Treatmea.. 
WATNUWGST Urinary Diagnosis 
and Treatment. 
By JOHN W. WAINWRIGHT, M.D., 
MEMBER OF THE AMERICAN MEDICAL ASSOCIATION; OF THE 
NEW YORK STATE MEDICAL ASSOCIATION; OF THE NEW 
YORK COUNTY MEDICAL ASSOCIATION, ETC. 
CHICAGO: 
G. P. ENGELHARD & COMPANY, 
1900. Copyright 1900 
By John W. Wainwright, M. D. CONTENTS. 
Pagb. 
Chapter I. 
Introduction 11 
Chapter II. 
Composition and Physical Properties of Urine 24 
Chapter III. 
Normal Constituents of Urine 38 
Chapter IV. 
Abnormal Constituents of Urine 49 
Chapter V. 
The Microscope and Microscopical Technique 69 
Chapter VI. 
Bacteria 87 
Chapter VII. 
The Qualitative Analysis of Urinary Calculi . 92 
Chapter VIII. 
Bright's Disease, Diabetes, Gout and Other 
Conditions 98 
Appendix, 
Favorite Prescriptions and Fomulae of Solutions 119 PREFACE. 
If an apology for increasing the already 
voluminous literature on urinary analysis and 
diagnosis be due the reader, it will be because 
there is at the present time no. work which em- 
bodies the simplest methods of chemical and 
microscopical examinations with the latest de- 
ductions and theories concerning the general 
routine treatment of the conditions found. 
The busy general practitioner, whose time 
will not permit of extensive study or reference 
to the various authorities on this subject, and 
whose somewhat limited knowledge of chem- 
istry and microscopical technique becomes more 
or less confused by the great number and in- 
tricacies of the innumerable methods given in 
the text-books, is often discouraged at the prob- 
lem before him. 
As the clinical examination of urine is of 
such positive necessity to the proper and intelli- 
gent understanding and definite treatment of 
the various conditions found, and as the meth- 10 
PREFACE. 
ods necessary to arrive at a positive diagnosis 
can be simplified tO' such an extent that hardly 
any chemical knowledge is really necessary, it 
will be my effort in the following pages not 
only to' give the easiest methods of examina- 
tion, but also to' elucidate the latest theories, as 
well as to point out the up-to-date treatment re- 
quired in each condition. 
J. w. w. 
New York, December ist, 1900. CHAPTER I. 
INTRODUCTION. 
The urine represents principally the products 
of metabolism. Its constituents are not formed 
in the kidneys, these organs only acting as the 
means of eliminating from the organism the 
waste products of the economy. 
The carbohydrates and hydrocarbons, repre- 
sented in the form of starches, sugars and fats 
of our food, go to supply the fuel of our bodies 
and are gradually oxidized or "burned up" by 
the lungs and liver without, under normal con- 
ditions and when partaken of to the normal 
extent, ever reaching the kidneys. 
The nitrogenous foods or albumins are by 
the digestive organs transformed into albu- 
moses and peptones, which, after absorption, 
are reconverted into albumins and go^ to re- 
plenish the waste in protoplasm of the various 
cells. The waste products, representing the 
retrogressive metamorphosis of the animal or- 12 
URINARY DIAGNOSIS AND TREATMENT. 
ganism, are absorbed by the blood, and elimin- 
ated by the kidneys in the form of nitrogenous 
constituents in the urine. Whenever, therefore, 
metabolism is at fault, whenever from, some 
cause pathological changes have taken place 
in the kidneys themselves, thereby interfering 
with their proper functions, we aim to establish 
the sequences by a proper examination of the 
urine, and thus by early recognition of all the 
existing troubles, we may succeed in our aim 
to bring the desired cure, or at least ameliora- 
tion, by appropriate treatment or regime. 
As we shall meet with better success in our 
efforts to stop further damage the earlier we 
recognize the existing trouble, it is of the ut- 
most importance that our examination of the 
urine be carefully and early made, and with 
the best and most modern appliances. It is 
easy enough to diagnose phthisis in its ad- 
vanced stages and when beyond cure. This is 
true also of severe diabetes or nephritis. It is 
the incipient forms of pulmonary disease, as 
well as of kidney affections, that take the most 
careful examinations; and thus we have as a 
reward for our investigations the satisfaction INTRODUCTION. 
13 
of an early diagnosis, while there is yet time 
for our treatment to bring relief or cure. 
To understand and appreciate fully the dif- 
ference between a pathological and a physio- 
logical condition which in one way or another 
show their effects in the urine, we will under- 
take a short resume of these conditions before 
attempting to classify and make clear the 
various methods of urinary examinations. 
The normal urine represents, as we know, 
the soluble nitrogenous waste products of ani- 
mal life which, together with inorganic and 
organic salts, are kept in solution by a varying 
amount of water. Whenever the tissue waste 
is abnormally increased, as in excessive physical 
exercise, the percentage of nitrogenous matter 
is correspondingly increased in the urine, while 
the percentage of phosphates is higher after 
severe mental effort or strain. The truth of 
these assertions is easily proven by the deter- 
mination of the amount of urea found in the 
urine of an athlete after a severe effort, or the 
amount of phosphate voided by a student at 
the time of examination. 
Under abnormal and still physiological con- 14 
URINARY DIAGNOSIS AND TREATMENT. 
ditions, the urine assumes temporary peculiari- 
ties which, if continued, shows that the con- 
ditions have gradually changed from physio- 
logical to pathological, causing more or less 
damage, which no treatment will undo, even 
if the conditions will temporarily improve un- 
der appropriate regimen. As an example of 
this we may quote the gourmand, who fre- 
quently indulges to an excessive extent in 
sugars and starchy foods, perhaps to almost 
total exclusion of nitrogenous foods. We shall 
find that the urine of such a person after this 
unreasonable indulgence will contain glucose. 
Experience has also proven that it is just this 
class of people who suffer from glycosuria, and 
it is therefore but logical to conclude that the 
first thing to be considered in the treatment 
of such a case is to entirely exclude carbohy- 
drates from the dietary, thereby giving the 
overworked liver a well needed rest. . 
What was at first a physiological condition 
has in such a case become, pathological, and 
even though the glycosuria disappears and the 
general condition of the patient is considerably 
improved by appropriate diet and treatment, INTRODUCTION. 
15 
still we may expect recurrence of the symptoms 
whenever the least indiscretion in the dietary is 
indulged. 
Another example may not be out of place. 
Many substances act as especial irritants upon 
the kidneys. Among these are certain drugs 
such as turpentine, cantharides, etc., also alco^- 
hol and the toxins formed by the blood in 
infectious diseases. Professor Atwater has 
proven that a certain small amount of alcohol 
can be partaken of without ever reaching the 
kidneys, as it is oxidized in the lungs. Any- 
thing above this amount must, however, be 
eliminated from the system by the kidneys, 
causing more or less irritation according to 
the quantity partaken of, as well as the suscep- 
tibility of the individual. In pyrexia and prob- 
ably also in cases of poisoning from venomous 
snakes, where the process of oxidation is es- 
pecially active, large amounts of alcohol can be 
taken without ever reaching the kidneys. In 
these cases it supplies the fuel that otherwise 
would have to be taken from the body tissues 
exclusively. The experience of arctic explor- 
ers, on the contrary, has proven that even small 16 
URINARY DIAGNOSIS AND TREATMENT. 
amounts of alcoholic beverages are undesirable 
under conditions of persistently low tempera- 
tures. 
The toxins of infectious diseases, such as 
diphtheria, scarlatina, erysipelas, etc., being 
so-called tox-albumins probably, take no part 
in the process of pulmonary oxidation, and are 
eliminated from the body through the kidneys. 
As the irritating effect of these toxins, as well 
as of alcohol, is more pronounced the more 
concentrated they reach the kidneys, we can 
well see the philosophy of the recommendation 
to give such individuals a liberal amount of 
water, diuretics and liquid nourishment. Not- 
withstanding such precautions, we shall as a 
rule find the presence of albumin in the urine 
of patients suffering from most infectious dis- 
eases, and if we do not "flush the kidneys" with 
large amounts of liquids we often find post- 
scarlatinal and other nephrites as a sequence, 
especially in individuals susceptible to nephritic 
troubles. 
In chronic alcoholics, who daily exceed the' 
amount of alcohol that in each individual case 
can be taken with impunity, there is a continual INTRODUCTION. 
17 
irritation to the renal epithelium with a coin- 
cident "low" inflammation. As a result there 
is, as in all chronic inflammations, a hyper- 
plasia or formation of new tissue which causes 
gradual cicatricial contraction of the surround- 
ing tissues, and partial atrophy of the epithe- 
lium-in other words, chronic interstitial neph- 
ritis. 
In such conditions the amount of albu- 
min is always very small, therefore we have 
to exercise especial care in making the chem- 
ical examinations; it is only by careful search 
of the urinary sediment with the microscope 
that we can confirm our suspicions, as we 
are always certain to find casts, - hyalin, 
epithelial or granular in character. In such 
interstitial troubles the new-formed scar tissues 
gradually compress the different renal arte- 
rioles; the general arterial circulation of the 
kidneys is impaired causing further atrophic 
damage, besides damming the blood back into 
the liver, stomach, etc., whereby at first hyper- 
trophic, then atrophic changes are wrought in 
these organs. The great importance of an early 18 
URINARY DIAGNOSIS AND TREATMENT. 
recognition of these conditions can consequent- 
ly easily be seen. 
We must, however, bear in mind, that traces 
of albumin may be found under many other 
conditions. In intestinal obstructions, persist- 
ent constipation, etc., where the excretion of 
the toxins formed by microbic or fermentative 
changes is prevented, they are absorbed by the 
blood and finally eliminated by the kidneys, 
and thus a more or less acute irritative inflamr 
mation with its coincident albuminuria is 
caused. Temporary albuminuria may also, fol- 
low cold bathing, muscular exertion, nervous 
shock, the taking of an anesthetic, and many 
other conditions. Whenever there is pus or 
blood in the urine, no matter from what cause, 
we will always find albumin, as leucocytes, pus 
and blood-cells are albuminous bodies. 
In certain forms of interstitial nephritis, it 
is sometimes very hard to demonstrate the 
presence of albumin. This is especially the 
case with the morning urine, which in other 
instances holds the greatest percentage of albu- 
min. Whenever, therefore, we have cause to 
suspect nephritis, without being able to demon- INTRODUCTION. 
19 
strate either albumin or casts, the best proced- 
ure is either to obtain the total amount of the 
urine for twenty-four consecutive hours, or 
else to examine separate specimens, voided at 
different times during the day, as for instance, 
morning, evening and after meals. 
As many errors may otherwise occur, we 
must always make it a routine practice to filter 
every specimen of urine before applying any 
test, be it for albumin or anything else. In 
cases of cystitis, where bacteria abound, it will 
sometimes be necessary to add a few drops of 
caustic soda or some calcined magnesia when 
the precipitated phosphates will carry with 
them the bacteria and we get a clear filtrate, 
which will enable us to' better observe small 
traces of albumin. The demonstration of albu- 
min in the urine is, however, per se of far less 
importance than formerly supposed. Even if 
repeated examinations show traces of albumin 
and some few hyaline or granular casts, there 
may be no' immediate danger so long as the 
amount of urea excreted in the twenty-four 
hours comes up to a fair average. Whenever 
the urea is considerably diminished, however, 20 
URINARY DIAGNOSIS AND TREATMENT. 
we have far more to fear, even though we get 
but a slight trace of albumin, as this clearly 
points to> impaired renal function, or in other 
words, shows that the products of tissue 
change, instead of being excreted by the kid- 
neys, remain in the blood causing a sort of 
toxemia or intoxication from which serious 
or fatal issue may at any time result. With a 
continued, small, daily excretion of urea we are 
very apt to' find fatty as well as granular casts, 
proving that the epithelium of the convoluted 
tubes (the functional excretory apparatus of 
the kidney while the glomeruli are the water 
filters, so to< speak, that wash out the excretory 
matter) is impaired by more or less general 
fatty, destructive degeneration. The prognosis 
under these conditions must always be most 
grave. 
A high percentage of albumin with numer- 
ous hyalin, some blood and granular casts, in- 
dicates an acute, parenchymatous nephritis, 
which is not necessarily serious, especially if 
the amount of urea is fair. 
It is easily seen, therefore, that the usual 
chemical tests for albumin are in themselves INTRODUCTION. 
21 
not of such positive importance as formerly 
taught. The microscopical examination of the 
urinary sediments are really of more diagnostic 
value, as the number and kind of casts, etc., 
prove the pathological condition before us far 
more clearly than does the percentage of al- 
bumin. 
We have seen that the total amount of urea 
excreted through the kidneys during each 
twenty-four hours is a most important indica- 
tion of their conditon. As the quantitative 
.tests described in the following pages are so 
simple that but a few carefully-made examin- 
ations will perfect even a beginner in the tech- 
nique, it is to be hoped that the aim of my 
work to popularize urinary diagnosis among 
general practitioners will be attained. 
Much has of late years been said and done 
regarding oxaluria, or the continued presence 
of crystals of calcium oxalate in the urine. 
Whether oxaluria is the cause of the nervous, 
mental and physical conditions of the patients 
thus affected, or only the effect, is not positively 
demonstrated. It seems, however, probable 
that oxaluria is the palpable effect of some 22 
URINARY DIAGNOSIS AND TREATMENT. 
faulty metabolism, as yet undefined, though 
digestive disturbances may be the causative 
agents. The presence, to any unusual extent, 
of uric acid (or, rather of urates, as the free 
acid is never present in the urine) indicates 
faulty oxidation; urea represents complete 
oxidation, uric acid but a transitory or incom- 
plete state of oxidation. We shall find an in- 
crease of urates in diseases of the heart and 
blood when the process of oxidation is im- 
paired, as well as in excessive meat-eaters, 
where the ingestion of nitrogenous foods is 
too great for their proper absorption and 
normal metabolism. 
The presence in the urine of peptone, albu- 
mose, bile, leucin and tyrosin, etc., will be con- 
sidered under their proper headings. 
Many an applicant for life insurance has 
been rejected on account of the accidental pres- 
ence in the urine of a more or less pronounced 
trace of sugar or albumin. The injustice of 
this is easily seen, and the careful and pains- 
taking examiner of a rival insurance company 
will in such cases be the one to discover the 
mistake. The same blunder is also often made INTRODUCTION. 
23 
in private practice, when (after finding a trace 
of sugar or albumin in the urine of a patient 
with ill-defined and numerous complaints) the 
careless practitioner, to the great discomfort 
and worry of both the patient and his family, 
gravely announces his discovery and gives a 
most discouraging prognosis. A careful and 
repeated examination of the urine is therefore 
indicated in all instances and great care should 
be taken that the patient is not unnecessarily 
alarmed or even informed of the condition until 
a diagnosis can be positively made. CHAPTER II. 
COMPOSITION AND PHYSICAL PROP- 
ERTIES OF URINE. 
COMPOSITION OF URINE. 
The average composition of human urine is, 
according to Simon: 
Water 95-76 per cent 
Urea 2.50 " " 
Uric Acid 0.04 " " 
Hippuric Acid 
Creatin 
Creatinine 
Coloring Matter 
Mucus 
0.40 " " 
Organic Matter 
Phosphates of Sodium, Po- 
tassium 
Chlorides, Calcium 
Sulphates, Magnesium 
Iron 
i.3o " " COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
25 
Or excreted in 24 hours. 
Grams. 
Per Cent. 
Total Solids .... 
.60 - 
70 
4-3 -4-6 
Urea 
•30 - 
-40 
2-5 -3-2 
Uric Acid 
. 0.4- 
- 0.8 
0.03 -0.05 
Creatinine 
• 0.5- 
- 1.0 
0.036-0.062 
Hippuric Acid .. . . 
• 0.3- 
- 1.0 
0.02 -0.06 
Chlorides 
. 10 - 
-13 
07 -0.8 
Earthy Phosphates. 
. 0.9- 
- 1-3 
0.07 -0.08 
Phosphoric Acid.. 
. 2.5- 
- 3-5 
0.19 -0.22 
Sulphuric Acid .. . 
i-5- 
■ 2.5 
0.16 -0.17 
Using the classification of modern investiga- 
tors we have a sediment from acid urine which 
differs from that of alkaline urine. 
