Nitric acid has enjoyed an equa y hio-h reputation in the hands of others; and I have recently 132 DIABETES. seen apparent advantage derived from the continued use of hydrochloric acid. It has always appeared to me, however, that the cases most benefited by treatment have been those in which no special regard has been paid to a specific remedy, but where general principles have been carried out steadily, and so as to meet every emergency as it arose. The use of opium, though it is always found to diminish the quantity of water excreted, can in no way be regarded as an advisable measure, if the drug be exhibited in itsuncombined state. Large doses become eventually necessary to keep up the effect first produced; and whatever apparent benefit may be observed in the secretion of the kidney, we find the'general symptoms of the disease become aggravated, and, moreover, that considerable difficulty is experienced in desisting from the use of the remedy. The Dover's powder is a favourite medicine in this disease; and I have constantly seen the greatest benefit follow its use, and considerable relief af- forded to the patient by its bringing about the partial re- storation of the function of the skin. In acute cases, when pain is felt in the loins or head, the use of this remedy, com- bined with the hydrargyrum cum creta, in small divided doses taken during the day, will be found a most valuable means of decreasing action, and with the use of moderate bleedings greatly to assist in affording relief to drowsiness which forms a distressing symptom in some cases. In addition to the above remedies, I know of none more applicable in the chronic form of the affection than mag- nesia taken frequently during the day. Warm bathing at intervals of a day or two is of great assistance ; and if we can sufficiently restore the powers of our patient, this may afterwards be replaced by cold sponging, or the shower- bath. It is absolutely necessary, however, that the pulse should improve, and the power of undergoing fatigue have increased, before the skin is called upon for this re-action, and the cold bath should always be taken immediately on rising from bed, when the powers of life are recruited and in full vigour. Among the tonics which have acquired credit in the treatment of diabetes, are several metallic salts; the sulphates of zinc and iron, and the phosphate and lactate of the latter, have been used with benefit. Various vegetable tonics have also at times flattered the practitioner DIABETES. 133 into a belief of their efficacy. Whatever may be the plan adopted, however, one important indication should never be lost sight of, and that is, the constipated state of the bowels almost always observed in this disease. The importance of attending to this point will at once be obvious, when we remember the emaciation so characteristic of this affection, and the propriety of affording as large a surface of intestine as possible for lacteal absorption, which cannot take place if the intestinal canal be obstructed. As regards the diet best suited to this form of disease, it ap- pears any thing but reasonable to subject the stomach to the severe discipline which has been applied by the fashion of the day in prohibiting the use of vegetable food, and restricting the patient to a purely animal diet. All the benefit derived from this plan of treatment con- sists in the fact that the profession are now well aware that the diabetic stomach will not convert fibrinous and albumi- nous ingesta into sugar, but that any advantage has accrued to the patient is greatly a matter of doubt. Several cases which I have seen do best have not been so restricted as regards vegetable aliment, but have been fed upon a whole- some, mixed, but restricted diet. The patient should be allowed his ordinary food, unless it be of a nature obviously calculated to produce or maintain dyspepsia ; the restriction being made in quantity rather than in quality or proportion. As regards drink, not only much good, but agreeable re- lief from thirst, is to be obtained from the use of Seltzer water, the salts contained in it probably exercising an im- mediate influence on the condition of the blood. Wines, spirits, and beer, should be avoided in the more acute forms of this disease, but they become necessary to maintain power in the advanced stages. ( 134 ) ON EXCESSIVE EXCRETION OF UREA. There is a condition of system characterised by the ex- cretion of large quantities of urea, which is sometimes accompanied by an excessive quantity of water, thus occa- sionally leading to a suspicion that the individual is the subject of diabetes. The specific gravity of the urine in this disease varies greatly, but it is generally above that of health ; and when such is the case, we obtain a copious and almost immediate crop of crystals of nitrate of urea, on the addition of an equal bulk of nitric acid to the urine. This crystallization nearly always occurs if the urine be above.1030 in specific gravity. When a large quantity of water, and, consequently, urine of a low specific gravity, is passed, the relative proportion of urea in the excretion is of course not increased, and may even be diminished ; but in all cases the absolute quantity excreted during the day is greater than in health. Nothing is satisfactorily ascertained concerning the causes of this tendency to increased ex- cretion. The symptoms of this disease do not differ par- ticularly from those observed in ordinary cases of dyspep- sia : there is, however, sometimes a frequent desire to pass urine. It is not uncommon to find the skin greatly in fault, and attention to the restoration of its function is always ne- cessary as a first part of our treatment. This is especially- desirable when the quantity of urine passed is large, and the specific gravity not above the healthy standard of 1022. It is not often that we meet with this disease unless com- bined with an excessive discharge of water, for the reason that this is often the only urinary symptom to which the patient's attention can be directed, and the dread of diabetes induces him to apply for relief. The waste of tissue shown by the large discharge of urea indicates the absolute necessity in these cases of ab- staining from all causes calculated to induce an increase of that action ; and violent exercise and hard study should be DEFICIENCY of urine. 135 avoided as much as possible, while wines and beer, with a light diet offish and vegetables, should form the dinner of such patients. Opiates have been found serviceable by Dr. Prout in this form of disease, and they are certainly often of great value, notwithstanding the prevalence of severe dyspeptic symptoms. The power they possess of restricting the rapid waste of tissue greatly assists in restoring the pro- portion of urea excreted to its normal standard. Mercurial alteratives with ipecacuanha or Dover's powder, according to the severity and duration of the disease, are among the most powerful remedies ; but it is well to avoid opiates in early cases, wThich will generally be found to yield to purga- tives, diaphoretics, and a restricted diet. ON DEFICIENT EXCRETION OF UREA. This disease, which has been called diabetes insipidus, to distinguish it from that form of excessive discharge from the kidneys known to contain sugar, is often confounded with those cases which have been treated of in the fore- going section, more especially when a large quantity of water accompanies the excess of urea. There is always a large excretion of urine in this disease, which, on being ex- amined, sometimes shows a specific gravity as low as 1002. I have seen it 1001, but for the most part it is observed at from 1002 to 1008. The proportion of urea is not only re- latively small in this urine, but the quantity excreted is ab- solutely less than in health, notwithstanding the enormous quantity of urine poured from the kidney. From six to ten pints are commonly excfeted in the twenty-four hours, and cases are recorded in which as much as twenty pints have been noticed. The dyspeptic symptoms are generally severe in this affection, and great thirst is always present, with a dry skin and red tongue, while the appetite is irregular. The bowels are constipated, and there is pain in the head and drowsiness, with mental depression, and 136 deficiency of urine. sense of fatigue on the slightest exertion. The predis- posing and exciting causes of this disease are not well ascer- tained, nor has its pathology been satisfactorily investigated. When large quantities of urine of very low specific gravity are passed, and there is great roughness of skin, the case may be looked upon as of very serious character, and the greatest difficulty will be encountered in affording relief. When, however, the symptoms are less severe, the fol- lowing plan of treatment frequently relieves the patient: the skin should be kept clean by warm baths, while anti- monials with small quantities of hydrargyrum cum creta are given at night. The bowels must be kept freely open, which is best effected by an aperient senna draught in the morning, which should not contain any saline purgatives in admixture, as they tend to aggravate thirst. Twice during the day a full dose of infusion of cascarilla or gentain will assist the treatment. I have lately attended a case of this disease in which hippuric acid was passed in the urine to the entire exclusion of lithic acid, and am inclined to believe, that in many of these cases characterised by a cloudy urine of very low specific gravity the hippuric acid will hereafter be found to exist. Should this prove to be the case, it may perhaps assist us in acquiring a clue to the pathology of the disease.* * A case has lately been read before the London Medical Society by Dr. Garrod, in which a very large quantity of hippuric acid was found to exist in the urine. Lithic acid was, however, also present in considerable proportion in this case. APPENDIX. ON LIME AND MAGNESIA, WHEN THEY EXIST TOGETHER IN COMBINATION WITH PHOSPHORIC ACID. There are some difficulties attending the chemical examina- tion of these mixed phosphates, owing to the great similarity of re-action which exists between them ; and we have not yet arrived at any well-ascertained method of performing their quantitative separation. The nearest approach, however, is by the following process :— The mixed phosphates are dissolved in dilute hydrochloric acid, and the solution is then nearly neutralised by ammonia. Alcohol is next added to the solution, and sulphuric acid care- fully dropped into the mixture. In this way we precipitate a sulphate of lime of considerable purity, which must be col- lected on a filter, and washed with dilute acid and water which has been digested on sulphate of lime. By this means we re- move any magnesian salt which may adhere. The sulphate of lime may now be dried and weighed ; and from its weight we may deduce that of the lime, and also of the magnesia ; for the proportional constitution as phosphate being known, we are able to do so from our previous knowledge of the original weight of the mixture on which we operated. Magnesia.—Lime. The presence of lime and magnesia, when they exist as phosphates, dissolved in an acid, is easily proved by first pre- cipitating the liquid (previously nearly neutralised by ammonia), with the solution of oxalate of ammonia, and allowing the pre- cipitate to subside. The mixture should now be briskly boiled 138 APPENDIX. to perfect the precipitation of the oxalate of lime ; the clear liquor is then to be poured off; and if the oxalate ceases to produce a further effect,* wre must add ammonia. Should we now observe a precipitate to occur, we may be sure that mag- nesia is present in the solution. When phosphate of iron ex- ists in admixture with these earths, as is the case in the ashes of blood, we can easily prove its presence by testing the so- lution with the ferrocyanuret of potassium, which yields a fine blue precipitate of prussian blue. The following substances have been noticed in minute quan- tity in the blood: viz. silica, manganese, copper, and titanic acid. An account of my experiments regarding the presence of the last-mentioned substance may be seen in the Philo- sophical Magazine for March, 1835. Marchand denies the existence of titanium in the blood; the blowpipe re-actions, however, which I have obtained from the ashes of blood, are not such as I have ever been able to pro- duce with any other substance than titanium. Fatty Matters of the Blood. Besides the fatty matters which are contained in the serum of blood, and which were first pointed out by Dr. Babington, we can procure others by the action of ether on the mixture of fibrin, albumen, and red particles. The best process for pre- paring these fats is as follows :— Let a quantity of fibrin, albumen, and red particles, be well dried, and then pulverised. Alcohol is now to be boiled on the powder, by separate portions, until the last added possesses no solvent action on the mass, which may easily be known by evaporating a portion of the fluid to dryness ; when, if no re- sidue be observed, we may be sure that the action is complete. The alcoholic solutions are now to be added together, and evaporated to half, when we frequently can observe that red particles become precipitated: in order to render this precipita- tion more complete, we must add a portion of cold alcohol to the warm fluid, when we shall perceive that a precipitate im- * Should the oxalate of ammonia continue to precipitate the solution, we must add an excess, and again allow the precipitate to subside before testing for magnesia with the ammonia. The magnesian pre- cipitate frequently requires some time for its formation. BLOOD. 139 mediately collects, and the supernatant liquor becomes yellow.* This clear liquor may be removed by a pipette, and left to spontaneous evaporation: as the alcohol dissipates, we shall observe a precipitate of a firm white fatty matter; this may be removed, and set aside; the clear liquor must now be evapo- rated to dryness, when we shall procure a fat of reddish tint, which, from its containing phosphorus, has been called the red phosphorised fat. It has no very peculiar properties: when heated it becomes of a dark-reddish colour, and its cinder has an acid re-action. It contains both sulphur and phosphorus. It does not saponify with the alkalies. The solid white fat which separated from the alcoholic solu- tion also contains phosphorus and sulphur; it has been named the white phosphorised fat: its re-actions are very similar to those of the red fatty matter. The alkalies possess no solvent action on this substance. Cholesterine has been rejected from the list of constituents of healthy blood, in the admirable work of P. S. Denis; but there are many re-actions procurable from the crystalline fatty matter, which much resemble those of cholesterine; and if it be not that substance, I cannot but think that at least it is an incipient form of the biliary fat which exists in the blood. * This precipitate contains the fatty matter called serolin. 140 APPENDIX. ON THE VARIABLE PROPORTIONS OF THE CONSTITUENTS OF THE HUMAN BLOOD. The extensive researches of M. Lecanu have led him to the following results, which I here append in a table, together with a translation of his observations on the subject:— " The proportion of water va- ries in the blood of individuals of different sex and age. In the blood of individuals of the same sex, but of different ages. The proportion of water is less in man than in woman. The quantity of water is not proportional to the age, at least from 20 to 60 years old, among individuals of the same sex. From 853-135, maximum quantity of water con- tained in 1001) parts of blood, to 778-625, the minimum, Difference 74-510 Mean - 815-880 From 853-135, maximum quantity of water con- tained in 1000 parts of female blood, to 790-394, the minimum, Difference G2 741 Mean - 821-7045 And from 905-263, maximum quantity of water contained in male blood, to 778625, minimum, Difference 20-633 Mean - 791-944 Mean proportion of water in wo- man's blood - - - 821-7645 Mean proportion in man - - 791-9440 Difference of excess in woman's blood .... 29-8205 1000 parts of blood, from females, have yielded of water:— at 22 years 853135 25 796-17.1 34 801-918 36 799-230 38 827-130 53 790-840 54 799-432 58 790-394 58 792-097 60 792-561 1000 parts of blood, from males, 'hare yielded of water:— at 20 years 26 from 30 to J 32 years \ at 32 years 34 36 from 38 to j 40 years j from 45 to I 48 years j from 48 to i 50 years j from 62 to 04 years j 790-900 778-625 788-323 785-881 795-870 782-271 783-890 780-211 805-263 801871 BLOOD. 141 In individuals of the same sex, there is less water in the blood of Ihose possessing a sanguine tem- perament than in that of those of a lymphatic temperament. In 1000 parts of blood from females :— Sanguine tempera- ment. Water 796175 792-561 792-897 790-394 Lymphatic tempera- ment. Water 790-840 827-130 801918 799.432 799-230 Mean of sanguine temperament - 793-007 Mean of lymphatic temperament - 803710 Difference of excess for lymphatic temperament - - - 10-703 1000 parts of blood from males yielded :— Sanguine tempera- ment. Water 780-210 7f3-890 801 871 778-625 788 323 Lymphatic tempera- ment. Water 805-263 795-870 The proportion of albumen va- ries in the blood of individuals of different sex and age. In the blood of individuals of the same sex, but of different ages. The quantity of albumen bears no proportion to the age, at least within the limits of from 20 to 60 years, in individuals of the same sex. Mean of sanguine temperament - 78G584 Mean of lymphatic temperament . 800-5665 Difference of excess for lymphatic temperament - - - 139825 From 78-270, maximum quantity of albumen in 1000 parts of blood, to 57-890, the minimum, Difference 20-380 Mean - 68-080 From 74-740. maximum quantity of albumen containeii in 10(0 purls of blood from women, to 59159. the minimum. Difference 15 581 Mean - 66 9495 From 78 270, maximum quantity of albumen contained in 1000 parts of blood from men, to 57890, the minimum, Difference 20-380 Mean - 68080 1000 parts of blood, from females, have yielded, of albumen. at 22 years, 68-756 73065 59 159 GO-125 69-100 71180 74-740 70-210 72-796 69062 1000 parts of blood, from males, have yielded, of albumen at 26 years, 26 from 30 to ) 32 years j at 32 years, 34 36 from 38 to? 40 years 5 from 45 to? 48 years rom 48 50 yen ■cm 62 04 years from 48 to? wrs 5 frctn' 62 to? 71-560 62-949 71061 64-790 78270 66090 57-890 71-97 65133 65-389 142 APPENDIX. It is almost the same in propor- tion for individuals of sanguine and lymphatic temperaments, of the same sex. The proportion of globules va- ries in the blood of individuals of different ages and sex. Also in the blood of individuals of the same sex, but of different The proportion of globules is greater in men's blood than in (hat of women. The quantity of globules does 1000 parts of Wood from not appear to be proportional to females have yielded, the age in individuals of the same i of globules, sex within the limits of from 20 at 2v! years, 68-349 In 1000 parts of blood from females :— Sanguine tempera- ment. Albumen 73065 69082 7021(1 72-796 Mean of sanguine temperament Mean of lymphatic temperament Lymphatic tempera- ment. Albumen 71-180 69-100 59159 74-740 69125 71-204 08-6li0 In 1000 parts of blood from males :— Sanguine tempera- ment. Albumen 71-970 57-89) 65 389 62-949 71061 Lymphatic tempera- ment. Albumen 65133 78 270 Mean of sanguine temperament - 65-85 Mean of lymphatic temperament - 71.7015 Difference .... 58515 From 148-450, maximum quantity of globules contained in 1000 parts of blood, to 68349, the minimum, Difference 80-101 Mean - 108-3995 From 148-450, maximum quantity of globules contained in 1000 parts of blood from males, to 115-850, the minimum, Difference 32 60 Mean - 132-150 From 129-999, maximum quantity of globules contained in 1000 parts of blood from females, to 68349, the minimum, Difference 6V641 Mean • 99 1695 Mean of female blood - - - 991695 Mean of male blood - - - 1321500 Difference of excess in male blood - 329805 to 60 years. 25 34 36 38 53 51 5S 58 60 '20 129-610 119-000 92-670 129-990 115-319 127730 125-590 129-654 1000 parts of blood from males have yielded, of grobules, at 26 years, 26 from 30 to ) 32 years j at 32 years, 34 36 from 38 to j 40 years j from 45 to i 48 years j from 48 to \ 50 years \ from 62 to j 64 years j 128-670 146-885 J31-688 139-129 ] 15-850 141-290 148-450 133-820 117-484 121640 BLOOD. 143 In individuals of the same sex, the proportion of globules is greater in those of a sanguine than in those of a lymphatic temperament. 1000 parts of blood, from females, yielded :— Sanguine tempera- ment. Globules 121 720 129-654 127-730 125-590 Mean of sanguine temperament Mean of lymphatic temperament Difference of excess in sanguine temperament Lymphatic tempera- ment. Globules 129-990 92670 129-610 115-319 119 000 126-174 117300 B-874 1000 parts of blood, from males yielded .— Sanguine tempera ment. Globules 133820 148 450 121-640 146885 131-688 Mean of sanguine temperament Mean of lymphatic temperament Difference of excess in sanguine temperament Lymphatic tempera- ment. Globules 117-484 115-850 136-497 116-667 19-830 On these results, the following remarks are made by Mon- sieur Lecanu: — 1. " The proportion of serum varies in the blood of indi- viduals of different sex and age ; also in the blood of individuals of the same sex, but differing in age." It is greater in the blood of women than in that of men. It is also greater in the blood of lymphatic individuals than in that of those possessing a sanguine temperament, the sex being the same. No relation is to be observed between the quantity of serum and the age of individuals of the same sex, at least within the limits of from twenty to sixty years old. 2. The proportion of albumen, fibrin, and colouring matter- in other words, the nutritive substances—varies in the blood of individuals of different sex and age. In the blood of individuals of the same sex, but of different age, it is less in the blood of women than in that of men; and also less in the blood of lym- phatic persons than it is in the blood of those possessing a sanguine temperament, the sex being the same. No relation is to be observed between the quantities of nutritive matters and the ages of individuals of the same sex, at least within the limits of from twenty to sixty years. As regards the serum (essentially formed of water and al- bumen^ the proportion of water, and, consequently, that of the albumen, varies in individuals of different sex and age. In individuals of the same sex and of different ages, it appears to be nearly the same in men as in women, and in individuals 144 APPENDIX. of sanguine and lymphatic temperament. In relation to the analysis of the blood of females, it must be observed that the menstrual losses to which they are subject contribute especially to vary the proportion of globules; thus the analysis of the blood of a female affected with the uterine discharges afforded in a first experiment.— Water .... 851*590 Albumen - 66*870 Soluble salts and extractives - 11*290 Globules - - - 70*250 Total And in a second experiment— Water Albumen - Soluble salts and extractives Globules ... Total - - - 1000*000 That is to say, in these two cases, and especially in the first, the quantity of globules was only about half that observed in the other analyses of woman's blood. It is easily foreseen that a similar effect to the above maybe produced by repeated bleedings. Thus, the woman who was the subject of the sixteenth experiment, having been blooded for the third time, I found that the blood, instead of containing as before— 1000*000 832*754 60*891 13*210 93*145 Water 792-897 Albumen 70-210 Soluble salts and extractives 9*163 Globules 127*730 Total - - 1000*000 Contained only— Water - 834*050 Albumen ... 71*111 Soluble salts and extractives 7*329 Globules 87*510 Total - 1000*000 BLOOD. 145 The proportion of albumen in the serum shows much less sensible variation in cases of successive bleedings or uterine discharges; which is easily conceived, since the liquid, ab- sorbed at the expense of the whole system, and proportionably to the blood drawn or discharged, is water charged with albu- men." I shall now append a statement of the inferences which have been drawn by various other experimenters, as the result of their researches into the constitution of the blood under different conditions both in health and disease. Arterial and Venous Blood. Sinion states that arterial blood contains more water than venous blood, and that the blood corpuscles of arterial blood contain less colouring matter than those of venous blood. Denis did not detect more water in arterial than in venous blood, but found them alike in this respect. Hering examined the arterial and venous bloods of several animals, viz. the bullock, the sheep, and the horse, and agrees with Simon in making arterial blood to contain more water than venous. Hering states the corpuscles in venous blood to exceed in number those of the arterial. Lecanu differs from all the foregoing chemists in finding a smaller proportion of water to exist in arterial than in venous blood—he also found a larger proportion of fibrin in the arterial blood. Simon, Denis, and Hering could discover no law as to the proportion of fibrin; sometimes it was in larger proportion in the arterial, sometimes in the venous blood. The evidence of other chemists is very conflicting as to the relative proportions of water and fibrin. There appears to have been some modifying cause in action to produce these discrepancies, and which has been entirely overlooked; proba- bly the time allowed to elapse after taking food before the blood was drawn may have caused these differences in result. Blood of the Vena Porlse. Schultz has experimented on this blood as obtained from the horse. He states it to be of a much darker colour than ordinary 10 146 APPENDIX. venous blood; but that it becomes brighter after a full meal. The neutral salts and atmospheric air do not brighten the colour of portal blood. Simon analysed the arterial and portal blood of a horse, and concludes from his experiments that portal blood contains less fibrin, more fat, more extractives and salts, and more colouring matter in proportion to globulin than arterial blood. Blood from the hepatic Vein. This blood has been examined by Simon, who concludes from his analyses that it is richer in solid constituents than either ordinary venous or arterial blood, even more so than that taken from the vena portae. It contains less fibrin, fat, globulin, and colouring matter than the blood of the vena porta?. Blood from the renal Veins. This blood has been shown by Simon to contain more solid constituent and albumen than that of the aorta, but it contains less fibrin and fewer corpuscles. Blood from I be Capillaries. Pallas analysed blood taken by leeches and cupping, and by comparing his results with the analyses of venous blood, came to the conclusion that capillary blood is richer in solid and coagulable constituents than either venous or arterial blood. Denis contradicts this, having found that blood taken from the arm and compared chemically with that taken from the side of the chest of the same person by cupping, yielded results almost identical in the proportions of water, corpuscles, and solids of serum. Blood of the Fat us compared with that of the Mother. Denis found the blood of the foetus to contain more solid matter and corpuscles than that of the mother. The foetal blood contains more iron than that of the mother, the ratio being 2*5 to 1. His analysis was made on blood taken from the umbilical artery, and is compared with the analysis of the venous blood cf the mother. BLOOD. 147 Influence of Blood-letting. Becquerel and Rodier have made a great number of analyses of the blood of persons who have undergone repeated venesec- tion. From the tables they have constructed it appears that loss of blood is followed by a decrease in the specific gravity of the circulating fluid. The albumen diminishes very slowly. The fibrin is not much influenced, the extractives and salts are unaltered, the fat is diminished, the corpuscles are greatly decreased in number. Blood in Inflammation. Andral and Gavarret have established, by analysis, the fact, that the proportion of fibrin is greatly increased in inflamed blood. Becquerel and Rodier have also shown this to be the case, and, moreover, have established, that the proportion of albumen in such blood is less than in the healthy state. Blood in Phthisis. Andral and Gavarret state that as this disease advances the proportion of fibrin increases, and that of the corpuscles de- creases. In extreme cases, however, the whole blood becomes impoverished. Blood in Puerperal Ferer. According to an analysis of this kind of blood made by Heller, the fibrin was increased beyond the normal standard, and the corpuscles greatly decreased in number. Blood in Typhus fever. The general results of Andral and Gavarret show that in this disease the proportion of fibrin in the blood decreases, while that of the corpuscles increases. Becquerel and Rodier analysed the blood of eleven men af- fected with typhoid fever, and obtained the following as the mean composition of their blood:— Water - - - 797 Fibrin - - - 2*8 Albumen . - - 64-8 Fat - - - - 1*7 Corpuscles . - - 127*4 Extractives and Salts - - 6*3 1000-0 148 APPENDIX. Here we observe the fibrin and corpuscles in about normal proportion, while the albumen is only very slightly decreased. Scherer found the salts of blood in typhoid fever to amount to 11*92 per 1000, which is an increase on the proportion of salts in health. The alkaline salts alone amounted to 10 per 1000, while in health they never amount to 9 per 1000. Blood in simple continued Fever. Andral and Gavarret have shown that in this disease we generally have a slight increase in the proportion of the fibrin of the blood, and a decrease in that of the corpuscles. When inflammatory complications occur in the course of this disease, however, we find the fibrin increasing very greatly indeed, while the corpuscles decrease to the proportion observed in in- flammatory affections generally. In three analysis made by Becquerel and Rodier, the albu- men and fibrin of the blood from a case of continued fever were in healthy proportion, while the corpuscles were slightly above the average weight in health. Blood in intermittent Fever. Andral and Gavarret have examined the blood in ague, and found an excess of fibrin and decrease of the proportion of the corpuscles. No difference was observed in the blood whether drawn during the hot or cold stages, or during the remissions. Blood in Scarlatina. Andral and Gavarret give the three following analysis of the blood in this disease: — Water. Fibrin. Corpuscles. Solids of Serum. 761*5 3*1 146*0 89*4 776.3 3*5 136*1 84*1 798*3 6.8 112-2 82*7 Blood in Apoplexy. Andral and Gavarret state that in the greater number of cases of cerebral apoplexy, the proportion of fibrin in the patient's blood is deficient, and the corpuscles in excess. The following is the mean of twenty-one analyses made by Andral and Gavarret of blood taken from patients suffering cerebral congestion, threatening apoplexy. It is compared with healthy blood. URINE. 149 Water. Fibrin. Corpuscles. Solids of Serum. Mean - 787-1 2-6 120 89*7 Healthy blood 790 3*0 127 80 Blood in Chlorosis. An analysis of this kind of blood by Dr. Vetter showed the proportion of corpuscles to be greatly diminished, the water in excess, and fibrin in about normal quantity. Andral and Gavarret have analysed the blood of chlorotic pa- tients, both at the commencement of the disease, and when it has advanced. The mean of eight analyses of the first kind of blood, and nine of the second, is compared below with the blood in health. Water. Fibrin. Corpuscles. Solids of Serum. Health - - 790 3 127 80 Insipient chlorosis 801 3*5 106.8 88 Advanced chlorosis 853*2 2*9 56*7 88 Organic Acids of Urine. Besides the acids which have been treated of as existing in this excretion, we have to notice the following; viz. Acetic. Butyric. Benzoic—hippuric or uro-benzoic. These acids have not been much examined, and there is some contrariety of opinion regarding them. Thus, though Prout and Thenard admit the existence of acetic acid in urine, we find that Berzelius expresses a directly opposite opinion, and be- lieves that the odour of the butyric acid mingled with that of hy- drochloric acid has led to the error ; for, on the addition of sul- phuric acid to a dry mass containing a chloride and a buty- rate, we have an odour evolved which simulates that of acetic acid. It is the opinion of Berzelius, that neither acetic acid nor acetates are to be detected in the urine; and Liebig has lately shown that acetic acid exists in urine only as a result of decomposition. The butyric acid has been observed but in one specimen of urine, and it is a matter of doubt whether it be not rather an accidental than a necessary constituent of the fluid. The benzoic acid was supposed to have been discovered in the urine of the cow by Rouelle. Liebig made some minute 150 APPENDIX. investigations into the nature of this acidas found in the urine, and has proved it to be a distinct acid from the benzoic—as its salts are less soluble in water, and it contains nitrogen, which the benzoic does not, being an oxide of a hydro-carbonous body, to which the name of benzule has been applied. Liebig named this acid the hippuric, as he considered it pe- culiar to the urine of the horse; but this is not the case, as he has lately detected it in the urine of man. Berzelius calls it the uro-benzoic acid, which is certainly a more appropriate term. The salts formed by this acid have been examined and described by Berzelius. When urine becomes stale it no longer contains hippuric acid, but benzoic acid becomes developed. Quantitative Estimation of Fixed Alkaline Chlorides, Phos- phates, and Sulphates in the Urine. The residue of the incinerated urine contains these salts* which may be separated as follows : — They are to be dissolved in distilled water, and the solution filtered. Half the filtered liquor is then rendered acidulous by the addition of a few drops of nitric acid. An excess of a so- lution of nitrate of barytes is now added. The precipitate is collected on a filter and dried perfectly; from the weight of this sulphate of barytes, we can deduce that of the sulphuric acid. The filtered liquor, which is acidulous, must now be saturated with ammonia, which lets fall a precipitate of phosphate of barytes; this is to be collected and dried on a filter; from its weight we can deduce that of the phosphoric acid.* It is to be remembered that we have here operated on half the liquor, and that, consequently, we must double our resulting quantity of sulphuric and phosphoric acids. The remaining portion of the filtered liquor is used to de- termine the quantity of hydrochloric acid present in the salts, as follows :— A solution of nitrate of silver is added to the liquid, previ- ously acidulated with nitric acid. A chloride of silver now precipitates, which is to be collected on a filter, and then dried in a platinum crucible over the spirit lamp ; from its weight we deduce that of the hydrochloric acid. * Care should be laken not to add too much nitric acid at the com- mencement of this process; for by this means we produce so much nitrate of ammonia, when we saturate, that the precipitated phos- phate is liable to be dissolved. URINE. 151 Having ascertained the weight of the acids, we have but to add the correct proportions of alkali for neutral combination, in order to discover the quantity of each alkaline salt. The sulphuric acid may here be divided between potash and soda. The phosphoric and hydrochloric acids are in combination with soda only. If we wish to ascertain the exact proportion of soda which exists in combination with the sulphuric acid, we must have recourse to precipitation by the chloride of platinum, on a known quantity of the saline solution, estimating the propor- tion of the alkali from the known constitution of the potash chloride of platinum. Albuminous Urine. This form of diseased urine is generally coagulable by heat, and is for the most part acid. We, however, occasionally meet with specimens which are alkaline, and incapable of becoming coagulated by a boiling temperature. It was supposed that this depended upon the presence of some fixed alkali, which held the albumen in solution ; and in order more thoroughly to ex- amine the matter, I made analyses of two specimens of urine taken at different times from the same individual: the one was neutral and coagulable by heat; the other not coagulable by heat, and possessing an alkaline re-action. Both these speci- mens became coagulated on the addition of nitric acid. 1st specimen.—Neutral, coagulable by heat, as also on the addition of nitric acid. Water - Albumen - Alkaline salts Urea, ammoniacal salts, and extractives Earthy phosphates, loss 200*0 2d specimen —Alkaline, not coagulable by heat, but becoming coagulated on the addition of nitric acid— 195*0 1*1 1*4 2*2 0*3 152 APPENDIX. Water .... 195*8 Albumen - - - - 1*7 Alkaline salts ... 