56 THE AMERICAN MONTHLY [Feb 



Washed-Out Red Blood Corpuscles in the Urine as an Aid 

 in the Diagnosis of Renal Calculus. 



By G. D. HEAD, M. D. 



Blood occurs in the urine in a large variety of patholo- 

 gical conditions. Its appearance depends upon the source 

 in the urinary tract from which the hemorrhage origin- 

 ates. If the blood appears in clots the hemorrhage is 

 usually from the lower urinary tract, the bladder or ure- 

 thra being involved. If the blood appear unclotted in 

 the urine and if the hemorrhage originates in the kidney 

 or the pelvis of the kidney, the urine will present a dark 

 smoky appearance. 



But blood may occur in urine and give to the naked eye 

 no evidence of its presence. Such a condition is not in- 

 frequent in the hemorrhage produced by a stone in the 

 pelvis of the kidney, or the ureter, and failure to examine 

 the urine microscopically will rob the clinician of a valu- 

 able aid in diagnosis. Microscopically studied, blood ex- 

 hibits itself in the urine : 



(a) As the normal red blood corpuscle. 



(b) As the crenated red blood corpuscle. 



(c) As the washed-out red blood corpuscle, or the so- 

 called "Shadow corpuscle." 



Particular interest centers about this third form of the 

 washed out red blood corpuscle because it is present in 

 freshly excreted urine only when the hemorrhage is 

 high up in the urinary tract. 



A washed out red blood corpuscle is one whose hasmo- 

 globin has been nearly or quite dissolved out. It ap- 

 pears under the microscope as a pale yellow, or colorless 

 ring with a very delicate but distinct border. It is some- 

 what smaller than a normal red blood corpuscle, and fre- 

 quently exhibits little irregularities in its contour. Some- 

 times so completely has the coloring matter been removed 

 that only the faintest shadow of the cell remains, and the 



