URINE. 



1293 



RHEUMATISM. 



In this disease the urine shows the usual 

 appearances of the inflammatory type, accord- 

 ing to Becquerc'l. Oxalate of lime not un- 

 frequently exists as a deposit. 



PHTHISIS. 



In this disease the principal feature ob- 

 served in the urine is the increase in the 

 quantity of uric acid. One analysis gave as 

 much as 2'40 of this acid in 1000 parts of 

 urine. 



STRUMA. 



In struma, generally speaking, the urine is 

 deficient in urea and uric acid. The phos- 

 phates are often excreted in excess, and there 

 is a tendency to the deposit of oxalate of lime. 

 In mollities ossium and rachitis the earthy 

 phosphates are excreted in very large quantity, 

 the alkaline salts are increased, and the urea 

 and uric acid diminished in proportion. The 

 analyses which showed the above results 

 were made on the urine of children, which 

 always contains less urea and salts than that 

 of adults. 



The following is an analysis, by Marchand, 

 of the urine of a child suffering from mollities 

 ossium. It was acid. 



Water 938-2 



Urea 27-3 



Uric acid - 0-9 



Lactic acid and lactates - - 14'2 



Phosphates of lime and magnesia 5'7 



Other constituents (loss) - - 13'7 



DIABETES MELLITUS. 



The urine in this disease contains a sugar 

 which may be regarded as identical with sugar 

 of grapes. It is generally of very high specific 

 gravity, varying from the highest specific gravity 

 observed in health to 1055 or even 1060. 



Schonlein has an opinion that in the first 

 stages of diabetes there is albumen in the 

 urine, and that this becomes replaced by sugar. 

 This opinion I scarcely can believe correct. 

 The fact, indeed, could not well have escaped 

 my notice, my attention having been parti- 

 cularly directed to the study of albuminaria 

 for some years past. The experiments of 

 Kant have shown that urea is generally ex- 

 creted in diabetes mellitus to the same amount 

 as in health in the twenty-four hours. During 

 the progress of the disease I have several 

 times observed the whole of the sugar sud- 

 denly disappear from the urine, and its place 

 supplied by an enormous excretion of urea. 

 I at first was inclined to regard this as a 

 favourable indication, but experience has not 

 confirmed that belief. Uric acid is |not un- 

 commonly present in considerable quantity, 

 and this I believe to be a favourable indication 

 in diabetes. Simon has shown that the ab- 

 solute quantity of urea excreted in twenty- 

 four hours is occasionally diminished; but the 

 general rule is that the quantity approaches 

 that of health. Caseous matter is sometimes 

 found in diabetic urine, and, when present, it 

 excites rapid fermentation immediately after 

 the urine is voided. 



Bonchardat has described a form of sugar 

 which occasionally exists in diabetes, which is 

 insipid, but which corresponds in every other 

 respect with the sweet sugar. Simon says he 

 once met with it. 



Lchmann, Ambrosiani, Miiller, and Simon 

 have observed the presence of hippuric acid 

 in diabetic urine. 



DIABETES INSIPIDUS. 



In this disease the urine contains an excess 

 of water, and varies in specific gravity from 

 1001 to 1006. The urea, if regarded in pro- 

 portion to the other solid matters excreted, 

 is excessive in quantity, but the proportion 

 discharged during the twenty-four hours is 

 generally far below that of health. 



This excessive discharge of urea, as com- 

 pared with the other solids, may be accom- 

 panied by a less discharge of water than that 

 which is generally found to accompany it. 

 Then the urine attains a specific gravity ap- 

 proaching that of health, and sometimes even 

 exceeding it. Chemically, these two con- 

 ditions so nearly approach, as scarcely to need 

 division. Pathologically considered, however, 

 the latter is the more serious form of disease, 

 and is believed by some to be not an un fre- 

 quent forerunner of diabetes mellitus. 



DIABETES CHYLOSUS. 



This disease is characterised by the dis- 

 charge of chyle in the urine. It is quite milky 

 in appearance. A specimen I examined some 

 few years ago yielded the following results : 



Specific gravity 1021. 



Acid in slight degree only. 



Milkiness, not changed from subsidence by 

 standing. 



Agitated with ether the urine was cleared, 

 and the ethereal solution, which then floated 

 above, contained a fat, yielding an alkaline ash 

 on incineration. This fat was not saponifiahle 

 by boiling with a solution of potassa. The 

 urine cleared from the fat coagulated by boil- 

 ing, and also on the addition of nitric acid. 



JAUNDICE. 



The elements of bile exist in the urine in 

 cases of jaundice. Simon has published the 

 following result, obtained from the urine of a 

 female, aged twenty, suffering from inflamma- 

 tory icterus. 



The urine was brownish red, and of specific 

 gravity 1020, and very acid. 



Water - - 951^50 



Urea - 12'3-t 



Uric acid, with biliphasin - 2'90 



Alcoholic extractive - 4>'35 



Spirituous ditto - - 5'29 

 Aqueous ditto, with mucus"! 



and bile pigment J 



Biliary resin - 1'45 



Biliverdin - - - - ]'08 



Earthy phosphates - - 3'14> 



Chloride of sodium and lactate ~[ . _ . 



of soda - J 



Alkaline phosphates and sul-1 



phates, with traces of chlo- > 3-90 



ride of sodium 



5'1-i 



