Urological dictionary: containing an explanation of numerous technical terms; the qualitative and quantitative methods employed in urinary investigations ...

Front matter

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■HiH

Large Microscope.

Preface

The capability of examining urine to assist In the diagnosis, prognosis, and therapeutics of disease, as manifested by the numerous works that have already appeared upon the subject, is recognized at this day as an important and necessary acquisition to medical practice, — one which no physican who values his professional standing can afford to ignore or neglect. The present Dictionary, while it lays no claim to erudition, nor to originality, is designed as a multum in parvo to the physician and the chemist, affording information concerning urinary technicalities and urinary investigations together with their clinical importance, that is not to be found in any one book yet published, and which, it is hoped, will prove instructive and useful.

In the determination or analyses of the several normal and abnormal elements encountered in the renal excretion, a number of tests and reactions are given that have been collected from the best sources, fully posting the reader, in these matters, up to the present time; and while many of them are tedious, frequently requiring a more thorough knowledge of chemistry than is generally had by the mass of practitioners, as well as a greater amount of time than can ordinarily be spared during an active practice, yet, in every instance where it was deemed necessary, the more simple and rapid processes have been described and pointed out by the indicator, t, as explained hereafter; so that examinations, sufficiently exact for clinical purposes, may be undertaken by any one without the embarrassing and irksome complication of extensive chemical reagents, instrumental apparatus, repeated filtrations, drying precipitates, minute and exact weighings, etc., without loss of time, and without difficulty. To the medical man especially, these are important considerations.

An exact knowledge of the quantity of any element, even to the fraction of a grain, that may be present in a given urine, as essential as it may be to science, is not so urgent for the medical practitioner, who can almost always satisfy all the requirements of practice, by simply determining the approximate amount of such or such important constituent, and then carefully iv PKEFACE.

observing its daily variations, — whether it remains stationary, diminishes, or augments, under the influence of the treatment pursued. In the Preliminary Remarks much valuable information will be found, leading to the result just named.

In the Appendix several Tables, etc., are given, to aid the investigator in effecting rapid calculations during his observations; and I embrace this opportunity to return my thanks to my young friends Mr. John U. Lloyd and Mr. Nathaniel W. Lord, for their kindness in furnishing the Table of Symbols. I must likewise acknowledge my indebtedness to the host of eminent authors from whose writings I have compiled much important and precious matter, in many instances, without special credit. Nor can I allow this occasion to pass, without expressing my gratification at the elegant style in which my publishers have issued the work.

J. K.

Cincinnati, February, 1878.

PRELIMINARY REMARKS.

N. B. For information concerning any urinary constituent, reagent, testing apparatus, or technicality, the name of which is italicised throughout the pages of this work, the reader will refer to it under its proper alphabetical heading. — It should likewise be stated that, with any given urine, the physician can separately perform such investigation as he may judge proper, qualitative or quantitative, without any preliminary operations (except for determining the presence of albumen), by simply turning to the article treating upon the urinary constituent in which he is interested, and pursuing the method (or one of the methods) therein named. A regular methodic analysis will require him to pursue the course indicated in the Table for Qualitative Analysis (page 10), and for Quantitative (page 11). For the advantage of practitioners who have not the time for lengthy and expensive processes, the more simple and rapid methods, with the ordinary normal and abnormal urinary elements, will, under their respective heads, be prefixed with the indicator J.

Explanation of Abbreviations.

c. c. Cubic centimetres.

cgrms. Centigrammes.

fl. oz. Fluid ounces.

grm. or grms. Gramme, or grammes ; as Ogrm. .02,=two hundredths of of a gramme ; or 0.02 grm.

mgrms. Milligrammes.

min. Minims.

mm. Millimetre : as 0mm. .006. = six thousandths of a millimetre ; or 0.006 mm.

sp. gr. Specifio gravity,

X- Diameters: as X 500 = 500 diameters.

