434 



A MANUAL OF PHYSIOLOGY 



anything of importance. The following simple scheme may serve as an 

 example ; but no routine should be slavishly followed, the object being to 

 get at the important facts with the minimum of labour : 



1. Anything peculiar in colour or smell? If colour suggests blood, 

 examine with spectroscope, haemin test, guaiacum test (pp. 62, 64, 66) ; 

 if it suggests bile, test for bile-pigments by Gmelin's test (p. 381). 



2. Reaction. 



3 Sediment or not ? Sediment may be procured by letting the urine 

 stand in a conical glass, or in a few minutes by the centrifuge. If the 

 appearance of the sediment suggests anything more than a little mucus, 

 examine with microscope. The sediment may contain organized or 

 unorganized deposits. 



Organized Sediments. (a) Red blood-corpuscles (considerably altered 

 if they have come from the upper part of the urinary tract). 



(b) Leucocytes. A few are present in health. A large number indicate 

 pus. When pus is present the sediment may be white to the naked eye. 



(<:) Epithelium from the bladder, ureters, pelvis of the kidney or the 

 renal tubules. A few squamous epithelial cells from the urethra are 

 always present in normal urine. 



(d} Tube casts, (e) Spermatozoa (occasional). (/") Bacteria, (g) Par- 

 asites (rare), (h) Portions of tumours (rare). 



Unorganized Sediments. 



IN ACID URINE. 



Uric Acid. Crystals coloured 

 brownish yellow with urinary pig- 

 ment. Various shapes, especially 

 oval 'whetstones,' rhombic tables, 

 and elongated crystals, often in 

 bundles. 



Urates. Usually amorphous, 

 in the form of fine granules, often 

 tinged with urinary pigment, some- 

 times brick-red. Soluble on heat- 

 ing. On addition of acids (including 

 acetic acid) they dissolve and uric 

 acid crystals appear in their place. 

 Acid urate of sodium and of ammo- 

 nium occasionally found in the 

 crystalline form (rosettes of 

 needles). 



Calcium Oxalate. Octahedral, 

 4 envelope ' crystals, not coloured. 

 Insoluble in acetic acid. 



Cyst in. Hexagonal plates. 

 Rare. 



Leucin and Tyrosin. (Figs. 

 122, 123.) Rare. Also found in 

 alkaline urine, but rarely. 



Triple Phosphate. Sometimes 

 found in weakly acid urine. 



IN ALKALINE URINE. 



Triple Phosphate. Clear, 

 colourless, coffin-lid or knife-rest 

 crystals. Also deposited in the 

 form of feathery stars. 



Calcium Hydrogen Phosphate 

 ('stellar' phosphate), CaHPO 4 . 

 Crystals often wedge-shaped and 

 arranged in rosettes. May also 

 occur in a dumb-bell form. (A 

 phosphate of calcium is also occa- 

 sionally seen in weakly acid urine.) 



Calcium Phosphate, Ca 3 (PO 4 ) 2 . 

 Amorphous. 



Magnesium Phosphate. Long 

 rhombic tablets, which are dissolved 

 at the edges by ammonium car- 

 bonate solution, unlike triple phos- 

 phate. All the above are soluble 

 in acetic acid without effervescence. 



Calcium Carbonate. Small 

 spherical or dumb - bell - shaped 

 bodies soluble in acetic acid with 

 effervescence. 



Ammonium Urate. Dark balls, 

 often covered with spines. Soluble 

 in acetic or hydrochloric acid, with 

 formation of uric acid crystals. 



4. Specific gravity. 



5. Quantity of urine in twenty-four hours. If quantity abnormally 

 large and specific gravity high, test for sugar. 



6. Inorganic constituents not generally of clinical importance, but in 

 special diseases they should be examined e.g.^ chlorides in pneumonia. 