0*5 Urea, ammoniacal salts, and extractives 1*8 Earthy phosphates and loss - - 0*2 200.0 It will be observed that the alkaline specimen contained the greatest proportion of albumen, and a much smaller proportion of alkaline salts, than the neutral urine. This would go strongly against the probability of any fixed alkali being the solvent of the albumen; for in this case we should expect a redundant quantity of fixed saline matter in proportion to the albumen present, whereas exactly the opposite was the case, in this speci- men at least. There has been said to exist in the urine an animal substance, to which the name of incipient albumen has been given. I do not believe in the existence of such a substance, and am of opinion that the fact of the precipitation of the earthy phos- phates by heat led to the erroneous belief in the presence of such a body. Tests of the Presence of Albumen in the Urine. It is customary with practitioners to test for albumen in the urine by the application of heat, and the addition of nitric acid. I will now notice the sources of fallacy connected with the use of each test. The test of heat fails to show the presence of albumen when the urine is alkaline, and this is also the case in some neutral specimens, no opalescence being produced even at a boiling temperature. It is necessary, therefore, before using this test, to examine the state of the urine, as to acidity or al- kalinity. Specimens of urine, when possessing either an acid or al- kaline re-action, will occasionally, when no albumen is pre- sent, become opaque when boiled, the flocculi produced simu- lating the appearance of albumen. This opacity is caused by the precipitation of the earthy phosphates which may be dis- tinguished from albumen by becoming immediately dissolved on the addition of a drop of dilute nitric acid. These phos- phatic specimens are not precipitated by nitric acid, and there- fore this source of fallacy is removed by testing with that re- agent. Nitric acid, however, is not in itself a satisfactory test for albumen, being productive of a source of fallacy in throw- URINE. 153 ing down Jithic acid in large quantity from some kinds of urine. These instances are rare, however,and may be distinguished by the addition of hydrochloric acid, which throws down the lithic acid quite as completely as the nitric acid does, while such is not the case with albumen. From what I have related above, it will be perceived that it is quite possible to meet with a speci- men of urine coagulable both by nitric acid and by heat, a*nd which shall notwithstanding be free from albumen, for heat may throw down the phosphates, while nitric acid may cause a deposit of lithic acid. I once met with such a case. There is another source of error connected with testing urine for albu- men by nitric acid, of which it is necessary that the practitioner should be aware, and I therefore here append* a notice extracted from the Guy's Hospital Reports, in which I entered at full upon several questions connected with the chemical pathology of* albuminous urine. In a recent number of the Medical Gazette, I noticed a pecu- liarity- in the urine passed by patients taking copaiba ; such urine becoming coagulated on the addition of nitric acid, not- withstanding that no albumen was present. Since the publica- tion of my observations on those specimens, I have had several opportunities of examining the urine voided by patients to whom cubebs had been administered ; and have found a curious similarity between the re-actions afforded by such specimens, and by those which were impregnated with copaiba. The latter urine, which I have examined several times, al- ways yielded a precipitate, on the addition of nitric acid: in some cases, this was very slight; but in the majority, very dense and white, and greatly resembling albumen. The action of the acid on urine impregnated with cubebs is precisely simi-, larin character, excepting that the colour of the precipitate occasionally verges on a pale pink. Previous to my publishing the re-actions of copaiba, there was but one substance (albumen excepted) supposed to be precipitable from the urine by nitric acid: this was lithic acid, which, however, could not be re- garded as a frequent source of fallacy ; as, when thus precipi- tated, it seldom comes down till the tested liquid has been al- lowed to stand some time, and then appears in a semi-crystal- line form, and of a brownish-red colour. The precipitate af- forded by cubebs and copaiba is, however, of that cloudy opaque character which simulates albumen, and moreover occurs im- mediately on adding the test. 154 APPENDIX. It became an object now, to discover some simple method of discriminating between this precipitate and that obtained by nitric acid from albuminous urine. Fortunately, a very easy means of doing so is afforded us, by allowing the urine to which the acid has been added to remain at rest for an hour or two; when, should the precipitate consist of albumen, it will be found to have collected at the bottom of the tube, or to be arranged in flocculi through the liquor, the greater part of which will appear clear. If, however, the precipitate be caused by the presence of a vegetable matter derived from copaiba or cubebs, the precipitate does not subside for several days; not, indeed, till decomposition has occurred. Another and more speedy method of discriminating between these two impregna- tions and albumen is by the use of the ferro-cyanuret of potas- sium as a precipitant, the urine being previously acidulated by acetic acid. If albumen now be present, it is immediately thrown down; but in the other cases, even if the acetic acid cause a slight turbidity, it is not increased by the addition of the ferro-cyanuret. It is interesting to observe how supposed exceptions to the law declared by Dr. Bright become explained away by advances in the chemical pathology of the urine; copaiba, for instance, has been stated to cause albuminous urine ; and probably cubebs may also have been looked upon as capable of affording the symptom which Dr. Bright has re- garded as characteristic of a peculiar morbid tendency in the kidney. It is greatly to be regretted, that the tests both of heat and nitric acid are not applied to the examination of urine: both are certainly not generally used. Perhaps, where one test only is employed, that of heat is the most common, and the sources of fallacy above alluded to are therefore less likely to occur; but still there are many who use nitric acid exclusively, and such are not very unlikely to meet occasionally with the decep- tive re-actions I have mentioned. On the whole, it would be far better, if one test only were applied, that it should be the nitric acid; for the phosphatic precipitates which so often occur on the application of heat to urine, and the suspension of albu- men, even after long boiling in some alkaline specimens, tend to render this an exceedingly imperfect test. Now, nitric acid throws down but one precipitate, resembling albumen; and that not being a constituent of the urine, but a matter derived from ingesta, we are the less likely to encounter such source of error: and even when it occurs, a little patience, in watching the after- URINE. 155 behaviour of the precipitate, might occasionally betray the real cause of the re-action obtained. Until very recently, it has been supposed, that if nitric acid and heat both caused a precipitate in urine, albumen must be present: this, though true in the general,is not strictly correct: and it is right to recollect, that we may have earthy phosphates precipitated by heat, while vegetable matters derived from in- gesta may be thrown down by nitric acid. Such kind of urine lately occurred to me, while collecting specimens impregnated by cubebs. There is no doubt that until very lately such a case would have been confidently quoted as one in which albumen existed in the urine. I must mention, that the conditions I have noticed are not always to be expected, either in the case of copaiba or cubebs ; appearing most strongly when the urine smells powerfully of the drug, and being scarcely perceptible when the characteristic balsamic odour is wanting. I have reason to believe, that when either cubebs or copaiba are administered with an alkali, that the urine becomes more rapidly and completely impregnated; but it is difficult to conceive what cause can be in operation to produce an occasional difference in this respect, the urine sud- denly becoming- (even when large doses of the medicine are being exhibited) comparatively free from impregnation. The frequent occurrence of the earthy phosphatic precipitate afforded by the action of heat on urine, and, consequently, the fallacious nature of the test by heat, may be better appreciated, if I now lay before the reader a statement drawn up from some valuable Tables which were formed by Dr. Barlow and Mr. Tweedie, at the suggestion of Dr. Bright. I find, by examining these Tables—in forming which, the tests both of heat and nitric acid were used to ascertain the presence of albumen—that in 482 cases, taken promiscuously from the hospital wards, 34, or about 7 per cent., were found which coagulated or became opalescent by heat, while they were not affected by nitric acid: these, therefore, were cases in which the phosphates were pre- cipitated; and had heat alone been used as a test for albumen, we now observe how many errors must have been committed, and how many cases might have been cited as exceptions to Dr. Bright's law. Though well aware of the frequent occur- rence of this source of fallacy, still I must say, I was scarcely prepared to find it in so large a proportion of cases as 7 per cent. In Tables constructed by Dr. Barlow, in which he examined the urine of 300 individuals, we find that 1 in 11 had albuminous urine: other Tables make 1 in 6 as the proportion; 156 APPENDIX. the former being about 9, and the latter nearly 17 per cent. This shows how impossible it is to arrive at a satisfactory ap- proximation to the truth by the use of the test by boiling alone: for among 100 persons, 16 might be declared to have albu- minous urine ; and of these, only 9 might present the degene- ration of kidney on post-mortem examination, the 7 cases op- posing the general truth which the observer was seeking to confirm. As it may be interesting to know the particulars of the cases showing the deposit of phosphates on the application of heat, I will give the names of the wards, and the number of cases found in each, with such particulars as the Tables afforded. These observations were not all made at the same time; a considerable period having elapsed between the first and second examinations of the patients in those wards, the names of which occur twice in the following Table. URINE. 157 Name of Ward. Cases yielding a Precipitate of earthy Phosphate on Application of Heat. Number of Patients in the Ward. OBSERVATIONS on Cases yielding the Precipitate. Job - Martha Name of Ward omit- ted in the Table Lazarus Charity Luke - Cornelius Dorcas Petersham Esther - Lazarus Job - Miriam Mary • Mary and Dorcas Martha Naaman Charity Cornelius Dorcas Two Tables without the names of Wards affixed 22 30 23 23 30 •{ I I 29 18 30 17 13 oo lli 8 20 10 25 20 28 -j " I 26 ^ In the two Wards, 46 I. Patient hemiplegic and cache- tic from intemperance. 2. Fe- ver. 3. Anasarca : hydrotho- rax worn by intemperance. Long an invalid, with chronic rheumatism and catarrh. 1. Boy with calculus,:'.% years old. 2. Worn and feeble: malignant disease. 3. Strumous, with hip- joint diseased. 4. Abscess in the mouth: somewhat emaci- ated. 5. Much depressed: para- lysis. 0. Constipation: pletho- ric person. Axillary abscess. 1. Renal tumour: has suffered much pain. 2. Knee-joint dis- ease : strumous. I. Fractured tibia and fibula- 2. Burn: child 5 years old. secondary symptoms: takes bi- chloride of mercury and sarsa- pari I la. I. Tumour of thigh : operation. 2. No account. 3. Phthisis: hip-disease. I. Ampliation: takes ammonia. 2. Effusion: not mentioned in- to what (avity. 1. Boy 2^ years old : panlysis. 2. Lung illness: takes calomel and opium; disease not mentioned. 3. Morbus cordis: has had rheumatism. 4. Pleuritis. 1, Taking tunics and alteratives. 2 Old disease : asthma. 3. i\o history. I. Abscess of leg. 2. Bad leg : is taking stimulants. I. Scrofula. 2. Morbus cordis. 3. Paralysis and diseased verte- bra;. 4. Au.euorrhusa. 158 APPENDIX. The examination of this Table becomes particularly instruc- tive, as a warning to observers not to be too apt to draw con- clusions from a few instances;—an error which is committed day after day in our profession, and which cannot be too often noticed and condemned. In this Table we have instances from Charity Ward of 6 patients out of 30; while, if we look to Luke's Ward, there is not a single case among 29. Again, in Martha Ward we do not find a case in 30; while in Esther Ward there occur 2 in 13. I need hardly say how completely 30 cases would have satisfied the minds of most inquirers as to the great rarity of these phosphatic cases; how, indeed, the question would be looked upon as well nigh settled; and a strong defence for the conclusion have been afforded, by the undeniable fact, that more than half the doctrines of medicine were based on a less substantial foundation. Here are 30 con- secutive cases affording no instance. Now, let us suppose the inquiry to cease. What would be the impression on the mind of the observer not cognisant of the fact, that the next thirty might yield him 6 instances? To one entirely unacquainted with the variable nature of the functions of the body, 30 con- secutive cases would be strong evidence. They might be strong evidence to the mathematical philosopher, who, if not a physiologist, would not duly appreciate the variations which so puzzle those who inquire into the more intimate parts of medi- cine. It may well be asked, If these varying causes are so numerous, how can we ever hope to arrive at a due apprecia- tion of the value of our collected instances ? The table above quoted is an answer to this question. It is only by such col- lected groups of facts, such as those of 30 here mentioned, that we can arrive at an estimation of the power of such varying causes, and, consequently, of the multiplicity of instances which may or may not be required, for satisfying the mind on any particular point; by making us feel a conviction, that the cases are sufficiently numerous to overpower the sources of fallacy. In the present inquiry, it was a difficult thing to conceive, that, after 30 cases were consecutively examined, and no result ob- tained, that the next 30 should yield us 6 instances : but having now ascertained this second result, we can bear in mind, that such groups may again occur (or something approaching to them) in future examinations connected with the pathology of the urine: and, by observing the limits of variation in a large collection of similar groups, we may hope eventually to arrive at something approaching to a correct estimation of the value of any number of instances which may be offered us as evidence, URINE. 159 by future observers. From the observations on the cases con- tained in the Table, I think it may be concluded that the phos- phates are apt to be precipitated from urine, on the application of heat, in patients of a cachectic habit, and in those worn by disease and suffering. The specific gravity of such urine is often as low as 1010 and 1012 : though this is not always the case, as we sometimes find it natural, viz. from 1017 to 1022. It has frequently been stated, that mercury, when administered in quantity, renders the urine albuminous. I was very anxious to put this to the test; and accordingly formed the plan of a Table which my friend Dr. D. Francis (who has attended much to the examination of diseased urine, and for whose ac- curacy and judgment I can vouch) kindly undertook to fill up with observations on those patients admitted into the hospital, who would probably be subjected to salivation. The urine of these patients was tested when salivation was complete, and, in some cases, before the administration of the remedy; the latter being necessary, to exclude cases of true Morbus Brightii, which would interfere with the inquiry. I have great pleasure in being able here to quote the follow- ing results of Dr. Francis's labours :— Action No. Name, Date and Disease on Lit-mus and Turmeric. Effects of Heat. Effects of Nitric Acid S. G. State of Gums. 1 Renjamin Neale. Dec. 1-. 14 Samaritan. Svphi lis. Acid No change No change 1016 Gums fairly affected: foetor: saliva increased 5. Jnhn Hart. Dec. IK 311 Samaritan. Syphi-lis. Jan. 2. Acid Acid No change Lithates dissolved No change No change 1022 Mouth not affected. Gums sore and turgid: foetor. 3. Edward May. Dec. 18 32 Samaritan. Syphi-lis. Jan. b\ Acid Acid No change Slight precipitate No change No chan g rhnnge No change No change No change Slight precipitate No change Deposit dissolvod: no subsequent chanm-: No change Mo change Kin; Cmuis tn r«iil and ulcerated: Trine natural in appearance: I linlor: face swollen | not. examined previously to exhibition of mercury : sa- Nn change 1018 Gums not sore No change ; 1010 Gums turgid: teeth loose : Urine clear, pale, and copious: faMor I saliva slightly acid. No change I 1022 Gums not sore. Nochaii'A 10C0 Gums ulcerated: face swollen: Ui ine pale, natural quantity: j upwards of a pint of saliva] precipitate by heat dispelled flowing from the mouth by addition of nitric acid; daily i saliva neutral. No change | 1020 Gums turgid and sore : glands Saliva slightly acid. of neck swelled : teeth loosej Nochange lOlii Gums turgid: teeth loose: Saliva neutral [ firtor. sputa about £ pint a day Nochange , 1017 Gums turgid and ulcerated: teeth loose. Nochange 1013 .Gums turgid: mercurial sores on lips No change Deposit dissolved JNochange | 1030 Teeth loose : gums sore and turgid; foetor Urine pale and copious, free from deposit: saliva slightly acid. Urine scanty and loaded with deposit; saliva neutral. 162 APPENDIX. From these observations we may safely conclude that mer- cury does not always produce albuminous urine: and though we cannot say, from these few instances, that it never is a cause of the existence of that principle in the excretion, yet these cases may serve to warn the reader from depending too much upon loose assertions. I have myself observed, that urine containing albumen sometimes becomes freed from that substance by exhibiting mercury to the patient. Dr. Francis, during his late inquiries, met with such a case: and I quote the following from a note I received from him:— " The other case was one of albuminous urine. The patient was salivated: and whilst under the mercurial influence, the albumen entirely disappeared." Guy's Hospital Reports, No. xii. 1841. Colouring Principle of the Pink Deposits. Dr. Prout has lately examined this point, and comes to the conclusion that the colouring matter is not necessarily com- posed of murexid, but may be produced by the action of nitric acid or any oxygenating agent on the colouring matters of urine as well as on lithic acid. He believes, however, that nitric acid is the principal cause of such change of colour. Distinction of the more Ordinary Deposits. It is frequently desirable to form a correct judgment con- cerning the nature of the deposits, when visiting patients, and when we have not our laboratory at hand. We cannot always determine their nature from their appearance; for though the lithates are generally darker in colour than the phosphates, still they sometimes approach so nearly in external appearance, that we are scarcely able to distinguish them but by chemical means. I lately was consulted concerning the nature of a de- posit which had been regarded as phosphatic. owing to its being of a pure white. It proved to be made up of lithates. When we observe a deposit concerning which we are in doubt, the sedimentary matter can be extemporaneously examined by shaking it up in the urine, and then applying heat to a portion of the turbid fluid; if the sediment dissolves, we may at once conclude that it consists of the alkaline lithates, and, for the most part, of the lithate of ammonia;* if, on the contrary, the * These salts are often found-as deposits, in urine which holds al- bumen in solution. When this is the case, the turbid urine first be- comes clear on the application of* heat, but afterwards an opaqueness is produced by the coagulation ctf the albuminous matter. URINE. 163 action of heat fails to render the urine clear, we may be pretty sure that we operate on phosphates, or organic matter in the form of pus or mucus. These may easily be distinguished, since the phosphates are at once dissolved on the addition of hydrochloric acid, whereas the latter substances resist that solvent. Deposits of Matters accidental to the Urine. The deposits which have been observed to occur owing to the presence of ingesta in the urine are composed of lime united to the citric, tartaric, and malic acids. These salts are all reduced to carbonates at a red heat. Citrate of lime is to be distinguished by the following exa- mination :— When boiled with a solution of carbonate of potash, a car- bonate of lime is deposited, and the citric acid forms citrate of potash with the alkali present. This alkaline citrate is precipated by neutral nitrate of lead, and the precipitate collected on a filter. This is known to be citrate of lead from the fact of its being soluble in a solution of caustic ammonia. Tartrate of lime is known from the characteristic odour of tartaric acid which it evolves when subjected to a charring heat; this test distinguishes the tartrates very com- pletely. Malate of lime, like the citrate, forms an alkaline salt when boiled with a solution of carbonate of potash; but the precipi- tate in neutral nitrate of lead produced by this solution is dis- tinguished from that formed by the citrate of potash, in not being soluble in ammonia, but being very freely dissolved by boiling water, and crystallising as the water cools in fine needle-shaped crystals. Diabetes. Dr. Henry has constructed the following table, by which we are enabled to determine the proportion of solid extract con- tained in any quantity of diabetic urine, simply by ascertaining its specific gravity. In the experiments which afforded these results a steam bath was used, and the heat continued until the extract ceased to lose weight. 164 APPENDIX. Specific Gravity. compared with 1000 parts of Water at 60°. Quantity of Quantity o f solid Ex:- solid Extract in a Wine Pint. tract in a Wine Pint, in Ounces, &c. oz. dr. scr. grs. 1020 382 4 0 6 1 2 1021 401-6 0 fi 2 1 1022 420 8 0 7 0 0 1023 4400 € 7 1 0 1024 459-2 0 7 1 19 1025 478-4 0 7 2 18 1026 497-0 1 0 0 17 1027 516-8 1 0 1 16 1028 5360 1 0 2 16 1020 5552 1 1 0 15 1030 574 4 1 I 1 14 1031 593-6 1 1 o 13 1032 612-8 ] 2 0 12 1033 6320 1 2 1 12 1034 051-2 1 2 2 11 1035 670-4 1 3 0 10 1036 6896 1 3 1 9 1037 708-8 1 3 2 8 1038 728 0 1 1 4 0 8 1030 7472 ! i 4 1 7 1040 766-4 ! i 4 2 r. 1041 785-0 i 5 0 5 1042 804 3 i 5 1 4 1043 824'0 i 5 2 3 1044 8432 i G 0 3 1045 8S2 4 i 6 1 o 1016 881 S l 6 2 1 1017 9oo-a | l 7 0 0 11148 9-20-0 l 7 I 0 1049 93-' 2 i 7 ] I'.i 1050 908-4 l " 2 IS The quantity of solid matter voided by diabetic patients is thus to be ascertained without the delay of evaporation. I have had occasion to test the correctness of this table, and can recom- mend it as calculated to afford most satisfactory results. Torulse in Diabetic Urine. This fungoid vegetable growth, which is delineated on the plate fig. 15., is characteristic of the existence of fermentation, and its presence may be regarded as a very correct microscopic test of the presence of sugar. Urine containing the Principles of Milk.—Kiestein. There is a substance of a caseous character which has been called kiestein, and gravidine, occasionally found in the urine of women during gestation. I have had several opportunities URINE. 165 of examining this, and believe it to be the caseous matter oi milk altered by passing through the kidney. In several cases of advanced pregnancy I was enabled to detect the presence of milk globules in such urine, and that too in considerable num- bers, so as to leave no doubt as to the real origin of the so- called kiestein. Fatly or Chylous Urine. I lately had an opportunity of examining a specimen of chy- lous, or chylo-serous urine, and being at the time engaged in the microscopical and chemical examination of chyle, was ena- bled to determine the existence of chyle in the excretion satis- factorily to my own mind. The microscopical appearances were such, indeed, as to leave but little doubt that in this form of disease the chyle passes through the kidney. The ordinary chyle granule and globule could be easily detected with the fatty globules intermixed. This kind of urine occasionally deposits a coagulum. The specimen I examined, however, remained unaltered by rest, and had quite the appearance of milk. The specific gravity was 1*021, and it was slightly acid, and remained so for several days. Agitated with ether, it be- came transparent, the ether dissolving: out the fatty matter. These fats were soluble with difficulty in alcohol, and did not saponify with caustic potassa. When incinerated they yielded an alkaline ash. The urine, when cleared by ether, proved to contain albumen, being coagulable by heat and nitric acid. A GUIDE TO THE EXAMINATION OF THE UlllNE IN HEALTH AND DISEASE, FOR THE USE OF STUDENT'S. BY ALFRED MARKWICK, SURGEON TO THE WESTERN GERMAN DISPENSARY ; MEMBER OF THE PARISIAN MEDICAL SOCIETY; AND FORMERLY EXTERNE TO THE HOPITAL DES VENERIEN3, PARIS, &C. &C. PHILADELPHIA: LEA & BLAN C II A 111). 1848 PREFACE. The great inpulse that has lately been given to the study of Chemical Pathology has thrown considerable light on many obscure subjects, and effected the solution of various difficult, and hitherto uncomprehended problems. Yet, however important the knowledge thus gained may be, there still remains a great deal to be obtained. The names of Prout, Bird, Bright, Willis, Percy, Day, Jones, &c, in our own country, and of Berzelius, Liebig, Lecanu, Rayer, Becquerel, Simon, and Lehmann, on the Continent, will ever be remembered by those interested in chemico-pathological investigations, and need only to be mentioned to bring others into this daily increasing field of interesting research. The urinary secretion is the chief, and at the same time, the most important subject of attention in this branch of science. I have, therefore, endeavoured in the following pages, to give a clear as well as correct description of its composition, both in Health and Disease, and of the various modes of detecting its several normal and abnormal ingre- dients, with a view to present the Student with a Manual or Pocket Companion that may be useful to him while IV PREFACE. prosecuting his Hospital Studies. I have strenuously avoided all discussion, preferring to confine myself simply to the narration of such facts, relative to this very important fluid, as it will then be necessary for him to be possessed of, leaving him to refer to other and more elaborate treatises for more detailed information on urinary diseases. Should I succeed in my object, my labour will be fully repaid by the satisfaction, the knowledge of having done so will be to me. 19, Langham Place, September, 1817. CHAPTER I. 1. Two very important actions are continually taking place in the body. They are, First, the Destruction or Metamorphosis of the different tissues of which it is com- posed ; and, Secondly, the Deposit of fresh materials for their nutrition and repair. Both are admirably effected by the blood, a fluid which takes up the different decomposed and waste matters, and carries to every part its requisite nutritive materials ; the former act constituting the second or destructive stage of the secondary assimilating process of Dr. Prout, or in the words of Professor Liebig, the meta- morphosis of the tissues, and the latter the primary or forma- tive stage of the same process. In order, therefore, that the blood may be fitted for its purposes, it is evident that fresh blood must be continually formed in order to make up for the loss it sustains, and that it requires to be continually purified. This we find to be accomplished by digestion and respiration, the one separating and rearranging the nutritive matters of our food, the other, through the influence of the atmosphere, converting them into blood ; and lastly, by the various secreting and excreting organs which remove from it the various matters with which it becomes impreg- nated during the destructive processes, some of these being perfectly effete or excrementitious, answering no further purpose in the (Economy, but which, if retained in the sys- tem, produce very serious, and even fatal consequences. The excreting organs are of two kinds ; first those which separate from the blood, its superabundant carbon and hy- drogen, namely, the liver, the lungs, and the skin; the first in the shape of bile, and the two last as carbonic acid and water ; and, secondly, those which remove from it its highly azotised compounds, such as the urea and lithic acid, 6 MARKWICK ON URINE. namely, the kidneys. To the latter, and to the skin, too much attention cannot be paid, as it is upon the due and proper performance of their respective functions that our health may be said in a great measure to depend. In fact, how frequently we are called to cases which have entirely arisen either from the suppression, or imperfect excretion of the perspiration or of the urine ; and was it not for the wise provisions of nature (which we can but admire) in enabling one excreting organ to antagonise, or, in other words, to compensate for, the deficient action of another, we should, considering the great and frequent changes to which these two excretions are liable, both as to quantity and quality, from various and constantly occurring causes, be continually the subjects of disease. It will be seen, therefore, that the relations or sympathies, if I may so term them, that exist between the different ex- creting organs, are of the utmost importance in preventing the imperfect performance of their respective functions, from frequently giving rise to some morbid condition of the system. Thus, when the functions of the skin are im- peded those of the kidneysare increased, and vice versa, and when the powers of respiration are diminished they are re- placed by an increased activity of the liver; and lastly, when the latter is sluggish, the kidneys make up for the de- ficiency, by excreting a larger quantity of carbonised mat- ter. Unfortunately, however, this compensating effect does not always take place ; hence it is that when an organ has been previously diseased and consequently weakened and rendered susceptible of, or predisposed to, further morbid action, it is almost sure to suffer, when, from any cause, it is called upon for increased exertion. Numerous examples of this fact are presented to us by the kidneys, than which, there is, I should say, no organ more susceptible of derange- ment, or whose secretion is subject to so much variation, both in health and disease, and from the slightest causes ; and this cannot be wondered at when we consider that these organs are the emunctaries by which not only a consider- able portion of the waste matter that is of no further use to the system is got rid of, but also large quantities of fluid with which the blood becomes overcharged after copious draughts of liquid, and various other matters which have MARKWICK ON URINE. 7 entered the circulation after a repast. It is evidently there- fore very essential that we should be thoroughly acquainted with the normal composition and character of the urinary excretion, and at the same time able, not only to discover any deviation from the healthy standard, but also correctly to ascertain in what that deviation consists. And this has of late years become the more necessary in consequence of the valuable researches, on this subject, of Prout, Becque- rel, Bird, Liebig, Simon, and others, who have thus ren- dered the study of urinary diseases extremely interesting and useful. In fact, as Dr. Bird has remarked " Med. Gaz. for Feb. 10, 1843:" " the examination of the urine in disease is now regarded as one of the most important aids in diagnosis, and which it would be alike injurious to the welfare of the patient, as to the credit and reputation of the practitioner to avoid." I propose then, first, to speak of the properties and com- position of healthy urine and the various modifications it is liable to undergo, both in health and disease, and after- wards to describe the mode of analysing it. o 8 MARKWICK ON URINE. CHAPTER II. 2. The urine is a fluid composed of certain effete, animal, and saline matters, which have been separated from the blood by the kidneys.* In health, immediately on being passed, it is in adults, transparent, of an amber colour, something like that of Sherry wine, and of a temperature varying between 95 degs. and 100 degs. Farhn. It has a bitter, disagreeable, saltish taste, which is more or less marked according as the urine is more or less concentrated ; an acid reaction on litmus, and a peculiar somewhat aro- matic odour, which is said to resemble that of violets. This on cooling goes off, and becomes replaced by one, sui- generis,, to which the term urinous has been applied; this also disappears in a few days, but may be restored by heating the fluid, and is succeeded by one resembling sour milk, and lastly by one of fetid ammoniaco-alkaline cha- racter. The urine of infants on the contrary, is almost co- lourless and without smell when passed, but evolves an odour on standing resembling that of veal broth. It has scarcely any reaction on test paper, and is very low in density. 3. The odour, however, is liable to be greatly altered by certain articles of food, such as asparagus, onions, gar- lic, &c, and by some kinds of medicine, as turpentine, co- paiba, assafcetida, and the essential oil of the juniper berry, each of which imparts to the urine its peculiar character- istic fragrant principles. It is likewise considerably in- fluenced by disease. Thus it is particularly strong in all cases of fever and inflammation, for instance, and slight or * The urine was formerly supposed to be secreted from arterial blood. Mr. Bowman has, however, attempted to prove in a paper, published in the Philosophical Transactions for 1842; also Med. Gaz. vol. xxx, " On the Structure and use of the Malpighian bodies." that it is like the bile separated from venous blood. MARKWICK ON URINE. 9 even entirely wanting in those of anaemia and hysteria; while in diabetes immediately the urine is voided, it re- sembles that of whey, and subsequently, when fermentation commences, is of an alcoholic najure. 4. The colour also varies and depends in a great measure on the degree of concentration of the secretion. Hence it is generally darker in summer than in winter, owing to the solid contents of the urine being relatively increased at this season. It is, generally speaking, somewhat darker in men than in women, owing, I fancy, in a great measure, to their more active exertion, causing an increase of the cutaneous exhalation, and thereby diminishing the amount of fluid in the urine. It is also greatly modified by particular states of the system, by certain articles of food, and by some me- dicines. Thus, it is deep in febrile affections, pale in nervous diseases, ansemia, &c, and yellowish or of a dirty brown in bilious disorders. It is of a more or less deep brown in proportion to the animal diet of the person, and when chimaphila or the pareira brava have been adminis- tered ; reddish after the ingestion of beet-root, the prickly pear (Cactus Opuntia;) and hgematoxylon, and yellowish when rhubarb has been taken. Rayer also states that the urine of an epileptic patient had a light green tint after a few day's use of sulphate of indigo, in doses of from one to three drachms in the course of twenty-four hours ; and De Velseu gives an instance of an old man affected with chronic inflammation of the bladder in whom it became of a deep violet colour after the use of lime water mixed with milk.* Drs. Prout and Simon have also met with cases in which it was of a dark blue owing to the presence of indigo which in all probability had become generated in the system. It is likewise much altered by foreign substances, as blood, pus and bile, the former renders it of a dirty red, brown or black, the second of a dirty yellowish white, and the last of a more or less deep yellow, sometimes approaching to a dark brown, or even black. 5. Dr. Prout is of opinion that the colour of the urine is due' to the presence of two colouring principles, one of * Quoted in the Med. Gaz. for August 8th, 1845, from Heller's Archive Heft 1, 18-1-1. 10 MARKWICK ON URINE. which is closely allied to lithic acid and lithate of ammonia, and gives them their yellow* colour, and the other to some modification of the colouring matter of the bile ; and he be- lieves both to be intimately connected one with the other from the circumstance that lithic acid and the biliary co- louring principle are similarly affected by. nitric acid. Simon believed the first to be identical with the yellowish brown matter, viz. the hcemaphdein that is extracted from the dried serum of the blood by ether and alcohol.* Bec- querel also supposes the colouring matters of the urine to be composed of two others ; one of a greenish and the other of a reddish colour, and he states that the latter generally pre- dominates when the urinary secretion is high coloured and loaded with uric acid and organic matters. This is perfectly in accordance with Dr. Prout's statement. Berzelius has applied the term halophyle to the yellow colouring matter of the urine, in consequence of the great difficulty of sepa- rating it from the saline principles of the secretion. Heller, on the other hand, has given it the name of wroxanthin, which he says " occurs in solution in very small proportion in healthy urine, but is much increased in certain forms of disease."! 6. Some discrepancy of opinion exists respecting the pigment which gives to the urine and its lithic deposits that peculiar rose and purple tint in certain cases of derange- ment of the portal circulation. Dr. Prout considers it to be the purpurate of ammonia, the murexid of Liebig. Dr. Bird believes it to be a principle very different to this, and to which he has given the name of Purpurine. His reasons for differing from Dr. Prout are founded on the different be- haviour of the two substances towards certain reagents; and on the latter being soluble and the former insoluble in al- cohol ; while M. Rayer thinks it is the rosacic acid of Vau- quelin. Simon describes a principle closely allied to it under the name of uroerethrin; and Heller states that the yellow pigment of the urine, which he has termed uroxan- thin, " possesses the property of being converted by oxida- tion, (either spontaneously or artificially,) in two other pig- ' Simon's Handbuch, b. 1. s. 328. j Simon's Animal Chemistry, by Day, vol. ii. p. 52*2. MARKWICK ON URINE. 