503 URINE, PATHOLOGY OF, AXD MORBID STATES OF. 



URINE, PATHOLOGY OF, AND MORBID STATES OF. 610 



Oxalic Acid Oxalate of Lime. Oxalic acid is never found in healthy 

 urine, although, according to the important investigations of Dr. 

 Golding Bird, deposits of oxalate of lime are of common occurrence. 

 Where the acid does not result from the peculiar character of the 

 ingesta containing it, as rhubarb or sorrel, the occasion of this morbid 

 deposit is the formation of oxalic acid in the living body, possibly from 

 some undue oxidation of carbon within the kidney. So strong is the 

 affinity between lime and oxalic acid, and so great the insolubility of 

 the resulting compound, that the addition of a very minute quantity 

 of oxalic acid occasions in the urine a precipitate of oxalate of lime, 

 because the oxalate, unlike the phosphate of this earth, is not at all 

 soluble in the natural acid of the secreted fluid. Dr. G. Bird says, 

 that when deposits of oxalate of lime exist, the urine is acid ; in tint 

 varying from a pale straw colour to deep amber, sometimes nearly 

 limpid, much more generally containing a copious deposit of urate of 

 ammonia of a very pale colour, rarely being tinged with pink ; and 

 frequently mixed with uric acid and numerous fragments of epithe- 

 lium ; the specific gravity generally exceeds the average density of 

 healthy urine, but sometimes is below it, varying from 1'016 to 1'029. 

 An excess of urea is frequently present, so that when the urine is 

 above the density of 1'020, it crystallises very quickly after the addi- 

 tion of an equal bulk of nitric acid. When the urine contains no 

 urate of ammonia the deposit of oxalate of lime, on account of its 



OuUte of Lime Crystals. 



transparency, is generally nearly imperceptible ; but on decanting the 

 superabundant fluid, after a few hours' repose, and placing a few drops 

 of the lowermost layers in a capsule, a white crystalline sediment is 

 very readily distinguishable, and this, when examined under the micro- 

 scope, presents a very beautiful appearance. The crystals are of three 

 forms, octahedra, hour-glass or dumb-bell bodies, and small flattened 

 disc-like bodies sometimes round but more frequently elongated, which 

 may be the beginning of the dumb-bell crystals. The octahedral 

 crystals are the most common. Bird and others have attributed a 

 variety of symptoms to the presence of oxalic acid in the system, but 

 Lehmann and Scherer have denied that any connection whatever can 

 be traced between the symptoms described and the appearance of 

 oxalate of lime in the urine. Such a view is also supported by those 

 writers who maintain that the oxalic acid is not formed in the blood at 

 all, but is the result of changes in other constituents of the urine after 

 it has passed from the bladder. 



Carbonic Acid; Carbonate of Lime. Carbonic acid was long ago 

 supposed to exist in urine, although its existence in this fluid is 

 doubted by Berzelius. Dr. Prout says that he has frequently met 

 with this acid in urine, and is most frequently derived from the 

 decomposition of urea, which with water is readily converted into 

 carbonate of ammonia. Carbonate of lime is occasionally found in the 

 urine, and is probably formed by the reaction of carbonate of ammonia 

 on the phosphatic salts : the urine in these cases is alkaline. Carbonate 

 of lime dissolves with effervescence in dilute acid. 



Uric Acid frequently exists in larger quantities than natural, and in 

 then precipitated in the urine, either with or without bases. Wln-n 

 combined with l>ases it forms what is called the " calculous sediment" 

 of urine. The exact composition of the sediments of uric acid with 

 base* has been the cause of much dispute. At one time all uric acid 

 deposits were considered as combinations of the acid with ammonia. 

 Subsequent analysis has shown that urate of soda is a very common 

 sediment. These deposits occur either directly after the urine has cooled 

 down to the temperature of the external atmosphere, or some hours after. 

 In the latter case the production of some other acid by decomposition 

 i the caue of the precipitate. These deposits may not alone occur 

 from increase of uric acid in the urine, but also from a decrease of 

 water in the urine and a relative increase of uric acid. The formation 

 of other acids may also cause this. Sometimes the uric acid is depo- 

 sited without any base, and then assumes its characteristic forms. 

 This may arise from excess of uric acid, but it may alao arise from the 



formation of such acids as the sulphuric, phosphoric, hippuric, lactic, 

 oxalic, or other acids. 



Phosphoric acid forms sediments of the ammoniaco-magnesian phos- 

 phate, the phosphate of lime, and the phosphate of magnesia. The 

 cause of the deposit of the ammoniaco-magnesiau phosphate is tho 

 decomposition of the urea. The carbonate of ammonia thus produced 

 lessens the acidity of the urine, and the ammonia partly combines with 

 the phosphate of magnesia. As soon as the acidity declines the 

 ammoniaco-magnesian phosphate is deposited with phosphate of lime. 



