A TREATISE

ON THE

PATHOLOGY OF THE URINE,

ETC.

CHAPTER I.

GENERAL CHARACTERS OF URINE.

PHYSICAL CHARACTERS OF URINE.

THE urine which has just been voided by a healthy individual is a clear fluid, of yellow colour, of the temperature of the body, of an odour which is peculiar to it, and is therefore termed urinous; it has a saline taste, with an admixture of some bitterness, and reddens blue litmus paper. A short time after the fluid has come to rest in the vessel into which it has been passed, a small, light cloud, of a grayish-white colour, may be observed settling towards the bottom of the vessel. This cloud consists of the mucus and epithelium of the urinary passages.

Clearness and Turbidity of Urine.

Turbidity of urine depends upon the admixture of solid and insoluble substances. The flocculent, small cloud of healthy mucus may be distinguished from other matters by its being easily diffused by agitation, and by its insolubility in nitric acid. So great a turbidity or thickness of the whole mass of urine, however, as after an interval of repose to cause the subsidence of a deposit to the bottom of the vessel or on the side, must be considered as abnormal, and therefore attracts attention. We then proceed to investigate its nature, which, taken together with the other properties of the urine containing the sediment, will often afford great

assistance in the inquiry into the seat and cause of the disorder, of which the turbid condition is a symptom.

In considering a specimen of urine with regard to its turbidity, great care must be taken in ascertaining whether it was passed in a turbid state, or whether the turbidity and sediment supervened after its emission, or after a lengthened period of rest. The prognosis of many cases is determined by this circumstance, an accurate knowledge of which, not always easily to be acquired, is therefore of practical impor

tance.

We must guard against considering simple clearness of the urine as a sign that there is nothing wrong in that fluid. Many abnormal substances, the products of disease, are found in clear urine, and many pathological alterations in the quantities of the normal ingredients occur in a limpid fluid.

At the end of this volume are given some tables for discovering the nature of urinary deposits by chemical reagents and the microscope. The appearance in the form of sediments of the separate bodies, normal and abnormal, their reactions and their general behaviour, are given under each body.

Tints of Urine.·

The normal amber-yellow colour of urine is due to a certain amount of colouring matters, which enter into the composition of that fluid. Though great progress has of late been made in the analysis of these bodies, and many valuable facts have been ascertained with relation to them, yet their nature is not so well defined as is desirable. For observation at the bedside gives ample proof that the colour of urine is frequently an exponent of the nature and amount of functional disturbance, and indicates to the physician the direction in which his further examination should proceed.

Starting from the fact that the normal colouring ingredients of urine are capable of generating a series of tints, varying, according to the degree of dilution, from a nearly colourless water-like, through the common pale amber, with an admixture of red, to red, reddish-brown, and up to deep brown; and, assuming as the standard scale of colours the table of Vogel, which is affixed to this volume, we have at once gained a basis which will secure uniformity of observation and description on this subject. Supposing, then, the different tints enumerated to be due to different degrees of dilution of the normal colouring matter, whether in

the urine of a patient or in that of a healthy person, then the colour is designated as of a normal character, its degree only being ranged amongst the pathological facts. These degrees of colour, as applied to the determination of the amount of colouring matter present, will be treated of in the chapter on Uræmatine. Here it may suffice to indicate the general practical conclusions which may be drawn from the different colours as regards the other characters of the urine, and the condition of the organism by which it has been voided.

Pale urine varies from nearly colourless, through a faint greenish tint, up to straw-yellow. It is the urine of early infancy, and is common in adults after the ingestion of large quantities of water or watery fluids. It is mostly neutral, less frequently alkaline, rarely acid. It is common in chlorosis and other anæmic conditions, and then contains a small amount of urea, and of solids generally. In diabetes, however, the pale colour does not admit of any conclusion as to the amount of solids generally. Practically the general rule holds good, that as long as a patient secretes this description of urine, he is not affected by any severe illness of a febrile and acute nature. (Vogel.)

Amber-coloured urine is the common urine of health. Its occurrence excludes all diseases of which either the pale or the very highly coloured urine is a usual symptom.

Highly coloured urine ranges from a reddish-yellow colour to red, and is of a decidedly acid reaction, and high specific gravity, indicating the presence of a large amount of solids, particularly urea. Concentration being the principal and uniform feature of this sort of urine, it is well to bear in mind that it may be produced in four different ways. 1. Either the person voiding such urine has taken very little liquid, and in that case the whole amount of concentrated urine will be very small. 2. Or the water of the blood has been evaporated by the skin in the form of perspiration. 3. The third way in which a concentrated highly coloured urine may be produced in healthy individuals, is by the ingestion into the blood of a large amount or an excess of nutritive nitrogenous matter. It is therefore of frequent occurrence with those who partake of sumptuous dinners, and who, like old Father Noah, "have a dislike to water, because all sinful men and beasts were drowned in it." 4. The fourth mode of formation of this description of urine is the more rapid disintegration of tissue and waste of matter in febrile diseases. Here the indication is the more valuable, as other symptoms, such as the temperature of the body or the state of the pulse, cannot always