BILE IN URINE. 413 



of oxyhemoglobin (fig. 17). (b) When bloody urine is exposed for some time, especially in 

 a warm place, it becomes more acid, and assumes a dark brownish-black colour. The haemoglobin 

 becomes changed into methsemoglobin ( 15). It is precipitated by lead acetate, which does 

 not precipitate oxyhemoglobin ; the spectrum of methsemoglobin resembles that of haematin in 

 an acid solution ( 15, fig. 17). The spectra may be combined, (c) The microscopic investiga- 

 tion must never be omitted. The shape of the corpuscles may vary considerably (figs. 264 to 

 266). 



266. BILE IN URINE (CHOLURIA). The physiological conditions which cause the bile- 

 constituents to appear in the urine are mentioned in part at 180. 



Hematogenic, or Anhepatogenic Icterus (Quincke), occurs when bilirubin ( 20) is formed 

 from extra vasated blood by the action of the connective-tissue corpuscles, so that bile pigments, 

 in addition to colouring the tissues, pass into the urine. 



I. Bile Pigments. Their presence is ascertained by Gmelin-Heintz's test. Green (Biliverdin) 

 is the characteristic hue in the play of colours obtained with this test, which is fully described 

 in 177. 



Modifications of the Test. 1. If icteric urine be filtered through filtering or blotting paper, 

 a drop of nitric acid containing nitrous acid, when applied to the inner surface of the spread- 

 out filter, gives a yellowish coloured ring (Rosenbach). 2. In order that the reaction may not 

 take place too rapidly, add a concentrated solution of sodic nitrate, and then slowly pour in 

 sulphuric acid (Fleischl). 3. On shaking 50 c.c. of icteric urine with 10 c.c. of chloroform, 

 the bilirubin is dissolved by the latter. On adding bromide water, a beautiful ring of colours 

 is obtained (Maly). If the chloroform extract be treated with ozonised turpentine and dilute 

 caustic potash, a green colour, due to biliverdin, occurs in the watery fluid (Gerhardt). 



In slight degrees of jaundice, urobilin alone may be found ( 261, 1) (Quincke). 



In persistent high fever, the urine contains especially biliprasin (Huppert). If it contains 

 choletelin alone, add to the urine some hydrochloric acid, and examine it with the spectroscope, 

 which gives a pale absorption- band between b and F ( 177, 3,/). 



Haematoidin. Sometimes crystals of haematoidin ( 20, fig. 14) appear in the urine, especially 

 when blood-corpuscles are dissolved within the blood-stream ; occasionally in scarlet fever and 

 typhus, and sometimes in cases of periodic hemoglobinuria. The breaking up of old blood- 

 clots in the urinary passages, as in pyonephrosis (Ebstein), or the dissolution of necrotic areas 

 (Hofmann and Ultzmann) produces them, and similar crystals occur in analogous cases in the 

 sputum ( 138). In jaundice due to congestion ( 180), the identical crystalline substance, 

 bilirubin, is found. 



II. Bile acids occur in largest amount in absorption jaundice, but they are never present to 

 any extent. The test is described at 177, 2, the cane-sugar solution consisting of 0*5 grm. to 

 1 litre of water. If the urine be dilute, it is advisable to concentrate it on a water-bath. [It 

 is rare to get a satisfactory result with Pettenkoffer's test in ordinary icteric urine.] V. 

 Pettenkofer's test may be used with the alcoholic extract of the nearly dry residue, but no 

 albumin must be present. Dragendorff found 0'8 grm. in 100 litres of normal urine. 



Strassburg's Modification. Dip filter paper into the urine, to which a little cane-sugar has 

 been added ; dry the paper and apply to it a drop of sulphuric acid. A violet-red colour is 

 obtained after a short time. [Hay's Reaction ( 177).] 



267. SUGAR IN URINE (GLYCOSURIA). Diabetes Mellitus. The excessively minute 

 trace of grape-sugar or dextrose, which is constantly present in normal urine, sometimes 

 becomes greatly increased and constitutes the conditions of diabetes mellitus and glycosuria. 

 The physiological conditions which determine this result are given at 175. In this condition, 

 the quantity of urine is greatly increased, it may reach 10 or more litres. Many pints may be 

 passed daily. [The usual abnormal amount of sugar is from 1 to 8 per cent., although 15 per 

 cent, has been found, i.e., found from 5 to 50 grs. per fluid oz., or 300 to 4000 grs. in twenty- 

 four hours.] The specific gravity is also increased (1030 to 1040). [In a case where a large 

 amount of urine is passed of a pale colour and a specific gravity above 1030, always suspect 

 sugar.] A diabetic person gives off relatively more water by the kidneys and less by the skin 

 (and lungs ?) than a healthy person. The colour is very pale yellow, although the amount of 

 pigment is by no means diminished it is only diluted [the depth of the colour being inversely 

 as the quantity passed]. The amount of the nitrogenous urinary excreta is increased. The 

 sugar is increased by a diet of carbohydrates and diminished by an albuminous diet. The uric 

 acid and oxalate of lime are often increased at the commencement of the disease, while yeast 

 cells are constantly present after the urine has been exposed to the air for some time. 



Sugar has been found occasionally after poisoning with or after the use of morphia, CO, 

 chloral, chloroform, curara ; after the injection of ether and amyl nitrite into the blood ; and in 

 gout, intermittent fever, cholera, cerebro-spinal meningitis, hepatic cirrhosis, and cardiac and 

 pulmonary affections. 



[There is no doubt that normal healthy human, urine contains a reducing agent, which reduces 

 cupric oxide to the same extent as if the urine on an average contained 6 grains of glucose in 



