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CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID Wap ae eee Sas Ss THE SYDENHAM SOCIETY INSTITUTED MDCCCXLIII 4) i “~ mt : — v4 f/ : G29) an ex Z, ! 4 cf A é a : aaa - om a } ce i ) YW 4 MOOT yoy NOUR === ——— LONDON M DCCCXLVI. ANIMAL CHEMISTRY WITH REFERENCE TO THE —, ~ PHYSIOLOGY AND PATHOLOGY OF MAN y —, i Se, ai — BY DR. J. FRANZ SIMON FELLOW OF THE SOCIETY FOR THE ADVANCEMENT OF PHYSIOLOGICAL CHEMISTRY AT BERDIN ETC, ETC. TRANSLATED AND EDITED BY GEORGE E. DAY, M.A. & L.M. Canras. LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS. IN TWO VOLUMES VOL. II. LONDON PRINTED FOR THE SYDENHAM SOCIETY MDCCCXLVI. } Said “= ahi fie ets ‘PRINTED BY TABLE OF CONTENTS. CHAPTER III. THE SECRETIONS OF THE CHILOPOIETIC VISCERA AND THE THEORY OF DIGESTION. Saliva Morbid saliva Saliva of animals Pancreatic fluid Bile ‘ Morbid bile . : Bile of animals ; On the action of the bile in the process of dlgestics Gastric juice Morbid gastric juice Intestinal fluid The process of digestion Diseased digestion CHAPTER IV. MILK. General physico-chemical characters of the milk Special chemistry of the milk Milk before delivery Milk immediately after delivery faaaateiel Ordinary human milk The effect of temperament on the milk . The changes in the milk dependent on nutrition Il, 42 Ad 47 49 50 54 ib. vi CONTENTS. Page Changes in the milk corresponding with the age of the infant. : 56 Diseased milk . ; ; ; : ; : 57 Colostrum of animals : 61 Milk of animals . ° : . peer. : : ib. Diseased milk of animals : . ; ; P 67 CHAPTER V. SECRETIONS OF THE MUCOUS MEMBRANES. Mucus , ‘ 2 es 70 Morbid mucus ¢ : ; 3 ’ ‘ 72 Purulent mucus . : : : : at - 83 Pus . é ‘ ; ‘ ; inn Ichor . BS ‘ : ‘ é : : 96 On the formation of mucus and pus on mucous membranes, and on the . deteetion of pus in mucus. ; i : j 97 CHAPTER VI. SECRETIONS OF THE EXTERNAL SKIN. Sweat (sudor) : : : : : ‘ 101 Morbid sweat ; ; ; tay 45a ; d 106 Sweat of animals ‘ ; : : as Z Tit: Fat. s : : ; uk, ‘ 112 CHAPTER VII. THE URINE. Healthy urine ; : : : Sere 113 Qualitative facto of urine ; ; ; , : 115 Quantitative analysis of urine ‘ ;: ‘ 5 4 134 A shorter method of separating the most important constituents of the urine 141 Composition of healthy urine é i “ : : 143, Physiological relations of the urine. ‘ ? ; i 147 Pathological changes in the urine . : : 170 Qualitative and quantitative analysis of urine modified by disease : é ye CONTENTS. On the general relations of the urine in disease urine in the phlogoses pericarditis phlebitis uterina meningitis encephalitis delirium tremens . myelitis bronchitis pneumonia pleuritis pleuropneumonia empyema emphysema | angina tonsillaris . gastritis enteritis and dysentery hepatitis peritonitis nephritis acuta Pa arthritica pe albuminosa seu morbus Brightii cystitis . metritis typhus . febris intermittens scorbutus et morbus maculosus Werlhofii chlorosis hemorrhagia cerebralis hemoptysis . heematemesis hematuria . : catarrh measles cholera rheumatism gout. erysipelas scarlatina 279 viii CONTENTS. On urine in yariola and varicella x = : ; ac scrofulosis . rachitis me osteomalacia a phthisis pulmonalis Ss diabetes mellitus . ; ; ¥ ¢ ” ” insipidus * dropsy . os jaundice me hysteria : . : ' . marasmus senilis “ carcinoma ‘ A . “ wt syphilis ei urticaria tuberculosa a herpes zoster > pompholix Fatin urine . | ‘ ; ; ; ‘ ‘ Milk in urine Excess of hippuric acid in urine Urostealith in urine Semen in urine Urine of peculiar colour Urine during pregnancy, at the period of ditivecs, and after bien On the passage of medicinal and other substances into the urine - Urine of animals CHAPTER VIII. THE SECRETIONS OF THE LACHRYMAL, MEIBOMIAN, AND CERUMINOUS GLANDS. The tears The gummy secretion of the eyes Cerumen . : 2 ; ‘ 5 CHAPTER IX. SECRETIONS AND FLUIDS OF THE GENERATIVE ORGANS. Semen - Prostatic fluid Liquor amnii ‘ ‘ ‘ . eee Fluid of the allantois. ‘ 5 ; ‘ ‘ Vernix caseosa 282 283 284 286 ib. 289 304 308 313 316 317 ib. 319 320 ib. 322 323 "ib. 324 . 326 327 ib. 329 336 342 353 ib. 354 356 359 ib. 363 364 CONTENTS. te CHAPTER X. THE INTESTINAL EXCRETIONS. Page Meconium . ‘ ; ae : ¢ } 367 Feces of infants ; ‘ j F ‘ ‘ 369 ¥ adults : ‘ ; ¥ ; ; 370 » during disease ; tae, : : ‘ ; 376 », in diabetes j Z i ; ‘ : 377 » dysentery ‘ ;: , ‘ : . 380 » enteritis ; ‘ 4 E a ; 381 » abdominal typhus : i : ‘ ‘ ib. » diarrhoea ; : ; ; d ‘ 382 » Cholera : i : ‘ ‘ : ib. » enterophthisis : ; ; . ‘ ‘ 384 »» jaundice ; 5 ‘ : ; ‘ ib. ‘Calomel-stools .. : E ; : : ; 386 Vomitus (matters discharged by vomiting) . ; ; <7 eee CHAPTER XI. THE COMPONENT PARTS OF THE ANIMAL BODY. — The bones : ; : , , P ‘ 396 Bones of the lower animals oR ; . : , 402 Morbid bones ; ; on : : : : 406 The teeth . ; é ; 3 ; ; 413 Cartilage ; ; ; , 2 es Synovia : : ‘ ‘ ; ; : 416 Cellular tissue, tendons, ligaments, skin, and hair ‘ ; ; ib. Crystalline lens and fluids of the eye ‘ ; : : 419 The arteries and veins - ‘ ‘ es : ; 421 The muscles . i ; ‘ ; ; ; 422 The brain, spinal cord, and nerves . S : ; ‘ 425 Fat ‘ ; ; — ; ‘ : 427 The glands . ° . ‘ : ; ecco Otolithes . : ; ‘ ; ‘ : = 429 x CONTENTS. CHAPTER XII. SOLID MORBID PRODUCTS. Concretions, their qualitative analysis Vesical and renal calculi Calculi of uric acid He urate of ammonia re uric (xanthic) oxide a cystin ws protein-compounds " oxalate of lime i neutral phosphate of lime e carbonate of lime is urostealith On the laminz of vesical and renal calculi, and on their quantitative analysis Urinary gravel Urinary calculi of animals Intestinal concretions in man s in animals Gall-stones in man i in animals Salivary calculi and tartar Various concretions Bouts eee Tubercle : ; i met " Scrofulous matter : - Scirrhus j : Incrustations on the surface of the body CHAPTER XIII. FLUID PRODUCTS OF DISEASE. Fluid contained in hydatids ; ovarian and other cysts ” Fluid of pemphigus ammoniaco-magnesian phosphate and phosphate of lime Page 430 437 440 442 444 445 446 ib. 448 449 450 452 453 459 461 464 466 469 471 473 474 478 480 481 482 CONTENTS. Fluid of hygroma ; ° » hydrocephalus » ascites Thoracic effusions . Subcutaneous serum in Bright’s disease Fluid of hydrocele Fluid effusions found in the body after death APPENDIX I. Ultimate cs ons of protein ‘i tritoxide of protein Pa binoxide of protein ” erythroprotid a leucin ” protid - albumen of the blood ” albumen of eggs eS or fibrin ns casein Hes crystallin % globulin ” pepsin ie chondrin ‘i glutin i glycicoll or gelatin sugar es hematin s cholic acid re urea Sar uric acid ee hippuric acid >" uric oxide % cystin vs glycerin = stearic and margaric acids + lactic acid xi Page A489 490 ib. 493 494 495 497 503 ib ib. 504 ib, ib; ib. ib, 505 ib. ib. ib. ib. ib. ib. ib. ib. 506 ib. ib. ib. ib. 507 ib. ib. ib. xii CONTENTS. APPENDIX II. ADDITIONS TO VOLUME I. Page Blood in thoracic inflammation . ~~. . 509 » intermittent fever . ; ; zs ; 510 » certain diseases of the eye ; ; : p ib. » serofula : ; ; hea 5 i » Bright’s disease ; A ; ri ‘ 514 Menstrual fluid . ‘ y ; : ; 516 ADDITIONS TO VOLUME Il. Saliva ; : . : ; i j 518 Morbid saliva ; : 3 : : ‘ -——_ ib. Fluid of ranula ; : Pe Bile . , : : : ; «Sens ib. Morbid bile ; : ; ‘ 5 ; 520 Use of the bile. 3 ; i d i j ib. . Gastric juice ; j : . ‘ ‘ ib. Vicarious secretion of milk 2 P : 521 Dumas’ experiments on the influence of food on the milk of the bitch ‘ ib. Colouring matter of urine (uroxanthin, uroglaucin, and urrhodin) é 522 Quantitative determination of urea. ee : ie Urine in Bright’s disease ‘ é y : : 528 Liquor amnii . : : : 4 ; : 541 CHEMISTRY OF MAN. PPP DLE CHAPTER III. THE SECRETIONS OF THE CHYLOPOIETIC VISCERA, AND THE THEORY OF DIGESTION. The Saliva. THE saliva is a peculiar fluid, secreted by the parotid, sub- maxillary, and sublingual glands, and conveyed from them by certain ducts into the cavity of the mouth, where it becomes mixed with the buccal mucus. It may, however, be obtained in a state of purity by collecting it as it flows from one of the ducts. The following observations respecting the secretion of the saliva were made by Mitscherlich,' on a person with a salivary fistula, in whom the saliva could be collected directly from Steno’s duct. He found that there was no flow of saliva while the muscles of mastication and of the tongue were in a state of perfect repose, and all nervous excitement avoided. He likewise observed that, during the acts of eating and drink- ing, (especially at the commencement,) the secretion was abundant, being proportionate to the stimulating nature of the food and to the degree it was masticated. From two to three ounces of saliva were collected from one of the parotid glands in the course of twenty-four hours. It is usually supposed that about ten or twelve ounces of saliva are secreted daily, but accu- rate observations are still required on this subject. Human saliva is a rather opalescent, viscid, colourless fluid ; 1 Rust’s Magaz. vol. 40. Il. 1 a THE SECRETIONS : when collected and allowed to rest in a cylindrical glass, it is observed to yield a deposit of epithelium-scales and mucus- corpuscles, while the supernatant fluid remains clear. When perfectly normal, its reaction is alkaline; it is devoid of taste and odour, and, when observed under the microscope, is seen to contain peculiar corpuscles, which differ very slightly in their form from tumid mucus-corpuscles. The appearance presented by human saliva taken from the mouth, when examined under the microscope, is depicted in fig. 13. I have always observed the cells (a) in the saliva; they appear to consist of swollen sali- vary corpuscles. The salivary corpuscles are represented in (8) ; (c) represents epithelium-scales ; and (d) fat-vesicles. Mem- branous shreds are sometimes observed, apparently fragments of injured epithelium-scales. The amount of solid residue in the saliva is very small; it is composed of fat, ptyalin, water-extract, spirit-extract, a little albumen, certain salts, and a trace of sulphocyanogen. The presence of the last constituent was first noticed by Treviranus ; it has since been detected by Gmelin and Tiede- mann, and other chemists.! The salts of human saliva are, according to Mitscherlich, chloride of calcium, lactates of soda and potash, soda either free or combined with mucus, phosphate of lime, and silica: according to Gmelin and Tiedemann, they consist of alkaline carbonates, phosphates, muriates, and traces of sulphates, toge- 1 The occurrence of this substance in the saliva is equally interesting in a physiolo- gical and chemical point of view; and it would be very desirable to establish its pre- sence in an unquestionable manner by experiments on a large quantity of saliva. Gmelin and Tiedemann (Die Verdauung nach Versuchen, vol. i, p. 9) formed an alcoholic extract of saliva, and distilled the residue, after mixing it with phosphoric acid. The fluid obtained by this distillation reddened litmus paper, after some days evolved an odour of prussic acid, yielded a deep yellow-red colour on the addition of perchlo- ride of iron, and precipitates on the addition of nitrate of silver and nitrate of peroxide of mercury. On the addition of sulphate of iron and sulphate of copper toa portion of the distilled fluid, a white precipitate was thrown down, which communi- cated a red colour to an acid solution of perchloride of iron, The clear chlorine- solution, obtained by mixing chlorate of potash, hydrochloric acid, and chloride of barium, was rendered turbid when digested with a portion of the distilled fluid, and there was a gradual deposition of sulphate of baryta, the sulphuric acid being obtained at the expense of the hydrosulphocyanic acid. Gmelin and Tiedemann observed the reaction indicating the presence of sulphocyanogen in the saliva of the sheep, and I have noticed it in the saliva of the horse. SALIVA. 3 ther with the phosphates and carbonates of lime and magnesia. According to Hiinefeld, ammoniacal salts are also present. On evaporating the saliva, we obtain a brown residue, which evolves a rather agreeable odour, resembling that of toasted bread. In certain pathological states the saliva contains other sub- stances besides those already enumerated: thus, in one case of morbid saliva I detected free acetic acid, and in another I found a considerable quantity of a substance resembling casein. The albumen contained in the saliva is indicated by the | turbidity produced on the application of heat; and after the _ removal of the coagulated albumen by filtration, the presence of the various extractive matters may be shown by the precipi- tates thrown down by acetate of lead, bichloride of mercury, and tannin; the casein may be indicated by the addition of acetic acid; ptyalin, and probably casein, by the addition of alcohol to clear and somewhat concentrated saliva; and sulpho- cyanogen, by the redness produced on the addition of perchlo- ride of iron. With a view to separate the constituents of the saliva I eva- porated a known quantity to dryness, and thus determined the water. I then treated the residue with ether, for the purpose of extracting the fat; and with water, in order to take up the ptyalin, extractive matters, and salts. The insoluble residue that had resisted the action of ether and water, consisted of albumen and mucus. Another portion of the saliva was de- canted from its precipitate, evaporated to a small residue, and the ptyalin, with a trace of extractive matter, precipitated by alcohol. When the saliva contains a caseous matter, (which I have observed in large quantity in the saliva of the horse,) the precipitate of ptyalin and casein produced by the alcohol must be dissolved in water, and the casein then thrown down by the careful addition of acetic acid. In this case, a portion of the casein precipitated by the alcohol usually remains un- dissolved by the water. I have detected free acetic acid in the saliva discharged during salivation. In order to determine its quantity, the saliva must be accurately neutralized by a solu- tion of carbonate of potash of known strength ; from the amount of the alkaline solution required, the quantity of acetic acid can be calculated. If, in addition to acetic acid, free lactic acid is likewise present, the residue of the saliva, after evaporation, 4 THE SECRETIONS: when dissolved in water, will still indicate an acid reaction, because lactic acid differs from acetic acid in not being vola- tilized at the ordinary temperature used for evaporating animal fluids. In order to determine the amount of free soda in the saliva, the dried residue must be extracted with alcohol; the free soda (which is left in the residue) must be saturated with acetic acid, the resulting acetate of soda extracted with alcohol, evaporated, and, by incineration, reduced to carbonate of soda. An analysis of my own saliva yielded the following results. It contained, in 1000 parts: Analysis 58, Water ‘ : . - . 991-225 Solid constituents ; ; é 8°775 | Fat containing cholesterin : ‘ 525 Ptyalin with extractive matter . ‘ 4°375 Extractive matter and salts . ‘ 2°450 Albumen, mucus, and cells : ; 1:400 Berzelius! found, in 1000 bats of human saliva : Water 4 ; - 992°9 —— Ptyalin ; ‘ ‘ : 2°9 Mucus : 14 Extract of flesh with alkaline lactis ‘ ‘9 Chloride of sodium : : 7 Soda ‘ . ; ; 2 According to the analyses of Tiedemann and Gmelin, 1000 parts of human saliva contain from 9 to 11:4, or even 11°9 of solid constituents, consisting in 100 parts, of phosphorized fat, extract of flesh, chloride of potassium, lactate of potash, and sulphocyanide of potassium, 31'25 ;—animal matter with traces of alkaline sulphates and chlorides, 1:25 ;—ptyalin, with alkaline phosphates, chloride of sodium, and traces of alkaline sulphates, 20-00 ;—mucus and a little albumen, with alkaline phosphates and carbonates, 40°00. This solid residue yielded on incine- ration 21:99 of inorganic constituents, 17°8 of which were soluble, and 4:1 insoluble in water. Mitscherlich found that 1000 parts of human saliva yielded from 14-7 to 16°3 of solid residue, of which 348 were insoluble both in water and in alcohol, 42° soluble in water but not in alcohol of ‘800, and 242 soluble in water and in alcohol. These proportions varied, however, in different analyses. : ' Thierchemie, p. 219. SALIVA. ; 5 The inorganic constituents in 1000 parts of saliva are, accord- ing to Mitscherlich, chloride of calcium, 1:8; lactate of potash, "95; lactate of soda, ‘24; soda, probably combined with mucus, 1:64; phosphate of lime, :17; silica, °15. [According to Dr. Wright, pure saliva is a limpid fluid, having a faint blue tinge, and a slight degree of viscidity. It is per- fectly uniform in consistence, and unobscured by frothiness or flocculi. It possesses a faint sickly odour sui generis, due to its constituent, ptyalin: this odour is strengthened by heat and by most acids, but alkalies diminish and destroy it. The saliva even of healthy people varies considerably in its specific gravity. It is always denser after a meal than during fasting ; and generally denser in an evening than in a morning. But the converse is usually the rule with dyspeptics. Dr. Wright found that animal (especially fatty) diet, and alcoholic stimulants, have a tendency to thicken the saliva; oysters, and vegetable diet, he says, produce an opposite effect. He states, as the result of many trials and observations, that healthy saliva is mostly of a sp. gr. of 1007-9. When above 1010:0 or below 1003-0, the secretion may be considered to be morbid. Healthy saliva, he affirms, is either alkaline or neutral, generally the former. If saliva be heated, it not uncommonly acquires an acidity in a few minutes, but this chiefly happens to neutral saliva. Dr. Wright believes in the existence of the principle called ptyalin, though he separates it from saliva by a new process. This process is “ to pass saliva through ordinary filtering paper, and, after filtration shall have been completed, to exhaust the residue with sulphuric ether; the ethereal solution contains a fatty acid and ptyalin.! It is to be allowed to evaporate spontaneously, and the residue left by evaporation is to be placed upon a filter and acted upon by distilled water, which dissolves the ptyalin and leaves the fatty acid. If the aqueous solution be carefully evaporated to dryness, the “ salivary matter will be obtained in a pure state.” “Ptyalin,” he says, “as thus pre- pared, is a yellowish-white, adhesive, and nearly solid matter, neither acid nor alkaline, readily soluble in ether, alcohol, and ' A reference to vol. i, p. 24, will show that Wright’s ptyalin differs in several respects from the ptyalin described by Simon. In truth, little is known regarding this constituent. oS THE SECRETIONS: essential oils, but more sparingly soluble in water. It alone possesses the characteristic odour of saliva; it is unaffected by galvanism and by most of the reagents which coagulate albumen. It is abundantly precipitated by sub-acetate of lead and nitrate of silver; feebly so by acetate and nitrate of lead, and tincture of galls; uninfluenced by bichloride of mercury and strong acids; the latter considerably heighten its proper odour and impair its solubility, whilst alkalies render it more soluble, and give it the smell of mucus. Moderate heat and oxygen gas also increase its odour, but a more intense heat or cold dimi- nishes or entirely destroys it. At a suitable temperature, ptyalin may be preserved for any length of time without risk of decomposition. The salivary fluid from which ptyalin has been removed, possesses a sickly mucous smell, decomposes much sooner than ordinary saliva, and, in the process of decay, invariably evolves ammonia. Ifthe fluid be heated, the mucous smell will be increased until the evaporation shall have been continued nearly to dryness, when a slight salivary odour may be recognized, due to a portion of ptyalin being liberated from the mucus with which it was previously in combination.” Dr. Wright says that sulphocyanogen is an invariable consti- tuent of healthy human saliva. He advises that it be sought for in the alcoholic extract of the residue left by the careful evaporation of the fluid, as the mucus, unless removed, offers considerable impediment to the action of reagents. The sulpho- cyanogen occurs in combination with potassium, the salt consti- tuting generally from ‘051 to :098 of the secretion. ‘The proportion,” he says, “is temporarily augmented by local sti- mulation of the salivary glands, as by smoking, chewing siala- gogues, &c. It is also increased by the internal use of prussic acid and salts of cyanogen, and remarkably so by the use of sulphur.” Pure saliva absorbs a variable quantity of oxygen. Dr. Wright says, “I have known the quantity absorbed to exceed 21 times the bulk of the saliva; but I once met with an instance in which the healthy secretion did not absorb more than half its volume of oxygen. The difference is generally dependent upon the carbonic acid gas naturally contained in the saliva, the proportion of which gas to the secretion varies from one eighth to one twelfth in volume, though, in some particular i fork eee tip : eo a Ae Ve ep cs 7 a , q Sd aol Ce ral eee oe a e- ; bas aoe ae SALIVA. 7 cases, it is much more abundant.” He says that saliva, in its healthy state, contains also oxygen gas, which it can be made to evolve on the application of heat. This in some measure aids its digestive powers; for he found that saliva which had been exposed for some hours to an atmosphere of oxygen, con- verted a much greater quantity of starch into gum and sugar than other saliva which had not been so exposed. This state- ment, founded upon a great number of comparative experiments was made by Dr. Wright long before the apparently less correct observation of Liebig, that the saliva collects “bubbles of air” to assist the digestive function. In pure saliva there are no “bubbles of air ;” the absorbed gases are carbonic acid and oxygen, the latter only contributing to the digestive properties of the fluid. As the result of numerous analyses, the process of which Dr. Wright has fully detailed, he gives the following as the constituents of the healthy secretion :1 Water . ; ; 2 9881 Ptyalin ; : ; 18 Fatty acid y ; . 5 Chlorides of sodium and potassium. 1°4 Albumen with soda : : > Phosphate of lime "6 Albuminate of soda ; aS 8 Lactates of potash and soda ; “3 Sulphocyanide of potassium “9: Soda ‘ : : 5 Mucus, with ptyalin , : 2°6 L’Heretier has recorded the mean of ten analyses of the saliva of healthy persons, collected while fasting : Water ‘ : : 986°5 Organic matter ; ; 12°6 Inorganic matter : . 9 The salivary matter, or ptyalin, formed 2°5 of the 12°6 parts of organic matters. In children, the amount of water is generally increased. As a mean of four analyses, he found : ' Der Speichel in physiologischer, diagnostischer, und therapeutischer Beziehung, p. 28, Wien, 1844. Dr. Wright’s investigations first appeared in the Lancet. 8 THE SECRETIONS : Water . x . 996°0 ' Organic matter ‘ : 3°5 Inorganic matter ‘ ° 5 The ptyalin amounted to only 1-1. He was unable to detect any difference between the saliva of man and woman. Enderlin has made numerous analyses of the ash left after the incineration of the saliva, and has always found it to have the same constituents. He considers that its alkaline reaction is due to the tribasic phosphate of soda (8NaO, PO.) which retains the mucus and protein-compounds in solution. Enderlin observes that, independently of conclusions deduced from the ash, he has sought unsuccessfully, in a direct manner, for lac- tates in the saliva. On incinerating salivary mucus obtained by washing that constituent from a filter, the residue is found to consist of phosphate of lime, with traces of chloride of sodium and phosphate. of soda, the same composition as the tartar that collects on the teeth. A quantitative analysis of the ash from a large amount of saliva obtained from different persons, yielded the following results : A. Constituents soluble in water. Tribasic phosphate of soda (3 NaO, PO,) : 28°122 . Chlorides of sodium and potassium 61-930 92-387 Sulphate of soda . ‘ ; 2°315 B. Constituents insoluble in water. Teenie of lime ’ ; ; i magnesia ; : . 5509 ] yi peroxide of iron Very little is known with certainty regarding the part taken by the saliva in the process of digestion. Spallanzani fancied that he had observed that food inclosed in tubes pierced with numerous apertures, and moistened by the saliva, was more rapidly digested than when simply moistened with water. Berzelius, however, found that the saliva exerts no greater solvent power than pure water, and Miiller confirms his state- ment. Himefeld, on the other hand, believes that the object of the saliva is to destroy the tenacity of the food, and he — Py (ST or WERT rats LT ts DSR oy peta Leah Ses: MORBID SALIVA. 9 thinks that it has the power of reducing fibrin to the condition of a viscid fluid. [The services which the saliva performs in the animal eco- nomy are classified by Dr. Wright as follow: Active.—1. To stimulate the stomach and excite it to acti- vity by contact. 2. To aid the digestion of food by a specific action upon the food itself. 3. To neutralize any undue acidity in the stomach by supplying a proportionate alkali. Passive.—1. To assist the sense of taste. 2. To favour the expression of the voice. 3. To clear the mucous membrane of the mouth, and to moderate thirst. Mialhe! has recently announced the discovery of an active principle in the saliva analogous in its physical and chemical characters to diastase. Jt is solid, white or greyish-white, amorphous, insoluble in alcohol, but soluble in water and spirit. The directions for obtaining it are the following: Filter saliva and treat it with five or six times its weight of absolute alcohol, adding it as long as any precipitate occurs. This animal dias- tase is insoluble, and falls in white flocks, which must be col- lected on a filter and dried. It forms about °22 of the whole saliva. | Leuchs? was the first who observed that saliva converts boiled starch into sugar. Morbid Saliva. The saliva becomes affected in various morbid conditions of the system, but the nature of the changes that it undergoes has not hitherto been sufficiently studied. Morbid saliva sometimes contains a free acid; this is most commonly lactic acid, but, in some cases, acetic acid is likewise present. The acid reaction may be at once detected by test paper; while normal saliva communicates a blue tint to red litmus paper, this, on the contrary, reddens blue paper. I have frequently seen the saliva acid in acute rheumatism, and in cases of sali- ' Lancette Francaise, 1845, April. * Kastner’s Archiv. 1831. 10 THE SECRETIONS: vation. According to Donné,’ the saliva has an acid reaction in all cases of irritation and inflammation of the stomach, in pleuritis, encephalitis, intermittent fevers, acute rheumatism, uterine affections, and amenorrhea. Brugnatelli? detected oxalic acid in the saliva of a phthisical patient. The secretion of saliva is sometimes increased to an extraordinary degree, - constituting salivation ; in such cases, the chemical characters of the saliva are also more or less affected. In a specimen of saliva forwarded to me for examination, which was obtained from a patient who had just terminated a course of mercury of some weeks’ duration, I observed an acid reaction arising from the presence of free acetic acid. It was very viscid, of a yellow colour, and possessed a sickly, disagreeable, acid smell. It contained no mercury. After evaporation to dryness, all the acid reaction had disappeared: thus showing that it contained no free lactic acid. This saliva contained a very large quantity of semifluid fat, a considerable amount of albumen, and traces of caseous matter. Under the microscope, an immense num- ber of fat-vesicles were seen, some epithelium-cells, and a very few partially-destroyed saliva-corpuscles. 1000 parts of this saliva were composed of : Analysis 59. Water : ; ; 974°12 Solid Feet SiH f : ; 25°88 Yellow viscid fat ‘ 6°94 Ptyalin with extractive matter and traces of casein 3°60 Alcohol-extract with salts : : 7°57 Albumen ; 3 ; yh of The salts consisted of a largely preponderating amount of the chlorides of sodium and potassium, associated with the lactates of soda and potash, and with a small quantity of the earthy phosphates. On contrasting this saliva with the normal fluid, we are struck with its large amount of solid constituents, arising not from any increase of the ptyalin, but of the fat, the extractive matters, the albumen, and the salts. [L’Heretier gives the mean of three analyses of this secretion during mercurial ptyalism. He found: * Arch. Génér. de Méd. 1835, May. * Stark. Allgemeine Pathologie, p. 1074. MORBID SALIVA. 11 Water ; ‘ 970°0 in place of 986°5 Organic matters - 28°6 12°6 Inorganic matters ‘ 1-1 £9 The mean amount of ptyalin was 2°6, or very nearly the normal quantity. He attributes the large amount of organic matter to the increased quantity of mucus secreted by the buccal membrane. Dr. Wright also found that the saliva of mercurial ptyalism contained an unusual amount of mucus. It consisted of: Water ; : ‘ : 988°7 Ptyalin : ; : : 1-9 ~ Fatty acid ; ; 4 . *4 Albumen with soda, and \ 6 Albuminate of soda Mucus with a trace of ptyalin > ‘ 3°8 Lactates : ee Phosphates . ; ; Soda . 2°4 Muriates tine Hydrosulphocyanates He could not detect the slightest trace of mercury in it. | Gmelin! has examined saliva discharged in consequence of salivation produced by mercurial inunction. In one case it was brown and turbid, and contained a large quantity of fat but not much albumen; in another instance it presented a yellow tint; it contained a large quantity of yellow fat, and when heated, gave no perceptible indication of coagulation, In both cases, but most decidedly in the latter, indications of mer- cury were obtained.?, Thomson’ found the saliva resulting 1 Pogg. Ann. 41, p. 438. ? Gmelin employed Smithson’s method for the detection of the mercury. A large quantity of saliva was treated with nitric acid, and evaporated; the residue was di- gested with nitric acid and dissolved in water; and, after the removal of fat by filtra- tion, a stream of sulphuretted hydrogen was passed through it. The precipitate obtained by this process contains sulphuret of mercury; it must be collected, digested in nitro-muriatic acid, evaporated, dissolved in dilute hydrochloric acid, and a bit of gold-leaf enveloped in tin-foil, or encircled by iron wire, suspended in the fluid. The gold is tarnished if mercury is present. No tin-foil should be used that has not been itself tested for mercury. In place of the gold-leaf I have employed the blade of a knife with advantage. * Annals of Philosophy, vol. vi, p. 397. 12 THE SECRETIONS : from the administration of mercury, turbid ; it deposited flocculi of coagulated albumen. It was not precipitable by tannic acid, had a specific gravity of 1003-8, and contained, coagulated albumen, 2°57; mucus, 3°67; chloride of sodium, ‘9; water, 992-8. Bostock analysed the saliva of a man who was secreting about two quarts daily in consequence of mercurial salivation. It was of a clear brown colour, neutral, viscid, but not stringy, and barely transparent. It became clear, however, after the deposition of the minute flocculi suspended in it; the appli- cation of heat, and also the addition of corrosive sublimate, gave indications of the presence of albumen. It yielded 2° of dried residue. After the discontinuance of the mercury, the saliva was found to be less transparent; it reddened litmus paper, contained more albumen, and more solid constituents generally. Vogel! analysed the saliva of a man with sponta- neous salivation; it contained 991-2 parts of water; 4-4 of ptyalin, osmazome, fat, and albumen; and 4°4 of salts of soda, potash, and lime; hence, in respect to the amount of solid constituents and ptyalin, this saliva did not differ very much from the normal standard. Mitscherlich also found that, in the salivary flow excited by nervous irritation, the amount of the solid constituents was not increased, that the ptyalin and sulphocyanogen were even below the normal standard, while, on the other hand, the extractive matters were somewhat in- creased. A similar observation has been made by Guibourt. I examined the saliva of a patient suffering from an inflam- matory affection of the pancreas. It was discharged from the mouth in large quantity; it was a clear, viscid fluid, mixed with mucus, alkaline in its reaction, and exhibiting, under the microscope, mucus-corpuscles, numerous oil-vesicles, epithelium- — cells, and membranous shreds: its specific gravity was 1005 ; and 1000 parts yielded only ten of solid residue, which, in addi- tion to mucus, and a very small quantity of albumen, consisted principally of an extractive matter which developed an aromatic odour on the application of heat, of fat, certain salts, and a little ptyalin. ' Lehrbuch der Physiologie, von R. Wagner, p. 212. ye rie 28 Fae rie OO MORBID SALIVA, 13 [L’Heretier observes that, in chlorosis, the amount of water increases in proportion to the progress of the disorder. An analysis of the saliva in this disease is given in page 299 of his Pathological Chemistry. In dropsy, with albuminous urine, the saliva contained : Water ‘ i ‘ 985-9 Organic matter ’ ‘ 13°6 Inorganic matter ‘ ‘ 5 In most inflammatory affections, the amount of water is ‘diminished. The following numbers express the mean results of six analyses in cases of inflammatory fever, pneumonia, and erysipelas : Water x 3 ‘ 968°9 © Organic matters ; ; 30:0 Inorganic matters ‘ > 11 The mean amount of ptyalin was 3°6; the ordinary amount, according to L’Heretier, being 2°5. The three following forms of morbid saliva have been ana- lysed by Dr. Wright : Fatty saliva. albuminate of soda Water : : F 987°4 Ptyalin ‘ i ; : 7 Adventitious fatty matter and fatty acid ‘ 3°9 Albumen with soda, and \ 15 albuminate of soda Sulphocyanide of potassium ‘. ‘ a trace Mucus : ‘. = : 2°4 Lactates ‘ Potash Muriates ‘ i Soda . } 1:8 Phosphates Lime Sweet saliva. Water ‘ : : : 986°9 : Ptyalin . : F 3 Fatty acid : : ; ‘ ‘2 Muco-saccharine matter , ‘ . 5°6 Albumen with soda, and \ 4 14 THE SECRETIONS: Snlphocyanogen ; : : a trace Mucus with a trace of aie : : 2°6 Lactates / Potash Muriates ; } Soda . } 19 Phosphates Lime . Bilious saliva. Water ; ; : : 986°7 Ptyalin ° ; 3) Fatty matter and fatty sal. ; ; 13 Biliary matter. ; ‘ ‘ 3°2 Cholesterin A : : s “4 Albumen with soda, and \ 1-9 albuminate of soda Mucus ‘ : " > 16 Carbonates A Potash Muriates i Soda . ; 2:3 ] Phosphates Lime . Saliva of animals. I have analysed the saliva of a horse suffering from ozzena. Professor Hertwig kindly assisted me in exposing Steno’s duct; and, in the course of eight hours, (during which time the horse was feeding,) about five ounces of saliva were collected from the opened duct. The fluid was viscid, of a faintly yellow colour, devoid of odour, alkaline in its reaction, and possessed a specific gravity of 1006. (Schultz? collected in a similar manner 55 ounces 7 drachms of saliva from a horse in the course of twenty-four hours.) After some time, the saliva deposited a white sediment, consisting of irregular mem- branous shreds and saliva-corpuscles. On the application of heat it became turbid. A copious precipitate was thrown down on the addition of acetic, dilute sulphuric, or lactic acid; and on evaporation it became covered with a film of coagulated casein. Perchloride of iron produced a vivid red colour, and a slight precipitate. It contained a larger amount of solid con- stituents than human saliva, and a very considerable quantity of casein, part of which coagulated on evaporation, and part was thrown down by acetic acid; in this manner it was sepa- ! De Alimentor. concoctione. Berol. 1834. aed aa SALIVA OF THE SHEEP. . 15 rated from the ptyalin. 1000 parts of this saliva were com- posed of : Analysis 60. Water ‘ a ‘ 982-000 Solid constituents ; : é 18-000 Fat containing cholesterin é . 120 Ptyalin with extractive matters . / 4°442 Casein ‘ 4 : 5°422 Albumen ‘ 5 ‘ ‘601 Extractive matters and salts : ; 7°178 Saliva of the dog. The saliva of a healthy dog was collected by exposing Steno’s duct, and examined by Gmelin and Tiedemann. It was rather turbid, of a pale yellowish-white colour, thick, capable of being drawn out in threads like albumen, alkaline in its reaction, and 1000 parts left, on evaporation, a solid residue of 25-8, consisting of a little extractive matter soluble in alcohol, an average quantity of ptyalin, mucus, a very large amount of chlo- ride of sodium, together with alkaline carbonates, acetates, sul- phates, and phosphates, and a little phosphate and carbonate of lime. - Saliva of the sheep. Gmelin and Tiedemann succeeded in collecting between three and four ounces of saliva in the course of fifteen hours from the stenonian duct of a sheep. It was of a reddish tint, in consequence of being mixed with a little blood, perfectly fluid, faintly alkaline, and of a slightly saline taste. 1000 parts of the saliva contained : Water : 989-0 Extract of flesh, an organic shatter with which chloride of sodium crystallized in octohedra, chloride of sodium, and a little sulphocyanide of sodium . I'l A little ptyalin, with a good deal of phosphate pce Sivhcuadn of soda, and chloride of sodium ‘ 8-2 Mucus or albumen, with a little phosphate and iadeacate of potash Gr 16 THE SECRETIONS: | The Pancreatic Fluid. The most accurate analysis of the pancreatic juice is that of Tiedemann and Gmelin.’ Earlier observers, as, for instance, De la Boé, De Graf, and others, had shown that it is an acid, clear, rather viscid fluid, possessed of a saline or acid-saline taste. Wepfer, Pechlin, and Brunner, on the other hand, had described it as turbid, of a whitish colour, not acid, but having a saltish taste, somewhat like the lymph. Mayer? described the pan- creatic juice of a cat as transparent, viscid, decidedly alkaline, and containing albumen, chloride of sodium, and a peculiar animal matter. Magendie found it alkaline and albuminous in a dog, and in birds it contained so large an amount of albu- men as to coagulate on the application of heat. Tiedemann and Gmelin cut down upon the pancreatic duct of a strong well-fed dog, and, in the course of four hours, col- lected about 155 grains of the fluid secretion. The portion that was first collected was turbid, and somewhat red, probably in consequence of the presence of a little blood. This was placed aside. The subsequent portion had a blueish-white tint ; could be drawn out in threads like dilute albumen, had a faintly saline taste, and an alkaline reaction. 1000 parts left 87 of solid residue. The red portion first collected has a faintly acid reaction. The principal constituents were extractive matters, chloride of sodium, albumen, and a sort of modified casein. The pancreatic juice of a sheep was found by Gmelin and Tiedemann to be clear, slightly acid, and of a faintly saline taste. 1000 parts left 36 of solid residue, consisting of the same ingredients as in the dog. In this instance, also, the portion that escaped during the latter part of the experiment was alkaline, and was richer in solid constituents than the fluid that escaped earlier; it contained 51-9 of solid constitu- ents in 1000 parts. | The following is the result of their analyses : In the dog. In the sheep, Water ft é - 917°2 963°5 Extractive matters and salts soluble in alcohol 36°8 15°5 Caseous matter and soda-salts soluble in water 15°3 2°8 Albumen and salts ‘ - $ 35°5 22°4 ' Op. cit. vol. i. p. 25. * Deutsch. Arch. fiir die Physiologie, vol. iii, p. 170. 