1889.] MICROSCOPICAL JOURNAL. 269 



On the Microscopical Examination of Urinary Sediment.* 



By WILLIAM BUCKINGHAM CANFIELD, M. D. 



LECTURER ON NORMAL HISTOLOGY, UNIVERSITY OF MARYLAJD. 



Physicians now generally recognize the fact that an examination of 

 the urine forms an important part in making the diagnosis of any dis- 

 ease. In many cases negative results may satisfy, as excluding certain 

 diseases. It is a matter of common occurrence that one physician not 

 being successful in the treatment of a case, a consultant or another 

 physician is tried, who, carefully examining the urine, a thing which 

 the first adviser had failed to do, finds enough to throw considerable 

 light on the malady and its treatment. In urinary analysis, an exam- 

 ination both chemical and microscopical should be made in all doubtful 

 cases. The former is a matter not difficult for the majority of physi- 

 cians, and there are few physicians who cannot make the ordinary tests 

 for albumen, sugar, etc. The microscopical examination, however, is 

 a matter not so simple. There are plenty of practitioners who cannot 

 make a microscopical examination of the urinary sediment in a manner 

 satisfactory to themselves. This part of the subject, although old and 

 often discussed, may be repeated with advantage, even at the risk of 

 uttering remarks well known and trite to many. 



First, as to the technique. The patient or attendant should be im- 

 pressed every time with the importance of saving clean specimens of 

 urine. The bottles and vessels in which the urine is collected and pre- 

 served should be scrupulously cleansed and dried. The urine obtained 

 should be passed in the morning on rising and in the afternoon, so that 

 two different samples may be examined. This is necessary, among 

 other reasons, because the urine may be free from albumen in the morn- 

 ing and loaded in the afternoon. These specimens should be examined 

 as soon as possible after receiving them, and in case of keeping them, 

 they should be preserved in a cool place, and some such substance as 

 salicylic acid maybe added, which will not affect the examination. 



Difficulties present themselves when the urine contains very much 

 or very little sediment. When very little, it is the general custom to 

 let it stand for twenty-four hours in a cool place in a conical glass, so 

 that the sediment may drop to the bottom of the vessel. Casts when 

 not abundant may remain suspended for a longer time in the urine, 

 and owing to their lightness they may stick to the sloping sides of 

 the glass and thus escape detection. Sometimes better results may be 

 obtained by letting the urine stand in a cylindrical glass for twenty-four 

 hours and then drawing up the bottom layer of fluid with a pipette and 

 examining it. I have turned the bottle upside down for one day and 

 then examined the sediment which had collected on the cork, but this 

 is not usually satisfactory. For the microscope it is well to have a 

 thick slide with a concavity ground in it. 



When there is much sediment it is not easy to separate the import- 

 ant from the unimportant matters. In this case it is better to let the 

 urine stand in a cool place in a conical glass for six or twelve hours, 

 and then pipette off the supernatant fluid and let that stand in a second 

 glass. Casts will be found in the second glass, and in the first, pus, 

 blood, epithelium, and inorganic matter. 



* Report of Section on Microscopy, Micro-Chemistry, and Spectral Analysis. 