SEDIMENT IN URINE. 
"A" Not Organised. 
a. Amorphous. 
Acid Urine. Alkaline Urine. 
i. Urates of sodium 
and potassium, 
2. Fat. 
i. Calcium phosphate, 
2. Calcium carbonate. 
b. Crystalline. 
I. Uric acid, 
2. Calcium oxalate, 
i. Ammonium urate, 
2. Triple phosphate, 26 
URINARY DIAGNOSIS AND TREATMENT. 
b. Crystalline-Continued. 
3. Cystin, 
4. Tyrosin. 
3. Calcium phosphate, 
4. Magnesium phos- 
phate. 
"B," Organized. 
1. Mucus and pus 
corpuscles, 
2. Blood corpuscles, 
3. Epithelium, 
4. Tube casts, 
5. Spermatozoa, 
6. Bacteria, 
7. Fungi. 
DETERMINATION OF SOLIDS IN URINE. 
Take the last two figures of the specific grav- 
ity and multiply by 2.33. The result will cor- 
respond to the amount of solids in 1000 c. c. 
of urine expressed in grams. For instance, if 
the patient shall pass 1450 c. c. of urine dur- 
ing the twenty-four hours which will have a 
specific gravity of 1,018, the total solids in 
1000 c. c. will be 18x2.33=41.94 grams, 
while for 1450 c. c. we will have 60.81 
grams. A more accurate method will be to 
evaporate the total quantity of urine voided for 
twenty-four hours over a water bath until all 
the water shall have been driven off, and 
weighing the amount of solids thus secured. COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
27 
The amount of solids contained in normal 
urine for 24 hours will vary between 60 and 
70 grams; should there be 200 grams we will 
suspect diabetes. If less than the normal 
amount, say 20 grams, and the quantity of 
fluid not diminished we will have hydruria. If 
there exist a diseased kidney, the amount of 
urine excreted, whether normal or diminished, 
if with a very low specific gravity will point 
to uremia, inasmuch as the usual amount of 
urea is not excreted (urea constituting nearly 
half the solids excreted). The character and 
amount of the food taken will influence the 
amount of solids excreted, and when there has 
been fasting, as in fevers, the amount will 
average 30 grams. In pneumonia under a 
strict diet 40 grams of solids will be regarded 
as an increase. 
QUANTITY OF URINE EXCRETED. 
The quantity of urine excreted normally 
during the 24 hours is forty to fifty ounces, or 
1500 c. cm. 
This quantity increases: 
a. after copious ingestion of fluids. 28 
URINARY DIAGNOSIS AND TREATMENT. 
b. in cold weather (diminished perspira- 
tion). 
c. in certain neurasthenic conditions and 
anemia. 
d. in hydruria (diabetes insipidus). 
e. in diabetes mellitus. 
f. after the administration of diuretics. 
g. in chronic Bright's disease of the atro- 
phic variety. 
This quantity decreases: 
a. when little fluid is taken. 
b. in hot weather (profuse perspiration). 
c. in pyretic conditions. 
d. in acute nephritis. 
e. In conditions accompanied by weak 
heart action. 
f. after the administration of certain drugs, 
as opium and its alkaloids, for in- 
stance. 
The urine is suppressed: 
a. in acute Bright's disease. 
b. in shock. 
c. in excessive diarrhea. 
d. in obstruction of urinary passages. COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
29 
SPECIFIC GRAVITY OF URINE. 
The specific gravity is normally between 
1.015 and 1.025, varying according to quanti- 
ties of constituents in solution. 
High specific gravity is found in: 
a. Concentrated urine. 
b. After the excessive ingestion of nitrog- 
enous foods. 
c. In diabetes mellitus. 
Low specific gravity is found in: 
a. Polyuria from the ingestion of large 
amounts of fluids. 
b. Diabetes insipidus. 
c. Chronic Bright's disease. 
SQUIBBS' URINOMETER. 
Dr. E. R. Squibb offers a small urinometer 
standardized for 25 deg. C. or 77 deg. F., a 
temperature much more usual than 60 deg. F., 
and at three points, 1.000, 1.030, and 1.060, 
with the variations marked, whence correc- 
tions are easily made. The glass jar supplied 
with it is fluted and in this way the instru- 
ment is kept from clinging to the side of the 
glass. This object is further secured by mak- 30 
URINARY DIAGNOSIS AND TREATMENT. 
ing the air-chamber a double cone, base to base, 
instead of a cylinder. In this way, also, there 
is obtained a single point of contact between 
the urinometer and the jar. Finally the instru- 
ment is provided with a thermometer to secure 
Fig. 1-Squibb's 
Urinometer. 
Fig. 2-Doremus 
Ureameter. 
greater accuracy, but as 4, if water be put 
at 1.000, is about the maximum error which 
can occur at any temperature at which urine 
is likely to be tested, it is not really necessary. 
This is certainly the most accurate uninometer COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
31 
I have seen; and by reason of the fluting of 
the glass, a smaller amount of urine is required 
than in the ordinary cylindrical jar. 
Normally, urine is transparent when voided. 
If turbid this may be due to: 
a. Excess of mucus, 
b. Pus corpuscles or abundant epithelium, 
c. Blood, 
d. Phosphates, 
e. Urates, 
f. Bacteria. 
On standing a short time these substances 
will settle, forming a precipitate. Mucus 
should not be present in an amount more than 
sufficient to give a slight haze. It is coagu- 
lated by acetic acid. Pus may be recognized 
by its becoming gelatinous on the addition of 
a sol. of caustic soda or potash. Epithelium 
and blood discs can only be verified by the 
microscope, although in the case of the latter 
the blood pigment may be identified as de- 
scribed elsewhere. A deposit of phosphates is 
cleaned up by the addition of a few drops of an 
TRANSPARENCY OF URINE. 32 
URINARY DIAGNOSIS AND TREATMENT. 
acid and that of urates by raising the tempera- 
ture. 
Phosphates are never deposited unless the 
urine is alkaline, either when voided or by sub- 
sequent decomposition, and the presence of 
turbidity or sediment under these circum- 
stances does not necessarily show that they are 
in excess. 
Specimens turbid from urates, or giving a 
deposit of this substance on cooling, are always 
acid, frequently to an abnormal degree, and 
deficient in water. Such specimens are fre- 
quently observed in children; during fevers, 
in acute rheumatism, and after paroxysms of 
gout.. The urates are thrown down because 
they are in excess relatively to the amount of 
urine, and usually also, in an absolute way. 
Turbidity due to bacteria, which are insolu- 
ble in acetic acid or heat, will not settle, nor can 
the bacteria be filtered out with filter paper. 
If the turbidity of freshly voided urine is 
due to decomposition, it may be recognized 
from the characteristic ammonia odor, and 
the cause is to be sought in some inflammatory 
condition of the genito-urinary tract (pyelitis, COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
33 
cystitis), which favors prolonged retention of 
urine (stricture, enlarged prostate, etc.) or 
some accidental infection, as from an unclean 
catheter. 
Pale urine indicates an excessive secretion, 
and suggests an examination for sugar, espe- 
cially if the specific gravity is above normal. 
Dark urine may be due simply to' diminished 
secretion or it may owe its color to the pres- 
ence of abnormal pigment, viz.: 
Pink to smoky red, due to admixture of 
blood, 
Brown, with an easily produced yellow 
foam, biliary matter, 
Olive-green to black, poisoning by carbolic 
acid and the phenols, 
Yellowish brown to dark red, medication by 
senna, rhubarb, etc. 
An abnormal color indicates the presence 
of abnormal constituents. 
COLOR OF URINE. 
The color of the urine should be determined 
in sunlight, never by artificial light. The best 
method is to put the urine into a test tube on 
foot and place it near a window. 34 
URINARY DIAGNOSIS AND TREATMENT. 
The normal color varies from a light yellow 
to a deep amber. 
Normally: aromatic, urinous; upon stand- 
ing, ammoniacal. 
If ammoniacal when voided: vesical disease, 
etc. 
If like molasses: diabetes mellitus. 
If like sweet apples: diabetic coma. 
The odor is also affected by various articles 
of diet (e. g., asparagus) and by the admin- 
istration of certain drugs. 
ODOR OF URINE. 
URINE REACTIONS. 
Normally the urine is acid, that is, it turns 
blue litmus paper red. The acidity is due to 
the presence of acid sodium phosphate, Na H2 
PO4. The urine may be alkaline in reaction, 
however, in which case red litmus paper is 
colored blue. This alkalinity may be caused 
by eating liberally of certain vegetables rich 
in alkaline salts or by taking large or repeated 
doses of alkaline salts themselves, as for ex- 
ample sodium bicarbonate or lithium tablets. 
When first excreted such urine is usually clear COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
35 
but it will soon become cloudy, as earthy and 
magnesium phosphates, as well as triple-phos- 
phates, will separate on cooling. The alka- 
linity of urine may also be caused by ammonia- 
cal decomposition, when it will always be 
found cloudy from the presence of bacteria and 
the precipitation of earthy phosphates. 
When the alkalinity is caused by ammonium 
carbonate, the litmus paper, which first turns 
blue, will on drying and consequent evapora- 
tion of the ammonium salt, return to its former 
red color, which it will not do when the alka- 
linity is caused by the so-called fixed alkalies, 
alkaline sodium phosphate and carbonate. 
We shall at times find that the same urine 
will turn both the red litmus paper blue, and 
the blue paper red, or, in other words, will be 
acid and alkaline in reaction at the same time. 
This is caused by the simultaneous presence 
of the acid mono-sodium phosphate (Na H2 
PO4) and the alkaline di-sodium phosphate 
(Na2 H PO4) which takes place in the be- 
ginning of alkaline fermentation. 
The degree of acidity of the normal urine 36 
URINARY DIAGNOSIS AND TREATMENT. 
varies at different times of the day, etc., and is 
increased: 
a. Whenever the urine is concentrated, as 
after decreased consumption of liquids or after 
increased elimination of water by excessive 
perspiration. 
b. Whenever metabolism is increased, as in 
fevers, or after excessive physical efforts. 
c. When the ingestion of albuminous food 
is excessive. 
The urine becomes alkaline: 
a. When it is diluted, as when partaking 
of large amounts of liquids, or in cold weather 
when there is but slight perspiration. 
b. In increased matabolism as in anemias, 
cardiac diseases, etc. 
c. In persistent vomiting, when the normal 
amount of free acid of the organism is de- 
creased by being ejected with the vomitus. 
d. By increased consumption of alkaline 
carbonates, or organic acids and salts, which 
in digestion are transformed into carbonates. 
As an example we may instance the taking of 
alkaline waters, medicines, liberal fruit or 
vegetable diet, lemonades, sour wines, etc., COMPOSITION AND PHYSICAL PROPERTIES OF URINE. 
37 
when the citric, tartaric or malic acids are 
changed into alkaline carbonates. 
e. By alkaline secretions and alkaline fer- 
mentation, as in pyuria from any cause, be it 
pyonephritis, cystitis, or what not. CHAPTER III. 
NORMAL CONSTITUENTS OF URINE. 
UREA. 
Urea, CO (N H2)2, is as we have seen, by 
far the most important factor in the chemical 
examination of urine, as the quantity excreted 
'during twenty-four hours will more than any 
other one factor indicate the conditions of 
metabolism in the organism, or perhaps show 
an advanced pathological condition of the kid- 
neys themselves. Whichever of these two con- 
ditions is the cause of the diminished excre- 
tion of urea can easily be determined by care- 
ful examination of the urinary sediment. In 
advanced renal disease we shall find more or 
less numerous fatty and granular casts and 
albumin, which are not liable to appear in 
simple, fatty metabolism. 
The urea normally excreted is about 2 
to 4 per cent, or about 1 ounce (30 gms.) 
per day for an adult of average weight. The NORMAL CONSTITUENTS OF URINE. 
39 
excretion in childhood is relatively greater in 
proportion to the body weight. 
There is increased elimination of urea: 
a. after excessive ingestion of nitrogenous 
foods, 
b. in fevers, 
c. in diabetes mellitus, 
d. in anemia and leucemia, 
e. in diseases interfering with aeration of 
the blood. 
There is diminished elimination: 
a. after exclusive ingestion of carbo- 
hydrates, 
b. in inanition, 
c. in uremia, 
d. in chronic hepatic diseases. 
Estimation of the quantity may be made by 
the aid of Doremus' ureameter, as follows: 
Make a solution of sodium hydrate, 6 ounces 
to a pint of water. Keep this in a bottle with 
a paraffined stopper. 
Sodium hypobromite is prepared by adding 
i volume of bromin to io volumes of this 
sodium hydrate solution and diluting with io 
volumes of water. 40 
URINARY DIAGNOSIS AND TREATMENT. 
It is convenient to' pour the sodium hydrate 
solution into the ureameter to the mark; then 
by means of the nipple pipette to add its 
measure of bromin and dilute with sufficient 
water to fill the long arm and bend. Tilt the 
ureameter and allow the hypobromite to flow 
into the long arm, filling it completely. 
Draw the urine to be tested into' the pipette 
to the graduation. Pass the pipette into the 
ureameter as far as the bend and compress the 
nipple slowly, the urine will raise through the 
hypobromite and the gas evolved will collect 
in the upper part of the tube. 
Each division indicates I grain of urea in a 
fluid ounce of urine. 
The quantity of urea voided in 24 hours is 
ascertained by multiplyng the result of the test 
by the number of ounces of urine passed during 
that time. 
Excessive elimination of urea during the 
pyretic state should not cause any uneasiness 
on the part of the practitioner. This will reg- 
ulate itself when the general condition im- 
proves. NORMAL CONSTITUENTS OF URINE. 
41 
URIC ACID. 
Uric acid, (C5 N4H4 O3), is the incom- 
pletely oxidized product of nitrogenous retro- 
gressive metamorphosis, while urea represents 
the complete oxidation. Uric acid is always 
excreted in the form of sodium or potassium 
urate, never as free uric acid. 
There is normally excreted about 8 grains 
or 0.4 to 0.8 grm. of uric acid per day. 
Its amount is increased : 
a. after albuminous food, 
b. in leucemia and simple anemia, 
c. in pyretic states, 
d. in conditions in which respiration is in- 
terfered with, 
e. in gout, shortly after the attack, 
f. in epilepsy, after the attack, 
g. in neuresthenia. 
Its amount is diminished: 
a. after a vegetable diet, 
b. in gout before attack, 
c. in various chronic diseases, such as 
nephritis, diabetes, etc., 
d. in epilepsy before attack. 42 
URINARY DIAGNOSIS AND TREATMENT. 
Test, qualitative: 
Place some urine in an evaporating dish; 
evaporate to dryness. Add to the residue 1 or 
2 drops of concentrated nitric acid. Evaporate 
again to dryness. Add 1 or 2 drops of diluted 
ammonia. Note the striking purple-red color, 
which turns violet when potash is added. 
CHLORIDES IN URINE. 
There is normally excreted about 200 grains 
or 10 to 16 grm. per day. 
The amount is increased: 
a. after a full meal, 
b. after the excessive ingestion of table 
salt, 
c. in diabetes insipidus. 
The amount is diminished: 
a. in acute pneumonia and pleurisy, 
b. in dropsical conditions, 
c. in chronic Bright's disease, 
d. in dyspepsia, 
e. in typhoid fever. 
Test, quantitative: 
Add a few drops of nitric acid to a little 
urine in a test tube. Then add some nitrate NORMAL CONSTITUENTS OF URINE. 
43 
of silver solution. If a prompt deposit to a 
depth equal to about one-quarter of the urine 
is obtained the chlorides are present in the 
average quantity. 
If urine becomes only cloudy without lumpy 
deposit, the chlorides are diminished. 
If urine remains unaltered, no chlorides are 
present. 
PHOSPHATES IN URINE. 
Phosphates occurring in the human urine 
are all salts of the so-called tribasic or ortho- 
phosphoric acid (H3 PO4) and will therefore 
appear in three different forms. To illustrate 
this we may take the sodium salts as a type. 
Of these we shall find: 
1. Na3 PO4-basic phosphate. 
2. Na2 H PO4-neutral or di-basic phos- 
phate. 