1S, hg NRE ryt = BILE. 17 The alcohol-extract of the pancreatic juice of the dog yielded a very singular reaction. On the addition of a little solution of chlorine to the dissolved alcohol-extract, a vivid rose-red tint was produced, and, in the course of twelve hours, there was a precipitation of delicate violet-coloured flocculi. The colour was immediately destroyed by the addition of an excess of chlorine. An attempt to isolate this colouring matter proved unsuccessful. Leuret and Lassaigne have analysed the pancreatic juice of a horse, and the result of their investigation is, that it is almost identical in its composition with human saliva. This statement is so much at variance with the results obtained by Tiedemann and Gmelin, that we must conclude that Leuret and Lassaigne were not sufficiently careful in their investigation. We are still unable to state with any degree of certainty what part the pancreatic fluid performs in the process of digestion. There can be no doubt that when the pancreas is diseased, the pancreatic fluid must be also affected, but we are perfectly in the dark as to the nature of those changes. The Bile. Bilin and urea can hardly be regarded as simultaneous pro- ducts of the metamorphic action of the blood ; for while I have detected small quantities of urea in the blood of a healthy calf, I have never been able to recognize the least trace of bilin or of bile-pigment. Hence, while urea is produced not only in the kidneys but in other parts of the system, bilin seems to be produced and secreted only in the liver. The bile is a very complicated fluid. According to the latest researches of Berzelius, it contains bilin ; cholepyrrhin (or bili- phein); biliverdin ; mucus; cholesterin ; oleate, margarate, and stearate of soda; chloride of sodium; sulphate, phosphate, and lactate of soda; and phosphate of lime. Gmelin and Tiedemann, as well as Frommherz, mention casein and ptyalin, and the carbonates and sulphates of soda and lime, among the constituents of the bile. A perfect analysis of bile would be a subject of extreme labour and. difficulty, and we must, therefore, confine our atten- tion to its most important constituents. Let us suppose that II, 2 18 THE SECRETIONS : it was required to ascertain the amount of bilin, bilifellinic acid, and cholesterin, in a specimen of bile; the fluid must be first evaporated to dryness, and the amount of water thus estimated ; the residue must be repeatedly extracted with ether, the ethe- real solution evaporated to dryness, and its residue, consisting of cholesterin and fluid fat, thoroughly washed with cold and not too strong alcohol, which dissolves the greater portion of the fluid fat. It must then be digested with hot alcohol of 0-83; and as this solution cools, the cholesterin separates in crystals. After the removal of the fat, the residue is treated with anhydrous alcohol, which takes up bilin, bilifellinic acid, and biliverdin. The filtered alcoholic solution is then treated with a solution of chloride of barium, as long as a dark green precipitate falls ; and afterwards with baryta water, guitatim, as long as it causes any turbidity; it is then filtered, the excess of baryta thrown down by a stream of carbonic acid, the car- bonate of baryta removed by filtration, and the solution evapo- rated to perfect dryness. The residue is dissolved in anhydrous alcohol, all the bases are thrown down from the alcoholic solu- tion by sulphuric acid dissolved in strong spirit, and then, after filtration, the solution is mixed with moist, pure carbonate of lead, and the greater part of the alcohol distilled. The fluid remaining in the retort is removed by filtration from the mso- juble portion, the lead removed by sulphuretted hydrogen, and the fluid evaporated. The residue, after being extracted with ether, leaves pure bilin mixed with a certain amount of fellinic and cholinic acids, which must be separated with oxide of lead. We then obtain pure bilin and bilifellinic acid combimed with oxide of lead. An accurate quantitative determination of the most important ingredients of the bile, although difficult, is by no means im- practicable. It is, however, very uncertain whether the result of the analysis would afford any insight into the true character of that changeable secretion. From the latest researches of Berzelius, it appears that the bilin is so unstable a compound, that it is hardly possible to obtain bile in the condition in which it is secreted by the liver, or as it exists in the gall-bladder: for when bile is left to itself, and much more when it is acted on by heat and other more or less energetic agents, the bilin undergoes a series of metamorphoses by which fellinic, cholinic, ot oe &-. ? ae i AS Blas teed ee Loy BILE. 19 and very probably also cholanic and fellanic acids are produced. The biliary secretion, as it exists in the liver, may be regarded as pure bilin mixed with biliverdin and fats; the bilin probably commences its metamorphoses in the gall-bladder, and conti- nues them in its passage onwards into the intestinal canal. If fellinic and cholinic acids are formed in the gall-bladder, then the presence of the two bilifellinic acids in fresh bile may be at once assumed, since they are only to be regarded as combina- tions of the former with different proportions of bilin. It is not by any means probable that cholic acid exists in fresh bile, and the presence of dyslysin and taurin may be positively denied ; consequently, the biliary resin, the mixture of fellinic and cholinic acids and dyslysin does not pre-exist in the bile. Berzelius and Thénard have made quantitative analyses of healthy human bile: they found, in 1000 parts : Berzelius. Thénard. Water x ‘ ; 907-4 Water. ‘ : 909-0 Bilin, fellinic acid, &c. ; 80°0 Yellow and very bitter resin $7°3 Mucus dissolved in a free alkali 3°0 Brown pigment and mucus 1°8—9-°0 Free alkali and the ordinary salts 9°6 Albumen , ‘ 38°2 Soda holding the resin in solution < 3 51 _ Salts of potash and soda, and peroxide of iron o% 4°] According to Gmelin and Tiedemann, human bile contains biliary sugar, brown pigment, a little biliary resin, cholesterin, ptyalin, mucus, oleic acid, and salts. [In the year 1837, Demarcay announced that the bile con- sisted essentially of an organic acid combined with soda. He termed this acid choleic, and obtained it in the following man- ner: Bile from which the mucus had been precipitated by alcohol was evaporated on the water-bath, and ten parts of the dried residue were dissolved in 100 of water, to which ten of hydrochloric acid had been added. Allowing evaporation at a moderate temperature to proceed, it was observed that a dark green oil collected on the surface, while, at the same time, the fluid became turbid. On removing the oil, and allowing the fluid to rest for some time, it gradually became clear, with the precipi- tation of a green deposit. This dark green bitter precipitate is 20 THE SECRETIONS: Demarecay’s choleic acid, and is regarded by him as constituting nine tenths of the solid constituents of the bile. It is still mixed with margaric acid, cholesterin, pigment, &c. After the removal of these impurities, it is described by Demargay as a yellow, spongy, pulverulent matter, which rapidly absorbs oxygen from the atmosphere ; very bitter, slightly soluble in ether, soluble in water, and very soluble in alcohol. Its solutions have an acid reaction, decompose carbonates, and form a pecu- liar class of salts with bases from which the choleic acid may be removed by acetic acid. Its composition is represented by the formula C,,H,,NO,,. The choleate of soda obtained by adding an alcoholic solution of soda to an alcoholic solution of choleic acid till there is an alkaline reaction, and then passing a current of carbonic acid through it to remove the excess of soda, possesses all the characters of bile; it yields, on evapo- ration, a brown resinous mass, and is soluble in water and in alcohol. 5 When choleic acid is boiled with hydrochloric acid, it yields ammonia, taurin,' and choloidic acid ; the latter being insoluble, is deposited. (Compare this with page 46, vol. I.) | Choloidic acid is solid, fusible, of a yellow colour, and bitter taste, insoluble in water, and soluble in alcohol. It combines with bases, neutra- lizing them, and forming salts which are soluble in alcohol. It contains no nitrogen, and its formula is C,,H.,,O.,. Dr. Kemp has communicated some experiments relative to the bile, tending to show that it is principally composed of a mere simple solution of a salt of soda, the acid of which differs from the choleic acid of Demarcay in several respects ; he terms it bilic acid. Liebig has published a memoir based on Kemp’s experiments, in which he arrives at very similar conclusions, but regards bilic acid as identical with the choleic acid of Demargay and the bilifellinic acid of Berzelius. Theyer and Schlosser have subsequently published an account of some new researches on the bile which were made in the Giessen laboratory, and confirm the accuracy of Liebig’s pre- vious conclusions. In a recent essay on the bile, by Platner,? it is shown that 1 It has been recently asserted by Redtenbacher that taurin contains 262 of sulphur, Hence the formula C,H, NO,, (see vol. I. p. 47) fails to represent its true com- position. 2 Muller’s Archiv, No. 2, 1844. BILE. 21 the bilic acid and acid bilate of soda may be procured in a crystalline state. In a subsequent communication by the same chemist, after correcting certain errors in his first paper, he proceeds to show that two distinct substances are met with in perfectly fresh bile: ‘I have been able,” he observes, ‘to cause bile, which was evaporated in a water-bath, and freed from mucus and the greater part of its salts by repeated solu- tion in alcohol, to crystallize immediately. For this purpose nothing further is necessary than to add ether repeatedly to as strong an alcoholic solution of the bile as possible, and then to set it aside in a cool place. The principal and most impor- tant constituent of the bile then crystallizes, in the same manner as in my former experiments; but }—1of the bile used does not crystallize, but remains as a yellowish-brown syrup. I have not been able to succeed in separating this in any manner from the crystals; consequently, I can say nothing more concerning its nature. It is, however, evidently a different substance from the principal constituent of the bile, possibly a product of its decomposition. The decomposition of the bile begins even in the organism, and it is impossible to examine fresh bile which is not partly decomposed. The brown liquid appears to consist principally of biliary colouring matter. I must, however, re- mark that the crystals have also a slightly yellow tint. The principal constituent of bile is a compound of soda with a peculiar organic body, and this compound may be immediately procured from the bile without its undergoing any important alteration. Liebig called this compound bilate of soda; I have denominated it choline-soda. It does not appear to me suffi- ciently proved that the principal organic constituent of bile is positively an acid. It is possible that, like albumen, it may combine with acids as well as with bases. The most recent examinations of the bile by Berzelius would then be partly true. Further experiments must decide this. These, however, are peculiarly difficult, because, in separating the bile from soda, an acid body may undoubtedly be formed. From the above observation, it is further evident that the formula advanced by Liebig for bilic acid must be incorrect; for Kemp, Theyer, and Schlosser have not analysed the essential biliary ingredient in a perfectly pure state, but have always at the same time in- cluded the brown syrup. | 22 THE SECRETIONS : Morbid Bile. Our knowledge of the changes that the bile undergoes in disease is still very superficial. In persons suffering from dropsy, the bile is stated by Forget to be thinner, and, in persons with diseased liver, thicker, than in the normal state. I examined the contents of the gall- bladder of the woman with icterus, referred to in vol. I, p. 329. I only obtained a small quantity of viscid, dirty yellow fluid, from which alcohol precipitated mucus and albumen. The portion soluble in alcohol yielded, after evaporation, a small quantity of a viscid substance with a sweet rather than a bitter taste. Bizio! has analysed a remarkable specimen of bile taken from the gall-bladder of a man who died in a jaundiced con- dition. It was a fluid of a dark-red colour, thick, of a nauseous but not bitter taste, with an odour of putrid fish, and holding in suspension red and black particles. It contained fatty oil, 3°972; stearin, 8°613; green resin, 2:030; a yellow, non-nitro- genous, hard substance, soluble in alkalies, in cold hydrochloric acid, and in alcohol, 1°937; erythrogen, 4°157; dissolved he- matin, 3:148; a gummy-saccharine extract with colouring matter, 1:978; soluble albumen, 7°282; fibrin, 11°348; phos- phate of soda, 1-340; chloride of sodium, 0-984; phosphate of lime, 1:320; peroxide of iron, 0°532; water, 51:232. [Scherer? analysed the bile of a man who died in a state of icterus. It was a thick fluid of a blackish green colour, and exhibited under the microscope a large number of pigment-cells. It contained in 1000 parts : Water ; < 5 859°6 Solid constituents é 140°4 Bilin . “ ; 48°6 Bilifellinic acid Z ; 30°5 Fat é ; i 8-6 Bile- pigment d ‘ 44°3 Salts 5 ‘ , 8:0 Not a trace of cholesterin could bé discovered in this bile, ' Brugnatelli Giorn. di Fisica, vol. xv, p. 455. ? Untersuchungen, &c. p. 103. MORBID BILE. — 23 which Scherer regards as singular, although, according to Berzelius, it amounts to only °00012 of healthy bile (in the ox), a quantity easily overlooked. The bile-pigment? in healthy bile is imponderable ; its amount in this case, as well as that of the solid constituents generally, is enormous. | Chevallier? found that the bile of a man with scirrhous pan- creas, who died jaundiced, was of a pale greenish yellow colour, evolved a putrid odour, had an alkaline reaction, and a faint, slightly saline taste: it contained a yellow, semi-crystalline fat, green resinous matter, ptyalin, osmazome, soluble albumen, hydrosulphate of ammonia, and phosphate, sulphate, and hydro- chlorate of soda. Chevallier found that the bile of a woman who died from pulmonary phthisis was of a brownish yellow colour, and yielded 2° of dried residue, of which 0:83 was biliary sugar. According to Chevreul, the bile in cases of phthisis contains very little fat. The bile of a woman who died from the effects of syphilis is described by Chevallier as of a dark green colour; it yielded 20— 308 of dried residue, of which one third, or 0:94, was biliary sugar, with resinous and yellow matter. Pheebus? found that, in persons who died from cholera, the gall-bladder was usually tolerably full, (sometimes to an excess,) and that the bile was rather dark-coloured. According to Hermann, the bile in cholera contains an excess of resin. In cases of fatty degeneration of the liver, there is, accord- ing to Thénard, a diminution of the biliary resin, and the bile appears as a mere albuminous fluid, and by the time that the liver contains five sixths of its weight of fat, the bile loses all its original characters. Lehmann‘ states that the bile of a dropsical boy developed a large amount of hydrosulphate of ammonia, a circumstance which, in other cases, did not occur even when the bile had been kept for some days. 1 [Scherer has recently investigated the composition and properties of biliary co- louring matter. A notice of his researches may be found in my Report on the Pro- gress of Chemistry in “ The Half-yearly Abstract of the Medical Sciences,’ vol. i, 1845.] ? Journ. de Chim. Méd., vol. ii, p. 461. 3 Cholera Archiv, vol. i, p. 399. 4 Summarium, vol. xii. 1839. 24 THE SECRETIONS: Bile of Animals. The bile of animals has been examined by Berzelius, Gmelin, Thénard, myself and other chemists. [According to the latest observations of Berzelius, filtered ox-gall, when evaporated to dryness at a temperature of 266°, gives off 928°38 parts of water, and leaves 71°62 of solid residue, consisting of— Mucus 2 s 2°310 Extractive matter insite in sete with dicate sulphates and phosphates : : 4°334 Chloride of sodium, lactate of soda, bats stron matter soluble in alcohol i = : . 15-000 Bilin and cholepyrrhin Fo ; : 50-000 Cholesterin “ $ ; : ; 001 According to Enderlin,! the following salts occur in _ the bile of the ox: Choleate (or bilate) of soda, Tribasic phosphate of soda, Alkaline sulphates, Chlorides of sodium and potassium, Phosphate of lime, . Phosphate of magnesia, Phosphate of peroxide of iron, and occasionally Sulphate of lime. The bile of the ox and of the swine Ling likewise been analysed by Thénard, and the bile of the dog by Gmelin, but the de- scriptions are of so vague a character as to be of little or no use. The same objection applies to their examination of the bile of various birds. | In the bile of the Python bivittatus Berzelius found bilin (as in the mammalia), a small quantity of bilifellinic acid, bile-pigment the same as in other classes of animals, a little crystalline biliary matter precipitable by carbonate of potash, similar to that which occurs in the bile of fishes, ptyalin or a substance resembling it, a peculiar animal matter soluble only in boiling water, fatty acids, and the ordinary salts. The bile of the Coluber ' Annalen der Chemie und Pharmacie, 1844. BILE OF ANIMALS. 25 natriz is described by Gmelin as of a grass-green colour, trans- parent, perfectly fluid, and passing through the ordinary change of colour (blue, red, and yellow) on the addition of nitric acid. The bile of the Rana esculenta and R. temporaria is very fluid, of a pale green colour, and yields the ordinary series of tests with nitric acid. The bile of the water-frog leaves a somewhat crystalline residue on evaporation; the bile of the grass-frog has a sweetish taste, and is less bitter than fish-bile. The bile of the Cyprinus leuciscus is described by Gmelin as green, transparent, and fluid, communicating a sweet and after- wards a very bitter taste to the gustatory organs, neutral in its reaction, affected, as to its colour, by nitric acid like other bile, and coagulating immediately on the addition of potash imto a greenish white granular mass, becoming covered, on evaporation, with an almost colourless crystalline film, and yielding 14°38 of a dark green, transparent, crystalline residue. The bile of the Cyprinus barbus is similar to that of C. leuciscus in its physical characters, and yields 19°3° of a dark green crystalline residue. The solid residue of the bile of the Salmo fario and Esox lucius is stated to be non-crystalline. On the Action of the Bile in the process of Digestion, We are as ignorant of the action of the bile on the che- mical changes that the food undergoes in the intestinal canal and in the process of chylification, as of the exact influence of the saliva or of the pancreatic juice. Experiments, with the view of deciding this point, have been instituted by Brodie and by Tiedemann and Gmelin, and the conclusions to which they lead are, that the bile does not exert any material influence upon digestion and chylification. Assuming that these experiments were correctly performed, the bile must be regarded as a mere excretion, whose removal from the organism is as necessary for the preservation of the normal constitution of the blood as the removal of carbonic acid, urea, &c. Tiedemann and Gmelin state as the results of their observa- tions on animals, in which the flow of bile into the intestine was prevented: Ist, that digestion (as had been stated by Brodie) proceeds just as perfectly as when the supply of bile is not 26 THE SECRETIONS: hindered ; 2d, that the contents of the small intestine, czecum, and large intestine, after the application of a ligature to the ductus communis choledochus, do not differ inany essential degree from their ordinary state ; and 3d, that the bile plays no essential part in the formation of chyle. Notwithstanding these general conclusions, they found that the chyle of dogs, in whom the ductus communis choled. was tied, was perfectly clear, whilst in the natural state it is white and turbid in consequence of the fat held in suspension, a diffe- rence not to be passed over as altogether unimportant. Another undeniable effect of the bile in chylification consists in the neu- tralization of the free acid of the chyme by the alkali that is as- sociated in so unstable a manner with the biliary secretion, in consequence of which the bilin gradually begins to undergo certain changes, but whether of the same nature as in the labo- ratory of the chemist it is impossible to decide. [That the bile is not merely an excrementitious fluid, in- tended to remove effete matter from the blood, but that it is a secretion essential to the animal economy, was rendered almost certain by the experiments of Berzelius, Theyer, and Schlosser, which showed that the human feces contained much too small a quantity of a substance resembling bile to justify the idea that it is evacuated in this manner. A further proof that the bile is absorbed and not excreted is afforded by an examination, made by Enderlin, of the ash yielded by the con- tents of the different portions of the intestinal canal of a hare. He found that the ash from the contents of the duodenum alone effervesced on the addition of an acid, thus showing that the choleate of soda (which yields the carbonate on incineration,) is absorbed before reaching the jejunum. Schwann has re- — cently established this opinion beyond a doubt, by a series of well- devised experiments on dogs. He tied the ductus communis cho- ledochus, and at the same time formed a fistulous opening in the gall-bladder, by which the bile escaped externally. His most important conclusions are, Ist, That when the bile does not get into the bowel, its absence is generally perceptible in dogs, about the third day, by a marked diminution in weight; and, 2dly, That unless the channel for the conveyance of bile to the duodenum is re-established, symptoms of deficient nutrition, GASTRIC JUICE. 27 wasting, debility, &c., ensue, and death is the ultimate conse- quence. | If the bilin becomes decomposed in the intestinal canal into various constituents, through the influence of the acid chyme, then a wide field of investigation is open to us respecting the function of the biliary secretion in relation to chylification. No explanation has yet been afforded of the discrepancy in the amount of albumen contained in the chyme absorbed by the intestinal villi, and in the chyle discharged by the absorbents, (even without passing through the mesenteric glands.) May it not happen that a constituent of the bile acts on some hitherto ill-defined protein-compound of the chyme, and con- verts it into the form known as uncoagulated albumen ? ON THE GASTRIC JUICE, DIGESTION, AND THE CHYME, Gastric Juice. The gastric juice has been examined by numerous chemists, in consequence of the importance attributed to it in the process of digestion. There have been found in it free acids, a con- siderable amount of salts, and certain indefinite animal sub- stances, which were known at the period to which we refer as osmazome or salivary matter. Experiments on artificial diges- tion have thrown much light on the nature of the gastric juice. Eberle’ proved that an artificially-formed gastric juice does not thoroughly dissolve food, unless a small quantity of gastric mucus, or a portion of the mucous membrane of the stomach be added to it. On the strength of this discovery, Miller and Schwann? instituted a series of experiments, from which Schwann was led to conclude that the gastric juice contains a peculiar substance, which, cooperating with an acid, possesses the pro- perty of rapidly dissolving substances insoluble in mere water, or in a mixture of extractive matters, salts, and a little acid, as for instance, fibrin, coagulated albumen or casein. To this 1 Physiologie der Verdauung. Wiirzburg, 1834. 2 Ueber die kiinstliche Verdauung des geronnenen Eiweisses, Miiller’s Archiv, 1836, 28 THE SECRETIONS : somewhat problematic substance he gave the name of pepsin: Wassmann! and Pappenheim? have endeavoured to isolate it. (See Vol. I, p. 224.) Prout? has shown that the free acid of the gastric juice is muriatic-acid. Gmelin and Tiedemann‘ have found it associated with acetic acid, and in the gastric juice of horses, with butyric acid: there is no doubt that lactic acid is likewise contained in it. From the researches of the latter chemists, which are the most perfect that we possess on the subject, it appears that in addition to the free acids, the gastric juice contains mucus, and occasionally (in horses) a very small quantity of albumen, ex- tractive and salivary matter, and that the ash consists of alkaline muriates and sulphates, a little phosphate and sulphate of lime, chloride of calcium, magnesia, and peroxide of iron. The gastric juice collected from the empty stomach, although mixed with mucus, was tolerably clear; it was neutral, of a yellow colour, a saline taste, and on evaporation left only 2° of solid constituents. Gastric juice obtained by irritating the stomach with pebbles was acid, viscid, and of a pale brown colour. Hiinefeld does not believe that there is any free hy- drochloric acid in gastric juice. Berzelius analysed gastric juice collected by Beaumont from a young man with a fistulous opening into the stomach. It had been kept for five months before Berzelius received it, and was therefore totally unfit for the purpose of analysis. In that condition it was clear, yellow, devoid of odour, reddened litmus paper in a decided manner, and left a solid residue of 1°2699, consisting principally of crystals of chloride of sodium, in the interstices of which was a brown extractive matter, which, on exposure to the air, resolved itself into a dark brown thick syrup. Its quantity was too small to admit of its being accu- rately examined, but it was proved to contain lime and a proto- salt of iron. Beaumont describes human gastric juice as a clear, inodorous, saline, and very acid fluid, which effervesces on the addition of alkalies. Dunglison detected in it free hydro- chloric acid, an animal substance soluble in cold but not in ' De Digestione nonnulla. Diss. inaug. Berol. 1839. ? Zur Kenntniss der Verdauung. Breslau, 1839. 5 Philos. Transactions, 1824, p. 45. * Die Verdauung nach Versuchen, p. 150. GASTRIC JUICE. 29 hot water, and acetic, phosphoric, and hydrochloric acids, in com- bination with potash, soda, lime, and magnesia. The gastric juice of a horse, collected by irritating its empty stomach with pebbles, was found by Gmelin to contain : Water "i A x 984-00 Solid residue ; : 16°00 Organic constituents ! 10°52 Salts soluble in water ; 5°02 Salts insoluble in water . 0°46 [Braconnot has examined the gastric juice collected by means of sponges from the stomachs of dogs, but his results are not very definitely given. | Hence it appears that the principal constituents of the acid gastric juice are pepsin ; a substance not yet carefully examined, but bearing a close resemblance to extract of flesh; an unex- amined substance resembling salivary matter; free acids, es- pecially muriatic acid; mucus; sometimes a little albumen; salts, especially alkaline chlorides, muriate of ammonia, (according to Hinefeld,) and a small quantity of earthy salts. [M. Blondlot has recently published a treatise on Digestion,' detailing very numerous experiments made upon dogs, in which fistulous openings into the stomach were maintained for upwards of two years. ‘The gastric juice was obtained in very large quantities. Submitted to distillation, the fluid passing over did not exhibit the slightest acid reaction, whilst the re- sidue in the retort was always strongly acid. Hence he con- cludes that the acid of the gastric fluid is neither hydrochloric nor acetic acid, since both these are volatile. The gastric fluid of other animals gave the same result on being distilled. When chalk or any other carbonate of lime was added, no effervescence ensued, proving the acid not to be the lactic. M. Blondlot concludes that the acid reaction of healthy gastric juice is owing to the presence of superphosphate or biphosphate of lime. He adds—Ist. That there is no other acid fluid which can remain acid, and fail to decompose car- bonate oflime. 2d. That sulphuric acid, added to gastric juice, ' Traité analytique de la Digestion. Paris, 1843. 30 THE SECRETIONS: precipitates an abundance of sulphate of lime, and oxalic acid precipitates oxalate of lime. 3d. Potass, soda, ammonia, and lime water, produce abundant precipitates of neutral phosphate of lime. 4th. That the calcined ash of gastric juice is not deli- quescent, dissolves without effervescence in hydrochloric acid, forming chloride of calcium; it therefore contains neutral phosphate of lime, the excess of acid being driven off in the calcination. M. Blondlot believes that the digestive property of gastric juice depends, not on its obvious chemical constitution, but upon a peculiar organic principle. If exposed to a temperature | of 104° to 122° F., or higher, it loses entirely and irrevocably its digestive powers, although to all appearance, and even as to its composition, as made known by analysis, it remains un- changed. With the exclusion of the air, gastric juice may be kept for two years without loss of its activity; but with the free access of air, it putrefies in five or six days, although the chyme which it forms from nitrogenous organic substances may be preserved for two or three months without change. The precipitation of all the lime it contains does not affect its ac- tivity, nor are its chlorides indispensable, but whatever acts upon its organic constituents, (heat, strong alcohol, or strong acids,) or which removes them, (such as animal charcoal, chlorine, tannic acid, or acetate of lead,) destroys all its digestive properties. M. Blondlot also shows—a. That coagulated albumen resists the action of the gastric juice only from its compact form. When coagulated in very small particles, as the white of an egg beaten into a froth and poured into boiling water, it is digested as quickly as soft fibrin. 6. That the action of the stomach in coagulating milk is not due to its digestive principle solely, but to its acid, which acts like lactic acid. c. That the effect of the gastric fluid upon bones, whether entire or not, is to disintegrate them slowly, beginning at the surface, and to reduce the earthy matter into a fine chalky powder, but without dissolving or decomposing it. The earthy matter not being dissolved, proves that no hydrochloric acid has acted upon it; it is all discharged with the feces. Since the work of M. Blondlot was published, two other French chemists, MM. C. Bernard and C. Barreswil,' have made 1 Journal de Pharmacie, Jan. 1845. GASTRIC JUICE. 31 an experimental investigation into the properties of the gastric juice. They start with the assumption that this fluid owes its digestive properties to the union of two principles: Ist, an acid ; 2d, a peculiar organic matter destructible by heat. What is the nature of the acid? ‘The principal fact which has been adduced to prove that the acid reaction is owing to the presence of biphosphate of lime is, that it may be treated with carbonate of lime without effervescence. Our experiments show that this arises from the dilution of the acid, which allows the carbonic acid to be dissolved as it is formed. When, therefore, the gastric juice is concentrated, it causes a considerable effer- vescence with chalk. Moreover, gastric juice dissolves neutral phosphate of lime, whilst this salt is entirely insoluble ina solu- tion of the biphosphate. On distilling gastric juice, the first distillate exhibits no acid reaction. If a mere trace of acetic acid or acetate of soda is added previous to distillation, it gives an acid reaction ; the normal acid is not therefore acetic. This also appeared, at first sight, to prove it could not be hydro- chloric acid; but on distilling water rendered slightly acid by hydrochloric acid, nothing passes over at first but pure water, the acid not distilling until the end of the operation. On dis- tilling gastric juice a neutral limpid liquor passes over, which is not precipitated with nitrate of silver; when about four fifths has distilled over, the distillate is perceptibly acid, nevertheless, it does not render a solution of nitrate of silver turbid ; but at the end, and when only a few drops of the gas- tric juice remain in the retort, an acid liquid passes over which precipitates salts of silver ; this is, doubtless, hydrochloric acid. Does this acid exist free in gastric juice, or has a chloride been decomposed in this operation? When the least trace of oxalic acid is added to gastric juice which we know contains lime, a turbidity is produced from the formation of an insoluble oxalate of lime ; but if to water acidified with 2000ths of its amount of hydrochloric acid, and containing chloride of lime, the same re- agent be added, no turbidity ensues. This clearly proves that hydrochloric acid exists as a chloride in the gastric juice, and not in a free state. When concentrated by evaporation, gastric juice is strongly acid, effervescing with chalk, and not loosing its acid reaction in the presence of an excess of the chalk. This proves the pre- 32 THE SECRETIONS: sence of phosphoric acid. On saturating the acid with lime and oxide of zinc, and filtering the solution, the neutral filtrate contains both zinc and lime, therefore phosphoric acid is not the only free acid in the juice. What is the acid combined with the zinc and lime in the filtered solution? It is one which, as we have seen, passes over at the end of the distillation, and does not precipitate salts of silver. These characters be- long to lactic acid. On distilling water slightly acidulated with lactic acid, a small quantity of chloride of sodium being added, we obtain a fluid analogous to gastric juice; first, pure water passes over, then an acid which does not precipitate salts of silver, and the last drops carry over hydrochloric acid. So that it is evident that the presence of hydrochloric acid in the last product of distillation of the gastric juice is owing to the de- composition of the chlorides by lactic acid.” Hydrochloric acid cannot exist in a free state in the presence of a lactate, a phosphate, or an acetate. ‘ We have observed,” say the authors, ‘‘in the acid of the gastric juice all the cha- racters of lactic acid, as pointed out by M. Pelouze; both give soluble salts of lime, barytes, zinc, and copper, a double salt of copper and lime, deeper in colourthan the simplesalt, and a salt of lime soluble in alcohol, precipitated by ether.” From the above facts, MM. Bernard and Barreswil conclude that the acid re- action of the gastric juice is not owing to biphosphate of lime, but arises from a free acid, which is not hydrochloric or acetic acid. They have always found lactic acid, with a minute proportion of phosphoric acid, the latter being a product of the reaction of the lactic acid on the phosphates present. In their opinion, lactic acid is a constant production of the © stomach. They do not mean to say that the digestive powers of the gastric juice are owing to lactic acid; on the contrary, — they think if an acid reaction be indispensable, other acids may supply its place, because among the various salts constantly in- troduced into the stomach with the food, some will have their acid replaced by the free lactic of the stomach, and the new acid liberated may supply the place of the normal acid. In a more recent memoir they enter more fully into the nature of the active organic matter, on the presence of which “they believe the digestive power of the gastric juice to depend. It is precipitated and destroyed at a temperature of 190°. One GASTRIC JUICE. 33 of the most remarkable of its properties is that its digestive powers vary according to the medium in which it is contained. In the gastric juice, which is acid, it dissolves nitrogenous mat- ters, such as fibrin, gluten, and albumen ; but exerts no action on baked starch; but if the gastric juice is rendered alkaline by the addition of a little carbonate of soda, it rapidly dissolves the starch, and no longer possesses the power of acting on the nitrogenous matters. As these physiological properties are exactly those of saliva and the pancreatic fluid, it became an in- teresting point to ascertain if a change in the reaction of these fluids would cause a corresponding variation in their solvent power. ‘This was found to be the case; on acidulating these naturally alkaline fluids, their ordinary mode of action was in- verted, and they were enabled to dissolve nitrogenous matters, while their capability of dissolving starch was lost. From nu- merous and varied experiments they believe that one and the same organic principle (the agent of digestion) exists in the gastric juice, the pancreatic fluid, and the saliva, and that its physiological action varies according to the acid or alkaline nature of the fluid in which it occurs. . M. Melsens' has also examined the gastric juice, and denies the accuracy of Blondlot’s conclusions. | The fluid secretion in the crops of birds is stated by Gmelin and Tiedemann to have an acid reaction; and the fluid in the glandular stomach, even when empty, contains free acids, es- pecially muriatic and acetic acids. Brugnatelli observed that Iceland spar inclosed in tubes is decidedly attacked after remaining for some time in the stomachs of hens and turkeys; and Treviranus noticed that a porcelain basin, in which the chyme of hens had been digested, was cor- roded, from which he concluded that fluoric acid was present. Tiedemann and Gmelin did not succeed in detecting fluoric acid in the gastric juice of ducks, although they carefully sought for it. Morbid Gastric Juice. It is well known that the gastric juice sometimes assumes anomalous characters, but important as such modifications are ' Journal de Pharmacie, Jan. 1845. Il. 3 34 THE SECRETIONS: to practical medicine, little is known with certainty in relation to their true causes, and still less respecting the peculiar influ- ences that morbid gastric juice exercises on chymification and chylification. The question naturally suggests itself, whether morbid changes in the gastric juice may not be the origin of many of the diseases of early childhood. Such changes may originate purely from internal causes (nervous influences,) or from a complication of the above with external influences, such as diet, &c. The only modifications respecting which we can speak with any degree of certainty are the following: Ist, There may be a considerable excess of free acid; 2dly, There may be a diminution of free acid; and 3dly, The gastric juice may become posi- tively alkaline. In all probability, with these there are associ- ated other changes in the composition of the fluid, producing an injurious effect on the process of digestion; but on this sub- ject we are unable to speak with certainty. The increased acidity of the gastric juice usually arises from an excess of those acids which exist in it in a normal state, namely, muriatic, acetic, and lactic acid. When there is a tendency to the formation of an excess of acid in the gastric juice, it appears to be developed from the food. Muriatie acid is principally developed from animal food; acetic and lactic acids from vegetable and especially saccharine food, such as acid bread, beer, and wine ; and the fatty acids from an excessive use of fatty matters. An excessive acidity of the gastric juice is frequently observed in cases of gastritis serosa, and of scrofula and rickets associated with disease of the spleen. In gout, po- dagra, and nettlerash, the gastric juice contains, according to Stark’, phosphoric and uric acids; the presence of the latter acid must however be regarded as very problematical. The cases in which the gastric juice exhibits a positively al- kaline reaction are comparatively rare. This deviation from the normal condition arises chiefly from the use of salted or putrid food and drink containing basic salts, from prolonged fasting, and especially from care and anxiety (Stark.) The experiments of Purkinje and Pappenheim show that when the gastric juice is mixed with bile, its digestive powers are diminished. | ' Allgem. Pathologie, p. 848. CHYME. 35 Our knowledge of the uses of the gastric juice in the process of digestion, is much clearer than that of the other fluids already described, as the saliva, pancreatic juice, and bile. We know that alimentary matters insoluble in mere water are readily dis- solved by the pepsin of the gastric juice combined with a little free dilute acid, and that some of these substances become chemically changed during the process of solution. The intestinal fluid. The small intestines, when empty and not irritated, secrete an almost neutral, very viscid fluid, but during digestion, or when irritated, the secretion becomes decidedly acid. We cannot examine this fluid in a state of purity, but it is most probable that in its constitution it is similar to the gastric juice, and that it possesses the property of acting on those substances which have escaped the solvent power of that fluid. According to Tiedemann and Gmelin it contains a large quantity of albu- men ; this is, however, most likely due to the pancreatic fluid which becomes mixed with it. It must also be more or less mixed with the biliary secretion. On the process of Digestion, and the Chyme. By the process of digestion we understand the solution and the modifications that the food undergoes in the stomach and adjoining portion of the intestinal canal, together with the ab- sorption and metamorphosis of the nutrient fluid (chyme) con- tained in the reduced pulpy mass of the food, till it becomes perfect chyle. The subject of digestion has attracted much attention for the last seventy years, but unfortunately the results that have been obtained are by no means proportionate to the time and labour involved in the experiments instituted in relation to this de- partment of physiology. The discovery and isolation of pepsin forms a new epoch in the chemical history of digestion. It is now in our power to institute experiments on artificial digestion with every prospect of success ; we can examine the new products that are developed, and we shall be thus led to the true understanding of the for- 36 THE SECRETIONS: mation of chyle, which as we know is always tolerably con- stant in its composition, although evolved from the most di- verse species of nutriment. Previously to commencing such researches, it would be’ re- quisite to study and examine the pepsin obtained from different classes of animals; for it is very possible, as Berzelius suggests, that it may be a mixture of various substances, differing in dif- ferent classes of animals. On this account, various simple natural substances, after the addition of a due quantity of acid (which must be determined experimentally,) should be artificially digested with the different sorts of pepsin, and the products, both soluble and insoluble, carefully analysed. Such terms as osmazome, salivary matter, &c. must be rejected. The researches, of Berzelius and myself have opened the way for an exact and separate determination of the extractive matters and ptyalin. We should then be enabled to see what real connexion there is between the substances resembling extract of flesh which are produced in artificial digestion, and those that are actually obtained from flesh itself. Our knowledge of the changes that the different elements of _food undergo in the process of digestion is at present very limited ; it is confined to the following leading points. 