11 ments, one of which is of a ruby-red tint, urrhodin" and no doubt identical with the purpurine of Dr. Bird, " w-hile the other is of the colour of ultramarine, (uroglaucin." They both " occur in diseases different in most of their cha- racters, but similar in one—the presence of an excess of urea in the blood: thus they are found in Bright's disease, in cholera, and in suppression of urine. Further, when these products occur in considerable quantity, (especially when the blue sediment is spontaneously formed,) there, is always much carbonate of ammonia, and very little urea (perhaps mere traces) in the urine, as is often the case in Bright's disease. Finally, Heller has observed the blue tint developed by nitrate of urea artificially prepared and kept moist, and has likewise produced it by adding nitric acid to an old solution of urea, partially converted into carbo- nate of ammonia,"* and hence they are in all probability, together with the uroxanthin, derived from urea. Scherer states as the results of his experiments that the colouring matter of urine is allied to both that of the blood and bile and he is led to believe that it is formed from the luematin of arterial blood, and that its formation is anala- gous to that of the urea and lithic acid. He states its com- position to be as follows: Carbon . • 58*43 Hydrogen . • 5*16 Nitrogen . • 8.83 Oxygen . • 27.58 100.00 In those diseases accompanied by an inactive state of the lungs and of the liver, and by rapid metamorphosis of the tissues, the two first elements become remarkably increased The opinion therefore expressed by Dr. Bird, namely: that an excess of this matter in the urine may be considered as an evidence of the kidneys performing a compensating function for the lungs and liver receives very strong cor- roboration ; and the great similarity that is found to exis between the composition of the normal colouring matter of * Simon's Chemistry. 12 MARKWICK ON URINE. the urine as given above, and that of purpurine, of the bile pigment, and of the urinary colouring matter in jaundice, still more confirms it. The following are the respective compositions of these principles according to Dr. Bird :— Urinary colour-ing mailer of jaundice. Urinary colour-ing mattrr in or-ganic disease of the liver. Bile Pigment from urine. Carbon . . . Hydrogen. . Nitrogen . . Oxygen . . . 60*19 6*68 I 34*25 65*76 6*01 J 28*23 68*182 7*437 < 7*074 { 17*261 A non-nitrogenized diet has likewise the effect of in- creasing, although not in equal proportions, the quantity of carbon and hydrogen passed with the urine, even when there is no alteration in the amount of exercise taken or of oxygen absorbed. An excessive secretion of this principle for any length of time, gives rise, according to Scherer, to anaemia and emaciation. 7. The quantity of urine passed in twenty-four hours has been differently stated by different authors. Thus, Haller estimated it a 49 ounces ; Simon at 45 ; Bostock and Rye at 40; Venables considered it to average between 40 and 50; Rayer between .21 and 57; Becquerel about 46, and Dr. Prout between 30 and 40 ounces. Becquerel also states that it may range within the limits of health between 28 and 53 ounces. Dr. Prout's estimate will I think on the whole, for this country at least, be found the most cor- rect. It appears to be somewhat less in men than in women, according to Becquerel; although the contrary is stated to be the case by Dumas and Burdach. 8. The quantity, however, is much influenced by various circumstances. It is generally found to be increased in cold and damp weather; by a vegetable diet, and according to Mr. Erichsen,* during the process of digestion, a short time after its commencement, and by exercise ;f by certain * Med. Gaz. July 4, 1845. f Exercise has generally been supposed to diminish the secretion of urine; but 1 think when we consider that any thing which accele- MARKWICK ON URINE. 13 medicines, as squills, digitalis, colchicum, and various resinous and saline compounds, particularly the salts of soda, &c, and by the ingestion of large quantities of watery and aerated fluids. In order, however, that liquid potations may have the effect of increasing the quantity of the urinary secretion it is necessary, as Professor Liebig, has proved, that their density should be less than that of the blood, otherwise instead of being absorbed into the circulation they attract water from the blood on the principle of exosmosis, causing the sensation of thirst, and eventually become dis- charged by the bowrels. Hence it follows that to ensure the action of a diuretic salt it should be given in a very diluted state. It is diminished in hot and dry weather: and when the cutaneous and pulmonary exhalation, and the alvine excretions are augmented; and according to Bou- chardat by alcoholics. It also varies-considerably in cer- tain morbid conditions of the system; thus it is increased in Diabetes, Polydipsia, Hysteria, and other nervous affec- tions, and likewise by fear, mental emotions and grief; and is diminished in cases of fever and inflammation, rheuma- tism, disease of the liver, and hepatic and cardiac dropsies. 9. The natural transparency of healthy urine is liable to be disturbed whenever the proper relative proportions of its constituents are altered, or when it contains some preter- natural or foreign matter. Hence it is that urine frequently becomes turbid from the presence of mucus, pus, or blood; from an excess of lithic acid or lithate of ammonia; from the superabundance of the phosphates, or in consequence of the decomposition which the fluid undergoes in disease, or by keeping. Some of these form a kind of scum on the surface of the urine, and constitute what is termed a pellicle; others float in it near the surface, and form a cloud; while others again become precipitated to the bottom of the con- taining vessel and give rise to a sediment. Dr. Bird has included the whole under the term of urinary deposits, which he has divided, into the four following classes. rates the circulation must tend to stimulate the secreting organs, we should have been perfectly justified in supposing the contrary, as now proved to be the case by the investigations of Mr. Erichsen. 14 MARKWICK ON URINE. Class 1.—Deposits composed essentially of ingredients formed directly or indirectly from the metamorphosis of tissues, or from the inorganic elements of food capable of assuming a crystalline form. Uric Acid and Urates. Uric Oxides. Oxalate of lime. Cystine. Class 2.—Deposits composed of ingredients of inorganic origin ; including:— Phosphate of lime. Ammonio-phosphate of magnesia. Carbonate of lime. Silicic Acid. Class 3.—Highly coloured deposits (black or blue) of doubtful origin:— Cyanourine. Melanourine. Indigo. Prussian Blue. Class 4.—Deposits consisting of non-crystalline organic products ; including:— A. Organised. Blood. Pus. Mucus. Organic Globules. Epithelium. Spermatozoa. Torulse. Vibriones. B. JYon-Organised. Milk. Fatty Matter. Stearolith. MARKWICK ON URINE. 15 10. Its consistence varies with its density, and with the presence of foreign matters. Thus the greater the specific gravity, the more consistent the urine, and vice versa. It is also increased by mucus, blood, pus, albumen, sugar, and oxalate of lime, and by an excess of lithic acid. 11. The specific gravity is subject to much variation. Like the consistence it depends on the degree of concen- tration of the urine, and on the presence of foreign matters, and has been stated by different authors to oscillate between 1.010 and 1.020. Thus M. Becquerel gives 1.018 as the mean in men, and 1.015 in women. Simon places the average at 1.012.6 ; Lecanu at between 1.020 and 1.030; Dumas at between 1.015 and 1.030, and Aldridge at 1.015; while Dr. Prout thinks 1.020 will be a more correct average for this country. 12. The specific gravity however differs, according to the specimen of urine examined, whether it be that passed on rising in the morning, or that excreted after copious liquid potations, or that voided after a meal. Hence, and from the particular source from which each is derived, the division of the urine into three different kinds. 1. The Urina Sanguinis, the urine of the blood, or morning urine. 2. The Urina Potus, and 3. The Urina Chyli, or of di- gestion. The first which may be considered as the urine par excellence, varies in density from 1015 to 1025 ; the se- cond being oftentimes excessively dilute is of extremely low weight, and in some cases indeed little heavier than dis- tilled water: while of the third, or the urine from food, the specific gravity is generally considerably increased both in health and disease, and may be said to range between 1020 and 1030. 13. Dr. Schweig states that there is a constant rate of increase and decrease in the density of the urine through- out the day, and that, cceteris paribus, it varies in the morn- ing from 1.017 to 1.022; in the afternoon from 1.023 to 1.028; in the evening from 1.019 to 1.028; and in the night from 1.022 to 1.025. Moreover, that the specific gravity of the night urine passes through certain limits in a cycle of six days, attaining a minimum twice in thatperiod. The following table represents the average density of twenty such periods. 16 MARKWICK ON URINE. ights of the Cycle. D< jnsity of the Urine 1 . . . 1.022 2 . . . # 1.017 3 . . . . 1.019 4 # 1.020 5 . . . # 1.019 6 . . . . 1.017 From this it appears that the specific gravity is higher on the first night and lower on the second and sixth than on any other. According to Dr Schweig five of these cycles occur in each lunar revolution, the night previous to the new moon being counted as the second day of one of the cycles.* 14. In consequence therefore of this variation in the density of the urine at different times of the day, it is ne- cessary, in order to avoid error, and for the sake of perfect accuracy, that three things should be attended to. The first is to collect the whole of the urine evacuated in twenty- four hours, otherwise we may be led to suppose from the low density of a given specimen of urine, that the amount of solids excreted in twenty-four hours is much below the healthy standard, whereas it may not only not be at all di- minished, but on the contrary, somewhat increased. In fact so important is this in disease that were we to neglect it we should be frequently liable to error, as an excess of the solid constituents of the urine, relatively to the quantity of water it contains may be present in a particular sample voided at a certain time, when the amount excreted in the twenty-four hours does not exceed, or perhaps is not so great as that in health, and vice versa. The second is to ascertain the quantity of its watery portion; for in propor- tion as this is increased or diminished, so will the density, ceeterisparibus, be decreased or augmented. Consequently if the quantity of urine passed during the day be not greatly above or below the normal standard and its specific gravity is very lowr, we may conclude that the proportion of its solid ingredients has considerably diminished ; but, if on the other hand, we find the amount of urine is much greater than natural, then we may attribute the diminution in den- * See Dr. Bird's work on Urinary deposits, Second Edition, page 32. MARKWICK ON URINE. 17 sity to the proper relative proportions that normally exist between the solid and fluid portions of the urine having be- come destroyed. And we must not, as I have just now alluded to, suppose that the decrease of specific gravity from this cause is the criterion of the urine of a given time containing a less amount of solid matter than it should do, as the very reverse will, in all probability, be found to be the case. Again if the amount excreted in the twenty-four hours be normal or even greatly augmented, and the spe- cific gravity high, we may confidently assert that the altera- tion is due either to an excess of urea or to the presence of some extraneous matter such as sugar. The third is to examine its temperature: for Simon found that urine of specific gravity, 1020.75, at 59 degs. Farh., became re- duced to 1019.85 when the temperature was increased to 64 degs. and increased to 1021.46 when it was lowered to 53 degs. Farh. 15. It often happens that we are unable to collect the whole of the twenty-four hours urine, either from the patient being ignorant of its importance, and in consequence unwilling to strictly attend to the rnquisite precautions, or from his in- ability to suppress the evacuation of the bladder when un- loading the bowels. In this case we must be content with the average density presented by the urine that is passed after a night's rest, and by that excreted after digestion on going to bed, which will be generally sufficiently accurate for all practical purposes. 16. The urine in some cases possesses certain optical proper- ties which have been taken advantage of as a means of diagnosis. They have been employed principally in the de- tection of saccharine diabetes, in which disease, as also in albuminuria, the urine has the power of producing the cir- cular polarization of a polarized beam of light. The ob- stacles and difficulties, however, attending this method, are such as will, in all probability, prevent its ever coming into general use,* notwithstanding all that has been said in its favour by Bouchardat and Biot; and moreover Dr. Leeson has proved that it is by no means to be depended on.f 17. Various analyses have been given of the urine. Ac- * See a translation of Bell on Diabetes by the author, page 17. f See part vii. of the Memoirs of the Chemical Society. 18 MARKWICK ON URINE. cording to Berzelius 1000 parts consist of 933 of water and 67 of solid ingredients, 30.10 of which represent urea and 1 uric acid ; the remaining 35.90 being constituted by 17. 14 of organic matters, such as the lactic acid, the lactate of ammonia and colouring principles, &c, by 18.41 of al- kaline and earthy salts, as the sulphates of potash and soda, the phosphates of soda, ammonia, lime and magnesia, the muriates of soda and ammonia, and a trace of fluate of lime, and by 0.32 of vesical mucus, and .03 of silex. It is much to be regretted, however, that this distinguish- ed chemist has not informed us either of the kind or the density of the urine he examined ; but we have every reason to believe, from the large proportion of solids it con- tained, that it was a specimen much above the normal standard, and therefore cannot be considered as a type, with which all calculations and investigations both in health and disease are to be compared. 18. Becquerel's analysis, as modified and arranged for this country by Dr. Prout, has been generally considered as more approaching the truth, and is given in the following table. TABLE I. Which shows the average .Yormal Quantity, Specific Gravity, and Composition of the Urine in t/iis country. Quantity, Specific Gravity, and Composition of the Urine. Urine in 24 iComposition hours. of 10(10 partf. Quantity of Urine.....35 fld. oz.1000 Specific Gravity......! 1.020 I General ( Water .... \ 14807 grsJ 967 Composition ( Solid Matters . . \ 505 | 33 L 226.802 7.190 146.467 Water.........|14807 grs, 967. Urea.......... Lithic Acid........ Organic f Lactic Acid . . . ] matters in- j Lactate Ammonia. . I separable 1 Colouring matters . I from each | Extractive matters . I other . [ Muriate Ammonia . j Fixed salts f Chlorides [ Lime . ] indecom- j Phospha- j Soda posible at | tes j Potash a red heat [ Sulphates [ Magnesia j 14.230 .468 10.16* 124.5416 8.135 15312.000 1000.000 MARKWICK ON URINE. 19 Composition of the entire quality of Fixed Salts voided in 24 hours ; and in a 1000 parts of urine. (a) Fixed Salts hours Chlorine . . . Sulphuric Acid . Phosphoric Acid . Potash .... Soda C Lime < . . Magnesia ( Here the solid matters are represented in the proportion of only 33 instead of 67 in 1000 parts of urine, the speci- fic gravity being 1020 ; an amount which will be seen to but little exceed the proportion of urea, and to be not quite one half that of the whole of the solids stated by Berzelius to be present in the same quantity. 19. This amount however appears to be much too small from the researches of Dr. Day,* who has proved the for- mula A X 2.33 of Dr. Christisonf to be more accurate than that of either Dr. Henry or Dr. Becquerel, which are A X 2.58 and A x 1.65 respectively ; the average error from using it being only .47 in 1000 parts, while the mean error of Dr. Henry's formula is 7.71 and that of Dr. Bec- querel, 21.92. The following table has therefore been constructed for the purpose of showing the probable composition of the urine according to Dr. Christison's formula. * Lancet vol. i. 1844, p. 373, X Library of Medicine vol. iv. p. 248. voided in 24 (b) Fixed Salts in 1000 parts. . . 9.04 .591 . . 15.39 Sulphuric Acid . . l.OOfi . . 5.72 Phosphoric Acid .' .373 . . 23.40 Soda . . . . 1.529 . . 70.99 Lime . . . Magnesia . . . { 4.638 124.54 8.137 20 MARKWICK ON URINE. TABLE II. Quantity, Specific Gravity and composition of the Urine. Quantity of Urine........ Specific Gravity........ Urea............ Uric Acid.......... Peculiar Azotised principle (Pettenkofer) Hippuric Acid......... Organic 1 matters in- | Colouring matters . . ~) separable ^ Extractive matters . . > from each J Muriate Ammonia . . ) other. J Fixed Salts } Chlorides ( Lime . ~\ indecom- ( „, , . j Snda . r ., , . > Phosphates < D , u > posible at a( r ) rotash . C red heat . 3 Sulphates ' Magnesia j Total amount of Solids..... Quantity of Water...... Total amount of Urine .... Urine in 24 Composition hours. j of 1000 parts. 35 fl. OZ. I 1.000 1.020 ' 304.550 9.999 76.600 7.365 140.929 a 174.118 19.889 0.653 5.000 0.481 9.206 b 11.371 713.561 14598.939 46.600 953.400 15312.500 1.000.000 Composition of the entire quantity of Fixed Salts voided in 24 hours; and in 1000 parts of urine. (a) Fixed Salts voided in 24 (b) Fixed Salts in 100 hours. parts. 12*64 0.826 Sulphuric Acid . . . 21.52 Sulphuric Acid . . 1.406 Phosphoric Acid . . 7.97 Phosphoric Acid . . 0.521 Soda } i Soda ) 99.25 Lime . . . Lime > .... 6.482 Magnesia ; Magnesia ; 174.10 11.372 20. Lehmann states the average amount of solid ingre- dients to be as follows: MARKWICK ON URINE. 21 After a mixed Diet........„. 1.047.000 " an Animal Diet........1.349.898 " a Vegetable Diet........ 914.541 " a non-nitrogenous diet...... 643.455 and Lecanu informs us that the composition of the urine will be found to vary but little in the same individual at stated times, but that very great differences will be found in the secretion of different persons. 21. Its solid contents however generally become di- minished in debilitated states of the system, and when the blood corpuscles are decreased in number, although in land scurvy Heller detected a slight increase. The proportion in this disease was in one case 50.72, the specific gravity being 1.021. M. Chambert, in a memoir presented to the Academie des Sciences, on the 2d June, 1845, deduces as the results of his investigations. 1st, That the urine of the food contains more saline matter than that of the blood; 2d. That the inorganic principles are in a direct ratio with the quantity of salts introduced with the food. 3d. That the saline ingredients are more abundant in the urine of the blood in proportion as they exist in larger quantity in that of digestion. 4th. That there is no relation between the saline matter and the specific gravity of the urine, or be- tween them and the organic principles. 22. The ingredients held in solution in healthy urine may with Dr. Bird be arranged under the three following heads. I. Organic Products. 1st. Ingredients characteristic of the } Urea, Uric acid, eolour- secretion produced by the destructive ( ing and odorous principles, assimilation of tissues, and separated I and a crystalline nitrogen- from the blood by the kidneys. J ised body. 2d. Ingredients developed principal-) Hippuric acid, lactic aeidl Jy from the food during the process of V amJ a'c|,idental consthuent9. assimilation ; II. Saline Products. 3d. Saline combinations separated ) Phosphate8, Chloride of from the blood, and chiefly derived > q.j:, ' , ' J i boaium. from the food. ) 4th. Saline combinations chiefly} generated during the processs of de- > Sulphates. structive assimilation. ) 22 MARKWICK ON URINE. III. I.NGREDIF.*TS DERIVED FROM THE URINARY PASSAGES. 5th. Mucus of the bladder. 6th. Debris of epithelium. Under the^rs^ head are placed those elements which are destined to be secreted by the kidneys from the blood, and to the presence of which in the urine, the characteristic properties of the latter are due. Under the second are classed several saline compounds most of which are present in the various other secretions, the sulphates alone appear- ing to be peculiar to the urine; while under the third head we find certain matters common to all secretions passing over mucous membranes. I. Organic Products. 23. Urea enters more largely than any other substance into the composition of the urine. It is described by Dr. Prout as assuming the form of four sided prismatic, colour- less, transparent crystals, of a pearly lustre, which leave a sense of coldness on the tongue like nitre. It has a faint and peculiar, but not urinous, smell, is neither acid, nor alkaline; undergoes no change on exposure to the air, except in very damp weather, when it slightly deliquesces, but does not seem to be decomposed. Pulverized and mixed with salts containing water of crystallization it sepa- rates the latter, and the mass becomes either soft or perfectly liquid according to the quantity of water contained in the saline substance. It also has a singular effect on the crys- tallization of particular salts. Thus it converts the natural cubical form of chloride of sodium (common salt) into the octahedral, and the characteristic octahedral shape of hydro- chlorate of ammonia into the cuboid. Its specific gravity is 1.35; is soluble in its own weight in cold and any propor- tion of hot water; and in four and a half parts of cold, and about two parts of boiling alcohol, from which latter it separates in a delicately crystallized form on cooling* Urea has no neutralizing power but combines with acids, espe- cially the nitric and the oxalic. 24. The nitrate of urea is represented by Drs. Prout and Lehmann as being composed according to their analyses of MARKWICK ON URINE. 23 one equivalent of nitric acid and one equiv. of urea. Reg- nault, and more lately Heintz, on the other hand, have found it to contain one equiv. of water in addition. The following is the composition of 100 parts of this salt as o-iven by different chemists. Prout. Lecanu. 3farchand. Nitric Acid.....47.375 - 47.00 - 66.11 Urea.......52.625 - 53*00 - 33.89 100.000 - 100.00 - 100.00 Regnault ty Becquerel. Heintz. Nitric Acid .... 43.781 - 44.14 Urea......48.938 - 48.86 Water......7.231 - 7.00 100.000 - 100.000 Oxalate of urea contains in 100 parts according to Ber- zelius, Oxalic Acid . . . 37.436 Urea.....62.564 100.000 25. In the opinion of M.M. Cap and Henry, urea exists in the urine, partly in combination with lactic acid. This however is doubted by Pelouze* Lecanu, Liebig, and Dumas; the latter indeed seems more inclined to believe that it is present in a free state, but nevertheless believes it possible that it may exist in combination with sal ammo- niac and chloride of sodium* to a greater or less extent. 26. Dr. Prout from his analysis gives the composition of urea as follows: Carbon . . . 19.99 Hydrogen . . • 6.65 Nitrogen . . . 46.65 Oxygen . . . 26.63f * Med. Times, vol. xvi. p. 29. f Thomson's Annals, vol. xi. p. 353 3 24 MARKWICK ON URINE. Wohler and Liebig represent it as being composed of Carbon . . . 20.02 Hydrogen . . • 6.71 Nitrogen . . . 46.73 Oxygen . . . 26.54* 27. Its formula is C„ 02, H4, N2,. Hence it will be seen to represent either one atom of Cyanogen, two of water, and one of Amidogen thus: C. N. H. O. 2+1 = one atom cyanogen. 2+2 = two atoms water. 1+2 = one atom amidogen. 2 + 2 + 4 + 2 = one atom urea. Or two atoms of carbonic oxide and two of amidogen thus: c. N. h. o. 2 2 = two atoms carbonic oxide. 2 + 4 = two atoms amidogen. 2 + 2+4 + 2 = one atom urea. 28. Its formula also readily explains the formation of the cyanate and carbonate of ammonia, and oxalic acid in the urine. For by abstracting one equivalent of water from one of urea we have the composition of one atom of cyanate of ammonia. c. N. h. o. 2 + 2+1 + 2 = one atom urea. minus 1 + 1 = one atom water. gives 2 + 2 + 3 + 1 = one atom cyanate ammonia. and if we add two equivalents of water to one of urea we * Poggend. Ann., xx. p. 375. MARKWICK ON URINE. 25 have the composition either of two atoms of carbonate of ammonia as follows: C. N. H. O. 2 + 2 + 4 + 2= one atom urea. plus. 2 + 2 = two atoms water 2ives. 2 + 2 + 6 + 4 which is equal to 2 4 = two atoms carbonic acid 2 + 6 = two atoms ammonia. 2 + 2 + 6 + 4 Or of one equivalent of oxalic acid, two of ammonia and one of oxygen, thus: C. N. H. O. 2 + 2 + 4 + 2 = one atom urea. plus 2 + 2 = two atoms water. gives. 2 + 2 + 6 + 4 which is equal to 2 3 = one atom of oxalic acid. 2+6 = two atoms ammonia. 1 one atom oxygen. 2 + 2 + 6 + 4 Another probable source of the oxalic acid occasionally met with in the urine will be alluded to under the head of uric acid, (32.) The above is Dr. Bird's hypothesis.* 29. The conversion of the urea into carbonate of am- monia occurs much more rapidly, generally speaking, in warm weather than in cold ; and also when the urine con- tains a good deal of mucus, which, in that case, by under- going putrefaction may, according to Dumas, act as a fer- ment But in order that putrefaction may take place in the healthy secretion it is essential, as proved by the researches * Guy's Hosp. Reports for April, 1842. 26 MARKWICK ON URINE. of Guy-Lussac, that the atmospheric air, or rather the oxy- gen contained in it, should have free access to the fluid. For it appears that so long as this is excluded from the air by being confined in well stoppered bottles, its odour, trans- parency, and natural acid reaction remain unaltered, uric acid being alone deposited ; whereas if placed in contact with the air, the oxygen of the latter becomes absorbed and may, by combining with the nitrogenous extractive princi- ples of the urine, in the opinion of M. Dumas and Dr. Al- dridge, and with the colouring matter as believed by Liebig, probably transform these substances into nitrogenized fer- ments which are thrown down in an insoluble state, and the urea into carbonate of ammonia, which, by rendering the urine alkaline, causes the phosphate of lime and triple phosphate to be also precipitated. Still it not unfiequently happens, however, that this change, namely the conversion of urea into carbonate of ammonia, takes place in the blad- der, into which no air is ever admitted; and I have no doubt, even in some cases, although it has been stated to the contrary, previous to secretion, the urine being under those circumstances passed in an alkaline condition. I shall have occasion to refer more particularly to this important fact bye and bye. 30. Moreover it would appear from the late investiga- tions of Drs. Sunderland and Rigby, that this metamorpho- sis is very prone to take place during certain forms of men- tal derangement. Thus they found that in dementia the urine effervesced on the addition of an acid in 34.37 per cent; in melancholia 30, and in mania, 16,67 per cent; and that in the first mentioned affection, the urine when passed in an acid condition, has a tendency to very speedily become alkaline.* Dr. Erlenmeyer however states that the urine of maniacs, which he says is generally pale and de- ficient in solid constituents, particularly lithic acid and its compounds, is more disposed to be alkaline than that of melancholies; and he considers that in proportion as there is a greater disposition in the latter class of cases for the urine to assume an alkaline reaction, without there being any accompanying organic affection either of the brain or * Me& Gaz. vol. 36. p. p. 235, 229. MARKWICK ON URINE. 27 spinal marrow, the more liable are they to become worse, and pass into mania.* 31. According to Berzelius's analysis we find urea to exist in the urine in the proportion of 30.10 to 1000, but Becquerel, who has made several apparently very careful examinations of the urinary excretion, considers this much too great. He states it to be between 10 and 14 parts only in 1000 and the quantity passed in 24 hours to vary be- tween 15 and 18 grammes,! or 231.570 and 277.884 grains; the minimum specific gravity being 1015 and the maximum 1018. 32. M. Lecanu found the proportion to be much greater than this in adult men and women and less in old men and children. The following shows the results he obtained from 120 analyses. Min. In adult men..... In adult women .... In old men (84 to 86 years) In Children of about 8 years In Children of about 4 years 357.466510.303 433.881 154.237;437.003 295.112 61.072 189.342.125.202 :161.759254.171207.965 I 57.271 81.821 69.548 Still the amount excreted by the same individual in a given space of time was always much the same. It is not present however in the urine of children at the breast ac- cording to Lecanu, Rayer, Guibourt and others. 33. The quantity moreover appears from the experiments of M. Lehmann on himself to be considerably modified by different kinds of diet; thus, from his urine of 24 hours he obtained, After a non-nitrogenous diet . . . 237.909 grains. After a vegetable diet.....347.061 „ After an animal diet .....821.270 „ And after a mixed diet.....501.704 „ Bouchardat also states it to be diminished by alcoholics, and Lehmann, Simon, and Percy have found it to be aug- mented by violent bodily exertion. * Med. Times, vol. xvi. p. 237. ! A Gramme is equal to about 15.438 grs. 28 MARKWICK ON URINE. 34. It is also much affected by disease, but an absolute excess in a given time is, according to Becquerel, of rare occurrence ; the general rule being an absolute diminution. According to the researches of Mr. Stuart Cooper, there appears to be no proportionate diminution between this and the other elements contained in the urine ; for he frequently found the urea to be considerably reduced in quantity and yet no very great decrease in the amount of the other or- ganic and inorganic matters. It is very abundant in ple- thoric states of the body, and remarkably scanty in anaemia; its quantity apparently coinciding in a direct ratio with the globules in the blood, for whatever increases or diminishes the latter, tends to augment the former (Andral.)* In cases of fever, rheumatism, and other inflammatory diseases, &c. the urine in twenty-four hours also contains a less amount of urea, although a given specimen may indicate an ex- cess. This is owing to the scantiness of the urine. It is likewise diminished in cirrhosis and hepatic dropsy, in va- rious chronic and neuralgic affections, and in albuminuria or granular degeneration of the kidneys, while in diabetes it was thought that the saccharine matter had taken its place. This has however been proved by more recent analysis not to be the case. In fact, Mr. McGregor was led to believe that patients labouring under this disease ex- creted " in twenty-four hours a much greater quantity of urea, than a person in health does in the same space of time,"! although a given specimen of diabetic urine con- tains a less proportion than the same quantity of the healthy secretion. Drs. Kane and Bouchardat consider the quan- tity to be the same as in health, while Drs. Prout and Henry estimate it at something less. Judging, however from the animal diet that must necessarily be employed in this dis- ease we should have been inclined to believe that the urea would be rather in excess than otherwise. It is also stated by Bouchardat to be considerably diminished in a disease of which one of the principal features is the presence of a large quantity of hippuric acid in the urine, and hence termed by him hippuria.| The greatest decrease observed * Med. Times, vol. xv. p. 285. , ! Bell's Essay on Diabetes, p. 21. X Annuaire de Therapeutique for 1842, p. 285. MARKWICK ON URINE. 29 by Becquerel in twenty-four hours was in those cases in which there was great debility accompanied by slight febrile action ; the average quantity here being only 75.924. It however frequently happens that in a given specimen of urine the amount of urea appears more abundant than na- tural in consequence of the water having diminished much more rapidly than it; and hence has arisen the erroneous idea that in fever, &c, it was actually increased in a given time. Two cases only were met with by^ Becquerel in which there was an increase in the normal quantity in 1000 parts. One was a case of milk fever, the other of san- guineous apoplexy. In the former it was in the proportion of 18.842 and in the latter of 16.452 ; 14, being the maxi- mum in health according to this author. The amount ex- creted in twenty-four hours was only 133.492 and 190.076 grains respectively ; thus showing that although there was a very considerable relative increase there was not only no augmentation in the natural quantity in the time specified, but, on the contrary, an actual diminution. The importance therefore of accurately ascertaining the actual amount of urine passed in the twenty-four hours before we can positively state that an increased excretion of the solid ingredients of the urine has taken place in the same period, at once becomes apparent. Still if a greater amount of urine than natural continue to be passed, then the quantity of urea may increase likewise, although M. Bec- querel states that he has never met with it, and is of opinion that it is an exceedingly rare occurrence. L'He- ritier however mentions a case in which during the com- mencement of an attack of gout, he obtained from the urine of twenty-four hours, 23.160 grammes, or about 357.454 grains. The specific gravity was 1028.315 and the quantity of water 44 fluid ounces. And Dr. Prout has long since described two distinct kinds of cases characterised by an excess of urea, one with diuresis the other without. In- stances of the latter, he says, are not uncommon in certain forms of dyspepsia. It is evident therefore, that as in exa- mining the specific gravity, so also in ascertaining the quantity of urea three things must be considered. First, the quantity of water; Secondly, the age and sex of the in- dividual, and Thirdly, the kind of food he has been taking, 30 MARKWICK ON URINE. for as we have seen from the researches of M. M. Lecanu (32) and Lehmann (33) it is subject to great variations in these respects. However we may generally calculate with a tolerable degree of certainty on an excess of this element whenever the specific gravity of the urine is above 1030.* 35. According to Dr. Prout urea appears to be generated from the gelatinous tissues during the destructive stage of the secondary assimilating processes. Dumas states it to be " manifestly derived from the oxidation of the azotised materials of the blood," which he says "have a tendency to pass into a cyanic acid and oxide of ammonia." And in order to avoid any unnecessary expenditure of oxygen, nature wisely checks "the combustion of the azotised matter so soon as they are converted into cyanate of ammo- nia," which thus, immediately on its production, becomes transformed by an izomeric change of its elements, into urea.! Dr- Aldridge considers it, and in fact all the more essential elements of the urinary secretion, to be " derived from the combustion of the non eliminated secretions, and not directly from the decomposition of the tissues."J It exists in healthy blood only in very minute proportion owing to its being removed from it by the kidneys as soon as formed. Therefore any thing which interferes with the eli- mentating action of these organs will cause the urea to be retained in the blood, from which on analysis it can be readily separated. Prevost and Dumas removed the kid- neys of different animals and found in five ounces of the blood of the dog above twenty grains of urea, and ten grains of it in two ounces of cat's blood. Urea is the first organic substance that has been formed artificially. Dr. Prout made several unsuccessful attempts to form it, but the honour of doing so was reserved for Wholer a German chemist. (82) 36. Uric or lithic acid is one of the most important con- stituents of the urine. It has neither taste nor smell, and when pure is perfectly white, and crystallizes generally in rhomboid scales. It is insoluble in alcohol and ether, and but very sparingly soluble in water, requiring, according to * Prout on Urinary Diseases, p. 99. Fourth Edit. Med. Times, vol. xv. p. 258. Lectures on the Urine, p. 21. MARKWICK OX URINE. 31 Liebig, 15000 parts of cold and 1932 of hot; and accord- ing to Dr. Prout, 10,000 parts at 60 degs. for its solution. It is soluble however in caustic potash and nitric acid, and on evaporating the acid solution we obtain transparent almost colourless crystals of the erythric acid ofBrugnatelli, the alloxan of Liebig, which assume a deep purple colour on the addition of ammonia, and constitute the purate of am- monia of Dr. Prout, the murexid of Liebig, and the purpu- rine of Dr. Bird. It is converted by heat into hydrocyanic acid, urea, carbonate of ammonia, and an empyrematic oil. Exposed to the blowpipe it turns black, and becomes dis- sipated with the evolution of a very peculiar animal odour. It has but feebly acid powers, and its salts are readily de- composed by all acids. Its crystals, as they are met with in the urine, are always somewhat tinged by the colouring matters present in the secretion. 37. According to Liebig and Mitscherlich it is composed of: Liebig.* Mitscherlich.X Carbon . . . 36.083 — 35.82 Hydrogen . . 