3. Na H2 PO4-acid phosphate. 
Only this last salt (Na H2 PO4), where 
only one atom of the hydrogen of the acid is 
replaced by an atom of sodium (Na), is acid 
in reaction. 
It is chiefly to this salt that urine owes its 
acidity. The two remaining types of phos- 44 
URINARY DIAGNOSIS AND TREATMENT. 
phates, i. e. the basic and the di-basic, are both 
alkaline in reaction,. 
The earthy phosphates (consisting of about 
two parts magnesium to one part of calcium 
phosphate) are soluble in acid urine, especially 
when warm, precipitate somewhat on cooling, 
and completely if the urine is alkaline or even 
neutral. 
The so-called triple phosphate is ammonium- 
magnesium phosphate (N H4) Mg PO4, 
which consequently is the basic salt, where one 
atom of H of the acid has been replaced by one 
atom (NH4), which will also result from the 
ammoniacal decomposition of the urea. 
Earthy phosphates eliminated per day about 
20 grains or 2.3 to 3.8 grm. 
Alkaline phosphates eliminated per day 
about 45 grains or 3.0 grm. 
They are excreted in larger quantities: 
a. in a number of nervous disorders, 
b. after much mental work, 
c. after an albuminous diet, 
d. in diseases of the bones, 
e. in diabetes insipidus et mellitus, 
f. in acute fevers. NORMAL CONSTITUENTS OF URINE. 
45 
Their amount is diminished in: 
a. during pregnancy. 
b. before an attack of gout, 
c. in functional renal diseases, 
d. diseases of the digestive organs. 
The earthy phosphates are deposited from 
alkaline urine, but such a deposit must not be 
taken for an excess of phosphates. The phos- 
phates may really be diminished, and yet in 
consequence of the reaction of the urine a 
copious deposit may be present. 
Test for earthy phosphates: 
Make urine alkaline with ammonium, 
sodium or potassium, and boil. Note white 
cloud, soon precipitating white or gray. This 
is dissolved on adding acetic acid. 
Test for alkaline phosphates: 
Filter off precipitated earthy phosphates and 
add to filtered urine one-third of its volume 
of magnesium fluid. Note snowy deposit, 
which will be alkaline phosphates. 
A peculiarity of the increased elimination 
of phosphates in acute fevers is that especially 
the potassium salt (which is usually very small 
in amount) is increased. The earthy phos- URINARY DIAGNOSIS AND TREATMENT. 
46 
phates are also markedly increased in menin- 
gitis (which has served as an aid in the differ- 
ential diagnosis of typhus, where the earthy 
phosphates are lessened) and also in chronic 
articular rheumatism, rickets and osteomalacia. 
THE SULPHATES IN URINE. 
The sulphates appear in the urine principally 
in combination with the alkaline metals (espe- 
cially sodium and magnesium), when a pre- 
cipitate is formed on the addition of barium 
chlorid. 
Under ordinary circumstances a small 
amount of sulphuric acid is combined with one 
of the aromatic phenyl radicles (as phenol, 
cresol, indol, etc.) forming aromatic, ethereal 
sulphates, which first have to be split up by 
long boiling with hydrochloric acid before they 
will give a precipitate with barium. This can 
especially be observed in cases of the dark- 
colored urine of carbolic acid poisoning or 
after prolonged administration of the sali- 
cylates, which by the usual barium test shows 
but a trace or total absence of sulphates. Very 
little clinical importance can, however, be NORMAL CONSTITUENTS OF URINE. 
47 
placed upon the fluctuations in the elimination 
of sulphates and an increased amount will 
usually only prove increased metabolism. 
The sulphates are generally excreted to the 
extent of about 30 grains or 1.5 to 2.5 grm. 
daily. 
They are increased: 
a. in fever, 
b. in pneumonia, 
c. after albuminous diet, 
d. in meningitis. 
They are diminished: 
a. in chlorosis, 
b. in carbolic acid poisoning. 
c. in convalescence from fever, 
d. in chronic kidney disease. 
Test, qualitative: 
Acidulate with hydrochloric acid and add 
solution of barium nitrate. Note white pre- 
cipitate of barium sulphate, indicating presence 
of sulphates. 
CARBONATES. 
Carbonates of the alkaline metals and am- 
monia are present in alkaline urine, and may 
be found after a liberal diet of fruit and vegeta- 48 
URINARY DIAGNOSIS AND TREATMENT. 
bles, as the vegetable acids are converted into 
carbonates during digestion. The ammonium 
carbonate is formed by the bacterial decompo- 
sition of urea in cystites, etc. 
Test, Qualitative: 
If to some urine, containing carbonates, is 
added hydrochloric acid, bubbles of color- 
less gas will form, with more or less of a 
hissing sound, according to the quantity. If a 
clean glass rod with a drop of clear lime water 
dependent be held above the surface of such 
a urine, it will be found that the drop of lime 
water will become turbid from the formation 
of carbonate of lime. CHAPTER IV. 
ABNORMAL CONSTITUENTS. 
ALBUMIN: 
Formerly only one albumin was found in 
urine and its presence was considered as suffix 
cient proof of renal disease, as was its relative 
quantity looked upon as the gauge of renal 
damage. Years of careful study and research 
have however proven the fallacy of these views. 
We know now that the urine may contain 
almost a dozen albuminous bodies. The most 
important of these is serum-albumin, but we 
must by no means forget serum-globulin, with 
which it is usually associated, nor the acid or 
alkaline albuminates, peptones, propetones, 
albumose, mucin, fibrin,hemoglobin, etc., which 
are all more or less constant and more or less 
important constituents. 
SERUM-ALBUMIN 
is, as we have seen, the most important 50 
URINARY DIAGNOSIS AND TREATMENT. 
albuminous substance found in urine. Blood 
serum contains normally about 4.5 per cent 
of this serum-albumin. Serum-albumin closely 
resembles egg albumin in its physical proper- 
ties, except that it is not coagulated by dilute 
mineral acids. 
The occasional presence of traces of albumin 
in urine is of no clinical or diagnostic signifi- 
cance, provided the percentage of urea is nor- 
mal and no casts are present. If, however, 
even so small a trace of albumin is constantly 
found in the urine of any individual, it is a 
never failing proof of renal pathological 
changes, and we can in such cases be sure to 
find both a decrease in the daily excretion of 
urea as well as some casts. 
SERUM-ALBUMIN MAY OCCUR IN URINE : 
a. after excessive ingestion of albuminous 
foods, 
b. in febrile states, 
c. under increased venous blood pressure 
(cardiac diseases), 
d. after severe muscular exertion, ABNORMAL CONSTITUENTS. 
51 
e. in certain non-febrile nervous affections, 
as apoplexy and delirium tremens, 
f. when blood or pus is present in the 
urine, 
g. after renal irritation, 
h. in diseases of the kidney, 
i. in uremic conditions. 
We can from the above easily see that it 
will be impossible to demonstrate the presence 
or even the extent of renal disease by simply 
proving the presence of albumin in the urine. 
The total amount of urea excreted during the 
24 hours is a far more reliable proof, though 
constantly fluctuating, according to the pe- 
culiarities of the individual, diet, metabolism 
from exercise or disease, etc. 
The most reliable proof of the actual condi- 
tion of the kidneys is furnished by the micro- 
scope, though the presence and amount of 
albumin and the amount of urea excreted in 
the 24 hours aids in a positive diagnosis. 
TESTS FOR SERUM ALBUMIN QUALITATIVE : 
i. Heat and acetic acid. 
Put a small quantity of urine into' a test tube 52 
URINARY DIAGNOSIS AND TREATMENT. 
and if alkaline, add a few drops of acetic acid. 
By holding the test tube by its lower part and 
heating the upper portion only, over a flame, 
and holding against a dark background, we 
can compare the upper boiled part with the 
lower, which will not be heated. If the urine 
on heating looks turbid, permit cooling and 
add some dilute nitric acid. If turbidity does 
not clear, or if it is even increased, albumin 
is present. 
2. Heat and nitric acid. 
Put two drachms of urine into a test tube 
and boil. If deposit occurs, it consists of albu- 
min or earthy phosphates. To, differentiate, 
add some nitric acid. If precipitate does not 
disappear, it is due to the presence of albumin. 
3. Heller's test. 
Fill a small test tube one-fourth full with 
strong nitric acid. Add to this carefully some 
urine by a common medicine dropper, perfectly 
clean, allowing the urine to run down the side 
of the test tube. If this is carefully done and 
without agitating the tube in the least, the 
urine, which is lighter in specific gravity than ABNORMAL CONSTITUENTS. 
53 
the acid, will form a layer above the acid. If 
albumin is present a white and milky ring or 
zone will appear at the line of contact of the 
two fluids. As, however, more or less cloudi- 
ness will appear from the precipitation of acid 
urates, albumose, resinous acids, etc., the diag- 
nosis of albumin should be confirmed by one 
or two other tests before giving a decision. 
4. Pavy's test. 
Into a test tube place half a drachm of acetic 
acid and about three times this quantity of a 
solution of ferrocyanide of potash and shake. 
Following this, add urine to* about two- 
thirds the depth of the tube. If albumin be 
present, there will be a pale, greenish coagulum 
at point of contact. This is a very trustworthy 
test. 
TEST FOR SERUM ALBUMIN, QUANTITATIVE". 
Esbach's Method: 
Reagent.-Picric acid grs. 150 
Citric acid grs. 300 
Distilled water enough to make 33 ounces. 54 
URINARY DIAGNOSIS AND TREATMENT. 
This test is made with the albuminometer, a 
standard graduated glass tube. 
Fill albuminometer with 
urine to letter U, add reagent 
to R; close tube with stopper 
and shake thoroughly. Set 
tube aside for a day and read 
off percentage of albumin con- 
tained in urine. 
The tubes are graduated to 
read the number of grams 
of albumin to 1000 cc. of 
urine. Percentage is readily 
calculated by removing the 
decimal point one figure to 
the left; for instance, I 
gram for 1000 cc. would 
be o.i per cent of albumin. 
Fig. 3 Esbach's Albu- 
minometer. 
SERUM-GLOBULIN. 
Serum-globulin very frequently is associated 
with serum albumin in the urine. As it is 
practically insoluble in pure water its presence 
can be demonstrated by Hammarsten's test, 
i. e., if a clear specimen of urine is diluted ABNORMAL CONSTITUENTS. 
55 
with an excess of water, it will become slightly 
hazy if serum-globulin is present. 
MUCIN OR NUCLEO-ALBUMIN. 
Mucin, or more correctly, nucleo-albumin, 
is always present in urine, but may be of pa- 
thological significance only if occurring in 
excessive amounts. 
Its presence in large quantity indicates a ca- 
tarrhal condition of some portion of the genito- 
urinary tract, and we are likely to find the 
urine of alkaline, or at least but faintly acid 
reaction. In some instances of alkaline urine 
it may be "stringy" or almost gelatinous from 
excess of mucin. 
Tests.-Add lime water; it is dissolved eas- 
ily. Alcohol and acetic acids form a precipi- 
tate, which is soluble in lime water. 
PEPTONES. 
Peptones are sometimes found in otherwise 
normal urine, but usually accompanying toxe- 
mias, whether of the infectious diseases or 
from phosphorous poisoning, absorption of ex- 
tensive exudates, in the involution of the puer- 
peral uterus, etc. It may be looked for as a 56 
URINARY DIAGNOSIS AND TREATMENT. 
consequence in all diseases associated with the 
disintegration and absorption of leucocytes and 
exudates and also in the localized inflamma- 
tions of a purulent tendency. Peptones are not 
precipitated by heat, acids or ferrocyanide of 
potassium and acetic acid. 
Propeptone and albumose are found in the 
same class of cases as peptones and also in gas- 
tric and intestinal ulcers, multiple myeloma, 
urine containing seminal fluid, etc. Propeptones 
and albumose are precipitated by strong acids; 
are redissolved by heat, but precipitate again 
on cooling. They are also, in contradistinction 
to peptones, precipitated by ferrocyanide of 
potassium and acetic acid. 
PROPEPTONE AND ALBUMOSE. 
TEST FOR PEPTONES AND ALBUMOSES. 
Treat about one pint of urine with neutral 
acetate of lead and filter clear. The filtrate is 
then mixed with almost an equal volume of 
strong hydrochloric acid, after which phospho- 
tungstic acid is added till no further precipi- 
tate occurs. This precipitate, which consists 
of peptones in combination with the phospho- ABNORMAL CONSTITUENTS. 
57 
tungstic acid and some other substances, is now 
quickly washed with 5 per cent sulphuric acid 
until the washings are clear. The precipitate 
is then removed from the filter into a porcelain 
dish with as little water as possible, after which 
dry barium carbonate and some water is added 
until the mixture becomes alkaline. After heat- 
ing this mixture on the water bath for 15 to 20 
minutes the precipitate is filtered off and the 
filtrate will, after being made strongly alka- 
line with liquor sodii or potassii, show a bluish 
red or violet color on the addition of a drop 
or two of a 10 per cent solution of copper sul- 
phate. If no peptones are present, the solution 
assumes a green color on the addition of the 
copper solution. 
FIBRIN. 
Fibrin occasionally is found in urine in cases 
of hematuria or chyluria in the form of casts 
or coagula. It is also occasionally found after 
the use of cantharides, turpentine and other 
substances, that cause acute renal irritation. 
Chyle is occasionally found in urine, espe- 
cially in tropical countries. Chyluria or galac- 
CHYLE. 58 
URINARY DIAGNOSIS AND TREATMENT. 
turia is frequently associated with the presence 
in the blood of filaria sanguinis hominis, but 
has been found repeatedly in other conditions 
and in people who have never visited a tropical 
country. Such urine is more or less milky, 
opaque or pinkish in color; is of low specific 
gravity, though the urea is normal. The opacity 
depends to' the greatest extent upon fine, gran- 
ular fat globules, but also partially upon leu- 
cocytes, etc. Chylous urine contains also 
albumin, fibrin, lecithin and blood cells. 
By shaking chylous urine with ether, the fat 
will be dissolved, and can be both qualitatively 
and quantitatively determined by evaporating 
the ether and weighing the fat obtained from a 
known quantity of urine. The amount of fibrin 
is sometimes very high in chyluria and will oc- 
casionally form large coagula upon shaking. 
In lymphus urine the percentage of albu- 
min and fibrin is so large that the urine coagu- 
lates spontaneously, and Neubauer relates a 
case where the coagula formed partly within 
the urinary passages, actually interfering with 
urination. ABNORMAL CONSTITUENTS. 
59 
Grape sugar or glucose (C6Hi2O6+H2O) is 
at times found in urine as well as (though in 
smaller quantities and of less clinical impor- 
tance) levulose or fruit sugar, inosite or muscle 
sugar and lactose or milk sugar. The claim of 
some investigators that a. trace of sugar is 
found in all normal urine has been repeatedly 
disputed. As, however, even if such were the 
case, only actual glycosuria is important to the 
diagnostician, we can with the tests given be- 
low feel certain of sufficient accuracy for all 
practical purposes, as diabetic urine contains 
from i to 4 per cent and even in some cases 
as high as 5 or 6 per cent, or even more. 
Every specimen of urine of 1.025 or even 1.020 
spec. gr. should be tested for sugar, especially 
if pale in color and increased in amount. The 
occurrence of sugar in urine may be classified 
under the following headings: 
(a) Physiological glycosuria, as after the 
ingestion of abnormal quantities of sugars 
or starchy foods, especially in elderly peo- 
ple, whose appetite for carbohydrates is 
greater than their digestive powers. 
GLUCOSE IN URINE. 60 
URINARY DIAGNOSIS AND TREATMENT. 
(b) Temporary glycosuria, as in: 
(i) Many infectious diseases, such, for in- 
stance, as erysipelas, typhoid, typhus, 
cholera, scarlatina, etc. 
(2) in some acute febrile conditions, as acute 
articular rheumatism. 
(3) in diseases of the heart and lungs, cirrho- 
sis of the liver, after paroxysms of whoop- 
ing cough, asthma and epilepsy, etc. 
(4) after chloroform narcosis, inhalation of 
carbon dioxid, and certain drugs. 
(5) in certain nervous affections, and after 
bulbar hemorrhage, when the floor of the 
fourth ventricle is injured or irritated. 