1. Albumen is dissolved and chemically changed. This ob- servation was made by Eberle, and has been confirmed by Miller, Schwann!, and others. The digested albumen no longer coagulates at the boiling point ; it is stated to have been changed into osmazome and salivary matter, (a vague statement requiring further proof,) and according to Schwann, into a third albumi- nous principle, which is thrown down by carbonate of soda, and in that condition is insoluble in water and spirit, soluble in muriatic and acetic acids, and not precipitable by acetate of lead — or alcohol, but copiously by nitric acid and bichloride of mer- cury, and partially by ferrocyanide of potassium and toma: acid. 2. Coagulated casein is partially converted by artificial di- gestion into albumen ; soluble casein becomes coagulated when submitted to the aetion of a solution of sugar of milk and pepsin, but not when acted on by the pepsin alone. 3. Fibrin is rapidly dissolved, and, from the experiments of 1 Miiller’s Archiv, 1836, p. 68. CHYME. 37 Tiedemann and Gmelin, appears to be partially converted into albumen. 4, Glutin becomes so changed by artificial digestion, that it loses its property of gelatinizing, and can no longer be precipitated by chlorine. 5. Sugar of milk, when submitted for a sufficient time to the action of pepsin, becomes completely converted into lactie acid. This fact has been established by Fremy and myself. 6. Starch is partially converted into sugar. (Tiedemann and Gmelin.) 7. The fluid found in the stomach of a horse, fed with oats, contained butyric acid, a resin, a substance resembling extract of flesh, salivary matter, and albumen. From recent experiments on digestion, we know that alimen- tary substances are dissolved as rapidly in an artificial digestive fluid, consisting of pepsin and properly diluted muriatic acid, as they are in the gastric juice itself. Hence we are justified in © the conclusion that pepsin, the free acid, and a suitable tempe- rature, are the principal agents in gastric digestion, and that the motions of the stomach are chiefly with the view of pro- moting the due admixture of the food with the secreted fluid, and of propelling it towards the pylorus, through which it must pass in order to enter the duodenum. It is impossible to state with certainty whether the pepsin and free acids dissolve and modify the food through a catalytic influence, or-whether they enter into any chemical combination with it, the products of these combinations being the dissolved and changed matter. If, however, the conversion of sugar of milk into lactic acid is explained by the catalytic action of the pepsin, we may fairly conclude that the pepsin exerts a similar influence on other substances, if no facts to the contrary present themselves. Hinefeld is imclined to attribute considerable influence in di- gestion to the ammoniacal salts of the gastric juice, in conse- quence of having observed that under certain conditions fibrin is readily soluble in the muriate or lactate of ammonia, especially when free lactic acid is also present. The various articles of food are dissolved in the process of _ digestion with different degrees of facility. Those which ap- proximate most closely to the constituents of the chyle, obvi- ously require the least modification, as, for instance, the fluid 38 THE SECRETIONS: albumen and yelk of egg, fibrin, boiled albumen, muscular flesh, casein, and the protein-compounds generally. Certain substances are not at all digestible, as, for instance, woody fibre, husks of fruit, horn, hair, &c. We always observe a relation — between the degree of the changes requisite for the assimilation of different sorts of nutriment, and the complexity of the di- gestive apparatus. Hence, in the carnivora, the intestinal canal is much shorter and simpler than in the herbivora, In the ruminantia, the first two stomachs do not secrete an acid, true gastric juice, such as occurs in the stomachs of men and carnivora, but a thin yellow saline fluid containmg enough alkaline carbonates to produce a marked effervescence on the addition of anacid. Their nutriment (grass, hay, &c.,) after being chewed and mixed with saliva, is first received into these sto- machs, where it is soaked in the alkaline fluid, which dissolves and takes up vegetable albumen and glutin. The fiuid gra- dually passes onwards into the third stomach, while the insoluble portion returns to the mouth for a second mastica- tion. The fluid obtained by pressure from the contents of the first stomach (the paunch) contains, according to Tiede- mann and Gmelin, carbonic acid and sulphuretted hydro- gen, albumen in combination with soda, carbonate of ammo- nia, and certain animal matters, one of which is volatile and assumes a red tint on the addition of muriatic acid. In addi- tion to carbonic acid and sulphuretted hydrogen gases, the first two stomachs occasionally develop (especially after the use of fresh clover) an extraordinary quantity of carburetted hydrogen. The third stomach secretes an acid fiuid, and in the fourth sto- mach the acidity is much more marked, the substances dissolved by the alkali being first precipitated and then redissolved in the excess of acid. Finally chyme is produced, said to be ana- logous to that which is formed in the stomachs of men and carnivora. In birds the food is first moistened in the crop with a faintly acid fluid ; from thence it passes into the proventriculus, where it meets with a peculiar and. very acid fluid, and it finally reaches the muscular stomach, which effects its thorough trituration. On leaving the stomach the food enters the small intestine, where it becomes mixed with the pancreatic juice and the bile. Here it commences to be absorbed by the intestinal villi; more- CHYME. 39 over, it is here mixed with the intestinal secretion, and it is probable that the digestion, not entirely accomplished in the stomach, is here perfected. There are many points connected with the process of digestion which have not been hitherto explained. We may especially instance the conversion of chyme into chyle. It is very diffi- cult to understand the source of the large quantity of albumen found in the chyle, even before it has passed the mesenteric glands, and just after its absorption by the intestinal villi. An experiment made by Tiedemann and Gmelin on the chyme and the chyle of a horse fed with oats, will place the difference clearly before the reader. a denotes the fluid expressed from the thick, pulpy, acid contents of the stomach. It was of a brownish yellow colour, turbid, became darker on exposure to the air, and much more turbid on boiling, and on the addition of bichloride of mercury. 6 is the brownish yellow fluid from the duodenum. c is the brownish yellow fluid obtained from the central portion of the small intestine, mixed with mucous flocculi and with a tough al- buminous substance, apparently resembling salivary matter. d is the brownish yellow fluid from the lower part of the small intestine. eis chyle from the absorbents before its entrance into the mesenteric glands. f is chyle from the absorbents after its passage through them: and g is chyle from the thoracic duct. We shall omit the amount of water in these various fluids, and merely compare the composition of their solid residue. 1000 parts of solid residue contained : a. b. « d. e. fe g- 1. Resinous matter, with an acid soluble in ether . 156 079 025 O15 2. Resinous matter soluble in anhydrous alcohol, alco- hol-extract, and salts so- luble in spirit J . 61°56 44°61 67°25 77:60 67°50 42°24 30°44 3. Spirit-extract, probably gummy mattersand salts 25°26 10°80 5°08 }r20 4. Insoluble brown matter . 0°66 9°14 5. Brown nitrogenous mat- ter, soluble only in water 16°32 12:44 7:40 250 2:17 311 ¢- Albumen, oxydised extrac- tive nfatter, and phos- phate of lime ‘ . 11:00 7:11 5:03 3:10 27:56 .49°82 63°98 40 THE SECRETIONS : The numbers in 2, under 4, ¢, and d, refer only to the extrac- tive matters and salts soluble im alcohol, while those under e, J, and g refer not merely to them but also to the fat, the re- lative proportions of which may be seen in the analyses 4, 5, and 6, of the chyle, in p. 357, vol. 1. The numbers in 6, under e, f, and g, indicate the amount of pure albumen in the chyle, whilst — under J, c, and d extractive matter and phosphate of lime are included. It is to the two lines 2 and 6 of the above table that I wish especially to direct attention. The chyme 8, ¢, and d differs from the chyle, by a deficiency of fat in the former, and by an excess of albumen in the latter. If the fat is really con- tained in the chyme, which we cannot doubt that it is, in what state of combination can it occur so as to escape detection ? Does the chyme contain fatty acids, combined with the alkalies (soaps), and the chyle, ordinary fat? The chyme contains an extraordinarily large amount of substances soluble in alcohol, whose place in the chyle seems to be supplied by albumen ; may we not endeavour to clear up this difficulty by supposing that some still unknown proteim-compound, soluble in alcohol, has been converted into albumen? If the chyme contains so small a quantity of pre-existing protein-compounds, as the above analyses 6, c, d teach us, we must assume that their extraordi- nary increase in the chyle of the absorbents and of the tho- racic duct, must be at least in part due to the influence of the lymphatic glands and vessels, and therefore either directly or indirectly to the blood. But, in opposition to this view, we may remark that it is impossible to conceive that the blood can impart that identical quality to the chyle which renders that fluid the means of supplying nutriment to the blood, and of imparting to it the carboniferous and nitrogenous materials requisite to supply the place of those that have been removed from the body in consequence of waste of tissue. _ If, however, we bear in mind that the mesenteric veins absorb a fluid from the chyme different from that which is taken up by the lym- phatics, we may then perhaps account for the discrepancy between the chemical composition of the chyme and the chyle, by the assumption of a ‘ vis electiva’ residing in the absorbent vessels of these two systems; for the lymphatics absorb and carry off a fluid abounding in protein and nitrogenous com- pounds, while the venous system takes up an excess of the DISEASED DIGESTION. 4] compounds of carbon and hydrogen; and since the absorbents of the lymphatic system in the small intestines must have taken up a very albuminous chyle, the chyme examined by Gmelin may on that account have been poor in coagulable albumen, and in the same manner the gradual decrease of the albumen in the chyle, as the large intestine was approached, would be accounted for. Diseased digestion. It is by no means rare to meet with an excessive formation of acid both in the stomach and the intestines, especially in children. Acid eructations, a sour smell from the mouth, and frequent green stools, afford indications of a morbid digestion which, doubtless, originates in too acid a condition of the gastric and intestinal fluids, and on the consequent rapid production of lactic and acetic acids from vegetables and milk. I have observed that the feeces of a child at the breast, suffering from improper digestion, consisted of a large quantity of coagulated casein, and a very acid, greenish, whey-like fluid, with nume- rous oil-vesicles on its surface. The fat was isolated and con- tained a large amount of the fatty acids. A copious secretion of gas is a frequent consequence of dis- eased digestion. This gas is not a mere mixture of carbonic acid and nitrogen with a little hydrogen (the ordinary gases) but also contains a considerable amount of sulphuretted hydro- gen, and, in all probability, phosphoretted hydrogen and car- buretted hydrogen. There can be no doubt that there are anomalies in the pro- cess of chylification, in consequence of which an unsuitable chyle is prepared and conveyed to the blood, modified both in its quality and its quantity ; but with respect to the particulars of these anomalies we are still perfectly in the dark. CHAPTER IV. MILK. Tne milk is a white, fatty, and rather thick fluid, which is secreted by the female breasts during pregnancy and after delivery. A metastatic or vicarious secretion of milk from the skin, the navel, the groin, the stomach, the intestines, the mucous surface of the genital organs, or the axilla, is by no means rare: it has also been observed in the breasts of men. General physico-chemical characters of the milk. Perfectly fresh milk has always a decidedly alkaline reaction, and it retains this property for a longer or shorter time: the milk of women retains its alkaline reaction longer than that of cows; and the milk of healthy women longer than that of in- valids. On examining the milk under the microscope we perceive a great number of fat-vesicles of very different sizes swimming in _a clear fluid, and occasionally epithelium-cells. From repeated comparisons I have found that the fat-vesicles in the milk of woman are generally rather larger than those in the milk of the cow. In addition to these fat-vesicles, we observe, under certain circumstances, other microscopic objects, of which I shall treat subsequently. The fat-vesicles have, as Raspail declared, a solid envelope, a point which has been confirmed beyond dis- pute by Henle and myself. Raspail considers that it is com- posed of coagulated albumen ; it is, however, more than probable that it consists of coagulated casein. Henle! has shown that this capsule may be dissolved by acetic acid, and that butter then issues from it; it is probable, however, that this fluid fat becomes inclosed in a new envelope, for Ascherson? has observed ! Froriep’s Notizen, 1839, No. 449. ? Ueber die Hautdriisen der Frésche und iiber die Bedeutung der Fettstoffe, Miiller’s Archiv. 1840. CHARACTERS OF MILK. 43 that a membrane immediately forms around every drop of fat that is brought in contact with a solution of albumen; and I have found that fat shaken with a caseous substance (crystallin) in a state of solution, causes a partial coagulation by the for- mation of such membranes or capsules. I have shown that when woman’s milk is evaporated, and the residue reduced to a fine powder, and extracted with ether (which takes up the butter), there are left the capsules of the fat-vesicles, which, when mixed with water, and placed on the object-stage, may be observed with the microscope. Milk is materially affected by a large number of substances, especially by those that precipitate its casein. The addition of any of these substances causes it to coagulate, that is to say, the casein becomes insoluble and incloses the butter, and thus produces the separation of awhey-like fiuid from the caseous mass. A precipitation of this nature is brought about by alcohol which, at the same time, takes up a very small quantity of fat: when milk is shaken with ether, no precipitation of casein ensues, but the milk becomes rather clearer and the ether is found to contain fat, but only a small portion of all that is contained in the milk. When milk is left to itself for a considerable time, it coagulates, in consequence of the conversion of a portion of its sugar into lactic acid: this change often takes place very rapidly in cow’s milk, and generally more quickly than in woman’s milk. If the milk is allowed to remain still longer exposed to an ordinary temperature, the surface becomes covered with peculiar forms of mould, and, under certain conditions which are not accurately known, particular species of infusoria are developed. These infusoria are the cause of a blue or yellow colouring matter, which is especially distributed over the sur- face, a phenomenon that has long been observed, and which has recently been carefully investigated by Fuchs. Rennet likewise precipitates the casein apparently by a cata- lytic action on the sugar of milk, by which it is converted into lactic acid ; hence the precipitation is hindered by the addition of an alkali, and, as Herberger has observed, does not occur in milk which abounds in alkaline salts. The solid constituents of the milk vary from about 9 to 358 ; the specific gravity usually lies between 1028 and 1042. 44 THE SECRETIONS: SPECIAL CHEMISTRY OF THE MILK. Constituents of the Milk, and methods of separating them. The following substances are contained in a state of solution in healthy milk: casein, fat (including olein, stearin, butyrin, caproin, and caprin), sugar of milk, extractive matters, and salts. The salts are the chlorides of sodium and potassium ; lactates of potash, soda, probably of ammonia, of lime, and magnesia; phosphates of potash, soda, lime, and magnesia ; and traces of phosphate of peroxide of iron. The plans that were formerly proposed for the analysis of milk could not give satisfactory results. For instance, the fatty portion which collects on the surface (the cream) was analysed separately from the poorer fluid beneath it; by this means, then, were obtained accurate estimates of the two sepa- rate portions, but not of the milk collectively. | The course adopted by the French chemists, was to evaporate the milk, to take up the butter with alcohol, or a mixture of - alcohol and ether, and then to wash out the sugar from the residue ; if we reflect, however, that the dried casein of cow’s milk is always slightly soluble, and that of woman’s milk is freely soluble in water, the source of error in this system be- comes at once obvious. By the adoption of this incorrect method, Payen fixed the amount of casein at 0°232, while the mean of seventeen analyses performed by myself yielded 3°48, or more than fourteen times as much. The following is the method that I adopt :! a known quan- tity of milk is evaporated to dryness, and the residue weighed; by this means we determine the amount of water. A weighed portion of the dried and finely-powdered residue is thrice ex- tracted with five or six times its volume of boiling sulphuric ether, in order to remove the fat. After the removal of the fat, the residue is placed in a porcelain basin, is again pulverized, and digested with a little warm water. The pulp which is thus formed is treated with an additional quantity of boiling water, in which it is partially soluble if the analysis is being conducted ' Die Frauenmilch nach ihrem chemischen und physiologischen Verhalten, p. 27. CONSTITUENTS OF MILK. 45 with cow’s milk ; it dissolves entirely, with the exception of an inconsiderable quantity of coagulated casein, if woman’s milk is used. The solution is then evaporated at a gentle tempera- ture to the consistence of a thin syrup, and is treated with ten or twelve times its volume of alcohol of 0°85, which precipitates the casein. As the casein may retain a little sugar, it is expe- dient to digest it once or oftener with a little water, and to treat the dilute pulp with spirit; the casein that remains must be thoroughly dried and weighed. The spirituous solution con- tains the sugar, and the greater part of the extractive matter, from which the sugar cannot be easily separated. A partial separation may be effected in this way: we may dissolve the impure sugar in a little water; on the addition of strong alcohol, the sugar with a very little extractive matter, is precipitated, while the alcoholic solution contains extractive matters and a little sugar. On evaporating this solution to the consistence of a syrup, and adding strong alcohol to it while still hot, some more sugar separates on cooling. I usually estimate the salts by incinerating a weighed por- tion of the dried residue of the milk; and, in some cases, I have separated the soluble from the insoluble salts. This analysis of milk does not yield, as Berzelius' justly observes, any very accurate results, since casein is slightly soluble in alcohol ; although strong cold alcohol takes up only a very small portion, dilute hot alcohol dissolves a considerable quan- tity. The determination of the sugar and of the extractive matters by the course that I have indicated is still more imac- curate. Berzelius proposes to precipitate the casein (and the butter) by rennet; but it must be observed that, by this means, we do not obtain results of greater accuracy, since a portion of the casein always remains in solution in the whey. ‘This amounts to a considerable quantity in woman’s milk, but is comparatively slight in the milk of the cow,” and has always to be obtained by means of alcohol from the evaporated solution. In order to precipitate the casein thoroughly by rennet, it would be requisite to supersaturate the free alkali of the milk by acetic or lactic acid; we should then obtain the casein in a state of combination with these acids; in fact, casein precipi- ! Thierchemie, p. 698. 2 Die Frauenmilch, &c. p. 33. 46 THE SECRETIONS: tated by rennet from non-acidulated milk does in reality exist in this condition. If we precipitate the casein of cow’s milk by sulphuric acid, and decompose the sulphate by carbonate of lime or baryta, we shall obtain soluble compounds of casein with lime or baryta. The casein of woman’s milk is very imperfectly precipitated by sulphuric acid. If albumen is present in milk, which is sometimes the case, it must be determined by a separate experiment. The milk must be boiled, and the coagulum must be collected and ex- tracted with boiling spirit, in order to remove the sugar and fat ; it must then be dried, and its weight estimated. The amount of albumen obtained in this manner is deducted from the amount of casein obtained by the method which has been — described, and which must sisi include both the casein and albumen. [Haidlen! has recently proposed a new method for analysing milk. It consists in coagulating the milk by gypsum, by which means the error in the determination of the casein that resulted from all former methods, is avoided. When milk is stirred with about one fourth of its weight of finely-pulverized gypsum, and heated to 212°, it is entirely coagulated ; and if the whole is then evaporated to dryness, a brittle mass is obtained, which is easily reducible to powder. From this powder the butter may be extracted by ether; the sugar of milk and soluble salts may be removed by hot alcohol of 0°85; while the caseate and sulphate of lime, and insoluble salts, remain undissolved. The alcoholic solution scarcely ex- hibits any perceptible opacity on the addition of chloride of barium, showing that no error in the result is occasioned by any of the gypsum being taken up by the alcohol. | About 100 grains of gypsum and four times its weight of milk answer very well. The soluble salts extracted from the milk by the alcohol may easily be determined by incineration ; and since their amount is to that of the insoluble salts in the average proportion of 5 to 7, the amount of the latter may at least be found approximately, and the ascertained weight of ' Simon’s Beitrage, p. 358. MILK BEFORE DELIVERY. 47 the sugar and casein corrected accordingly. But if it be required to determine the salts with perfect accuracy, it is best to inci- nerate a weighed quantity of milk, and to analyse the residue. The analyses of Clemm,! which will be presently noticed, were made in the following manner: One portion of milk was used for the determination of the water and of the solid residue, and afterwards (by incineration) of the fixed salts. Another portion was evaporated nearly to dryness, and treated with one or two drops of acetic acid to coagulate the casein and render it insoluble. It was then treated with ether, in order to remove the fat, and with water in order to take up the sugar of milk, extractive matters, and salts. The residue was regarded as casein. | Healthy Milk. 1. Milk before delivery. The mammary glands secrete a milky fluid during pregnancy which, at first, differs considerably from normal milk, but, as the period of delivery approaches, gradually approximates to it in its characters. In the first stage of its secretion, albumen preponderates, and sugar is almost entirely absent ; the albumen gradually gives place to casein, and, at the same time, sugar and fat are more abundantly formed. There are no means of obtaining any very accurate information respecting the fluid secreted in the breasts of women previous to childbirth,? but experiments have been made by Lassaigne and myself on this secretion in animals. I analysed the milk of an ass pregnant for the first time, and within about fourteen days of her full period of gestation. The fluid was transparent, scarcely opalescent, tenacious, and viscid ; it had an alkaline reaction. The microscope revealed a few fat-corpuscles, some granular bodies, composed of accu- mulated minute fat-vesicles and mucus-corpuscles. It did not become more gelatinous or stringy on the addition of caustic ammonia; when heated, a considerable quantity of 1 The investigations of Clemm are contained in the article “ Milch” by Scherer, in Wagner’s Handworterbuch der Physiologie, vol. 2, 1845. 2 [Clemm found that the fluid obtained from the breasts of a woman shortly before delivery contained 5:4782 of solid constituents. ] 48 THE SECRETIONS: albumen coagulated. The presence of casein was shown, and its amount determined, by the addition of acetic acid, by boiling the fluid till it evaporated to the consistence of an extract, and by then extracting it with boiling spirit. The casein differed from the ordinary casein of cow’s milk, in being soluble to a very considerable extent in boiling spirit ; it par- tially separated from the clear hot solution on cooling: it seemed rather to resemble the casein of the crystalline lens. After the removal of the fat, by means of ether, it was almost perfectly soluble in water; on the application of heat, the surface of the solution became covered with an irregular film, and the addition of a little dilute acid was followed by a very copious precipitate. The analysis of this milky fluid yielded, in 1000 parts : Analysis 61. Water ; ; : 3 ; 737°00 Solid constituents : ; ; ; 263°00 Fat 3 P ; : : 7°98 Casein ; ‘ ‘ ; ; 28-93 Albumen J ‘ - ‘ . 198°34 Extractive matters, traces of sugar and casein, chloride of sodium, and lactate of soda x , ‘ 18°41 The milk of the same ass was examined eight days after- wards ; it was less thick and sticky, and rather whiter than before. It more closely resembled true milk in its smell, and it had a mild, faintly sweet taste. It contained, in 1000 parts: Analysis 62. Water | ; ; e ? yee 814-0 Solid constituents ; , 4 ; 186°0 Fat ; , ; ‘ ; 8°5 Casein é ‘ d ; 25-0 Albumen 6 ; ? . ‘ 123°9 Extractive matter, with a little sugar, salts ; s 28°6 The change in the constitution of the fluid was very striking ; the solid constituents collectively, and especially the albumen, were diminished, while the fat, casein, and sugar, had relatively mereased. In the first analysis, the casein formed only one ninth of the solid residue; in the second, it amounted to one seventh. Lassaigne has observed similar proportions in the fluid secreted by the mammary glands of cows previous to calving. Forty-one days before calving, it contained albumen in place COLOSTRUM. 49 of casein, had an alkaline reaction, a specific gravity of 1063, and, when allowed to stand, deposited a large quantity of cream, from which a very soft sort of butter was obtained. The fluid retained these properties till ten days before calving; it then acquired a milder taste, but still contained albumen in place of casein. If Lassaigne had been acquainted with my method of separating casein from albumen by means of boiling spirit, he would, doubtless, have found casein, as I did, in the asses’ milk. It was not till five days after calving, that the fluid resembled ordinary milk; it then had a specific gravity of 1035, and contained casein instead of albumen. 2. Milk immediately after delivery. The lacteal secretion immediately after delivery differs from the ordinary milk produced after the milk-fever, and has re- ceived the name of colostrum. In woman I found the colostrum thicker than true milk.! It had a dirty light yellow colour, an alkaline reaction, no peculiar odour, but a remarkably sweet taste. [Clemm states that the alkaline reaction very soon disap- pears. He has found the colostrum become acid in the course of three hours. | . According to other observers, it resembles a thin solution of soap and water (Joannide”), with drops of oil on its surface. On examining the colostrum with the microscope, a very large number of fat-globules are seen, some of which are larger than those that occur in ordinary milk, and these are frequently observed clinging to one another; besides these, there are gra- nulated, yellow, roundish corpuscles, larger than the milk-cor- puscles, which appear to be composed of very minute fat-vesicles; they seem to be peculiar to the colostrum, and were first observed by Donné,? who states that they occur in woman’s milk till the twentieth day, when the milk loses all the characters of colos- | * Die Frauenmilch, &c. p. 51. ? Physiolog. Mammar. Mulieb. Specim. Halle, 1801. 3 Du Lait, et en particulier de celui de nourrices, etc. Paris, 1837, p. 19. II, 50 THE SECRETIONS : trum; I have never succeeded in detecting them after the eighth or tenth day. [According to the observations of d’Outrepont,! the granu- lated corpuscles usually disappear on the third day.] The following analysis represents the composition of 1000 parts of the colostrum of a woman. The other analysis repre- sents the average composition of healthy milk, deduced from many observations, and is given in order that the reader may contrast the composition of the colostrum with that of the normal secretion. 8 Analysis 63. Healthy milk of the Colostrum, same individual. Water ure us J 828°0 887°6 Solid constituents : g 172-0 112°4 Fat ; ‘ ns 50°0 25°3 Casein . ed: ‘ 40°0 34°3 Sugar of milk : : 70:0 48-2 Ash z ; : 31 23 Of the fixed salts, 1:2 were soluble, and 1°8 insoluble in water. The chemical differences between the colostrum and the milk are at once obvious; the former is much the richer of the two in solid constituents, especially in butter and sugar of milk. The absolute quantity of casein is also greater, but the ratio of the casein to the solid constituents is less than in ordinary milk. The salts are also increased; the aperient property of the colostrum is probably due to the Jeetinned quantity of aed and sugar of milk. 3. Of ordinary milk. The ordinary milk of the human female is a white or blueish fluid, and of a sweeter taste than cow’s milk. It usually ex- hibits nothing but the milk-globules under the microscope. It has always an alkaline reaction, which it retains for five or six days before it becomes acid. Its specific gravity varies from 1030 to 1034; the average of a large number of analyses yielded the number 1032. On evaporation, it becomes covered, like every other sort of milk, with a film of coagulated casein; and when the evaporation has been sufficiently prolonged, it yields ' [Neue Zeitschrift fiir Geburtskunde, vol. 10, pp. i—7 a} HEALTHY HUMAN MILK, 51 a brownish extract-like residue which, when dried, is perfectly soluble in water, (with the exception of a little albumen,) and forms a milky fluid. Everything that precipitates casein, coa- gulates milk; the mucous membrane of the stomach of an infant a few days old, that has recently died, seems, from my obser- vations, to coagulate woman’s milk more perfectly than the mucous membrane of the stomach of the calf.! The solid con- stituents fluctuate between 8°60 and 13°862. I shall now give - some analyses of milk: Ist, the average of fourteen analyses - made at different periods with the milk of the same woman ; 2d, the analysis of the milk of a woman aged 36 years; 3d, the analysis of the milk of a nurse aged 20 years; 4th, the maxima, and, 5th, the minima, of numerous analyses. An. 64. An. 65. i 2, 3. 4. 5. Water . ‘ Y . 883°6 894:0 898°0 9140 861°4 Solid constituents “ . 1164 1060 102°0 1386 86:0 Butter a ~ 25S SSE. 263° 640 8-0 Casein A : ett SMB VE Sa OS BSD: 452. 996 Sugar of milk and extractive matters 482 40°5 360 624 39:2 Fixed salts ; ; ‘: 23 1°8 27 16 The maximum table gives the highest amount of each indi- vidual constituent, and the minimum the lowest that occurred in the whole series of analyses. [Clemm has recently published the following analyses : The 4thday The 9th The 12th after delivery. ditto. ditto. Water : : ; . 879°848 885°818 905°809 Solid constituents 2 : « 120°152 114°182 94°191 Butter . F R - 42°968 35°316 33°454 Casein . i 3 AN 35 55 | 36°912 29-111 Sugar of milk and extractive matters . 41°135 42-979 31°537 Salts x : ; : 2°095 1691 1939 Two analyses of healthy human milk have been made by L’Heretier.2 He found: 1. 2. Water : ; ; . 867°8 870°6 Solid constituents ; ‘ a ohoee 129°4 Butter. : : s- £2°5 52°0 Casein. : : ae a: 9°5 Sugar of milk : ; . 74:0 63°4 Salts : : ; : 4:0 4°5 ' Die Frauenmilch, &c. p. 29. ? Traité de Chimie Pathologique, p. 627. 52 THE SECRETIONS : Haidlen,' by the method already noticed, found that 1000 parts of woman’s milk contained : iS 2. Butter ‘ ret K ; ; 13 34 Casein and insoluble salts . ; 27 31 Sugar of milk and soluble salts x , 32 43 In the second analysis, the milk was extremely rich in solid constituents. | Meggenhofen? has also analysed woman’s milk; but, from the method which he pursued, we can place no reliance on the determination of the individual constituents. The dried resi- due was extracted with alcohol of 0°83, and afterwards with water, as long as any additional matter was taken up. It is evident that fat, some of the sugar, and perhaps even traces of casein must be contained in the alcohol-extract; the water-— extract contains the rest of the sugar, some extractive matter, and a great part of the casein. According to Meggenhofen, the solid constituents in woman’s milk vary from 10 to 12-565, and the salts from 1:2 to 2°4%. These numbers correspond very closely with my results. The analyses gave in 1000 parts: Water : - : . 827°5 883°5 789°3: Solid constituents . ; 1725 1165 210-7 Fat with sugar and iadibrSitrect : 91:3 88-1 171°2 Sugar and casein . ‘ 11°4 12°9 8°8 Coagulated casein . ‘ ’ ; 24°1 14:7 28°38 Payen? has likewise analysed woman’s milk, but his results, — especially regarding the amount of casein, differ so very much from those of other chemists that they can only be explained on the assumption that there was an error in the plan of his analysis. The following numbers represent the mean of three analyses; water, 857:7; solid constituents, 142°3; butter, 51:5; casein, 2°2; residue of evaporated whey, 78:0. ' Annalen der Chemie und Pharmacie, vol. 45, No. 3. * Dissert. inaug. sistens indigationem lact. mul. chemic. auct. Meggenhofen. Frankf. a. M. 1826. | 3 Journal de Chim. méd. vol. iv, p. 118. HEALTHY HUMAN MILK. 53 The salts of woman’s milk appear, according to my own ob- servations, and those of Meggenhofen, to range at about from ; to } per cent. of the fluid; of these, usually about 2 are insoluble, and } soluble in water: the former consist of phosphate and carbonate of lime, with a little magnesia, and a very small quantity of (phosphate of ?) peroxide of iron ; the latter, of chlo- rides of sodium and potassium, with a little chloride of calcium, -carbonate of soda, (corresponding with the lactate in the milk,) and a little sulphate of potash, the acid of which does not pre- exist in the milk, but is produced during incineration. Pfaff and Schwartz' found a larger proportion of salts in woman’s milk, namely, 0:44072; they were composed of phosphate of lime, 0°25; phosphate of magnesia, 0°05; phosphate of iron, 0:0007 ; phosphate of soda, 0°04; chloride of potassium, 0:07 ; and soda originating from lactate of soda, 0°03. Carbonate of lime, sulphate of potash, and chloride of sodium are not noticed, although all other observers concur in finding them in the milk. Chevallier and O. Henri have instituted some researches on the milk ; they precipitated the casein by acetic acid, evaporated. the fluid portion, and determined the salts by the incineration of the residue. They estimated the part that was consumed as sugar of milk, and removed the fat from the precipitated casein by means of ether. By this process they obtained much too small a quantity of casein from woman’s milk, (since this con- stituent is only imperfectly precipitated by acetic acid,) and too large a quantity of sugar, which was thus made to include all the destructible constituents, with the exception of the casein and fat. In the other sorts of milk, the precipitation of the casein by acetic acid is also imperfect. The following is the result of their analysis of woman’s milk : Water Ea é : 879°8 Solid constituents : : 120-2 Butter . ; x rs Na Dried casein : 15:2 Sugar of milk ; : 65°0 Salts ; 3 ; 4°5 ‘! Dissert. inaug. sistens nova experimenta circa lact. princip. constit. Kiel, 1833. 54 THE SECRETIONS: On the effect of temperament on the milk. [It has been long believed that the milk of fair women is inferior in its properties to the milk of brunettes. As far as I am aware, the only analyses bearing on this point are those of L’Heretier. He selected two females of equal age, and made them submit to the same diet and mode of life. The following are the results of his analyses : A Blonde, aged 22. A Brunette, aged 22. te FE 1. be Water " - 892°0 881°5 853°3 853°0 Solid constituents - 108-0 118-5 146°7 147°0 Butter. - . 855 40°5 54:8 56°3 Casein : : 10°0 9°5 16°2 17°0 Sugar of milk ; 58°5 64:0 71:2 70:0 Salts ; : 4:0 4:5 4°5 4°5 He appears to have selected the analyses that presented the most marked contrast; for he observes, that if he had taken the mean of all his analyses, the difference between the amount of the solid constituents in the two cases would have been less marked, the average ratio being 120 : 134. L’Heretier has likewise investigated the changes produced in the milk by a prolonged sojourn in the breast. The two fol- lowing analyses illustrate the effect thus produced. The milk in each analysis was afforded by the same woman: in the first case it had remained in the breasts for forty hours; in the second, it was obtained after the infant had been sucka for some little time. | 1. 2. Water Z - ; 901-1 858°0 Solid residue ; ; 98°9 142°0 Butter : ; ; 34:0 36°5 Casein ; ‘; : 1°9 13°0 Sugar of milk ‘ ‘ 58°5 780 Salts is A i 4°5 4°5 ] On the changes in the milk dependent on nutrition. That the character of the food exerts an influence on the quality and quantity of the milk, is a fact that has been long known, although the nature of the changes could not be cor- MODIFICATIONS OF MILK. 55 rectly determined. I analysed the milk of a very poor woman fifteen times at regular intervals during the course of half a year, commencing with the second day after delivery. It so happened that she was suddenly deprived of the means of ob- taining even the most ordinary necessaries of life. The milk secreted at this period, (the 11th of November,) was sufficiently abundant in quantity, but was very poor in solid constituents, containing only 8°62. Some days afterwards (the 18th of November) she was placed upon a full and nutritious meat diet. The milk, in consequence, was secreted so copiously as to run spontaneously from the breasts: it left 11:92 of solid consti- tuents. Her circumstances again became very bad, and she was frequently in a state of the utmost destitution: on the Ist of December, while in this condition, the milk again be- came very thin, and left only 9°82 of solid constituents. I con- cluded my researches on the milk of this woman, by an exa- mination on the 4th of January, after she had been supplied for two days with a nutritious meat diet: the milk was then very rich in solid constituents, and left a residue of 12-62. The following are the results of my examinations on these four occasions; below them is the average of the fourteen analyses to which I have already referred : Solid Sugar and Water. constituents. Butter. Casein. extractive matter. 1. Milk on Nov. llth . 914:0 86°0 8:0 35°5 39°5 2. Ditto Noy.18th : 8806 119-4 34:0 -37°5 45°4 3. Ditto Dec. Ist - 920°0 98:0 8:0 39°0 49-0 4. Ditto Jan. 4th . 873°6 126°4 37°0 40°0 46°0 5. Average of 14 analyses 883°6 116°4 25°3 38°3 48°2 It is evident from these analyses, that however much the nutriment of the mother may vary, no great influence is thereby exerted on the relative quantities of casei and sugar. The changes consist in a greater or less degree of saturation, in the rich yellowish white or the blueish colour, in the quantity of the milk, and in its amount of solid constituents ; with the ex- ception of the variation in quantity, all the other changes are dependent on an increase or diminution of the butter; the former occurs under the use of a copious and nutritious diet, the latter when the food is poor and scanty. Donné’s' proposal ' Du Lait, etc. p. 54. 