2.441 — 2.38 Nitrogen . . . 33.361 — 34.60 Oxygen . . . 28.126 — 27.20 38. Its formula is C,10 N4, H4, 06, which may be said to represent four atoms of cyanogen, two of carbonic oxide, and four of water thus: c. x. n. o. 1 atom uric acid - - =10+4+4+6 Equal to 4 atoms cyanogen - —8+4 2 " carbonic oxide =2 2 4 " water = 4+4 10 + 4 + 4 + 6 Or, from the fact of its being decomposed into oxalic acid, allantoin and urea when boiled in water with peroxide of lead, as shown in the following diagram. * Ann. der. Pharm., vol. x., p. 47. j- Poggend. Ann., vol. xxxiii., p. 335. 32 MARKWICK ON URINE. C. N. H. 0. 1 atom uric acid - - =10+4+4+6 + 2 " oxygen = 2 + 3 " water - - = 3+3 10 + 4 + 7 + 11 Equal to = 2+2+4+2 = 4 6 = 4+2+3+3 10 + 4 + 7 + 11 it may be considered with the distinguished chemist of Giessen, as consisting of one atom of the compound radical called Urile, (composed of two atoms of cyanogen and four of carbonic oxide,) and one atom of urea. The composition of uric acid will then be represented as follows: 1 atom uric acid - - =.10 + 4 + 4 + 6 Equal to 1 atom of urile - - = 8 + 2 4 1 atom of urea - - =2+2+4+2 10 + 4 + 4 + 6 Now inasmuch as urile differs from oxalic acid only in having two atoms of cyanogen in the place of two atoms of oxygen, and as it requires merely the addition of two atoms of water to be converted into this acid and also the hydro- cyanic, we can, with Dr. Aldridge, easily explain the formation of both these acids as well as the formic acid and ammonia in the urine. For 1 atom urile = 8 + 2 4 + 2 " water - - = 2+2 8 + 2 + 2 + 6 Equals 2 atoms oxalic acid = 4 6 2 " hydrocyanic - =4+2+2 1 atom urea 2 " oxalic acid 1 " allantoin - 8+2+2+6 MAKRWICK ON URINE. 33 But as immediate reaction takes place between the hydro- cyanic acid thus formed and water, there is then produced, by an interchange of elements formic acid and ammonia : or in other words formate of ammonia. 1 atom hydrocyanic + 3 " water acid = Equals c. 2 + N. 1 + H. 1 3 + 0. 3 1 atom formic acid 1 atom ammonia 2 + 2 + 1 + 1 + 4 + 1 + 3 3 3 2 + 1 + 4 + 3 39. Liebig states that when uric acid is acted on by oxygen, it is converted first into alloxan and urea, and sub- sequently by the further action of oxygen on the alloxan into either the oxalic or carbonic acid and urea. The formation of alloxan and urea may be represented as follows : 1 atom uric acid - - =10+4+4+6 plus 4 " water - - = 4+4 plus 2 " oxygen - - = 2 10 + 4 + 8 + 12 Equal to 1 atom alloxan - - =8+2+4+10 l „ urea - - = 2 + 2 + 4+2 10 + 4 + 8+12 That of oxalic acid and urea from alloxan thus: 1 atom alloxan - - =8+2+4+10 plus 1 " oxygen - - = 8 + 2 + 4+11 Equal to 3 atoms oxalic acid - = 6 » ! u urea - - =2+2+4+2 8 + 2 + 4+11 34 MARKWICK ON URINE. And that of carbonic acid and urea from alloxan, thus: C N. H. O. 1 atom alloxan - - =8+2+4+10 plus 4 " oxygen - - = 4 8 + 2 + 4+14 Equal to 6 atoms carbonic acid - = 6 12 1 « urea - - =2+2+4+2 8 + 2 + 4+14 Or the formation of the oxalic and the carbonic acids may be explained by the direct action of oxygen on uric acid itself; thus if we add 4 equivalents of water = 4+4 and 3 " of oxygen = 3 to 1 " of uric acid =10+ 4+ 4+ 6 we have the formula 10 + 4 + 8+13 Equal to 2 atoms urea - - =4+4+8+4 3 " oxalic acid - = 6 9 10 + 4 + 8 + 13 And if we add three equivalents more of oxygen, we have then the composition of 2 atoms of urea and six of carbonic acid, thus: 4 atoms of water - = 4+4 plus 6 " oxygen - = 6 plus 3 " uric acid - =10+4+4+6 10 + 4 + 8 + 16 Equal to 2 atoms urea - - =4+4+8+4 6 " carbonic acid - = 6 12 10 + 4 + 8+16 MARKWICK ON URINE. 35 Hence then we have two probable sources of the oxalic and carbonic acids in the urine, one from the re-arrangement of the elements of urea (Bird,) (28,) the other from the oxidation of uric acid (Liebig.) A third may also be men- tioned as being equally probable, namely, the perverted or mal-assimilation of the saccharine matter, (Prout,) (66 m.) 40. Lithic acid is supposed by Dr. Prout to be the result of the re-arrangement of the elements of the albuminous tissues. 41. Accordingto Becquerel, about 8.1 grains are excreted in the course of*t\venty-four hours. In Table 2 we have stated the quantity at 9.999 grains. It exists in the urine, in all probability (as Dr. Prout has stated) in combination with ammonia, an opinion which appears to be greatly favoured by the comparative insolubility (36) of the acid, and by the fact that it is precipitated when any weak acid is added to the urine. Dr. Bird believes that it separates the ammonia from the double phosphate of soda and am- monia, a natural constituent of the healthy secretion, and by this means sets free phosphoric acid, which thus pro- duces the natural acid, reaction of urine, and which requires for saturation about 15 grains of carbonate of soda. 42. From the investigations of M. M. Lecanu and Leh- mann however, we learn that the quantity, like that of urea, varies considerably according to the age, sex, diet, and exercise of the individual; but that in the same person, in a given time, but little variation is found to take place. Thus, M. Lecanu states the average in twenty-four hours to be In adult men In adult women In old men . In young children while M. Lehmann ascertained that his urine in the same time contained 18.25 grains after a mixed diet of animal and vegetable food ; 22.70 when he restricted himself en- tirely to an animal diet; 15.76 after eating nothing but vegetables, and 11.26 when he confined himself to food perfectly free from nitrogen. Moreover, it has been found to be increased by alcoholic drinks (Bouchardat,) and di- minished by much bodily exertion, (Lehmann.) 13.153 grains. 10.034 " 6.792 " 1.775 " 36 MARKWICK ON URINE. 43. It is augmented when the cutaneous exhalation is impeded, and is also increased both absolutely and rela- tively in all cases of fever; in rheumatism and gout, and in diseases of the heart, lungs, and liver, being according to professor Andral, in cirrhosis, together with dropsy, an almost positive sign of the hepatic affection ;* but is di- minished in chlorosis, anaemia, and other diseases, accom- panied by great debility. This is decidedly opposed to the statement of Liebig that the uric acid disappears in pro- portion to the accelerated state of the circulation, and the amount of oxygen taken into the system.- 44. "Excluding all abstract theories," says Dr. Bird,! " whenever an excess of uric acid or its combination with bases occurs in the urine, a normal quantity of water being present (30 to 40 ounces in twenty-four hours,) it may safely be inferred that one or other of the following states exist. A. Waste of tissue more rapid ] Fever, acute inflamma- than the supply of nitrogenized } Uon' rheumatic inflamma- • , A • ° i tion, phthisis. nourishment, as in .... J r B. Supply of nitrogen in the] Excessive indulgence in food greater than is required for I animal food, or the quan- . b . . . i „ . y tity of food remaining the the reparation and supply of tissue, [ samei with two ]ittie bo- as in .........J dily exercise. C. Supply of the nitrogenized food not being in excess, but the digestive functions unable to as- similate it...... D. The cutaneous outlet for] nitrogenized excreta being ob- j All or most stages of structed, the kidneys are called J- diseases attended with ar- upon to compensate for the defi- j ^st of perspiration. cient function...... E. Congestion of the kidneys], Blows and strains of the , , P t , J > loins, diseases ot the ge- produced by local causes . . f nital apparatus.- All the grades of dys- pepsia. * Med. Times, vol. 16. p. 156. f Urinary deposits, p. 110. MARKWICK ON URINE. 37 45. When it exists in excess in the urine, it either be- comes deposited as the fluid cools, or on the addition of an acid. (63.) The urine is also of a deeper colour than na- tural, contains in many cases a greater amount of urea, is somewhat increased in specific gravity, and has always an acid reaction on litmus. The urine of suckling infants, however, which not unfrequently contains an abundance of this element, has not these qualities; but is very pale, of exceedingly low weight, and, as we have seen, contains no urea. 46. Lithic acid is met with in the urine either combined with ammonia in the form of an amorphous sediment of a whitish, yellow, pink, purple, or red colour, according as it is mixed with the yellow colouring matter of the urine. with purpurine, or with both ; or as a crystallized deposit constituting the red and yellow gravel, and also the va- riously coloured amorphous and pisiform concretions that have "descended from the kidneys. 47. Urine containing an excess of lithate of ammonia presents the following varieties, Thus it is either (a) of a very pale colour reduced in density, and turbid in conse- quence of a whitish lithate being dispersed through it; or, (6) of a licdit amber hue, somewhat lower in density than na- tural, and depositing a yellowish or pale drab coloured se- diment; or, (c) it is very high coloured, increased in specific gravity and with a reddish brown or brick-dust deposit; or, (d) lastly it may have a peculiar copper coloured, purple or crimson tint, owing to the presence of purpurine (6;) the deposits in these cases having always the same hue. 48. In gouty and rheumatic subjects lithic acid is fre- quently found united with soda, and the urate of soda thus formed is sometimes produced in such abundance that it not only renders the urine perfectly white, but also cannot be entirely got rid of from the system by the urinary secre- tion. It is therefore retained in it and eventually becomes deposited in and round the joints giving rise to those pecu- liar and characteristic, and often painful swellings called chtuK stones. 49 The natural acidity of healthy urine has lately been accounted for by Liebig and Bird by the uric and hippuric acids acting on the alkaline phosphates, and either setting 38 MARKWICK ON URINE. free a portion of their acid or converting them into acid salts. (46) 50. Hippuric acid, so called from being present in large quantities in the urine of the horse, was formerly supposed to be peculiar to the urine of herbivorous animals. Leh- mann, Wittstock, Ambrosiani, Muller, and Simon however, have ascertained its presence in that of diabetic patients; and Scheele, Prout, Fourcroy and Renard, in that of young infants ; and Professor Liebig has lately proved it to con- stitute a natural ingredient of the healthy human excretion, in which he says it exists in nearly the same proportion as uric acid in combination with soda. Its composition is, according to Liebig, Dumas, Mitscherlich, and Bird, as follows : Liebig.* Dumas.X Mitscherlich.X Bird.§ Carbon.....60.742 - 60.5 - 60.63 - 63.93 Hydrogen .... 4.959 - 4.9 - 4.98 - 4.64 Nitrogen .... 7.816 - 7.7 - 7.90 - 8.21 Oxygen.....26.483 - 26.9 - 26.49 - 23.22 And its formula Cl8,Nl3 H8, O , + H. O. Liebigstates it, as well as the uric acid, to exist in the urine in solution with the phosphates of soda and potash ; and he ascribes the fact, that these salts no longer possess in the urine, the alkaline reaction, peculiar to them when contained in the blood, to the presence of these two acids, and partly to the formation of a small portion of sulphuric acid as the re- sult of the combustion of the sulphuric compounds con- tained in the system. 51. Hippuric acid crystallizes in long semi-transparent four-sided prisms, with dihedral summits, and has a some- what bitter taste and a powerful acid reaction on litmus. It is soluble in about 400 parts.of cold water, more soluble in boiling water, and still more abundantly in alcohol, by which therefore it can be readily separated from uric acid, which, as I have said, is insoluble in this menstruum ; but * Ann. der Pharm., vol. xii. p. 20. Ann. de Chimie et de Physique, vol. lvii., p. 327. Poggend. Ann., vol. xxxiii. p. 335. § Urinary Deposits, p. 51. MARKWICK ON URINE. 39 is comparatively insoluble in ether. It becomes trans- formed into benzoic acid during the decomposition of the urine. It is also converted by nitric acid into the benzoic, and by sulphuric acid, with the addition of heat into the benzoic and carbonic acids and ammonia. Hydro-chloric acid dissolves it but does not decompose it. The addition of perchloride of iron to its aqueous solution produces a yellow colour. It is fused by a strong heat, and eventually becomes converted into a reddish coloured oil having an odour like that of Tonquin beans, ammonia, benzoic acid, and a black carbonaceous mass, and eventually into hydro- cyanic acid with the evolution of its peculiar odour. 52. Dr. Bird believes that the quantity represented by Liebig, as normally present in the urine, is not constant, but always much less than he has stated. He is of opinion, however, that hippuric acid, considering the abundance of carbon it contains, may possibly be one of the means by which this element may be eliminated, in large quantities, from the system by the kidneys, and that these organs may in those cases, where the lungs and liver, the proper emunctories of the carbon, do not effectually perform their functions, in some measure compensate for the deficiency, by excreting a larger quantity of hippuric acid. This is a subject well worthy of investigation. Mr. Stuart Cooper, in a memoir which gained the Corvizart prize for 1845, states the quantity to be in an inverse ratio with that of urea. 53. I know of only three well authenticated cases in which there was an excess of this acid in the urine. The first is described by M. Bouchardat under the title of hip- puria,* a disease characterized by excessive thirst, a harsh dry skin and an abundant secretion of watery urine, having an odour of whey, which contained only fourteen parts per 1000 of solid matters, 2.23 of which were hippuric acid, and no uric acid. The second is recorded by Dr. Garrod who obtained from about six ounces of urine as much as half a drachm of the acid, and this for several days together. A remarkable feature in this case is that this excess was met with durino-the administration of small doses of muriate of * Loc. Cit. 4 40 MARKWICK ON URINE. morphia for a superabundance of urea, and a deposition of the triple phosphate of ammonia and magnesia, which had been previously met with in the urinary secretion of the patient. The uric acid in this case was not in the least diminished in quantity. The third occurred in a young female aged thirteen affected with chorea, who had lived for some time on nothing but bread and water and apples. M. Pettenkofer examined her urine which was of a limpid yellow colour, and states that it contained as much as 1.2286 per cent of hippuric acid.* 54. According to Liebig hippuric acid is derived from the non-nitrogenized elements of food ; and we learn from the experiments of Wohler, Ure, and Keller, that benzoic acid when administered internally becomes converted into the hippuric with the disappearance of the urea, and, according to Dr. Ure, of the uric acid, also. Dr. Garrod has, however, proved this to be a mistake, and in this state- ment he is confirmed by the researches of Dr. James Booth and M. H. Boye of Philadelphia, from which it results ; First, That the uric acid suffers no alteration, either in quantity, or in its external properties, by the exhibition of benzoic acid and its subsequent metamorphosis into the hippuric. Secondly, That this metamorphosis is apparent in the urine in from twenty to forty minutes after the benzoic acid has been taken, and continues to be so for eight hours; Thirdly, That the quantity of hippuric acid obtained from the urine exceeds by about one-third, that of the benzoic acid taken ; Fourthly, That the hippuric acid is not com- bined with the urea in the urine, but that, Fifthly, it is united with and kept in solution by ammonia,f and not soda as has been stated by Liebig. Dr. Bird explains the conversion of the benzoic into the hippuric acid by sup- posing four atoms of the former and one of urea to act on 48 of oxygen and become converted into two atoms of the latter, 44 of carbonic acid, and 8 of water. Drs. Liebig and Garrod give a different explanation ; they account for the transformation by supposing two atoms of "benzoic acid to act on the elements of one atom of lactate of urea and produce two atoms of the acid in question. * See Liebig and Wohler's Annalen, vol. 50. f Med. Gaz. for Nov. 21, 1845, p. 1286. MARKWICK ON URINE. 41 55. The presence of Lactic acid and its compounds in the urine has been disproved by Liebig, who on repeating the experiments of Berzelius, discovered a particular crys- tallizable substance, that had not been previously described, and which he believes to have been mistaken for them. This new matter appears to be very rich in carbon and ni- trogen, and therefore it is the more to be wondered at that it should have been confounded with lactic acid, a com- pound entirely free from the latter element. 56 The normal proportion of this acid in 1000 parts of healthy urine cannot, I think, be considered as decided even supposing it to exist there. Becquerel believes it to constitute the greater portion of what he terms the insepa- rable organic matters, wrhich according to him, vary between 7 and 10 parts in 1000, and to exist partly in a free state and partly in combination with ammonia, soda, and urea. M. Lehmann states the average amount of free lactic acid to be 1.525, and that of combined lactic acid 1.160, making a total of 2.685 parts in the quantity stated. The mean daily quantity of free lactic acid discharged, accord- ing to the same observer was : After a mixed Diet.....23.68 grains. „ an Animal Diet .... 33.45 ,, „ a Vegetable Diet .... 18.35 „ While that of combined lactic acid was: After a mixed Diet.....18.12 grains. „ Vegetable Diet - - - - 21.16 „ 57. The composition of this acid is: Carbon......44.90 Hydrogen - - - - - - 6.11 Oxygen......' 1H-99* And its formula C6, Hs, 05. It is therefore greatly al- lied to C,2,H]0,O10, = Starch. C]2, Hu,Ou, = Gum. C24, H24, 024, = Sugar of Milk. C j 2, H i 4, 014, = Grape Sugar. Ci2, Hi i, Oi l, = Cane Sugar. * Liebig's Animal Chemistry, p. 309. 42 MARKWTICK ON URINE. 58. Peculiar azotised principle. This is a neutral sub- stance lately discovered in the urine by Pettenkofer. It has a sharp bitter saline taste, and is easily dissolved both by water and alcohoL From its watery solution it is thrown down by chloride of zinc. When heated on platinum foil it first melts and subsequently enters into slow combustion, at the same time giving off an odour of urine and ammonia. It is said to contain 54.02 per cent of nitrogen, and to exist in the urine in proportion of five grains to 1000. Its for- mula is C8, N3, Hg, 03, which, according to Dr. Bird, " differs only in the proportion of the elements of water from that of uramil, a product of the decomposition of uric acid, and which may be regarded as uric acid in which the elements of urea are replaced by those of ammonia and water." Thus, on comparing the two formulae together, we shall find that of uramil which is Cg, N3, H5, 06, con- tains three equivalents less of hydrogen and three equiva- lents more of oxygen than does the new principle of Pet- tenkofer. Dr. Bird, moreover, suggests, that it is a tran- sition formation between uric acid and urea," and there seems some probability of such being the case, from the fact that when uric acid is acted on by oxygen, it is, as I have already stated (39,) converted into an alloxam and urea, to the former of which Pettenkofer's formula may be considered to somewhat approach. The following is Dr. Bird's explanation of his views: C. X. H. 0. 1 atom of the new body - =8+3+8+3 8 „ oxygen - - = 8 8 + 3 + 8+11 Equal to 1 atom alloxam - - =8+2+4+10 1 atom ammonia - = 1 + 3 1 atom water - - = 1 —J— 1 8 + 3 + 8 + 11 MARKWICK ON URINE. 43 Its composition may be represented as follows: Carbon.......39.37 Nitrogen -..--.- 33.63 Hydrogen ------- 6.79 Oxygen......- 20.21 59. Extractive Matters.—These are certain organic nitro- genous principles, combined, in the opinion of Dr. Aldridge, with some substance resembling sugar or dextrine, which remain in combination with the saline constituents of the urine after the urea and lithic acid have been removed. They consist principally of the colouring matter already- described (6,) and which is considered by Scherer to be analogous to both that of the bile and blood ; are entirely dissolved by water, less so by rectified spirit, and still less by alcohol; hence their division by the last named writer, into the water extract, the spirit extract, and the alcohol ex- tract. They are composed of carbon, hydrogen, oxygen, nitrogen, and sulphur. Their watery solution very speedily undergoes the putrefactive fermentation, a very foetid dis- agreeable odour being then evolved, and a large quantity of acetic acid generated. During this process the presence of sulphur is manifested by the glass vessel in which it is allowed to take place, becoming blackened. On burning the extract in a test tube over a spirit lamp fumes of am- monia are disengaged, and may be detected in the usual way, namely, by holding a glass rod dipped in strong hydro- chloric acid, or the wetted stopper of the bottle containing it, over the mouth of the tube, a black carbonaceous mass being left behind. The spirit extract also generates acetic acid in considerable quantity during its putrefaction, and on being heated gives off, according to Dr. Aldridge,* a pyroligneous oil, water, carbonate of ammonia, and leaves a porous charcoal. The alcohol extract, on the other hand, that is, that portion of the extractive matters, which in the words of Dr. Aldridge is "precipitable in white flocks from a concentrated watery solution by the addition of an- hydrous alcohol," does not produce any acetic acid by putrefaction. Thus then we are now able to explain the * Lectures on the Urine, p. 11. 44 MARKWICK ON URINE. cause of the decomposition which always takes place in the urine by keeping, and the origin of the acetic acid which is frequently found in it. Prout it is true some years ago proved its existence in the secretion by distilling the latter with sulphuric acid ;* and Liebig has more lately ascribed its presence to the putrefaction of the colouring matters of the urine, which, he says, become converted by this process into the acid in question and a brown resinous highly azo- tised substance.f But, thanks to the labours of Scherer, we now know7 what particular portion of the urinary ex- tractive it is that becomes transformed by decomposition into the acetic acid. 60. In Table 2, I have represented the quantity of ex- tractive and colouring -matter with muriate of ammonia passed in the twenty-four hours to be 140.929 grains. The amount was found by Lehmann to be considerably in- fluenced by diet, the greatest proportion being excreted after vegetable food. The following are the results of his investigations: After a vegetable diet 254.929 grains. After an animal diet.....80.215 After a mixed diet .... 161711 " And after a non-nitrogenous diet . . 182.940 " The quantity is also considerably diminished by exercise, the mean daily amount during a pedestrian tour, being 130.528 grains according to the last named author. 61. The quantity of Fixed saline matters in healthy urine is stated by Becquerel to average about 140 grains in the 24 hours. This is hardly enough for this country at least; that given in the table I have constructed from Dr. Christi- son's formula will probably be found more correct. Lecanu found the quantity to fluctuate between 75 and 378 grains, the following are the results of his analysis: Max. Mean. Min. In Men .... 378 265 153 grains Women 302 234 166 " Children of about 8 years 168 160 152 " Old men 151 122 94 '* * Annales de Physique et de chimie, vol. 14, p. 260. f Lancet, June 1, 1844. MARKWICK ON URINE. 45 Becquerel gives 7.695 grains as the mean amount he ob- tained from 1000 parts of urine from four healthy men, and 6.143 grains from the same quantity from four healthy women ; while the mean result of six analyses of the morn- ing urine of a healthy man made by Dr. Day was 9.27 in 1000 parts. 62. These saline matters are derived partly from the food and partly from the metamorphoses constantly taking place in the tissues. Thus the alkalies, potash and soda, are furnished by the blood and the albuminous tissues, and the earths lime and magnesia by the fibrinous and muscular structures. The hydro-chloric acid appears to be derived principally from the common salt we eat, and the sulphuric and phosphoric acids in great part from the oxidation of the sulphur and phosphorus contained in the albuminous and fibrinous tissues; the former in the proportions of 0.68 and 0.36, and the latter of 0.33 and 0.33 respectively. The presence of sulphuric acid in the urine may likewise be partly ascribed to the oxidation of the sulphur recently dis- covered by Professor Redtenbacher in taurine, a substance obtained by the decomposition of the choleic acid of the bile, in the proportion of nearly twenty-six per cent,— 25.70. It exists in the urine in combination with potash and soda, in the proportion, according to Professor Dumas,* of from 30.7 to 57.6; while the phosphoric acid is found united with both the earths and the alkalies; the earthy phosphates varying from one-fourth to one-eighteenth and the alkaline phosphates from three-fourths to seventeen- eighteenths. (Dr. Bence Jones.) It is evident, therefore, that these salts must be subject to considerable variation in quantity both in health, in conse- quence of the difference in the conmposition of the various articles of food we take, and also in disease. In the latter they are generally absolutely diminished and to this Bec- querel appears to have met with but one well marked ex- ception. It was in the case of a girl convalescent from chlorosis accompanied by pulmonary emphysema, in which it was 32.759 grains above his highest normal standard. In this instance, however, it had increased conjointly with * Med. Times, vol. xvi. p. 71. 46 MARKWICK ON URINE. the water which amounted to upwards of 32 ounces. A relative increase, however, is by no means uncommon, especially in febrile and inflammatory infections. Indepen- dant of the alteration in the quantity of these saline matters taken together, variations in their relative proportions to each other also frequently occur. The greatest differences have been observed in the earthy phosphates; Lecanu indeed found them to oscilate between 0.56 and 30.2 grains. Some very interesting researches have lately been made by Dr. Bence Jones relative to this subject. Thus it appears from the results of his investigations, that the urine passed soon after eating a meal, no matter whether it consists of animal food or only of bread, contains a much larger quantity of the earthy phosphates than that voided at other times ; whereas the proportion contained in that excreted after long fasting, is greatly diminished. The alkaline phosphates on the contrary, become very remarkably de- creased in quantity after a purely meat diet, and augmented in the greatest degree when bread alone is taken. Exercise, on the other hand, he found not to affect the earthy phos- phates, but to occasion an increase of the alkaline phos- phates to the. extent of nearly one-third. A considerable augmentation in the amount of the earthy phosphates is also occasioned by the exhibition of the chloride of calcium and the carbonate and sulphate of magnesia. The same author also ascertained a remarkable difference in the quantity of phosphates excreted with the urine during certain diseases of the brain. For instance, in inflammation of the brain he found the quantity to be much greater than in delirium tre- mens; the average in three cases of the former being 8.26 per 1000 urine sp. gr. 1.025,3, and in three cases of the latter only 0,67 per 1000, sp. gr. 1.020.4. Great mental exertion tends likewise very materially to increase the amount of phosphates. The average amounts of the earthy phosphates obtained by Lehmann in the 24 hours were as follows: After an animal diet .... 34.990 grains. " a mixed diet.....17.414 *' The quantity of chloride of sodium also varies remarkably in adult men and women. Thus, while in the former it MARKWICK ON URINE. 47 may be stated to average between 30 and 70 grains, in the latter, and likewise in old men, it scarcely ever reaches above 10 or 11 grains, and has been found even as low as 0.26 grains. From the urine of dying persons, it is accord- ing to Prout, almost entirely absent. Lecanu found it to fluctuate between 0,26 and 116 grains in 24 hours in dif- ferent individuals. 63. According to Berzelius sulphur exists in the urine not only as sulphuric acid, but also in some particular state of combination not yet defined ; and Mr. John T. Barry has, by repeating and modifying the experiments of the Swedish chemist, detected a very tolerable proportion of it. Dr. Bird also states, on the authority of Dr. Edmund Ronalds, that from three to five grains of sulphur in a compound form are excreted with all urine in the course of twenty-four hours. According to Dr. Ronalds the sulphuric acid bore to the non-oxydised sulphur, in five different specimens of healthy urine the following proportions: 1.06 : 0.17 — 146 : 0.18 — 1.42 : 0.18 — 2.44 : 0.153 1.32 : 0.165 64. The quantity of Mucus contained in healthy urine is generally very small, and from its transparency, invisible. In some cases, however, as the excretion cools it becomes slightly opaque and forms a distinct cloud near the base of the containing vessel, constituting what is termed an eneorema. In females during the menstrual period it is more abundant, and from being somewhat altered in its properties, by having lost its natural transparency, can always be distinctly observed. Lecanu found it to vary in six different individuals (male) from 4.6 to 26.5 grains, and from 3.3 to 5.68 grains in various women and old men. In certain diseases it becomes considerably increased in quantity as will be more particularly alluded to hereafter. (118) When examined under the microscope it has a nu- cleolo granular appearance and is found to contain several exfoliated epithelial scales. 65. Butyric acid is a compound which Berzelius states may be procured in small quantities from urine when it is distilled with sulphuric acid. Dr. Prout, however, appears 48 MARKWICK ON URINE. from the following passage at page 568 of his celebrated work " neither if we except the lactic acid does any form of the saccharine principle exist in healthy urine" to doubt its existence in the normal secretion, and is of opinion that it is only present during some particular derangement in the assimilation of the saccharine matters. It may therefore, I think, be considered as intermediary between the preceding healthy constituents of the urine and the abnormal ingre- dients frequently present in it during certain morbid states of the system; and which now remain to be described. M. Lehmann found it to exist in rather large quantities during the first week after labour, in the urine of a female who did not suckle her child. 66. The Abnormal ingredients may be divided into two classes. The first contains those matters resulting from the various alterations or decompositions which take place in the renal secretion ; and the second those of an organic and inorganic nature which have either been secreted with the urine, or which have entered it in consequence of some pathological change having taken place in some part of the urinary passages. They may be conveniently arranged in the following TABULAR VIEW. Carbonate of lime . . . Carbonate of magnesia . Neutral phosphate of lime . Neutral triple, or ammonia- co-magnesian phosphate . Basic triple phosphate . . 1 CLASS I. I. The rearrangement of the ele- ments of urea and water producing carbonate of ammonia, (a.) Previous to secretion........ II. The rearrangement of the ele- ments of urea and water producing carbonate of ammonia, (b.) Subse- quent to secretion—change taking place in the bladder...... \ £ A low kind of inflammation or irri- tation of the kidneys. Injury to, or disease of, spinal marrow. Injury to the loins. Depression of the vital powers. Nervous irritability, or exhaustion. Disease, of, or stone in the bladder. Enlarged prostate. w Stricture of urethra. The natural decompositions which the urine undergoes by keeping. III. The rearrangement of the 1 elements of urea and water, pro- j ducing carbonate of ammonia. } (c.) Subsequent to secretion—change I taking place out of the bladder . . j IV. Some kinds of indigestion. V. The immoderate use of alkalies. VI. The internal administration of mercury in large quantities. CLASS II. ORGANIC MATTERS. (.#.) Organised. External violence applied to the lumbar, hypogastric, or perinaeal regions. Injury to the ureters, bladder, or urethra from spiculaj of bones in fractures. Laceration of the lining membrane of the urethra from the introduction of in- struments. Calculus, either in the kidneys, the ureters, or the bladder. Irritation of the kidneys produced by stimulating diuretics. Inflammation, congestion, tubercular degeneration, and cancer of the kidneys. Obstruction of the Henal vein (Robinson.) Inflammation and ulceration of the mucus membrane of the bladder. Fungus hecmatodes and cancer of the bladder. Inflammation of the urethra. Diseased states of the blood in malignant and petechial, fevers, scurvy, purpura, &c. Abscess in some parts of the urinary apparatus. " in the neighbourhood of the urinary apparatus, and communicating with it. Inflammation and ulceration of the genito-urinary mucous membrane. Purulent absorption"? Chronic inflammation or catarrh of the bladder. Irritation of the bladder from calculus. (/. Torula- tlie result of c Vibrioncs, cause /. Spermatozoce g. Albumen Saccharine matter in the urine. Unknown, apparently connected with great prostration of strength. Involuntary seminal emissions. t'oitllS. The passage of the spermatic fluid into the bladder in consequence of stricture of the urethra. (/>.) iVd/i Organized. ( From external injury. From the retrocession of a cutaneous eruption. From febrile, states of the system. From impeded respiration. From checked perspiration. From weakness of the vessels. From pressure on renal veins. Fnun large doses of mercury and stimulating lt diuretics. Granular degeneration of the kidneys. An inflammatory state of the kidneys in Scarletina. (Prout.) A diseased state of the blood. 1. Congestion of the kidneys h. Bile.......-o 1. Certain diseases of the liver. 2. Obstruction to the flow of bile into the intestines. i. Milk and oil . . . . k. Kiestien, the result of /. Fatty matter, id. m. False Membranes, id. Mixed with the urine for the purposes of deception. Pregnancy. Mai assimilation of albuminous matters. blisters of Spanish fly. (Morel Lavallee.) n. Sugar, the result of . . . <*. o o. Oxalic acid.....1 Oxalate of Ammonia . . £ .a o p- Sugar.......% and g Oxalic acid.....* q. Carbonic acid . and Carbonate ammonia I. Mal-assimilation of saccharine matters. (Prout) 2. Fermentation of the Epithelium. (Aldridge.) 1. Slight deoxidation of the elements of urea and water. (Bird.) • 2. Oxidation of uric acid. (Liebig.) 3. Mal-assimilation of certain articles of food. Improper or perverted assimilation. 1. Of saccharine matters. 2. Of gelatinous matters. 3. Of albuminous and oleaginous matters -5 r. Acetic acid . and Ammonia Deoxidation of the elements of urea and water. 1. Fermentation of the extractive matters. 2. id. id. epithelium. 03 ■s J s. Lactic acid, the result of (. Uric.......g id. id. id. or, Xanthic oxide « I 1. Probably of perverted assimilation of the albuminous tissues. " f 2. id. id. id. id. nitrogen of food. ,03 •5 J ■i 1 it. Cystine I. Probably of perverted assimilation of the albuminous and gelatinous tissues. H J> 2. Ol imperfect secretion of bile. jjj 3. Of Oxidation of the tissues as in chlorosis. (Shearman.*) v. Silicic acid arising from io. Iodine, iron, Indigo x. Arsenic, Antimony, . ."a Mercury ...... 3 y. Cyanourine, cause of z. Percyanide a.a. Melanourine, cause INORGANIC MATTERS. The water drank. (Berzelius.) Their internal administration. Their internal or endermic admiiustratioi Unknown. « 1. The rearrangement of the elements of urea and water after secretion, producing of iron "" i cyanate of ammonia, and the presence of iron in the urine. £ j 2. The rearrangement of the elements of urea and water before secretion, producing cyanate of ammonia, which acts on the iron of the blood. Unknown. * Sec Dr. Bird's work, p. 150, 54 MARKWICK ON URINE. CHAPTER III. 67. Having spoken, in the foregoing pages, of the com- position of healthy urine and of the various modifications it is liable to undergo both in health and disease, it now remains for me to describe the mode of obtaining this information, or in other words, the process by which the nature of the different natural and unnatural urinary con- stituents can be ascertained. This will form the subject of the present chapter. 68. From what has been already said, it is evident that in examining the urine, it is always necessary to previously discover when it was passed, and then to commence by noticing its physical properties and its acid or alkaline re- action ; for by this means we become possessed of certain facts by which we are better enabled to regulate our subse- quent analytic researches. 69. We should begin then by making ourselves ac- quainted with the colour, odour, transparency, and con- sistence of the urine, and then with its density, quantity, and chemical reaction on test paper. By its colour (4) we judge, First-, of its degree of concentration or dilution and consequently of the amount of solid ingredients; Secondly, of the presence of certain foreign matters, and Thirdly, of certain morbid states of the system. By its odour, (3,) we not only ascertain whether decomposition has taken place or whether some foreign odoriferous principles are present, but we are also enabled to suspect the existence of certain diseases. By a deviation from its natural transparency (9,) we discover either that some of its natural constituents are in excess; that it contains some abnormal element, or that some change has taken place in it by decomposition. By an increase in its consistence, (10) we detect the presence of mucus, pus, albumen, sugar, and even in some cases of oxalate of lime. By its density (11) and quantity, (7) we MARKWICK ON URINE. 