(c) Lactosuria may at times be found in 
nursing mothers. 
(d) Permanent glycosuria is the disease 
known as diabetes mellitus, when the per- 
centage of grape sugar is dependent upon 
the amount of carbohydrates of the food. 
TESTS FOR GRAPE SUGAR, QUALITATIVE. 
I. Bismuth test (Bottger's). 
Put one drachm of urine into a test tube, add 
equal amount of liquor potass.; also some sub- ABNORMAL CONSTITUENTS. 
61 
nitrate of bismuth. Boil gently. If glucose 
is present precipitate of gray or black will ap- 
pear, according as there is a small or large 
amount of glucose present. 
2. Ammonium hydroxid test. 
Take I drachm of urine and add equal 
amount of ammonium hydroxid; then add 5 
drops of a strong solution of lead acetate. A 
white, flocculent sediment appears at once. 
Gently heat part of the sediment until two or 
three boiling bubbles ascend. If glucose is 
present there will appear on the heated place 
of the sediment a distinct pink spot, the in- 
tensity of which is dependent upon the amount 
of grape sugar present; as minute a quantity 
as only 0.1 per cent of grape sugar is thus 
shown. 
3. Haines' test. 
Reagent.-Copper sulphate grs. 30 
Distilled water oz. | 
Make a perfect solution and add : 
Pure glycerine oz. 
Mix thoroughly and add: 
Liquor potass oz. 5 
This solution does not alter. 62 
URINARY DIAGNOSIS AND TREATMENT. 
Place in. a test tube i drachm of the reagent 
and boil. Then add 6 to 8 drops, and not more, 
of the suspected urine; boil again. If sugar 
is present, a yellow or reddish discoloration 
will occur. 
A very simple test for glucose in the urine 
consists in placing a small quantity of the sus- 
pected urine upon a piece of bright tin, which 
is to be held over the flame of a spirit lamp 
until all the liquid is evaporated. If sugar is 
present the last portion will disclose the char- 
acteristic odor of burnt sugar. Such a test, 
however, is not to be alone relied upon to 
furnish the basis for a diagnosis of diabetes. 
QUANTITATIVE ANALYSIS OF GLUCOSE IN 
URINE. 
If the specimen to be examined for sugar 
contain even the least trace of albumin this 
must first be removed before a correct analysis 
can be made. Heat the urine in a flask or tube 
till boiling, when a couple of drops of acetic 
acid are added to make the specimen slightly 
acid. Heat up to' boiling point several times, 
so that the albumin will separate in flakes; ABNORMAL CONSTITUENTS. 
63 
these are allowed to settle, after which the 
specimen is filtered and tested with copper- 
solution as below described. For the fer- 
mentation test the presence of albumin need 
not be considered. 
FERMENTATION TEST FOR SUGAR. 
The fermentation test for the quantitative 
estimation of sugar in urine is easiest and most 
Fig. 4-Einhorn's Saccharometer. 
satisfactorily carried out by the Einhorn fer- 
mentation saccharometer. In this test io c.c. 
of the urine to> be examined is thoroughly shak- 
en up with about one-sixteenth part of a cake 64 
URINARY DIAGNOSIS AND TREATMENT. 
of Fleischman's or some other good com- 
pressed yeast, after which the mixture is 
poured into the bulb of the instrument. By 
inclining the saccharometer the mixture flows 
into the upright cylinder, driving out the air. 
The whole is now left undisturbed for from 
18 to 24 hours in a room of even, ordinary tem- 
perature. If the urine contains sugar, we will 
within this time find that the upper portion of 
the liquid in the tube has been replaced by car- 
bonic acid gas, resulting from the fermentation 
of the sugar, and the approximate quantity of 
sugar is found by reading off the amount of 
CO2. 
If the urine contains more than 1 per cent 
of sugar it must be diluted with from one to 
ten times its amount of water, and the percent- 
age of sugar multiplied from one to ten times, 
as the case may be. 
Another fairly accurate and very simple fer- 
mentation determination is to first take the 
specific gravity of the specimen suspected. Add 
to this some Fleischman's compressed yeast 
and set aside to ferment for twenty-four hours 
at a temperature of about 85 degrees F. Then ABNORMAL CONSTITUENTS. 
65 
take again the specific gravity of the fermented 
specimen, subtract the latter specific gravity 
from the original. For every degree of specific 
gravity lost we have one grain of sugar to the 
ounce of urine, provided we have taken the spe- 
cific gravity at the same temperature. If, for ex- 
ample, the specific gravity of the original speci- 
men was 1.025, and after fermentation for 
twenty-four hours the specific gravity is only 
1.018, we have seven grains of glucose to the 
ounce of urine, and by multiplying the number 
of ounces of urine passed during the twenty- 
four hours with seven we have the amount of 
glucose passed in the same length of time. 
QUANTITATIVE ANALYSIS OF GLUCOSE BY COP- 
PER SOLUTION. 
Boil in test tube or flask any convenient num- 
ber of drachms of Pavy's solution diluted with 
an equal bulk of water. Drop in slowly from a 
burette or other accurate measuring vessel the 
urine to be tested. When the blue color has 
just disappeared, note the amount of urine 
used. For every drachm of Pavy's solution 
reckon 1-3 grain of glucose; for example, if 4 
drachms of Pavy's solution require 120 min- 66 
URINARY DIAGNOSIS AND TREATMENT. 
ims of urine, then 120 minims contain 4.3 
grains of glucose, or 5 1-3 grains per fluid 
ounce. 
Similarly, if 10 cubic centimeters of the 
mixed Fehling's solution requires 5 cc. of 
urine, then as each cc. is decolorized by 5 milli- 
grams of glucose, there are 50 milligrams of 
glucose contained in 5 cc. of urine, or 1 per 
cent (0.050-5.000, 1-100). 
PIGMENT CHANGES. 
Occurs in urine in affections of the liver and 
gall ducts, and in certain toxic conditions: 
Put a few drops of the urine on a white dish, 
and bring into contact with it a drop of nit- 
rous acid. A play of colors will be observed, 
green (biliverdin) predominating. 
BILIARY PIGMENT. 
BLOOD PIGMENT. 
Shake a small portion of the urine in a test 
tube with a little fresh tincture of guaiac and 
a few drops of spirits of turpentine. The latter 
should be an old sample which has been freely 
exposed to the air. Or it may be replaced by a 
few drops of peroxide of hydrogen.. The mix- ABNORMAL CONSTITUENTS. 
67 
ture will shortly assume a blue color. Pus, if 
present, should be allowed to separate from the 
suspected urine, as it also gives the above re- 
action. 
INDICAN. 
Add to the urine an equal volume of hydro- 
chloric acid, and slowly add a few drops of 
liquor sodae chlorinatae-a blue color results. 
The following is a good test for Indican: 
Twenty (20) c. c. of the urine is gently shaken 
with a few drops of sulphuric acid, five (5) 
c. c. of chloroform and five (5) c. c. of a 10 
per cent solution of sodium persulphate. The 
indigo thus generated dissolves in the chloro- 
form, coloring it a more or less deep blue, 
according to the amount present. 
This pigment is normally present to the ex- 
tent of a trace, but a well-defined reaction indi- 
cates albuminoid decomposition within the 
body, due to constipation, obstruction of the 
bowels, purulent accumulations, etc. 
The remaining organic constituents are of 
no significance, and as the care necessary for 
their separation is more than can generally be 68 
URINARY DIAGNOSIS AND TREATMENT. 
given by the physician we will mention them 
very briefly. 
Creatinin is excreted in about the same pro- 
portion as is uric acid, and is found to be less 
when a vegetable diet is partaken of than when 
an animal diet prevails. The quantity is in- 
creased in pneumonia, in intermittent fevers, 
in typhus and in kidney diseases in advanced 
stages; diminished in inanition. 
Hippuric acid is present in small quantities 
only in the human urine; is increased by vege- 
table diet, in febrile conditions, diabetes and 
after the injection of benzoic acid. It is di- 
minished by a strict diet of meats. 
Xanthin is found in very small quantity. 
Oxalic acid is found always as the oxalate 
of calcium, which will be treated of elsewhere 
in this work. CHAPTER V. 
THE MICROSCOPE AND MICROSCOPI- 
CAL TECHNIQUE. 
No one article is of such importance in 
proper urinary diagnosis as a good microscope 
of sufficient magnifying power. The first cost 
of such an instrument is greater than all the 
other apparatus and reagents necessary for 
thorough clinical urinary examination. Com- 
petition and improved methods of manufacture 
have, however, of late combined to reduce the 
price considerably, and it is now possible to get 
a very good instrument comparatively reason- 
able. It will be found that the size of most 
pathogenic micro-organisms is so minute that 
a I-12 inch oil immersion lens (magnifying 
from 800-1000 times according to objective, or 
eye-piece) is indispensable for their detection 
and study. The structure of casts, blood and 
certain salts can be made out properly only by 
similar magnifying power, though for the 70 
URINARY DIAGNOSIS AND TREATMENT. 
first, hasty routine examination a 2-3 or 1-6 
inch objective is serviceable. 
It is needless to say that the greatest care 
must be taken with the microscope, and espe- 
cially the lenses, as the most minute scratch is 
a hundredfold magnified. After each exami- 
nation under oil immersion the cedar oil should 
be carefully removed with a fine cloth, before 
it dries on the lens. The greatest care and 
cleanliness must also be observed in the prep- 
aration of the specimen to be examined. The 
cover slip and slide must be carefully cleaned, 
as also the pipette or glass-rod with which the 
drop is applied to the slip. The fingers must 
not be allowed to touch the slide or slip. The 
specimen should not be too thickly applied. If 
the specimen is too dense, take a new one and 
dilute with a minute quantity of clean water. 
With reasonable care and some experience 
the average practitioner will soon find his la- 
bors rewarded by the great, new field of pos- 
sibilities opened up to him in his search for 
knowledge and positive diagnosis. 
THE CENTRIFUGE. 
The centrifuge is now recognized as an es- THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
71 
sential and time-saving means of producing 
sedimentation of all solids of the urine, wheth- 
er of crystalline substance or of blood, pus or 
bacteria. A description is hardly called for 
Fig. 5-The Centrifuge. 
here, as it is presumed that so valuable an as- 
sistant to urinary analysis is pretty generally 
well known. 
When used the centrifuge should be kept 72 
URINARY DIAGNOSIS AND TREATMENT. 
at a speed of from 1,200 to 1,500 revolutions 
per minute for at least three minutes, or until 
sedimentation is complete. The amount of 
total sediment is then read off from the grad- 
uated scale on the glass tube. A pipette, closed 
Fig. 6-Glass Tubes and Pipette used in the Centrifuge. 
at the upper opening with the forefinger, is 
introduced into the tube to a point near or 
quite to the bottom; the upper opening made 
free for an instant, closed again by the fore- 
finger, and the pipette withdrawn. Transfer 
a small quantity of the contents to a glass slide 
upon which a circle has been made with ce- THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
73 
ment, and allowed to dry; this is then covered 
with a clean glass cover, and the excess of fluid 
removed with white blotting paper. The speci- 
men is now ready for examination with the mi- 
croscope. In some instances, or when bacteria 
are sought for, the specimen will have had to' 
be stained, as will appear later. If the centri- 
fuge shall not have been used, the urine to be 
tested should be first placed in a conical glass, 
tapering to a point at the bottom, covered with 
a clean glass plate or watch glass, and set aside 
until the solid particles shall have subsided to 
the bottom. Then proceed to secure a portion 
of the sediment with the pipette, etc., as before 
described. 
Uric acid, if not already recognized macro- 
scopically, will appear in crystalline form. 
They are described as rhomboid or six- 
sided, or, other forms, as ovoid or whet- 
stone shape, and are of varying sizes. Occa- 
sionally they resemble in shape sections of bar- 
rels, envelopes, spears, a fan or a fine tooth 
comb with teeth on both sides. Again they 
appear dumb-bell in shape. They are colored, 
URIC ACID. 74 
URINARY DIAGNOSIS AND TREATMENT. 
varying from a pale yellow to a dark red or 
brown, are often aggregated or rosette in ap- 
pearance. 
The application of the murexid test to uric 
acid crystals will remove any doubt as to their 
character by the well known display of colors. 
The urates are mostly amorphous, and con- 
sist mainly of the acid sodium urates; are 
sometimes accompanied by small quantities of 
potassium, ammonium or calcium urates; are 
generally yellow or red, and are known as 
"brick dust deposits." (see figure.) Urine 
rendered cloudy by the presence of amorphous 
urates, becomes clear by addition of a drop of 
acetic acid, or by heating. Crystalline urates 
occur in urine which has undergone fermenta- 
tion, and in the form of prisms, or stellate 
bundles. When the fermentation has gone so 
far as to produce ammonia, the crystals will be 
highly colored and spherical in shape, but with- 
out spines. 
URATES. 
OXALATE OF LIME. 
(Calcium Oxalate.) 
Oxaiate of lime may occur in either acid or THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
75 
Fig. 7-A Model Microscope, 76 
URINARY DIAGNOSIS AND TREATMENT. 
alkaline urine, and generally accompanies crys- 
tals of uric acid. In neutral urine, with the 
crystals of the triple phosphates. They are 
plentiful after a meal of certain vegetables, 
particularly rhubarb plant or tomatoes. The 
crystals are octahedral or dumb-bell in shape; 
are insoluble in acetic acid or water. This test 
will distinguish them from the crystals of uric 
acid. 
Calcium oxalate crystals, when found in the 
urine, do not necessarily indicate disease, as 
they are often found in abundance in the urine 
of perfectly healthy persons. 
EARTHY PHOSPHATES. 
The earthy phosphates occur in slightly 
acid or alkaline urine, but more abundantly in 
urine which has undergone advanced alkaline 
fermentation. They appear as bulky, opaque, 
white deposits, often recognized as shiny specks 
when the test tube is rotated in the sunlight; 
are more abundant in irritative affections of 
the bladder, and occasionally accompany dis- 
ease of the spinal cord, resulting from a partial 
paralysis of the bladder and the consequent 
retention of the urine; are soluble in acids, and THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
77 
precipitated by alkalies and heat. These prop- 
erties will distinguish them from uric acid salts, 
which are dissolved by both alkalies and heat. 
Further, the murexid test will not respond to 
phosphates as does uric acid. 
TRIPLE PHOSPHATES. 
Triple phosphates, or ammonio-magnesium 
phosphate, are usually found in alkaline and 
even in neutral urine, usually in the form of 
six-sided prisms with bevelled edges (the so- 
called "coffin-lid" crystals), but also in many 
other forms (see illustration), as the stri- 
shaped groups of feathery crystals, etc. 
Leucin and tyrosin occur always together, 
and are found in urine loaded with biliary col- 
oring matter. The former yields yellow, high- 
ly refracting spheres of varying sizes, marked 
with radiating and concentric striations. Ty- 
rosin crystallizes in bundles of delicate hair like 
crystals arranged in brush-like groups. They 
attend only grave destructive diseases of the 
liver, especially yellow atrophy and phospho- 
rous poisoning. 
Leucin, unlike oil globules, for which it is 
LEUCIN AND TYROSIN. 78 
URINARY DIAGNOSIS AND TREATMENT. 
sometimes mistaken, is insoluble in ether, but 
soluble in caustic alkalies. 
CYSTIN. 
Cystin occurs rarely in urine, but when it 
does it appears as a light yellow deposit. It 
may be found in both acid and alkaline urine, 
and shows as hexagon plates placed one upon 
the other. Cystin develops in decomposing 
urine a strong odor of sulphuretted hydrogen; 
is soluble in ammonia and insoluble in boiling 
water or acetic acid. 
MUCUS AND PUS. 
Mucus and pus will be found as round 
granular cells, somewhat larger than blood cor- 
puscles. Mucus will appear as a delicate cloud, 
Pipette. 
descending towards the bottom of the contain- 
er. Upon the addition of acetic acid mucin will 
be formed, which is not coagulable by heat, is 
precipitated as delicate fibrillated bands, some- 
times having the appearance of threads and 
again tortuous in shape. If iodide of potassium THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
79 
is added to acetic acid and applied to the speci- 
men, the thread will become more distinct. 