The processes usually described for the examination of urine, as, repeated filtrations, drying and weighing of precipitates, volumetric operations, etc., together with the expensive and complicated instruments required, as, chemical balance, saccharometer, drying ovens, graduated burettes, etc., as desirable and valuable as they may be in the laboratory, or in the hospital, are embarrassing and discouraging to the general practitioner, who, not having the time and many other material conditions, requires simple and rapid processes for his investigations. The important point for him is, to ascertain whether the urine contains elements not found in it when in a normal condition, and whether its normal elements are deficient or in excess ; bearing in mind that albumen, biliary coloring matter, and sugar, are the three most important morbid soluble substances met with in this fluid, indicating more or less danger, the same as a deficiency of urea. It is not indispensable that he should know to the sixth part of a grain, the absolute quantity of such or such element present, but it is highly necessary that he should carefully watch its daily variations. And if, in testing the urine of a patient from time to time, he will always place himself under the same operative circumstances, and surround himself with the same precautions, he will be enabled to arrive at constant and sufficiently accurate results.

In most instances, the physician has but little time to devote to quantitative analyses, and he will find the method, named hereafter in the succeeding paragraphs, ordinarily sufficient to determine not only the presence of albumen, phosphates, urates, etc., in the specimens of urine under examination, but likewise their daily variations, — whether they increase or diminish in quantity, or remain stationary, — and thus be enabled to appreciate the value of the treatment pursued. True, this method is not an absolutely exact one, but it is sufficiently so for practical purposes, and what is lost in exactness is gained in the saving of time and in instrumental simplification.

For the more extended urinary investigations the medical man should be fully provided with every convenience for prompt and accurate analyses. Among which may be named the possession of a small laboratory room furnished with shelves to securely hold chemicals and apparatus, so that they may always be within easy reach ; a stout, well-made table, four or five feet by two, and furnished with drawers for the reception of infrequently employed materials; sufficient apparatus and chemicals, that there may be no delay nor trouble in the examinations ; a good light (a northern is preferable) for both the chemical and microscopical researches; various accurately computed tables for expediting the determination of certain reactions and results ; and in addition to which a blank book will be found decidedly useful for recording the various results of the investigations. The liquids and other chemicals should be pure, and, together with the apparatus, should be kept constantly clean when not in use, in their proper places, and easy of access for prompt and thorough examinations, so as to occasion the least possible delay or inconvenience. Apparatus kept in an uncleanly or disorderly condition, impure or carelessly arranged chemicals, as well as an insufficiency of apparatus and chemicals, are sources of great annoyance and inconvenience, interfere with precision and accuracy of results, and tend to render the practitioner disgusted with, and ultimately opposed to, all urinary examinations.

In the examination of urine, the different specimens passed at various periods of the day, should be tested both singly and combined, especially in maladies presenting obstinate, severe, or obscure symptoms; and that recently voided should be examined at the time, and likewise after it has stood for 12 or 24 hours. And however difficult or troublesome it may be to accurately collect all the urine passed by a patient within 24 hours, it must be borne in mind that, unless this quantity be correctly known, the examination will be of no value, whatever may be the method of analysis pursued. It may be observed here, that, if the number of cubic centimetres of urine passed be multiplied by its sp. gr. the result will approximatively give the weight of the urine in grammes.

For qualitative analysis, 200 or 300 c. c. (6 or 10 fl. oz.) of the urine are sufficient ; but when it is desired to follow the qualitative by the quantitative analysis, the urine to be investigated should be divided into two large parts, say 500 to 1,000 c. c. (16£ to 33| fl. oz.), each of which may be subdivided into as many portions as may be necessary. It will prove a great economy of time and money, beside giving much clearer results, to operate upon small quantities only, at a time, say 5 or 10 c. c. (81 or 162 min).

The quantity of a precipitable substance in urine can be approximatively ascertained by placing a given volume of the urine in a graduated jar, or test tube, allowing it to stand a sufficient time, and then observing the height of the precipitate that occurs ; by employing the same volume of urine in this manner, daily, and observing the height of the precipitate in each specimen at the end of 24 hours, or at the visit of the next day, closely comparable results may be obtained. In this manner may be followed the daily quantitative variations of such or such element, and the curve they represent may be traced in a book kept for this purpose. Substances, which it is not desirable to test in this manner, may be removed from the urine, by agents that will rapidly precipitate them, — the precipitate being removed by filtration; or, they may be prevented from precipitation by the addition of an agent or agents that will hold them in solution.