55 are not only enabled to ascertain the amount of solid matters present in a given specimen, and the quantity ex- cre eel in a certain time, but are also led to infer either that certain dements are diminished or in excess, or that some abnormal ingredient is present, or even the existence of Z7.V?? TlV mala,y' Thus ^ way of illustration,) wo distinct classes of cases may present themselves. In the first the urine is low in density, and either normal, di- minished, or increased in quantity. If it be normal or diminished we have positive proof that the amount of its con- stituents is reduced ; the extent of the reduction being ex- actly in proportion to the decrease in the quantity and spe- cific gravity; while, if it be increased, no such reduction may have taken place, but on the contrary, the actual quantity of solid matter excreted may be perfectly normal, in fact, augmented. In the second class, the urine is of high spe- cific gravity, and its quantity either natural, decreased or augmented. If it be natural it is a certain sign that a greater amount of solid matter is held in solution. If it be decreased, which is most commonly the case, it shows that the quantity of solids has either remained unaltered, or that it has not diminished in the same proportion as their solvent. If it be augmented, it is a certain criterion that a much larger amount of solid is excreted than natural, and affords us a valuable means for ascertaining the cause of the emaciation that occurs in some cases. Lastly, by its acid neutral, or alkaline reaction, (2,41,29.), our former suspicions respecting the cause of the change in its colour, odour, transparency, and consistence, become in a great measure confirmed. For instance, suppose we find the urine thick or turbid, strong smelling, and high coloured, with a reddish or pinkish coloured deposit and acid, we know immediately that there is an excess of the lithates in combination with purpurine, (6, 46, 47 ;) while if it be pale, opaque, covered with a pellicle presenting numerous co- lours like the surface of a soap bubble, and alkaline, or perhaps, somewhat acid, we then strongly suspect an excess of the phosphates, more especially if the urine is alkaline, has a foetid ammoniacal odour, or contains a large quantity of mucus, (29,) which, as I have before said, is liable to 5 56 MARKWICK ON URINE. act as a ferment, and by thus effecting the decomposition of the urea causes a deposit of the earthy phosphates. The valuable information that is thus derived from the examination of the physical properties and chemical reac- tion of the urine is obtained in a very short time and with little trouble. 70. To ascertain the chemical reaction of the urine, blue and red litmus paper should be employed. The former will be changed to red if the urine be acid and the latter to blue if it be alkaline, but if it be neutral neither will be acted on. These test papers are now conveniently ar- ranged in small books by Griffin of Glasgow. 71. The density may be obtained in two ways, either with the specific gravity bottle,* which is the most correct; or with, what is more commonly used, the urinometer, an instrument consisting of a stem graduated from 0 to 60 de- grees and two bulbs, the lower one being, partially or quite filled with mercury in order to increase the weight of the instrument. It may be purchased at any Philosophical Instrument Makers, conveniently arranged in a case, con- taining a cylindrical glass vessel in which the urine to be examined is intended to be placed, a test tube, a bottle for nitric acid, a watch glass, and test paper. In using it, all that is required to be done is to place it in the urine contained in the glass vessel just alluded to, and then to carefully note the figure corresponding to the surface of the fluid which will be the density of the latter; or, as Dr. Bird recommends, the degree immediately below it in order *• to compensate for the errors arising from capillary adhe- sion of the urine to the glass." 72. In estimating, however, the specific gravity, it is ne- cessary for the urine to be perfectly clear and free from im- purities; therefore, when turbid, either from the presence of foreign bodies, or from the precipitation of some of its natural constituents, these must be previously removed by filtration ; and it behoves us also at all times, as I have before said, to pay strict attention, both to the temperature, * The specific gravity bottle holds exactly 1000 grains of dis- tilled water, therefore the density of any other fluid will be repre- sented by the increase above 1,000. MARKWICK ON URINE. 57 (which should be about 60 degs. Farnh.) and the quantity of the excretion in twenty-four hours ;(7.14) and when it is desirable to come to some correct conclusion with respect to the nature of the urine in that time, we must always en- deavour to collect, if possible, the whole that is passed, and then to submit a portion of the mixture to examination ; for it is evident that the results that are otherwise obtained can have reference only to the particular specimen examined. Another source of fallacy also requires to be avoided, viz., the sinking of the instrument too rapidly in the fluid, for if any of this collect on the stem above the degree corres- ponding to its density, it will cause the instrument to de- scend so much lower, and consequently indicate a less spe- cific gravity than the fluid in reality possesses. 73. Various tables have been constructed by different au- thors, by which it is proposed to calculate the solid amount of matter contained in a given quantity of urine, from the specific gravity of the secretion. These tables are all based on the now well-known fact that the proportion of the solid contents of one thousand parts of urine is equal to the excess of its density over that of water multiplied by a given number; this number being, according to Dr. Henry, 2.58; according to M. Becquerel, 1.65, and according to Dr. Christison, 2.33. Now it must be evident to every one, from the great difference existing between these three amounts that fallacy must exist somewhere. Dr. Day has, however, proved, by numerous experiments, that the for- mula of Dr. Christison, viz. A + 2.33, in which A repre- sents the difference between 1000 grains and the density, is far more accurate than either of the others. I have therefore from it formed the following tables which, as they prove each other, may be relied on for their accuracy. Cm oooooooooooooooooooooo lOWWtitOlOtitClKll-t-MMWHl-MHh.OOO o o o o CI Oi o o o o o o o o p*>. 60 tO i— o o o P 8 < 2. ~ ai OO — *-i— — — -- — h-.— (OtOtOtOtO (B O O IS W t- Ol O -1 00 ffl O i- IO u »-to so to b b o b o -- ■— -- ►- — Jo r^ fi ►b-ClOOOtOtf-ClQOOlOrf-ClOOOOhf io to o> Ol to to CI 00 tO h-to io 4- tO »i- ^. 4^ »£>. i£. £t to to to CO CO CO -1 GO SO O h- tO CO CO CO CO CO *■ o to h- oi oo o CO CO 60 ** to *> 437.50 436.48 435.46 Amount of water in one fluid oz. in grains. «o tj K) ta to » ts o io m i- h w m w m 00 M C. W - U Ii - O !0 00 •■) K w *. w U> Ol Oi CI - i. .'- i. i. w W W CO W (3 tO Clp(kBOQ0C.*.tiO0DOli(.t5OCDm o to 00 ^1 ocoffi*. OS Ol to o oi to b b 00 Ol tO K-b b 4»- tO : Weight of solids in 1 fluid oz. in grains. Orn oooooooooooooooo moioioio'tioioii.fch.fttwb*. m o oi »- u to i- o a oo ^i o oi *- w ts o o h- o o o o o CO CO CO CO woovja o o CO 60 Ol ift o o CO CO co to O O CO CO i— o o to so w w u o: w w m :; w to to co co co co w ^1 GO GO X GO 00 fj '/• OD I 00 ■ SO ^} Oi Ol bo bo ao to inOiooo CO CO CO CO co to — o o ^1 to to to to Ol 00 Amount of water in one fluid oz. in grains. oi n oi :a oi oi oi ui *. *. ^ *. * *. >u *-oo>iei(;i*.coBM!sa)^o«i*M(i Weight of solids in 1 fluid oz.in grains. *->—'—lOOOOOSDtOtOtOSOTlGOaO MSOOOOJ-tSOOOC-.iUKlOOOO'i- 00 00 to o ^» ^1 -f ^J rr.< ci -^ to O 00 Ol Ol Ol «- Ol Ol to o ooooooooooooooooooooooooooooo (5(StO(3K)»K)KlW-'HHHHHM^HHOOOOOOpoOO OOOOlOirfi-COtOf-OtOOOOCTlOl^COtOl—'OtOOOOClOl*»60tOi— o xooaoaoaoaoooaoaoaoooaoooaoooaoooaoooaoooaooorogoaDOoaooo h"Mtototot3wwwww*.^^i*'if"Jiui*J'OioiaiOiO)050iM^t--i ^so»-htiaiODOtOHuaiOooto^criQooto4-cioooto*-oigootooi cotooooo — ►-* tototoww^^^-oioippipoooooooototop bok)bb^aobbbI^bobbb!^ODk)bb^xbbb^bojooio ooooooooooooooooooooooooooooo ooooooooooooooooooooooooooooo WO«WWif»**'*if'UUWWWt0tit0»K)i- i— ►-* ►— — _ _ ^ v • --lOicoH-ooai^tooooaitt-tcoooci^tooooci^toooocivf^to- ^-OOOt0tO000000-J--*010i0iwi0i>^>*^*-C0C0t0t0t0i—' — OO; k)bc^bbk)bo^bbk)bo^bbk>bo^bbtocD^o^toaD^. OOOOOOOOOOOOOOOOOOOOOOOOOOOO' OOOOOOOOOOOOOOOOOOOOOOOOOOOO" OOOOOOOOOOOOOOOOOOOOOOOOOOOOO OlOlOlOlOlOlOlOl*.if*.*.|^ifif>li**'WWWWUWWWWWW wto-otooovimoiirWto^o(ooov(050i((-wtjHOW OvJO^<(vJvlv!sJ^v)vJ^vlvl^vJvJsJ^vI0000C00000000000 oiooocicioooooaoooooooaDop^to^opooo — H-h- o- §.* «S?3 S O B _. = a. 2 CD ~> E rj> «* M CD C ^ •" =• = o «7J *" > 53 Fa 3 o o Bi= -'to i° 2 -• ~ p -. a' o ^ ^ ^ re *-». > ex CO 60 MARKWICK ON URINE. TABLE V. Showing the proportion of fluid and solid in 1000 grains of the secretion at various specific gravities. Amount of water in 1000 grains. Amount of solids in ! 1000 ! grains. Specific Gravity. Amount of water in 1000 grains. 1001 997.67 2.33 1029 932.43 67.57 1002 995.34 4.66 1030 930.10 69.90 1003 993.01 6.99 1031 927.77 72.23 1004 990.68 9.32 1032 925.44 74.56 1005 988.35 11.65 1033 923.11 76.89 1006 986.02 13.98 1034 920.78 99.22 1007 983.69 16.31 1035 918.45 81.51 1008 981.36 18.64 1036 916.12 83.88 1009 979.03 20.97 1037 913.79 86.21 1010 976.70 23.30 1038 911.46 88.54 1011 974.37 25.63 1039 909.13 90.87 1012 ' 972.02 27.96 1040 906.80 93.20 1013 969.71 30.29 1041 904.47 95.53 1014 967.38 32.62 1042 902.14 97.86 1015 965.05 34.95 1043 899.81 100.19 1016 962.72 37.28 1044 897.48 102.52 1017 960.39 39.61 1045 895.15 104.85 1018 958.06 41.94 1046 892.82 107.18 1019 955.73 41.27 1047 890.49 109.51 1020 953.40 46.60 1048 888.16 111.84 1021 951.07 48.93 1049 885.83 114.17 1022 948.74 51.26 1050 883.50 116.50 1023 946.41 53.59 1051 881.17 118.83 1024 944.18 55.!) 2 1052 878.84 121.16 1525 941.75 58.25 1053 876.51 123.49 1026 939.42 60.58 1054 874.18 125.82 1027 937.09 62.91 1055 871.85 128.15 1028 934.76 65.24 1056 869.52 130.48 MARKWICK ON URINE. 61 74. Having obtained then the specific gravity in the manner above recommended, we refer at once to Tables 3 or 4 for instance, and we there find corresponding to it, the amount of solids contained either in an ounce or a pint of the urine, and then by a simple multiplication we can readily discover the actual quantity excreted in twenty- four hours. To illustrate this, let us suppose the urine to be healthy, that is of specific gravity 1020 and about 35 fluid ounces in quantity. By looking at the tables we find at this density, one fluid ounce contains 20.40 grains, and a pint 408 grains of solids. If then we multiply 20.40 by 35, or add to 408, the result that will be obtained by mul- tiplying 20.40 by 15, the surplus above a pint, the quotient will be the amount sought for, thus :— 20.40 X 35 = 714 ) . . „r a 20.40 X 15 + 408 = 714 \ 2rains m 3d fl" ounces" Dr. Bird has constructed a Table* by which he proposes to calculate the amount of solids contained in a pint of urine by multiplying the weight of the latter by the quantity of solid matter found by Table V., to exist in 1000 grains, and these dividing by 1000. But the results obtained from it do not coincide with those given in the preceding Tables. 75. In consequence, however, of the various densities of the different elements of the urine, of the various relative pro- portions in which they exist in it, and also of the foreign matters with which it is frequently contaminated, Tables thus constructed can never do more than give an approxi- mation to the truth. Still they are sufficient for practical purposes. When, therefore, greater accuracy is required, another mode of proceeding must be adopted, which con- sists in the evaporation of the urine. For this purpose Simon recommends us first to ascertain its specific gravity at the temperature of 60 Farhn., and then to evaporate about 25 grains of it over a steam bath to the consistence of a thin extract in a previously weighed light porcelain dish or capsule, the edges of which must be perfectly even, so that when covered by a piece of glass (the weight of which should be known) all air may be excluded. The * Loc. Cit. p. 38. 62 MARKWICK ON URINE. dish with the residue thus obtained, is then to be placed in the vacuum of an air pump over strong sulphuric acid, and allowed to remain for a period of from thirty-six to forty- eight hours, when it is to be removed, care being taken to cover it directly with the piece of glass above mentioned, in order to prevent the dry mass which remains from ab- sorbing moisture from the surrounding atmosphere. The capsule is now to be weighed, and the increase above its known weight and that of the glass will represent the amount of solid in the quantity of urine examined. We have then only to multiply this by 17^ to ascertain how much is contained in an ounce, and the product obtained multiplied by the number of ounces voided in the twenty- four hours will give the actual quantity, excreted in that time. 76. Having now made ourselves acquainted with the density, and formed, with the assistance of the Table, a to- lerably correct idea of the amount of solid matters contained in the urine, our next step is to ascertain the quality of the secretion. This can generally be sufficiently effected for practical purposes, by means of heat and nitric acid. Heat will throw down any albumen that may be present, pro- vided the urine is not alkaline, and likewise the phosphates when in excess. The latter are distinguished from the former by being re-dissolved by a few drops of nitric acid. Heat, when raised to the boiling point, will even precipitate the phosphates when not increased in quantity, as has been observed by Dr. Rees, and more recently by Dr. Schaffner who explains the*circumstance by the fact that at this tem- perature they, that is the earthy phosphates, become de- composed into subphosphates which are deposited. It will also dissolve a deposit of the lithates, but not of lithic acid or of the phosphates. It also alters the unnatural colour given to the urine by blood and disturbs the transparency of the secretion by coagulating the albuminous matter. Nitric acid will precipitate the lithic acid if it exist in excess, and detect a superabundance of urea. (78) It will throw down albumen, dissolve the phosphatic deposits, and also the lithates with the deposition of the lithic acid in a crys- tallized state, and detect the presence of bile by producing a rapid and interesting display of colours in a thin layer of MARKWICK ON URINE. 63 the urine containing it, but will not affect the purulent or mucus sediments. It sometimes happens, however, that the urine not only contains albumen, but is at the same time turbid from the deposit of phosphates ; and, as in this case, the disappearance of the latter, when nitric acid is added, is frequently marked by the coagulation of the former by the same re-agent, it follows that an error in diagnosis would in consequence very frequently result, especially if, from the alkaline condition of the urine heat had no power in solidifying the albumen, were we not aware of the possi- bility of such an occurrence, and likewise of the best means of detecting it. When, therefore, urine of this description is presented to us, a little acetic acid should first be added; this will restore the transparency by dissolving the phos- phates, and we can then have recourse to the usual tests for albumen, namely heat and nitric acid. Again, albuminous urine may be turbid from a deposit of lithates, and the disappearance of these not perceptible owing to the coagulation of the albumen. Under such cir- cumstances the best plan to be adopted is to place some of the urine in a conical glass vessel for the sediment to sub- side ; we can then pour from it the supernatant fluid and apply the several tests to each. To discover the proportion of the various natural con- stituents of the secretion, and the nature of any abnormal ingredients that may be contained in it recourse must be had to a more elaborate process. 77. We have seen that healthy urine is composed of certain organic and inorganic elements, and that in disease it frequently becomes impregnated with others. I propose, therefore, to consider the whole analytically under two heads : 1st. The normal and abnormal Organic Elements, and 2dly. The normal and abnormal Inorganic Elements. 1. Organic Elements. (A) JYormal. 78. Urea.—To detect an excess of urea, (34.) Pour a small quantity of the suspected urine into a watch-glass, and gradually add to it an equal volume of nitric acid. Slight 64 MARKWICK ON URINE. effervescence first takes place and afterwards a crystalline deposit of nitrate of urea. The rapidity of the crystalliza- tion being in proportion to the amount of the urea. This operation requires the mixture to be kept at a low tempera- ture. When it is desirous to know the exact quantity of urea we must adopt one or other of the following processes. 79. I. Dr. Prout recommends us to evaporate the urine to the consistence of a thick syrup and then add to it when cold, concentrated nitric acid until it becomes a crystallized mass of a dark colour. This is then to be repeatedly washed with distilled water and the acid neutralized with a solution of carbonate of potash or soda. The nitrate thus formed must be removed by crystallization, and the super- natant liquor, containing the urea and a portion of the nitrate, made into a paste with powdered charcoal and allowed to remain for a few hours. Distilled water is then to be added to it, to dissolve the urea and nitrate, and the solution, after having been filtered, evaporated to dryness. If the residuum thus obtained is now heated with boiling alcohol, the urea will be dissolved away from the nitrate of potash or soda, and can be obtained from the alcoholic solution almost in a state of purity by evaporation and crys- tallization.* II. Or the nitric acid may be saturated with carbonate of lead, and the alcoholic solution afterwards obtained as above, and heated with sulphuretted hydrogen and animal charcoal to remove any remaining particles of lead and colouring matter. The urea will thus be obtained in a crystallized form, and nearly pure by subsequent solution and evaporation. III. Evaporate fresh urine in a water bath to about l-12th or l-14th of its volume, allow it to cool, and then filter; to the residue of every pint of urine employed, add slowly, with continual agitation, a solution of half an ounce of oxalic acid in twice its weight of hot water, and an abun- dant buff-coloured precipitate of oxalate of urea will be the result. Collect this on a calico filter, wash it with a cold solution of oxalic acid and separate the mother water by * Med. Chir. Trans, vol. viii. MARKWICK ON URINE. 65 pressure. Then dissolve it in hot water in a large vessel and neutralize the acid by means of chalk; filter the solu- tion so as to remove the oxalate of lime, and digest it w-ith animal charcoal, again filter and evaporate. Brown coloured crystals of urea will then be obtained and can be procured perfectly colourless and inodorous by repeated solution in warm water and digestion with animal charcoal.* IV. Evaporate the urine to the consistence of syrup, taking care that the temperature be not raised too high so as to decompose the urea ; then for every pint of urine em- ployed add to it about five ounces of alcohol, which will take up the urea, the extractive and colouring matters, and leave the lithic acid and its compounds, together with the various alkaline and earthy salts behind. Separate these by filtration, and wash them with alcohol to remove any re- maining portion of urea. Mix the two solutions, evaporate them to a syrupy consistence, and then treat the residue with an equal weight of pure nitric acid, when the nitrate of urea will be formed in such abundance as to constitute a solid crystalline mass, containing an excess of nitric acid, the organic matters, and a portion of the mother water. From these it must be separated by squeezing it in a fine linen cloth, and frequently rinsing it while contained in the latter in ice-cold water. It is then to be compressed be- tween sheets of blotting paper, dried by a gentle heat and weighed. The nitrate of urea thus obtained is slightly coloured and contains a certain portion of organic matter, while the weight of urea present in it may be ascertained from its composition. (Lecanu.) V. Berzelius's method consists in evaporating the urine to dryness over a water bath and treating the solid mass with alcohol in order to separate those matters soluble in it. The alcoholic solution thus obtained is then submitted to distillation and the yellow residue dissolved in a little water and digested with animal charcoal. The liquor is then filtered, heated to 122 degs. and saturated with oxalic acid ; oxalate of urea is formed which becomes deposited in colourless crystals as the solution cools. The mother water must be evaporated, and a fresh portion of oxalic * Graham's Chemistry, p. 993. 66 MARKWICK ON URINE. acid added to it, in order to obtain more crystals of the Sxalate of urea. The whole of the crystals are now to be washed in ice-cold water and afterwards dissolved in boil- ing water mixed with a little animal charcoal. This is then to be separated by filtration, and the liquor saturated with carbonate of lime ; effervescence takes place, oxalate of lime is precipitated, and the urea remains in solution from which it is to be procured by evaporation. It may be obtained perfectly free from impurities by repeated solution in pure anhydrous alcohol and distillation. VI. Mix the urine with basic acetate of lead, and add sufficient sulphuric acid to convert the acetates into sul- phates. Then filter the solution through animal charcoal, evaporate it, and tolerably pure crystals of urea will be obtained. (0. Henry). VII. Ragsky proposes to determine the amount of urea from the products of its decomposition. For this purpose he mixes in a flask one part of urine with three or four of strong sulphuric acid, and raises the temperature of the mixture to nearly b!2 degs. The urea begins to be de- composed at 383 degs. Carbonic acid gas is disengaged and is evolved in great abundance at 393 degs.. while the ammonia, which is also formed, unites with the sulphuric acid. He then determines the amount of ammonia in the form of the ammonio-chloride of platinum, from which he afterwards calculates the quantity of urea. By this process he found that 4.03 grains of urea yielded 29.8 grains of ammonio-chloride of platinum which corresponds to 4.01 grains of urea ; and that 4.84 grains of urea yielded 35.7 grains of the double platinous salt corresponding to 4.81 grains of urea.* VIII. Heintz also recommends a similar process. It is as follows : " A weighed quantity of urine, 6.8 grammes, is treated with about thirty drops of muriatic acid, and set aside in a cool place for twenty-four hours, then filtered through a very small filter into a large platinum or porcelain crucible; the filter and glass are washed with a small quan- tity of water; the filtrate is treated, with about six grammes of sulphuric acid, and the liquid evaporated over a small * Liebig's and Wohler's Annalen for October, 1845. MARKWICK ON URINE. 67 spirit-lamp, taking care that it does not boil, until the evo- lution of carbonic acid commences. The crucible is then covered with a watch glass and heated until the evolution of carbonic acid ceases, the temperature not being allowed to exceed 180 degs. The contents of the crucible are then filtered into a porcelain dish, the crucible and the watch glass are well washed, and the filtrate is evaporated until almost all the water is passed off. About twenty drops of muriatic acid are then added to the residue, a sufficient quantity of chloride of platinum and alcohol mixed with ether being then added. If the liquid from which the pre- cipitate has subsided is of a very pale colour, more chloride of platinum must be added. After 8.10 hours the pre- cipitate is separated by filtration, washed, dried, and heated to redness in a crucible, which is at first covered, but sub- sequently open. The residue is treated w'ith boiling dilute muriatic acid, the solution filtered, and this is repeated until the liquid winch drops from the filter leaves no residue when evaporated upon platinum-foil; the crucible and filter are dried at a gentle heat; the latter is burnt in the former and weighed. Thus the amount of platinum, which cor- responds to that of the potash, ammonia, and urea, is ob- tained. Another weighed quantity of the fresh urine is treated once with chloride of platinum, three volumes of alcohol, and one of ether; at the end of ten or twelve hours the mixture is filtered, and the precipitate heated to redness in a well-covered and weighed platinum crucible. The residue is treated as above with dilute muriatic acid, the filter is burned and weighed. We thus obtain the weight of platinum which corresponds to the potash and ammonia contained in the urine ; its per-centage is calculated and then deducted from that obtained in the first experiment ; the difference gives the amount of platinum which cor- responds to the urea."* 80. The urea, as we have seen, (34), is also liable to be deficient in quantity, both absolutely and relatively. When there is an absolute deficiency, it may take place in common with a diminution of the other solid constituents of the * Chemical Gazette, vol. iv. p.p. 19, 20. 68 MARKWICK ON URINE. urine, and of the water; or of the solid constituents alone, the amount of wTater remaining normal. In both these cases the actual decrease can only be ascertained by one or other of the preceding processes, (79). When a deficiency of urea is suspected, it has been recommended to evaporate the urine to about one-half, and then to add to a portion thus concentrated and placed in a watch glass, an equal quantity of strong nitric acid or a saturated solution of oxalic acid ; when, if no crystallization takes place, the urea is to be considered as deficient. It is obvious, however, that this method cannot be relied upon ; the detection of any deficiency requiring in fact, as Dr. Prout has stated, " a more elaborate process." 81. Should albumen be present in large quantities in the urine it must be previously thrown down by means of alcohol, collected on a filter, and washed with the spirit. The washings are then to be mixed with the alcoholic so- lution obtained as above directed, and from which the urea is to be procured. M. Heintz's method consists in boiling a carefully weighed portion of the albuminous urine with the bichloride of mercury in a large open dish, collecting the precipitate that is formed on a filter, breaking it up and washing it with water. Then passing a stream of sulphu- retted hydrogen slowly through the filtered liquid, and re- moving from it by filtration, the sulphuret of mercury that is produced. The filtrate is now to be evaporated mixed with sulphuric acid, until the whole of the urea is decom- posed, which may be known by the cessation of effervescence as pointed out by Ragskv, and the fluid which remains, treated, as already described (viii.) It now remains to calculate the amount of potash and ammonia. This is done by throwing down the albumen from a second portion of the urine, (also weighed), by means of bichloride of mer- cury, and heating the filtered fluid with bichloride of pla- tinum and ether, when the quantity of platinum obtained from the precipitate will indicate the proportion of the alkalies. This method is applicable to urine containing blood, milk, or bile, and in the opinion of Heintz, even to Diabetic urine. Dr. Griffith recommends the alcoholic solution of the residue that is left on evaporating albuminous urine to dry- MARKWICK ON URINE. 69 ness, to be evaporated, and the extract dissolved in distilled water, the solution then reduced to the consistence of syrup and mixed with half its bulk of pure nitric acid. The for- mation of crystals of the nitrate having been promoted by placing the mixture in ice, the supernatant liquid is to be poured off", and the crystals then washed in ice-cold water, and subsequently dried in an open steam bath. 81.* To obtain the urea from Diabetic urine M. Bou- chardat proceeds by taking the residue left after the evapo- ration and crystallization of the urine, and dividing it into several portions, and treating each successively with alco- holated sulphuric ether. He then mixes the several solu- tions, evaporates them at a gentle heat, and dissolves the residue in a sufficient quantity of water, from which, when filtered, and a few drops of weak nitric acid have been added, he obtains the urea in the form of nitrate.* Dr. Christison merely evaporates the urine quickly over a steam bath at a temperature of about 200 Farn. to about one-sixth of its volume, then adds to this one-fourth of its amount of pure nitric acid diluted with an equal weight of water, and exposes the mixture to a moderate degree of cold. Some have recommended to previously destroy the sugar by fer- mentation, but it is doubtful whether the transformation of the urea into carbonate of ammonia is not more likely by this process to be occasioned. 82. Urea may be artificially prepared by well mixing twenty-eight parts of dry ferrocyanuret of potassium with fourteen of peroxide of manganese both in fine powder and heating the mixture, placed on a smooth iron plate to a dull red heat, at which temperature it inflames, and must be kept stirred so as to allow of a free access of air and pre- vent agglutination. When cold the mass is to be treated by repeated portions of water, and twenty and a half parts of sulphate of ammonia, are to be added to the solution, from which a copious deposit of sulphate of "potash then takes place. The supernatant liquor containing the cyanate of ammonia must afterwards be decanted off and evaporated in order to separate still more of the sulphate, and this pro- cess repeated until the whole of it is removed, when the last * Loc. Cit. 70 MARKWICK ON URINE. decanted liquor is to be evaporated to dryness, and boiling alcohol of from eighty to ninety per cent added to the re- sidue. This takes up the urea, which is obtained as the solution cools, or by evaporation, in beautiful colourless crystals. One pound of ferrocyanuret of potassium will yield about four ounces of urea. 83. Lithic Acid. This is frequently met with in the urine in the form of a crystalline deposit, varying in colour from a light fawn to a deep brown or brownish red, which is owing either to its being in excess (44,45,) and consequently no longer entirely retained in solution, when the fluid cools, by the double phosphate of soda and ammonia, (41,) or to the presence in the secretion of some free acid, (45,) by which the lithate of ammonia becomes decomposed. 84. To ascertain whether a particular deposit be lithic acid, place the urine in a tall conical glass vessel, and when it has stood some time, and the sediment has sub- sided, decant nearly the whole of the supernatent liquor and pour a small quantity of the turbid remainder, containing the deposit, into a watch glass. Then if uric acid be present it will be known by its remaining undissolved when the urine is heated over a spirit lamp ; by being precipitated in com- bination with ammonia from its solution in liquor potassae by hydrochlorate of ammonia; by its not being acted on either by hydrochloric or acetic acid ; by its being soluble in nitric acid with the disengagement of equal volumes of nitrogen and carbonic acid gases, and also in sulphuric acid from which it is again precipitated by water; by the pink coloured residue (the erythric acid of Brugnatelli,) left after the evaporation of the acid solution, being changed to a beautiful purple when exposed to the vapours of ammonia, owing to the formation of murexid, and lastly by its yielding urea and evolving an odour of prussic acid when burnt, and leaving a white substance composed principally of phos- phate of soda and lime. 85. When examined under the microscope uric acid is seen to crystallize in rhomboidal prisms, or in some modifi- cation of this form ; the particular shape of the crystals ap- pearing to depend on the rapidity of their crystallization, on the quantity of colouring matter contained in them, and on the nature of the precipitating agent. The forms most fre- MARKWICK ON URINE. 71 quently observed are the rhomboid and the quadrilateral tables, which, in some cases appear nucleated by being marked all round at a short distance from their borders. Occasionally, however, we meet with them of a spindle shape, at other times they appear like so many flattened cy- linders which are in reality " thick lozenges lying on their sides," (Bird) and require to be made to roll over, either by agitation or by the addition of a few drops of alcohol, in order that their true shape may be detected. Sometimes, when the urine is very acid for instance, the surface of the quadrilateral tables are either entirely or partially covered with numerous dark straight lines, their extremities, in con- sequence, having a serrated appearance. In those cases where they are only partially striated, the plane part fre- quently presents two concentric lines placed with their con- vexities towrards each other. Or the striae may be so arranged as to leave between them two clear triangular spots united at their apices. When the deposit is of a deep orange or red colour, the crystals are generally found ad- hering together in clusters having the appearance either of thick rhombic prisms collected together in bundles, or placed across or parallel to each other; or of spinous or striated masses of cohering lozenges. 86. Before examining the deposit it is however always better to previously dissolve the urate of ammonia with which it is frequently combined, by heating the urine and then to remove the latter with a pipette and replace it with a little distilled water. 87. To detect an excess of uric acid (41, 44, 45,) for a deposit is no proof of it, Dr. Bird recommends the whole of the urine voided in twenty-four hours to be collected and well shaken, and about an ounce of it gently warmed and mixed in a conical glass vessel with about half a drachm of hydrochloric acid. By allowing the mixture to stand for six or eight hours, the sides of the glass will become covered with a copious deposit of crystals of uric acid. The urine is now to be poured off and replaced by cold distilled water, and the crystals detached with a feather or a spatula, and collected at the bottom of the vessel. The water is then to be decanted and the acid placed in a watch glass, the weight of which is known, dried and weighed. 6 72 MARKWICK ON URINE. This process also enables us to ascertain, by simple multi- plication, the actual quantity excreted in the twenty-four hours ; but as hippuric acid is obtained at the same time it should be removed by means of boiling alcohol previous to drying the precipitate in order to avoid error in calcula- tion. (51.) An excess of lithic acid, when it does not constitute a deposit, as is sometimes the case, can also be detected by nitric acid, when added to a high coloured urine, producing a brown precipitate possessed of the preceding chemical and microscopic properties. 88. The amount of lithic acid contained in the urine may also be discovered by proceeding as for urea, viz. by eva- porating the secretion to the consistence of syrup, and then treating it with alcohol. This will throw down the uric acid in combination with some of the colouring and animal matters and the alkaline and earthy salts. The supernatant liquor containing the urea and hippuric acid in solution, is then to be poured off and the precipitate washed with alco- hol and allowed to dry. Cold hydrochloric acid is after- wards added to dissolve the saline matters and decompose the urates, when the uric acid will be left tolerably pure, and requires only to be dried and weighed. In having recourse to this test it is necessary that the urine should be perfectly limpid, that is, free from viscidity, for if any mucus for instance, be present it will prevent the uric acid from being precipitated ; therefore when it is not so, it had always better be previously filtered. 89. Another mode consists in taking the residue, (com- posed of lithic acid, and vesical mucus, the extractive and colouring matters, the alkaline and earthy phosphates, and silex,) that is left when alcohol is added to the urine re- duced to a syrupy consistence, for the purpose of separating the urea, and washing it with water in order to remove the alkaline salts, then drying and weighing it and aftenvards incinerating it in a platinum or porcelain capsule. By this means we get rid of the organic matters, viz. the uric acid and mucus, and obtain as a residue, the earthy phosphates in combination with silex if any be present in the urine. We have now only to weigh this when we at once ascertain the quantity of uric acid and vesical mucus, by the loss MARKWICK ON URINE. 73 that has been sustained by incineration. The mucus, however, being as we have seen, (64) in such exceedingly minute proportion, may be neglected in the calculation. 90. Urate of Ammonia.—Deposits of this substance never occur in the urine in a crystallized form, therefore are not likely to be confounded with uric acid, (85) but gene- rally in an amorphous state, of a yellow, red, pink, or pur- ple colour, and sometimes nearly white. Occasionally, however, they have a ropy appearance, and are dispersed through the fluid like mucus or muco-pus (47a.) They are known by being dissolved on the application of heat and by the addition of a solution of ammonia or potash. The hydrochloric and acetic acid, also dissolve them with de- composition setting free the uric acid which becomes deposited, and may be recognized by its various chemical and microscopic properties above described. (85.) 