Mucus contains no albumin, while pus does; 
therefore, so. long as albumin does not appear 
in urine, pus may be excluded. 
Pus in the urine may come from any part of 
the genito-urinary tract; a diseased prostate, 
gonorrhea, leucorrhea, or other discharges 
from the vagina. 
Some pus cells or leucocytes are often pres- 
ent in otherwise perfectly normal urine. If, 
however, any considerable number is to be 
seen, a suppurative condition of some part of 
the genito-urinary tract is certain. As some 
of the causative conditions we may enumerate: 
Pyonephrosis from any cause, cystitis, urethri- 
tis, prostatitis, vaginitis. The prime causative 
micro-organism may be almost any form of 
bacterial life, but we usually find either gon- 
ococci, tubercle bacilli, coli communis, typho- 
sus, strepto or staphylococci, though many 
bacteria are usually also present. 
Leucocytes are generally easily recognized 
by the microscope in acid and neutral urine, 
while in alkaline urine they appear more or 80 
URINARY DIAGNOSIS AND TREATMENT. 
less formless and swollen. The addition of a 
drop or two of a i per cent acetic acid solution 
is, in such cases, usually all that is necessary to 
clear them up sufficiently to make their nucleus 
visible. 
EPITHELIAL CELLS. 
Epithelial cells, when met with in urine, 
are of three varieties: the round epithelial 
cells, the columnar or conical epithelial cells, 
and the flat epithelial cells. 
The round epithelial cells come from the con- 
voluted tubes, the pelvis of the kidney, the 
bladder and the male urethra. They are 
rounded, granular bodies, somewhat larger 
than pus-corpuscles, and contain a single nu- 
cleus. 
Columnar epithelial cells come from the pel- 
vis of the kidney, the ureters and the urethra, 
are elongated, conical bodies, granular and 
have a nucleus in the center. 
Flat epithelial cells proceed from the bladder 
and the vagina, are large, irregular, scale-like 
bodies, and contain a single nucleus. 
BLOOD CORPUSCLES. 
Blood corpuscles come from the pelvis of 
the kidney, the bladder, the prostate, from the THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
81 
uterus or the vagina. When occurring in urine 
in large amounts, the urine will be red. If the 
urine should be acid, it will be a blackish brown 
or smoky color. If alkaline, it will be in 
appearance a bright red. Urine containing 
blood visible to the naked eye will be albumin- 
Fig. io-Graduated Measuring Glasses. 
ous. If blood corpuscles are in quantity suf- 
ficient to produce a deposit of a brownish red 
mass at the bottom of the container, they are 
almost certain to proceed from the kidney. If 
they come from the bladder or urethra they 82 
URINARY DIAGNOSIS AND TREATMENT. 
will appear as coagula. If they appear as 
moulds of clotted blood, nephritic colic is to 
be diagnosed. 
Blood corpuscles may be diagnosed by the 
reversal of light and shadow as the slide is 
made to approach or is withdrawn from the 
object glass. 
TUBE CASTS. 
Tube casts are cylinder moulds from the 
uriniferous tubules, and appear as 
a. epithelial casts, 
b. blood casts, 
c. hyaline casts, 
d. granular casts, 
e. fatty or oil casts, 
f. waxy casts. 
They are said to be produced by admission 
into the tubules of the coagulable portions of 
the blood, where they solidify; are detached 
by liquid, which is followed by contration of 
the tubules, discharged through the pelvis of 
the kidneys into' the bladder, and from thence 
voided with the urine. 
If the tubes are filled with detached epithe- 
lium which is later discharged, we will have THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
83 
epithelial casts. If the tubules contain blood, 
we will have blood casts. If the epithelium be 
attached to> the tube and is discharged alone 
and after the epithelial cast, we have the hya- 
line casts. If the cast contains granular sub- 
stances, it is known as the granular cast. If it 
contains quantities of oil drops, it is called a 
fatty or oil cast. 
A cast which is solid and has the appearance 
of wax is called a waxy cast. If the tubule is 
first filled with leucocytes and afterwards dis- 
charged, we have another variety not enumer- 
ated above, and known as the pus cast, but this 
variety is rarely met with. 
The comparative number and kind of 
CASTS FOUND, TOGETHER WITH THE AMOUNT 
OF UREA EXECRETED IN THE 24 HOURS, ARE 
THE BEST INDICATORS AS TO THE PATHOLOGI- 
CAL CHANGES THAT HAVE TAKEN PLACE IN 
the kidneys, and the importance of a thor- 
ough microscopical study of the urinary sedi- 
ments can, therefore, not be overestimated. 
A few words on the pathology of nephritis 
may not be out of the place, in order properly 
to elucidate this point. 84 
URINARY DIAGNOSIS AND TREATMENT. 
In acute cases of primary nephritis-acute 
parenchymatous nephritis-following a severe 
cold, especially during or after a debauch, 
when excessive ingestion of alcohol adds its 
specific irritating effect on the renal structures, 
there is marked dilatation of the renal vessels 
with corresponding exudation into the tubes. 
Some of the capillaries of the Malpighian tubes 
may rupture, whereby blood corpuscles and 
serum will escape forming the "blood casts," 
so characteristic of early and acute cases, be- 
sides the hyaline casts, which is the exudate. 
This condition,-no matter how acute,-is 
likely to subside under appropriate nursing and 
treatment without leaving the renal functions 
appreciably impaired. In the less acute cases, 
-known to the pathologists as subacute 
Bright's disease with large, white kidneys,- 
there is a proliferation or catarrhal condition of 
the tubal epithelium with, undoubtedly, the 
addition of leucocytes. The epithelial cells are 
swollen ("cloudy swelling") and fill some of 
the tubes more or less completely. As we al- 
ways in these conditions may expect more or 
less exudation, we are certain to find in the THE MICROSCOPE AND MICROSCOPICAL TECHNIQUE. 
85 
urinary sediment both epithelial and hyaline 
casts. 
The prognosis in such a condition must 
necessarily vary. The hyperemia and epithel- 
ial proliferation may almost totally subside 
without doing much damage to the excretory 
epithelium, or else the vitality of the epithe- 
lium is impaired to such a degree that we shall 
find fatty degeneration of some of the epi- 
thelial cells, which degeneration increases 
according to the damage wrought; and we 
find fatty, as well as granular casts in more or 
less abundance. According to the duration or 
frequency of recurrence of such attacks, more 
or less of the intertubular connective tissue also 
becomes involved in the inflammation. New 
connective tissue is formed, which is gradually 
replaced by scar tissue, which contracts and 
interferes with the circulation of the adjacent 
vessels. This interstitial nephritis causes more 
or less irregular contraction and atrophy of the 
organ (small, white kidney). As the inflam- 
mation is not of an acute character, a chemical 
examination of the urine of such an individual 
will show but a trace of albumin and but few 86 
URINARY DIAGNOSIS AND TREATMENT. 
casts. As, however, the renal excretory appa- 
ratus, which is the epithelium, is impaired, 
the amount of urea in such a urine is decreased 
and the renal permeability is also decreased. 
It is again but natural that we should find 
abundant albumin, as well as casts, in acute 
nephritis, with an intermediate amount of both 
in the subacute cases. It is unnecessary to add, 
that these inflammatory processes, be they of 
the parenchyma or the interstitial tissues, be 
they acute, subacute or chronic, will vary in 
different individuals and from different causes. 
As, however, a more extended review of the 
subject is beyond the scope of this work, the 
student is referred to1 the text-books on path- 
ology for further information on this impor- 
tant and interesting topic. 
SPERMATOZOIDS. 
Spermatozoids often occur in the sediment 
of urine of perfectly healthy men, and will be 
recognized by the oval head with a delicate 
tail or tadpole-like body. CHAPTER VI. 
BACTERIA. 
Cohn classifies the fungi found in the urine 
as: 
(a) Spherobacteria or micrococci. 
(b) Microbacteria or rod bacteria. 
(c) Desmobacteria or filamentous bacteria 
with a subdivision of the latter: 
I. A straight form, the bacillus. 
2. A curved form, the vibrio. 
TECHNIQUE IN STAINING AND EXAMINATION 
OF BACTERIA. 
Place upon a perfectly clean and dry cover- 
slip a very minute drop of the specimen to be 
examined. Spread this carefully over the slip 
with a platinum wire (sterilized by holding it 
over a gas, or alcohol flame for a moment, and 
then allowing to dry. Evaporate the mois- 
ture by holding the slip some distance over the 
flame. When thoroughly dry, pass the slip, 
now held by forceps (and with the side upon 
which the specimen is spread upward), quickly 88 
URINARY DIAGNOSIS AND TREATMENT. 
through the flame three times, allowing about 
one second for each fire bath. The object of 
this "fixing" process is to coagulate the gelat- 
inous coating of the bacteria, when they will 
adhere to the glass, and not be washed away 
by the subsequent proceedings. When the 
specimen is thus "fixed," and the glass cool, 
add a few drops of Loeffler's or Ziehl's solu- 
tion. After, say, thirty seconds, the slip is 
gently rinsed in water and then, without dry- 
ing, placed upon a clean glass-slide, bacteria 
down. The excess of fluid is removed by blot- 
ting paper, so that the upper side of slip is 
dry. Now put a small drop of cedar oil on 
upper side of slip, and examine with the oil- 
immersion lens, when the bacteria will be 
easily seen. 
If it is desired to mount the specimen for 
preserving, it is best to« allow the slip to dry 
after rinsing off superfluous stain, and then 
place a small drop of Canada balsam upon its 
bacterial side, after which it is inverted upon 
the glass-slide. 
There is a great variety of bacilli, as well 
as cocci, present in the urine of most cases of BACTERIA. 
89 
cystitis. To properly diagnose the special 
kinds, quite extensive bacteriological pro- 
cedures are necessary, which are beyond the 
skill and time of the average practitioner. 
Bacilli increase by transverse division, and 
often form long strings known as leptothrix. 
It is not constricted at the joints as are the 
moniliform threads sometimes formed by glob- 
ular bacteria. The first two' are isolated, and 
consist of jelly-like masses. 
Bacteria in urine cause a cloudy appearance 
which cannot be entirely removed by filtration, 
but may be by heat and by precipitating the 
phosphates with a few drops of caustic soda 
solution, when the bacteria are carried down 
with the precipitate. 
The examination of urine for bacteria in 
general has to be made with a i-inch oil im- 
mersion lens, as bacteria are too small to be 
well seen by a smaller magnifying power. The 
staining of specimens containing bacteria, for 
clinical purposes, can usually be very easily 
accomplished with but few accessories, and 
the simplest and best method for general diag- 
nostic purposes may be given in a few lines, 90 
URINARY DIAGNOSIS AND TREATMENT. 
with the understanding that reference to the 
text-books on Bacteriology is necessary for 
more extended information on the subject. 
GONOCOCCI 
are diplococci consisting of two hemispheres 
with their flat sides adjacent. They show os- 
cillatory and rotary movements, and are 
usually enclosed in pus and epithelial cells. 
Their presence confirm a diagnosis of gonor- 
rhea. 
is found in urine more readily since we have 
the assistance of the centrifuge. When sought 
for, a portion of the sediment, from the centri- 
fuge or other glass, should be placed on a clean 
slide at ordinary temperature, and fixed over 
the flame from a spirit lamp, stained with fus- 
cin, decolorized with an alcoholic solution of 
nitric acid (HN O3) and examined with im- 
mersion lens. 
THE BACILLUS TUBERCULOSIS 
STREPTOCOCCI 
are micrococci, growing in chains, giving the 
appearance of a string of beads. Their in- 
crease takes place by segmentation in one direc- 
tion only. Regarding the pathogenic qualities BACTERIA. 
91 
of the various streptococci, the reader is re- 
ferred to the text-books on Bacteriology. 
STAPHYLOCOCCI 
appear as individual cocci, alone, or in clusters, 
but not in chains. They segment by division 
into pairs or fours. 
This fungus is found in saccharine urine. 
They are small oval cells, and often arrange 
themselves in rows of two, three or more, as 
seen in illustration elsewhere. 
YEAST FUNGUS. 
PENICILLIUM GLAUCUM (BREAD MOULD). 
Occur in acid urine with or without al- 
bumin or sugar. They furnish cells similar 
to yeast fungi in the sporule-stage; later there 
is union of cells which form branches brush 
like, characteristic in appearance. CHAPTER VII. 
THE QUALITATIVE ANALYSIS OF 
URINARY CALCULI. 
The more common forms of urinary calculi 
are those of: 
a. Uric acid and its various compounds, 
b. The oxalate of lime, 
c. The mixed phosphates, 
d. Occasionally xanthin and cystin. 
The specimen to' be examined is to be first 
powdered and portions from the different 
layers preserved and analyzed separately, as 
the chemical composition differs often in differ- 
ent parts of the calculus. First heat a portion 
of the powder on platinum foil or in a platinum 
crucible, over a dull red heat for a considerable 
time, or until it becomes colorless. If there 
remains only a small amount of residue it will 
indicate that the stone is composed of uric acid 
or of ammonia urate. To the residue apply 
the murexid test. If a purple color develops, 
you will be certain that the specimen is com- QUALITATIVE ANALYSIS OF URINARY CALCULI. 
93 
posed of uric acid. A further test will be in the 
absence of an ammonia odor during the heat- 
ing. If a strong ammonia smell is developed 
you will conclude that the specimen is one of 
ammonium urate. 
If a yellow flame is produced during the 
application of a flame from the blow pipe you 
will have sodium urate. If a violet color, po- 
tassium urate. 
Dissolve a portion of the residue in dilute 
hydrochloric acid, add ammonia solution until 
alkaline, then add ammonium oxalate. If a 
white precipitate is formed you will have cal- 
cium urate. 
If there be no precipitate, add sulphuric 
acid ; neutralize with ammonium hydroxid. If 
then a white precipitate is formed by the addi- 
tion of disodic phosphate, you will have mag- 
nesium urate. 
If a portion of the calculus melts under the 
flame of the blow pipe, but does not produce a 
purple color, treat the residue with acetic acid; 
afterwards add solution ammonia to excess. A 
whitecrystalline precipitate indicates ammonio- 
inagnesiwm phosphate. If the residue is in- 94 
URINARY DIAGNOSIS AND TREATMENT. 
soluble in acetic acid dissolve in hydrochloric 
acid, and add to* the solution, ammonia. If a 
white precipitate appears, you will have cal- 
cium phosphate. 
If the specimen does not melt under the 
flame of the blow pipe, test with red litmus 
paper; and if alkaline treat with hydrochloric 
acid and afterward add excess of solution am- 
monia. A white precipitate will indicate 
calcium phosphate. If there is no fixed resi- 
due, mix a portion of the powder with lime 
and moisten with water. If there develop an 
odor of ammonia, and red litmus paper is 
turned blue, you have ammonium urate. If no 
ammonia is developed, uric acid. If no purple 
color is produced, treat with nitric acid. If it 
turn yellow as evaporated and remaining por- 
tion is not soluble in potassium carbonate, you 
have xanthin. If the nitric acid solution turns 
dark brown on evaporation you have cystin. 
THE DIAZO-REACTION'. 
The diazo-reaction in the urine of those 
suffering from typhoid fever is produced as 
follows: First a solution containing a satu- QUALITATIVE ANALYSIS OF URINARY CALCULI. 
95 
rated solution of sulphanilic acid in a solu- 
tion of hydrochloric acid (50 c.c. to 1,000 
c.c.); another solution, a half-per-cent so- 
lution of sodium nitrite. Take a few cubic 
centimeters of urine, place in a small test tube 
with an equal quantity of a mixture of the 
solution of the sulphanilic acid (40 c.c.) 
and sodium nitrite (1 c.c.), the whole being 
well shaken. One c.c. of ammonia is then 
allowed to flow carefully down the side of the 
tube, forming a colorless zone above the yellow 
urine, and at the junction of the two' a deep 
brownish red ring will be seen if the reaction 
be present. With normal urine a lighter 
brownish ring is produced without the shade of 
red. The color of the foam of the mixed urine 
and reagent, and the tint which it produces 
when largely diluted with water, are character- 
istic, being in both cases of a delicate rose-red 
if the diazo-reaction be present; if not, the 
color will be a brownish yellow. 