In disease, whether acute or chronic, it is frequently required that the urine passed for several consecutive days must be examined daily, or oftener, before the average condition of this fluid can be correctly arrived at. And, in doing this, the several portions of urine passed during each 24 hours should be collected in separate vessels, so that samples of each one can be examined previous to combining them.

The specimen of urine to be examined should be voided into a well cleansed bottle, and a small portion of it be at once tested, to determine its sp. gr., its acidity or alkalinity, its color, odor, general appearance, and whether albumen or sugar be present. This done, the remainder, or a portion of it, should be placed in a clean cylindrical vessel, and covered, so aa to keep out dust and foreign matters. It is then to be set aside until a sedi-

8 PRELIMINARY REMAKES.

ment is formed at the bottom of the fluid ; in summer this requires about 12 hours, and about 24 hours in winter. Small portions of this sediment are to be removed, by means of a small pipette, for microscopical or clinical examination, as may be required. Ordinarily, the urine first passed early in the morning, or the last half of it, is that which is examined ; this will usually answer to give a general idea of the condition of this fluid, but where completeness and accuracy is required, samples of the whole of the urine passed in 24 hours must be analyzed, as heretofore observed. It must not be forgotten that, even in a state of health, the urine will be found to vary more or less daily, in its specific gravity, its acidity, its color, and the amount of its constituents. Too great a variation is the evidence of some morbid condition of the system.

In most cases the principal characters of a urinary deposit may be determined at the bedside, by means of a Coddington or Stanhope lens; or, still bet- ™ -. ter, by a portable pocket microscope. But, if the deposit cau

not be examined at once, and has likewise to be carried some

T distance for this purpose, it will be useful to have several small well-closed sample tubes, in each of which a few drops of the deposit maybe placed; these should be wrapped in paper, upon which the patient's name is written. To prevent any change or putrefaction, a layer of oil will serve to protect the deposit from atmospheric contact, provided the tube be exactly filled before closing it. A small fragment of cam- CoddingtonLens. phor> or a jj^ carbolic water ( car bolic acid 1, water 1,000),

will likewise answer.

In all instances, when a specimen of urine, or of a urinary deposit, is presented for investigation, it is necessary to ascertain how long since the fluid was voided, in order to determine concerning any changes, decomposition, etc., that may have occurred. And, in cases where several days may pass before a specimen of urine can be examined, it may be preserved by the above named articles, or by the addition of chloral, 10 grains to each fluidounce of urine; or, of salicylic acid, 3 grains to each fluidounce of urine. However, chloral is not suitable for urine that is alkaline, or that contains sugar, or urates, as it seriously interferes with the tests ordinarily employed for the estimation of these substances. Larjorrois states that l-40,000th its weight of fuchsine, or aniline violet, will thoroughly preserve urine from putrefaction. The addition of a little borax will likewise preserve urine for several days, but should not be used where the determination of soda salts is required.

Albumen, it should be remembered, embarrasses or prevents both qualitative and quantitative analyses; hence, when present, it should be promptly removed by one of the processes hereafter indicated. It will also be proper to refer to the article on Sugar before proceeding to the other examinations.

In order to effect a systematic examination of a specimen of urine, the following order will be found the most convenient, always ascertaining the quantity of this fluid passed each day, for several successive days:

1. Observe the color and appearance of the urine.

2. Observe its odor.

3. Examine its reaction, whether acid, neutral, or alkaline.

4. Ascertain its specific gravity.

5. Test for albumen. If albuminous, examine under the microscope for Renal Casts, Pus Corpuscles, and Bed Blood Corpuscles. If the urine contains albumen, remove it, and then test the filtered urine for other substances, if indicated. But if neither albumen or sugar be present, unless there be some special indication, no farther examination will be required.

