538 APPENDIX. 



while there was a mere trace of earthy phosphates. The sub- 

 sequent dissection confirmed the accuracy of the diagnosis. 



/. An aged man, under the care of Dr. Folwaczny. The 

 urine was extremely turbid, of a dark clay colour, and formed 

 a sediment without itself becoming clear. The sediment was 

 composed of albuminous fungi, numerous cylinders, pavement 

 epithelium, and urate of ammonia. It was upon the presence 

 of the last ingredient that the turbidity was dependent, for on 

 the application of a gentle warmth the fluid became clear. The 

 reaction was strongly acid, and the specific gravity 1029. After 

 the removal of the albumen the specific gravity was only 1017. 

 Hence a large quantity of that constituent was present. On the 

 addition of nitric acid, albumen with a deep violet tint was 

 precipitated; consequently there was much uroxanthin in the 

 urine. The urea was far below the average ; the uric acid and 

 urate of ammonia were abundant. The salts collectively were 

 much diminished, but most especially the chloride of sodium. 



The subsequent dissection proved the accuracy of the diag- 

 nosis. 



From these and five additional cases Heller draws the fol- 

 lowing conclusions. 



He divides the disease into three stages, in all of which the 

 urine presents separate and distinctive characters. 



The first is the congestive stage, during which the urine is 

 red from dissolved blood or haematin, but at the same time is 

 acid unless neutralized by the presence of very much blood. 



In the second the chronic stage the urine is pale and of 

 a clay-yellow colour, and frequently resembling whey. 



In the stage of dissolution which (frequently but not invari- 

 ably) shortly precedes death, the urine is ammoniacal, developes 

 a putrid odour, and is again bloody. At this stage the drop- 

 sical eifusions give off an odour resembling that of rotten 

 eggs. 



In all three stages the urine is (with occasional exceptions) 

 diminished. The largest amount is passed during the chronic 

 stage, when the oedema frequently diminishes for a short time. 

 During the first and last stages, the daily amount of urine 

 seldom exceeds a few ounces, and blood is often present. 



The following are the physical characters of the urine. In 

 the first stage it is red and turbid, forming either a red or 