The toxicity of urine in typhoid fever is very 
much increased. It has been stated that many 
patients, convalescent, have a urine contain- 
ing large numbers of the typhoid bacillus, and 96 
URINARY DIAGNOSIS AND TREATMENT 
it is also declared that the bacillus may be 
found in the urine of. those recovering from 
typhoid for months after convalescence. The 
urine should always be thoroughly disinfected 
by corrosive sublimate or carbolic acid. 
RENAL PERMEABILITY. 
Renal permeability has lately been found one 
of the best aids in the diagnosis of interstitial 
nephritis, and a few words on the subject may 
be opportune. It has been found that if a 
patient with interstitial nephritis, after first 
urinating, be given about one grain of methy- 
lene blue, enclosed in a gelatine capsule, it will 
take from 3 to 12 hours before the urine shows 
any of the greenish discoloration. 
The patient must be instructed to attempt 
micturition half-hourly, besides closely watch- 
ing for and noting the time of change of color 
of the urine voided. The normal kidney ex- 
cretes the drug in from one-half to two hours, 
while all color disappears in from twenty-four 
to ninety hours. In renal coagestion, acute 
and subacute parenchymatous nephritis, the 
color appears even earlier than when the kid- QUALITATIVE ANALYSIS OF URINARY CALCULI. 
97 
neys are normal, and the time of elimination 
is shorter. As the time before any discolor- 
ation appears is lengthened in interstitial 
trouble, so, is also the time for total elimination 
prolonged and it may take several days and 
even weeks before the color entirely disappears. 
Though this test for renal permeability is still 
rather crude, and as yet not sufficiently studied, 
still it has its great usefulness and deserves its 
place in ordinary diagnosis. CHAPTER VIII. 
BRIGHT'S DISEASE, DIABETES, GOUT 
AND OTHER CONDITIONS. 
BRIGHT'S DISEASE. 
Bright's Disease is any disease of the kid- 
neys marked by the persistent presence of al- 
bumin in the urine, and attended by disintegra- 
tion and wasting of the organs. It occurs in 
two forms, acute and chronic. The acute form 
is accompanied by changes in the epithelial, 
vascular and intertubular tissues of varying 
intensity, and is often caused by exposure to 
cold or wet. It may follow overindulgence 
in intoxicants, or scarlet fever, measles, diph- 
theria, typhoid fever, meningitis and malaria. 
Certain chemicals and medicines, such as chlor- 
ate of potassa, carbolic acid, turpentine and 
cantharides, will produce a nephritis. Albu- 
minuria will sometimes accompany pregnancy. 
Acute nephritis is usually ushered in by 
chills, pain over the kidney, elevation of tem- 
perature, at first scanty urine which is highly 
colored from the presence of blood. There are bright's disease, diabetes, gout, etc. 
99 
large quantities of albumin, tube casts, and con- 
sequently high specific gravity. 
The color will vary in intensity from the 
normal to a dark brown, and will have often 
a smoky hue. The deposit will show when 
examined by the microscope, blood corpuscles, 
epithelium, hyaline, tube and blood casts. 
Uremia will sometimes follow an attack of 
diphtheria, scarlet fever and measles, where 
there has been subsequent albuminuria. 
Chronic Bright's Disease may follow an 
acute attack, a free indulgence in alcoholic 
stimulants and gastro-intestinal disturbances. 
There will be a diminished amount of urine, 
somewhat yellow in color and turbid from 
urates. Upon standing, it will deposit a heavy 
sediment, which the microscope will show 
contains tube, hyaline, epithelial and granular 
casts, with leucocytes, blood corpuscles and 
abundant albumin. Specific gravity will often 
reach 1.025. There will be puffy eyelids and 
a pallid skin, gastro-intestinal disturbances, etc. 
THE TREATMENT OF BRIGHT'S DISEASE 
varies according to the degree and circum- 
stances. In acute cases, where there may be 100 
URINARY DIAGNOSIS AND TREATMENT. 
almost anuria, or threatened convulsions, the 
first thing is to cause rapid, free and watery 
catharsis, with croton oil 2 or 3 minims, mixed 
with olive oil, given far back on the tongue; 
repeated doses of elaterin gr. 1-12, or repeated, 
concentrated solutions of magnesium sulphate. 
Diaphoresis should be established by hot 
baths, hot packs (by wrapping the patient in 
a blanket wrung out of hot water, over which 
several other blankets should be added), hot 
air baths, etc. Hot air baths can easily be im- 
provised by suspending a rubber-horse-blanket 
or oilcloth over the patient's body on barrel- 
hoops. Several blankets are placed over this 
most carefully, so that only the patient's head 
is uncovered. At the foot of the bed a common 
stove-pipe elbow is introduced, and the heat 
from a good lamp is allowed to enter through 
the pipe. If the patient is able to swallow, a 
hot lemonade will aid the diaphoresis, and at 
the same time act as a diuretic. 
Pilocarpine may have to be given hypoder- 
matically in the dose of 1-10 to 1-6 gr., but 
great care should be used in its employment. 
After good, thorough diaphoresis is estab- bright's disease, diabetes, gout, etc. 
101 
lished, the patient is wrapped with several dry 
and warmed blankets without underclothing. 
As diuretics, besides large quantities of 
water, alkaline mineral waters, lemonade and 
buttermilk, citrate of potassium in 15 to 30 
grain doses may be administered every few 
hours. 
Too much stress cannot be laid upon the fact 
that water, per se, is the best diuretic, and 
should be partaken of liberally. 
If the patient is unconscious and unable to 
swallow, normal salt-solution may be given by 
infusion into' the cellular tissue under aseptic 
precautions, or as an enema, high up in the 
colon, through a long, rectal tube. 
The diet in all forms of nephritis should 
consist mainly of milk, 2 to' 4 quarts daily. Af- 
ter the acute symptoms are relieved farinaceous 
foods, eggs, fish, oysters, fruits and broths may 
be added to the dietary, but meats should be 
avoided as far as possible, even in chronic cases. 
Coffee, tea and alcoholic beverages are to be 
prohibited. 
In chronic cases (and even at times in acute) 
the infusion of digitalis will be found beneficial. 102 
URINARY DIAGNOSIS AND TREATMENT. 
Iron, in the form of Basham's mixture, or 
otherwise, is indispensable in chronic nephritis, 
as are warm baths and prophylaxis against 
colds, by warm clothing, avoidance of draughts 
and sudden changes of temperature. 
Diuretin, in doses of 20 to 40 grs., and glo- 
noin, in 1-100-gr. doses, repeated every two 
or more hours, will sometimes be found very 
useful to' relieve the dropsy. 
DIABETES. 
Diabetes insipidus is always a chronic dis- 
ease and is characterized by the passage of 
large quantities of urine, which, excepting for 
a lowered specific gravity, is normal in charac- 
ter, while diabetes mellitus is a disorder of nu- 
trition in which the urine contains variable 
amounts of grape sugar. Diabetes insipidus 
may exist for years without serious impair- 
ment of health. It occurs mostly under 25 
years of age, and is thought to be a disease 
of nervous origin originating through a vaso- 
motor disturbance. The polyuria is best con- 
trolled by valerian, strychnin, arsenic, ergotin 
or antipyrin. bright's disease, diabetes, gout, etc. 
103 
DIABETES MELLITUS. 
Elsewhere will be found tests for the pres- 
ence of grape sugar in the urine (diabetes mel- 
litus), and as the etiology of the disease pro- 
ducing it is fully treated of in the text-books, 
and other works upon general practice, only a 
brief resume of the latest writings regarding 
the rationale of the treatment will be given. 
The aim has heretofore been to eliminate all 
the sugar-forming substances from the diet of 
diabetic patients, but recent study has demon- 
strated that a goodly number of these cases do 
better when allowed a moderate amount of 
these substances. It is clear that the question 
of the elimination of the carbohydrates in these 
cases is not the sine qua non of treatment; 
there are other elements to be considered than 
the non-production of sugar. The patients will 
have, as a rule, an accentuated appetite, and in 
some instances a craving for starches and 
sweets, due to the enormous elimination of su- 
gar and a consequent demand for water as 
well as for materials with which to manufac- 
ture sugar. The main object will be in the 
treatment of such cases to avoid the excessive 104 
URINARY DIAGNOSIS AND TREATMENT. 
consumption of food by which the digestive 
organs are overtaxed and functional distur- 
bances brought about. 
The diet should be a mixed one in which 
a diminished amount of carbohydrates is aimed 
at, but not such as to eliminate them entirely. 
Fermentation should be avoided and the bow- 
els kept free. 
Opium or preferably codeia and antipyrin 
will favorably influence the disease and dimin- 
ish the production of sugar. Benzosol has also 
been successfully used. Iron and arsenic will 
be found useful as tonics. 
Liberal quantities of pure water should be 
allowed because of its mechanical effects in 
flushing the kidney, and thus getting rid of the 
accumulated sugar. 
It has been claimed that micro-organisms 
play an important part in the etiology of dia- 
betes, and that a certain number of persons 
suffering from pruritis, eczema, furuncles and 
gangrenous lesions will be found to have the 
disease. 
When albumin is associated with the excre- 
tion of glucose the prognosis will be considered bright's disease, diabetes, gout. etc. 
105 
of grave import; it points to a sclerotic change. 
The prognosis is unfavorable also in one suffer- 
ing from diabetes in early life, as the disease 
will likely terminate fatally within a short time. 
In the loss of the reflex knee jerks there is 
associated with the glycosuria a neurotic ele- 
ment which is always of grave import. Cramps 
in the legs are unfavorable symptoms. 
When diabetes is associated with pregnancy 
great danger is to be apprehended for the fetus. 
Hepatic complications are also unfavorable. 
Some writers regard diabetes as contagious, 
basing this opinion on cases of conjugal dia- 
betes, as well as that persons having daily 
intercourse with these sufferers often contract 
the disease. 
GOUT. 
Some writers claim that gout results from 
an increased production of uric acid, while 
others believe it to follow a faulty elimination 
of uric acid or the urates. We are not, how- 
ever, called upon in a work of the scope of this 
one to discuss the views or theories of the 
etiology of gout, but rather to deal with such 
characteristics as will help in the diagnosis and 106 
URINARY DIAGNOSIS AND TREATMENT. 
treatment of such complaints as are classed as 
gouty, or due to a uric acid diathesis. Osler 
classifies gout as acute, chronic and irregular. 
In the acute form there are twinges of pain in 
the smaller joints of the hands and feet, acid 
urine, scanty and high colored, which deposits 
urates upon standing. Ganol asserts that there 
may be transient albuminuria and occasionally 
traces of glucose. 
Preceding an attack of gout there will be a 
diminished amount of urates or uric acid found 
in the urine. Occasionally there will be sore 
throat, or symptoms of asthma, swelling of 
the joints, fever, extreme sensitiveness, great 
pain, dyspepsia, and irregular heart action last- 
ing usually from five to eight days. After a 
time these attacks, if continued, will pass into 
the chronic form of the disease, other joints 
will become affected, deposits of urates will 
take place in the articulations and cartilages, 
thus, by degrees proceeding to the conditions 
so characteristic of chronic gout. 
The irregular form is generally termed the 
gouty diathesis, and is found usually in gener- 
ous livers. There are many irregular features bright's disease, diabetes, gout, etc. 
107 
or symptoms, such as skin eruptions, particu- 
larly eczema. There will be gastro-intestinal 
disturbances with constipation and inactive 
liver; disturbances of the circulation, progress- 
ing occasionally to sclerosis, neurasthenia, 
epilepsy, heart and kidney changes with al- 
buminuria and dropsy; finally nephritis and 
pericarditis may follow. 
Urinary disturbances are the rule. There is 
an increase of uric acid which deposits upon 
the urine cooling. Sometimes, as elsewhere 
stated, a glycosuria follows which may in rare 
instances proceed to true diabetes, oxaluria, 
vesical and renal calculi; albumin and tube 
casts in the urine; urethritis; pulmonary dis- 
orders, such as bronchitis and asthma; affec- 
tions of the eye, as, for instance, glaucoma, 
etc. 
Treatment for the several forms of gout 
will be largely dietetic and hygienic. Abstem- 
iousness must be insisted upon; saccharin, 
starchy or fatty foods should be restricted; 
bowels kept freely open-in fact, the treatment 
should begin with a free use of an alkaline 
or saline purgative. Patients with elevation 108 
URINARY DIAGNOSIS AND TREATMENT. 
of temperature should be compelled to remain 
quietly in bed in order to secure the greatest 
amount of rest in the inflamed joints. A diet 
of milk is desirable. 
It has been found that the lithium salts of 
uric acid are far more soluble than the combi- 
nation with other elements, and the lithium 
salts and waters are, therefore, extensively em- 
ployed in gouty affections. Lysidin and piper- 
azin form, also, freely soluble salts with uric 
acid, and have proven of great value in this 
and similar troubles. 
For local application to the inflamed joint 
or joints various remedies are employed, such 
as oil of wintergreen; 5 to io per cent alcoholic 
solution of menthol, guaiacol in ointment, or 
10 per cent solution in glycerine, etc. After 
local applications the parts should be covered 
with cotton and bandaged. 
Dry, hot air of a temperature from 250 to 
400 deg. F. has lately received favorable men- 
tion. 
Never bleed a gouty patient or apply cold to 
the inflamed parts, but cover with cotton and 
oil silk. The application of cold is most dan- bright's disease, diabetes, gout, etc. 
109 
gerous. Very hot air applied to the painful 
joints is recommended. 
Alcoholics should be sparingly indulged in; 
if used at all should be in the form of spirit- 
uous liquors, preferably whisky. Beer and wine 
should be at all times avoided. Vichy water 
taken with milk is useful and agreeable to the 
patient. When there is an absence of acute 
symptoms patients should be urged to take 
plenty of outdoor exercise. Light woolens 
should be worn, and frequent hot baths fol- 
lowed by friction should be indulged in. Luff 
and others declare that sodium salicylate is 
contraindicated in gout because of its tendency 
to favor an increased production of uric acid. 
In acute or chronic forms of gout, colchicum 
will be found the most useful remedy; its ac- 
tion being that of a chologogue, it prevents 
the glycocin from passing untransformed into 
the blood and so acts as a preventive to the 
formation of uric acid. Great caution should 
be exercised in giving colchicum to asthenic 
cases, because of its depressing action. Alka- 
lies other than the salts of sodium are useful by 
their influence upon metabolism and the im- 110 
URINARY DIAGNOSIS AND TREATMENT. 
provement of the general nutrition, as well as 
the gastric and hepatic functions. 
Sir Wm. Roberts, as well as Luff, declares, 
after repeated experimental studies, that the 
salts of sodium, reduce the solubility of the 
biurates. The last mentioned author declares 
that plain water dissolves i.i per 1000 of the 
sodium biurates. Water should, therefore, be 
freely partaken of by those having a gouty 
diathesis. Guaiacum is recommended by Gar- 
rod in those cases where gouty pains are re- 
lieved by warmth, its action being a stimulant 
to the liver metabolism. He claims that it 
acts also as a powerful prophylactic. 
CYSTITIS. 
Cystitis is a far more frequent disease than 
formerly supposed. By the invaluable aid of 
the microscope we are now, however, able to 
diagnose cystitis in its early stages, and while 
still curable. Have the patient urinate into 
two or three separate glasses or receptacles, if 
possible, or secure the urine by a recently ster- 
ilized catheter under aseptic precautions. If 
the last portion of urine obtained contains nu- BRIGHT'S DISEASE, DIABETES, GOUT, ETC. 
111 
merous bacteria, a positive diagnosis of cystitis 
can be made; even though the reaction of the 
urine is neutral or faintly acid. Naturally, the 
condition is of a more chronic character when 
the urine is alkaline, perhaps ammoniacal, 
lumpy or stringy. 
Serious complications, such as pyoneph- 
rosis, etc., may follow a recent and ap- 
parently mild cystitis, according to the 
virulence of the causative micro-organisms. 
With the exception of comparatively few trau- 
matic cases, cystitis is always infective, i. e., 
a bacterial disease. It accompanies many of 
the infective diseases, and is a usual compli- 
cation of lithiasis, gonorrhea, prostatic hyper- 
trophy, stricture, etc., and invariably follows, 
and is the frequent cause of death in spinal 
and other diseases, where retention and conse- 
quent catheterization causes trauma and in- 
fection from careless sterilization of catheters. 
