318 THE AMERICAN MONTHLY [Oct. 



regarded as an evidence of a serious malady. The ad- 

 vance in medical microscopy in the later years have 

 taught us to consider the quality of the casts of far more 

 importance then the quantity. 



Mucine casts, with small amounts of albumen in the 

 urine, the formative elements absent, indicate simply 

 catarrh of the kidneys, while the same casts with form- 

 ative elements present and imbedded in their matrix, 

 indicating their acquisition to the casts during their 

 formation in the uriniferous tubules, changes the diag- 

 nosis to catarrhal nephritis, with favorable prognosis 

 under treatment. 



Hyalifie casts, with formative elements absent, indi- 

 cate a more advanced state of disease than mucine casts 

 under same conditions of association, yet favorable prog- 

 nosis. Hyaline casts with albumen pus and renal epith- 

 elium embedded in the casts, indicate clearly a case of 

 tubal nephritis. 



Fatty casts, with columnar epithelium and with oil 

 globules in situ, alkaline reaction, large amount of al- 

 bumen — 20 per cent or over — large amount of pus, mark 

 the completion of the destructive process of which the 

 hyaline casts mark the beginning and points clearly to 

 a hopeless case of Bright's disease with rapid fatal ter- 

 mination. 



Pus in quantity in the urine of alkaline reaction, no 

 tube casts, no blood casts, large quantities of bladder 

 epithelium, small amounts of albumen, indicate a case of 

 cystitis. 



Blood casts are only found in the urine in disease of 

 the kidneys. 



Gonococci may occur in the urine from the extension 

 of an old gonorrhoea. 



Small round concretions in the urine are evidence of 

 stone. If intermittent hematuria also exist, it is prob- 

 ably in the ureter or pelvis of kidney, usually the crys- 