6. Test for sugar.

7. Test for coloring matters, normal or abnormal.

8. Any sediment found in urine, which has been allowed to stand for 12 or 24 hours, must be examined microscopically, and often chemically. The more common sediments are:

A. Pink or reddish, and dissolved on heating it in the test tube, — urates.

B. White crystalline, dissolved when acetic acid is added, — phosphates. Insoluble in acetic acid, but soluble when nitric acid is added,— oxalate of lime.

c. White amorphous flocculent, becoming ropy when liquor potassa, or ammonia, is added, — pus.

D. Brownish-red crystalline, — uric acid.

E. Red amorphous, — blood.

Other substances may be present in the urine, as spermaiozoids, fungi, epithelial cells, cancerous fragments, mucus, biliary pigments, or acids, leucin, tyrosin, cystin, carbonate of lime, hippuric acid, extraneous substances, etc.

Or, the order given in the following table (on page 10), which slightly varies from the preceding, may be pursued, and will give similar results; for the details refer to the articles in the body of the book.

PRELIMINARY REMARKS.

I. General Table of the Course to Pursue for Qualitative

Analysis.

i. Color of the urine.

Normal colors.

Abnormal colors.

Urine pale ; colorless to straw yellow.

do normal; golden yellow to amber.

do highly colored ; reddish yellow to red.

do dark colored; brownish; dark, beer color.

~ . . . • f Coloring matters of the blood.

Essential arising Bm |

'VthVnZ^ 1 UroxZnthine; indican. of the organism. [ Uroerythrin .

Accidental, de- f rived from without, and only pass- j Various coloring matters. ing through the organism.

2. Odor.

Essential.

Normal, sui generis.

Abnormal.

Accidental, from odoriferous substances introduced into the organism.

Very varied by

Urinous, due to Carbonate of Ammonia.

Sulphureted? (Beale).

Asparagus.

Oil of Turpentine.

Cubebs; Copaiba.

Sandal, etc.

3. Aspect.

Urine clear.

do turbid (slightly). — Cloudy or Flocculent.

See Mucus, Epilhelia.

Urine sedimentary. — See Examination of Sediments.

4. Chemical f Normal. reaction with litmus.

Abnormal.

Acid.

Neutral

By Carbonate of Ammonia.

Alkaline. \ By fixed Alkalies.

A persistent sp. gr. below 1015. — Test for albumen. 1028 to 1050. — Test for sugar ; excess of urea. 1001 to 1008. — Test for deficient urates.

1005 to 1030. — Test for phosphates. See sp. gr. of urine, with each urinary constituent.

6. Detection of the abnormal elements in the urine. (Divide the urine into several portions, in which we successively search for the following principles:

7. Examination of the sedi-

ments.

Albumen.

Sugar.

Bile.

Blood.

Fibrin.

Fat.

f Coloring matters. \ Biliary acids.

Microscopically and Chemically.

In a methodical investigation of urine, quantitative analysis must perfect the information obtained from the qualitative. But as regards medical practice exclusively, it is rarely necessary to perform a complete and exact analysis ; however, the medical man may be frequently desirous of effecting the quantitative analysis of such or such urinary element, the variations of which he is interested in ascertaining. Therefore, the following brief table defining the order to be systematically pursued in this analysis, is given ; the detection and determination of the urinary constituents will be found in the body of the work under their respective heads. —

PRELIMINARY REMARKS.

i. Quantity of urine excreted in 24 hours.

II. General Quantitative Analysis.

Averaging 1,500 grammes (about 60 fl. ounces.)

Variations.

According to the following physiological condition:

According to the pathological condition.

a. The more or less copiousness of water in the blood.

b. The excretory activity of the kidneys.

Diminution of urine.

Increase of urine.

Acute diseases.

Approach of death.

The increase temporary.

The increase permanent.

2. Den of the

Normal

3. Quantity of urinary pigment.

4. Quantitative analysis of some of the constituent elements of the urine.

Hydruria.

