500 BILIARY CONSTITUENTS IN THE URINE. 



Traces of hematoporphyrin are constant in the urine, btit in considerable 

 amount this substance is, however, rare (in cases of lead-poisoning, intestinal 

 hemorrhage, administration of sulfonal). 



Demonstration. To 500 cu. cm. of urine are added 100 cu. cm. of a ten per 

 cent, sodium-hydrate solution. The precipitate is washed upon a filter, dissolved 

 in hydrochloric-acid alcohol, and exhibits spectroscopically acid hematoporphyrin. 



(c) If urine containing blood is coagulated by boiling and the brownish-black 

 coagulum is washed out and dried, and then extracted at gentle heat with alcohol 

 containing sulphuric acid, a brown fluid is obtained, which, if sufficiently concen- 

 trated, proves on spectroscopic examination to be hematin in acid solution (Fig. 

 15,5). 



BILIARY CONSTITUENTS IN THE URINE: CHOLURIA. 



The physiological factors that are of importance in connection with the pres- 

 ence of biliary matters in the urine have been in part already discussed (p. 319). 

 If bilirubiii is formed from hemorrhagic extravasations through the activity of the 

 connective-tissue cells, bile-pigment may pass over into the urine, while the tissues 

 acquire a yellow color. Cases presenting this peculiarity have been designated 

 instances of hematogenous or anhepatogenous icterus. 



The biliary coloring-matters are demonstrated by the Gmelin-Heintz test 

 (P 3 J 7-) ! the appearance of the green color-ring of biliverdin can be considered as 

 characteristic. The method has received several modifications, (i) If a consid- 

 erable amount of icteric urine is passed through filter-paper, one drop of nitric 

 acid with nitrous acid yields the color-rings upon the inner surface of the yellow- 

 colored, and, if necessary, warmed, filter. (2) If 50 cu. cm. of icteric urine, acidu- 

 lated with acetic acid, be agitated with 10 cu. cm. of chloroform, bilirubin passes 

 over into the latter. If bromin-water be added, beautiful color-rings appear. If 

 to the chloroform-extract oil of turpentine containing ozone be added, together 

 with a little dilute potassium hydrate, a green color due to biliverdin appears in 

 the watery solution. (3) Tincture of iodin diluted ten times with alcohol and 

 overlaid on the urine gives rise to a grass-green ring. (4) According to Jolles, 

 the following procedure yields the most distinct results: To 50 cu. cm. of urine 

 are added 5 cu. cm. of a ten per cent, solution of barium chlorid and 5 cu. cm. 

 of chloroform, agitation being practised for four minutes in a vessel closed with 

 a glass stopper. After the lapse of ten minutes chloroform and precipitate are 

 pipetted into a dish, placed over the water-bath at a temperature of 80 until 

 evaporation takes place. The mixture is then permitted to cool. Now one or 

 two drops of concentrated nitric acid are permitted to flow upon the precipitate 

 at several places, and the color- rings appear. (5) The urine is rendered alkaline 

 with soda, and calcium chlorid is added drop by drop until the fluid overlying 

 the precipitate appears normal. The precipitate is filtered off and washed, over 

 it is poured alcohol, and it is dissolved by means of hydrochloric acid. If the 

 solution be boiled, a color varying between green and blue develops. When 

 cooled, it yields a play of colors from blue to violet to red with nitric acid. 



In the presence of protracted high fever, the urine at times contains only 

 biliprasin. If it contains only choletelin, the urine, to which hydrochloric acid 

 has been added, is examined with the spectroscope, and a pale absorption-band 

 will be found between b and F. 



Hematoidin-crystals (Fig. 92, b) are present in the urine when erythrocytes 

 are destroyed in the blood-stream in large number. After these had been found 

 first by v. Recklinghausen and Landpis, after transfusion of heterogeneous blood, 

 they were observed in conjunction with various infectious diseases that exercise a 

 destructive effect upon the erythrocytes; in cases of scarlet fever; in lesser degree 

 in cases of typhoid fever; ' and Landois with Strubing observed them in the urine 

 in association with attacks of periodic hemoglobinuria. Landois refers the biliary 

 acids often observed by him in the urine after solution of the erythrocytes to 

 the hemoglobin of the destroyed corpuscles. If old collections of blood rupture 

 into the urinary passages, as in cases of pyonephrosis or in conjunction with the 

 perforation of necrotic areas, the appearance of the crystals is comparable to 

 that in the sputa in analogous cases. In cases of hypostatic icterus, bilirubin, 

 which is identical, was found in crystalline form. 



The biliary acids, which Dragendorff demonstrated to the extent of 0.8 gram 

 in 100 liters of normal urine, appear in larger amount in connection with resorption- 

 icterus, although even under such circumstances never in considerable amount. 



