APPENDIX 383 



becomes inflamed with lymphangitis and swollen glands. The fever falls in a few 

 days to be succeeded by other febrile paroxysms. An erythematous eruption accom- 

 panies the second paroxysm. Supposed to be due to a protozoon. 



Sprue. A form of chronic diarrhoea characterized by diaphanous thinning 

 of gut and ulcerations of buccal cavity. 



Tsutsugamushi. A disease of Japan somewhat resembling typhus fever. 

 Supposed to be due to a protozoon transmitted by the Kedani mite. 



Verruga Peruana. A disease with a fever characterized by a profound involve- 

 ment of the bone marrow producing very rapidly an anaemia resembling that of 

 pernicious*anaemia. Pains of bones and joints marked. Death may occur before 

 the eruption, which appears as patients improve, either as red spots which enlarge 

 to the size of pea (miliary) or as pedunculated lesions as large as a pigeon's egg 

 (nodular). The lesions are very haemorrhagic and may appear in crops. The 

 nodular form is located chiefly about the knees and elbows but the miliary form 

 may cover entire skin surface and mucous membranes. 



Yellow Fever. Supposed to be due to a protozoon transmitted by the Stego- 

 myia calopus. A disease characterized by sudden onset, rachialgia, albuminuria 

 and jaundice about the third day. Pulse becomes slow even with rising temperature. 

 Black vomit often precedes fatal termination. Virus exists in the blood and is 

 filterable. 



E CHEMICAL EXAMINATION OF URINE. 



For the prevention of decomposition when a urine is not examined shortly after 

 voiding, chloroform (10 to 20 drops added to a tightly corked bottle) or formalin 

 (4 or 5 drops to a pint of urine) are ordinarily employed. Formalin is better for 

 microscopical material, but, owing to its reducing power, should be substituted by 

 boric acid in urine to be examined for sugar. For clearing urine, turbid by reason 

 of bacteria, rubbing up with Talcum purificat. U. S. P. and filtering is recommended. 



A twenty-four-hour specimen is necessary for accurate work. The urine should 

 be collected in clean separate bottles. Where pus comes from the bladder the 

 proportion of pus in each bottle will be practically the same; if from the kidneys 

 the amount will vary in the different bottles. 



The amount of urine varies in different individuals (water or beer habit). It is 

 usually given as from 1000 to 1500 c.c. 



Long proposes to substitute 2.6 for Haeser's coefficient which, if multiplied by 

 the two final figures of the specific gravity taken at 25 C., gives the weight of urin- 

 ary solids in 1000 c.c. 



Albumin. Practically serum albumin alone is clinically important. 



The two usual tests are i. Heat test and 2. Heller's nitric acid test. For the 

 former, add 3 to 10 drops of 5% acetic acid to the perfectly clear urine in a test- 

 tube and bring to a boil. By boiling the upper portion a turbidity in contrast with 

 the clear lower portion may be obtained. 



A more delicate test for albumin is the following: Add to a test-tube half filled 

 with filtered urine one-fifth it's volume of a saturated aqueous solution of sodium 

 chloride; heat to the boiling point; add two to five drops of fifty per cent, acetic 

 acid and heat again. This test may serve to distinguish nucleo-albumin, as most 