Dropsy.

Polyuria.

Uroheinatin.

Bile Pigment Blood.

Accidental.

Urea.

Uric acid.

Phosphates.

Chloride Oj

Sodium.

Sulphates.

Instruments and Reagents.

These will vary according to the character of the analysis, and the extent to which the physician wishes to carry his investigations. He should always have a book in which to sketch, as far as possible, the various appearances met with in the urine in its original state, as well as when acted upon by reagents; he should likewise possess another book in which is kept the date, name of the person, age, occupation, etc., appearance and character of the urine, symptoms present, curves of variation of important urinary characters, when these can be examined daily, reference to drawings in the drawing-book, as well as to the treatment, and its result.

H. Bedside Case.

A neat pocket case, holding the articles named below, carefully and compactly fitted, and, at the same time, easy of access, will be found very useful for urinary investigation at the bedside : —

Urinometer. 1 small vial Acetic Acid, £ fl. oz.

3 test tubes, £ fl. oz. each. 1 " " Liquor of Potassa at T ^th

1 small alcohol lamp. \ fl. oz.

1 watch glass with wire support 3 glass slides and a few thin glass

and handle". covers.

PRELIMINAEY REMAEKS.

1 graduated small pipette, 6 in. long. 1 small brass forceps.

1 small thermometer. 2 small vials for extra reagents when

1 wire holder for test tubes. required.

Strips of blue and red litmus paper. Small plate of platinum.

1 glass jar of 2 fl. oz., graduated into half fl. drachms ; or of 8 grammes

graduated into c. c. 1 Coddington lens ; or a small microscope of about 200 diameters (Nachet).

More extensive investigations in the medical laboratory will require cases containing the instruments and reagents as follows :

The fluids named should be in quantity from 2 to 4 fluid ounces each, with the exception of alcohol and water, which should be in the quantity of from 6 to 8 fluid ounces each.

II. Instruments for Qualitative Analysis.

6 or 12 test tubes.

4 conical glasses, or champagne glasses.

Fig. 2.

Fig. 3.

Conical Test Glasses.

2 or 4 porcelain capsules.

Alcohol lamp.

2 small dropping pipettes.

These should always be well cleansed immediately after use, so as to be in readiness for the next investigation.

1 pipette, graduated into 5, 10, and

Achromatic microscope of X 300 to

X500.

Slides and thin glass covers.

Urinometer and containing glass.

Small thermometer. 1 burette.

Filtering paper.

Blue litmus paper.

Eeddened litmus paper. 1 graduated cylindrical jar of 1,000

c.c. 1 glass funnel.

Swabs for cleaning test tubes. 3 glass stirring rods.

Coddington lens. Fig. 1.

Small brass forceps.

Reagents for Qualitative Analysis.

Pure Nitric Acid.

" Hydrochloric Acid.

" Acetic Acid.

11 Sulphuric Acid.

Nitroso-nitric Acid.

Chromic Acid, 4 grs. to 1 fl. oz.

Alcohol.

German Yeast.

Distilled water.

Solution of Acetate of Lead, 1 part

to 4 parts of distilled water.

Liquor Ammonia.

Liquor Potassa.

Pavy's Solution in separate parts.

Tincture of Iodine, 1 part to 4 parts

of distilled water,

Besides the other reagents named throughout the work.

PRELIMINARY REMARKS.

If pharmacists would keep pure chemicals on hand, they could dispense the reagents whenever the physician's prescription therefor was received. It seems to us that, in examinations made at the bedside, the patient should bear the small expense of investigations pursued in his interest; and, it is very frequently the case that, where daily examinations are desired, the physician can instruct some intelligent person around the patient how to conduct the processes, and observe and report the results.

Figs. 5 and 6.

Fig. 4.

Wash Bottle.

Graduated Glass Jars.

III. Instruments for Quantitative Analysis.

Urinometer and containing glass.

Apparatus for determining urea.

Nest of beakers. Fig. 8.

2 precipitating jars.

3 conical glasses. Figs. 2, 3. 12 test tubes, and rack.