56 THE SECRETIONS: for determining the goodness of the milk by a microscopic ex- amination, is founded on incorrect principles; he assumes that the increase of the butter and of the other constituents is simultaneous ; an assumption that the above analyses show to be inconsistent with facts. Changes in the milk, corresponding with the age of the infant. It seems probable that certain changes will be observed in the milk when the progress of development of the child indicates the necessity for other food. The question is one of consider- able physiological interest, and in order to elucidate it I made analyses of the milk of a woman during a period of nearly six months, commencing with the second day after delivery, and repeating my observations at intervals of eight or ten days. The results would doubtless be more decisive if the expe- rimentalist were able to exclude all disturbing influences: but in almost all cases the exercise of a strict control over the method of living and the nature of the food of the mother, is just as impossible as the exclusion of exciting moral forces. The fourteen analyses (the colostrum being excluded) gave the following results : ; Specific Solid ; Fixed Analyses gravity. Water. constituents. Casein. Sugar. Butter. salts. 66 3ist Aug. 1031°6 873-2 126°8 212. 624 346 0°84 67 7th Sept. 1030°0 883°8 116°2 196 576 314 1:66 68 8th Sept. 1030°0 899-0 101-0 257 (523 180 2:00 69 14th Sept. 1030°0 883°6 116°4 220 520 264 1:78 70 = 27th Oct. 1034°0 898:2 101°8 430 450 140 2:74 71 3d Noy. 1032°0 886-0 114:0 45°2 . 392. 274 2°87 72 ~=11th Nov. 1034°5 914-0 86°0 35°33 39°5 80 2°40 73 =: 18th Nov. 1033°0 880°6 119°4 37:0 45:4 34:0 2°50 74 25th Nov. 1033°4. 890°4 109°6 38:5 «475 = =619°0 2°70 75 Ist Dec. 1032°0 902-0 98-0 39°0 49-0 8-0 2°08 76 8th Dec, 1033°0 890-0 110°0 410 43:0 22:0 2°76 77. ~—-: 16th Dec. 10344 8910 = 109°0 42°0 44:0 20:0 2°68 78 =3ilst Dec. 1034°0 861°4 138°6 310 52:0 540 2°35 79 4th Jan. 1032°0 873°6 126°4 400 460 37:0 . 2°70 A glance at the three columns of casein, sugar, and butter, will show that, with few exceptions, Ist, the quantity of casein is at its minimum at the commencement; it then rises consi- derably, and ultimately attains a nearly fixed proportion ; that, MODIFICATIONS OF MILK. 57 2d, the quantity of sugar is at its maximum at the commence- ment, and subsequently diminishes; and that, 3d, the butter is a very variable constituent of the milk. The variations observed in the columns of the sugar and of the casein arise in all probability from those disturbances of the mode of living, and of the tranquillity of the mind, which produce a decided influence on the composition of the milk, and over which the experimentalist can exert no control. Milk changed by disease. There are certain morbid states of the system which produce such an influence on the milk that the infant cannot partake of it without detriment to its health. It is a well-known fact that the milk of women who are exposed to violent mental agi- tation, to passion, grief, &c. will occasionally produce very serious effects (and sometimes even instantaneous death,) on the in- fant: and some physiologists and physicians are of opinion that chronic diseases may be transmitted by the milk from the mother to the child. When we read the statements of trustworthy authors re- garding the instantaneously fatal effect produced by the milk on the infant, on the occurrence of a sudden shock affecting the mind of the mother, we cannot deny that some chemical change is produced through the nervous influence on the milk, although we cannot determine the nature of that change. In many cases the milk, possibly, acts only as a conducting fluid, and thus conveys the nervous shock from the mother to the child. Certain morbid changes in the milk which are dependent on the formation of mammary abscess, may be easily recognised by the microscope, which will then reveal the -presence of pus- or mucus-corpuscles. Thus in cow’s milk which was drawn from a teat affected with vaccinia, I found a considerable quantity of mucus- or pus-corpuscles, while in the milk drawn from an- other teat of the same udder there were none. When a mammary abscess opens internally, the milk always contains pus-corpuscles, and frequently also blood-corpuscles, if blood has escaped with the pus. Donné! has frequently made ' Du Lait, etc. p. 40. 58 THE SECRETIONS : microscopic examinations of the milk of women with swelled breasts ; it resembles, in some measure, the colostrum. In the milk of a cow affected with vaccinia, I found a number of cor- puscles, which were very like the yellow granulated colostrum- corpuscles. I have had an opportunity of examining the milk of a re- cently-delivered woman, who was in a state of considerable fever in consequence of a violent fit of passion: her child, after - partaking of her milk, was seized with vomiting, diarrhoea, and convulsions. The breasts were swollen, tense, and painful ; the milk had an alkaline reaction, and apparently possessed the qualities of the ordinary secretion ; it had, however, a different and not very easily described animal odour. When boiled it exhibited no albumen, but after evaporation to a certain point it coagulated, and had a marked acid reaction. Another por- tion that was set aside, coagulated after some hours, and had an acid reaction, a circumstance I have never observed in healthy human milk, which will remain undecomposed for five or six days. After twenty hours it developed so large an amount of sulphuretted hydrogen, that a slip of paper which had been moistened in a solution of lead, and was then placed in the flask, in a short time became brown. ‘The casein, sugar, and butter, did not seem to have undergone any change, either qualitative or quantitative. In fact there appeared to be little difference be- tween it and the milk that was secreted twenty-four hours before, and six days later, as may be seen by a comparison of analyses 67, 68, and 69: analysis 68 merely exhibits a smaller proportion of solid constituents, which is principally due to the decrease of butter. The differences observable in this milk were undoubtedly connected with the bad effects which it pro- duced ‘on the infant. The case was altogether different with the milk of a woman who contracted syphilis after the birth of her first child, and who, in consequence of defective or improper medical treatment, carried the remains of the disease about her for years. The children which she bore while in this condition, and which were begotten by her husband who also had some suspicious sores on the feet, did well for the first half year, they then became highly scrofulous, and died in a state of marasmus: _ the first child was perfectly healthy. The milk, when she was MODIFICATIONS OF MILK. 59 suckling her sixth child, which was a year and half old, and in a dreadfully scrofulous state, exhibited no deviation from the healthy secretion: it appeared rich, tasted and smelled like healthy milk, and had an alkaline reaction, which it retained for the space of six days. Its constituents, casein, sugar, and. butter, appeared normal, and there was no peculiarity in their quantitative admixture. (See analysis 64, p.51.) Hence, although the woman was suffering from a malignant chronic disease, no morbid change was observable in the milk. Donné’ has frequently submitted the milk of syphilitic women to microscopic examination, but never observed any deviations from the normal appearance. Meggenhofen? found that the milk of a syphilitic woman reddened tincture of litmus, and that it was coagulated by protonitrate of mercury, basic acetate of lead, and infusion of galls, but not by hydrochloric or acetic acid, protochloride of tin, neutral acetate of lead, or alcohol of 0:83. Herberger? has analysed a specimen of diseased human milk ; he found it composed of, water, 895; solid constituents, 105 ; casein, 18°3; sugar, 26:9; butter, 23°3; chlorides of potassium and sodium, lactate and phosphate of potash, and an imorganic substance, insoluble in oil of turpentine, 41°6 ; organic matter soluble in oil of turpentine, 1:6. The latter substance was a yellow extract soluble in water and alcohol. The solution re- duced the salts of gold, silver, and platinum, yielded no ammonia by dry distillation, and was not precipitated by tannic acid. Deyeux* examined the milk of a woman who was liable to frequent nervous attacks: he found that simultaneously with these seizures, the milk became transparent and viscid, like albumen, and did not reassume its normal condition for some time. : Other changes in the milk. Certain substances which are not included in the ordinary constituents of the milk are sometimes detected in it, after having been taken into the system, either as food or medicine. It is ' Op. cit. p. 52. ? Dissert. inaug. etc. p. 16. * Journal fiir prakt. Chemie, vol. vi, p. 284. * Crell’s Chemische Annalen. vol. i, p. 369. 60 THE SECRETIONS : not to be expected that all the substances which enter the cir- culating fluid and are separated by the kidneys, should be found in the milk, since the absorbents appear to exert a sort of selective power, and would thus reject those substances which occur in the blood, but which would produce an injurious effect on the tender frame of the infant, if they entered into the milk. I have sought in vain for ferrocyanide of potassium in the milk of women who were suckling, and to whom I have given it in doses of six drachms. This salt is known to enter very readily into the circulation, and is found after a very short in- terval in the urine. After the lapse of two days I gave the same woman twenty-three grains of iodide of potassium, but I could detect no trace of this salt in the milk. Lastly, I at- tempted in vain to detect sulphate.of magnesia in the milk of a woman who was suckling, and to whom I had administered it in a sufficient dose to act as a laxative. For the particulars of these experiments I must refer to my essay ‘On the Milk of Woman, in its Chemical and Physio- logical Relations. From these observations I think that I am justified in the conclusion that energetic substances, which are foreign to normal milk, either do not enter into that secretion at all, or if they do, they undergo modifi- cations, which render them more compatible with the organism. Although I could not detect the sulphuric acid of the sulphate of magnesia in the milk, it is very probable that the magnesia entered the milk as a lactate, while the sulphuric acid was car- ried off by the urine as a sulphate. Peligot, however, has detected iodide of potassium in asses’ milk ; and Herberger in the milk of woman. [I have on several occasions observed the ordinary indication of iodine on the ad- dition of xyloidin, or of starch and a drop or two of nitric acid to the urine of infants at the breast during the period of the mother taking three grains of hydriodate of potash thrice a day—a convincing proof that the salt has entered the milk.] Mercurial medicines used by women who are suckling have never been traced in the milk, [although their effects on the infant are undoubted. | COLOSTRUM OF ANIMALS. 61 OF THE MILK OF ANIMALS. Colostrum of animals. In the colostrum of the cow Chevallier and Henri found: water, 803°8 ; casein, 170°7 ; and butter, 26:0. They describe it as a dark yellow, thick, viscid fluid, sometimes marked with fine streaks of blood; it has an alkaline reaction, contains little butter, (as shown by the analysis,) coagulates on heating, and in all probability contains a mixture of albumen and casein, in the same manner as I observed in the mammary secretion of the ass a short time before delivery. Boussingault and Le Bel’ found in the colostrum of a cow the day after calving: water, 784°0 ; casein with albumen, 151-0; butter, 26:0; sugar, 36:0; and earthy salts, 3:0. | (I shall pre- sently describe a specimen of cow’s milk resembling colostrum, which was analysed by me.) _ In the colostrum of the ass Chevallier and Henri found : water, 828°4; casein, 123°0; butter, 5°6; and sugar, 43-0 ;— and in the colostrum of the goat: water, 641:0; casein, 275-0; butter, 52°0; and sugar, 32-0. _ The 170°7 parts of casein found by Chevallier and Henri in the colostrum of the cow, consisted of 150°7 of a substance coagulable at a boiling heat, which they termed colostrum-casein, and of 20 of a substance remaining in the whey, to which they applied the name of matiére muqueuse. The 123 parts of casein in the colostrum of the ass con- sisted of 116 of the former, and 7 of the latter substance ; and in the colostrum of the goat they were in the proportion of 245:30. These numbers approximate very closely to the pro- portional amount of casein and albumen in asses’ milk, pre- viously to delivery. (See page 48.) 1. Cow’s milk. Cow’s milk is a rich white fluid of an agreeable, somewhat sweetish taste, and of a peculiar odour; when allowed to stand, 1 Anal. de Chim. et de Phys. May 1839. 62 THE SECRETIONS :. the fatty portion (cream) collects on the surface ; when boiled, it becomes covered with a film of coagulated casem. My own observations and those of others show that, when fresh, it has always an alkaline reaction. D’Arcet and Petit have, however, found it to be acid. This discrepancy may probably be explained by the circumstance of the speedy conversion of the sugar into lactic acid, which is sometimes noticed in cow’s milk. The state of acidity is hastened by a heightened temperature, and is most rapidly induced by being brought in contact with rennet. The specific gravity of cow’s milk varies from 1030 to 1035. We possess several analyses of cow’s milk; it has been exa- mined by Herberger and myself by the method I have pre- viously explained, and our results approximate closely. The third of my analyses (No. 82) represents the milk a short time after calving, while it still retained the character of colostrum. Boussingault and Le Bel have also analysed normal milk with the view of ascertaining the influence of various sorts of fodder on its composition ; by the adoption of the French method to which I have already alluded, they obtained too little casein and too much sugar. I shall give the mean of twelve of their analyses : F. Simon. Herberger. 3 Ae bie a = le - ee 3 FH 5 3 s An.80. 81. 82, 1. 2. se 63 23 Qs Os Water “ ; 857°0 861-0 823°0 853°0 8620 868 8740 870-2 Solid constituents . 143°0 139°0 177°0 147:0 1380 132 1260 129°8 Butter ‘ 400 380 55:0 389 375 36 390 313 Casein § . 720 680 67:0 698 670 56 340 448 aati grep } 28-0 290 51:0 31° vice 330. 407 Fixed salts i 6°2 61 13:0 70 7°2 6:0 Earthy salts ° 2:2 [Haidlen found, in the milk of a cow: water, 878; solid residue, 127; butter, 830; casein and insoluble salts, 51 ; sugar and soluble salts, 46. He has carefully studied the salts of the milk, and is of opinion that the carbonate of soda that occurs in the ash does not originate from a lactate in the fresh milk, but exists there combined with casein. The salts are combinations of phosphoric acid with lime, magnesia, and per- ASSES’ MILK. 63 oxide of iron; chlorides of sodium and potassium, and soda in combination, with casein. The following numbers represent the amount of the various salts found in 1000 parts of milk: the per centage of each con- stituent is added in order to show the slight variation to which the different salts are liable, in relation to the mass of the ash. i Per centage. 2. Percentage. Phosphate of lime : ; 2°31 47°1 3°44 50°7 Phosphate of magnesia . , 0°42 8°6 0°64 9°5 Phosphate of peroxide of iron . 0:07 14 0°07 1-0 Chloride of potassium rasa be” 29°4 1°83 27°71 Chloride of sodium . ; 0°24 4°9 0°34 5°0 Soda ; ; : ; 0°42 8°6 0°45 6°7 490 100-0 6-77 1000 | Berzelius! found, in skimmed milk: water, 928°75; casein, with butter, 26:00; sugar, 35°00; alcohol-extract, with lactic acid and salts, 6:00; chloride of potassium, 1°70; alkaline _ phosphates, 0°25 ; phosphates of lime and magnesia, with traces of iron, 2°30. The cream consisted of: water, 920; butter, 45 ; casein, 35. Pfaff and Schwartz? estimate the fixed salts at 0°37429, scarcely more than half the quantity obtained by Herberger and myself. They contained phosphate of lime, 0°1805 ; phos- phate of magnesia, 0°0170; phosphate of iron, 0:°0032; phos- phate of soda, 0°0225; chloride of potassium, -0°1350; and lactate of soda, 0°0115. A comparison of my analyses of cow’s milk with those of woman’s milk will show that the former contains the larger amount of solid constituents, especially of casein, while the latter contains the greater quantity of sugar. 2. Asses’ milk: Asses’ milk is a tolerably rich white fluid, with a sweeter taste than cow’s milk, and occasionally having an acid reaction. - Its specific gravity fluctuates between 1035 and 1023. I found ! Thierchemie, p. 701. ? Diss. inaug. sist. nova experim. circ. lact. princip. constit. Kiel, 1833. 64 THE SECRETIONS: the milk of an ass, about a year after foaling, to be com- posed of : ; Analysis 83. Water : : : ‘ 907-00 Butter, with some lactic acid . . : 12°10 Casein : “ 16°74 Sugar, with scisakiiee: matter nd alkaline aie . 62°31 The following is the mean of several analyses of asses’ milk made by Peligot ;' his numbers approximate pretty — to mine : Water i é . Z é 904-7 Butter s ‘ : ; ¥ 12°9 Casein ‘ i 19°5 Sugar, extractive srintbee: and nits ; : 62°9 Chevallier and Henri found in 1000 parts of asses’ milk : Water J , 4 916°3 Solid constituents ‘ : ‘ 83°5 Butter : . Z a i | Casein i ; J < 18-2 Sugar Z ; ‘ - ‘ 60°8 Salts i = ’ e 3°4 Asses’ milk contains a smaller amount of solid constituents, especially of casein and butter, than cow’s milk ; it also differs from it in its great abundance of sugar and extractive matter, in which peculiarity it resembles woman’s milk. 3. Mare’s milk. fae)» Mare’s milk is very rich in solid constituents; it has a spe- cific gravity of 1034°6—1045-0; it contains little butter, but a large amount of sugar. Stipriaan, and Luiscius and Bondt ob- tained from it 0°88 of cream, 1-628 of casein, and 8°752 of sugar. I obtained a yellow, viscid, saltish, and nearly inodorous fluid from the teats of a mare expected to foal shortly : it coagulated on heating, exhibited a few fat-vesicles and granular corpuscles under the microscope, and acetic acid separated a small quan- tity of casein. It contained 5% of solid constituents, of which only 0°15° was butter. The solid constituents consisted for the most part of albumen, mixed with a little casein, butter, and extractive matter. ’ Annal. de Chimie et de Physique, Aéut 1836, p. 432. GOAT’S MILK. 65 4. Goat’s milk. Goat’s milk is a very rich white fluid, of specific gravity 1036, with a peculiar disagreeable odour arising from the hircic acid which is present in the butter. Its solid constituents are as abundant as those of cow’s milk, and it contains in 1000 parts : Chevallier Stip., Luisc., and Henri. Clemm. Boysson. John. Payen. and Bondt, Water ‘ . 868-0 865°175 892°8 849°3 855°0 744°4 Butter ; - a2 42-507 29°9 11:7 40°8 45°6 Casein : - 402 60°321 52°9 105°4 45°2 91-2 Sugar : - 528 : 20°7 23°4 43°8 Salts : . 5°8 hg Residue of whey 58°6 Cream 75°0 [An analysis of the mammary secretion of a he-goat has been recently made by Schlossberger.' The animal was four years old, and had. given undoubted proof of his generative powers. The fluid obtained by repeatedly milking the animal, had the colour, consistence, and taste of milk, and was perfectly devoid of any unpleasant odour. Under the microscope, the globules appeared numerous, and a considerable amount of cream separated after standing for some time. The milk was analysed according to Haidlen’s method, and found to contain : Water. ‘ ‘ 3 : 850°9 Butter. ‘ , ‘ ; 26°5 Casein (with salts insoluble in alcohol) - . . 96°6 Sugar (with salts soluble in alcohol) . é 26:0 The milk left 7822 of ash, of which ‘325 were soluble, and ‘457 insoluble in water. This case is interesting in reference to the theory of secretion ; it seems to show that the secretion of milk is independent of any peculiar condition of the blood incident to pregnancy, but that it depends far more upon the development of the secreting organ. | 1 Annalen der Chemie und Pharmacie, 1844. Le | Il. 66 THE SECRETIONS : 5. EHwe’s milk. Ewe’s milk is an extremely rich, thick, white fluid, with an agreeable smell and taste, and having a specific gravity of 1035 to 1041. Stipriaan, Luiscius, and Bondt found in 1000 parts: Water 3 t : , 632°0 Solid constituents . ; j 368°0 Butter . ‘ 5 F 58-0 Casein . ; ‘ 153°0 Sugar . : : : 42°0 Cream . ; - 115°0 We cannot help thinking that in this, as well as in the pre- vious analysis by the same chemists, the amount of solid con- stituents, and especially of the casein, is higher than is likely to be correct. Chevallier and Henri found in 1000 parts: Water é ‘ ‘ 856°2 ee Butter 4 ' P ; 42:0 “ Casein . é : : 45-0 Sugar ‘ ; F ‘ 50:0 Salts 4 ; ; ‘ 6°8 6. Bitches’ milk. I have made two analyses of the milk of a bitch of the bull- dog breed. The milk was drawn from one of the teats that was not used by the pup: it was very thick, (whereas the milk from the teats which the pup was in the habit of sucking was very thin,) had a disagreeable animal odour, and a rather saltish, mawkish, but not sweet taste. A period of ten days elapsed between the two analyses. : Anal, 84. Anal. 85. Water Z ; : 657°4 682°0 Solid constituents £ 5 342°6 318°0 Butter . ; , 162-0 133°0 Casein é : é 174:0 146-0 Extractive matter and traces of sugar 29-0 30°0 Fixed salts é : 15°0 14'8 This milk is distinguished from every other kind of milk that I have examined, by the immense amount of its solid consti- tuents, and by the nearly total absence of sugar. DISEASED MILK. — 67 [Clemm examined the milk of a bitch. Its specific gravity was 1033; and 1000 parts yielded 274689 of solid constituents, consisting, for the most part, of casein and, butter, but still giving undoubted indications of the presence of a very small quantity of sugar. The bitch was fed entirely on flesh.] On diseased milk in animals. The changes produced by disease have been especially studied in cow’s milk. The milk may contain mucus, pus, and blood, under similar conditions to those which we have noticed in woman’s milk. (See page 57.) These substances are easily detected by the microscope. Through the kindness of Dr. Bremer, I obtained some milk from the udder of a cow affected with vaccinia, and indeed one portion of the milk was taken from a teat covered with the eruption, while the rest was drawn from a healthy teat. The two specimens differed both chemically and physically : the milk from the diseased teat was strongly alkaline, had a slightly saline taste, and exhibited under the microscope a number of mucus- and pus-corpuscles. It became gelatinous on the addi- tion of a spirituous solution of caustic ammonia; it yielded a precipitate of mucus- or pus-corpuscles on standing, while the upper portion became clear; and it coagulated on heating, in consequence of the presence of albumen. The milk from the healthy teat had a mild acid reaction, tasted like ordinary milk, contained no pus- or mucus-corpuscles, but a larger proportion of fat-vesicles than the diseased milk. These analyses gave : Analysis 86. Analysis 87. Milk from the Milk from the : healthy teat. diseased teat. Water - . : 912°10 935°40 Solid constituents : ; ; 87°90 64°60 Butter P 3 é é 19°58 12°05 Casein ‘ ‘ - ‘ 40°62 Casein, with pus or mucus, and albumen ‘ 31°40 Sugar, with alcohol-extract, lactates, and 29-36 chloride of sodium j : : Extractive matter, with chloride of sodium, 16°18 lactate of soda, and a little sugar Water-extract : : ‘ 0°32 Salts soluble in water . ‘ ; 3°87 6°42 Salts insoluble in water ; 3 3°20 2°42 68 | THE SECRETIONS: The great increase of the soluble salts, especially of the free alkali, the presence of albumen, and the almost total absence of sugar, are the points most worthy of notice in the morbid specimen. Herberger' has analysed the milk of cows suffering from the grease, and found it materially affected. In the first stage of the disease he found that the milk only coagulated imperfectly on the addition of rennet, in consequence of the increased quantity of alkaline salts; moreover (and probably for the same reason) the fat-vesiclesw ere not distinct, as they usually are, but merged into each other. In the second stage, only a few fat- vesicles were observable, the coagulation by rennet was very imperfect, and the milk, which was thick and viscid, had an unpleasant putrid smell and taste. In both stages the sugar and casein were below their normal proportions, but the amount of salts was increased ; the presence of carbonate of ammonia (an ingredient never before observed in the milk) was detected. His analyses gave the following results : In the first stage. In the second stage. Healthy milk. ee 2. ‘a 2. Water ‘ ‘ 869°0 872°4 87471 879°3 857°5 Solid constituents 131-0 127°6 125°4 120°7 142°5 Fat ? : 39°0 38°5 38-2 37°9 38°2 Casein . 4 52°4 51°0 50°0 49-0 68°4 Sugar . ‘ 22°8 21-0 21°0 19°0 28°8 Fixed salts. 16°8 17°1 16°6 13°9 71 Specific gravity 1033°6 1033-0 103371 =—1029-1 1033°7 The most striking changes in the diseased milk are the dimi- nution of the solid constituents, especially of the casein and sugar, and the extraordinary increase of the salts. Hence the modifications of the fluid in this instance closely resemble those in my analyses in the preceding page. Donné found that the milk of the cow during “la maladie aphtheuse,” resembled colostrum. It was less fluid and homo- geneous in its mixture than ordinary milk ; it became viscid on the addition of ammonia, and, besides the ordinary milk-cor- puscles, the microscope revealed mucus-granules and tubercular (mulberry-form) corpuscles. 2 ' Pharm. Centralblat. Jahrg. 1840, p. 138. OTHER CHANGES IN MILK. 69 Of other changes in the milk. The passage of various substances into the milk has been more frequently observed in animals than in the human species. Peligot detected iodide of potassium, and chloride of sodium in the milk of the ass, after internal administration. The salts of iron, zinc, and bismuth, are also said to enter it in minute quantities. The sulphates of soda and potash, sulphuret of potassium, and the mercurial salts have never been met with in the milk. The smell, taste, and colour of vegetable substances are taken up by it. The milk is sometimes observed to become blue on its sur- face after standing for 24 to 48 hours, and the tint gradually diffuses itself through the whole fluid: the milk has also been observed to turn yellow in a similar manner. Fuchs! has care- - fully investigated this phenomenon, and has detected in milk of this nature a peculiar infusorium, to which he has applied the name vibrio cyanogenus ; it is not of a blue colour itself, but it appears to have the power of gradually changing the milk to this tint. When removed from the milk, and placed in an infusion of marsh-mallows, these animalcules increase in size, and communicate a faint blue tinge to the fluid; in this way they may be preserved for a long time. Closely allied to this animalcule is the vibrio xanthogenus ; they are sometimes found together in milk, and Fuchs had also an opportunity of observing them in milk which had become yellow, a much more rare change than the former. ‘ Beitrage zur naheren Kenntniss der gesunden und fehlerhaften Milch der Hausthiere. Magazin fiir die gesammte Thierheilkunde, Jahrg 7, Stiick 2. CHAPTER V. SECRETION OF THE MUCOUS MEMBRANE. Mucus. Aut the internal parts of the animal body which are connected by direct continuity with the external surface, are covered by a soft velvety and highly vascular coat—the mucous membrane, which in its turn is protected by a delicate layer of epithelium.’ The mucous surfaces, especially when they are in a state of irritation, secrete a viscid, stringy, and often tough fluid ; occa- sionally it is clear and colourless, but most commonly it is turbid, of a faint yellow or grayish white colour, and is frequently of sufficient consistence to separate in gelatinous globular masses, or tough flocculi. Of normal mucus. The transition from healthy to diseased mucus is so inde- finitely characterized, that it is almost impossible to draw a strict line of demarcation between them, and the same remark is equally applicable to the further change of the diseased se- cretion into pus: hence it is not very easy to form a distinct conception of what normal mucus really is. Henle states that in the same manner as the outer surface of the external skin is continually peeling off and giving place to ? According to Henle the epithelium consists of one or more layers of cells which, from the peculiarity of their form, are arranged in three groups: Ist, Pavement epithelium [the scaly epithelium of Bowman], fig. 14 a, which occurs in the mouth, in the intestinal canal as far as the pylorus, in the vagina, &c.: 2d, Cylinder epithe- lium, [the prismatic of Bowman, the columnar of Todd,] fig. 14 b, having a conical form, and arranged perpendicularly to the basement membrane; this form occurs in the portion of the intestinal canal below the pylorus, in the gall-bladder, and in the male genito-urinary apparatus: and 3d, The ciliated epithelium, fig. 14, which re- sembles the cylinder epithelium in form, and has its free edges armed with cilia. This occurs in the respiratory organs, in the uterus, and fallopian tubes. Bs MUCUS. 71 the layer beneath it, so there is also a continuous desquamation or separation of the epithelium of the mucous surfaces, which sometimes occurs in men, who are in other respects healthy, to such an extent that thick clots of mucus are expectorated in the morning ; which, on being examined with the microscope, contain merely epithelium-cells. This, which is formed by a mere act of separation from the uppermost layer of epithelium, is regarded by Henle as normal mucus: he gives it the name, however, of epithelium, and restricts the term mucus to the morbid secretion of the mucous surfaces in which mucus-cor- puscles (of which I shall speak presently) are found. I have always found these corpuscles in the secretion from the nasal and pulmonary mucous membrane of perfectly healthy persons: they are mixed in a small quantity with the epithelium-cells, and become increased when the mucous membrane is irritated. Physical character of mucus. Normal mucus, when fresh and recently secreted, is denser than water, and when mixed with that fluid it gradually sinks to the bottom of the vessel, unless it should be hindered from doing so by extraneous causes. Dried mucus sinks very rapidly: normal mucus from the lungs or nostrils usually floats on water for a considerable period ; in fact it was regarded as characteristic_of mucus to float on water, in contradistinction to pus, which always sinks. A more careful investigation enables us to trace the floating of the mucus to two causes: first to the number of air-bubbles that are entangled in it, (after the removal of which it sinks) ; and, secondly, to the proportionally small amount of solid con- stituents in the secretion. The insolubility of fluid mucus in water is the cause of the long retention of the air-bubbles. When mucus contains pus, the proportion of solid consti- tuents increases, the fluid portion diminishes, and its place is supplied by albumen. Water rapidly permeates mucus in this state, the air-bubbles escape, and it speedily falls to the bottom in consequence of its specific gravity. Mucus from the bladder or from the intestines does not swim on water in consequence of the absence of air-bubbles. When some fresh, fluid, transparent, nasal, or bronchial mucus 72 THE SECRETIONS: is examined under the microscope, it is found to consist of a liquid in which minute rounded or prolonged corpuscles of a granular appearance (mucus-corpuscles) are inclosed, which do not exhibit any independent motion, in consequence of the thick viscid nature of the fluid in which they are suspended; but when the fluid is stirred they are seen to move with it. In addition to the mucus-corpuscles, some epithelium-cells are also observed, and a finely-granulated substance which pervades the whole fluid, and can only be seen with a good light. Nasal mucus, from my own observations, is represented in fig. 15 ; @@ mucus- corpuscles, 6 6 epithelium cells; cc the faintly a substance. ' According to Henle, the diameter of the mucus-corpuscles varies from 0:003 to 0:007 of a line: according to Vogel, from 0-004 of a line: Gruby’ considers them from 2 to 4 times the size of the blood-corpuscles. They are prolonged, oval, or round, and when observed in fresh mucus have a clear well- defined contour, a pale gray colour, a granular appearance, and © sometimes give faint indications of one or more nuclei. After remaining for some time in water, the mucus-corpuscles become more or less swollen, paler, and more transparent ; the granular appearance on the external capsule disappears, and one or more nuclei may be observed in the interior of the cell. The external capsule frequently becomes so colourless as to render its de- tection difficult. The epithelium-cells appear under the microscope in the form of elliptic dises ; according to Gruby, the axis major varies from 0:013 to 0°0333 of a line, and the axis minor from 0-010 to 0-016 of a line: the surface is frequently irregular, wrinkled, or plicated. We sometimes find them swollen and vesicular, and sometimes, but more rarely, almost circular or elliptic. The nucleus is of the same prolonged form as the mucus-corpuscle; it is granular and rather darker coloured. If mucus is fre- quently observed, the transition of mucus-corpuscles into epithe- lium-cells may easily be seen. We have attempted to illus- trate this progressive change in d, e, f, fig. 15. ' Observationes Microscopice ad Morphologiam Pathologicam. Vindobone, p. 15. MUCUS: 73 Chemical character of mucus. The action of chemical reagents on the epithelium cells and - mucus-corpuscles may easily be observed under the microscope. The former are not affected by the addition of water or of dilute acids; they disappear, however, under the influence of caustic alkalies or concentrated acids. According to Gruby, solutions of the ordinary earthy, and metallic salts effect no change on the epithelium cells. The mucus-corpuscles are very differently acted on. Dilute acetic, oxalic, and tartaric acids speedily deprive the capsules of the mucus-corpuscles of their granular appearance. The corpuscles themselves become round and transparent; the nuclei become apparent, the cap- Sules at length disappear, and the nuclei frequently divide into several granular bodies, so that in place of the mucus-corpus- cles previously visible, there are at last only two, three, or more rounded granules to be seen. Dilute mineral acids do not produce these changes in the capsule of the mucus-corpuscle, which remains unchanged, as shown by the observations of Giiterbock, Vogel, Gruby, and myself. Dilute, as well as concentrated solutions of the alkalies and their carbonates render the capsules clearer, and ultimately dissolve them. The free fixed alkalies produce these changes more rapidly than their carbonates; free ammonia much less rapidly than free potash. The liquid portion of the mucus always exhibits a decidedly alkaline reaction: when examined under the microscope it ap- pears like a clear fluid, in which, with a very good light, a faint granular appearance is perceptible. On the addition of a little water, a decided coagulation may be observed, and an extremely fine granular precipitate is formed. Acetic, and indeed any weak acid produces a.similar effect, but the precipitate is more copious, and forms a grayish granular film, sufficiently strong to admit of traction. The free alkalies and their carbonates do not precipitate this fluid. It is clear from the preceding observations that mucus is composed of two distinct parts, the cells and the fluid. The viscidity of the secretion evidently pertains to the latter, and ‘the ingredient that gives rise to this property must be contained 74 THE SECRETIONS: in it in a state of solution, as is obvious from microscopic ex- amination. There can, I conceive, be no doubt that the prin- cipal constituent of the fluid, mucin,’ is held in solution by means of an alkali, since water (by taking up the alkali) is sufficient to precipitate it, and the effect is produced in a much higher degree by the addition of a free acid. | When mucus is allowed to remain in contact with water, a slight quantity of the mucin always dissolves, probably through the aid of a free alkali; hence it is that the water in which the sputa, during catarrhal affections, are allowed to float, always become slightly turbid on the addition of acetic acid. In addition to the mucin, the fiuid portion of the mucus also contains a small quantity of extractive matters and salts, (espe- cially lactate of soda and chloride of sodium,) and either no albumen, or at any rate a mere trace. The contents of the mucus-corpuscles are not accurately known; in all probability they contain a fluid in addition to their nuclei. The fat that occurs in mucus is probably contained in the corpuscles, for no fat-vesicles are generally observed in fresh mucus, but after the solution of the corpuscles by the addition of acetic acid, a few fat-vesicles make their appearance ; indeed in some of my obser- vations, the nuclei of the mucus-corpuscles, have seemed to lose their dark granular appearance, and, after a time, to become clear and like minute fat-vesicles. The nuclei of mucus-cor- puscles do not appear to undergo this change invariably ; there are probably different stages of development, and on the as- sumption that the nuclei of the least-developed corpuscles are composed of fat, the relative increase of fat will clearly corre- spond with the amount of mucus that is secreted. 1 [Simon observed the great similarity between mucin and pyin; the researches of Eichholtz seem to show that these substances are identical. The substance de- scribed by Eichholtz as pyin differs from the protein-compounds in being precipitated from an alkaline solution by an aqueous solution of iodine and by distilled water. A considerable excess of water dissolves a slight portion of it. Dilute mineral acids, when carefully added, precipitate it, but when in slight excess, immediately redissolve it; moreover, ferrocyanide of potassium causes no precipitate in a clear acid solution, but a turbidity is produced by the same substances that throw it down from its alkaline solutions. Acetic, tartaric, and oxalic acids precipitate, but do not redissolve it, and a solution of alum, gradually added, produces a precipitate insoluble in an excess of the test. On evaporating an alkaline solution of mucin on the water-bath, it becomes covered with a film of coagulated mucin which is difficult of solution in water. ] MUCUS. 75 It follows, from the preceding observations, that mucus con- tains the following constituents: mucus-corpuscles, epithelium cells, mucin, small quantities of extractive matters and fat, chlorides of sodium and potassium, alkaline lactates, a little carbonate of soda and phosphate of lime, and sometimes a minute quantity of albumen. In order to separate these con- stituents I adopt the following course. A known weight of mucus must be washed with distilled water and evaporated to dryness on the water-bath. The re- sidue must be finely triturated and repeatedly extracted with boiling ether in order to remove the fat ; it must then be boiled in spirit of 0-91 as long as any additional matter is dissolved. The spirituous solution must be evaporated to a small syrupy residue, and alcohol of 0°85 added, in order to precipitate any dissolved mucin, caseous matter, water-extract, and pyin: the alcoholic solution, containing the alcohol-extract and lactates, is also to be evaporated. The portion undissolved by boiling spirit of 0-91, consists of mucin with cells, and traces of albu- men, if the previous qualitative investigation has shown that this substance is present. In order to determine the salts, a portion of the dried re- sidue must be submitted to incineration. It is difficult to ob- tain a white ash in consequence of the fusion of the salts, The chlorides may be extracted with spirit; the residue must be then treated with acetic acid, in order to convert the carbonates, which have arisen from the incineration of the alkaline lactates, into acetates, which may be extracted with alcohol. Anything that still remains, is composed of phosphates and perhaps sul- phates, in very minute quantity, together with traces of iron and silica. : I have analysed mucus both from the nose and lungs, during pulmonary catarrh, but as I cannot regard these cases as illus- trations of normal mucus, I shall defer their consideration for the present. From an analysis of nasal mucus made by Berzelius, it appears that there are in 1000 parts: Watet. : : ‘ i 9337 Mucin ‘ : ‘ . ‘ 53°3 Alcohol-extract and alkaline lactates : , 3°0 Chlorides of sodium and potassium 3 : 5°6 Water-extract with traces of albumen and phosphates 3°5 Soda, combined with mucus. j : 3°9 76 THE SECRETIONS: Consequently Berzelius found no fat, but he detected traces of albumen. : The foregoing remarks refer especially to the mucus of the nostrils and lungs, but as the physico-chemical properties of all sorts of mucus are not quite the same, I shall briefly commu- nicate my own observations and those of Berzelius on the different varieties of mucus. 