Carelessness in catheterization may, in fact, 
be put down as one of the most frequent and 
least excusable causes of some of the worst 
cases of cystitis met with; and enough em- 112 
URINARY DIAGNOSIS AND TREATMENT. 
phasis cannot be expressed as a warning against 
such malpractice. 
In chronic cystitis the mucous glands are 
so overstimulated that the urine is more often 
stringy, especially as the urea, through bac- 
terial agencies, has become converted into 
ammonium carbonate, which last further irri- 
tates the bladder-walls. 
Following this, is hyperplasia and forma- 
tion of granulation tissue, which condition 
can be improved only by an open operation, 
curettage or similar treatment. In some cases 
the pathogenic conditions extend through the 
ureters into the pelvis of the kidney, if not into 
the renal tissues themselves, causing pyone- 
phrosis or perinephrosis. 
The symptoms of cystitis are: Great fre- 
quency of micturition, with the passage of only 
a small amount, or even but a few drops of 
urine, tenesmus and burning, pain over pubes 
or in perineum and rectum, radiating into the 
thighs and loins, or over the sacrum. There is 
more or less elevation of temperature, and 
sometimes even a chill. The urine contains a bright's disease, diabetes, gout, etc. 
113 
quantity of albumin, bacteria and pus, as well 
as blood. 
The treatment of acute cystitis must first be 
directed to an effort to remove the cause. If 
from irritating drugs, this is easily accom- 
plished, as also if from improper catheteriza- 
tion. In all acute cases the next step must be 
to reduce the irritation caused from acid, con- 
centrated urine, by administering excessive 
amount of water-plain, or as the alkaline 
mineral vichy water, a weak lemonade (which 
through digestion renders urine alkaline), or 
other demulcent drinks, such as milk. 
Urotropin, grs. 7 in hot water, 2 to 3 times a 
day, salol, sodium benzoate or boric acid, grs. 
5 every three hours, are, perhaps, the most suc- 
cessful remedies. If the pain is severe, 15 min- 
ims of the tincture of hyoscyamus may be 
given three times a day, or a suppository con- 
taining one grain of opium. Keep the bowels 
loose with a saline cathartic. A hot sitz-bath 
may often relieve the patient. When the acute 
symptoms have subsided, it may be advisable 
to wash out the bladder or treat a posterior 
urethrites with deep injections. 114 
URINARY DIAGNOSIS AND TREATMENT. 
In chronic cystitis similar procedures are 
used, but it is here usually necessary to draw 
off residual urine a couple of times a day or 
more with a soft rubber catheter under due 
antiseptic precautions, after which the bladder 
is irrigated with solutions of boric acid, bi- 
chloride (115000), permanganate (1 :iooo, or 
less). 
If a chronic cystitis is of very long duration 
and nothing else will help, perineal cystotomy 
with drainage, or superpuberic operation with 
or without curettage and perineal drainage 
may be necessary. 
Suppression (anuria) of urine may result 
from acute nephritis, stone in the kidney or 
from irritant poisons, such as turpentine, phos- 
phorus, lead, as well as from shock and hys- 
teria. Cupping, hot applications and the use 
of pilocarpin hypodermically are appropriate 
means of treatment, as are the hypodermic 
injections of strychnia, 1-60 gr.; digitalin, 
1-60 gr., or nitroglycerin, 1-50 to 1-100 gr. 
Hematuria (hemorrhage) may follow acute 
inflammatory condition of the kidneys, ulcer 
OTHER CONDITIONS. bright's disease, diabetes, gout, etc. 
115 
of, or stone in the bladder or kidneys, gonor- 
rhea and the taking of poisons such as carbolic 
acid, turpentine, cantharades, etc. The urine 
will be colored in intensity according to the 
amount of blood present. When the blood 
proceeds from the kidneys it will be thorough- 
ly mixed with the urine; if from the bladder 
or urethra it will be noticed at the end of mic- 
turition. Treatment should consist of rest, 
opium, gallic acid and cold applications to the 
loins. 
Pyruria (pus) in the urine indicates abscess 
in the kidney, pyelitis, cystitis, gonorrhea or 
leucorrhea. In abscess of the kidney the pus 
will be discharged at once following rupture 
of the abscess walls, and will have been pre- 
ceded by pain in the kidney with pyrexia. In 
pyelitis there will be lumbar pain, vesical irri- 
tation, and flexion of the thighs. In cystitis 
the urine will be alkaline, ropy and accompa- 
nied with mucus; pus and urine will be dis- 
charged with the last portion of urine, while 
in gonorrhea it will precede the discharge of 
urine. In leucorrhea the quantity of pus will 
be small, and accompanied with flat epithelium. 116 
URINARY DIAGNOSIS AND TREATMENT. 
Treatment for pyruria will be suggested by the 
conditions which cause it. 
Retention of the urine is produced by me- 
chanical obstructions, as paralysis, spasm, 
inflammation, etc. If from mechanical ob- 
structions, such as stone, enlarged prostate, 
stricture, etc., the treatment will consist of 
removal of the obstruction; if from paralysis 
or spasm by the use of the catheter, or, in the 
case of spasm of the neck of the bladder by 
anodynes. If urgent, chloroform may be nec- 
essary. Retention from inflammation will be 
best treated by the use of warm enemas, 
diluents, warm bath and mild laxative. 
Polyuric symptoms of certain nervous affec- 
tions are best treated by the administration of 
tinct. of valerian and fluid ext. ergot of each 
15 drops, three to five times a day. The polyu- 
ria of diabetes insipidus by an exclusive milk 
diet and syr. hypophos. co. U. S. P. in tea- 
spoonful doses alone or with codeia. 
Hyperacidity is corrected by 
a. Prophylactic; mixed diet, settled habits, 
plenty of sleep, large draughts of plain and 
carbonated water. bright's disease, diabetes, GOUT,' etc. 
117 
b. In diabetes by the exclusion of proteids 
and the ingestion of sufficient amounts of car- 
bohydrates. 
c. Medicinal; citrate of potassa, 5-30 grains 
in half an ounce of peppermint water three or 
four times a day. 
Renal congestion is due to an increased 
amount of blood to the kidneys, and is diag- 
nosed by pain along the course of the ureters 
into the genitals and bladder; urine is highly 
colored and scanty, with increased specific 
gravity, and may contain albumin, casts, as 
well as epithelium, also urates. If not relieved, 
dropsy of the lower extremities will follow. 
The treatment will aim to remove the irrita- 
tion; rest in the recumbent position, demul- 
cent drinks, hot poultices over lumbar region 
and tonics. 
Incontinence may result from numerous 
causes, and is best treated with ergot and tinct. 
chlorid iron, together with tonics. 
Acid and alkaline urine must be treated by 
remedies directed to the changing of the char- 
acter of the urine reaction. 
Irritable bladder will yield best to antispas- 118 
URINARY DIAGNOSIS AND TREATMENT. 
modics such as opium, hyoscyamus, or bella- 
donna. 
F ermentation of the urine will require a 
germicide such as salol, benzosol, naphthalin, 
etc. This will be appropriate treatment also 
for bacteria and fungi in the urine. 
Gonorrhea and Prostatis, as well as Vesical 
and Renal calculi, will require treatment as 
outlined in works on surgery. FAVORITE PRESCRIPTIONS. 
FOR UREMIA. 
R.-Ext. pilocarpi ale., 
Ext. scillae, 
Resin jalapae, 
Resin scammonii aa grs. 15 
M. Ft. pil. No. 20. Sig.: Four or five pills 
daily during as many days. 
FOR ALKALINE URINE. 
R.-Acidii boraci dr. 2| 
Ext. uva ursa, fl., 
Ext. hyoscyam, fl., 
Ext. lupulin fl aa dr. 4 
Syr. zingerberis oz. 2 
Aqua q. s. ad oz. 6 
M. Sig.: Two, teaspoonfuls in water after 
meals. 
R.-Salol, 
Tinct. hyoscyami aa dr. 2 
Infus. buchu q. s. ad oz. 6 
M. Sig.: Tablespoonful three times a day. 
-^othergill. 
FOR IRRITABLE BLADDER. 120 
URINARY DIAGNOSIS AND TREATMENT. 
FOR ACID URINE AND FREQUENT URINATION. 
R.-Lithii citratis oz. 2 
Tinct. opii camph oz. 1 
Infus. lupulini q. s. ad oz. 16 
M. Sig.: Tablespoonful in water after meals. 
DIURETIC FOR CHILDREN. 
R.-Potassii acetat, 
Potassii nitrat aa gr. 15 
Oxymel scillae 
Syr. sarsaparill. co aa dr. 2| 
Infus. juniper berries oz. |~3| 
M. Sig.: To be taken during the day. 
FOR CYSTITIS CHRONIC. 
R.-Ext. uva ursa dr. 6 
Tinct hyoscyami dr. | 
Tinct. opii camph oz. i| 
Liq. potassae dr. 2 
Tinct. lupulini dr. 3 
Syrup simp oz. | 
Aq. menth. pip. q. s. ad oz. 6 
M. Sig.: Dessertspoonful twice daily. 
FOR NOCTURNAL INCONTINENCE OF URINE. 
R.-Antipyrin gr. 8 
Sig.: Give such a powder at bedtime and 
continue until habit is corrected. FAVORITE PRESCRIPTIONS. 
121 
FOR GOUT. 
R.-Tinct. colchici sem gtt. 15 
Magnesia carb gr. 6 
Magnesia sulph dr. | 
Aq. menth. pip. q. s. ad oz. 1 
M. Sig.: Give in one draught and repeat 
according to conditions. 
R.-Ext. colchici acet, 
Ext. rhei, 
Ext. aloes soc aa gr. 12 
Ext. belladonna gr. 2 
M. Ft. pil. No. 10. Sig.: One pill at bed- 
time twice a week. 
another-garrod's gout pills. 
FOR THREATENED UREMIA. 
R.-Pilocarpin gr. |-i 
Acid hydrochlor, dil dr. 2 
Aqua dest oz. 2 
M. Sig.: Teaspoonful every three hours. 
R.-Potassii bitart 30.0 
Potassii sulph 15.0 
Scilli pulv 8.0 
Antimon et potassii tart 0.06 
FOR NEPHRITIS. 122 
URINARY DIAGNOSIS AND TREATMENT. 
M. Sig.: Teaspoonful in tumbler of water 
every four hours until active purgation and 
free diuresis is obtained. 
R.-Ext. buchu fl oz. 2 
Potassii cit dr. 3 
Spir. ether nit dr. 4 
Syrupi q. s. ad oz. 8 
M. Sig.: Dessertspoonful every four hours. 
R.-Ext. hyoscyami gr. 9 
Ext. cannab. ind gr. 9 
Sacch. alb gr. 75 
M. Ft. pulv. No. 12. Sig.: One three times 
day.-Ultzmann 
R.-Canada Balsam gr. 300 
Calc, magnesia gr. 30 
Soap, 
Benzoin, aa q. s. ft. pil. No. 100. 
M. Sig.: At first four times a day, after- 
wards five times a day. 
FOR ACUTE CYSTITIS. 
R.-Ext. hyoscyami gr. | 
Camph. mono gr. 2 
Morph, sulph :.... gr. | 
Ol. theobromat q. s. suppository No. 1. 
FOR PAIN IN CYSTITIS. FAVORITE PRESCRIPTIONS. 
123 
FOR CHRONIC OR IRREGULAR FORM OF GOUT. 
R.-Sodii bicarb gr. 45 
Acid benzoic gr. 40 
Sodii phosph gr. 80 
Aq. bullien oz. 
Solve et ad 
Aq. cinnamon oz. 3 
M. Sig.: Dessertspoonful three times a day. 
FOR RELIEF OF PAIN AND VESICAL SPASM. 
R.-Ext. opii gr. 6 
Ext. hyoscyami gr. 3 
Olei theobromat. q. s. ft. suppository No. 
6. Sig.: Introduce one into the rectum and 
repeat in two hours if required 
R.-Ichthyol gr. 5-12 
Ext. belladonna gr. | 
Cocoa butter q. s. for suppositories No. 1. 
Sig.: Two or three such suppositories daily. 
FOR PROSTATITIS. 
FOR IRRIGATION OF THE BLADDER. 
R.-Acidi borici dr. I 
Sodii borat dr. | 
Sodii chloridi gr. 15 
Aqua pint 2 
M. Warm to 100 deg. F. and use through 
double canula catheter. 124 
URINARY DIAGNOSIS AND TREATMENT. 
DIABETES INSIPIDUS. 
R.-Opii pulv gr. 4 
Acidi gallici oz. 2 
Mix into 12 powders and give one powder 
three or four times a day. 
Fothergill's diuretic pills. 
R.-Pulv. fol. digital., 
Pulv. scillae, 
Hydrarg. chlor, mit.. . .aa grs. 100. 
M. ft. pil. No. C, one to two pills a dose. 
basham's mixture. 
R.-Tinct. ferri. chloridi parts io 
Acidi acetic dil " 15 
Sol. ammon. acetat " 100 
Elix, aromat " 50 
Glycerini " 60 
Aqua ad " 500 
M. Dose 1 to 4 teaspoonfuls. FORMULAE OF SOLUTIONS. 
125 
FORMULAE OF SOLUTIONS. 
pavy's solution. 
Cupric sulphate gr. 320 
Neutral potassic tartrate gr. 640 
Caustic potash gr. 1,280 
Distilled water fluid ounces 20 
Note.-One dram is decolorized by one-third 
grain of glucose. 
fehling's solution. 
a. Copper sulphate gm. 34.65 
Distilled water to make cc. 500 
b. Potassium sodium tartrate, .gm. 173 
Potassium hydrate gm. 125 
Distilled water to make cc. 500 
For use mix equal parts of the two solutions 
when required. 
Note.-One cubic cent, of the combined so- 
lution is decolorized by 5 millograms of glu- 
cose. 
esbach's fluid. 
Picric acid ;.. .gm. 2.5 
Citric acid gm. 5.0 
Distilled water to make cc. 250 126 
URINARY DIAGNOSIS AND TREATMENT. 
HAINES' SOLUTION. 
Cupri sulphat, pure gr. 30 
Distilled water oz. 4 
Glycerin oz. £ 
Liq. potassa oz. 5 
DOREMUS' SOLUTION. 
Caustic soda (oz. 6) gm. 100 
Distilled water (oz. 16) c.c. 250 
Add when dissolved and cool 
Bromine c.c. 2.5 
MAGNESIUM FLUID. 
Magnesium sulphate, pure part 1 
Ammonium chloride, pure parts 2 
Distilled water parts 8 
Liquid ammonia, pure part 1 
loeffler's methylene blue solution. 
Concentrated alcoholic solution of 
Methylene blue c.c. 30 
Caustic potash solution 1-10,000. 
c.c. 100 
Mix. 
( for staining bacteria.) FORMULAE OF SOLUTIONS. 
127 
ziehl's carbol-fuchsin solution. 
Fuchsini gm. i.o 
Alcohol c.c. io. 
Distilled water c.c. 100. 
Acid carbolic cryst gm. 5.0 
Mix and make solution. 
(for staining bacteria.) 128 
URINARY DIAGNOSIS AND TREATMENT. 
REAGENTS REQUIRED. 
Nitric Acid c. p. 
Nitric Acid com. 
Hydrochloric Acid c. p. 
Sulphuric Acid c. p. 
Acetic Acid c. p. 
Solution Caustic Potassa 
(1 part to 2 parts dis- 
tilled water.) 
Solution Caustic Soda 
(1 part to 2 parts dis- 
tilled water.) 
Solution Sugar Lead 
(1 part to 4 parts dis- 
tilled water.) 
Solution Copper Sulphate 
(15 grs. to 1 oz. dis- 
tilled water.) 
Solution Magnesium Sul- 
phate. 
Solution Barium Chlorid. 
Pavy's Copper Solution. 
Fehling's Copper Solu- 
tion. 
Liquor Ammonia. 
Distilled Water. 
Alcohol, 95 per cent. 
Tinct. Guaiac. 
Turpentin (oxidized). 
Bismuth Subnitrate. 
The above reagents, with the exception of the last 
5, are offered by Messrs. Eimer & Amend, New York. 