91. They not unfrequently exist in combination with the lithate of soda and occasionally also with that of lime. When this is the case the deposit is not entirely dissipated by heat, the soda and lime remaining behind as a white ash at the bottom of the capsule, when they may be detected by the usual tests. Thus by adding to their solution in hydro- chloric acid a little oxalate of ammonia, the lime if present becomes precipitated as an insoluble oxalate, and the super- natant liquid will yield on evaporation crystals of chloride of sodium (common salt) if it contain soda. Moreover soda gives a rich yellow colour, and lime a dull brown to the flame of a blow-pipe. 92. A positive proof of a deposit consisting of lithate of ammonia is its disappearing when the urine is heated, and its being replaced by crystals of uric acid when a few drops of acetic acid are added to it in a watch-glass. It occa- sionally happens, as when the lithate is mixed either with the earthy phosphates or wTith mucus, that the urine does not become perfectly transparent by heat. If this be owing to the presence of the phosphates they will be dissolved by acetic or hydrochloric acid, but if to mucus no such change will take place. In order to avoid error from the latter in- gredient, the urine ought always to be filtered before it is warmed. It also sometimes occurs that the urine after it has been rendered clear by being submitted to a gentle heat, 74 MARKWICK ON URINE. becomes again turbid by the further application of heat. This is owing to the presence of albumen. 93. To determine its quantity, collect the whole of the urine of twenty-four hours, ascertain its specific gravity and divide it into two portions. Evaporate the one in order to obtain the amount of solid constituents, and collect the sediment from the other; mixed, as the case may be, with lithic acid, the earthy phosphates or mucus on a filter, the weight of which is known. Wash it in ice cold water, dry and weigh it, and its proportion to the solid matters and to the urine will be obtained. Then place it in a test tube and boil it with a little of the urine. Afterwards filter it, wash the residue with hot water and stand the clear fluid that passes through in a freezing mixture, to promote the separation of the lithate. When this has taken place it can be collected, dried, and weighed, and its absolute and rela- tive proportion ascertained. 94. The most frequent appearance presented by lithate of ammonia under the microscope is that of very small globules arranged together in rows. Occasionally, how- ever, particularly in albuminous urine, the globules are con- siderably larger, and distinct, some of them having sharp or obtuse processes attached to them. Both varieties are generally mixed with crystals of uric acid. 95. Hippuric acid. I have already alluded to two modes by which hippuric acid may be obtained (87, 88.) Another, that recommended by Liebig, consists in evaporating the urine in a water-bath to the consistence of syrup, then mix- ing it with hydrochloric acid, and agitating it with its own volume of ether. This will, in all probability, remain en- closed by the fluid like froth, and require to be separated after a short time, by the addition of one-twentieth of its volume of alcohol, which will at the same time remove the froth and cause a separation of the fluid into two layers. The upper layer containing the hippuric acid and urea in solution, must now be removed with a pipette and treated with several small portions of water, in order to wash away the alcohol and urea and leave the hippuric acid dissolved in the ether. By then evaporating the etherial solution, the acid will be obtained in the crystallized form.* From this * Lancet for June 1, 1811. MARKWICK ON URINE. 75 statement we should suppose hippuric acid to be soluble in ether, but we have already seen that this is not the case, or at least to a very slight extent only. (84.) The best method for detecting this acid is to add to the urine, reduced to the consistence of syrup, an excess of hydrochloric acid. By this means the hippuric acid will be thrown down together with the lithic, from which, after some little time, when the supernatant liquor has been poured off", it can be separated by boiling the precipitate in alcohol, in which lithic acid is insoluble. The alcoholic solution thus obtained, will then yield on evaporation, crystals of hippuric acid, to be recognized by their chemical and microscopic characters already described (51.) 96. Dr. Day recommends the following process: "Evapo- rate the urine till there is a copious deposition of salts. Add strong alcohol and place the mixture in a stoppered bottle. With the aid of a gentle heat (for instance, by placing the bottle in warm water,) we ensure the solution of the urea, the lactates, (if any are present,) and the hip- purates in the alcohol, whilst the urates remain with the in- soluble constituents. When the supernatant fluid is per- fectly clear it must be decanted, evaporated nearly to dry- ness, and re-dissolved in hot water. If a stream of hot water be passed through the aqueous solution, the urea is destroyed ; and, by gradual concentration, and the addition of a little free mineral acid, we obtain crystals of hippuric acid. 97. When an excess of hippuric acid is suspected in the urine, place some of the latter in a large watch-glass, and evaporate it nearly to dryness over a spirit lamp, then add about half its bulkof hydrochloric acid which will cause the mixture to assume a bright pink colour, and give off a powerful odour somewhat similar to that of new hay. Set the mixture aside, and after a few hours, provided the acid is in excess, crystals of a peculiar linear shape will make their appearance." (Bird.) In order to purify hippuric acid Dr. A. Bensch has re- course to the following process. Having precipitated the acid from the urine by means of hydrochloric acid, he col- lects it on a strainer, well presses it, and treats it with ten times its weight of boiling water and an excess of milk of 76 MARKWICK ON URINE. lime. He then filters the mixture, presses the precipitate, treats the fluid with a solution of alum as long as it has any alkaline reaction, allows it to cool to 104 degrees Farnh., saturates with a solution of bi-carbonate of soda, again strains and presses, and lastly adds hydrochloric acid to throw down the hippuric. This is afterwards washed, pressed, and dissolved in boiling water: an ounce of animal charcoal is then added to every pound of the moist acid, and the boiling liquid filtered through paper, when perfectly white hippuric acid will be obtained.* (B.) Abnormal. a. Crystalline. 98. Uric or Xanthic Oxide, (66,) has been but very rarely met with. It has a great resemblance to uric acid which is very liable to be mistaken for it. When, therefore, its presence is suspected in a deposit, Dr. Bird recommends the latter to be treated with a weak solution of carbonate of potash, which will separate the uric acid and leave the oxide undissolved. The principal features by which it is distinguished are the fleshy colour of its external surface; the brownish-red, or cinnamon hue it presents when broken; the waxy appearance it assumes on being rubbed, and also its different actions towards various reagents. Thus it dis- solves but slowly in nitric acid and without effervescence, and leaves a yellow, not a pink residue like uric acid (36,) on the evaporation of the acid solution. It is not precipi- tated by water from its solution in strong sulphuric acid, nor from its solution in liquor potassse by hydrochlorate of am- monia. It is insoluble in a solution of carbonate of potash and yields no urea or bitter almond odour like lithic acid when burnt. When examined under the microscope it has not been found to have any distinct crystalline form, even when precipitated from its solution in liquor potassa. 99. Oxalate of Lime, (66.) Crystalline deposits of this substance wTere formerly supposed to be of exceedingly rare occurrence, but this has been entirely disproved by the late * Chem. Gaz. for Nov. 16, 1846. MARKWICK ON URINE. 77 researches of Dr. Bird,* who, from his experience, is led to the conviction that "in the cases of disease occurring in the metropolis, the oxalate is of far more frequent occurrence in the urine than the deposits of earthy phosphates," an opinion which is fully corroborated by Dr. Shearman of Rotherham, who states as the result of his observation, that, next to the urates, small quantities of the oxalate are most commonly met with in the secretion.f It appears to be intimately connected with that particular state of the system characterized by great nervous irritability. The urine in these cases has its natural amber colour, but is generally somewhat darker than in health, and has only been met with by Dr. Bird of the citron yellow or greenish hue described by Dr. Prout as being peculiar to the oxalic acid diathesis, when blood corpuscles have been present in the secretion. It is likewise acid in the great majority of instances, and subject to very great variation in its specific gravity. Thus it has been observed by Dr. Bird as low as 1.009 and as high as 1.030. " It increases with the quantity of urea,'''1 of which the urine, generally in these cases, con- tains an excess, sometimes even to a very considerable extent, so that crystallization takes place immediately nitric acid is added ; the abundance and size of the crystals of the oxalate appearing also to be in a direct ratio with its amount. It may, however, be said to range generally speaking, between 1.015 and 1.025. I have already alluded (66) to the various sources to which the existence of oxalate of lime in the urine is to be ascribed, namely, slight deoxidation of the elements of urea and water, oxidation of uric acid, certain articles of food, and the mal-assimilation of saccharine matters. With re- ference to the last, and considering the great importance of the subject, the following interesting remarks may with con- siderable advantage be quoted from our great authority on Oxaluria, Dr. Bird. " It is scarcely possible," says he$ " to avoid being impressed with the very probable physiological relation between oxalic acid and sugar: we know that the * See Med. Gaz. for 1842. f Urinary Deposits, p. 165. X Loc. Cit. p. 175. 78 MARKWICK ON URINE. latter substance forms a considerable item in our list of ali- ments ; we know that the great majority of farinaceous matters are partially converted into this element during the act of digestion.* It is indisputable that, under certain cir- cumstances, it finds its way into the blood, and is elimi- nated by the kidneys; even when artificially introduced it is thus thrown out of the system. I have in my possession fine crystals of sugar prepared by my friend, Dr. Percy of Birmingham, from the urine of a dog, into whose veins he had previously injected a solution of that substance. Lastly, we know that, under certain morbid influences, the great proportion of our food may, wdrilst in the stomach, become converted into sugar, which becoming absorbed, rapidly passes through the circulation, and is thrown out of the system by the kidneys as an effete matter, with the effect of producing more or less rapid emaciation, and in most cases leading to fatal marasmus. Dr. Aldridgef of Dublin, has even lately suggested the probability of a substance analo- gous to sugar, [59] capable of undergoing acetous fer- mentation, being a normal element of the urine. Then, re- collecting the facility with which sugar and its chemical allies, as starch, gum, and wood fibre, are, under the influ- ence of oxydizing agents, converted into oxalic acid, and having sufficient amount of evidence to prove that when ox- alic acid is really found in the urine, symptoms bearing no distant relation to those of a diabetic character are met with, we are almost inevitably led to draw the induction that the ox- alate of lime found in the secretion owes its origin to sugar, and to locate the fons et origo mali in the digestive organs. This appears to be nearly the view adopted by that very ex- cellent authority in these matters, Dr. Prout." And he goes on to state that his experience has led him " to the following conclusions regarding the circumstances under which the oxalate of lime occurs in the urine. i. That in the urine under examination oxalate of lime is present, diffused through a fluid, and in a crystalline form. * Gmelin and Tiedemann, Recherches experimentales sur la Di- gestion*—Paris, 1827, p. 202. [Also Papers, by the Author, in the Med. Times vol.xv. from the French of M. Bouchardat relative to this subject.] X Lectures on Urine. MARKWICK ON URINE. 79 ii. That in rather more than one-third of the cases, uric acid or urates existed in large excess, forming the greater bulk of the existing deposit. in. That in all, there exists a greater proportion of urea than in natural and healthy urine of the same density; and in nearly 30 per cent of the cases so large a quantity of urea was present, that the fluid crystallized into a nearly solid mass on the addition of nitric acid. iv. That the urate of ammonia found in the deposits of oxalic urine is occasionally tinted of a pink hue. v. That an excess of phosphates frequently accompanies the oxalate. vi. That the existence of free sugar in the specimens I have examined, is the exception to the rule." 100. Deposits of oxalate of lime, independent of nu- merous epithelial scales with which they are almost always found combined, generally occur alone in the urine. They have, however, been sometimes found mixed with lithic acid and lithate of ammonia, and occasionally with the triple phosphate. 101. In order to detect the presence of this salt in the urine, a portion of the latter, passed a few hours after a meal, is recommended by Dr. Bird to be set aside in a tall glass vessel for a short time, the upper 67-ths then poured off" and a little of the remainder placed in a watch glass and gently heated over a spirit lamp so as to dissolve any urate of ammonia that may have become deposited (a circum- stance of frequent occurrence in winter,) and to promote the subsidence of the crystals of the oxalate, which have the very remarkably tendency to remain diffused through the urine, even when present in it in considerable quantity. By then giving the fluid a slight rotatory motion, they will be collected together at the bottom of the capsule. The urine is now to be almost entirely removed from them with a pipette and replaced with a little distilled water, when a white, often brilliant powder will make its appearance, which with the aid of a microscope, furnished with a half- inch object glass, will be seen to consist of transparent, well defined, octahedral crystals of oxalate of lime. Exa- mined when dry, they are found to have a quadrilateral shape, and appear to be composed of two squares, one 80 MARKWICK ON URINE. within the other, the central one being transparent and the outer one dark, and so arranged that the sides of the former correspond to the angles of the latter. Sometimes they are somewhat of a dumb-bell shape, or resemble that presented by two kidneys united together at their fissures. 102. Deposits of oxalate of lime may also be recognized by their solubility in the nitric and hydrochloric acids ; by their remaining undissolved when boiled in liquor potassse or acetic acid ; by yielding on incineration first carbonate of lime and afterwards the oxide of the metal, and by their being decomposed when boiled in a solution of carbonate of potash, with the formation of carbonate of lime and oxa- late of potash; the former being precipitated while the latter remains in solution. 108. Cystic oxide or Cystine, (66), constitutes rather a rare deposit. In the opinions of Drs. Prout and Bird, it is to be met with in the urine more frequently than has been imagined. When present in the urine, the latter is always turbid when passed, and lets fall a very abundant sediment. It is of a pale or greenish-yellow, or honey colour, and gene- rally somewhat reduced in specific gravity. When fresh, it has, in the greater number of cases, no reaction on test paper, occasionally, howrever, it is acid, and if kept, soon becomes alkaline. Its odour on emission resembles that of sweet-briar, and assumes a peculiar foetid character when putrefaction takes place, owing probably to the disengage- ment of sulphuretted hydrogen. On standing it also becomes coated writh a gray looking pellicle, which has been found to consist of crystals of the substance under ex- amination and the triple phosphate. 104. Deposits of crystine are characterized by the follow- ing properties. They are of a pale or light fawn colour; are not affected by heating the urine ; are insoluble in alco- hol ; but slowly dissolved by nitric or hydrochloric acid, which readily distinguish them from the lithates (90) and phosphates, (153 to 156), are decomposed by an excess of the former, a brown residue being left. They are also soluble in the sulphuric, phosphoric, and acetic acids, in solutions of the volatile and of the fixed alkalies, and also of the carbonates of the latter, but not in the carbonate of ammonia or in the vegetable acids. When burnt they give MARKWICK ON URINE. 81 a greenish blue tint to the flame, and emit a disagreeable acid but characteristic odour. 105. To examine the microscopical characters of cystine, first remove any lithate of ammonia that may be present by boiling the sediment in water, and afterwards dissolve the oxide in a little liquor ammonia?, and allow the ammonia- cal solution to slowly evaporate on a slip of glass; then place this under the field of the microscope, and crystals will be observed, either of a well-defined hexagono-lami- nated shape, perfectly transparent or with opaque centres ; or in round masses, dark in the centre, with serrated or notched borders resembling rosettes, and numerous markings on their surface, an appearance which seems to be due to several plates having become placed one above the other. Or the compound deposit, consisting of a mixture of cys- tine with either the urates or the phosphates, may be treated at the onset with a little liquor ammoniae, the cystic solu- tion then evaporated, and the residue examined under the microscope. 6. Organized. 106. Blood.—The presence of blood in the urine is owing, as we have seen, (66a), to very various causes, and is sometimes so abundant as to give it a dark red, or port-wine, or even black appearance ; while in others it exists in such a minute proportion as to be almost imper- ceptible. Its existence in large quantities in the urine may be suspected from the dark colour just alluded to of the latter; from the large black masses resembling coagula, contained in the secretion ; and, together with these, from the alkaline reaction of the urine on test paper. In those cases where the blood is less abundant, the urine instead of assuming the dark colour above-mentioned, has a dirty aspect, is without coagula, and lets fall a reddish sediment. 107. When urine, contaminated with blood, is boiled, it becomes turbid, owing to the coagulation of the albumen, and changed to a dirty brown colour, and, when nitric acid is added to it, deposits an albuminous precipitate, more or less copious in proportion to the quantity of blood present in it. 108. To detect its presence, one or other of the follow- ing processes may be resorted to : 82 MARKWTICK ON URINE. I. Boil the urine, previously saturated with nitric acid, if it be alkaline, collect the coagulum that is formed, on a filter and treat it with alcohol, acidulated with sulphuric acid in order to remove its colouring principle. Evaporate the brown coloured liquid thus obtained, and which is changed to a bright red on the addition of ammonia, and the colouring matter will collect on the surface as a black resinous looking mass, soluble in acetic ether and* ammo- niated alcohol. To the latter fluid it communicates a red colour, which is converted to a yellow* by hydrochloric acid; a blue precipitate being also subsequently formed when ferrocyanate of potash is added to the yellow solution, (Lecanu). II. Boil the urine, collect the coagula on a filter, and pour over them liquor potassae ; add hydrochloric acid to the greenish fluid that passes through, and white coagula consisting of protein will be formed (Pariset Journal de Chimie, 1840, p. 68.) 109. The most speedy and certain mode, however, of ascertaining the presence of blood in the urine is by means of the microscope. Place a little of the suspected dark coloured urine in a watch glass under the field of this instru- ment, and if blood be present it will be detected by its characteristic corpuscles, which are more or less altered in shape in proportion to the length of time they have been acted on by the secretion. They are generally distinct and appear flatter than natural, owing to exosmosis, and have sometimes fringed or serrated borders. Occasionally, when the urine is examined very shortly after its admixture with blood, they are met with in their normal condition, namely, as flattened vesicles with bright central spots adhering to- gether in rouleaux. When the quantity of blood is so small as to scarcely tinge the urine, then a portion of the coloured deposit which mostly subsides, or of the lowermost stratum of the fluid must be examined. It sometimes happens, however, that in these cases the blood corpuscles have become dis- solved, and then the microscope is of no avail. Our only resource then left is to ascertain if the fluid becomes coag- ulated or opaque, and if its colour disappears by boiling. Having detected the presence of blood it becomes highly MARKWICK ON URINE. 83 necessary to discover from what part of the urinary appara- tus it has arisen, whether from the kidneys, the ureters, the bladder, or the urethra. This is not at all times an easy matter and requires several circumstances to be considered before we can arrive at just and true conclusions. 110. When it proceeds from the kidneys, there will generally be some symptoms referrible to these organs, caused either by an injury to the loins or by some morbid condition of the glands themselves, as inflammation or con- gestion, or tubercular or cancerous degeneration, or by the presence of a calculus. The urine, moreover, will be tole- rably uniform in colour, and when the blood is very abun- dant, will contain dark elongated coagula. This is more particularly the case when the haemorrhage has been occa- sioned by a violent blow, or by a penetrating wound in the lumbar region, or by the presence of a stone. 111. When it proceeds from the ureters, it is almost always produced by a calculus, which may be readily de- tected by the symptoms it gives rise to, namely : sudden and severe, but intermitting pain, extending round the loins downwards towards the testicles, rendering these spas- modically painful and forcibly retracted, and giving rise to distressing nausea, vomiting and even faintness. 112. If it proceeds from the bladder it may generally be readily discovered by the accompanying symptoms being principally referred to this viscus; the kidneys and ureters remaining unaffected. The symptoms however will van- considerably, according to the cause which has given rise to them, (See Tabular view,) and in some cases, indeed, will be entirely wanting, as when the haemorrhage is vica- rious to some periodical discharge of blood, such as the menses, and in some cases hcemorrhoidal flux, &c. 113. If the urethra be the seat of the haemorrhage, it will be easily detected by the escape of pure blood, free from urine, both previous to and after the evacuation of the bladder, and by the first portion of urine passed being slightly tinged, while the remainder is perfectly clear and of its natural colour. There are likewise no symptoms re- ferrible, either to the bladder or the kidneys. It sometimes happens, however, that the blood has pa.ssed backwards into the bladder; in that case the whole of the urine will be 84 MARKWICK ON URINE. coloured in proportion to the quantity of blood that has re- trograded. The true seat of the haemorrhage may, never- theless, be generally detected by the accompanying symptoms. 114. Pus (666). Urine containing pus is always more or less turbid when passed. On standing, it becomes some- what clearer, but never perfectly transparent. This is owing to the subsidence of the purulent matter, which then has the appearance of a thick sediment of a pale yellowish- green, or dirty white colour, and is easily disturbed by the slightest motion of the fluid. The urine is mostly acid or neutral when voided, and but slowly undergoes decompo- sition. The ammonia, however, which is formed when this change does take place, not only renders the secretion alkaline, but also completely alters the nature of the deposit by making it tenacious and viscid. 115. To ascertain whether a sediment consists of pus, pour from it the clear supernatant fluid, and test it for albu- men with heat and nitric acid; then collect the suspected deposit and add to a part of it an equal volume of liquor potassae, and to another portion some ether, and place the remainder under the field of the microscope. Then, if coagulation or an opacity takes place in the first; gelatini- zation or coagulation in the second ; and yellow fat globules are left by the evaporation of the third ; while, in the fourth, granular and opaque globules are observed floating in an albuminous fluid—the liquor puris—we have positive proof of the purulent nature of the morbid deposit. 116. Pus globules are distinguished from blood corpus- cles or discs (109) by being larger, granulated, and less transparent, and by their external membrane becoming dis- solved, and the nuclei which they contain, thereby ren- dered distinctly visible, when acetic acid is added to them. 117. Purulent deposits are liable to be mistaken for mucus or the phosphates. The former may be diagnosti- cated by its characteristic features, (119) while the phos- phates may be known by their being dissolved by an acid. 118. Mucus (66c.)—Urine containing mucus in excess is always more or less turbid, and frequently is so consistent and viscid as to have the appearance of a gelatinous mass. It is remarkably prone to decomposition, the mucus in all MARKWICK ON URINE. 85 probability acting as a ferment (29), and has, when this takes place, a remarkably foetid, disagreeable odour, and an alkaline re-action on test paper. If the decomposition com- mence previous to its excretion, it then acquires irritating qualities, and by acting on the lining membrane of the blad- der, causes an increased formation of mucus. The mucus therefore must be considered as both the cause and efl'ect of the putrefactive change which the urinary secretion under- goes. Mucus, when present in the urine in large quantities, always falls in great part to the bottom of the vessel in which the secretion is placed, from which it rises, when the fluid is shaken, in large stringy or ropy masses. 119. The characteristic features of a mucous deposit, and those which distinguish it from pus, are its ropy or stringy appearance; its not perfectly separating from the urine as a homogeneous yellowish substance, but always remaining somewhat suspended in it in the form of long stringy masses; its being coagulated by acetic acid; its yielding very few, if any, fat globules to ether, and its not rendering the urine albuminous. Another distinguishing feature be- tween mucous and purulent urine is that the former is alka- line and the latter mostly acid or neutral; the one being prone to putrefaction while the other undergoes that change but very slowly. 120. The microscopic characters of mucus are much the same as those of pus, and therefore are of no avail in diag- nosis. 121. It not unfrequently happens that both pus and mucus are contained in the urine at the same time. In that case the secretion will present more or less of the charac- teristic appearances above described as peculiar to each substance. The whitish ropy deposit of lithate of ammo- nia (90,) is liable to be mistaken for the sediment occurring under these circumstances. It may, however, be distin- guished by disappearing when the urine is heated. 122. Urine voided in an alkaline state may be owing, (and I have had frequent opportunities of verifying the fact) to its having undergone some change or decomposition in the bladder in consequence of some morbid or inflammatory condition of this viscus, either originating in it or the result of some derangement of the parts anterior to it, as stricture 86 MARKWICK ON URINE. of the urethra, for instance, and enlarged prostate ; or to its having been secreted in that state, and constituting then, according to Rayer, a symptom of chronic nephritis. It is of the utmost importance, therefore, to distinguish between these two classes of cases, and the only way of doing so is to draw off the urine, then to wash out the blad- der, and examine the fluid that is next secreted. 123. Besides the pus and mucus globules already de- scribed, the urine occasionally contains others for which Dr. Bird has proposed the name of Organic Globules. They are of two kinds, the large and small. The former differ from the pus and mucus particles only in the fluid in which they float not possessing the albuminous properties of the Liquor Puris or the viscid or glairy nature of the Liquor Muci. They seldom constitute an actual deposjt but are generally diffused through the urine. They are met with in cases of ardor urinae, and in the latter months of pregnancy, but are most numerous in confirmed cases of Bright's disease. The Small Organic Globules are of more rare occur- rence. They differ from the larger ones, in always forming a distinct deposit, in having a smooth non-granular surface, and in being devoid, to all appearance, of nuclei. 124. Epithelium Scales may be recognized by their flattened cellulo-nucleated aspect under the microscope. They are occasionally met with in very large quantities, especially during the occurrence of the oxalate of lime de- posits. Dr. Johnson has lately discovered fat globules in them, an appearance which, in his opinion, is characteristic of Bright's disease. 125. Spermatozoa (66.) The only way to detect the existence of these animalcules is to submit to microscopic examination a few drops of the lowest stratum of the suspected urine, or a little of the deposit that may have formed, when they will be observed as small oblong bodies with delicate tapering tails. 126. Torulce (66,) are only met with in saccharine urine, while it is undergoing the alcoholic fermentation. Their true nature can only be detected with the microscope. When first examined with this instrument, they are found to consist of small oval vesicles containing in their interior MARKWICK ON URINE. 87 minute granular corpuscles. At length, by the gradual in- crease in size of these granules, the vesicles expand, become tubular, and finally put forth small granular, bud-like pro- jections, which enlarge and undergo the same change as their parent cells, so that the fungoid, or confervoid vege- tation has then a beaded or jointed appearance, and con- stitutes a thin pellicle on the surface of the fluid. Occa- sionally, however, these fungi appear to increase in a different manner, namely, by the bursting of the parent vesicles and the escape of the contained granular bodies, which eventually form themselves into fresh cells. When the vesicles have remained on the surface united together in the manner above described, for some little time, they separate and fall to the bottom in their original distinct state. 127. Vibriones, (66,) have been met with in the pale, light urine of cachectic and debilitated persons. They are excessively small linear bodies, having an oscilating motion, but without any distinguishable organization. g. Non-Organized. 129. Albumen, (66,) is by no means an unfrequent ab- normal ingredient in urine, and in some cases is present in it in great abundance. It admits, generally speaking, of easy detection. The principal tests are heat, nitric acid, and the ferrocyanide of potassium with the addition of a few drops of acetic acid. The appearances presented by the urine after the applica- tion of these tests will be a good criterion of the quantity of albumen present in it, as in some cases it is merely ren- dered a little turbid, while in others it becomes almost a solid mass. 129. If heat occasion an opacity or a deposit, we must not be too hasty in attributing it to the presence of albumen, as it may be owing to the precipitation of the phosphates. This, however, may be readily discovered if the precipitate is dissolved by the addition of a few drops of nitric acid. Dr Griffith, however, has stated in a communication to the Medical Gazette for Oct. 21, 1842, that the albumen, when in small quantity, may also be dissolved by a few 7 88 MARKWICK ON URINE. drops of this acid ; but that there is this difference between the two substances, that the latter (albumen) is precipitated, while the phosphates remain dissolved when the acid is added in excess. 130. If the urine be alkaline no coagulation or opacity may take place. Nitric acid must be used in this case either alone, or what is better, in combination with heat. 131. If nitric acid alone renders the urine turbid, ascertain whether the patient has been taking copaiba or cubebs; for according to Dr. G. 0. Rees, such an effect is liable to be the result of the administration of these medicines. This statement has been confirmed by Simon, who states that the precipitate consists of small oil vesicles. No turbidity or deposit is produced in these cases by heat. It will be seen, therefore, by the preceding remarks, that the effects of both heat and nitric acid require investigation before they can be received as evidence of the presence of albumen, and in fact that each test necessitates the confir- mation of the other. 132. To ascertain the amount of albumen it must be pre- cipitated by boiling a given weight of urine then collected on a filter, dried, and weighed, and the quantity contained in the whole of the urine voided in twenty-four hours, cal- culated from that obtained from the portion examined. Or we may adopt the process recommended by Heller,* which is as follows : Take a given quantity of urine, say from ten to twenty grains, and determine the percentage of solid matters contained in it; then rapidly raise another portion of equal weight to the boiling point in a small narrow- mouthed flask. Set this by with its mouth closed, and when the fluid is cold, filter it through a tolerably fine linen cloth, and the albumen will collect upon it. If the addition of nitric acid causes no further precipitation of al- bumen we may be sure that the whole has been separated. The difference between the amount of solid residue left by the strained fluid on evaporation, and that from the first specimen examined, will represent the quantity of albumen. * Quoted by Dr. Day in Simon's Chemistry, from vol. i. p. 192, of the Archis fur phys, und Patholog Chimie und Mikroskopie. MARKWICK ON URINE. 89 133. " There is a class of cases," says Vogel in his Er- lauterungstafeln zur Pathologischen Histologic* in which the urine—sometimes bloody, sometimes of its natural co- lour, but always turbid at the commencement—when al- lowed to remain at rest, lets fall a yellowish white sediment, whereby it becomes clear and transparent. This sediment is not mucous; on agitation it readily mixes with the urine, whereby this latter is rendered turbid for the time, but be- comes clear again, as soon as the precipitate is again de- posited. The urine sometimes contains a large quantity of albumen, which coagulates on boiling; at other times it contains but little, rarely none at all. Under the microscope this sediment appears to consist of colourless coagula, of a cylindrical form, the diameter and shape of which corres- pond exactly to the tubuli uriniferi of the kidneys. Like the uriniferous tubules of healthy kidneys they contain, in- closed within them, portions of epithelium, and now and then, rusty coloured granules (altered blood.) These co- agula readily dissolve in caustic potash, with difficulty in acetic acid ; but by this latter re-agent the epithelial cells contained within the coagula are rendered very distinct. There seems hardly a doubt that these cylindrical masses are fibrinous coagula, which are formed in the uriniferous tubes, and that during their coagulations portions of the epithelium of these tubes become entangled within them, and the whole substance is then discharged together with the urine, from which the several masses are afterwards pre- cipitated, still preserving the shape of the canals in which they were formed. They vary in length, often measuring several lines: their transverse diameter corresponds with that of the tubules, varying from T'ff to rfo of a line. More- over, there are sometimes a large quantity of pus corpuscles present in these cylindrical masses; probably in those cases in which the inflammation has extended to the pelvis of the kidneys and to the ureter." Dr. George Johnson, of King's College, also states that oil globules, or epithelial cells containing fatty matter, are likewise frequently met with adhering to these tubular fibrinous masses, and that he considers them, when in large * Translated by Mr. Kirkes in the Medical Gazette, for May 2,1845. 90 MARKWICK ON URINE. numbers, an alarming symptom of Bright's disease, of which they are, in his opinion, pathognomonic. 134. Bile (66,) when present in the urine, communicates to it an unnatural tint varying from that of a saffron-yellow to a dark brown, similar to that produced by blood. 