If the urine become alkaline from potash or soda, and not from 

 ammonia, then the phosphates of lime and magnesia are thrown down. 

 This occurs after eating much vegetable food, or after the carbonates 

 or the mixed alkalies have been used for a length of time as medicines. 

 This group of deposits often become the source of stone in the 

 bladder. [CALCULUS.] 



The next group of abnormal deposits in the urine are those which 

 have never been dissolved in the urine, and which fall when the urine 

 is allowed to stand. These are mostly organic, and are detected 

 chiefly by the aid of the microscope. 



Bl/tod is often poured out in abundance from the mucous membrane 

 lining the urinary passages, and is generally diffused through the urine, 

 or is passed entire. In other cases small quantities of blood are passed 

 mixed with pus or mucus, or alone, after the urine has been voided. 

 When large quantities of blood are passed, especially without pain, it 

 is probably a simple exudation from some part of the mucous surface 

 of the urinary organs ; on the other hand, when the blood is mixed 

 with pus or mucus, and passed with pain, it denotes ulceration of the 

 kidney or bladder, and may be combined with the existence of a 

 foreign body hi the bladder. Dr. Willis, and other writers, quote 

 several authorities to show that ha?maturia is endemic in some countries. 

 M. Chapotain, for instance, informs us that in the Isle of France 

 children from their infancy are liable to hiematuria without suffering 

 any pain from it, or its appearing to prejudice their general health. 

 M. Salesse, a native of the Isle of France, and now a practitioner of 

 medicine there, states that three-fourths of the children are affected 

 with luematuria at one tune or another. In these cases the bloody 

 urine is generally observed to alternate with that which is chylous or 

 oleo-albuminous. During the invasion of Upper Egypt by the French, 

 many of the men suffered from an epidemic hicmaturia. 



When blood corpuscles are present in the urine, of course albumen 

 is also there. It is sometimes a question whether the albumen is 

 greater in amount than can be accounted for by the blood or not. 



Pui is often found in great abundance in the urine. Upon standing, 

 the pus subsides to the bottom of the vessel, in a state more or less 

 pulverulent, and the fluid resumes its transparent character. If pus 

 be present as well as mucus, the former is found lying on the latter, 

 and presents a much yellower tint ; it is also quite opaque, whereas 

 mucus is more or less transparent. A ready test for determining 

 whether the deposit from the urine be of a purulent nature, is to add 

 liquor potassse to the sediment collected in a phial or test tube. If it 

 be purulent, it will, on agitation, form with the alkali a transparent 

 viscid compound. 



Fat may be either dissolved in the form of a soap, or free in the 

 urine. It is more frequently free. The urine has a turbid emulsion- 

 like appearance. What is called chylous urine depends on the presence 

 of fat globules. This state of the urine sometimes comes on from 

 fatty food, and at other times from some defect hi the assimilative 

 functions. It is not at all a dangerous symptom. The administration 

 of gallic acid is said to arrest its development. 



jiithclial cells are very frequently present in abnormal numbers in 

 urine. In all urine, after standing, a slight cloud will be seen forming, 

 which, when examined by the microscope, is found to consist of ill- 

 defined granular cells from the mucous membrance of the urinary 

 passages. In many diseases this becomes increased. The shape of 

 these cells will indicate their source. The epithelial cells of the 

 urethra, bladder, and kidney are of different forms. The cells of the 

 urethra are flattened, those of the bladder ovate, whilst those of tho 

 renal epithelium are caudate. 



Cancer cells are also found when cancerous disease of the kidneys or 

 bladder is present. It is very difficult to distinguish between the 

 caudate cells of cancer and the cells of the renal epithelium. The 

 latter are not often in such abundance as the former, but general 

 symptoms must assist in the diagnosis. 



Renal catti are frequent in the urine in disease. They vary in 

 breadth from the ^th to the nboth of an inch, and are from the ,^th 

 to the jjf,th of an inch in length. They vary, however, in size and 

 transparency, according to the materials of which they are composed. 

 It is, however, impossible to diagnose the nature of the disease of tho 

 kidneys by the composition of the renal cast. Large bodies are often 

 found, called cylinders, which are not found in tho kidneys, but in the 

 bladder, prostate, or ureter. The caste have been thus named accord- 

 ing to their composition by Dr. George Johnson : epithelial caste, 

 large and small waxy caste, granular caste, oily caste, bloody caste, 

 purulent casts. 



Other bodies are less frequently found in the urine, as fibrinr, 

 starch, spermatozoa, hydatids, hair, and entozoa, the sources of which 

 are indicated by then- nature. 



Urine sometimes, after standing, presents the mycelium of lower 