Acids in 2-oz. glass-stoppered bottles, and the Solutions 
in 4-oz. rubber-stoppered bottles, for $3.50 net. TABLES AND APPARATUS. 
129 
APPARATUS. 
1 doz. Test Tubes. 
1 Test Tube Rack. 
J4 doz. Test Tubes on 
foot. 
% doz. Settling or Wine 
Glasses. 
1-3 doz. (Nest) Beaker 
Glasses. 
1 Graduate, 4 ozs. 
1-3 doz. Porcelain Cap- 
sules, asst, sizes. 
1-6 doz. Glass Funnels 
and Support. 
1-6 doz. Watch Glasses. 
1 Glass Stirring Rod. 
1 Pipette, 10 c. cm. 
1 Burette with Glass Stop- 
cock and Support. 
i Cylinder Graduated 500 
c. cm. 
1 Spirit Lamp. 
1 Water Bath. 
Filter Paper, White. 
Litmus Paper, Red 
and Blue. 
Platinum Foil. 
1 Urinometer, Squibb. 
1 Ureaometer, Doremus. 
1 Albuminometer, Es- 
bach. 
1 Saccharometer, Ein- 
horn. 
1 Centrifuge. 
1 Microscope with Slides, 
&c. 
The above apparatus, exclusive of Centrifuge and 
Microscope, are offered by Messrs. Eimer & Amend, 
New York City, for $12.80 net, the Centrifuge for 
$13.00. 
The Spencer microscope 4 F, consisting of a stand, 
as illustrated on page 75, with two eye-pieces, objectives 
2-inch, 2-3-inch, and 1-6-inch, with triple nose-piece, and 
one-half gross slides, ground edges, complete in case, 
for $56.35. 130 
URINARY DIAGNOSIS AND TREATMENT. 
METRIC WEIGHTS AND MEASURES. 
Weights. 
I milligram o.ooi grams 0.O15 grains Troy. 
1 centigram 0.01 " 0.154 " 
1 decigram 0.1 " T-543 " 
1 gram 15-432 " 
1 decagram 10. " 154.324 " 
1 hectogram 100. " 0.268 pounds " 
1 kilogram 1000. " 2.679 " 
Measures. 
1 millimeter 0.001 meter 0.0394 inch. 
1 centimeter 0.01 " 0.3937 " 
1 decimeter 0.1 " 3.9371 inches. 
1 meter 39-37o8 " 
1 decameter 10 " 32.8089 feet. 
1 hectometer 100 " 328.089 " 
1 kilometer 1000 " 0.6214 mile. 
1 yard or 36 inches 0.9144 meter. 
1 inch 25.4 millimeters. TABLES AND APPARATUS. 
131 
FOR CONVERTING MINIMS INTO CUBIC 
CENTIMETERS. 
Cubic 
Cubic 
Minims. Troy. 
Centi- 
Minims. 
Troy. 
Centi- 
meter. 
meter. 
480 1 oz. 
30.00 
40 
2.50 
360 6 dr. 
22.50 
30 
1.90 
300 5 dr. 
18.75 
20 
1-25 
240 4 dr. 
i5-oo 
IS 
1.00 
180 3 dr. 
11.25 
10 
.60 
160 
10.00 
8 
• 50 
120 2 dr. 
7-50 
7 
• 42 
100 
6.25 
6 
• 36 
90 
5-6o 
5 
• 30 
80 
5-oo 
4 
.24 
60 
3-12 
3 
.18 
50 
3-75 
2 
.12 
1 
.06 132 
URINARY DIAGNOSIS AND TREATMENT. 
FOR CONVERTING GRAINS INTO 
GRAMS. 
Grains. 
Troy. 
Grams. 
480 
1 oz. 
32.00 
420 
27.20 
360 
23.30 
300 
19.40 
240 
Vz oz. 
16.00 
180 
11.65 
120 
7.80 
60 
1 dr. 
4.00 
50 
3.20 
40 
2.60 
30 
Vz dr. 
i-95 
25 
1-57 
20 
1.30 
15 
1.00 
io 
0.65 
8 
0.52 
6 
0-39 
5 
0.32 
4 
0.26 
Grains. 
Troy. 
Grams. 
3 
0.20 
2 
0.13 
I 
0.065 
l/2 
0.032 
1/3 
0.02 
1/4 
0.016 
l/6 
O.OI 
1/8 
0.008 
1/10 
0.006 
l/l2 
0.005 
l/l6 
0.004 
l/2O 
0.003 
l/3O 
0.002 
l/4O 
0.0016 
l/6o 
O.OOII 
1/100 
0.0006 
1/120 
0.0005 
1/200 
0.00033 
1/400 
0.00016 TABLES AND APPARATUS. 
133 
COMPARATIVE THERMOMETER 
SCALES. 
Reau- 
Centi- 
Fahr- 
mur. 
grade. 
enheit. 
8o° 
100° 
2120 Water Boils. 
76 
95 
203 
72 
90 
194 
68 
85 
185 
62.1 
78.9 
174 
60 
75 
167 Alcohol Boils. 
56 
70 
158 
52 
65 
149 
48 
60 
140 
44 
55 
131 
42.2 
52.8 
127 
40 
50 
122 
36 
45 
113 
33-8 
42.2 
108 
32 
40 
104 
29-3 
36.7 
98 Blood Heat. 
28 
35 
95 
25.8 
32.2 
90 
24 
30 
86 
21.3 
26.7 
80 
20 
25 
77 
16 
20 
68 
12.4 
15-5 
60 Temperate. 
10.2 
12.8 
55 
8 
10 
50 
5.8 
7-2 
45 
4 
5 
4i 
1.3 
1-7 
35 134 
URINARY DIAGNOSIS AND TREATMENT. 
0 
O 
32 
Water Freezes. 
- o.g 
- 1.1 
30 
- 4 
- 5 
23 
- 5-3 
- 6.7 
20 
- 8 
-10 
14 
-9.8 
-12.2 
10 
-12 
-15 
5 
-14.2 
-17.8 
0 
Zero Fahr. 
-16 
-20 
- 4 
-20 
-25 
-13 
-24 
-30 
-22 
-28 
-35 
-31 
-32 
-40 
-40 INDEX. 
Acid urine, 117 
Albumin 49 
occurs in urine, 50 
qualitative test for 51 
Esbach's test, 53 
heat and acetic acid 
test, 51 
heat and nitric acid test, 
52 
Heller's test, 52 
nitric acid test, 52 
Pavy's test, 53 
quantitative test for, 53 
Albuminometer, Esbach, 
54 
Albumose, 56 
test for, 56 
Alkaline urine, 117 
Ammonium hydroxid test 
for sugar, 61 
Apparatus, 129 
Bacillus tuberculosis, 90 
Bacteria, 87 
bacillus tuberculosis, 90 
gonococci, 90 
staphylococci, 91 
streptococci, 90 
technique in staining, 
87 
Biliary pigment, 66 
test for, 66 
Blood pigment, 66 
test for, 66 
corpuscles, 80 
Bread mould, 91 
Bottger's test for sugar, 
60 
Bright's Disease, 84-97 
treatment of, 99 
Carbonates, 47 
quantitative test for, 48 
Centrifuge, 70 
illustration of, 71 
glass tubes and pipette 
for use in, 72 
Chlorides, 42 
decrease of, 42 
increase of, 42 
quantitative test for, 42 
Chyle, 57 
test for, 58 
Comparative thermome- 
ter scales, 133 
Copper test for sugar, 65 
Creatinin, 68 
Cystin, 78 
Cystitis, no 
symptoms of, 112 
treatment of, 113 
Diabetes, 102 
insipidus, 102 
treatment of, 104 II 
INDEX 
mellitus, 103 
treatment of, 104 
Diazo reaction, 94 
Doremus solution, 126 
Einhorn's test for sugar, 
63 
Epithelial cells, 80 
columnar, 80 
flat, 80 
round, 80 
Esbach's fluid, 125 
test for albumin, 53 
Favorite prescriptions, 
119 
Fehling's solution, 125 
Fermentation of urine, 
118 
test for sugar, 63 
Fibrin, 57 
Formula of solutions, 125 
Globulin, 54 
test for, 54 
Glucose, 59 
ammonium hydroxid 
test for, 61 
bismuth test for, 60 
Bottger's test for, 60 
fermentation test for, 
63 
Haines' test for, 61 
quantitative copper test 
for, 65 
quantitative test for, 62. 
Glycosuria permanent, 60 
simple, test for, 62 
quantitative test for, 64 
physiological, 59 
temporary, 60 
Gonococci, 90 
Gonorrhea, 118 
Gout, 105 
treatment of, 106 
Guaiac test for blood pig- 
ment, 66 
Hammersten's test for 
globulin, 54 
Haines' solution, 126 
test for sugar, 61 
Hematuria, 114 
Hippuric acid, 68 
Hyperacidity of urine, 116 
Incontinence of urine, 
117 
Indican, 67 
test for, 67 
Irritable bladder, 117 
Lactosuria, 60 
Leucin, 77 
Leucocytes, 79 
Loeffler's methelene blue 
solution, 126 
Magnesium fluid, 126 
Measuring glasses, 81 
Metric weights and meas- 
ures, 130 
Microscope and micro- 
scopical technique, 69 
illustration of 75 
Mucin, 55 
test for, 55 INDEX. 
III 
Mucus, 78 
Murexid test for uric acid, 
42 
Nephritis, 83 
Oxalic acid, 68 
Oxalate of lime, 74 
crystals of 74 
Pavy's solution, 125 
Peptones, 55 
test for, 56 
Phosphates, 43 
alkaline, 44 
test for, 45 
decrease of, 45 
earthy, 44-76 
test for, 45 
increase of, 44 
sediments of, 77 
test for, 44 
triple, 44-75 
sediments of, 77 
test for, 45 
Pigment changes, 66 
Pipette, 78 
Polyruria, 116 
Propeptone, 56 
test for, 56 
Prostatitis, 118 
Pus, 78 
cells, 79 
Pyruria, 115 
Reagents, 128 
Renal congestion, 117 
permeability, 96 
methylene blue in, 96 
Retention of urine, 116 
Saccharometer, Ein- 
horn's, 63 
Sediment in urine, 25 
organized, 26 
not organized, 25 
Solids in urine, deter- 
mination of, 26 
Specific gravity test for 
sugar, 65 
Spermatozoids, 86 
Staphylococci, 91 
Streptococci, 90 
Sulphates, 46 
decrease of, 47 
increase of, 47 
qualitative test for, 47 
Suppression of urine, 114 
Tables for converting 
grains into grams, 132 
minims into cubic cen- 
timeters, 131 
Tube casts, 82. 
epithelial, 82 
blood, 82 
hyalin, 82 
granular, 82 
fatty or oil, 82 
waxy, 82 
Tyrosin, 77 
Urates, 74 
crystals of, 74 
Urea, 38 
Doremus test for, 39 
decreased elimination 
of, 39 IV 
INDEX. 
estimation of quantity, 
39 
increased elimination 
of, 39 
normally excreted, 38 
Ureameter, 30 
Uric acid, 41-73 
crystals of, 73 
diminished amount of, 
41 
increased amount of, 41 
qualitative test for, 42 
Urinary calculi analysis 
of, 92 
Urine, abnormal constitu- 
ents of, 49 
acidity of, 35 
alkalinity of, 36 
bacteria in, 89 
Urine, color of, 33 
composition of, 24 
decrease in quantity of, 
28 
excreted, 25 
quantity of, 27 
fermentation of, 118 
hyperacidity of, 116 
incontinence of, 117 
increase in quantity of, 
27 
normal constituents of, 
38 
odor of, 34 
pus in, 116 
reaction of, 34 
retention of, 116 
specific gravity of, 29 
suppression of, 28-114 
transparency of, 31 
toxicity of in typhoid 
fever, 95 
Urinometer, 30 
Xanthin, 68 
Yeast fungus, 91 
Ziehl's carbo-fuchsin so- 
lution, 127 i. Epithelium from the straight tubes of the kidney. 
The cylindrical cells come from the part nearest 
the papilla, the others from the higher tubules 
(medullary rays). After long standing these be- 
come spherical. -2. Epithelium from the kid- 
ney, pelvis, and ureters.-3. Epithelium of the 
bladder.-4. Epithelium of the prostate.-5. 
Epithelium of Cowper's glands. 
Plates. I. to XVI. inclusive are after Hoffman & Ultzmann. 
PLATE I. PLATE II. 
I. Epithelium of the male urethra.-2. Epithelium of 
the female urethra.-3. Epithelium of Littre's 
glands. Plate I., 4 and 5, and Plate IL, 1 and 2, 
all represent the so-called cylindrical epithelium. 
-4. Vaginal epithelium. PLATE III. 
Primary forms of uric-acid crystals, the so-called whet- 
stone crystals. These are always colored as a 
native precipitate, but are rendered colorless by 
solution and reprecipitation. Uric acid: the sediment as found in native urine; 
rosettes, and lamellated crystals; also the sharp 
crystals as found in pyelitis calculosa. 
PLATE IV. PLATE V. 
I. Nitrate of urea, as seen when a drop of HNO3 is 
allowed to flow under the cover-glass. Rhombic 
and hexagonal plates.-2. Oxalate of calcium, 
as the native sediment of an acid urine. Tetra- 
gonal octahedrons and the so-called hour-glass 
forms. PLATE VI. 
Triple phosphate (NH4)MgPO<+6H2O. The common 
coffin-lid crystals at the bottom of the figure, 
and above the fern-leaved crystals of the same, 
as seen when quickly precipitated by addition of 
ammonia. The crystals in the upper righthand 
corner are crystals of phosphate of calcium, of 
the formula PChHCaH^ELO, from a weakly acid 
urine, with a tendency to become alkaline. The 
triple phosphate is found in alkaline urine. PLATE VIL 
Leucine and tyrosine: sediment from acute yellow 
atrophy of the liver; sheaves of tyrosine needles, 
and the drop-like forms of leucine, with small 
double spheres of ammonium urate. PLATE VIII. 
The sediment of alkaline fermentation: the coffin-lid 
triple phosphates; the brown double spheres of 
ammonium urate, and the amorphous tribasic 
calcium phosphates mixed with bacteria. i. Haemin, or chloride of haematin, obtained by add- 
ing a grain of salt to the residue of a drop of 
urine evaporated on an object-glass, and then 
allowing a drop of acetic acid to flow under the 
cover.-2. Blood-corpuscles of various forms, 
and a blood-cylinder. 
PLATE IX. PLATE X. 
Urate of sodium, the amorphous precipitate (sedi- 
mentum lateritium); also, the crystals of calcium 
oxalate and uric acid, together with fermentation 
fungi, which make up the sediment of a febrile 
urine. PLATE XI. 
i. Cystine: the powder of a cystine stone dissolved 
in ammonia, and evaporated on an object-glass; 
hexagonal plates, colorless.-2. Gonorrhoeal 
thread, the catarrhal secretion from the acces- 
sory glands of the urethra.-3. Spermatozoa. I. Calcium carbonate, seldom found.-2. Sediment 
of an alkaline urine, spheres, dumb-bells, and 
granular precipitate, found usually in connection 
with the earthy phosphates. 
PLATE XII. PLATE XIII. 
I. The massive fibrin cylinder.-2. The granular 
cylinders.-3. The hyaline cylinder.-4. The 
waxy cylinders.-5. Epithelial casts and cylin- 
ders.-6. The uric-acid cylinders. PLATE XIV. 
I. The ordinary pus-corpuscles.-2. Those with 
prolongations showing amoeboid movements.-3. 
Corpuscles with their nuclei rendered distinct by 
adding acetic acid.-4. Corpuscles as altered by 
chronic pyelitis.-5. Corpuscles swollen by the 
action of carbonate of ammonium. PLATE XV. 
i. Yeast fungi.-2. Penicillum glaucum.-3. Sar- 
cina.-4. Cyst of the echinococcus, with de- 
tached hooks. I. Cancer elements, as seen in the sediment of medul- 
lary epithelial cancer of the bladder.-2. A frag- 
ment of cancerous villous tissue of seldom oc- 
currence.-3. Epithelial cells stripped from sur- 
face of villous cancer. 
PLATE XVI.