135. It may be detected by the following processes:— i. Dip a piece of clean linen in the suspected urine, and if bile be present it will be changed to a yellow colour, which will be converted to a green by hydrochloric acid. n. Pour a little of the urine on any flat white surface, as the bottom of a plate for instance, and gradually add to it a few drops of nitric acid. A rapid display of colours will be exhibited, in which the green, blue, violet, pink, and red will be observed. in. Add basic acetate of lead to the urine, and a yellow- ish precipitate, soluble, with the production of a green colour, in alcohol acidulated with .sulphuric acid, will be thrown down. (Schwertfeger in Day's Simon's Chemistry.) iv. Gradually add to a little of the urine, previously de- prived of any admixture of albumen, contained in the.test tube, two-thirds of its volume of sulphuric acid perfectly free from sulphurous acid, and then shake the mixture, kept below 144 degrees, with two or three drops of a solution of cane sugar, made in the proportion of five parts of water to one of sugar, when a more or less distinct violet-red colour, in proportion to the amount of bile present in the secretion, will make its appearance. (Pettenkofer.) This test, however, cannot be safely relied on, owing to the action of the sulphuric acid on the sugar employed. v. Treat the urine, previously deprived by filtration of the mucus and lithic acid that may have become deposited, with chloride of barium ; collect the precipitate that is formed on a filter, and wash it wTith distilled water. Then boil it in water with carbonate of soda, and separate the biliary colouring matter from the yellow solution thus ob- tained, by hydrochloric acid. Collect it on a filter, dissolve it in a mixture of two parts of alcohol and one of ether, and evaporate the resulting green solution, when the colour- ing matter will be left in the form of a dark green mass. Or the barytes precipitate above alluded to, may be at once decomposed by digesting it with alcohol and hydrochloric MARKWICK ON URINE. 91 acid at a moderate heat, the alcoholic solution then evapo- rated and the residue washed with distilled water, and afterwards dissolved in the alcoholic ethereal mixture and again evaporated. (Scherer Ann. der Chimie und Pharm, March 1845. Lancet, May 24, 1845.) When dried, this colouring matter may be reduced to a powder, which has a very beautiful dark green colour. It is very sparingly soluble in water and ether, but very soluble in alcohol and liquor potass^, to the latter of which it communicates a brownish hue. Hydrochloric acid converts it to a blackish brown. vi. Add the white of an egg, or any other albuminous fluid to the suspected urine, and afterwards separate it by means of nitric acid. If bile be present in the secretion, the coagulated albumen will have a blueish, or perfectly blue or greenish colour. But if there be no biliary matter, the precipitate will be white, being gradually, however, tinged yellow by nitric acid. (Heller.) This test is stated by its author to be extremely delicate, the most minute quantity of bile being detected by it; a thing, impossible with nitric acid alone. 136. The colouring matter of bile has been found by Heller to suffer considerable modification in certain dis- eases, particularly cholera, and in this state not to give its characteristic reaction with nitric acid, a red instead of a green colour, being in fact produced when this acid is added. In these cases he considers ammonia to be the best test. It is to be dropped into the suspected urine in small quantity, when, if bile be present, a bright red colour, which passes to a brownish red on the addition of more ammonia, will be produced.* 137. If Milk (66/*.) be present in the urine, the latter will let fall a precipitate consisting of casein, when acetic acid is added to it, and will exhibit fat globules when examined under the microscope. 138. 'Kiestien, (66g.)—This substance is principally met with in the urine of pregnant women, in the form of a greasy fat-like pellicle, which, after having remained sta- tionary for three or four days, breaks up and gradually falls * Med. Gaz. October 17th, 1845. 92 MARKWICK ON URINE. to the bottom of the cylindrical vessel in which the urine has been placed. It has been supposed to consist princi- pally of casein owing to its occurring in combination with butyric acid. M. Regnault is of a different opinion. Ac- cording to him it is composed only of very minute micro- scopic animalculae and phosphatic crystals, and therefore he considers that the deposit under consideration is not due to the spontaneous coagulation of a substance primatively existing in the urine, but rather to the decomposition of a nitrogenized matter secreted by the kidneys in excess during gestation, which by acting as a ferment in the urine, pro- motes the conversion of urea into carbonate of ammonia and occasions the peculiar appearance presented by the se- cretion in these cases.* 139. According to Dr. Golding Bird, its formation is prevented by an inflammatory state of the system, a state- ment which has lately been corroborated by M. M611er,f Suppressed perspiration has also been stated by Dr. Bird to be a cause of the non-appearance of this peculiar pellicle. This, however, does not appear always to be the case, M. Moller having met with an instance to the contrary in a young female in the eighth month of her pregnancy, who, from long continued mental emotion, had become attacked with severe hectic and profuse sweats, without there being apparently any local affection present which could have given rise to them. In this patient's urine not a trace of kiestien could be detected during the whole of the febrile attack, but the moment the hectic disappeared it was found to exist in it in large quantities. 140. Lehmann treated it with ether, evaporated the solu- tion obtained, and procured a fatty matter resembling butter, which yielded butyric acid on the addition of sulphuric acid after being saponified with potash; and Dr. Rees informs us in the last edition of his work, that he has discovered in it globules exactly similar to the fat globules contained in milk. Moller, after he had evaporated the etherial solution at a gentle temperature, removed the phosphates by means of diluted hydrochloric acid, neutralized any excess of the * Med. Times, vol. xvi. p. 176. f See Med. Gaz. June 5, 1846. MARKWICK ON URINE. 93 latter with ammonia, and expelled any remaining portion by the application of a moderate heat, procured it in a pul- verulent form, without taste or odour, and of a whitish or yellowish colour, insoluble either in alcohol, ether, or water. Urine from which pellicles of kiestien have formed appears to contain no albumen, and but very rarely casein. It is generally neutral or alkaline and occasionally acid; while the pellicle itself is stated never to become mouldy. 141. Fatty matter, (66h,) occasionally met with in the urine, may also be detected with the microscope, by its characteristic globules; and likewise by the yellow solution that collects on the surface of the urine when ether is added to it, and which yields fat globules on evaporation. 142. Urostealith.—This is the name given by Dr. F. Heller, to a peculiar concretion that was passed by a patient while suffering from symptoms of calculus in the bladder, and which he found to consist of a particular kind of fatty matter. These concretions, when first passed are soft, but become hard by drying. They are then brittle, have some- what the appearance of wax, and a greenish yellow hue when viewed by transmitted light. When heated they melt, then swell and burn with a characteristic pungent odour, something like that of gum benzoin, leaving an abundant ash. Urostealith is soluble in ether, from which it can be obtained by evaporation, but is insoluble in water, and nearly so in alcohol. It is also soluble in nitric acid with effervescence, a colourless substance being formed; and combines readily with alkalies, which will separate it from its etherial solution. 143. Sugar, (66 i.k.)—The presence of saccharine mat- ter in the urine constitutes diabetes mellitus, an interesting disease characterized by the excretion of an extremely limpid urine " of a pale greenish straw colour, of a peculiar odour deprived of the urinous character; sometimes re- sembling that of whey, of a sweet taste, of considerable specific gravity and generally acid;" and which, " when left standing by itself in the vessel for some time, becomes somewhat turbid, loses its greenish tint, and undergoes spontaneously the alcoholic fermentation, if the weather be hot."* * Bell's Essay, by the Author, p. 12. 94 MARKWICK ON URINE. 144. Sugar may generally be detected by the sweet taste it gives to the secretion ; occasionally, however, this is completely masked by the other constituents of the urine. (Bouchardat.) The following are the various tests that have been pro- posed for it. i. "The most convenient means of ascertaining the presence of saccharine matter in diabetic urine, is to add to it some yeast, which gives rise to vinous fermentation, a most delicate test, as it can detect one part of it in a thou- sand parts of urine.* Every cubic inch of gas given off nearly corresponds in round numbers with one grain of sugar—forty-seven of gas to forty-five of sugar."f The amount of gas may also be ascertained by the increased weight of Liebig's bulb apparatus. In healthy urine no change takes place on the addition of yeast, with the exception of the disengagement of a small quantity of carbonic acid necessarily present in the latter. n. Another equally delicate test is the growth of Torulae. These spores or fungoid vegetations make their appearance in the urine whenever saccharine matter is present in it in however minute proportions. They may be recognized by their peculiar characters. (126.) in. Add a few drops of a solution of copper to the sup- posed diabetic urine contained in a test tube. Slight opacity will take place owing to the formation of phosphate of copper which is precipitated. Then add an excess of liqaor potasses and a deposit of the hydrated oxide of copper will be formed, which will be re-dissolved by an excess of the alkali if sugar be present, with the production of a blue solution similar to that of the ammoniuret of copper. By gently raising the mixture to a boiling point, the copper will be deposited as a red suboxide if it contain any saccharine matter, and as a black oxide if it does not. (Trommer.) Dr. Bird evidently gives the preference to this test, as being the most delicate of all those hitherto proposed for the detection of sugar in the urine, and in fact, one which " will readily detect it in diabetic urine, even when very largely * Christison's Lib. Pract. Med. vol. iv. 249. f Bell's Essay, p. 16. MARKWTICK ON URINE. 95 diluted, provided "no more of the solution of sulphate of copper be used than is sufficient to afford a decided pre- cipitate on the addition of the liquor potassa."* iv. Add to the suspected urine, contained in a conical glass vessel, a small quantity of the hydrated oxide of cop- per, and an excess of liquor potassae. The fluid, if it con- tain sugar, will then become of a reddish colour, and the deposited oxide will gradually assume a yellow hue. (Capezzuoli.) v. Evaporate a little of the urine at a gentle heat in a shallow porcelain dish, and drop upon the dry warm residue a few drops of sulphuric acid diluted with six parts of w'ater, when, if it contain sugar, it will assume a dark browTn, or even black colour. (Runge.) This test, it is said, will detect as much as one part in two thousand ; but as similar results will be obtained, ac- cording to Dr. Bird, if albumen be present, this must be previously removed before it is had recourse to. vi. Treat the urine, reduced to the consistence of syrup, with alcohol, and add to the solution obtained a little of an alcoholic solution of potash. A white precipitate, if sac- charine matter be present, will then be formed, consisting of a compound of sugar and potash. Wash it in alcohol and dissolve in water ; a saccharine solution will thus be obtained, from which the amount of sugar may be deter- mined. (Lowig, quoted in the Lancet for Sept. 6, 1845, from part 2, vol. 38, of Buchnerh Repert.) vn. Boil the suspected urine in a test tube with an excess oi liquor potassa, and if it contain sugar it will assume an orange-yellow, or brown, or claret colour, in proportion to the quantity present, owing to the conversion of the dia- betic saccharine matter into melassic acid. (Moore.) Heller, who seems to have recommended this test about the same time as Mr. Moore, (see Archiv fur phys. und Path. Chem. und Mikrosk., 1844, 2 S. 212), states that " if an excess of nitric acid be now added, a strong odour will be developed by the sugar. If a drop of diabetic urine be diluted with ten drops, or even more of water, the pre- sence of sugar will be shown by'the above test."f * Med. Gaz. for May 24, 1844. X Quoted in Pharmaceutical Journal, vol. v. p. 188. 96 MARKWTCK ON URINE. In having recourse to this test we must be careful that the liquor potassae contains no lead, (which it may do if it has been kept in a white glass bottle) and the urine no al- bumen, otherwise, the sulphur contained in the latter, by acting on the lead would prodnce a sulphuret of this metal, which would give rise to a dark colour similar to that occa- sioned by sugar. This source of fallacy has been lately pointed out by Dr. Rees, who recommends that no liquor potassae should be employed but what has been kept in green glass vessels. The presence of lead in the liquor potassae may be easily detected by means of the hydrosul- phuret of ammonia. M. Bouchardat prefers milk of lime to the solution of potash ; first, because in the country it can be more readily obtained; and, secondly, because many of the extractive matters of the urine are darkened by potash, which is not the case with milk of lime.* vin. Digest some cheese, previously cleansed from foreign matter, in the suspected diabetic urine for a few hours, and then add to it some acetate of zinc; a white precipitate will be formed if sugar be present, owing to a portion of it being converted by the casein into lactic acid. (Ross.) ix. " The urine is to be evaporated to dryness, the resi- due is then treated with alcohol, which dissolves the sugar, and all the extractiform matters soluble in this menstruum. By slowly evaporating this solution, the sugar crystallizes in small grain-like crystals, similar to the sugar of grapes." (Bell's Essay on Diabetes). ■ x. Add diacetate of lead to the urine, filter, remove the lead by means of sulphuretted hydrogen ; filter a second time and evaporate to a syrup ; treat this with alcohol and allow the solution obtained to spontaneously evaporate. The saccharine matter will then be procured in the crystal- lized form. xi. Mix together sulphuric acid and bile until the pre- cipitated choleic acid is redissolved, then add to the mix- ture a few drops of the urine to be examined, when, if sugar be present, a violet colour will be immediately produced. * See a translated paper by the Author, in the Med. Times, for March 6, 1847. MARKWICK ON URINE. 97 Should any albumen be contained in the secretion, it must be previously removed by ebulition. (Pettenkofer). 144. *Some of these tests it will be seen only enable us to ascertain the presence of sugar in the urine, while the others admit of our calculating its quantity. For the precise determination of the proportion of sac- charine matter contained in a quart of urine, M. Bouchardat* gives the preference to M. Biot's polarizing apparatus, and has proposed the following formula for this purpose. If the length of the tube in millemetres, in which the diabetic urine is examined, be represented by L, and the deviation measured with the naked eye, corresponding to the violet blue tint that is observed immediately preceding the ap- pearance of the yellowish red—by a, then by multiplying 2353.6 by the latter, and dividing the product by the former, the quotient will be the amount of the sugar con- tained in a quart of this urine in grammes. Thus 2353 : 6 + a L Crystallized diabetic sugar contains two atoms of water, and is represented by the following formula: C12, H12,012, + 2 HO., " On saturating diabetic urine with common salt, and leaving it to spontaneous evaporation, crystals, three-fourths of an inch in diameter, may be obtained. They are not very regular in their form, but most of them are six-sided double pyramids. These crystals are hard, easily pulye- rizable, transparent, of a combined saltish and sacharine taste, and dissolve in about 3-7 parts of cold water and slightly in alcohol. The formula for this combination is: C]2,HJ2, 012,211 O + Cl2, H12,012,NaCl."t 145. To obtain the Extractive Matters evaporate a given quantity of urine to dryness over a water bath, treat the * Med. Times, March, 1847. X Day in Simon's Chemistry, vol. i. p. 66. 98 MARKWICK ON URINE. residue with alcohol of 0.83 and the water extract will be precipitated in combination with the phosphates and sul- phates. Collect the deposit on a weighed filter, wash it with alcohol of the same degree of strength and dry it, and its amount will be represented by the increase in the known weight of the filter. The proportion of water-extract contained in it can then be ascertained by the loss it sus- tains by incineration. Mix the spirituous solution with the washings of the con- tents of the filter, evaporate the mixture to the consistence of an extract, and treat this when cold, with anhydrous al- cohol. The spirit-extract together with, the chlorides of sodium and potassium and a portion of the alkaline lactates will then be thrown down. When the supernatant alcoholic liquid is no longer rendered turbid by any further addition of anhydrous alcohol, it must be poured off from the residue, and this washed with pure alcohol; afterwards carefully dried on the water bath and weighed, and the spirit-extract estimated by the loss occasioned by incineration. To determine the alcohol-extract and the ammonia salts, Simon proceeds in the following manner : the alcoholic fluid obtained from the precipitation of the spirit-extract, is eva- porated on the water bath to the consistence of a thick syrup, then thoroughly dried over a strong sulphuric acid in a receiver and weighed. The residue is dissolved in a little water, and free baryta gradually added, a gentk warmth being kept up as long as it continues to dissolve, and as long as ammonia is perceptibly evolved. This point being attained the mixture is evaporated to the consistence of an extract, and moistened with a little alcohol of 0.83; a large quantity of anhydrous alcohol is then added, and the whole allowed to clear itself. There remain undissolved, chloride of barium, a compound of baryta, which has pro- bably been added in excess. Dissolved in the alcohol are urea, lactate of baryta and a small quantity of free baryta. The undissolved portion is burnt in a platinum crucible, the residue incinerated, and the ash digested in water. The solution is then filtered, slightly acidulated with nitric acid, and the chlorine precipitated by nitrate of silver, when the chloride of ammonium can be calculated from it. The alcoholic solution must be evaporated, the residue MARKWICK ON URINE. 99 dissolved in water, the solution filtered, and a current of carbonic acid passed through it, until the free baryta is pre- cipitated : it must then be again filtered, acidulated with nitric acid and the baryta of the lactate of baryta precipi- tated by sulphuric acid. The lactate of baryta is estimated from the residual sulphate. By substracting from the solid residue of the alcohol ex- tract the weight of the urea, of the free lactic acid, of the lactate of ammonia, and chloride of ammonium, we obtain the quantity of the alcohol-extract. 146. To detect an excess of the extractive matters boil a little of the suspected urine in a test tube, with a small portion of hydrochloric acid, when if the quantity be in- creased, the fluid will assume a dark hue, and will deposit a sediment of a brownish, or blackish, or even of an indigo blue tint, readily soluble in alcohol, to which it imparts a peculiar colour. 147. According to Heller " the existence of a large quantity of uroxanthin (6) in urine is indicated : i. By the clear, light yellow colour of the urine when that secretion is acid, as in cholera, and sometimes in Bright's disease. n. By the presence of the products of its oxidation, uro- glaucin and urrhodin, which, either of themselves, form a violet coloured sediment, or communicate that tint to a sediment already formed. On allowing urine abounding in uroxanthin to stand for some time, it is observed that after the formation of the sediment has ceased, the fluid from the surface downwards, assumes a violet tint, and this change of colour takes place with a rapidity proportional to the amount of carbo- nate of ammonia produced by the decomposition of urea. Hence, on keeping such urine in a high cylindrical glass, three distinct strata are observed ; lowermost, a violet sedi- ment ; in the middle, yellow and nearly clear urine ; and superiorly, a violet or purple turbid layer. On shaking the glass, the whole urine assumes a blueish- green tint, because the urrhodin, formed principally at the surface, becomes converted, by agitation, with a full sup- ply of atmospheric air, into uroglaucin, which, mixing with the central yellow layer of urine, developes a green 100 MARKWICK ON URINE. tint. The uroglaucin thus formed, ultimately settles as a blue powder on the sides, and at the bottom of the vessel. Hence there is obviously no fixed proportion between the quantities of uroglaucin and urrhodin. in. If much uroxanthin is present, the crystals of uric acid (separated spontaneously, or by the addition of an acid) have a beautiful blue or amethyst tint. iv. Lastly, if much uroxanthin is present, it may be re- cognized by the addition of concentrated nitric acid, (ten drops to half an ounce of urine,) which at once communi- cates a brilliant violet colour to the fluid : if a smaller amount is present, the change of colour is developed more slowly. The nitric acid oxydizes the uroxanthin, and converts it into uroglaucin and urrhodin. Sulphuric and hydrochloric acids act similarly, but with less activity. If albumen is present in urine treated in this manner, it is either precipi- tated blue at once, or assumes that tint gradually, according to the amount of uroxanthin. This is constantly noticed in BrightVdisease on treating urine abounding in uroxanthin with an acid, and allowing it to stand for a couple of days ; uroglaucin separates in dark blue crystalline groups, visible to the naked eye, partly on the surface and partly at the bottom of the vessel. On taking a drop from the surface, and examining it under the microscope, uroglaucin [has the appearance of a dark central spot, from which proceed numerous lengthy tentaculae]. To separate the two products of oxidation of uroxanthin, we collect on a filter the sediment thrown down by nitric acid, and agitate it with cold spirit of .830, which takes up the urrhodin, (as also does ether;) the residue is boiled for some time with spirit of the same strength, until the fluid becomes somewhat concentrated ; we thus get a bright blue solution of uroglaucin. To exhibit these substances in normal urine, the fluid must be so far evaporated as just to remain liquid. On adding concentrated nitric acid to the cold residue, a crys- talline magma of nitrate of urea is at once formed ; on add- ing to this a few more drops of nitric acid (and sometimes even this is unnecessary) it assumes a violet tint. If the crystalline mass is allowed to stand for some time, and is MARKWICK ON URINE. 101 then dissolved in the smallest possible quantity of distilled water, after being left at rest for some time, it deposits a sediment in which urrhodin and uroglaucin may be detected either by the microscope or by extraction with cold, and then with boiling spirit. The action of nitrate of silver on uroxanthin is very sin- gular. On precipitating the chlorine by an excess of nitrate of silver from urine acidulated with nitric acid, and then carefully neutralizing the filtered liquid by ammonia, there is not only a pale yellow precipitate of phosphate of silver, but the fluid assumes a brown tint, and in a short time there is likewise a brown sediment. Heller has not yet succeeded in isolating uroxanthin. Uroglaucin associated with urrhodin, occurs in urinary sedi- ments in Bright's disease, and in cases in which urine, abundant in uroxanthin, has become alkaline in the blad- der. Heller has noticed it in these sediments forming groups of delicate prisms. It likewise assumes this form when urine abounding in uroxanthin is treated with nitric, sulphuric, or hydrochloric acid. In this case it is princi- pally found on the surface of the fluid. When allowed to crystallize from its cold spirituous solu- tion, it forms groups which appear nearly black, but are blue and transparent at the edges. Urrhodin appears to be a less oxydized product of urox- anthin than uroglaucin, and usually occurs in much larger quantity. It is most commonly observed in cases in which the urine is alkaline before emission, in consequence of containing much vesical mucus, and its developement in such cases is hastened by the addition of nitric acid. The method of isolating it has heen already described. Heller has never succeeded in obtaining it from its spirituous solution in a crystalline form. It occurs in granules, which, under the microscope, appear of a beautiful rose-colour. It is resinous in its nature, and burns with a clear flame. On treating uric acid crystals obtained from healthy urine, with cold alcohol, the pigment formed a carmine solution, and the uric acid remained comparatively devoid of colour, being of a yellowish brown tint, from the brown pigment of the urine. The spirituous carmine solution, on exposure to the air, gradually became purple, and had all the proper- 102 MARKWICK ON URINE. ties of uroglaucin, previous to which it appeared to be iden- tical with urrhodin. On treating the red sediment common in inflammatory affections, and tinged with uroerythrin, with hot and cold alcohol and ether, the red pigment remained unaffected, unless a little acid was added. The difference of insolu- bility in the above menstrua is therefore sufficient to sepa- rate uroerythrin from urrhodin."* II. Inorganic Elements. (a.) Normal. 148. The normal inorganic elements of the urine are constituted by the fixed salts, namely the sulphates and phosphates of potash, soda, lime, and magnesia, the chlo- rides of their metals, and by silex. To ascertain their amount evaporate three or four ounces of urine acidulated with nitric acid, incinerate the residue and wreigh the melted wrhite ash that is obtained. Dissolve a given portion of it in water, to which a small portion of nitric acid has been added. Filter the solution and the silicic acid, if any be present, will remain on the filter probably in combination with a little carbon. Wash it, burn it with the filter, and determine its weight. Then mix the solution with the washings of the contents of the filter and add liquor ammonae to a slight excess. Warm the mixture and the earthy phosphates will be completely precipitated. Wash and dry them and expose them to a red heat and weigh them. To discover the proportion of lime dissolve them in very dilute nitric acid, and saturate the free acid with ammonia, then by adding oxalate of ammonia, the lime will be thrown down in the form of an oxalate. Separate it by filtration and calculate the amount of lime from its compo- sition. Then add liquor ammonias to the clear fluid to pre- cipitate the ammoniaco-magnesian phosphate. Collect the triple salt on a filter, wash it with water, dry and weigh it, and add the washings to the ammoniacal solution from which the earthy phosphates have been obtained, and supersaturate the whole with nitric acid. Then add chlo- * Simon's Chemistry by Dr. Day. MARKWICK ON URINE. 103 ride of barium until a precipitate is no longer formed, warm the fluid to promote the separation of the sulphate of baryta; separate this by filtration, wash it, expose it to a strong heat and weigh it. The quantity of sulphuric acid must then be calculated.* Mix the washings of the sulphate with the so- lution from which it was procured, in a stoppered bottle a little larger than sufficient to contain the whole of the mix- ture, and add liquor ammoniae to supersaturation, and after- wards chloride of barium as long as phosphate of baryta continues to be thrown down. Set the bottle by with the stopper in it for the salt to subside ; then pour off the super- natant liquor ; collect the precipitate, treat it as the sulphate and calculate the amount of acid it contains.f Mix the ammoniacal fluid now remaining, and which contains the fixed alkalies, with the washings of the phosphate, evapo- rate it, treat the residue with sulphuric acid, and, after the excess of acid has been expelled by heat, dissolve it in water. Filter the solution and separate the sulphuric acid by means of chloride of barium ; again filter, and the chlo- rides of potassium and sodium will be obtained by evapo- ration. The proportion of chlorine may be determined by dissolving a given weight of the fixed salts in water acidu- lated with nitric acid, and then adding nitrate of silver, so long as a precipitate is formed, to the filtered solution.! 149. Soda may also be detected in the urine by evapo- * Composition of Sulphate of Baryta : Baryta......r5-G3 Acid.......34.37 100.00 t Phosphate of Baryta : Baryta......68.20 Acid.......31.80 100.00 X Chloride of silver: _r Silver......'°-iAl Chlorine......24*67 100.00 8 104 MARKWICK ON URINE. rating the alcoholic solution, obtained by treating the secre- tion, reduced to the consistence of syrup, with this fluid; the chloride of sodium will then be left and may be dis- tinguished under the microscope by its crystals, which, owing to their containing urea, have lost their natural cu- boid shape and assumed that of octahedrons. By submit- ting the salt thus procured to the action of the blow-pipe a yellow flame will be produced. The presence of soda in the urine is also indicated by the formation of the microcosmic double salt of phosphate of soda and ammonia, characterized by its rectangular prisma- tic crystals when the urine becomes decomposed. 150. Potash.—To detect this alkali dissolve the fixed salts in a little hydrochloric acid, extract them by alcohol, and add to the alcoholic solution of chloride of potassium some chloride of platinum which will throw down a yellow precipitate of chloride of potassium and platinum in the form of small yellow shining prismatic crystals. Potash also communicates a violet tint to the flame of a blow-pipe, and is precipitated from its aqueous solution by an excess of tartaric acid. 151. Ammonia.—Heintz demonstrates the presence of ammonia, and indeed of potash likewise, by the following process. He treats urine that has been recently passed with chloride of platinum and then adds to it a mixture of alcohol and ether, made in the proportion of three volumes of the former to one of the latter. A precipitate is thus formed which is collected on a filter, washed with etherized alcohol, dried and heated to redness. The residue is then repeatedly taken up with boiling dilute hydrochloric acid, the solution filtered and the filter afterwards burnt. The platinum which remains corresponds to the amount of am- monia and potash in the urine. By this process Heintz found the proportions of these alkalies to vary between 2.16 and 2.19, and 1.315 and 1.325 respectively in 1000 parts. (b.) Abnormal. 152. The subcarbonates of lime and magnesia may exist in the urine, either in solution, being retained in it in that state by an excess of carbonic acid, or as a deposit. If in MARKWICK ON URINE. 105 solution, they will be thrown down when the acid is ex- pelled by heat, and may be detected by their solubility in an acid with effervescence. The presence of lime maybe ascertained by the addition of oxalate of ammonia to the ammoniacal solution of the precipitate producing a deposit of oxalate of lime ; while the existence of magnesia may be discovered by saturating the double carbonated salt with phosphoric acid, then set- ting the liquid by to crystallize, dssolving the crystals that are formed in hydrochloric acid, separating the lime in the manner just described, and adding to the supernatant liquor, solution of ammonia, when the ammoniaco-magnesian phosphates will be precipitated. 153. Neutral Phosphate of Lime.—To separate this salt from the ammoniaco-magnesian phosphate with which it is generally mixed, treat the deposit with acetic acid; this will dissolve the triple salt and leave the phosphate of lime behind in an amorphous state. It is precipitated from its solution in hydrochloric acid by liquor ammoniae, and its acid solution, when neutralized with this alkali yields a precipitate on the addition of oxalate of ammonia. The lime may be also separated, either from the solution of the phosphate in hydrochloric acid, or from the compound deposit, by means of sulphuric acid as an insoluble sul- phate. The phosphate of lime is precipitated from healthy urine in combination with the ammoniaco-magnesian phosphate by caustic ammonia, and with the phosphate of magnesia by liquor potassae. When examined under the microscope it generally ap- pears as an amorphous powder, but is occasionally met with in the crystallized state, as for instance, when the urine has remained long in a state of decomposition. 154. The neutral and bibasic ammoniacal-magnesian phosphates are distinguished by the following characters. They are very slightly soluble in either hot or cold water, but are soluble in acids, from which they are again precipi- tated by ammonia. Mixed with caustic potash and heated, ammonia is evolved; and their solution in hydrochloric acid yields on evaporation crystals of hydrochlorate of am- monia. 106 MARKWICK ON URINE. 155. The neutral triple phosphate is the form most com- monly met with. It occurs during the commencement of the decomposition of the urine, or when a small quantity of ammonia is added to the healthy secretion, and may be recognized by its prismatic crystalline appearance under the microscope. It is the only variety of the triple salt that can occur in acid urine. 156. The bibasic fbrm is met with in urine that has been long kept and become putrescent, and may be thrown down artificially from the healthy fluid by an excess of ammonia. It crystallizes in beautiful stellae. Dr. Bird gives the following formula as representing the probable composition of the two salts. salt^ry)1 ? ^T^ ] = - and most captivating in her subject. Therefore it is we are for the book ; and we hold such presents as Mrs. Somerville has bestowed upon the public, to be of incalcu- lable value, disseminating more sound information than all the literary and scieniinc institutions will accomplish in a whole cycle of their existence.—Blackwood's Mag. HERVEY'S COURT OF GEORGE II. MEMOIRS fOF THE REIGN~0F GEORGE THE SECOND, From his Accession to the Death of Qneen Caroline. BY JOHN LORD HERVEY. EDITED, FROM THE ORIGINAL MANUSCRIPT, AT ICKWORTH, By the Right Hon. JOHN WILSON CROKER, LL. D., F. R. S., &c. In two handsome volumes, royal 12mo., extra cloth. PARDOE'S FRANCIS THE FIRST.—Now Ready. THE COURT AND REIGN~6f FRANCIS THE FIRST, KING OF FRANCE. BY MISS PARDOE, AUTHOR OF " LOUIS the fourteenth," " city of the sultan," &c. &c. In two very neat volumes, royal 12mo., extra cloth. 6 LEA & BLANCHARD'S NEW PUBLICATIONS. HERSCHEL'S OUTLINES OF ASTRONOMY.-JVow H«adj». OUTLINES OiTaSTKONOMY. BY SIR JOHN F. W. HERSCHEL, F. R. S., &c. In one neat volume, crown octavo, with six plates and numerous wood-cuts. With this, we take leave of this remarkable work, which we hold to be, beyond a doubt, the greatest and most remarkable of the works in which the laws of astrono- my and the appearance of the heavens are described to those who are not mathema- ticians nor observers, and recalled to those who are. It is the reward of men who can descend from the advancement of knowledge to care for its diffusion, that their works are essential to all, that they become the manuals of the proficient as well as the text-books of the learner.—Athenaum. Probably no book ever written upon any science has been found to embrace with- in so small a compass an entire epitome of everything known within all its various departments, practical, theoretical, and physical.—Examiner. A text-book of astronomy, from one of the highest names in the science.—Silliman's Journal. It.tltfKX* ffV.llIt OLOT'S JVEW W,ORK.—J\~ow Beady. ASPECTS OF IVATURE, IN DIFFERENT LANDS AND DIFFERENT CLIMATES. WITH SCIENTIFIC ELUCIDATIONS. BY ALEXANDER YON HUMBOLDT. TRANSLATED BY MRS. SABINE. In one very neat volur»«, royal 12mo., extra cloth. It is not without diffidence that I present to the public a series of papers which took their origin in the presence of natural scenes of grandeur or beauty, on the ocean, in the forests of the Orinoco, in the Steppes of Venezuela, and in the mountain wilder- nesses of Peru and Mexico. Detached fragments were written down on the spot, and at the moment, and afterwards moulded into a whole. The view of nature on an en- larged scale, the display of the concurrent action of various forces or powers, and the renewal of the enjoyment which the immediate prospect of tropical scenery affords to sensitive minds—are the objects which I have proposed to myself.—Authok's Preface. ZOOLOGICAL RECREATIONS.—Just Issued. BY W. J. BRODERIP, Esq., F. R. S. In one neat volume of 376 pages, royal 12mo., extra cloth. BOWJfKAJVS PRACTICAL CHEMISTRY*.—Just Issued. INTRODUCTION TO PRACTICAL CHEMISTRY. INCLUDING ANALYSIS. By JOHN E. BOWMAN, Demonstrator of Chemistry, King's College. In one handsome volume, royal 12mo., of over 300 pages. WITH nearly one hundred engravings on wood. STEINMETZ'S HISTORY OF THE JESUITS. HISTORY OF THE JESUITS, PROM THE FOUNDATION OF THEtR SOCIETY TO ITS SUPPRESSION BY POPE CLEMENT XIV. Their Missions throughout the World • their Educational System and Literature; with their Revival and Prtsent Slate. BY ANDREW STEIN METZ, Author of''The Novitiate," and "The Jesuit in the Family." In two handsome crown 8vo. vols, of about four hundred pages each, extra cloth. LEA & BLANCHARD'S NEW PUBLICATIONS. 