URINE. 245 



colour; and at the period of the crisis, sediments are also 

 deposited. 



Willis 1 remarks, that the state of the urine in typhoid fevers, 

 especially in regard to its acid or alkaline reaction, may be 

 studied with advantage, as affording an indication of the progress 

 of the disease. During the early stage it is acid ; as the disease 

 advances, it becomes neutral, and then alkaline ; as the disease 

 decreases it again becomes neutral, and 'ultimately acid. The 

 return to the acid state is always a good symptom, and will 

 sometimes enable us to offer a favorable prognosis. 



The observations made by Pelletan in Bouillaud's clinique, 

 perfectly coincide with the above statements ; he observes that, 

 during the first days of typhus, the urine is of a dirty yellow 

 colour, and transparent ; during the whole of the first stage it 

 is always more or less acid, and the darkest kind, which has an 

 odour like gingerbread, is usually the most acid. At a later 

 period it changes, resembles turbid whey or putrid broth, and 

 is usually neutral ; it is also sometimes found of a dark colour, 

 with an odour like cow-dung. At a still later period, it is turbid, 

 putrid, and smells rather ammoniacal, assuming at the same time 

 a corresponding reaction. If the disease takes a favorable turn 

 from this period, the urine goes through the same changes in a 

 reversed order. 



The observations which I have made in Schonlein's clinical 

 ward correspond entirely with those already communicated. 



In two men aged between 20 and 30 years, who had very 

 severe attacks, I observed that the urine became alkaline to- 

 wards the seventeenth and twenty-fourth days of the disease : 

 it was then discharged in greater quantity than before, and was 

 clearer; it was pale, somewhat turbid, and soon deposited a dirty 

 or a bright-red sediment composed of earthy phosphates, urate 

 of ammonia, and mucus. Test-paper and a rod moistened in 

 hydrochloric acid, afforded indications of ammonia, and by the 

 addition of an acid the presence of carbonic acid, but not of al- 

 bumen, was demonstrated. Both men recovered, but convales- 

 cence, especially in one of them, was very slow. The urine then 

 became gradually clear, yellow, and acid, as before : the period 



1 Urinary Diseases and their Treatment, p. 128. 