4 porcelain capsules, various sizes.

Small platinum capsule.

Hot water drying oven. Fig. 9.

3 glass stirring rods.

Sp. gr. bottle, 50 or 100 grms.

2 funnels ; large and small.

Blue and reddened litmus paper.

Wash bottle for washing precipitates

on filter. Fig. 4. 2 graduated burettes, and holder.

Copper water bath.

Portable sand bath.

Thermometer. 12 glass slides. 24 thin glass covers. 2 brass forceps.

Agate mortar.

2 dropping pipettes.

3 pipettes of 5, 10, and 20 c. c.

Figs. 11 and 27.

Pipette of 50 c. c, graduated into

T Vths. Fig. 28.

Small retort stand.

Litre flask. Fig. 38.

Chemical balance to weigh at least

5 Vth grain. Fig. 7.

Sett of gramme, and grain weights.

PRELIMINARY REMARKS.

2 graduated glass jars of 100 c. c. and 500 c. c. Figs. 5 and 6.

Fig 7.

2 test tube holders.

6 ground glass covers.

Graduated test glass.

Microscope, of X 100, 200, and 500 or thereabouts.

Platinum foil.

Platinum wire.

Spirit lamp.

Blowpipe.

2 small tripods.

6 watch glasses.

Bibulous paper.

Filtering paper.

Cylindrical jar of 2,000 c. c. graduated into |ths.

Chemical Balance.

Reagents for Quantitative Analysis.

Absolute Alcohol.

Alcohol, 95 per cent.

Sulphuric Acid.

Hydrochloric Acid.

Nitric Acid.

Oxalic Acid.

Lime Water.

Baryta Water.

Chloroform.

Ether.

Pavy's Solution, in separate parts.

Perchloride of Iron.

Bichloride of Platinum.

Distilled Water.

Ammonia.

Oxalate of Ammonia.

Liquor Potassa.

Solution of Soda.

Solution of Hypochlorite of Soda*

Carbonate of Soda.

Phosphate of Soda.

Chloride of Ammonium.

Chloride of Calcium.

Chloride of Barium.

Nitrate of Silver.

Sulphate of Copper.

Volumetric Solutions, Besides the other instruments and reagents referred to throughout the work.

Fig. 8.

Beaker Glasses.

The Beaker Glasses, Fig. 8, should consist of thin, well annealed glass ; they are used for containing hot fluids, as well as for heating fluids when an elevated temperature is required. Precipitating jars are for collecting precipitate in quantity. Conical glasses, Figs. 2 and 3, are for containing urine to determine sp. gr., and to collect small amounts of precipitate from any given specimen; the bottom of the cavity of these glasses should be pointed, not rounded. Porcelain capsules are for heating substances that can not well be placed into the beakers; in observing reactions, they are seen best on a white ground; also for the evaporation of fluids. Platinum oapeula, foil and wire, are for holding matters requiring an elevated temperature, for calcination, fusion, or decomposition, and for ascertaining the effects of intense heat upon minute fragments of calculi, sedimentary substances, etc. Bloicpipe,\o direct the flame of the spirit lamp upon bodies to be calcined or fused. Sand bath, a shallow sheet-iron vessel, filled with hot sand, upon which is placed a glass vessel, or porcelain capsule, watch glass, etc.; the iron vessel is exposed over a spirit lamp, or other source of heat, and the temperature raised to the degree required. Water bath (seen to the left of Fig. 10), is a copper or porcelain vessel containing water, and in which fluid another similar vessel, capsule, or glass dish, holding a fluid to be heated or evaporated, is placed, and the whole is then exposed to a source of heat, as required. Hot water drying oven, Fig. 9, is a copper vessel, in which

substances are placed to be dried that t,. »

, , . Jcig. y.

require for this purpose a temperature

higher than that of boiling water ; when a less elevated temperature is required for dessication, a tin water bath is employed. Tripods, Retort Stands (seen to the right of Fig. 10), are for holding vessels under exposure to lamp

heat, and for supporting filters, dishes,

' rr & > > Hot -Water Drying Ovea.

retorts, etc.