1. Nasal mucus. Nasal mucus generally occurs as a gelatinous or fibrous, and nearly transparent mass ; after complete evaporation it remains in the basin as a yellow, and tolerably transparent coating. It contains epithelium cells and a few mucus-corpuscles, is not soluble in water, but if it remains in contact with that fluid for a considerable time it yields some mucin, in consequence of which the addition of acetic acid to the water produces a very slight turbidity. When water containing mucus is sub- mitted to filtration, the latter remains on the filter and gra- dually solidifies. Berzelius has observed that it may be dried and again diffused through water repeatedly, without changing its properties ; it ultimately, however, becomes opaque, yellow, and apparently purulent. When boiled with water it does not shrivel and harden, but only slightly contracts, and may be diffused by shaking. On cooling, it again becomes tenacious and viscid. By dry distillation of evaporated mucus we obtain carbonate of ammonia and Dippel’s oil. Mucus dissolves in dilute sulphuric acid; in the concentrated acid it becomes dark ‘coloured and is decomposed. Dilute nitric acid causes a su- perficial coagulation ; acetic acid induces a degree of contrac- tion, and the mucus does not dissolve in it at a boiling heat. On the addition of caustic alkalies, it, at first, becomes tough and thick, but subsequently dissolves into a thin fiuid. 2. Bronchial and pulmonary mucus. These are very similar to nasal mucus. They separate into clear and gelatinous, or else into gray or yellowish flocculi, which remain suspended in water for some time, but ultimately sink to the bottom. MUCUS. 77 [Nasse! has analysed pulmonary mucus expectorated in the morning bya healthy man. Analysis No. 1 refers to the mucus itself, and No. 2 to the solid residue. 1. 2. Water ‘ , : 955-520 Solid constituents : i 44°480 Mucin, with a little albumen : 23°754 53°405 Water-extract 3 ‘ 8°006 18-000 Alcohol-extract ; ; 1810 4:070 Fat : ; ; 2°887 2°490 Chloride of sodium. ; 5°825 13°095 Sulphate of soda ‘ ‘ 0-400 0°880 Carbonate of soda é ; 0-198 0°465 Phosphate of soda ‘ 0-080 0-180 Phosphate of potash, with traces ‘of iron 0°974 2°190 Carbonate of potash . ; - 0°291 0°655 Silica, and sulphate of potash. 0°255 0°570 ] 3. Mucus from the intestinal canal. When evacuated with watery motions after the administra- tion of a purgative, I found it occurring in yellow gelatinous masses, which, on being examined with the microscope, were ob- served to contain a large quantity of mucus-corpuscles. Berzelius found that the mucus discharged with the feces becomes hard and black on drying; if it is then placed in water it becomes softer, and if the water contains any free alkali it again becomes viscid. It is thoroughly soluble in caustic potash, and it may be precipitated from its alkaline solution by the addition of any acid. According to Gmelin,? the mucus from the small in- testines of dogs and horses appears, after being washed in cold water, in the form of white shreds or flocculi. Dilute acids increase its coagulation, but concentrated acetic acid dissolves the greater part. It also dissolves in the alkalies, from which it may be precipitated by an acid. 4. Mucus from the gall-bladder. When bile is submitted to filtration a certain quantity of mucus which is suspended in the bile is detained on the filter, while another portion chemically combined with an alkali passes through in a state of solution, and may be precipitated by 1 Journal fiir praktische Chemie, vol. 9, p. 59. ? Handbuch der theoretischen Chemie, vol. ii, p. 1118. 78 THE SECRETIONS : an acid: the latter has, however, lost the characteristic vis- cidity of mucus. If the acid be removed by means of an alkaline carbonate, the mass does not become viscid; if, however, in- stead of a carbonate, a caustic alkali is employed, the viscidity is restored. If the mucus of the gall-bladder is precipitated by alcohol, the viscidity disappears, it is restored, however, by being washed in water. When dried, it becomes transparent and yellow; on the addition of water it swells, and is rendered opaque but not viscid. : 5. Mucus from the urinary bladder. Vesical mucus is always present in the urine, but only in very small quantity in the normal secretion. In recently dis- charged urine it cannot be detected with the naked eye, but after the fluid has stood for some time, there are formed light, often hardly perceptible nebule of smking mucus, in which the microscope reveals mucus-corpuscles and epithelium-cells. On filtration the mucus remains on the paper in the form of co- lourless flocculi ; it contracts and ultimately forms a glistening varnish-like coating, which does not resume its former appear- ance on being moistened with water. According to Berzelius it is insoluble in sulphuric acid, but the greater part of it dissolves in acetic and hydrochloric acids : ferrocyanide of potassium throws down a precipitate from these solutions.1 . Morbid Mucus. It is well known that any irritation will increase the secretion of mucus in an extraordinary degree; this is seen in the secretion of the mucous membrane of the nostrils and lungs during a common cold or catarrh. The mucus is then mate- rially changed ; at the commencement of the attack it is gene- 1 [We have at present analyses of only three varieties of mucus, viz. the mucus of the oviduct of frogs, the mucus of the cesophagus of the peculiar species of swallows which build edible nests, and the mucus of the gall-bladder. The results differ so much that either animal mucus is a variable mixture of heterogeneous substances, or that different substances at present bear the name of mucus in common. ‘The ana- lyses are quoted in Mulder’s Chemistry of Vegetable and Animal ee p- 240, English translation. } MUCUS. 79 rally thinner than usual; but, towards the termination, it be- comes thicker ; the epithelium-cells diminish, while the mucus- corpuscles increase in number ; the reaction continues alkaline; in fact, in most cases it is more strongly so than in the normal state; the fat is increased, and always contains cholesterin ; _ and at the same time there is an excess of albumen. Gruby found that mucus secreted by the nasal mucous mem- brane during a state of irritation of that surface, was white, of the consistence of the white of eggs, and had a saline taste. When examined with the microscope, there were only a few epithelium-cells and mucus-corpuscles to be seen. I have analysed nasal mucus which accumulated in the upper part of the nose of a man aged thirty years; it generally came away in the form of thick, tough, yellow lumps, about the size of an ordinary bean, or, if it had only been retained in the nos- tril for a shorter period, it was obtained as an extremely copious, tough, yellow fluid; it was invariably discharged from only one nostril. This mucus was devoid of odour, had an alkaline reaction, and being moistened with water, (in which it sank,) it exhibited an extraordinarily large quantity of epithelium-cells, and a few mucus-corpuscles, connected by a pretty thick mem- brane of coagulated mucin. When the mucus was gently dried and pressed between the fingers, they presented the same glistening appearance as if they had been pressing fat ; no fat could, however, be distinctly recognised by the microscope in consequence of the dense strata of membrane and mucus-cor- puscles. In 1000 parts of this mucus there were contained : Analysis 88. Water ‘ F ; ; : 880°0 Solid constituents : : ‘ ‘ 120-0 Fat, containing cholesterin : ; 6:0 Caseous matter, with pyin or mucin in ‘solution : 13°2 Extractive matters, with lactates and chloride of sodium . 12°0 Albumen, cells, and coagulated mucin : <2 84:0 Gruby found that the mucus secreted during catarrhal affections (slight inflammation) of the mucous membrane of the nose, conjunctiva, fauces, larynx, bronchi, ureters, vagina, and intestinal canal is thicker than the mucus secreted during mere irritation of those membranes; it was thick, tough, lubricous, of a yellowish white colour, and, as it gradually dried, it formed a grayish-yellow elastic mass. It sank in water, 80 THE SECRETIONS : unless air-bubbles were entangled in it, and exhibited no change for a considerable time, but ultimately became whiter. With the aid of the microscope, Gruby observed, Ist, a white amor- — phous mass, not acted on by water (coagulated mucin,) and 2d, round yellowish-white globules, whose number seemed in a direct ratio with the intensity of the yellow colour of the mucus. These cells which were observed in the mucus of the larynx, had eight times the diameter of the blood-corpuscles, were inti- mately connected with the amorphous white mass, and consisted of a very delicate transparent capsule that was easily ruptured, of an inner round cell with a nucleus twice as large as a blood- corpuscle, and very many small vesicles one sixth the diameter of the blood-corpuscles, some of which were transparent and some opaque. The large vesicles sometimes contained two inner central cells. I have also frequently observed these large cells (which strongly resemble the full primary cells described and figured by Henle,') in the gray or yellow-streaked gelatinous mucous flocculi which are expectorated during a slight catarrh of the trachea and bronchi, as well as in the thick, tough, yellow nasal mucus that is secreted during a cold. I have repre- sented this bronchial mucus in fig. 16, in which aa represent the large cells. Other observers have detected these cells in tu- bercular matter ; it is clear, however, that they occur in diseased mucus, and are not to be regarded as diagnostic of tubercle. Gruby found that the mucus in ophthalmoblennorrhea, and in the uterine and vaginal discharges of some women after their confinement, is of a deep yellow colour, thready and opaque ; it sinks in water and forms flocculi, which, on being stirred, dis- colour the fluid ; but after remaining in the water for some time, they lose their power of communicating their colour to a fresh supply of clear water. This mucus, when dried, forms a yellow, transparent, brittle mass, which continues to burn when lighted. Under the microscope, a white amorphous mass, insoluble in water, 1s observed, together with a large number of yellow vesicles of the form and nature of those. previously described, some with, and others without a central cell. These vesicles swell in water, the capsule bursts, the inclosed molecules escape, and Ueber Schleim und Eiterbildung u. s. w. fig. 14. ~ MUCUS. 81 either become scattered or else accumulate round the unchanged. internal cell, and often exhibit for some time the phenomena of molecular motion. Only a few epithelium-cells are observable; those that are present are full, round, and often closely resemble the large mucus-vesicles. I have likewise observed these epithelium-celis, which I regard as characteristic of a lower stage of development, in nasal mucus. (See fig. 14, d, e, f.) The mucus secreted in chronic blennorrheea of the vagina and bladder is, according to Gruby, of a yellowish white colour, and slightly thready. It quickly renders water turbid, and deposits white flocks at the bottom of the vessel: in other respects it resembles the former varieties of mucus. Under the micro- scope we observe a small number of yellowish white vesicles, some with a capsule, granular contents, and a central cell, some with merely a capsule and a central cell, and some that are composed of an aggregation of granules, without any cap- sule whatever. Gruby found that the lochial discharge,’ a short time after delivery, is of the colour of blood, is possessed of an animal odour, is only slightly thready, and when dried leaves a red pulverisable mass ; it consists of hzematoglobulin, fibrin, (pro- bably also albumen,) and vaginal mucus: under the microscope we observe an amorphous thready mass, blood-corpuscles, mu- cus-vesicles with capsules and aggregated granular molecules, and finally epithelium-cells. Very shortly before delivery we can observe nothing in the vaginal mucus beyond the true mucus-corpuscles (fig. 14, a,) and epithelium-cells; but very soon after delivery the large mucus-vesicles, with granular con- tents (molecular granules) and delicate capsules, make their appearance. Fig. 16, a, exhibits these cells, and is copied from the plate in Gruby’s work. On the second day after delivery vesicles with a central cell (fig. 16, 5) are visible, the mucus becomes less dense, the blood-corpuscles diminish, and the large mucus-vesicles increase in number. On the third day the red- dish lochial discharge contains yellow vesicles with granular contents and central cells. On the fourth day the discharge is considerably less red, and contains white stringy flocculi. On the fifth day the mucus contains grayish white, viscid flocculi, ' Scherer’s observations on this subject have been already given : see Vol. I, p. 338: II. 6 82 THE SECRETIONS : together with white vesicles, eight or ten times the size of blood- corpuscles, which contain only a few, and, in some cases, no gra- nular molecules; these are represented in fig. 16,c,d. Between the sixth and tenth days the lochial discharge becomeswhite, and con- tains white round vesicles, with finely granular contents, but de- void of a central cell, or the larger molecules. (Fig. 16, e, f, g.) Gruby has shown that the mucus discharged by stool at the commencement of dysentery is clear and stringy, and scarcely different from the mucus secreted in simple diarrhoea, but as the disease becomes more severe, there is a secretion of thick red mucus, consisting of blood- and mucus-corpuscles, resem- bling the ordinary secretion of inflamed mucous membranes. I have observed that the mucus secreted during inflam- matory affections of the mucous membrane of the respiratory organs is thick, rounded in form, of a white or pale yellow colour, and floats on water. These clots of mucus remain un- broken for a considerable time, but ultimately break up, and sink to the bottom: they then spread out into long tough fibres, which, when observed with the naked eye, have an uniform non- granular appearance: they possess a certain degree of con- sistency, and feel slippery, in consequence of the mucin which connects the mucus-corpuscles ; they are consequently not very easily fixed and broken up by pressure against the sides of the vessel with a glass rod. When examined with the microscope, the white masses of mucus are found to consist of a large num- ber of mucus-corpuscles, and a few epithelium-scales, connected. by a delicate granular membrane of coagulated mucin: the yel- low clots contain, in proportion to the intensity of their colour, a greater or smaller quantity of the large cells with granular contents, (fig. 16, aa,) in some of which a central cell is visible, while in others no cell can be seen. ‘The fluid in which the thick clots of mucus are swimming is slightly clouded by acetic acid, but rendered very turbid by nitric acid: on the applica- tion of heat, it becomes white and opalescent ; and infusion of galls, and basic acetate of lead yield tolerably copious flocculent precipitates ; there is, consequently, a greater quantity of dis- solved mucin and albumen present than the water would have extracted from healthy mucus. A quantitative analysis of these floating clots, after being well washed in distilled water, gave the following results. MUCUS. 83 The numbers are calculated for 1000 parts : Analysis 89. Water 2 941°75 Solid sinstidrannte 3 i i 58°25 Fat with traces of cholesterin 5°01 Spirit-extract, with lactates and chloride of sodium 11-09 Alcohol-extract ‘ 6°95 Cells, mucin, and a little ‘albumen : 34°80 In a case of severe bronchitis that recently occurred in Schénlein’s clinical wards, the patient expectorated purulent mucus, which, when placed in water, assumed a delicate arbo- rescent form, the ultimate fibrils floating on the water when the slightest motion was communicated to the vessel. When placed in acetic acid, it swelled and became converted into a trans- parent jelly, and after long digestion almost entirely dissolved; the solution being precipitable by ferrocyanide of potassium. Under the microscope the fibrils resembled coagulated fibrin, and there can be no doubt that plastic lymph was exuded as a consequence of the bronchitis, and expectorated in a coagu- lated form. [Observations on the sputa in bronchitis and pneumonia may be found in Scherer’s ‘ Untersuchungen,’ pp- 93-97. | Gruby states that the sputa expectorated during the ordi- nary inflammatory affections of the mucous membrane of the respiratory organs, are, at the commencement of a catarrh, white, transparent, and mixed with gray flocculi ; under the mi- croscope they. are seen to contain a few round vesicles with granular contents, and numerous epithelium-cells, swimming in a transparent fluid. As the catarrh gets worse, the gray floc- ‘culi increase, and become more of a yellow colour, and the amount of transparent mucus decreases; the coloured flocculi contain numerous cells with granular contents (molecular gra- nules) and a central cell, which are all connected together by very tough mucus. As the inflammation decreases the amount of this globular sputa diminishes, and it assumes a whiter colour. Purulent Mucus. If the mucous membranes or the tissues immediately beneath them pass into a state of suppuration, pus becomes mixed with the secreted mucus: in this manner the mucus of the lungs, bladder, intestinal canal, generative organs, &c. may contain 84 THE SECRETIONS: pus. When tubercles form in the lungs, they produce, like any other foreign body, a degree of irritation in the surrounding tissue, and an increased secretion of mucus is the result. Gruby’s observation that the mucus discharged during irritation of the mucous membrane, dependent on the deposition of tubercle, does not differ from the mucus produced during catarrhal affections, is confirmed by Hetterschig! and other observers ; the secretion of mucus at the commencement of a catarrh is, however, more abundant than that which is produced by the irritation of existing tubercles. The quantity of expectoration increases with the more ex- tended deposition of tubercle, until softening commences; the tubercular matter is then expectorated, and, in consequence of the inflammation that occurs, pus is secreted by the walls of the cavity thus produced, and in this manner gets mixed with the sputa. | The purulent expectoration of persons with tubercular phthisis is easily distinguished by the experienced practitioner from healthy sputa,? and with tolerable certainty from diseased mucus, nor can there be any doubt regarding its nature while tuber- cular matter is being discharged from a vomica, but the tran- sition from diseased into healthy purulent mucus is so slight and imperceptible, that it is hardly possible to detect the first traces of pus that are mingled with the mucus; for although, as I Shall presently show, their general physical and chemical rela- tions are perfectly sufficient to distinguish pure pus from pure mucus, we have no means of determining with certainty the presence of a little pus in mucus, or the presence of a little ‘mucus in pus. Purulent mucus from the lungs contains much less mucin than normal or diseased mucus,? and consequently the mucous clots have not the toughness, lubricity, and consistence ob- served in mucus, unmixed with pus: in fact they have a de- cided tendency to dissolve. Purulent mucus sinks more quickly in water than the normal secretion, partly im conse- ' De Inflammatione ejusque exitu diverso. Trajecti a. R. 1841, p. 176. * [Dr. Wright’s papers on Expectoration (recently published. in the Medical Times) may be consulted with advantage. ] i 3 [This ‘is perfectly consistent with the observation of Eichholtz, that the pyin (or mucin) varies inversely with the pus-corpuscles. ] MUCUS. 85 quence of the fewer air-bubbles that are inclosed, (on account | of slighter tenacity of the fluid medium of communication, and the comparative facility with which they escape,) and partly in consequence of the greater amount of albumen in the fluid, and its higher specific gravity. If the secretion is composed of nearly equal parts of mucus and pus, it sinks rapidly to the bottom, and forms small definite tough clots: the masses may easily be broken up by means of a glass rod, and can often be separated by mere shaking: they have not so uniform an ap- pearance as the healthy or morbid clots of mucus which float on water, but to the naked eye they appear finely granulated or gritty, since, in consequence'of the deficiency of the con- necting medium—the mucin, the cells of the secretion are not so closely associated. When there is only a small amount of pus in the globular sputa during phthisis, it separates from the mucus on being placed in water ; the pus at once sinks, and while the mucus is still floating on the surface we may observe long dependent viscid fibres, at the extremities of which white or yellowish gra- nular particles of pus may be noticed. Phthisical sputa deposit a whitish granular sediment at the _ bottom of the vessel, while masses of mucus are still floating on the surface of the water. A microscopic examination of the sediment shows that it consists of cells, which closely resemble mucus-cells, especially when they have been in the. water for any time: since, however, the cells of purulent sputa come in contact with the water more readily in consequence of the smaller quantity of the connecting medium, mucin, they swell and become larger than the mucus-corpuscles, after they have been for only a short time in water: the capsules become transparent and vesicular, the granular appearance vanishes, and one, two, three, or even more nuclei with internal nucleoli, be- come visible: the capsules of many of the cells burst, and the nuclei swim about in a state of freedom, in the same manner as we observe in mucus that has been long under water. Gmelin’s Chemie, vol. 2, p. 1395. 94 THE SECRETIONS : On the fifth, sixth, eighth, and ninth days after the com- mencement of the eruption the pustules contained a thick yellow fluid, which had a slightly alkaline reaction, and con- tained numerous yellow pus-corpuscles, the capsules of which readily burst. Tremoliere describes the contents of a well-conditioned pus- tule as yellow, turbid, and with an oily appearance. The smell and taste of this fluid were unpleasant, its specific gravity was 1031, and it consisted, according to his statement, of fibrin, mucus, chloride of sodium, sulphate of potash, and phosphate of lime. Gruby found that the fluid in the pustule on the seventh day was transparent; it contained white, nearly spherical vesicles, which appeared wrinkled on one side. Vogel has made some important observations regarding the modifying influence of tissue, constitution, &c., on the nature of pus. Pus from the cellular tissue is usually the purest, pus from mucous or serous surfaces being too thin and fluid, and con- taining in one case an admixture of mucus, in the other of serosity. Pus from the liver is pultaceous, thick, and of a brownish red colour. On allowing it to stand for some time, a dense, thick, and reddish matter separates from the white pus. Pus from the kidneys is usually rather fluid, of a whitish- yellow colour, and saltish. Pus from the urinary bladder may be either fluid or tough, and varies in colour from a yellow toa dirty brown-red tint; it frequently also has an ammoniacal odour. Pus from the bones is blackish, or white with black specks ; it has an odour and taste of phosphorus. Syphilitic pus is of a yellow or yellowish-green colour ; it possesses a nau- seous smell, and a sweet but sickly taste. Scrofulous pus is caseous, very fluid, grumous, and sometimes resembles coagu- lated milk ; according to Gendrin, it contains more soda and chloride of sodium than ordinary pus; according to Preuss, it contains casein, like tubercular matter. Rheumatic and arthritic pus are very similar; for the most part very fluid, irri- tative, and corrosive. I have examined the dried residue of the liquor puris of an arthritic person ; it was of a grayish- yellow colour, contained no membranous shreds, could be easily pulverised, and exhibited no appearance of crystals when exa- mined under the microscope. -On heating it with nitric acid, I PUS. 95 obtained, after the evaporation of the acid, and more strikingly on the addition of ammonia, a brilliant purple colour, indicating the presence of uric acid beyond a doubt. On triturating this substance with water I obtained a pulpy mass, which, when exa- mined under the microscope, was found to contain numerous epithelium-cells and pus-corpuscles, but no crystals of uric acid. Alcohol extracted 5:46 of fat, consisting chiefly of margaric and oleic acids, with a little cholesterin; boiling water took up 52°69, of which a little fat, extractive matters, with hydrochlorate of ammonia and lactate of soda, were soluble in anhydrous alco- hol; and chloride of sodium, extractive matter, and albuminate of soda in spirit. The remainder was washed with cold water, (which extracted very little,) and was then dissolved in a faintly alkaline solution. On the addition of hydrochloric acid to this alkaline solution, crystals of uric acid were deposited, and some albumen thrown down from the albuminate of soda: the acid solution then contained hydrochlorate of ammonia and chloride of sodium. The portion insoluble in water yielded on incinera- tion 5° of ash, consisting of earthy phosphates, with a little peroxide of iron and carbonate of soda; the dried residue of the liquor puris yielded, however, 102 of ash, composed of carbonate of soda, a little phosphate of soda, carbonate and phosphate of lime, a little chloride of sodium, and traces of peroxide of iron. It contained in 100 parts: Analysis 91. Portion insoluble in water . : : P 47°4 Fat ‘ ° ‘ A ‘ ‘ 5°4 Alcohol-extract, with hydrochlorate of ammonia and lactate of soda ‘ ‘ : ; ; 49 Spirit-extract, with chloride of sodium and albuminate of soda ; : . ‘ ; 17°5 Uric acid and albumen, combined with ammonia and soda _ . 17°2 The amount of the individual salts was not determined. I have received, through the kindness of Dr. Piutti, of El- gersburg, two small flasks filled with a white fluid discharged from an abscess on the foot of a gouty patient, who had been trying the water-cure. On standing, the fluid threw down a copious white sediment, the supernatant liquid portion having a reddish tint. When shaken, innumerable crystals might be ob- served with the naked eye, which, under the microscope, ex- hibited an acicular form; a few pus-corpuscles were also present. 96 THE SECRETIONS: The crystals, after being carefully washed, so as to remove all extraneous matter, formed, when dry, a white powder, and when incinerated on platinum foil, left a white fused ash, consisting of carbonate of soda. The white crystalline mass, when warmed with nitric acid, yielded the deep purple tint indicative of uric acid. On digesting a portion with dilute hydrochloric acid, a large number of rhombic tablets of uric acid appeared on cooling. The hydrochloric acid solution yielded, on gentle evaporation, crystals of chloride of sodium. Hence the white acicular crystals consisted of urate of soda. The red super- natant fluid contained a few corpuscles, a large quantity of albu- men, and some hematoglobulin. Scorbutic pus is thin, ichor-like, of a bad odour, often mixed with blood, and soon becomes putrid. Cancerous pus possesses a very peculiarly fetid odour, and appears very frequently to contain sulphuretted hydrogen and ammonia. Pus sometimes contains infusoria; thus R. Wagner’ has ob- ‘served minute ciliated animalcules, in some slight degree resembling pus-corpuscles, in pus taken from cancer of the lip; they appeared to be the colpoda cucullus. Valentin has also observed infusoria in the purulent fluid of carcinoma. Donne? has observed the vibrio lineola in the pus from chancres and gonorrhea: he found other forms of infusoria in the pus from syphilitic vaginitis ; they were twice the size of the blood-cor- puscles, with a round or elliptic body, considerably prolonged anteriorly ; he proposes for this animalcule the name of ¢rico- monas vaginalis. Ichor. When pus begins to undergo decay, or is secreted from ma- lignant or carcinomatous growths, or when mortification comes on in consequence of the depressed state of the vital powers, it becomes thin and discoloured, (being often of a brown or reddish tint,) and emits a fetid odour: it is then termed ichor. Ichor frequently contains no pus-corpuscles, or only a very few, and those partially broken : it is of a blood-red colour, but does not always contain blood-corpuscles, the red colour being apparently due to their solution in the putrid and decomposed fluid. From ' Valentin’s Repertorium, p. 119. 3 Recherches microsc. sur la nat. du Mucus, ete. Paris, 1837. PUS. 97 the odour we may infer the presence of hydrosulphate of am- monia. Vogel examined some ichorous pus from a sore in the foot of a rheumatic patient ; he found perfectly normal pus-cor- puscles in it, and it only differed from normal pus in its greater fluidity. Pus of animals. I have analysed pus from a lymphatic gland in a horse. There were contained in 1000 parts : Analysis 92. Water ‘ ; : ‘ R 976°00 Solid constituents 4 ‘ ; ; 24:00 Fat, containing cholesterin . ; = 1°68 Water-extract and caseous matter ; 1:26 Spirit-extract, with lactates, and chloride of sodium ‘ 2°94 Albumen, cells, — and np ae of lime, and traces of iron : 17°64 Gobel! has analysed pus from the uterus of a mare ; it was a thick fluid, of a whitish-yellow colour, opaque, of specific gravity 1079, and had a faint animal odour: it was neutral, and coagu- lated on the application of heat. It contained, water, 913°3 ; albumen, 7°2; gelatinous non-coagulable animal matter, 9°4; chloride of sodium, lactate and sulphate of potash, phosphates of lime and magnesia, protoxide of iron, and silica, 5°3. Dumas analysed pus from the frontal sinus of a mule: it reddened lit- mus paper, formed an emulsion with cold water, and when heated to 158°, yielded a granular coagulum. It contained, 17-9° of solid constituents, of which 16:5 were albumen; the Ferivaitidae consisted of extractive matter, free lactic acid, phosphates and sulphates. On the formation of mucus and pus on mucous membranes, and : on the detection of pus in mucus. It seems to be now almost generally admitted that the dis- tinctions between pus and mucus are to be sought for, not in the morphological character or chemical relations of their respective corpuscles, but rather in the chemical peculiarities of the fluid portions of these secretions. It has been already shown that the fluid of mucus contains a large quantity of dissolved mucin, while no albumen, or, at the most, a mere trace, is present: on the other hand, the fluid of ’ Schweigger’s Journal, vol. 34, p. 407. Il. 7 93 THE SECRETIONS: pus is rich in albumen, and contains only a very small quantity of dissolved mucin. Hence, if it were proved that normal mucus never contains albumen, we might conclude that all mucus which gave indications of the presence of that substance was purulent. We should then also arrive at the conclusion that most persons, on the slightest irritation of the mucous mem- brane, secrete purulent mucus. In this manner we should have to agree with Vogel that normal mucus contains only epithe- lium, and that any secretion of mucus-corpuscles indicates an admixture of pus. To the physician the detection of traces of pus in mucus is a point of little importance ; it is of much more consequence to be able to decide from the sputa whether suppuration of the parenchyma of the lungs or of other tissues has actually com- menced. The point is one of very great difficulty, in conse- quence, as has been previously observed, of the imperceptible changes that mucus undergoes in its transition from the normal secretion into pus. My own observations, as well as those of others, lead me to concur in the view that Henle! has developed in his essay on the Secretion of Pus and Mucus, in which he distinctly and in- geniously points out the analogous phenomena between mucous membranes and the external skin. The mucous membranes are covered with several layers of epithelium, and in the ordinary course of secretion, the more recent and inferior layer of cells projects against the superior and older cells which constitute the existing epithelium. The inferior cells themselves gradually become epithelium, and, in their turn, are thrust out and supplanted by still deeper cells. As the fiuid portion of the mucus is secreted at the same time, it evidently cannot be re- garded as the cytoblastema of these cells, but must be looked upon as effete, and no longer essential to the formation of mu- cus-corpuscles; the albumen for their nutrition having been ex- tracted from it during the progress of their development towards actual epithelium, and only mucin (the product of their meta- morphosis) left in its stead. As the secretion is increased by irritation of the mucous mem- brane, it follows either that such epithelium as is thrown off in the normal state is then not formed at all, or else that it is 1 Hufeland’s Journal, May 1836. PUS. 99 only secreted imperfectly, and consequently we meet with cells in every state of development under these circumstances. These changes in the epithelium lead to corresponding variations in the fluid portion of the mucus, for if a normal stratum of epithelium is no longer formed, that is to say, if the deeper layers throw off the superior cells before they have arrived at maturity, the changes impressed on the fluid must be different from those which it would undergo during the ordinary secre- tion of healthy mucus. It is impossible that all the nutritious matter of this fluid can be consumed by these immature cells, and we consequently find in it, under these circumstances, a greater or less quantity of albumen and fat, two substances which universally yield a cytoblastema forthe higher development of cells. If an increased secretion of mucus takes place on a mucous membrane which possesses only a single layer of epithelium, (either the cylinder or the ciliated variety,) the mucus-corpuscles appear immediately after the epithelium has scaled off. The transition of the mucus-corpuscles into epithelium-cells is not observed so well in this instance, as when there is a profuse secretion from a surface possessing several layers. These transitions and various stages of development lead us to the con- clusion that the mucus-corpuscles represent the first stage of formation of the epithelium-cells, into which they would ulti- mately have been converted if they had not been thrown off too early, and, further, that the different forms of epithelium-cells are in their primary state identical with one another. The same elements are likewise recognised, according to Henle, in other tissues, in the ganglia of nerves, in the brain, in the contents of the Graafian vesicle around the ovum, in the parenchyma of the liver, and in the blood-formative glands, (the spleen, thymus, and thyroid.) These cells occur also in the blood, where I have termed them chyle-corpuscles ; they proba- bly represent the blood-corpuscle in a preparatory stage of de- velopment. If we suppose the secretion of mucus to be still further in- creased, the mucous membrane will produce only these primary cells, which cannot be distinguished from pus-cells, with which, in fact, they are identical. Whether the secreted fluid is to be regarded as pus, mucus, or purulent mucus, depends on the quality of the liquid that is secreted with the cells. If it con- 100 THE SECRETIONS. tains much mucin, the fluid must be regarded as mucus ; if there is no mucin in it, or only a small quantity, but on the other hand much fat and albumen, it must be regarded as pus ; while if all three are contained in the fluid, it must be regarded as purulent mucus. In a very diseased state of the mucous mem- brane the fluid may even contain fibrin, and thus resemble plastic lymph. Henle! has observed this in one instance. We may consequently observe the various stages of transition from plastic lymph to the normal fluid of mucus (containing mucin, but no albumen), in the same manner as we can trace the epithe- lium-cells gradually downwards till they assume the form of primary cells. The following conclusions are all that we are entitled to de- duce from the previous observations : (1.) Pure mucus floats on water for a considerable time if air-bubbles are entangled in it; pure pus sinks rapidly to the bottom ; purulent mucus swims if it contain air-bubbles, but allows the pus to deposit itself; the deposit frequently takes place in the form of pendent fibres. If pure mucus contain no air-bubbles it sinks. 7 (2.) Pure mucus, lying in water, appears as a homogeneous, streaked, vesicular, viscid, and tenacious mass, of a white or whitish-yellow colour, and yielding readily to pressure. Pure pus forms a stratum at the bottom of water, of a white or greenish-yellow colour, and sometimes tinged with blood; by agitation it is diffused through the water, and in a short time | again sinks to the bottom. Purulent mucus forms streaked, vesicular, often discoloured masses, or mucous sediments ; they are easily diffused through water, and have a granular, non- homogeneous appearance. (3.) Pure mucus imparts no albumen or mucin to water; mucus which is mixed with much saliva does, however, render water a little albuminous; pure pus communicates a large amount of albumen to water, and purulent mucus imparts a quantity of albumen proportionate to the amount of pus. None of what have been termed the “ pus tests” are calcu- lated, in my opinion, to detect minute quantities of pus in mu- cus, and no test is requisite to distinguish pure mucus from pure pus, or to recognise a large quantity of pus in mucus. ' Hufeland’s Journal, 1836, p. 21. 101 CHAPTER VI. SECRETION OF THE EXTERNAL SKIN. Sweat. (Sudor.) THE sudoriparous glands continuously secrete a very consi- derable amount of watery fluid, which, in consequence of the ex- tent of surface over which these glands are distributed, usually passes off directly in the shape of vapour, leaving behind, how- ever, on the skin, its various solid constituents, mixed with the secretion of the sebaceous glands. It is only under the influ- ence of active exercise, high external temperature, or certain forms of disease, that the secretion is elaborated in such quan- tity as to stand in drops on the skin, instead of being carried off as insensible vapour ; it is then termed sweat. ; Attempts have been made by Sanctorius, Dodart and Reil, and more recently by Lavoisier and Seguin, to determine the quantity of fluid which escapes from the skin within a certain time, in the form of vapour. Seguin found that, on an average, 18 grains of fluid were discharged in a minute by the skin and lungs ; the former exhaling 11 and the latter 7 grains. The minimum exhalation from both sources amounted to 11 grains; the maximum, in a state of rest, to 82 grains in a minute. From these data the maximum of matter lost by the body through the skin and lungs in 24 hours, would amount to 5 pounds, and the minimum to 1 pound, 11 ounces, and 4 drachms. Taking the average of 11 grains in the minute, the whole quan- tity would amount to 29 ounces of fluid. The amount of solid constituents carried off with the fluid, is comparatively very small, and does not exceed 7 or 8 scruples in the 24 hours: all the rest is mere water, with some carbonic acid, and perhaps some nitrogen. The solid constituents of the sweat consist of a mixture of salts and extractive matters, of which the latter preponderate ; the principal ingredient of the salts is chloride of sodium. 102 THE SECRETIONS: I have on several occasions collected and analysed the sweat of persons in the vapour-bath ; it is, however, always mixed with more or less water condensed on the body from the vapour of the bath. The sweat collected in this manner from the arms and face was a turbid, rather dirty-looking fluid, which, after standing for some time, deposited gray floccules, recognizable under the microscope as epithelium-scales, for the most part broken and in fragments. The filtered sweat had in one in- stance a specific gravity of 1003, in another of 1004; it was slightly acid, which appears to be the ordinary reaction of nor- mal sweat; in the course of 24 hours it became neutral, and on holding over it a rod moistened with hydrochloric acid, a slight cloud was observed. On evaporation of my own sweat, as well as that of another healthy man, the peculiar smell of the axilla was observed, and an odour of ammonia developed; the presence of this sub- stance was also indicated by the test to which we have just re- ferred. On evaporation to dryness, the odour of extractive matter became perceptible. On triturating a portion of the residue with free potash, ammonia was developed ; on the addi- tion of sulphuric acid to another part, sulphurous acid was first given off, and afterwards a marked odour of acetic acid. In one instance the odour of butyric acid was so clearly asso- ciated with that of acetic acid, as to leave no doubt of its presence. On boiling the dried residue of sweat with ether, a small quantity of fat is taken up, which may be isolated by evaporating the ether, and possesses the peculiar odour of sweat. Alcohol, on being then added to the residue, becomes of a pale yellow colour, and is rather strongly precipitated by tannic acid and acetate of lead,—indications of the presence of alcohol-extract. On evaporation of the alcohol, chloride of sodium crystallizes in cubes, and in addition to these cubes, which constitute the greater part of the salts, and many of which have octohedral surfaces, there are also long prisms, plates, and fern-like crystal- line clusters of hydrochlorate of ammonia; the latter, especially, _ is very abundant in sweat that has stood for some time. On treating a portion of the residue of the salts with sulphuric acid, there is extricated in the first place some hydrochloric acid in a state of vapour, and subsequently a decided odour of acetic acid. SWEAT. 