804 THE UEINE. 



rence in the urine. When present in a larger amount, together 

 with pus-corpuscles and epithelia of the middle layers, exhibiting 

 endogenous new formation of pus-corpuscles, they indicate acute 

 catarrhal cystitis. The flat epithelia of the bladder may be 

 found in clusters similar to those from the vagina ; their size, 

 however, is a sufficiently distinguishing feature. If the cuboidal, 

 epithelia largely outnumber the flat, or are scanty in comparison 

 with the large amount of pus-corpuscles, the diagnosis of chronic 

 cystitis is justified, and with greater certainty if some pus- 

 corpuscles contain dark brown pigment-granules. 



Caudate epithelia, somewhat smaller than those of the mid- 

 dle layers of the bladder, originate from the pelves of the kidneys. 

 They are sometimes combined with clusters of uric acid crystals, 

 which, when present in freshly passed urine, indicate their origin 

 in the pelvis. Not infrequently these are accompanied by a large 

 number of red blood-corpuscles and shreds of connective tissue, 

 caused by haemorrhage and ulceration in the pelves. Pelvic 

 epithelia are often found in connection with kidney epithelia 

 (pyelo-nephritis). 



Small cuboidal and columnar epithelia are shed from the 

 uriniferous tubules of the kidneys. They invariably indicate 

 catarrhal nephritis, when pus-corpuscles are also present; with 

 pus-corpuscles and tube-casts, they prove the presence of croup- 

 ous nephritis. Without kidney epithelia in the urine, nephritis 

 cannot be diagnosticated ; these and the tube-casts are the only 

 positive evidences of the presence of inflammation o.f the kid- 

 neys. In very acute nephritis, clusters nay, cast-like tubes 

 of kidney epithelia, may be found in the urine. 



Tubular Casts. The most characteristic sign of croupous 

 nephritis is the presence of tube-casts in the urine, and in my 

 experience the casts are always indicative of the disease, and, 

 with greater certainty, the larger the accompanying amount of 

 the albumen. Reliable observers have seen casts without any 

 albumen in the urine, and it has been asserted that mere hyper- 

 aemia of the kidneys may suffice to throw casts into the urine, 

 without any evil consequences for instance, after treatment 

 with large doses of iodide of potash. The former assertion I can 

 corroborate, the latter is not in concurrence with what I have 

 seen ; the casts surely indicate nephritis, and the greater their 

 number the more serious is the disease. 



We distinguish six varieties of tube-casts, viz.: hyaline, 

 epithelial, blood, granular, fatty, and waxy casts. (See Figs. 367 

 and 368.) Their diagnostic value is as follows : 