Dilute solutions of the different reagents are made by the addition of 1 part of the chemical agent to 1, 2, 4, 8, or more, parts of distilled water, as may be required. In all cases the reagents employed should be strictly pure, else there will constantly be a risk of having an investigation interfered with or rendered useless by some unforeseen and inexplicable accident. As quantitative or volumetric analyses are generally conducted in a laboratory, the practitioner undertaking them may keep on hand a quantity of each reagent, say 1 or 2 ounces of solid chemicals, and 6 to 8 ounces of liquids, or even more, the bottles containing which should be closely stopped. The small bottles, with capillary orifices (Beale's), for holding the principal fluid reagents, will be found exceedingly useful in micro-chemical investigations.

All the apparatus, reagents, and volumetric solutions may be had of Messrs. Bullock and Crenshaw, No. 528 Arch Street, Philadelphia, Pa.; of Mr. E. B. Benjamin, No. 10 Barclay Street, New York City ; of Mr. W. J. Rohrbeck, No. 4 Murray Street, New York City, etc. Dr. W. H. Pile, of Philadelphia, furnishes accurate urinometers, minim, and other graduated pipettes, specific gravity bottles, glass tubes, jars, etc., graduated as may be ordered. Practical chemists, most philosophical instrument makers, and first-class surgical instrument makers, can supply many of the articles referred to.

PKELIMINAEY REMARKS.

Chest of Apparatus and Chemicals for Urinary Analysis.

ABN 17 ACE

UROLOGICAL DICTIONARY.

A.

Abnormal Constituents of Urine, when met with, indicate the existence of more or less serious disease, and afford the practitioner highly important information. Each one of these constituents is significant of a particular disease or morbid condition, that has occasioned its presence, the detection of which enlightens the diagnosis in cases of doubt and obscurity, especially in the earlier stages of such disease. The more common and important abnormal constituents are, in point of order : albumen, sugar, bile, blood, fibrin, fat, leucin, tyrosin, and some likeviise include urinary sediments, considered abnormal not in point of composition, but in point of place. Those less frequently encountered, and the indications of which are imperfectly understood, are : alkapton, inosite, benzoic acid, lactic acid, butyric acid, allantoin, and sulphureted hydrogen.

Abnormal Deposit in Urine. Any visible deposit in urine which has stood from the time of voiding for twelve or twenty-four hours. See Urinary Sediments.

Accidental Abnormal Constituents of tbe Urine, are those substances which are derived from food, drinks, drugs, etc., and which pass into the urine either changed or unchanged. Their presence is not always a pathological indication, though it is frequently useful to determine such presence, especially in cases of poisoning, when the toxic agent has passed into the urine. The processes to pursue for such determination, are the same as are employed when such substances are found mixed with organic matters, as in cases of death from poison. These accidental constituents are alkaline carbonates, antimony, arsenic, benzoic acid, bismuth, bromine, bromide of potassium, camphoric acid, chlorate of potassa, chloroform, cobalt, gold, iodine, iron, lead, mercury, nickel, phosphorus, quinine, salicin, santonin, senna, strychnia, succinic acid, sulphide of potassium, tannin, tar, zinc. See Coloring Matters; Urinary Sediments.

Acetate of Lead. Lead or Plumbic Acetate. There are two acetates of lead employed in urin ary investigations : 1 . Neutral Acetate of Lead, Neutral Plumbic Acetate, Superacetate of Lead, Sugar of Lead, Lead Acetate, and which is determined from the subacetate of this metal by not causing a copious precipitate with carbonic acid, which only partially decomposes it, and, likewise, by not forming a precipitate with solution of gum Arabic ; with sulphuric acid, acetate of lead forms a white precipitate of sulphate of lead, at the same time evolving vapors of a vinegar odor ; it also forms precipitates with lime water, sulphate of lime, the alkalies, and salt. In solution, it is used to precipitate coloring matters of highly colored urine, when these interfere with the 2