103 If a portion of the residue is incinerated, the ash effervesces on the addition of hydrochloric acid. On dissolving out the chlorides with alcohol, and adding bichloride of platinum, we obtain a slight yellow precipitate. The residue is soluble in water, with the exception of some gray flocculi, and on the ad- dition of tannic acid this aqueous solution yields a precipitate, which shows that the sweat contains-water-extract. The solu- tion also contains a small quantity of lime, but hardly a trace of phosphoric acid, and only once, in several trials, was there a faint indication of sulphuric acid. When the whole residue of the sweat was incinerated, the amount of phosphate of lime was _ much larger, and a considerable quantity of sulphuric acid, as well as traces of peroxide of iron, were always perceptible. It is true that these are superficial and merely qualitative in- vestigations ; they are, however, sufficient to establish the ex- istence, in normal sweat, of 1. Substances soluble in ether: traces of fat, sometimes in- cluding butyric acid. 2. Substances soluble in alcohol : alcohol-extract, free lactic or acetic acid, chloride of sodium, lactates and acetates of pot- ash and soda, lactate or hydrochlorate of ammonia. 3. Substances soluble in water: water-extract, phosphate of lime, and occasionally an alkaline sulphate. 4. Substances insoluble in water: desquamated epithelium, and (after the removal of the free lactic acid by-alcohol) phos- phate of lime, with a little peroxide of iron. The results of the investigations of other chemists coincide generally with these conclusions of mine. Berzelius infers from his analyses of sweat that collected in drops on the fore- head, that it contains in solution the same substances which occur in a dissolved condition in the acid fluid of muscu- lar flesh, together with an excess of chloride of sodium. The most comprehensive analyses of sweat have been made by Ansel- mino.! He inclosed the naked arm in a glass cylinder, and collected the sweat that had exhaled during several experiments: in the course of five or six hours a table-spoonful had condensed. A portion was heated with sulphuric acid, evaporated, and 1 Tiedemann’s Zeitschrift, vol. 2, p. 321. 104 THE SECRETIONS : caustic potash added to the residue; by this means the pre- sence of ammonia was established beyond a doubt. On digesting another portion with oxide of lead, and moistening the dried mass with sulphuric acid, vapours of acetic acid were developed. A third portion, which was treated with lime water, became turbid, in consequence of the presence of carbonic acid. For the purpose of determining the solid constituents, Anselmino made use of sweat that had been collected by clean sponges from the vapour-bath ; it was turbid, and had a strong though by no means a constant odour. After the distillation of a portion of the filtered liquid in the steam-bath, acetate of ammonia was found in the fluid that had collected in the receiver. A very small amount of solid residue (from 0°5 to 1:25) was left after evaporation of the sweat. Anselmino extracted the solid resi- due with alcohol of ‘833, evaporated the alcoholic solution to dryness, and then, by means of anhydrous alcohol, extracted | from the saline residue an acid, extract-like matter, similar to the alcohol-extract of flesh, and containing free acetic acid, acetate of potash, and animal matter precipitable by tannic acid. Berzelius conceives the free acid of this extract (like the free acid in extract of flesh,) to be lactic acid. Now I will not assert that the sweat always contains free acetic acid, but I cer- tainly have observed cases in which the odour clearly showed that the free acid was principally the acetic; lactic acid may, however, still be always present. The occurrence of acetic acid in sweat is placed beyond a doubt by my experiments. The matters which are undissolved by anhydrous alcohol are princi- pally chlorides of sodium and potassium, and spirit-extract ; the latter is not precipitated by chlorine, protochloride of tin, or bichloride of mercury. In this investigation Anselmino seems to have overlooked, as Berzelius remarks, the hydrochlorate and lactate of ammonia. All that is insoluble in alcohol may be dissolved in lukewarm water, with the exception of a gray mat- ter; this aqueous solution contains sulphates and an animal matter precipitable by tannic acid, and perchloride of tin, (water- extract.) The gray insoluble matter leaves on incineration a considerable amount of phosphate, pueiare with a little car- bonate of lime. Anselmino has consequently ened at results which entirely correspond with my own, excepting only that I could not in every SWEAT. 105 case detect the presence of sulphates in fresh sweat, although I always found them in the incinerated residue ; from this cir- cumstance I am led to infer that some of the constituents of sweat contain sulphur. In 100 parts of the solid residue of sweat Anselmino found : Substances insoluble in water and alcohol, chiefly salts of lime . 2:0 Water-extract and sulphates P ‘ . 21:0 Spirit-extract, with chlorides of sodium and si a ‘ 48-0 Alcohol-extract, acetic acid, and acetates (lactates) . : 29°0 These figures must be regarded merely as approximative. In 1000 parts of sweat there are contained, according to Anselmino: ; Water ‘ . . 995-000 987-500 Epidermis and salts of haw ’ ‘ "100 250 Water-extract and sulphates ‘ ‘ 1050 2°625 Spirit-extract, chlorides of sodium and potassium 2°400 6°000 Alcohol-extract, acetates, lactates, and free acetic acid : ; ‘ : 1450 3°625 From 100 parts of dried residue of sweat Anselmino obtained 22°9 of fixed salts, consisting of carbonates, sulphates, and phos- phates of soda and (in small quantity) of potash, chloride of sodium, phosphate and carbonate of lime, and traces of per- oxide of iron. The peculiar odour of sweat from different parts-of the body is dependent in a great measure on the secretion of the seba- ceous glands in those parts: thus it is well known that the sweat from the feet of many persons has a very penetrating odour, that the sweat from the axilla gives off a peculiar ammoniacal smell, and that the sweat of the external organs of generation contains and smells faintly of butyric acid. The gases which are given off by the skin are, according to Collard de Martigny,' carbonic acid and nitrogen ; they are not exhaled in constant, but in varying proportions, and generally in the greatest quantity after meals and after violent exertion. Collard has observed that an excess of carbonic acid is exhaled after the use of vegetable food, and an excess of nitrogen after a nitrogenous diet. Since these gases are contained in a state ' Magendie’s Journal, vol. 10, p. 162. 106 THE SECRETIONS: of solution in the blood, (see vol. I, p. 135,) it may readily be conceived that they will exhale at those pomts where the blood in its passage through the capillaries comes in the most inti- mate contact with the external atmosphere; at least it seems a simpler view to regard it as a mere physical process than as a disintegration of animal matter by the secreting organs. In fact, the cutaneous exhalation must be regarded, as Edwards has observed, in the light of a partly physical, partly organic process. The product of physical exhalation is pure water and . gas; the product of organic exhalation contains animal consti- tuents, which must be regarded as secretions of cells. The amount of exhaled matter is liable to great variations : it is increased by a dry and light atmosphere; and is lessened by a moist, vapoury, dense, and calm atmosphere. During and immediately after meals the exhalation is at its minimum; it attains its maximum during the actual period of digestion. The cutaneous exhalation is in antagonism with the urinary secretion and the pulmonary exhalation, so that an excessive secretion of urine diminishes the action of the skin, and, conversely, the renal functions are less energetic when the skin exhales freely. On Morbid Sweat. Our knowledge of the chemistry of normal sweat is very im- perfect ; but our information respecting the changes which this secretion undergoes in disease is still more deficient. Our ignorance may be explained, and in some measure excused, by the extreme difficulty of obtaining, in a state of purity and un- adulteration, a sufficient quantity of the secretion for the pur- pose of forming a successful chemical analysis. Dr. Piutti, of Elgersburg, has had the kindness to present me with some sweat which he obtained from persons during the use of the water-cure, and also with a manuscript communi- cation containing some analyses of sweat instituted by himself, which I shall at once proceed to enumerate. The manner in which he conducted his analyses is not stated. We observe the absence of salts of lime in these analyses, and Piutti states that he could find no traces of phosphate or ben- zoate of lime, the former of which has indisputably been de- SWEAT. 107 tected by other chemists. Since the phosphate of lime doubt- less pertains to the epidermis, we may conclude that Piutti removed all the desquamated cuticle before he commenced his analyses. All mention of sulphuric acid, and of potash, is likewise omitted. I have already stated that I only once detected traces of sulphuric acid in fresh sweat, although I always found a considerable quantity of it in the incinerated ash. Piutti has made three analyses of the sweat collected from invalids. They gave the following results : 1. , 3. Water : : : 995°5 993-0 994°6 Chloride of sodium ‘ 30 4:0 3°3 Phosphate of ammonia . ‘ az) 8 11 Acetate of ammonia tre ‘ 5 6 5 Hydrosulphate of ammonia ; trace trace Extractive matters : ; D 1°6 5 The first analysis was made with the sweat of a man aged 36 years, who during twelve years had suffered from atonic gout, and had been trying the water-cure for ten weeks. The specific gra- vity of the sweat was 1003°5. The sweat in the second analysis was taken from a woman aged 54 years, who for six years had suffered from gout, and who had been under the water-cure for twelve weeks: its specific gravity was 1004, In the third case it was collected from a girl .22 years of age, suffering from para- lysis of the lower extremities, but in other respects blooming and healthy. The animal matter in this case was of a greenish colour when isolated ; it was soluble in ether, but not in alcohol. The specific gravity was 1003. The sweat that was forwarded to me by Dr. Piutti, and which was inclosed in ounce-bottles with ground stoppers, was in a state of decomposition when I received it, and therefore was not in a proper condition for an accurate qualitative ana- lysis. It smelt strongly of hydrosulphate of ammonia, espe- cially a specimen collected from a man who had had psoriasis diffusa for seventeen years. The gray deposit which was found in every bottle consisted of desquamated epidermis. The sweat, to which I have just referred, had a penetrating odour of sul- 1 Berzelius, however, is of opinion that a portion of phosphate of lime appertains to the sweat itself, and that it is held in solution by a free acid. 108 THE SECRETIONS: phuretted hydrogen, which continued during evaporation, and ultimately merged into a nauseous animal smell. Its specific gravity was comparatively high, being 1008 ; and it yielded 9-9 of solid constituents, which, after being exposed to the influence of a red heat, were found to consist of a large proportion of chloride of sodium, carbonate of soda, a little phosphate of lime, and a fair amount of sulphuric acid. The statements which we possess from other sources, regarding the morbid changes of the sweat, are very loose and inconclusive ; in fact we have no accurate observations on the subject. 1. The quantity of the sweat is sometimes increased in an : extraordinary degree. 7 Thus critical sweats are usually very abundant, continuous, and watery, in intermittent fevers, in rheumatic affections, and in colliquative disorders. : 2. The quality of the sweat is changed. a. The sweat may be distinguished by a peculiar odour. The sweat of persons with the itch is said to have a mouldy odour, while that of syphilitic patients is said to smell sweet. The sweat of rheumatic and gouty persons has an acid smell, while in putrid fever and scurvy, it has a putrid odour; in jaundice it is said to resemble musk in its smell. In Stark’s ‘General Pathology,’ (p. 1126,) we find it stated that the odour of the sweat in scrofula resembles that of sour beer, while in intermittent fever it smells like fresh-baked brown bread. The determination of odours is, however, very subjective, and (with ~ a few exceptions) it is more than probable that different ob- servers would detect different resemblances. 6. Some of the normal constituents may be abnormally in- creased. Ist. The free acid of the sweat may be increased. Lactic acid, which is the ordinary free acid, is usually increased in cases of rheumatism and gout; the sweat in these diseases has a strong acid reaction. When there is also an acid odour, acetic acid is present. Prout has found free acetic acid in the SWEAT. 109 sweat of a person suffering from hectic fever. | After an attack of acute rheumatism, the joints of the feet remained swelled, for which potash-baths were ordered. These baths, in the course of three weeks, brought on an attack of eczema, extending as high as the knee. The sweat from the feet had then a de- cided odour of acetic acid, which became more strongly developed when they were sharply rubbed. Anselmino' found free acetic acid in the sweat of women during their confinement; and, ac- cording to Stark, the quantity of free lactic acid is increased in the sweat during scrofula, rachitis, and certain cutaneous eruptions. 2d. The ammonia of the sweat may be increased. Anselmino found a larger proportion of (free?) ammonia in the sweat after an attack of gout than in any other case. Berend? states that the sweat in putrid and typhus fever is ammoniacal; and in nervous diseases (?), according to Nauche,? it becomes alkaline. All sweat with a putrid odour probably contains free ammonia. 3d. The salts may beincreased. Prout* observed that in the case of a man with dropsy the skin became covered with a white saline crust of chloride of sodium, after an abundant perspira- tion. Anselmino found in the sweat, after a severe attack of gout, more salts than usual. In cases of gouty and urinary concretions, the quantity of phosphate of lime appears to be in- creased. ; c. Abnormal constituents may be present in the sweat. 1st. Albumen has been observed by Anselmino in a critical sweat, which broke out in large quantity one evening over the whole body in a case of febris rheumatica, with severe pains in the joints; on the following day it had disappeared. Stark asserts that albumen may be found in the sweat in gastric, putrid, and hectic diseases, and also on the approach of death, in consequence of the abnormal solution of the solid constituents. I failed in detecting any certain indications of albumen in sweat collected (by means of linen washed with distilled water) from the breast of a person in the colliquative stage of tubercular phthisis. ! Tiedemann’s Zeitschrift, vol. 2, p. 223. 2 Vorlesungen iiber Semiotik, p. 388. 3 Stark, p. 1127. 4 London Med. Gaz. vol. 15, Oct. 1834. 110 THE SECRETIONS: 2d. Blood or its constituents. Voigtel! observed an instance of bloody sweat from under the arm of a young man; it ap- peared after any violent exertion. In scurvy, putrid fever, and typhus icterodes, bloody sweat has likewise been observed. 3d. Uric acid is stated to have been found in the sweat of arthritic persons (Stark). Wolff? found that the sweat which had hardened on the forehead into a solid white substance, (in a patient with stone in the bladder,) contained uric acid. Urate of soda is likewise stated to have been found in the sweat of persons suffering from gout or stone. 4th. Bilin and biliphein have been found in the sweat of persons with jaundice, and sometimes in such large quantity as to colour the linen yellow, and to communicate a bitter taste to the perspiration. According to Berend, the sweat in febris putrida biliosa likewise contains bile-pigment. 5th. Red colouring matter of the urine (uroerythrin) was found by Landerer? in sweat from the axilla of a fever patient. A blue colouring matter, doubtless allied to cyanurin, has occa- sionally been observed in the sweat. Dr. Bleifuss* has seen blue sweat from the foot of a patient with disease of the abdomen. Michel has likewise observed it in an hysterical woman and in a hypochondriacal man ; it was most marked on the right side of the body. Billard® observed a blue sweat on the upper part of the body of a girl. 6th. Fat is stated to occur in colliquative hectic sweats. d. Substances altogether foreign to the animal organism may be conveyed, through the process of digestion, into the blood, and thus occur in the sweat. Landerer® has observed in his own person that after taking large doses of quinine, the sweat assumed the bitter taste of the drug. The following substances enter into, and have been de- tected in the sweat: sulphur, mercury, iodine, iodide of po- tassium, assafcetida, garlic, saffron, olive oil, rhubarb, indigo, prussian blue, and copper. (Stark, General Pathology, p. 1127; ’ Stark, p. 1131. * Diss. sing. casum calculositatis. Tub. 1817. ® Buchner’s Repert. 2d series, vol. 5, p. 234. 4 Wirtemberg. Med. Correspond. Blatt. 1835, No. 26. 5 Froriep’s Notiz. 32. ® Buchner’s Repert. 16, p. 238. SWEAT. 111 Baumgartner, Elements of Physiology and Therapeutics, p- 486.) Many of these statements, regarding the changes undergone by the sweat in disease, are fully confirmed; some must, however, still be regarded as doubtful. Sweat of animals. Anselmino has analysed the sweat of the horse, the only animal of whose sweat we have any accurate knowledge. He used for his analysis the scaly matter that falls from horses during the process of currying, in the form of a white powder, and consisting of dried sweat mixed with a considerable amount of dirt and epithelium. It contained, Ist, a substance with an acid reaction, soluble in anhydrous alcohol, alcohol-extract, together with an alkaline lactate or acetate ; 2d, an extract-like matter, soluble in alcohol of ‘833 and possessing an odour like that of the horse, together with chloride of sodium; 3d, an extractive matter soluble in, and communicating a brown colour to water, and precipitable by infusion of galls, together with chloride of sodium and sulphates. The portion still undissolved evidently consisted of epithelium. Anselmino regarded it as coagulated albumen ; doubtless it was in it that the phosphate of lime and magnesia occurred, which were recognised in the ash of the sweat. The ash consisted of sulphates of potash and soda, chlorides of sodium and potassium, a large proportion of the phosphates of lime and magnesia, with traces of iron, but no alkaline carbonates or phosphates. Anselmino seems to have overlooked the ammonia-salts, for itis only by the presence of hydrochlorate of ammonia that we can explain how it is that the ash contains no alkaline carbonate, while the alcohol- extract contains either lactate or acetate of potash. The pre- sence of acetic acid was established by a separate experiment. Fourcroy and Vauquelin sometimes found small quantities of urea in horses’ sweat, but Anselmino could never detect it. 112 THE SECRETIONS. Fat. The minute sebaceous glands (folliculi sebacei) which are distributed over the whole surface of the body, secrete a peculiar fat, which renders the skin supple and flexible, and hinders it from being permeated by water. The composition of this fat varies in different parts of the body, as is clear from the variety of smell which it evolves in the axilla, on the generative organs, on the scalp, and on the feet of many persons. It is usually of a pale yellow colour, not viscid, and insoluble in water, with which, when it is rubbed, it forms an emulsion. It contains relatively only a small amount of true fat, and is associated with several other animal matters, (as, for instance, albumen and extractive matter,) and a considerable amount of inorganic salts. Esenbeck has made an analysis of the fat collected in an enlarged sebaceous gland. It did not coagulate on boiling, and was precipitated by acids, corrosive sublimate, and tannin. It contained in 100 parts: Stearin ; : : 24:2 Extractive matter, with s some olein . ‘ 12°6 Salivary matter : ; ; : 11°6 Albumen with casein (?) 5 ; : 24°2 Phosphate of lime ; : : ‘ 20:0 Carbonate of lime , : ; ; 21 Carbonate of magnesia : 1:6 Traces of acetate of soda, chloride of sodkieen,. and loss . 37 113 CHAPTER VII. THE URINE. THE urine is an extremely complex fluid, but the relative proportions of its different constituents are not very variable. The following are the ordinary constituents of healthy human urine: urea; uric acid; [hippuric acid]; extractive matters, embracing alcohol-extract, spirit-extract, and water-extract, with their respective constituents; mucus; brown colouring matter of the urine (hemaphezin) ; red colouring matter of the urine (uroerythrin) ; carbonic, lactic, hydrochloric, sulphuric, phosphoric, silicic, and hydrofluoric acids;'’ ,soda; potash ; ammonia; lime; magnesia; and peroxide of iron. Recently discharged urine ordinarily possesses the mean tem- perature of the body; it is of an amber yellow colour, perfectly transparent, has a well-marked acid reaction, and exhales a peculiar but not disagreeable odour, which it loses on cooling. Its specific gravity fluctuates from 1005 to 1030, the average being about 1012°5. It has a saline and disagreeably bitter taste ; it undergoes no apparent change upon being heated to the boiling point, and its behaviour towards reagents is depen- dent upon that of its various constituents, although modified by the very dilute state in which they occur. Acids, with the exception of the oxalic, which produces a turbidity, throw down no precipitates ; the free alkalies, on the contrary, throw down the phosphate of lime; the salts of baryta, silver, and lead, cause precipitates ; so also does tannin, but in a less degree. _ When urine is left to itself for some time, slight nebule, con- sisting of mucus, are formed in it, which gradually descend to the bottom. Soon after the appearance of this phenomenon, an unpleasant odour is developed; instead of an acid, an alkaline 1 [In addition to these constituents, two new acids, to which no names have been yet assigned, have been described by Pettinkofer and Heintz. ] II. . 8 114 THE SECRETIONS : reaction is observed, and carbonate of ammonia is formed, which causes more or less turbidity by precipitating the am- moniaco-magnesian phosphate, and phosphate of lime. A portion of these salts, associated with mucus, forms a greasy whitish scum, in which, by means of the microscope, beautiful crystals of ammoniaco-magnesian phosphate may be seen, mixed with an amorphous mass of phosphate of lime and decomposed mucus. On treating the urine in this state with hydrochloric acid, it effervesces, in consequence of the presence of carbonate of ammonia. If the urine is allowed to stand for a still longer period, the smell becomes more disagreeable ; cubic, and four- and six-sided prismatic crystals, composed of chloride of sodium, hydrochlorate of ammonia, and phosphate of soda and ammonia, are produced in consequence of the concentration produced by the spontaneous evaporation, and the urine ultimately becomes covered with a sort of mould, which is usually of a blue or blueish-gray colour. We have no certain knowledge regarding the manner in which the acids and bases combine to form salts in fresh healthy urine. We may fairly conclude that the chloride of sodium preexists in it; the sulphuric acid is generally supposed to be united with potash, phosphoric acid with lime and magnesia, and ‘if (as is generally the case) more phosphoric acid be present than is required for the saturation of these earths, the excess combines with soda; and if there be not sufficient soda present to effect the saturation of the acid, the ammonia combines with it, forming the biphosphate of ammonia. The lactic acid of the urine is partly free, and partly combined with ammonia, potash, and soda. Hydrochlorate of ammonia is also supposed to pre- exist in the urme. Carbonic acid, when it occurs in the urine, is held in solution and in a free state. Uric! acid is supposed by Berzelius to exist in a free state in solution in the urine, although warm urine usually holds a larger quantity of uric acid in solution than an equal quantity of water at the same tempe- rature could retain. There is, however, this point in favour of his view, that the uric acid, which separates spontaneously from the urme on cooling, contains mere traces of ammonia 1 [It is stated in volume I, page 54, that the formula for hydrated uric acid is C,,.N,H,0,+HO. From various analyses of urates by Bensch (Liebig’s Annalen, vol. 54, p. 189), there is reason to believe that the true formula is C,N,HO,-=-HO.] URINE. 115 and soda, and he conceives that, in all probability, the uric acid is held in solution through the agency of some of the other con- stituents of the urine. [Liebig’ has shown that uric acid possesses the property of combining with a portion of the soda of the alkaline phosphate of soda, and acquires in the combination a higher degree of solubility than it possesses in its uncombined state, at the ordi- nary temperature of the body. By this reaction there are produced a urate of soda and an acid phosphate of soda. | Prout, on the contrary, is of opinion that the uric acid is held in solution in the urine in the state of urate of ammonia, a combination which probably always occurs in healthy urine, and which is often found in large quantity in the urine of diseased persons, giving rise to the formation of sediments. The real state of the case may be, that normal urine contains both free uric acid and urate of ammonia. Qualitative analysis of healthy urine. The qualitative analysis of healthy urine seldom presents any _ great difficulty. Many of its constituents may be detected with ease, unless, as is sometimes the case, they exist in very minute quantity. Others, as for instance, the extractive matters, can only be detected with any degree of certainty by isolating them, in the same manner as is done in quantitative analysis. The analysis of the urine is something like that of mineral waters ; some of the constituents may be at once recognised by the addition of a test, while we can only be assured of the pre- sence of others, by separating them in a distinct and _ iso- lated state. : The specific gravity of the urine is most accurately deter- mined by the ordinary 1000-grain glass bottle. An areometer will give the result with less trouble, but, at the same time, with less accuracy. Becquerel? has published a table for the purpose of enabling us to calculate the amount of the solid constituents in a known weight of urine, from the observed specific gravity, [but it has 1 Lancet, June 1844. 2 Séméiotique des Urines, p. 17. - 116 THE SECRETIONS: been proved to give results on which no dependance can be placed.?] 1. Urea. This constituent seldom occurs so abundantly in the urine, as to be immediately detectible by the addition of any reagent. A portion of urine is usually evaporated in the water-bath to the consistence of a syrup, anhydrous al- cohol is added, and the alcoholic solution is filtered, and eva- porated on the water-bath nearly to dryness; some drops of water, and subsequently of nitric acid are added, upon which crystals of stellar and foliated shapes very speedily develop themselves. Upon leaving the alcoholic extract to spontaneous evapora- tion, long acicular crystals of urea will be formed ; on examining some of them under the microscope, they will be found to pre- sent the appearance of four-sided prisms, as shown in figure 20, If, (which however is not often the case,) the urea should be present in very small quantity, and no crystals are formed for some time after the addition of nitric acid, it only requires a microscopic examination to ascertain whether the crystals are those of nitrate of urea: if they are, they will occur in the forms indicated in fig. 21. If, instead of nitric, oxalic acid has been used for the detection of the urea, we obtain the forms represented in fig. 22. z 2. Uric acid. It is but seldom that the uric acid exists in — such large amount, as to be precipitated in the form of a fine crystalline red sediment when the urine cools. When, how- ever, this is the case, the crystals, under the microscope, exhibit the rhomboid form shown in fig. 23. Another method of proving that the sediment consists of uric acid, is to place some of it in a porcelain capsule moistened with nitric acid, and to apply heat till the acid evaporates. A purple-red colour then appears, which is characteristic of uric acid: this colour becomes more intense on -the approximation of a rod dipped in ammonia. If no crystalline sediment is deposited as the urine cools, two or three drachms of hydrochloric acid must be added to six or eight ounces of urine, and the mixture must be allowed to ' [On the specific gravity of the urine in health and disease, especially in diabetes and granular degeneration of the kidneys. By George E. Day. Lancet, June 15> — 1844. ] . URINE. 117 stand, covered, for twenty-four to forty-eight hours. A red or reddish-brown sediment of uric acid then separates, consisting of crystals of the forms represented in fig. 23a, and 230. 2*, [Hippuric acid is regarded by Liebig! as an invariable constituent of ordinary human urine. “ All the urine taken in this country from individuals living upon a mixed animal and vegetable diet, contains hippuric as well as uric acid, and about the same proportion of both acids. Hippuric acid may be obtained in the following manner, even from proportionally small amounts of fresh urine :—Fresh urine is evaporated in a water-bath to the consistence of a syrup; it is then mixed with some hydrochloric acid, and agitated with its own volume of ether, which latter substance dissolves the hippuric acid. It usually happens that the mixture does not separate spontane- ously, but that the ether remains inclosed by the fluid, like froth ; the separation of the ether takes place immediately upon adding to the mixture, after having allowed it to stand at rest for an hour, one twentieth part of its volume of alcohol. In this case the froth disappears, and the fluid separates into two layers ; the upper layer contains the hippuric acid in solution; but besides it also contains urea, owing to the addition of the alcohol. This upper layer is carefully removed by means of a pipette or syphon, and agitated with small portions of water ; the water removes the alcohol and the urea, whilst the hippuric acid remains in solution in the ether. By evaporating the ethereal solution the hippuric acid is obtained in crystals. The crystals produced are usually of a yellowish or brown colour, arising from the presence of a resinous substance, which may be easily and completely removed by means of charred blood.? 1 Lancet, June 1844. 2 [The following is asimple method of obtaining pure crystals of hippuric acid from human urine. Evaporate the urine till there is a copious deposition of salts. Add strong alcohol, and place the mixture in a stoppered bottle. With the aid of a gentle heat, (for instance, by placing the bottle in warm water), we ensure the solu- ’ tion of the urea, the lactates (if any are present) and the hippurates in the alcohol, whilst the urates remain with the insoluble constituents. When the supernatant fluid is perfectly clear, it must be decanted, evaporated very nearly to dryness, and redissolved in hot water. Ifa stream of chlorine be passed through the aqueous solution, the urea is destroyed; and by gradual concentration, and the addition of a little free mineral acid, we obtain crystals of hippuric acid. ] . 118 THE SECRETIONS: _ “In its pure state the hippuric acid produced from human urine presents the same long, shining, transparent, four-sided ob- liquely-truncated prisms, by which the hippuric acid produced from the urine of animals is so easily detected and distinguished from benzoic acid. (See fig. 23.) The hippuric acid of human urine is not volatile at the subliming temperature of benzoic acid; at a higher temperature it undergoes fusion, forming a brown-red liquid, and yielding upon dry distillation the same products which common hippuric acid forms under the same circumstances, viz., a red-coloured oil smelling like tonka-beans, ammonia, benzoic acid, and a copious residue of carbon. It dissolves in nitric acid at a high temperature, and yields, upon cooling, crystals of benzoic acid, owing to the decomposition which it undergoes. “From 0-499 of hippuric acid produced from urine, 10791 of carbonic acid and 0°2317 of water were obtained. This gives for 100 parts— i Found. Calculated. Carbon . , ; 59°47 ‘ : 60°89 Hydrogen F : 5°15 . ‘ 4°45 This analysis corresponds sufficiently with the calculated results to remove all doubt as to the nature of the acid ; it will be per- ceived that it contains 10 less carbon than benzoic acid.’ | 3. Extractive matters. The exhibition of the divisions of ex- tractive matter, namely, the water-extract, the spirit-extract, and the alcohol-extract, can only be effected by evaporating the urine, and treating it with alcohol, as we shall presently show in speaking of the quantitative analysis of this fluid. Little has yet been done in this department of chemistry, but the presence of the extractive matters can generally be easily re- cognized by the addition of certain tests: for instance, acetate of copper, chloride of tin, perchloride of iron, and sulphate of prot- oxide of iron, throw down precipitates from freshly-passed urine; ° and bichloride of mercury, nitrate of tin, and tannic acid, cause a degree of turbidity. There is, however, no certain proof, al- though there is every probability that normal urine in all cases behaves in this way with the above tests. The extractive mat- URINE. 119 ters which I formerly separated from the urine were not precipi- tated by the salts of iron, while, on the contrary, its perchloride throws down a copious precipitate in a specimen of urine, which I am now analysing. Berzelius states, that after urine has been neutralized by an alkali, precipitates are induced by the salts of zinc, tin, and mercury: I find that fresh urine, with a strong acid reaction, becomes clouded or deposits a sediment upon the addition of these salts. 4. Mucus. Mucus in the urine is readily detected by the microscope. We take up with a spoon a portion of the sepa- rated nebulous matter, and on placing it on the object-glass we - can easily recognize the mucus-granules, and frequently a few epithelium-scales. 5. Hemaphein. It is this constituent which gives to healthy urine its amber or brownish-yellow colour. The variations in the tints of the urine are dependent upon the quantity of this colouring matter. [Scharling! has recently examined the brown organic matter which gives the colour to inspissated urine, and seems also to be the source of its peculiar odour. By treating urine con- centrated by the application of a freezing mixture, with ether, and evaporating, he obtained a brown fusible resinous mass, which he calls oxide of omichmyle, and supposes to contain a radical, omichmyle, the composition of which is still unknown. It has a strong odour of castoreum, and when heated smells like urine. It dissolves in alcohol, forming a solution that reddens litmus. It burns with a clear flame, leaving scarcely any ash. | 6. Uroerythrin. This red colouring matter exists only in very small quantity in healthy urine, and cannot be easily de- tected by tests. It is always associated with uric acid, and seems to increase and decrease in the same proportion as that constituent. It is precipitated with the uric acid and urate of ’ Ann. der Chemie und Pharmacie, vol. 42, p. 265. 120 THE SECRETIONS: ammonia, to the former of which it appears to enact the part of a mild base, imparting to it a more or less deep red colour, This constituent can therefore be detected by the addition of hydrochloric acid to the urine, in the manner already described in speaking of uric acid. In some few diseased states, we find a gray or yellow precipitate of uric acid, as if this constituent was present in large quantity, while the uroerythrin was defi- cient: on the addition, however, of hydrochloric acid, dark coloured uric acid is soon precipitated. 7. Carbonic acid is probably a constituent of healthy urine, existing in a state of solution: in order to detect it, fresh urme must be warmed in a retort, the neck of which rests a few lines under the surface of lime-water. The presence of carbonic acid renders the lime-water turbid. In order to guard against the production of carbonate of ammonia, we must take care that the urine is not submitted to too powerful a heat, and that the distillation is not carried too far. 7 [The following method is far less liable to give erroneous re- sults. It is founded on the principle that one gas passed through a solution of another will displace it, so that hydrogen or ni- trogen will liberate carbonic acid and dissolve in its place. A series of Wolfe’s bottles must be arranged, so that hydrogen gas evolved in the ordinary manner from the first shall pass through a strong solution of caustic potash to free it from any carbonic acid that may be mixed with it, and then through an- other bottle containing lime-water, in order to certify its purity; in the next bottle through thé urime to displace the gas dis- solved in it, and, finally, through lime-water a second time, to show if the displaced gas were carbonic acid or contained it. | 8. Lactic acid is always present in the urine, imparting to it an acid reaction. It may be presumed that the carbonates which are left upon the incineration of the solid residue of the urine correspond to the lactates, because lactates with fixed bases are transformed into carbonates by incineration, and because the other salts which occur in the urine, the sulphates, phosphates, and hydrochlorates, are not similarly changed. It may, however, happen that no carbonic acid is found in the URINE. 121 ash, although there has been a large proportion of lactic acid in the urine ; for if the urine contained only free lactic acid, or lactate of ammonia, or even the lactates of soda and potash, at the same time with phosphate of ammonia or chloride of ammo- nium, the ash might be devoid of carbonic acid, in consequence of the liberated phosphoric or hydrochloric acid uniting with the base.' In this case the lactic acid would have to be determined analytically. The alcohol-extract of the urine contains both free lactic acid and alkaline lactates ; after dissolving it in ab- solute alcohol, precipitating the bases by sulphuric acid, filtering, evaporating the alcohol, dissolving the residue in water, and digesting the acid solution with oxide of zinc, we obtain a lac- tate of zinc, which may be decomposed by free baryta. This is certainly a very tedious proceeding for the mere qualitative de- termination of lactic acid, and need never be adopted: since, as far as I am aware, the ash (more especially the ash of the spirit-extract,) always contains carbonates, and as the presence of lactic acid in healthy urine has been sufficiently proved by - Berzelius. [It is well known that Liebig denies the existence of lactic acid and the lactates in the urine ; and as the subject has re- cently attracted much attention, I have thought it advisable to state the grounds upon which that chemist has arrived at his conclusions. “ Lactic acid,” he observes, “is a non-nitrogenous substance. Nothing has hitherto been observed tending to show that it may be produced from the elements of a nitrogenous substance, by the decomposition of such a substance and the transposition of its elements. In every instance where the for- mation of lactic acid has been observed, the result of careful examination has proved the presence of a non-nitrogenous sub- stance of an identical, or, at least, similar composition with that acid. 1 [It has been recently shown by Dr. Golding Bird that an alkaline acetate (and the observation applies equally to a lactate) may exist in a solution of phosphate of soda in considerable quantity, and yet yield no carbonate by ignition. The reaction is explained by the equation : NaO, C, H, O,4-HO, 2 NaO, PO,=3 NaO, PO,+CO,, HO+C, H, 0. (Lond. and Edin. Phil. Mag., June 1845.)] 