7 PAGET'S TRAVELS IN HUNGARY-Just Ready. HUIVCJAKY ANI> ~TRATVSYIiVAWIA: WITH REMARKS ON THEIR CONDITION, SOCIAL, POLITICAL, AND ECONOMICAL. BY JOHN PAGET, ESQ. In two neat volumes, royal 12mo., extra cloth. "We must now turn aside to make a short excursion into Hungary, with Mr. Paget for our guide. It would not be well possible to choose a better, for he never suffers our interest to flag, and appears to have made himself accurately acquainted, not only with the localities and traditions of the country, but with its whole history and institutions, which presents so many points of analogy to those of England, as really to invest the subject with a new and peculiar interest for an Englishman."—Quarterly Review. SPIRITS IVEST IJVDJES.—Jrotv Ready. IMPRESSIONS AND EXPERIENCES OFgTHE WEST INDIES AND XORTH AMERICA IN 1849. BY ROBERT BAIRD, A. M. In one neat volume, royal 12mo., extra cloth. 11 We have here a new instalment, not of British prejudice and grumbling, common to transatlantic tourists who pass a few months in the country, but a fair, judicious, matter-of-fact book by a Scottish gentleman who makes the pilgrimage of a consider- able portion of the western world in pursuit of health, and in a frame of mind, we may add, well adapted to its recovery. There is no illness or dyspepsia in Mr. Baird's speculations. He has a good legal digestion of every fact or sentiment which comes before him.''—N. Y. Lit. World. '■A most faithful and attractive description of the countries which the author has visited—formin? altogether a tourist's note-book and traveler's guide of the very best cImss.1'—John Bull. . ■■ The narrative embraces topics of absorbing interest at the present day. — Liver- pool Mail. ., ■■ Mr Baird wields a delicate and graceful pencil, and touches lightly and cheerily on the salient and light reflecting points of the varied and magnificent scenery he wanders over or floats amidst."—Glasgow Citizen. NEW AMERICAN WORK ON SHOOTING—Nearly Ready. NOTES ON SHOOTING; OR HINTS TO SPORTSMEN. COMPRISING The Habits of the Game Birds and Wild Fowl of North America; The Dog, the Gun, and the Field. BY E. J. LEWIS, M.D., Editor of " Youatt on the Dog," &c. In one handsome volume, royal 12mo. HISTORY OF THE HUGUENOTS—A NEW EDITION, CONTINUED TO THE PRESENT TIME. BY W. S. BROWNING. In one large octavo volume, extra cloth. "One of the most interesting and valuable contributions to modern history."-ffen- tleman's Magazine.__________________ RISH'S MEMORANDA OF A RESIDENCE AT THE COURT OF LONDON. In one large and handsome octavo volume, extra cloth. THE BOY'S TREASURY oTsPORTsTpASTIHES, AND RECREATIONS. WITH FOUR HUNDRED ILLUSTRATIONS. In one very neat volume, royal ISmo., crimson extra cloth. 8 LEA & BLANCHARD'S NEW PUBLICATIONS. MACFARLANE'S TURKEY—Now Ready. TURKEY AND~TTS DESTINY; THE RESULT OF JOURNEYS MADE IN 1P47 AND 1848 TO EXAMINE INTO THE STATE OF THAT COUNTRY. BY CHARLES MACFARLANE, ESQ., Aulhor of '• Constantinople in 1~28 " In two neat volumes, royal 12mo., extra cloth. "The author of this work has made valuable contribuiions to the Western world's knowledge of the people and customs of the East, and none of more value than this. He is a close observer, an acute thinker, and master of a pleasant, lively style. We have seen no picture of Turkey, as it is, and of its future destiny, that approaches these volumes in minuteness of detail, blended with philosophical comprehensiveness. Every one interested in the present position and future destiny of the Turkish go- vernment—should read Mr. Macfarlane's volumes."—N. Y. Com. Advertiser. SIX MONTHS IN THE GOLD MINES-Now Ready. SIX MONTHS INlTHE GOLD MINES. FROM A JOURNAL OF A THREE YEARS' RESIDENCE IN UPPER AND LOWER CALIFORNIA DURING 1847, lfc48, AND 1849. BY E. GOULD BUFFUM, ESQ., Lieut. First Regiment New York Volunteers. In one well printed royal 12mo. vol., paper, price 50 cents, or extra cloth. "To those who intend visiting California this book is invaluable, and the general reader will find it, in some respects, as fascinating and interesting as a work of fic- tion."— N. Y. Herald. FLETCHER'S NINEVEH—Now Ready. NOTES FROM NINEVEH, And Travels in Mesopotamia, Assyria, and Syria. BY THE REV. J. P. FLETCHER, In one neat royal 12mo. volume, extra cloth. "Well written, and deeply interesting."—North American. " One of the best books of travels that we have taken up for a long time."—Boston Evening Gazette. "The narratives of these excursions are deeply interesting."—N.Y Com. Advertiser. "Full of new and stirring interest/'—Saturday Post. CARPENTER ON ALCOHOLIC LIQUORS- Just Ready. A PRIZE" ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH AND DISEASE. BY W. B. CARPENTER, M.D., F.R.S., Author of "Principles of Human Physiology," &c. In one neat volume, royal 12mo. A prize of one hundred guineas having been offered in London for the best essay on the above subject, that sum has been awarded to Dr. Carpenter for the present work, by the adjudicators, Dr. John Forbes. Dr. G. L. Roupell, and Dr. W. A. Guy. A treatise on a subject of such universal interest by so distinguished a physiologist and teacher as Dr. Carpenter cannot fail to attract general attention, and be product- ive of much benefit. WALPOLE'S LETTERS. In six handsome octavo volumes, extra cloth. Four volumes containing the General Correspondence, and two the Suppressed Letters to Sir Horace Mann. WALPOLE'S MEMOIRS OF THE REIGN OF KING GEORGE THE THIRD. In two handsome octavo volumes. LEA & BLANCHARD'S NEW PUBLICATIONS. 9 Now Complete.—STRICKLAND'S QUEENS OF ENGLAND. NEW AND IMPROVED EDITION. LIYES OF THE QUEENS OF ENGLAND, FROM THE NORMAN CONQUEST. WITH ANECDOTES OF THEIR COURTS. Now First Published from Official Records, and other Authentic Documents, Pri- vate as well as Public. NEW EDITION, WITH ADDITIONS AND CORRECTIONS. BY AGNES STRICKLAND. In six volumes crown octavo, extra crimson cloth, or half morocco, printed on fine paper and large type. In this edition, Volume One contains Vols. 1, 2 and 3 of the 12mo. edition j Volume Two contains Vols. 4 and 5; Volume Three contains Vols. 6 and 7 ; Volume Four contains Vols. 8 and 9 ; Volume Five contains Vols. 10 and 11 ; and Volume Six contains Vol. 12. The whole forming a very handsome se- ries, suitable for presents, prizes, &c. The publishers have great pleasure in presenting to the public this work in a complete form. During the long period in which it has been issuing from the press, it has assumed the character of a standard work ; and, as occupying ground hitherto untouched, as embodying numerous historical facts hitherto unnoticed, and as con- taining vivid sketches of the character and manners of the times, with anecdotes, documents, &c. &c, it presents numerous claims on the attention of both the student of history and desultory reader. Those who have been waiting its completion can now obtain it, forming a handsome set, twelve volumes in six, in various styles of binding. A few copies still on hand of the Duodecimo Edition. Vol. I.—Contains Matilda of Flanders, Matilda of Scotland, Adelicia of Louvaine, Matilda of Boulogne, and Eleanor of Aquitaine. Vol. IL—Berengaria of Navarre, Isa- bella of Angouleme, Eleanor of Provence, Eleanor of Castile, Marguerite of France, Isabella of France, Philippa of Hainault, and Anne of Bohemia. Vol. III.—Isabella of Valois, Joanna of Navarre, Katharine of Valois, Marga- ret of Anjou, Elizabeth Woodville, and Ann of Warwick. Vol. IV.—Elizabeth of York, Katharine of Arragon, Anne Boleyn, Jane Seymour, Anne of Cleves, and Katharine Howard. Vol.V.—Katharine Parr and Queen Mary. Vol. VI. —Queen Elizabeth. Vol. VII.—Queen Elizabeth (continued), and Anne of Denmark. Vol. VIII.—Henrietta Maria and Catharine of Braganza. Vol. IX. —Mary of Modena. Vol. X.—Mary of Modena (continued), and Mary II. Vol. XI.—Mary II. (continued), and Queen Anne. Vol. XII.—Queen Anne (concluded). Any volume sold separately, or the whole to match in neat green cloth. These volumes have the fascination of a romance united to the integrity of history.— Times. Amost valuable and entertaining work.—Chronicle. This interesting and well-written work, in which the severe truth of history takes almost the wildness of romance, will constitute a valuable addition to our biogra- phical lileraiure.—Morning Herald. . A valuable contribution to historical knowledge, to young persons especially II contains amass of every kind of historical matter of interest, which industry and re source could collect. We have derived much entertainment and instruction from the work.—Athenceum , The execution of this work is equal to the conception. Great pains have been taken to make il both inleresting and valuable.— Literary Gazette. . A r-harminff work—full of interest, at once serious and pleasing.- Monsieur Guizot. A most charming biographical memoir. We conclude by expressing our unquali- fied oninion that we know of no more valuable contribution to modern history than This ninth volume of Miss Strickland's Lives of the Queens.-Mormng Herald. *2 10 LEA & BLANCHARD'S NEW PUBLICATIONS. NEW WORK BY MISS KAVANAGH—Now Ready. WOMAN IN FRANCE IN THE EIGHTEENTH CENTURY. BY JULIA KAVANAGH, Author of " Madeleine, a Tale of Auvergne." In one neat vol., royal 12mo , extra cloth. In treating other subjects of her gallery—as for instance those widely different per- sonages, Md lie. A'iss6 and Madame Roland—Miss Kavanagh puts forth a pathetic power which gives depth and repose to a book that in other hands might have become wearying from its unmitigated sparkle. The critic dealing with such an encyclopedia of coquetries, amours, vicissitudes, safft rings, and repentances as the history of" Woman in France" must necessarily be, is fain to content himself with offering merely a general character like the above. Such is the fascination of the subject—such is the fullness of matter—such is its afflu- ence of suggestion—that every page tempts him to stop for a gossip or for speculation of modes and morals. Which among us will ever be tired of reading about the Women of France ? espe- cially when they are maishaled so agreeably and discreetly as in the pages before us.— The Athenceum. ________„^ ERMAN'S SIBERIA.-Now Ready. TRAVELS TKl SIBERIA. INCLUDING EXCURSIONS NORTHWARD, Down the Obi to the Polar Circle, and Southward to the Chinese Frontier. BY ADOLPH ERMAN. Translated frovi the German, by WILLIAM DESBOROUGH COOLEY. In two large vols., royal 12mo., extra cloth. Much interest attaches to this work as the only complete and authentic account which we possess of the vast territories extending from the Ural Mountains to Beh- ring's Straits, of which less is known, than perhaps of any other densely inhabited portion of the globe. Dr. Erman devoted several years to these researches, and has embodied in these volumes a large amount of curious and novel information. Lately Issued__INGERSOLL'S NEW WORK. HISTORICAL. SKETCH OF THE SECOND WAR BETWEEN THE UNITED STATES OF AMERICA AND GREAT BRITAIN, DECLARED BY ACT OF CONGRESS THE 18th OF JINK 1812. AND CON- CLUDED BY PEACE THE loth OF FEBRUARY, 1S15. BY CHARLES J. INGERSOLL. EMBRACING THE EVENTS OF 1 S 1 4 . In one well-printed 8vo. vol., of 318 pages, double columns, paper covers. FRANCE UNDER LOUIS PHILIPPE. The Ilistory of Ten Years, 1830-1840; or, France under Louis Philippe, BY LOUIS BLANC, Secretary of the Provisional Government of 1848. TRANSLATED BY WALTER K. KELLY. In two handsome crown 8vo. volumes, extra cloth, or six parts, paper, at fifty cents. HISTORY OF THE FRENCH REVOLUTION OF 1789. BY LOUIS BLANC, Author of*' France under Louis Philippe," &c THAW .jfED FROM THE FRENCH. one volume, crown octavo LEA & BLANCHARD'S NEW PUBLICATIONS. 11 THE WAR IN HUNGARY. Now Ready. MEMOIRS OF AN~HUNGARIftN LADY. BY THERESA PULSZKY. WITH AN HISTORIQAL INTRODUCTION BY FRANCIS PULSZKY. In one neat volume, royal 12mo., extra cloth. We need hardly inform our readers that the authoress of this work is the accom- plished wife of the gentleman who was originally accredited to the English Cabinet by the Provisional Government of Hungary. The private interest attaching to the recital of events which have become so famous, would ensure a wide popularity for Madame Pulszky's book. But we should very mnch underestimate its value if we so limited our praise. The Memoirs, indeed, contain sketches of social life which are worthy of a place by the side of Madame de Stahl de Launay and Madame Campan. But they are also rich in political and topographical information of the first character. Madame Pulszky was in the habit of direct intercourse with the foremost and most distinguished of the Hungarian generals and statesmen, and has given a complete summary of the political events in Hungary, from the arrival of the Hungarian Depu- tation in 1848, to the treason of GenerarGeorgy on the 13lh of August, 1849. M. Puls- zky has also prefixed a valuable introduction, which gives the most complete History of Hungary that has ever issued from the English press.—Globe. TALES AND STORIES FROM HISTORY. BY AGNES STRICKLAND, Author of " Lives of the Queens of England," etc. In one handsome royal 18mo. volume, crimson extra cloth, with illustrations. THE SUGAR PLANTER'S MANUAL.. BEING A TREATISE ON THE ART OF OBTAINING SUGAR FROM THE CANE. BY W. J. EVANS, M. D. In one neat volume, small 8vo., 263 pages, with wood-cuts and two plates. THEORY OF LIFE. BY S. T. COLERIDGE. In one small volume, 12mo. POEMS, BY ELLIS, CURRER, AND ACTON BELL, Authors of "Jane Eyre," &c. In one vol., royal 18mo. EASTERN LIFE, PRESENT AND PAST. BY HARRIET MARTINEAU. In one large and handsome volume, crown octavo. HOUSEHOLD EDUCATION. BY HARRIET MARTINEAU. In one handsome vol., royal 12mo. MIR ABE All, A Life History. In one neat volume, royal 12mo. A TREATISE ON ASTRONOMY, BY SIR JOHN F. W. HERSCHEL, F. R. S., &c. WITH NLMEBOUS PLATES AND WOOD-CUTS. A NEW EDITION, WITH A PREFACE AND A SERIES OF QUESTIONS, BY S. C. WALKER. In one volume. 12mo. 12 LEA & BLANCHARD'S NEW PUBLICATIONS. MAGNIFICENT PRESENTATION WORK. IRISH MELODIES. BY THOMAS MOORE, Esq. WITH NOTES AND BIOGRAPHICAL PREFACES. ILLUSTRATED WITH BEAUTIFUL STEEL. PLATES, ENGRAVED UNDER THE IMMEDIATE SUPERINTENDENCE OF MR. EDWARD FINDEN, In one large imperial quarto volume of 174 pages, handsomely bound in extra cloth, with gilt edges. Beautifully printed on superior paper. LIST OF PLATES. Nora Creina, .... Painted by W. P. Frith, Engr'd by E. Finden. Rich and Rare were the Gems she Wore, " W.Fisher, " W H. Mote. Eveleen,......" R. T. Bolt, " E. Finden. Love's Young Dream, " A.Derby, " E. Finden. Lesbia, ......" W. P. Frith, " W. Holl. Kathleen and St. Kevin, " E. Hawkes, " W. Holl. The Hamlet's Pride, .... '< W. Room, " W.Edwards. Laughing Eyes,....." W. P. Frith, " E. Finden. The Mountain Sprite, ... " F. Wood, " E. Finden. The Desmond's Love, - - - - " F. Crowley, " W. Edwards. The care which has been exercised in every portion of this volume, both as to its mechanical and artistical execution, renders it in all respects well worthy of the "Irish Melodies." In illustrations, type, printing, paper, and binding, it is equal to anything that has as yet appeared in this country ; and, as a work whose attraction is not confined to a single season, it should command the attention of the public. Now Ready.—MACKAY'S TRAVELS IN THE UNITED STATES. THE WESTERN WORLD; OR, TRAVELS IN THE UNITED STATES. EXHIBITING THEM IN THEIR LATEST DEVELOPMENT, SOCIAL, POLITICAL, AND INDUSTRIAL. INCLUDING A CHAPTER ON CALIFORNIA. BY ALEXANDER MACKAY, Esq. FROM THE SECOND AND ENLARGED LONDON EDITION. In two very neat vols., royal 12mo. READINGS FOR THE YOUNG. FROM THE WORKS OF SIR WALTER SCOTT. WITH NUMEROUS AND BEAUTIFUL PLATES. In two very handsome vols., royal 18mo., crimson cloth DOMBEY AND SON, COMPLETE. BY CHARLES DICKENS. In one large octavo vol. of 320 double-columned pages, with 16 plates, price 50 cents. ALSO, AN EDITION ON PINE PAPER, WITH 40 PLATES, EXTRA CLOTH. DICKENS'S DAVID COPPERFIELD. PUBLISHING IN NUMBERS, WITH PLATES, PRICE 5 CKNTS EACH. Uniform with Lea & Blanchard's complete edition of Dickens's Novels and Talea. ALSO, Part I of the Cheap Edition, TO BE COMPLETE IN TWO PARTS. Price 25 Cents each. ________LEA & BLANCHARD'S NEW PUBLICATIONS. 13 LIBRARY OF ILLUSTRATED SCIENTIFIC WORKS. UNDER THIS TITLE LEA & BLANCHARD ARE PUBLISHING A SERIES OF BEAUTIFULLY ILLUSTRATED WORKS, ON VARIOUS BRANCHES OF SCIENCE, By the most distinguished men in their respective departments. Printed in the handsomest style, and embellished in the most efficient manner. Oj-* No expense has been or will be spared to render this series worthy of the sup- port of the scientific public, and at the same time one of the handsomest specimens of typographical and artistic execution which has appeared in this country. Specimens of the Engravings and style of the volumes may be had on application to the publishers. MULLER'S PHYSICS—LATELY ISSUED, PRINCIPLES OF PHYSICS AND METEOROLOGY BY PROFESSOR J. MULLER, M. D. EDITED, WITH ADDITIONS, BY R. EGLESFELD GRIFFITH, M. D. In one large and handsome octavo volume, with 550 wood-cuts, and two colored plates. This is a large, elegant, and most admirable volume—theflrst of a series of scien- tific books now passing through the press in London, and which cannot fail to com- mend themselves to the favor of all who take any interest in the progress of science among the great mass of the people. The author is one of the most distinguished scientific men in Germany, and these works have been prepared with the utmost care, and are put forth in a form admirably adapted to secure that wide circulation and universal favor which they deserve.—N. Y. Courier and Inquirer. NOW READY. PRACTICAL-PHARMACY. COMPRISING THE ARRANGEMENTS, APPARATUS, AND MANIPULA- TIONS OF THE PHARMACEUTICAL SHOP AND LABORATORY. BY FRANCIS MOHR, Ph. D., Assessor Pharmacia: of the Royal Prussian College of Medicine, Coblentz; AND THEOPHILUS REDWOOD, Professor of Pharmacy in the Pharmaceutical Society of Great Britain. EDITED, WITH EXTENSIVE ADDITIONS, BY PROFESSOR WILLIAM PROCTER, Of the Philadelphia College of Pharmacy. In one handsomely printed octavo volume, of 570 pages, with over 500 en- gravings on wood. In Preparation, works on Metallurgy, Pood, the Steam Engine, Machines, Astronomy, Rural Economy, AV. 14 LEA & BLANCHARD'S NEW PUBLICATIONS. Library of Illustrated Scientific Works.—Continued. KNAPP'S CHEMICAL TECHNOLOGY. TECHNOLOGY; OR, CIIEMISTRY APPLIED TO THE ARTS AND TO MANUFACTURES BY DR. R KNAPP, Professor at the University of Giessen. Edited, with numerous Notes and Additions, by DR. EDMUND RONALDS, and DR. THOMAS RICHARDSON. First American Edition, with Notes and Additions, BY PROFESSOR WALTER R. JOHNSON. In two handsome octavo volumes, printed and illustrated in the highest style of art. Volume One, lately published, with two hundred and fourteen large wood engravings. Volume Two, now ready, with two hundred and fifty wood engravings. One of the best works of modern times.—New York Commercial. We think it will prove the most popular, as it is decidedly the best of the series. Written by one who has for many years studied both theoretically and practically the processes which he describes, the descriptions are precise, and conveyed in a sim- ple unpretending style, so that they are easily understood, while they are sufficiently full in detail to include within them everything necessary to the entire comprehen- sion of the operations. The work is also carefully brought down to include the most recent improvements introduced upon the continent of Europe, and thus gives us full descriptions of processes to which reference is frequently made in other works, while many of them are, we believe, now for the first time presented in a complete state to the English reader.—Franklin Institute Journal. WEISBACH'S MECHANICS. PRINCIPLES OF "THE MECHANICS OF MACHINERY AND ENGINEERING, By Professor JULIUS WEISBACH. TRANSLATED AND EDITED BY PROFESSOR GORDON, OF GLASGOW. First American Edition, with Additions, Br Prof. WALTER R. JOHNSON. Inhoo Octavo Volumes, beautifully printed. Volume One, with five hundred and fifty illustrations, just issued. Volume Two, with three hundred and thirty illustrations, now ready. This work is one of the most interesting to mathematicians that has been laid be- fore us for some time; and we may safely term it a scientific gem.— The Builder The most valuable contribution to practical science that has yet appeared in this country.—Athence.um. In every way worthy of being recommended to our readers— Franklin Institute Journal. From Charles H. Haswell, Esq., Engineer in Chief U. S. N. The design of the author in supplying the instructor with a guide for teaching, and (he student with an auxiliary for the acquirement of the science of mechanics, has, in my opinion, been attained in a most successful manner. The illustrations, in the fullness of their construction, and in typographical execution, are without a parallel. It will afford me much pleasure to recommend its use by the members of the pro- fession wilh which I am connected. LEA & BLANCHARD'S NEW PUBLICATIONS. 15 SCBMITZ & ZUMPT'S CLASSICAL SERIES, VOLUME I. C. JUIill CAESARIS COMMENTARII DE BELLO GALLICO. WITH AN INTRODUCTION, NOTES, AND A GEOGRAPHICAL INDEX IN ENGLISH. ALSO, A MAP OF GAUL, AND ILLUSTRATIVE ENGRAVINGS. In one handsome ISmo. volume, of 232 pages, extra cloth, price 50 cts. VOLUME II. PUBLII VIRGILII MAR'-NIS CARMINA. WITH AN INTRODUCTION AND NOTES. In one handsome ISmo. volume, of 438 pages, extra cloth, price 75 cts. VOLUME III. C. CRISPI SALLUSTII CATALINA ET JUGURTHA. WITH INTRODUCTION, AND NOTES IN ENGLISH. ALSO, A MAP OF NUMIDIA. AND OTHER ILLUSTRATIVE ENGRAVINGS. In one handsome 18mo. volume, of 168 pages, extra cloth, price 50 cts. VOLUME IV.—IVow Ready. I^ATIIV ORAUOIAR. BY LEONHARD SCHMITZ, Ph.D., F.R.S.E., RECTOR OF THE HIGH SCHOOL, EDINBURGH. In one handsome 18mo. volume, of 318 pages, neatly half-bound, price 60 cts. VOLUME V.—Now Ready. Q. CURTII RUFI DE GESTIS ALEXANDRI MAGNI. LIBRI QUI SUPERSUNT VIII. WITH A MAP, INTRODUCTION, ENGLISH NOTES, &C. In one handsome ISmo. volume, of 326 pages, price 70 cent*. VOLUME VI.—Now Ready. IVT. TULMI CICERONIS 0RATI0NES SELECTS XII. WITH INTRODUCTION, ENGLISH NOTES, &C. &C. In one handsome 18mo. volume. VOLUME VII.—Nearly Ready. INTRODUCTION TO THE LATIN GRAMMAR. BY LEONHARD SCHMITZ, Ph. D., F. R. S. E., &c. In one handsome 18mo. volume. The neatness, cheapness, and accuracy of this series, together with its skillful adaptation to the wants both of teachers and students have secured fo the almost universal approbation of those tc.whom it has been submitted. From among the very numerous testimonials which the publishers have re- ceived, they beg to submit the following 16 LEA & BLANCHARD'S NEW PUBLICATIONS. Schmitt and XumpVs Classical Series.— Continued. From Prof. Roche, Transylvania University, Lexington, Ky., March 31, 1849. Whatever influence my position may give me shall be most cheerfully employed in bringing into general use in the West these very valuable works. I trust that you will prosecute to a close the proposed series, and that the execution of those that re- main to complete a Latin Curriculum may be as neat and in all respects as unex- ceptionable as that of those already published. From Prop. John Wilson, Prep. Dep. Dickinson College, Carlisle, Dec. 8,1843. I have examined the three volumes with considerable care, and can give them my unqualified approbation. The plan is judicious, and the execution worthy of all praise. The notes comprise all that a student needs, and all that he should have; and their position at the foot of the page is just what it should be. From Prof. E. E. Wiley, Emory and Henry College, Va. Nov. 30,1848. From the cursory examination given them, I must say that I have been highly grati- fied. Such a series as you propose giving to the public is certainly a great desidera- tum. Our classical text-books have heretofore been rendered entirely too expensive, by the costly dresses in which they have appeared, and by the extensive display of notes appended; many of wh'ch, though learned, are of little worth to the student in elucidating the text. It will afford me pleasure to introduce into my department such books of your series as may be in our course. From S. H. Taylor, Esq., Andover, Mass., Oct 30,1848. The notes seem to me very accurate, and are not so numerous as to do for the stu- dent what he ought to do for himself. I can with safety, therefore, recommend it to my pupils. From Prof. M. M. Campbell, Principal of the Grammar School. Indiana University, Nov. 6,1848. I like the plan of your series. I feel sure it will succeed, and thus displace some of the learned lumber of our schools. The notes, short, plain, and apposite, are placed where they ought to be, and furnish the learner just about help enough. From Philtp Lindsley, D. D., Pres. of the University of Nashville, Nov. 27, 1S48. The classical series, edited by Drs. Schmitz and Zumpt, has already acquired a high and well-merited reputation on both sides of the Atlantic. I have carefully ex- amined your editions of Ccesar and Virgil. I think them admirable text-books for schools, and preferable to all others. I shall avail myself of every suitable occasion to recommend them. From B. Sanford, Esq., Bridgewater. Mass., Jan. 17,1849. I have examined, with considerable care, both the Caesar and the Virgil, and am much pleased with the plan and execution of the series ihus far. I am particularly gratified with the propriety and judgment displayed by the editors in the preparation of the notes ; avoiding, as I think, the prolixity and profuseness of some of our class- ical works, and, at the same lime, the barrenness and deficiency of others ; giving a body of annotations better suited to aid the teacher in imparting a knowledge of the language, than is to be found in any edition heretofore in use. From Prof. Sturgess, Hanover College, Indiana, Dec. SO, 1848. The mere name of the editors is a sufficient and most ample guarantee of the accu- racy of the text, the judicious choice of various readings, and the conformity of those adopted to the latest investigations of MSS., and the results of the most enlightened criiicism. The notes I have not examined very carefully, except those of the Virgil. They are admirable, extremely condensed, and conveying a great deal of most valu- able criticism in the briefest possible way. They are particularly valuable for their resthetifal remarks, and the frequent references to parallel passages in the same au- thor. The preliminary life is excellent, and of great value to the student. The Sal- lust appears to be of the same general character, and the notes to furnish just such help as the diligent student really needs. I think that in bringing out such a course at a cheap rate you are conferring a great boon on the country, and additional honor on your press, already so distinguished for the value of its issues. LEA & BLANCHARD'S NEW PUBLICATIONS. 17 SHAW'S ENGLISH LITERATURE. OUTLINES OE ENGLISH LITERATURE. BY THOMAS B. SHAW, Professor of English Literature in the Imperial Alexander Lyceum of St. Petersburg. In one large and handsome royal 12mo. volume. A valuable and very interesting volume, which for various merits will gradually find its way into all libraries.— iV. Y. Knickerbocker. Supplies a want long and severely felt.—Southern Literary Gazette. Traces our literary history with remarkable zest, fairness, and intelligence.—N. Y. Home Journal. An admirable work—graphic and delightful.—Pennsylvanian. The best publication of its size upon English literature that we have ever met with. —Neat's Saturday Gazette. Eminently readable.— City Item. A judicious epitome—well adapted for a class-book, and at the same time worthy of a place in any library.—Penn. Inquirer. From the Rev. W. G. T. Shedd, Prof essor of English Literature in the University of Vt. Burlington, May 18,1849. I take great pleasure in saying that it supplies a want that has long existed of a brief history of English literature, written in the right method and spirit, to serve as an introduction to the critical study of it. I shall recommend the book to my classes. FOSTER'S EUROPEAN LITERATURE.—Now Ready. HANDBOOK OF MODERN EUROPEAN LITERATURE: British, Danish, Dutch, French, German, Hungarian, Italian, Polish and Rus- sian, Portuguese, Spanish, and Swedish. "With a full Biographical and Chronological Index. BY MRS. FOSTER. In one large royal 12mo. volume, extra cloth. (UNIFORM WITH SHiW'S OUTLINES OF ENGLISH LITERATURE.) This compilation will prove of great utility to all young persons who have just com- pleted their academical studies. The volume gives both a general and particular view of the literature of Europe from the revival of letters to the present day. It is compiled with care and judgment, and is, in all respects, one of the most instructive works that could be placed in the hands of young persons.—Morning Herald. ATLAS TO DANA ON CORALS. In one large Imperial folio volume, with Sixty-one Plates, Drawn and Colored after Nature, by the best Artists. Beautifully and strongly bound in half morocco. Of this magnificent work but a very few copies have been offered for sale, and these are nearly exhausted. Those who are denrous of enriching their libraries with so spfendkl a specimen of American Art and Science will therefore do well to procure copies at once. ^ pEw coplEg gTILL ON HAND OF DANA ON CORALS A N D ZOO PH YTES. Being Volume VLU. of the United States Exploring Expedition Publications. WILKES'S CALIFORNIA—A New Work, Just Issued. WESTERN AMERICA, INCLUDING OREGON AND CALIFORNIA. With Maps of those Regions and of the Sacramento Valley. BY CiIAULKfS WILKES, U. S. N., Commander of the United States Exploring Expedition. Octavo. Price 75 cents. LEA AND BLAN CHARD'S PUBLICATIONS. CAMPBELL'S LORD CHANCELLORS. JUST PUBLISHED. LIVES OF THE LORD CHANCELLORS AND KEEPERS OF THE GREAT SEAL OF ENGLAND, FROM THK EARLIEST TIMES TO THE REIGN OF KING GEORGE IV., BY JOHN LORD CAMPBELL, A.M., F.R.S.E. First Series, forming three neat volumes in demy octavo, extra cloth. Bringing the work to the time of Lord Jeffries. THE SECOND SERIES WILL SHORTLY FOLLOW IN FOUR VOLUMES TO MATCH. " It is sufficient for us to thank Lord Campbell for the honest industry with which he has thus fiu prosecuted his large task, the general candor and liberality with which he has analyzed the Uvea and characters of a long succession of influential magistrates and ministers, and the manly style of his narrative. We need hardly say that we shall expect with great interest the continuation of this performance. But the present series of itself is more than sufficient to give Lord Campbell a high station among the English authors of his age."— Quarterly Review. " The volumes teem with exciting incidents, abound in portraits, sketches and anecdotes, and are at once interesting and instructive. The work is not only historical and biographical, but it is anecdotal and philosopMcaL Many of the chapters embody thrilling incidents, while as a whole, the publication may be regarded as of a high intellectual order."—Inquirer. "A work in three handsome octavo volumes, which we shall regard as both an ornament and an honor to our library. A History of the Lord Chancellors of England from the institution of the office, is necessarily a History of the Constitution, the Court, and the Jurisprudence of the King- dom, and these volumes teem with a world of collateral matter of the liveliest character for the general reader, as well as with much of the deepest mterest for the professional or philosophicxl mind."—Saturday Courier. " The brilliant success of this work in England is by no means greater than its merits. It is certainly the most brilliant contribution to English history made within our recollection; it has the charm and freedom of Biography combined with the elaborate and careful comprehensiveness uf History."—N. Y. Tribune. MURRAY'S ENCYCLOPEDIA OF GEOGRAPHY. THE ENCYCLOPEDIA OF GEOGRAPHY, COMPRISING A. COMPLETE DESCRIPTION OF THE EARTH, PHYSICAL, STATISTICAL, CIVIL AND POLITICAL. ESHIBITINQ ITS RELATION TO THE HEAVENLY BODIES, ITS PHYSICAL STRUCTURE, THE NATURAL HISTORY OF EACH COUNTRY, AND THE INDUSTRY, COMMERCE, POLITICAL INSTITUTIONS, AND CIVIL AND SOCIAL STATE OF ALL NATIONS. BY HUGH MURRAY, F.R.S.E., &c. Assisted in Botany, by Professor HOOKER—Zoology, &c., by W. W. SWAIN SON—Astronomy, &c. by Professor WALLACE—Geology, &c, by Professor JAMESON. REVISED, WITH ADDITIONS, BY THOMAS G. BRADFORD. THE WHOLE BROUGHT UP, BY A SUPPLEMENT, TO 1843. In three large octavo volumes. VARIOUS STYLES OF BINDING. This great work, furnished at a remarkably cheap rate, contains about Nineteen Hundred large imperial Pages, and is illustrated by Eighty- Two small Maps, and a colored Map of the United States, after Tan ner's, together with about Eleven Hundred Wood Cuts executed in the best style. CATALOGUE OF LEA AND BLANCHARD'S PUBLICATIONS. THE AMERICAN ENCYCLOPAEDIA. BROUGHT UP TO 1847. THE ENCYCLOPEDIA AMERICANA: A POPULAR DICTIONARY OF ARTS, SCIENCES, LITERATURE, HISTORY, POLITICS AND BIOGRAPHY. IN FOURTEEN LARGE OCTAVO VOLUMES OF OVER SIX HUNDRED DOUBLE COLUMNED PAGES EACH. For sale very low, in various styles of binding. During the long period which this work has been before the public, it has attained a very high character as an ENCYCLOPAEDIA FOR DAILY REFERENCE, Containing, in a comparatively moderate space, a vast quantity of informa- tion which is scarcely to be met with elsewhere, and of the exact kind which is wanted in the daily exigencies of conversation and reading. It has also a recommendation shared by no other work of the kind now before the public, in being an American book. The numerous American Biogra- phies, Accounts of American Inventions and Discoveries, References to our Political Institutions, and the general adaptation of the whole to our own peculiar habits and modes of thought, peculiarly suit it to readers in this country. From these causes, it is also especially fitted for all DISTRICT SCHOOL AND OTHER PUBLIC LIBRARIES, in some of which it has been tried with great satisfaction. It fulfils, to a greater extent than perhaps any similar work, the requirements for these mstitutions, presenting, in a small compass and price, the materials of a library, and furnishing a book for every-day use and reference, indispensable to those removed from the large public collections. '■Some years having elapsed since the original thirteen volumes of the ENCYCLOPEDIA AMERICANA were published, to bring it up to the present day, with the history of that period, at the request of numerous subscribers, the publishers have just issued a SUPPLEMENTARY VOLUME (THE FOURTEENTH), BRINGING THE WORK UP TO THE YEAR 1847 EDITED BY HENRY VETHAKE, LL.D. Vice-Provost and Professor of Mathematics in the University of Pennsylvania, Author of "A Treatise on Political Economy." In one large octavo volume of over 650 double columned pages. LEA AND BLANCHARD'S PUBLICATIONS. ENCYCLOPAEDIA AMERICANA. The numerous subscribers who have been waiting the completion of thia volume can now perfect their sets, and all who want A REGISTER OF THE EVENTS OF THE LAST FIFTEEN YEARS, FOR THE WHOLE WORLD, nan obtain this volume separately: price Two Dollars uncut in cloth, or Two Dollars and Fifty Cents in leather, to match the styles in which the publishers have been selling sets. Subscribers in the large cities can be supplied on application at any of the principal bookstores ; and persons residing in the country can have their sets matched by sending a volume in charge of friends visiting the city. Complete sets furnished at very low prices in various bindings. " The publishers of the Encyclopedia Americana conferred an obligation on the public when, fourteen years ago, they issued the thirteen volumes from their press. They contained a wonder- ful amount of information, upon almost every subject which would be likely to occupy public attention, or be the theme of conversation in the private circle. Whatever one would wish to inquire about, it seemed only necessary to dip into the Encyclopedia Americana, and there the outline, at least, would be found, and reference made to those works which treat at large upon the subject. It was not strange, therefore, that the work was popular. But in fourteen years, great events occur. The last fourteen years have been full of them, and great discoveries have been made in sciences and the arts; and great men have, by death, commended their names and deeds to the fidelity of the biographer, so that the Encyclopedia that approached perfection in 1832, might fall considerably behind in 1846. To bring up the work, and keep it at the present point, has been a task assumed by Professor Vethake, of the Pennsylvania University, a gentleman entirely competent to such an undertaking; and with a disposition to do a good work, he has supplied a supplementary volume to the main work, corresponding in size and arrangements therewith, and becoming, indeed, a fourteenth volume. The author has been exceedingly industrious, and very fortunate in discovering and selecting materials, using all that Germany has presented, and resort- ing to every species of information of events connected with the plan of the work, since the pub- lication of the thirteen volumes. He has continued articles that were commenced in that work, and added new articles upon science, biography, history, and geography, so as to make the present volume a necessary appendage in completing facts to the other. The publishers deserve the thanks of the readers of the volume, for the handsome type, and clear white paper they have used m the publication."—United States Gazette. " This volume is worth owning by itself, as a most convenient and reliable compend of recent His- tory, Biography, Statistics,