270 THE AMERICAN MONTHLY [December, 



There is a great difference between the urine of the male and female 

 as regards sediment. Urine from the female generally contains large 

 flakes of epithelium from the vagina, blood corpuscles, etc. This ex- 

 cess of sediment may be excluded by having the urine drawn off with 

 a clean catheter, or by directing the patient to syringe out the vagina 

 and genitals with warm water before urinating. 



Red blood corpuscles are of no clinical significance unless present in 

 large numbers. They may occasionally be mistaken for air or oil 

 globules. Stray leucocytes are rarely absent, and are only to be con- 

 sidered when they are present in large numbers, as from a cystitis or 

 rupture of some abscess in the genito-urinary-renal tract. Bladder 

 epithelium, and in the female, vaginal epithelium, is always present. 

 Some of the bladder and vaginal cells so strongly resemble each other 

 that they at times cannot be distinguished, and indeed vaginal epithelial 

 cells have been described as being present in the male urine occasion- 

 ally. Again, some cells from the bladder so much resemble epithelium 

 from the ureter or renal pelvis that I always have trouble in distinguish- 

 ing them. Renal epithelium, when it has not undergone fatty or other 

 degeneration, is not difficult to recognize. 



The principal object of the microscopical examination of the urine 

 is to see if casts are present or absent. Although they are found in 

 some of the acute diseases, and at times without sufficient explanation, 

 still their continued presence cannot fail to be alarming. They should 

 be looked for whether albumen be present or not. Albumen is often 

 absent at the time of the micoscropical examination, it having appeared 

 at an earlier stage of the disease. Albuminuria without casts is said 

 to be more common than it really is, and the majority of investigators 

 agree in believing that they were present but could not be found. This 

 was deduced from autopsies. In an interesting case * of cyclic or physi- 

 ological albuminaria, I have never been able to find casts although I 

 look at intervals. 



I generally draw off a little of the sediment with a pipette, and 

 drop it on a hollow slide, and examine it with a low power. The 

 sediment may be then seen floating about. Most books warn against 

 taking up too much fluid on the slide ; I find this an advantage. I 

 take up a large drop on an ordinary slide, and as the fluid runs along 

 the slide, an opportunity is offered to review the sediment as it passes 

 by, taking care, of course, that it does not get on the stage of the 

 microscope. If casts are found, then another diop maybe taken, and, 

 before putting on a cover-class, a small bit of broken cover-glass or a 

 hair is put by the preparation and then covered. This prevents the 

 casts from being crushed. I generally prefer to examine first without 

 a cover-glass, because it is rarely necessary to use siich a high power 

 that the objective comes near the preparation. Some writers suggest 

 that when there is much sediment to roll the cover glass backward and 

 forward with two fingers. I have done that several times and suc- 

 ceeded in making casts when there were none there. When a cover- 

 glass is used, as little liquid as possible should be taken up, and as 

 this lessens the chance of finding them if few are present, it is not 

 always advisable. Staining is generally superfluous, but if desirable, 



* See author's article on "Cyclic Albuminuria," in the Philadelphia Medical News, July 30, 1887. 