122 THE SECRETIONS: “These observations would seem to render the formation of lactic acid in the body of the herbivorous and graminivorous animals, which take starch and sugar in their food (substances from which lactic acid may be formed), not merely possible, but in many cases highly probable; and yet, strange to say, chemists have hitherto attempted in vain to detect lactic acid in the urine of the cow and of the horse. The urine of the cow or horse has no acid reaction ; on the contrary, its reaction is strongly alkaline ; it contains carbonated, hippurated, or ben- zoated alkali, or alkalies combined with mineral acids, but no trace of any /actate. “Tn contrast with this, the urine of man, and of carnivorous animals, manifests, when in a healthy state, a strongly acid re- action. Now, it is precisely in analyses of the blood and urine of man, and of carnivorous animals, that we find lactates men- tioned as constant constituents ; not because they have in reality been detected in these fluids—for no one has as yet succeeded in producing lactic acid therefrom—but because, upon examin- ing the aqueous and alcoholic extracts of blood and urine, some non-crystalline matters have been found which sometimes mani- fested an acid reaction, and upon incineration left a carbonated alkali as a residue, thus presenting a remote similarity in deport- ment to the alkaline lactates. “ From what substance could lactic acid be formed in the body of carnivorous animals? With the exception of fat, they partake of no non-nitrogenous matter in food, no substance, in fact, so far as we know, capable of producing lactic acid. Car- nivorous animals partake of no sugar, no starch, no gum, no mucus; there is a total absence of the non-nitrogenous sub- stances which form so large a part of the aliments of herbivorous and graminivorous animals. “ The assumption, @ priori, that neither the blood nor any other fluid in the body of carnivorous animals can possibly con- tain any lactic acid, has been positively established by the ex- periments of Enderlin, (Annalen der Chemie und Pharmacie, vols. 49 and 50.) Finally, Pelouze has proved that the experi- ments of Henry, who pretended he had detected lactate of urea in urine, are erroneous, and by no means to be relied upon. “ Consequently, as our knowledge of this subject stands at present, the acid reaction of urine cannot proceed from lactic URINE. 123 acid. And although processes of transposition take place in the healthy animal body, rendering insoluble substances soluble in the stomach and bowels, yet these processes are of a different kind from that process of putrefaction of casein in milk which causes the formation of lactic acid. “ Direct experiments prove that fresh urine, of a strongly acid reaction, and taken from various healthy individuals, when cautiously neutralized with baryta water, does not retain in so- lution the least detectible trace of baryta. Now, as lactate of baryta is readily soluble in water, the urine would certainly, and of necessity, contain baryta, if its acid reaction were really owing to the presence of lactic acid. Upon the addition of the very first drop of the baryta water to urine an extremely copious pre- cipitate is formed; this precipitate contains urate and phosphate of baryta and of lime, but no detectible trace of baryta is found, even although only just so much baryta water is added as to leave the urine still possessing a feebly acid reaction. “ Carbonate of magnesia and calcined magnesia act upon urine in precisely the same manner. If either of these sub- stances be mixed with water, so as to form a milky fluid, and be then added to urine with an acid reaction, the acid reaction will immediately cease, and a very considerable white precipi- tate be formed. The fluid now manifests a feebly alkaline re- action, and contains a trace of magnesia in solution. It is a remarkable circumstance that magnesia withdraws the phos- phoric acid from the urine so completely, that a mixture of per- chloride of iron and acetate of potash no longer indicates a trace of phosphoric acid in the urine which has thus been treated with magnesia. “ Had lactic acid been the solvent of the lime and magnesia present in the urme, one would have expected that a corre- sponding amount of baryta, or of magnesia, would have taken its place upon its separation. But, as I have already observed, not a trace of baryta is found in solution when that substance has been employed for neutralizing the acid, and only a slight trace of magnesia when it has been used for the same purpose. “ But as urine contains a certain amount of alkaline phos- phates, i. e. phosphate of soda and phosphate of potash, and as baryta and magnesia form, with phosphoric acid, insoluble 124 THE SECRETIONS : salts, it might have been supposed that the neutral lactates formed upon the neutralization of the urine with the two bases had been decomposed, together with the phosphates of soda and potash contained in the urine, and transposed themselves anew, with these substances, into phosphate of baryta or of magnesia, and into neutral lactate of potash or soda. In this case neither baryta nor magnesia could remain in solution. This cireum- stance, therefore, renders these experiments indecisive, and leaves the question as to the presence or absence of lactic acid in urine dependent upon more direct experiments, “ T employed putrid urine in my attempts to detect lactic acid, because lactic acid is not destroyed by putrefaction, and it must, therefore, of necessity be present in putrid urine if it really forms a constituent of fresh urine ; and because if lactic acid can at all be formed by the putrefaction of urine, from matters containing previously no lactic acid, the question whether lactic acid is to be reckoned among the constituents of normal urine is at once practically decided; or, more correctly speak- ing, the problem is proved to be impossible of solution, since we possess no means of positively determining which urine may be considered of a normal constitution, and, on the contrary, which is, to this extent, abnormal. « As matters at present stand, therefore, with regard to this subject, it was immaterial whether the presence of lactic acid was detected in fresh or in putrid urine ; if it was found to exist in the latter, this fact must be considered as a confirmation of Berzelius’ examination of fresh urine ; whilst its absence from putrid urine would justify us positively in asserting that it does not form a constituent of fresh urine ; and, moreover, that urine contains no substance giving origin, my means of putrefaction, to the formation of lactic acid. “« T have come to the latter conclusion. I have found it im- possible to detect the presence of lactic acid in putrid urine ; and if we examine somewhat more closely and minutely the experiments made by Berzelius, and from which he inferred the presence of lactic acid in urine, we find that not one of them amounts to a positive proof that lactic acid really forms a con- stituent of fresh urine. * The experiments which I made for the purpose of ascer- URINE. 125 taining the presence of lactic acid in putrid urine are the following : “ Putrid urine was first evaporated over an open fire, and afterwards to dryness in a water-bath ; the residue was treated with a mixture of alcohol and sulphuric acid, which caused the solution of phosphoric acid, hydrochloric acid, and of lactic acid also, if this latter substance were really present. The fluid ob- tained was saturated with oxide of lead, and then filtered off from the phosphate, sulphate, and chloride of lead formed ; the lead contained in solution in the filtrate was separated by means of sulphuretted hydrogen. The solution thus freed from lead, and which ought to have contained the lactic acid had there been any present, was evaporated in a water-bath, and the re- sidue treated with alcohol: a quantity of common salt remained. In order to remove the soda from the alcoholic solution, efflo- resced oxalic acid was dissolved in the latter, at a high tempe- rature, and the oxalate of soda formed was separated from the fluid by filtration; the fluid was then saturated with oxide of lead, which again gave rise to the formation and separation of chloride of lead. The solution was, by means of sulphuretted hydrogen, again freed from the lead which had. dissolved, then concentrated in the water-bath, and basic acetate of lead added. in excess ; a copious white precipitate was formed, from which the fluid was filtered off. This fluid must contain the lactic acid if any had been present in the urine; the lead which this fluid held in solution was precipitated by means of sulphuretted hydrogen, the fluid filtered off from the precipitate, concen- trated in the water-bath, and boiled with hydrate of baryta: a quantity of ammonia was expelled by this operation. After the decomposition of the ammoniacal salt the new-formed salt of baryta was cautiously decomposed, by means of sulphate of zine, and every possible means was applied to obtain from this fluid crystals of lactate of zinc, but without success ; no trace could be discovered. « The white precipitate obtained by means of the basic acetate of lead contained hydrochloric acid, and a brown resinous sub- stance, which, upon combustion, comported itself like an ani- mal substance. “ In other experiments the putrid urine was boiled until all the carbonate of ammonia it contained was completely expelled ; 126 THE SECRETIONS: then, with addition of hydrate of lime to destroy the remaining salts of ammonia, evaporated to dryness, and the residue treated with cold water, which must have dissolved lactate of lime had any lactic acid been present in the urime. The aqueous extract was evaporated to dryness, and the residue again treated with alcohol ; the fluid obtained contained a copious amount of lime combined with an organic acid ; the lime was then removed by the addition of oxalic acid, and the excess of oxalic acid by the addition of oxide of lead; the minute trace of dissolved oxide of lead was removed by means of charred blood. The fluid obtained was very acid; it contaimed hydrochloric acid, which was removed by the addition of oxide of silver; a por- tion of the fluid filtered off from the hydrochlorate of silver was saturated with oxide of zinc, and left to crystallize, but no lactate of zinc was obtained; the fluid settled into a dark- coloured resinous mass. Another portion of this acid fluid was evaporated in the water-bath ; a quantity of acetic acid was ex- pelled during the evaporation, and there remained at last only a very minute amount of a resinous matter, which upon calcina- tion emitted a very fetid odour. “ All the other experiments, which I made in order to detect lactic acid in putrid urine, and a detailed description of which would be as tedious as useless, gave the same negative result. These experiments were usually made upon quantities of from forty to fifty pounds of urine, so that even a very minute amount of lactic acid, if really present in the urine, could not have escaped detection. All these experiments indicated the presence of an organic acid, but after the removal of all the inorganic acids and bases contained in the urine, this acid turned out to be a mixture of acetic acid with a brown resinous substance rich in nitrogen. “The presence of acetic acid in putrid urine does not warrant us to infer that this acid is present also in fresh urine ; on the contrary, the experiments made with regard to this matter prove that fresh urine contains no acetic acid. I have treated it exactly in the same manner as putrid urine, and have, by, distillation with oxalic acid, obtained a fluid of a strongly resi- nous odour, but not possessing any acid reaction. When em- ploying sulphuric acid and hydrochloric acid the distillate was acid, but the acid reaction proceeded from hydrochloric acid.” URINE. 127 In the analyses of Lehmann, to which we shall presently re- fer, the lactic acid is determined quantitatively in a large number of cases. The following independent investigations of Heintz and Pettinkofer are important, as offering a clue to the real nature of the crystals assumed by Lehmann and other chemists, to consist of lactate of zinc. In the observations of Liebig, quoted above, it is assumed that as lactic acid is not destroyed by putrefaction, it cannot be altered in putrefied urine. Heintz conceived that during the putrefaction of the urine certain causes might prevail to cause the destruction of the lactic acid, and in order to determine the point he instituted the following experiment. * About fifty pounds of fresh urine, obtained from several young healthy men, were first evaporated over a free fire, and then in the water-bath ; the extract obtained exhausted with alcohol, to which a sufficient quantity of dilute sulphuric acid had been added, The acid solution was saturated with oxide of lead, the precipitate filtered, the liquid much evaporated, and the urea contained in this concentrated solution precipitated with pure oxalic acid. A considerable quantity of oxalate of | urea was obtained, which, after washing with water and re- crystallization, separated in perfectly white, large crystals. The liquid, separated by pressure from the urea, from which it was now almost free, was evaporated to dryness, extracted with alcohol, and effloresced oxalic acid added to the solution to re- move the soda. The oxalate of soda was separated by filtration, the filtered solution saturated with oxide of lead, and then pre- cipitated with basic acetate of lead. The lead was removed from the filtered liquid by sulphuretted hydrogen; the filtered solution was concentrated over the water-bath, and boiled with hydrate of baryta, when a considerable disengagement of am- monia resulted. The salt of baryta obtained in solution was de- composed with sulphate of zinc, in such a manner that only a slight excess of this latter remained in the solution. It was then evaporated to a small volume, when some delicate micro- scopic crystals separated, which were at first taken for lactate of zinc, but on examination under the microscope they soon proved to be distinct. The lactate of zinc, for instance, forms needles with acute dihedral summits, while the crystals of the zinc salt obtained from the urine have truncated terminal sur- 128 THE SECRETIONS: faces. To ascertain more precisely the nature of the acid combined with the oxide of zinc in this salt, the crystals were separated as carefully as possible from the mother-ley, pressed between blotting-paper, dissolved in a large quantity of boiling water, in which they were but sparingly soluble, and allowed to crystallize by cooling. The mother-ley afforded more crystals on further evaporation. They were again separated from ad- hering liquid by pressure. “The zine salt thus obtained had a faint greenish-yellow tint, and was therefore probably not quite pure, although its solution was perfectly colourless. The acid was isolated from this salt by means of sulphuretted hydrogen; after separation of the sulphuret the solution was entirely free from zinc. The liquid, which had a strong acid reaction, was freed by boiling from the excess of sulphuretted hydrogen, and evaporated on the water- bath. When it had become sufficiently concentrated, the acid separated in prismatic crystals, which appeared to form quadri- lateral rectangular columns and tables. It is easily soluble in water, and separates in crystals on evaporation; the solution has - a strong acid taste, and reddens litmus-paper. It likewise dis- solves in alcohol, but not quite so easily as in water; ether dissolves scarcely a trace of it. Heated on platinum foil it melts, becomes brown, and leaves behind a coal, which is difficult of combustion, but which disappears entirely by stronger heat. “From the mode of preparation it is evident that the acid forms with oxide of zinc a very sparingly-soluble salt, which separates in microscopic crystals. When the acid is supersatu- rated with ammonia, and the solution evaporated on the water- bath, so much ammonia escapes that it again becomes acid ; if it be evaporated to dryness, so that all the ammonia that could escape at this temperature is expelled, and caustic potash be added to the mass, a considerable quantity of ammonia is given off ; therefore it appears that this acid, like many organic acids, forms acid salts. The ammonia-salt obtained in this manner is somewhat more difficult of solution in water than the acid itself. When the acid is accurately neutralized with pot- ash, it forms an easily-soluble salt, the solution of which affords no precipitate with sulphate of copper. The oxide of copper is not thrown down from this mixture by an excess of potash, but the colour of the solution becomes somewhat darker. Acetate URINE. 129 of lead produces a slight turbidity, most probably arising from a small quantity of some impurity. No precipitate is obtained with nitrate of silver, and the mixture, after having been ren- dered ammoniacal, is not altered by boiling. 4°45 15°29 Chloride of ammonium j é 1:50 Phosphate of lime and magnesia : : 1-00 Silicic acid ° . 0°03) I have made two analyses of the urine of a healthy man, aged 33 years, of a decidedly sanguineous temperament, whose digestion and nutrition were not very good. 1000 parts contained : Analysis 93. Analysis 94. Specific gravity F - 1011 1012 Water 3 . - 963°20 956°00 Solid residue ‘ - 36°80 44:00 Urea F ‘i - 12°46 14'578 Uric acid 0°52 0-710 Alcohol-extract, with free lactic acid J 5°10) . 4:800 Ext. mat. & Suisit-dktract 2-60 Extractive matter 5590 amm.-salts. , Water-extract and vesical — mates tin mucus ° 1:00 { ~ 2°550 Lactate of ammonia . 1:03 Chloride of ammonium . 0°41) Chloride of sodium Ss 5°20) 27°280 Sulphate of potash ‘ 3°00 ot Phosphate of soda : 2°41 : 2°330 ; Phosphates of lime and 0°58 . ict 0°654 { cacti magnesia ; | Silicic acid ‘ . a trace J a trace J) _ | Thierchemie, p. 458. 2 This includes the lactate (carbonate) of soda and a little sulphate of potash. 144 THE SECRETIONS: I have analysed the urine of the same man upon three other occasions under the following circumstances. A represents urine passed upon rising in the morning, after having drunk several glasses of water the previous evening. After drinking coffee and a glass of water, such violent exercise was taken for two hours, that the pulse rose to above 100, with occasional intermissions ; the urine B was then voided. Half an hour af- terwards the urine C was discharged. In all three cases the urine was clear, B being the most slightly tinged. They all had an acid reaction, that of C being the strongest, and of B the weakest. The analyses, in which, however, all the prox- imate constituents were not determined, gave the following results : Analysis 95. Analysis 96. Anal, 97, A. B. C. Specific gravity : ‘ - 1010 1008 1014 Water : ; : 972-600 981-000 957-600 Solid residue ‘ < ; 27°400 19-000 =—--42400 Urea : 8-402 7°568 15257 Uric acid, extractive matter, ammonia- salts, and chlorine compounds . 13960 8°618 19-140 Phosphate of soda ‘ - 1-850 1°250 2-750 Sulphate of potash ‘ 4 2°790 2-200 5°000 Phosphates of lime and magnesia . 0°479 0°264 0°656 C. G. Lehmann has likewise made some very minute analyses of the healthy urine of a young well-fed man, [himself in fact. ] These analyses approximate closely in their results to those of Berzelius. They were made with the collected urine of the past twenty-four hours. The concentration of the fluid may be explained by the circumstance of the young man by whom the urine was passed, taking only a very little drink, as is the usual habit with persons of the sanguineo-bilious temperament. 1, 2. 3. Water ; ; , - 937°682 934-002 932°019 Solid residue ‘ : - 62°318 65998 - 67:981 Urea ‘ ° ‘ - 931°450 32°914 32°909 Uric acid. - ; ; 1-021 1-073 1-098 Lactic acid . 2 j 1-496 1°551 1°513 Water-extract ‘ A 5 0-621 0°591 0°632 Spirit- and alcohol-extract - 10°059 9°871 10°872 Lactates 1-897 1-066 1-732 Chlorides of sodium and ammonium _—3-646 ~ 3602) 4 3712) 5 Alkaline sulphates ; ; 7314 (38 7:289 |= 732142 Phosphate of soda : 3°765 (6 3°666 (5 3°989 (> Phosphates of lime and magnesia ee: ite Bax rTs7y 1-108) ™ Mucus 5 5 é : 0-112 0-101 0-110 URINE. 145 Christison! published an analysis of healthy urine, in which, however, he did not enter into very minute details. The specific gravity was 1029. In 1000 parts, he found 67:7 of solid residue, of which 55:2 were composed of urea, extractive matters, and lactates, 11:1 of alkaline chlorides, sulphates and phosphates, 1-0 of earthy phosphates, and 0:4 of mucus. Hence 100 parts of the solid residue contain about 40 urea, 16 fixed salts, 39 extractive matters and ammonia-salts, and 1°5 earthy phosphates. : ' _Dumenil made an analysis of urine in 1826. He found the specific gravity of the mixed urine of several healthy persons to be 1016. In 1000 parts there were 31'8 of solid residue, which con- sisted of 13:2 parts of urea not quite free from alcohol-extract, 0:08 of uric acid, 2°09 of extractive matter, 0°6 of earthy phos- phates, 1-03 of phosphate of soda, 0°55 of phosphate of ammonia, 2°69 of sulphate of potash, 8-03 of chloride of sodium, 2°69 of sulphate of potash, 8:03 of chloride of sodium, 1:16 of chloride of ammonium, 0°18 of phosphate of lime, peroxide of iron, and sulphate of lime, and 0°39 of mucus. [In addition to these analyses we may mention those of Becquerel, Marchand, and myself. Becquerel obtained the following results : Mean composition of urine of Ditto of General 4 healthy men. 4 healthy women. mean. Specific gravity , ‘ 1018°9 1015-12 1017-01 Water ‘ ‘ F 968°815 975°052 971°935 Solid constituents ; 31°185 24°948 28-066 Urea : : 3 ~ 13°838 10°366 12°102 Uric acid 3 a 0°391 0°406 0°398 Fixed salts ’ : 7°695 6°143 26°919 Organic matters ; , 9-261 8-033 8°647 \ 1 Edin. Med. and Surg. Journal, vol. 33. 2 [These salts consisted of : Chlorine F ; 3 0°502 Sulphuric acid P ; 0°855 Phosphoric acid . ‘ 0°317 Potash : ‘ 7 1°300 Soda, lime, and magnesia ‘ 3°944 ] Il. 10 146 THE SECRETIONS : Marchand’s! analyses correspond very closely with those of Lehmann. He cites the two following analyses as representing the composition of the healthy secretion : Water : : : 933°199 938°856 Solid constituents ; : 66°801 61°144 Urea : : ; 32°675 30°321 Urie acid d ; ‘ 1:065 1:00T Lactic acid . A ‘ 1°521 1°362 Extractive matters : 4 11°151 10°553 Mucus : ; *283 201 Sulphate of potash : ‘ 3°587 3°201 Sulphate of soda ; : 3°213 3°011 Phosphate of soda ; : 3°056 2°998 Biphosphate of ammonia : 1-552 1231 Chloride of sodium "5 ; 4218 4:001 Chloride of ammonium 1°652 1°231 Phosphates of lime and magnesia 1-210 1-001 Lactates ; 1618 1°032 The following table gives the mean result of six analyses of the morning urine of a healthy man, instituted by myself,? Bin: Specific gravity 4 * - 1022°5 Water ; ‘ i - 961°00 Solid constituents ; z . 39°00 Urea ; ‘ é ‘ 16°60 Uric acid 3 4 ; *61 Fixed salts 5 : 9°27 Organic matter and loss : -- A The apparent discrepancies in the composition of healthy urine, as shown in the analyses that have been quoted, depend for the most part on the fluctuating amount of water. If we calculate the proximate constituents of the urine in relation to an equal amount of solid residue, we shall find these dif- ferences exhibited in a much less striking manner, although to a certain degree they still exist. 100 parts of the solid residue of the urine contain— ? Lehrbuch der physiologischen Chemie, p, 292. * Lancet, Feb. 1844. 147 URINE. 96-1 99-GF “Avg £9-1 18-1 06-6 Lob SLOL 8T1-0T FLIES 6F-ZE 8S-6F I16-8F i 6 a *‘pueyoreyy 69-1 OFT LI 09-1 6] SOT CL J61 08-9 GZ9 ¢4£9 OL-¢ 0¢.9 g9-¢ 88S 96-¢ 00-21 00-IT 10-01 08-8 #1. 66-01 14-01 8¢-TT LE-LE O06-LF 06-09 00-9F 09.2% ¥6.62 08-62 [6-82 09-T OFT £9T LoL 19-1 06-9€ O86 10-08 OL-€ O8-€2 OL-6F 6£:8) 89-6F See - J en ve y) *L6 “96 96 “t6 "66 Mi °9 % of *uOWIS *aUueUyo'T : visouseu pue 0¢-T { oul] Jo sazeydsoyg 88-9 soyeydsoyd ourexry 0€-01 ° sozeydins ourpeyry UINIpOs JO spLioyyo 0€-9¢ 4 pur ‘sz[es-ermomUeE ‘T9}JVUL = DATIONIRXY OST. °* * .ppe oun ae eS 4+ in *sniTezlag On the physiological relation of the urine. position of the g on the influence of the food, upon the com [The following observations of Liebi the salts contained in urine are well worthy of consideration. 148 THE SECRETIONS : “ The alkaline reaction of the lymph, chyle, and blood of man, and of the carnivorous animals, cannot be owing to the presence of a free alkali; for the nutriment of man, and of the carnivorous as well as the graminivorous animals, contains no free alkali, nor any salt formed of an alkaline base and an acid which might be destroyed in the organism, by the vital pro- cess, and thus cause the alkaline base to be liberated. The blood must contain the same salts as exist in the aliments. With the exception of common salt, nothing is added during the di- gestion of the aliments. We have seen that this substance undergoes decomposition in the upper part of the digestive ap- paratus, being resolved into free soda and free hydrochloric acid ; but we have also seen that the liberated soda rejoins the hydrochloric acid during the preparation of the chyme, and previous to the transformation of the latter into chyle ;! that is, when the acid has performed its function, namely, the solution of the aliments; the salt formed by this combination, that is, common salt, has neither an acid nor an alkaline reaction. The salts with an alkaline reaction contained in meat, flour, or grain, are alkaline phosphates. Hence it is obvious that the alkaline reaction of the chyle, lymph, and blood of animals feed- ing upon animal and vegetable substances, can only be derived from their alkaline phosphates. “The bibasic phosphates of soda and of potash are, in many respects, highly remarkable salts ; although of a tolerably strong alkaline reaction, yet they exercise no destructive action upon the skin or upon organic formations; they possess all the pro- perties of the free alkalies without being such; thus, for in- stance, they absorb a large amount of carbonic acid, and this in such a manner that acids produce effervescence in a satu- rated solution.of this kind, just as they would in alkaline car- bonates ; they dissolve coagulated casein, as well as coagulated albumen, into clear fluids, with the greatest facility, just as caustic or carbonated alkalies do. But of still greater im- portance in relation to the secretion of urine is their deport- ment towards hippuric and uric acids. Hippuric acid dis- solves with the greatest facility in water to which common — phosphate of soda has been added ; uric acid possesses the same ' Liebig’s Animal Chemistry, 2d edit. p. 112. URINE. 149 property at a high temperature ; the phosphate of soda, in this process, loses its alkaline reaction completely upon the addition of uric and hippuric acids, and assumes an acid reaction. The acid nature of the urine of man, and of the carnivorous and graminivorous animals, is thus explained in a very simple manner. “There are but two principal channels through which the salts entering the organism with the aliments can effect their exit from the body ; viz., they must either be carried off in the feces or in the urine. The most simple experiments show that soluble salts are carried off by the feeces only when the amount of salt contained in the fluids in the intestines is larger than that contained in the blood; if the amount of salt in these fluids is equal or inferior to that of the blood, the soluble salts are reabsorbed by the absorbing vessels of the intestinal tube, and enter the circulation, and are then removed from the body by the urinary organs and channels. If the amount of salt contained in the intestinal tube is larger than that contained in the blood, the salts exercise a purgative action. “ Tf, after previous evacuation of the rectum, a weak solution of common salt (one part of salt to sixty parts of water) be taken by means of a clyster, no second evacuation will take place ; the fluid is absorbed, and all the salt is found in the urine. This experiment yields the most convincing results if ferrocyanide of potassium is substituted for common salt; in this case, the first urine excreted after the injection of the saline solution, and frequently even after so short a time as fifteen minutes, contains so large an amount of ferrocyanide of potas- sium as to yield, upon the addition of persalts of iron, a copious precipitate of Prussian blue. “The influence which salts in general exercise upon the se- cretion of urine is, in the highest degree, worthy of attention. It is a well-known fact that a very speedy emission of urine takes place, in healthy individuals, after drinking fresh pump- water. If ten glasses of water, of from six to eight ounces each, containing no more than 1-500th of its amount in salts, be drank at short intervals, an emission of urine of the usual colour will, after the lapse of about ten minutes, follow the second glass, and from eight to nine evacuations of urine will generally occur in the course of an hour and a half. The 150 THE SECRETIONS : urine, in this experiment, emitted in the last evacuation, will be clear and colourless, like pump-water, and the amount of salts it contains is little more than is contained in pump-water. There are individuals who are capable of thus imbibing from six to eight quarts of water consecutively without any in- convenience. “ But the case is quite different with water possessing an amount of salts equal to that of the blood; if even as little as 1-100th part of common salt be added to pump-water, and from three to four glasses drunk, no evacuation of urine will take place, even two hours after drimking. It is almost impossible to drink more than three glasses of this saline water, for it weighs heavily on the stomach, as if the absorbent vessels had no power of taking it up. This obviously arises from the fluid within the channels of circulation, i. e. the blood, and the fluid without these vessels, i. e. the saline water, not exercising any physical action upon one another, i. e. not intermixing by endosmose or exosmose. “Water containing a larger amount of salts than the blood, such as common sea-water, for instance, and even the weaker kinds of saline mineral waters, exercise again a different action from that of pump-water mixed with 1-100th of common salt ; not only no emission of urine takes place after the imbibition of such saline water, but water exudes from the circulating vessels into the intestinal tube, and, together with the saline solution, is carried off through the rectum; purgation takes place, attended with much thirst, if the saline solution be in some measure concentrated. Considering that a certain amount of salts is absolutely ne- cessary to constitute normal blood, we may deduce from these observations and experiments (which any one may easily imi- tate and verify upon his own person) that the physical condition of the tissues or of the blood-vessels opposes an obstacle to any increase or decrease of the amount of salts in the blood; and thus that the blood cannot become richer or poorer in salts beyond a certain limit. Fluids containing a larger amount of salts than the blood, remain unabsorbed, and leave the organism through the rectum ; fluids containing a smaller amount of salts than the blood enter URINE. 151 into the circulation, absorb, and remove from the organism, through the urinary channels, all the soluble salts and other substances which do not belong to the constitution of the blood; so that, finally, only those substances remain in the organism which exist in chemical combination with the constituents of the blood, and which, therefore, are incapable of being secreted by the healthy kidneys. “JT have convinced myself, by careful and minute examina- tions, that urine emitted after drinking a copious amount of water, invariably contains a somewhat larger amount of salts than the water which has been drunk; whilst the amount of phosphates contained in the last emitted portions of the urine is extremely minute, and no longer detectible by the ordinary tests. It is therefore obvious that all the salts, without excep- tion, contained in the urine, are to be considered as accidental constituents of the blood, which are excreted and removed from the organism precisely because they no longer form a part of the normal constitution of the blood. The phosphates emitted with the urine were, previously, constituents of substances which have been decomposed in the vital processes, or they existed as con- stituents of the blood, but upon its transformation into living tissues they were not admitted into their composition, not being required for their constitution. : “Now, among the products of the vital processes, which, together with the soluble phosphates, are removed from the or- ganism through the urinary organs and channels, there are two organic acids, namely, wric acid and hippuric acid, both possess- ing the property of combining with the soda or potash of the alkaline phosphates, and acquiring in the combination a higher degree of solubility than they possess, per se, at.the common temperature of the body. It is obvious that by the accession of these two acids, and by their action upon the phosphates of soda, an urate and hippurate of soda must be formed on the one hand, and an acid phosphate of soda on the other ; and that, consequently, the urine must acquire an acid reaction. But the presence of these two acids in the urine is not the only cause of its acid nature; there exists another cause which tends powerfully to maintain and increase it. “ According to the preceding remarks we ought to find in 152 THE SECRETIONS: the urine all the soluble salts of the food, as well as a small amount of the phosphate of lime, which is soluble to a certain extent in acid fluids, together with magnesia. The amount of . these latter substances will be in proportion to their solubility in acid phosphate of soda. The other insoluble salts of the ali- ments we ought to find in the feeces. In other words, assuming that the materials composing the aliments become converted into oxygen compounds, that is, are burnt in the organism, we ought to find in the urine, all the soluble salts of their ashes, and in the feces, all the insoluble salts. Now, upon comparing the constitution of the ashes of the blood or of the aliments, (or, rather, the salts contained therein,) with those of the urine, we find that there exists a striking difference between their re- spective amount of sulphates. “ According to the analyses of the ashes of the grains of wheat and rye (Ann. der Chemie, vol. 46, p. 79), the urine of an individual feeding exclusively upon bread, ought not to con- tain a trace of a sulphate, whilst the urine of an animal fed upon peas or beans ought to contain sulphates together with phosphates in the proportion of 9 of the former to 60 of the latter. Finally, as flesh contains no soluble alkaline sulphate (broth does not yield any precipitate of sulphate of baryta when tested with salts of baryta), the urine of carnivorous animals ought to be equally free from soluble sulphates. We find, on the contrary, that the urine of man, according to the most correct analyses, contains a far larger proportion of sulphates than the aliments partaken of; nay, even that the amount of the sulphuric acid evolved from the system must, in many cases, be equal or superior to that of the phosphoric acid contained in the aliments. According to the analyses of human urine made by Berzelius and Lehmann, the amount of the sulphates present in urine is nearly double that of all the soluble phosphates to- gether. Hieronymi found the amount of sulphate of potash contained in the urine of the tiger, the lion, and the leopard, compared with that of the phosphates, to be as 1to 71. Itcan be distinctly and positively proved that these salts have not been partaken of in such proportions. But we now know the origin of the greatest portion of the sulphuric acid contained in the urine ; this acid has entered the organism with the food, not in the form of a sulphate, but as sulphur. URINE. 153 *‘ Glutin!, vegetable casein, flesh, albumen, fibrin, and the cartilages and bones, contain sulphur in a form quite different from the oxygen-compounds of this substance. This sulphur is separated as sulphuretted hydrogen during the putrefaction of these substances; it combines with the alkalies, which act powerfully upon these animal substances, and may be obtained from such combinations in the form of sulphuretted gi by means of stronger acids. “Now, we know, from the experiments from Wohler, that the soluble sulphurets become oxidized in the organism; and that thus, for instance, sulphuret of potassium becomes converted into sulphate of potash ; and it is therefore unquestionable that the sulphur of the constituents of the blood, derived from the aliments, or, what comes to the same point, the sulphur of the transformed tissues becomes finally converted into sulphuric acid by the oxygen absorbed in the process of respiration, and thus that in the urine it must appear in the form of sulphates ; and from this cause the original amount of these salts contained in the aliments become increased. The alkaline base which we find in the urine, in combination with this sulphuric acid, is sup- plied by the soluble alkaline phosphates; and the latter, in conse- quence of the loss of part of this base, are converted into acid salts. “It follows, from all we have hitherto stated, that the acid nature of the urine of carnivorous animals, as well as that of man, depends upon the nature of the bases partaken of in the aliments, and upon the particular form of their combinations. In the flesh, blood, and other parts of animals, as well as in the grains of the cereal and leguminous plants, there exists no free alkali. The alkali which these substances contain is invariably combined with phosphoric acid: the acids formed in the or- ganism by the vital process, namely, sulphuric acid, hippuric acid, and uric acid, share the alkali amongst them, and this, of course, must give rise to the liberation of a certain amount of phosphoric acid, or what comes to the same point, to the for- mation of a certain amount of acid phosphates of soda, lime, and magnesia. The proportional amount of the liberated phos- phoric acid varies with the temperature ; at a higher tempera- ‘ Dietrich (in the laboratory of Giessen) has examined glutin with regard to its amount of sulphur ; he found wheat-gluten to contain from 0-033 per cent. to 0°035 per cent. of sulphur, exactly the same proportion as is contained in albumen or fibrin. 154 THE SECRETIONS : ture the phosphate of soda dissolves a larger amount of uric acid and hippuric acid than at a lower temperature,——at 100° more than at 60°. It is owing to this, that urme, upon re- frigeration, sometimes deposits uric acid, or urate of soda in a crystalline state, which, of course, can only take place by the uric acid, at a lower temperature, restoring to the phosphoric acid the soda or potash which, at a higher temperature, it had withdrawn from it. At the common temperature phosphoric acid decomposes urate of soda, whilst, at a higher temperature, uric acid decomposes phosphate of soda. When urine, con- taining uric acid and manifesting an acid reaction, forms no sediment upon cooling, it shows that the amount of the phos- phoric acid and that of the uric acid exactly balance each other with regard to their affinity forsoda. Had there been present a larger proportion of uric acid, this would have separated upon cooling ; whilst, on the other hand, the presence of a prepon- derating proportion of phosphoric acid would likewise have caused the precipitation of uric acid, because the affinity of the former for soda would then exceed that of the latter: This explains the circumstance that urine, in certain states, when, from some cause or other, its amount of sulphuric, hippuric, or other acid, becomes increased, precipitates a larger proportion of uric acid than urine in its normal state. The solubility of uric acid in urine must decrease in proportion as the amount of the other acids present in the urine increases, because those acids share the soda with the uric acid; and, of course, the larger the amount of soda which combines with these other acids the less comes to the share of the uric acid. It is like- wise owing to this, that uric acid is very frequently precipitated from urine upon the addition of mineral or other acids, and that urime of a turbid whey-like appearance, from the presence of uric acid, frequently manifests a far more strongly acid re- action than normal urine. “Now, bearing in mind that the use of alkaline citrate, of neutral tartrate of potash, bi-tartrate of potash, acetates of potash and soda, and tartarized soda, renders the urine alka- line by creating in it an amount of carbonated alkali; and that, likewise, after the eating of fruit, such as cherries, strawberries, &c., the urine is of an alkaline nature, inasmuch as these fruits contain alkalies combined with vegetable acids, URINE. 155 it is obvious that the acid reaction of healthy urine is purely accidental, and that urine of an alkaline or neutral reaction cannot be considered as a symptom of a diseased condition of the body. All the vegetable aliments, without exception, tubers, roots, and leaves, potatoes, turnips, greens, &c., contain alkalies in combination with vegetable acids: potatoes, for in- stance, contain alkaline citrates; turnips, alkaline racemates and oxalates, &c. All these plants yield, upon incineration, more or less strongly alkaline ashes, the bases of which were contained in the living plants, as salts of vegetable acids. “It is obvious that by adding these vegetables to a meat diet, to bread and to other aliments prepared from flour, the nature of the urine must become thoroughly altered ; for the alkalies which these vegetables contain in combination with organic acids, enter the urine, in the form of carbonated alka- lies, and neutralize the acids, of whatever kind, which may be present. When partaken of in a certain proportion, they render the urine neutral ; when partaken of in a larger pro- portion they impart to it an alkaline reaction. “The urine of all animals feeding upon vegetables, such as grass, herbs, roots, &c., has an alkaline reaction. The urine of the horse, of the cow, of the sheep, of the camel, of the rabbit, of the guinea-pig, of the ass, &c., is alkaline; it contains alkaline carbonates, and acids produce in it a lively effervescence. “The acid, neutral, or alkaline reaction of urine of healthy individuals does not depend upon any difference in the pro- cesses of digestion, respiration, or secretion, in the various classes of animals, but upon the constitution of the aliments, and upon the alkaline bases which enter the organism through the medium of these aliments. If the amount of these bases is sufficiently large to neutralize the acids formed in the or- ganism, or supplied by the aliments, the urine is neutral ; whilst it manifests an alkaline reaction when the amount of alkaline bases thus supplied to the organism is more than sufficient to neutralize the acids; but in all these cases the urine accords with the nature of the aliments taken. “The inorganic bases and acids contained in the urine were, with the exception of sulphuric acid, which joins them in the organism, constituents of the aliments. The amount of imor- ganic bases and acids emitted through the urine in twenty-four 156 THE SECRETIONS: hours must, in adult individuals, be equal to that of these bases and acids supplied to the organism, during the same period, through the medium of aliments.”! Our knowledge respecting the influence of diet on the com- position of the urine has been much increased by the admirable researches of Lehmann,” instituted on himself. The whole of the urine passed in twenty-four hours was always collected, the absolute weight and specific gravity determined, as well as the amount of solid residue. The investigation was commenced in October, and the amount of drink was only just sufficient to allay thirst. During thirteen successive days, on which he lived on > his ordinary mixed diet, the following observations were made: Amount of urine Solid residue Whole amount of in 24 hours. Spec. grav. per mille. solid residue, in grammes. 1088 grammes ® 101774 58°432 63°5718 ‘898 1022-2 65-998 59-2662 927 1025°1 67°842 62°8895 | 1022 : 1024°7 66°744 68°2124 712 1029-2 79°923 56°9052 1361 1020-2 65-008 78°4759 900 1019-2 62-318 56°0862 940 1022°5 66°423 62°4376 1100 1019-1 61°984 68-1824 939 1029°4 80°878 75°9434 1448 1016°7 56°264 81°4702 1088 1025°2 67°981 73°9633 1328 1015°6 55°932 74°2777 A perfect analysis of the urine was made on three of these days, the results of which are recorded in p, 144. The amount of urea was determined on the Ist, 2d, 4th, 6th, 7th, 8th, 11th, and 12th days. The results are given in the following table : Solid residue Urea Urea Daily amount in 1000 parts in 1000 parts in 100 parts of urea, of urine. of urine. of solid residue. in grammes, 58°430 26°72 » 45°74 39°077 65-988 32°91 49°87 29°556 66°744 28°22 43°79 29-869 65-008 29°25 | 44°99 35°306 62°318 31°45 50°46 28°301 66°423 29°50 44-4] 27°728 56°264 23°72 — 42°15 34°339 67-981 32°91 : 48°41 35°804 ' Lancet, June 1844. ? Journal fur praktische Chemie, 1842.3. ’ The gramme = 15°4 grains troy. URINE. 157 From these data it appears that, during his ordinary mixed diet, the urea amounted on an average to 46°23° of the solid residue, and that the average amount of urea excreted in twenty- four hours was 32°498 grammes, or about 500 grains. The amount of uric acid was determined on the 2d, 6th, 7th, 8th, 11th, and 12th days. The following results were obtained : Uric acid Urie acid Daily amount in 1000 parts in 100 parts of uric acid, of urine. of solid residue, in grammes. 1-073 1°626 0°967 1°124 1:729 | 1°357 1:021 1638 0°919 1-097 1-651 1031 1131 2-001 1°630 1098 1615 1195 From these numbers it appears that 1000 parts of urine con- tain, on an average, 1:089 of uric acid; and that 100 parts of solid residue contain 1°71 of uric acid; likewise, that the daily amount of excreted uric acid is 1:183 gram., or about 18°3 grains. Hence the daily amount of urea is to that of uric acid as 27:1. The mean amount of free lactic acid, (or, at least, the sub- stance regarded by Lehmann as lactic acid,) in 1000 parts of urine was 1°525; and in 100 parts of solid residue, 2°325. The mean daily amount was 1:534 gram., or 23°6 grains. — The mean amount of combined lactic acid in 1000 parts of urine was 1°160 ; and in 100 parts of solid residue, 1:703. The mean daily amount was 1°173 gram., or 18 grains. Having thus determined a standard of comparison, he pro- ceeded to notice the effect of a purely animal diet on the urine. He lived for twelve days on a purely animal diet, and for four of these days entirely on eggs, during which period he consumed 128, or 32 a day. From an analysis of the eggs it appeared that he took daily 189°7 grammes of dry albumen, free from ash, and 157-48 grammes of fat; and from Scherer’s analyses it appears that this albumen contained 104°335 grammes of carbon, and 30°16 grammes of nitrogen ; while the fat contained 124-41 grammes of carbon. Hence the whole amount of carbon was 228°75 grammes, a little within the amount given off in the course of twenty-four hours, according to Liebig. The obser- vations were conducted for twelve successive days in July, and yielded the following results : 158 THE SECRETIONS : Absolute weight Solid residue Whole amount of urine in 24 hours, Spec. grav. in of solid residue, in grammes. 1000 parts. in grammes. 921 1029-2 80°87 79°34 1240 1021-9 66°12 81-99 998 1030°7 84°23 84:06 1075 1027°8 77°72 83°55 1184 ’ 1026°4 72°30 85°61 1384 1018°7 59°21 82°09 1113 1028°5 78°15 86°99 1092 1028-9 79°04 86°23 979 1033°8 90°68 88°78 1211 1026°3 72°38 87°85 1346 1024°3 66°73 89°84 1127 1029°0 78°38 88°38 If we compare the mean of these numbers with the mean of the former corresponding table, we have : During a mixed diet. | During animal diet. The absolute weight of the urine in = 24 hours ; : : 1057°8 grammes (1202°5 grammes Specific gravity . é 1022°0 1027°1 Amount of solid residue in 1000 parts of urine 5 ‘ 65°82 75°48 Sum of the solid pele ; 67°82 grammes 87°44 grammes Hence it appears that, during a purely animal diet, the amount of solid constituents is increased, while at the same time the amount of water is augmented by no less than 125 grammes, notwithstanding these experiments were made in June, and those with a mixed diet in October. From the above data it appears that the solid matters dis- charged by the urine during an animal diet amount to about one fourth of the amount of dry nutriment. The following are the principal changes in the urime induced by use of a strictly animal diet. It becomes pale, of a straw colour, limpid, and similar in appearance to the urine of the carnivora. On the addition of nitric acid, crystals of nitrate of urea were immediately produced. Uric acid was gradually deposited in large crystals. The reaction of the urine was always decidedly acid. ‘Two analyses instituted with the urine passed on the 28th and 30th of July, (the 9th and 11th days of the experiment,) gave the following results : URINE. 159 July 28th. July 30th. Water ak . ; ‘ 909-32 933°27 Solid residue : ; ‘ 96°68 66°73 Uréa : : x 53°79 41°65 Uric acid ; i 4 1°41 118 Free lactic acid A : 2°28 1°64 Lactates ‘ 1°67 1°02 Extractive matter soluble i in water } 0°82 0°61 Extractive matter soluble in aleohol . 4°50 3°24 Mucus : 0:09 0-11 Chlorides of sodium and ammoniém 3 5°37 3°46 Sulphates ; : ; 11°51 7°08 Phosphate of soda ‘ : 5°52 4:04 Earthy phosphates ; ; 3°72 2°70 The six following observations were made regarding the amount of uréa : Urea in 1000 parts Urea in 100 parts Urea secreted in of urine. of solid residue, 24 hours, in grammes. July 23d { the expen) bas: 71 58°815 49-134 27th : 46°67 59°043 50°913 28th : . 53°79 59°320 52°034 29th : . 46°19 63°811 56:095 30th : - 41°65 62°413 54°071 31st ‘ - 50°36 64°382 56°887 From these numbers it appears that, during a purely animal diet, there is a mean daily increase of 20°7 grammes in the amount of urea. During a mixed diet, the relation of the urea to the other solid constituents = 100: 116, while onan animal diet it = 100:63. The uric acid was estimated on the last four days of the experiment : Urie acid Uric acid Daily amount in 1000 parts in 100 parts of uric acid, of urine. of solid residue. in grammes. 28th July ‘ : 1°41 1°554 1371 29th : : 1:20 1°630 1°432 30th " “ 118 1°764 1°565 31st R ; 137 1:749 1546 Hence, while the mean daily amount of uric acid during a mixed diet is 1:183 grammes, the amount is increased during an egg-diet by ‘295 of a gramme, an increase not sufficiently large to entitle us to suppose that a purely animal diet favours the formation of uric acid in the healthy organism. During a mixed diet, the proportion of uric acid to the other solid con- 160 THE SECRETIONS: stituents = 1:58°5, during an animal diet it = 1 :59-7; i.e. there is a relative diminution. The proportion of uric acid to urea during a mixed diet = 1: 27-0, during an animal diet it = 1: 32:7; consequently the uric acid is not by any means increased in the same proportion as the urea; and, indeed, it can hardly be regarded as produced from the protein-compounds in the same manner as the urea probably is. The mean amount of free lactic acid excreted daily (as de- duced from four analyses) was 2°167 grammes. The earthy phosphates were determined daily from the 27th till the 31st of July, when the experiments were discontinued. The following are the results obtained : In 1000 parts In 100 parts Daily amount, of urine, in grammes. of solid residue. in grammes. 3°09 3°913 3°374 3°72 4:102 3°642 2°99 4°134 3°632 2°70 4°046 3°635 ae 3°13 3°994 3°530 Consequently, during a purely animal diet, 3-562 grammes of earthy phosphates are, on an average, discharged daily by the urine; while, during a mixed diet, the average quantity is only 1:13 grammes. If we estimate the amount of earthy phos- ‘phates in the albumen at 2°, the whole quantity consumed daily with 189°7 grammes of albumen, amounts to 3°794 grammes ; consequently, much the greater part (namely, 3°562 grammes) is carried off by the urine, while the remaining -232 of a gramme is removed with the excrements, perspiration, &c. During a mixed diet, a much larger amount of earthy phos- phates was consumed without there being a corresponding in- crease in the urine, the greater part being removed by the intestinal canal. Generally speaking, the amount of excreted earthy phosphates exceeds the amount consumed, the excess, doubtless, arising from the oxidation of the phosphorus con- tained in the protein-compounds during the metamorphosis of the tissues. This view is confirmed by the preceding observa- tions; for, during the egg-diet, the phosphorized fat contained in the oil of the yelk is conveyed into the fluids of the body, and, by the oxidation of its phosphorus, in addition to the phosphorus of the protein-compounds, the phosphoric acid of URINE. ‘ 161 the phosphate of lime is generated, while only a portion of the earthy phosphates of the food is conveyed into the blood. Lime occurs in the blood in considerable quantity, being conveyed there by the water taken as drink, and combining readily with the free phosphoric acid. Moreover, a further confirmation of this view is afforded by the fact of the increased excretion of phosphate of soda. During a mixed diet, the daily average is 3°673 grammes, while, during a purely animal diet, it amounts to about 5:217 grammes. Lehmann next proceeded to investigate the effects of a strictly vegetable diet. The urine was examined daily from the 12th to the 23d of August ; it was of a yellowish-brown rather than a yellow colour ; tt had a faint odour, and a decidedly acid reaction, which did not disappear for six or eight days. The morning urine was of a dark brown colour, and rapidly depo- sited a mucous sediment, after which there was a gradual sepa- ration of bright red crystals of uric acid. The following table contains the daily amount of urine and of its solid constituents, and the specific gravity : Absolute weight Solid residue Daily amount of urine in 24 hours, Spec. grav. in of solid residue, in grammes, 1000 parts. in grammes. 980 1028-9 ' 67°60 66°25 765 103671 82°76 63°31 1059 1020°1 55°85 59°14 978 1025°7 60°13 58°81 1212 1016°4 50°01 60°61 817 1032°3 . 75°68 61°83 916 1026°8 63°09 57°79 720 1034-2 80°76 58°15 796 1029-8 70°90 56°44 931 1023°8 58°09 54°08 811 1028°6 67°01 56°35 892 1027°9 65°08 58°05 By taking the mean of these numbers we are enabled to construct the following table : On- On On mixed diet. animal food. vegetable food. Amount of urine in 24 hours . 1057°8 gr. 1202°5 gr. 909 gr. Specific gravity . - 1022-0 10271 1027°5 Solid residue in 1000 parts of urine : . - 65°82 75°48 66°41 Solid constituents in 24 hours. 67°82 gr. 87°44 gr. 59°23 gr. II. 11 162 THE SECRETIONS : The amount of urea was ascertained daily from the 17th to the 23d of August : Urea in 1000 parts Urea in 100 parts Daily amount of urea, of urine. of solid residue. in grammes. 28°87 38°145 23°585 26°00 41°211 23°815 30°68 37°988 22-089 28°31 40°078 22-618 22°42 38°607 20°880 25°52 33°093 21°467 25°69 39°478 22°917 ad Hence, on an average, the urea amounted to 39°086% of the solid residue, and 22-481 grammes were daily excreted. The effect of diet on the urea may be seen by the following table: In 100 parts of Daily amount, solid residue, in grammes, Urea during a mixed diet , ‘ 46°230 32°498 ” an animal diet a? ‘ 61°297 53°198 » avegetable diet . . 89-086 22-481 Consequently, during a vegetable diet, there is both an ab- solute and a relative diminution of urea. The uric acid was determined on five occasions : Urie acid in 1000 parts Urie acid in 100 parts Daily amount of uric acid, of urine. of solid residue. in grammes, 1°40 1°836 1°135 1°23 1:947 1°125 117 1°652 933 1:01 1:743 "942 "89 1489 969 Consequently, the average daily amount (from these five analyses) was 1:021 grammes; and, on comparing this with the previous data, we have: In 100 parts of Daily amount, solid residue. in grammes. Uric acid during a mixed diet . : 1-710 1183 Pe an animal diet . é 1°674 1478. ma a vegetable diet j 1-737 1021 Hence the uric acid is scarcely affected by the diet. From three analyses it appeared that 1:189 grammes of free, and 1:371 grammes of combined lactic acid were daily excreted during a vegetable diet; and, associating these with the pre- vious numbers, we have: _ URINE. 163 During | During During a mixed diet. an animal diet. a vegetable diet. Free lactic acid : 1°462 2°167 1-189 grammes Combined lactic acid . 1-162 ? 1°371 Hence there is not any very appreciable effect produced on the amount of the lactic acid. The phosphates and sulphates were much the same as during a mixed diet. The three following perfect analyses of the urine were insti- tuted : Aug. 20th ‘ Aug. 2lst. Aug. 23d. (the 9th day of the experiment.) Water i j ‘ 929°10 941°91 934°92 Solid residue : ‘ 70°90 58:09 65°08 Urea ‘ ; 23°o1 22°42 25°69 Uric acid : ‘i 1t7 1-01 0°89 Lactic acid 4 1°55 1:01 1°35 Lactates . A : 2°39 1°89 2°06 Extractive matter solublein water 3:80 3°07 3°71 8 » alcohol 17°84 13°78 15°77 Mucus ° é Ae 10 10 Chlorides of sodium and ammonium 3°80 3°07 3°71 Sulphates i ‘ 7°16 7°14 7:23 Phosphate of soda F 3°54 3°68 3°74 Earthy phosphates ; 1:22 1:09 Ill The following table shows how much the extractive matters are influenced by diet : Extractive matters in 100 parts Extractive matters of solid residue. discharged daily, During a mixed diet 3 16°637 10-489 grammes » ananimal diet . ; 5°818 5196 yy a vegetable diet . 29°482 16°499 Lehmann concluded his experiments with some observations on the influence of a strictly non-nitrogenous diet on the urine. These are the least satisfactory of the series, because the general health becomes so rapidly injured as to affect the results. His daily food consisted of about 400 grammes of starch, sugar, or gum, and 125 grammes of almond oil. The urine passed after this diet had been continued for twenty-four hours had a brownish red colour, a slightly acid reaction, and became alkaline in twenty-four to thirty-six hours. The following analyses were made in the month of June, on the 2d and 3d day from the commencement of this course of diet : 164 THE SECRETIONS: 1, 2. Water ; a : - 953°98 965°11 Solid constituents ‘ : zi 46°02 34°89 Urea ea : : : 18°92 11°08 Uric acid : : *89 54 Lactic acid and lactates ; $ 4°89 511 Extractive matter soluble in water ‘ 2°80 271i me alcohol ; 8°32 8°78 Mucus a ; ‘ll “4 Chlorides of sodium and ammonium A 2°74 1:14 Sulphates : : ; 3°25 2°98 Phosphate of soda. ‘ ; 3°01 2°48 Earthy phosphates . 1:00 “91 On the second day 977 grammes, i eesti on the third 1113 grammes of urine were discharged, so that the whole amount was calculated as follows: ; On the 2d day. On the 3d day. Solid constituents ‘ ‘ 44-524 grammes 38°836 grammes Urea é ; ‘ 18-484 12°332 Uricacid . z ‘ "869 *601 Lactates . ; . 4°865 5687 Extractive matters . ; 10°864 12°844 In conclusion, the following table gives the mean daily amount of the various solid constituents during these different systems of diet : Mixed diet. Animal diet. Vegetable diet. Non-nitrogenous diet. Solid constituents . 67°82 87°44 59°24 41°68 grammes Urea 4 . 38260 53°20 22°48 15°41 Uric acid Rees i 1°48 1-02 “73 Lactic acid and lactates 2°72 2°17 2°68 5°82 Extractive matters . 10°49 5°20 16°50 11°85 Lehmann’ has likewise examined the effect of severe bodily exercise on the urine, and has found that the urea, lactic acid, phosphates, and sulphates are increased, while the uric acid and extractive matters are diminished. The following are the mean results obtained from the frequent examination of the daily urine during a pedestrian tour : In 24 hours. In 1000 parts. Water ‘ : : 900:006 grammes 916°707 Solid constituents ; é 82°594 83°293 Urea A ; 45°314 45°697 Uric acid - . “642 "647 Lactic acid é ‘ 3°140 3166 °* Extractive matters . é‘ 8°455 8:526 Alkaline phosphates ‘ 4:598 4°636 Alkaline sulphates : 15°047 15°174 Earthy phosphates . j 1105 1114 14 ' Wagner’s Handworterbuch der Physiologie: Art. Harn. vol. 2, p. 21. URINE. 165 The admirable researches of Lecanu’ show that the urine of the same person, analysed at different times, gives nearly uni- form results. The urine of persons of different ages and sexes exhibits deviations both in the relative and absolute proportion of its constituents, while in persons of similar ages and sexes, the variations are very trifling. The quantity of urine discharged by different persons, in the course of the twenty-four hours, varies considerably, even although the circumstances under which the obser- vations are made are apparently similar. In 16 individuals of different ages and sex, with different but sufficient food, the quantity varied from 18 to 78 ounces. The mean specific gravity of the urine of different persons varies. The highest specific gravity was 1030, the lowest 1016. It was most frequently between 1020 and 1030. The urine of men in the prime of life was more concentrated than that of old men, women, or children. The quantity of urea amounts, according to Berzelius and Lehmann, to nearly one half of the solid constituents ; accord- ing to my observations, to a little more than a third. It follows, from the experiments of Lehmann, which have just been stated, that these proportions are dependent on the nature of the food; it is certain, however, that they are also dependent on the powers of assimilation, for we know that some persons thrive upon a very frugal, and barely sufficient diet; while others appear half-starved, although taking an abundance of nutritious food. According to Lecanu, the quantity of urea which different individuals, living under different circumstances, secrete during the same period, differs greatly; it approximates, however, in proportion to the similarity of the circumstances. In the course of twelve days there was secreted by— A man aged 20 years, 334 grammes of urea 22 334 38 310 43 351 53 364 A woman aged 28 205 16 210 A child aged 8 171 8 168 1 Journal de Pharmacie, vol. 35, 1839. 166 THE SECRETIONS: The quantity of urea is greatest i in men in the prime of life ; it is greater in women than in old men, or children. It amounts in— Mean. Maximum, Minimum. Men ; ‘ : 432 509 357 grains Women : 3 294 436 553 Old men J > 125 189 60 Children aged 8 : ; 207 253 161 i 4 ; ‘ 69 82 57 The quantity of urea excreted bythe same individual in twenty- four hours, is always nearly the same; and if instead of twenty four hours, we compare it for a longer period, the deviation will be still less marked. The quantity of uric acid excreted in twenty-four hours by persons of different age and sex, and living under different cir- cumstances, is as variable as the quantity of urea. It fluctuated between 1°38, and 24°25 grains. A comparison of the quan- tities of uric acid excreted during a longer period by persons of the same age, sex, &c. will show that they nearly coincide. In twelve days there were excreted by— A man aged 20 years, 11°945 grammes of uric acid 22 11:967 38 13°434 In eight days there were excreted by— A girl aged 19 years, 3°778 grammes of uric acid A woman aged 43 3°619 The quantity of uric acid excreted by the same person during the same period (a period of some days for instance) is always nearly constant. This observation is confirmed by the analyses of Lehmann, and myself. The amount of fixed salts, (earthy phosphates, chloride of sodium, alkaline sulphates and phosphates,) excreted in twenty- four hours, varies considerably with age and sex. It fluctuated (in Lecanu’s analyses) between 378 and 75 grains. There was apparently no uniformity in the amount of these salts in the urine of the same person during different equal periods. For instance, in a man aged 20, the amount of fixed salts in the urine of twenty-four hours, was determined four times. It varied from 348 to 224 grains. In men, in the prime of life, the amount of fixed salts is higher than in aged persons, children, or women. URINE. 167 They occur, according to Lecanu, in the following proportions: Mean. Maximum. Minimum. InMen . ‘ 4 260 378 153 grains Women ; : 222 302 166 Children of about 8 years. 135 168 152 Old men ; ; 124 151 94 Lecanu found the earthy phosphates in the urine of twenty- four hours vary in different persons from 30°3 grains to rather less than half a grain. The amount of earthy phosphates, excreted in twenty-four hours by the same person, is not always uniform; it appears to have no direct connexion with either age or sex. In accordance with Guibourt and Rayer, Lecanu found these salts in smaller quantity in the urine of old men than in that of children. From the analyses made by Lecanu, Lehmann, and myself, it appears that the variations in the amount of the earthy phosphates, both absolutely and relatively, are less than those of the other constituents of the urine. A considerable difference was observed by Lecanu in the amount of chloride of sodium excreted by different persons. In his analyses the quantity excreted in twenty-four hours fluc- tuated between 116 grains and a quarter of a grain. Moreover, the quantity excreted by the same person in twenty-four hours is by no meaus constant. In four observations, each made on the urine of twenty-four hours, of a man aged 20, the maximum was 116, and the minimum 67 grains: in six similar obser- vations on the urine of a man aged 35 years, the maximum was 82, and the minimum 29 grains. Lecanu found the quan- tity of chloride of sodium very small in the urine of women and old men. ! It is clear that the excretion of a salt taken with most of our articles of food, must be entirely dependent on the quantity consumed, and must therefore vary very considerably. The urine, generally speaking, is deficient in salts during disease: our analyses show that the deficiency occurs at the expense of the chloride of sodium; the sulphates and phosphates taking only a small part in it. I have analysed urine in typhus which contained a mere trace of chloride of sodium. Lecanu observed differences similar to those we have just 168 THE SECRETIONS: noticed in the alkaline sulphates and phosphates. The quan- tities excreted in twenty-four hours not only varied in different persons, but also in the same persons at different times. From my analyses, and those of Lehmann, it appears probable that a connexion subsists between the quantity of urea and of the sulphates, and possibly of the phosphates likewise ; that is to say, the sulphates always increase with the urea, and vice versd. I incline, therefore, to the opinion of Berzelius, that at least a portion of the sulphates and phosphates owe their origin to the oxidation of sulphur and phosphorus, previously associated with protein which has become changed during the active metamor- phosis of the blood. We do not, however, mean, in making this statement, to deny that the salts are also supplied to the blood by the food, and again separated by the kidneys. The five following results, of much importance in physiology, have been deduced from the admirable researches of Lecanu: 1. The quantity of urea excreted by the same person during equal periods is constant. : 2. The same is the case with respect to the uric acid. 3. The quantities of urea and uric acid excreted by different persons during equal periods are variable. 4, The varying amounts of urea excreted during equal periods by different persons, bear a relation to age and sex. 5. The amount of fixed salts varies in different persons without reference to age or sex. It also varies in the same person during equal periods. An observation simultaneously made by Lehmann! and myself,? appears to me of high physiological import. We have ascertained that the amount of the urea, as well as of the | sulphates, is increased by strong bodily exercise. I produced this state by taking such violent exercise for two hours that the pulse continued for some time above 100. Further confirmation of the above observation is certainly desirable. If, however, we might assume it as a general fact, it would be an additional argument in favour of my view regarding the formation of urea; for it would then become still clearer that the urea is not formed during the change which occurs in the 1 See page 164. ? See page 144. URINE. 169 blood as a consequence of peripheral nutrition, but that it is formed during those processes which are dependent on the respiratory and circulatory functions, in which we must seek for the greater part of the carbonic acid which is exhaled, and for the principal source of animal heat. I refer to the active meta- morphosis of the blood, or to the mutual action excited by the blood-corpuscles, the plasma, and the oxygen held in solution in the blood, on each other. [I am indebted to the kindness of Dr. Percy for the following analyses, which, to a certain amount, corroborate Simon’s views. The urine of a man, aged 30 years, training for a pedestrian match, was examined on two occasions: on the first, a quarter of an hour after running a mile in five minutes and a few seconds ; on the second, after running three races of one mile each on the same day. In both cases the urine was of a pale straw colour; it depo- sited a slight mucous cloud on the first occasion, and was rather more turbid on the second. It was acid, and its specific gravity was 1019. It contained in 1000 parts: | 1, 2. Water ‘ ea. : ° 956-00 950°80 Solid constituents : 2 3 44:00 49°20 Urea js . : : 14°01 20°42 © Uric acid ‘ ‘ ‘ 1:58 64 Salts soluble in water : ‘ 11:16 7°88 Salts insoluble in water ? R 1:10 1:48 Although the soluble salts are not increased as in the cases of Lehmann and Simon, the augmentation of urea is very striking. | To sum up once more: the urine is most abundant in urea, uric acid, and the most important salts, in men in the prime of life ; it is less rich in these constituents in women; while the minimum occurs in old men and children. The nature of the food exerts an influence upon the composition of the urine: the amount of urea is increased by an excess of nitrogenous food, and diminished after living on food deficient in nitrogen. Upon a diminution of the quantity of food, the urine becomes deficient in nitrogen, as has been shown by my own experi- 170 THE SECRETIONS : ments! and those of Lehmann, but the separation of nitrogenous compounds, as for instance urea, through the urine, occurs even when no food is taken. The urine is most abundant in | urea and sulphates after active bodily exercise, in consequence, doubtless, of increased vascular excitement. The quantity of urine discharged in twenty-four hours, amounts on an average to about 45 ounces. It is more abundant in the prime of life than in old age or childhood, and in the male than in the female sex. ON PATHOLOGICAL CHANGES IN THE URINE. During disease the urine may undergo numerous modifica- tions, both in its physical characters and its chemical constitution. The chemical changes may be reduced to one of the following forms. 1. One or more of the normal constituents of the urine ex- isting in larger quantity than in healthy urine. 2. One or more of the normal constituents existing in less quantity than in healthy urine. 3. A normal constituent absent. 4. The presence of substances that do not exist in normal urine. Qualitative and quantitative analyses of urine modified by disease. In tracing the changes which the urine undergoes in dis- ease, the simple addition of certain tests is sometimes all that is sufficient, while in other cases it is requisite to institute a quantitative analysis. I shall now proceed to describe these changes in accordance with the above scheme. INCREASE, DECREASE, OR ABSENCE OF THE NORMAL CONSTI- TUENTS OF THE URINE. 1, Increase or diminution of the solid constituents generally. I have already observed that the proportion of the solid con- stituents to the water is so very variable, is so dependent upon the vicarious action of the skin and lungs, and upon the quan- ' Brande’s Archiv, xxii, p, 25. URINE. 171 tity of fluid that has been taken into the system, that it is im- possible (without taking other facts into consideration) to de- termine from the urine alone, whether a mere increase or de- crease of the solid constituents is due to diseased action. Pale urine, more or less like water, may be fairly considered deficient in solid matters, while a deep brown colour is indicative of an abundance of these constituents. The specific gravity,! and still more the determination of the solid constituents in the manner which has been already de- scribed, will give the required information. The colour of the urine is sometimes deceptive, especially the fiery red that occurs during fevers. Urine of this sort is frequently found to be poorer in solid constituents, and its specific gravity lower than we should have anticipated from its colour: it is usually, how- ever, more abundant in uric acid than normal urine. 2. Increase or decrease of free lactic acid. With a little practice we may form a rough estimate of the increase of free acid, by observing the colour which the urine imparts to blue litmus paper. If neither the blue nor the red litmus paper is affected the urine is neutral. 3. Increase, decrease, or absence of urea. In the course of my analyses, I have found that the quantity of urea may vary from 0°3° to 2°4° in fresh urine; I have ob- served, however, at the same time, that these statements are very deceptive, if the amount of solid residue is not at the same time given. It is only by comparing it with the solid residue that we can judge whether the urea has increased or decreased in an extraordinary manner. In healthy urine the urea may probably fluctuate from } to } of the weight of the solid con- stituents. Further experience is wanted to show whether an in- crease or decrease of this constituent (apart from other changes) implies a diseased state of the urine. Urine has been known to yield crystals of nitrate of urea, 1 The common urinometer is sufficiently accurate for ordinary cases. 172 -THE SECRETIONS : a short time after the addition of nitric acid, without being first concentrated by evaporation. Indeed Lehmann observed that his morning urine, after living exclusively for five days on animal food, contained so much urea, as to stiffen immediately upon the addition of nitric acid. This might arise either from — an absolute increase of urea, or from a relative increase, cor- responding with an augmentation of the solid constituents generally. An entire absence of urea has been observed in cases of diabetes insipidus, in which the urine is distinguished by an extreme deficiency of solid constituents: such statements should, — however, be received with caution. Willis! instances such cases ; he is, however, inclined to believe that it is always present in very small quantity. In order, therefore, to offer a decided opinion regarding either the absolute pathological increase or decrease of urea, it is requisite to estimate its weight, and the ratio of its weight to that of the solid constituents generally. The method of determining the urea is described at page 136. If the quantity of urea is so small as to render the crystallization of its nitrate imperceptible to the naked eye, the microscope must be used in the manner described when treating of the Blood, in Vol. I, page 182. 4. Increase, decrease, or absence of uric acid and the urates. The variation in the quantity of uric acid in diseases has long been known, but it has not yet been determined with certainty whether this is in all cases an absolute, or whether in some cases it is merely a relative increase dependent upon the increased amount of solid constituents generally. The point must be determined by the quantitative analysis of uric acid, and its ratio to the solid constituents generally. a. Increase of uric acid. Urine, containing an excessive quan- tity of uric acid, exhibits in most cases a very high colour, and has an acid reaction. Its specific gravity is frequently lower than would have been supposed from the intense colour. 1 Urinary Diseases and their Treatment. By Robert Willis, m.p. p. 12. URINE. 173 If this urine is allowed to stand for some hours, there are deposited, partly at the bottom, and partly on the sides of the vessel, (and they are not unfrequently observed on the surface,) small crystals perceptible to the naked eye, whose form, under the microscope, usually appears as delineated in fig. 23a, some- times as in fig. 23. Vigla! states, that in addition to the crys- tallized uric acid, a portion separates as an amorphous powder. It is only rarely that I have observed uric acid deposited in this amorphous form: the amorphous sediment of a yellow or red- dish colour, which frequently occurs in large quantity in acid urine, may be shown to consist of urate of ammonia, by its ready solubility when the urine is warmed. Rayer, in his work on Diseases of the Kidneys, describes the crystalline form of uric ‘acid, which is represented in fig. 23c. As a further evidence that these crystals are composed of uric acid, they may be tested with nitric acid in the manner explained in page 116. A brown or reddish-brown sediment is sometimes observed to be deposited in dark reddish-brown urine, which does not disappear either upon the application of heat or the addition of hydrochloric acid, and in fact in the latter case is rather in- creased. Under the microscope it exhibits the described forms of uric acid. We also observe, although more rarely, that dark urine will deposit a dense gray or yellow granular sediment, which is shown, by the application of heat, by the addition of hydrochloric acid, and by the microscope, to consist also of uric acid coloured by a peculiarly small quantity of uroerythrin. If the amount of uric acid is to be determined quantita- tively in these instances, we must have regard not merely to the uric acid which is deposited, but also to that which remains in solution. The amount of the whole urine is determined as accurately as possible, the sedimentary uric acid collected on a weighed filter, washed with distilled water, dried, and weighed. Any uric acid that adheres to the glass, and cannot be removed. by a feather or a glass rod, or by washing out the glass with water, must be treated with some warm solution of potash, until it is dissolved. 1 Etude microscopique de l’urine, eclarée par l’analyse chymique. (L’Expérience, vol, 1, p. 193.) 174 THE SECRETIONS : The alkaline solution must be filtered, and the uric acid precipitated by hydrochloric acid, collected on a filter, dried, and its weight ascertained. We thus estimate the ratio of the separated uric acid to the whole fluid and to the solid residue, if indeed this element has been determined from a weighed quantity of the urine. A certain quantity of the urine is treated with hydrochloric acid in the manner indicated in page 137, allowed to rest for twenty-four to forty-eight hours, and the precipitated uric acid collected on a filter and weighed. We thus obtain the amount of uric acid held in solution, and its ratio both to the whole amount of urine, and to the solid residue. b. Increase of urate of ammonia. Urate of ammonia, which, as we have already mentioned in page 115, is probably an inva- riable constituent of urine, is occasionally excreted to a very large amount during the exacerbations of fever, arthritic attacks and various other diseases. It is the most common form of urinary deposit, but seldom occurs alone; it is frequently mixed with uric acid, sometimes with urate of soda or of lime, and occasionally, but not often, with earthy phosphates. Urine depositing urate of ammonia is generally of dark colour, is seldom clear, and usually exhibits an acid reaction; it is, how- ever, occasionally neutral or even alkaline. It is only in the latter case that earthy phosphates can be present, as they are never precipitated in urine with a marked acid reaction. The colour of urate-of-ammonia sediments varies from a yellowish to a brick-red tint. The red sediments frequently contain free uric acid, and sometimes urate of soda: nearly white sediments of urate of ammonia have occasionally been observed. Urate of ammonia seems to preponderate in the yellow and yellowish- red sediments, and free uric acid in those of a more purple-red colour. All these sediments may contain more or less mucus, 1. If the sediment consists of urate of ammonia alone, it may be at once recognized by its perfect solution when the fluid is raised to incipient ebullition. To determine this point, the clear fluid is poured from the sediment, some of which is placed in a test tube and heated over the flame of a spirit-lamp: the fluid first becomes transparent on the surface, and gradually URINE. 175 clears throughout its whole extent: on being allowed to cool it again becomes turbid, and deposits the sediment afresh. Ifa portion of the sediment, after being washed, is rubbed with caustic lime, a perceptible odour of ammonia is developed: and if a few drops of nitric acid are poured over it in a porcelain basin, and gentle heat applied, the purple colour, indicating the presence of uric acid, appears. On heating a little of it on platinum foil, it burns away without a residue. 2. If uric acid is mixed with the urate of ammonia, the sedi- ment sinks rapidly to the bottom, as a dense granular powder, after the fluid has been cleared by the application of heat. If hydrochloric acid is added, after the urate of ammonia has been dissolved by heat, the precipitate on cooling consists of uric acid alone. 3. If earthy phosphates are mixed with the urate of am- monia, the urine is either neutral or alkaline, and is only partially cleared by heat. The turbidity which remains, pro- duced. by the earthy phosphates in suspension, disappears imme- diately upon the addition of hydrochloric acid. Free uric acid is precipitated on cooling. 4. If mucus or pus is mixed with the urate of ammonia the fluid becomes only partially cleared on warming, neither does it become perfectly clear on the addition of hydrochloric acid, since mucus and pus are not dissolved by that agent. If there should be so large a proportion of mucus and earthy phosphates mixed with the urate of ammonia, that the solution of the latter salt on the application of heat produces no perceptible effect, it will only be necessary to filter the heated urine, and to allow it © to cool. The separation of urate of ammonia on cooling renders it turbid, and crystals of uric acid may be obtained on the addition of hydrochloric acid. 5. If urine containing urate of ammonia is albuminous, it is necessary to be very cautious in the application of heat as a test. On gently warming the tube, the urate of ammonia dissolves before the albumen begins to coagulate. If the fluid which has thus become clear is exposed to a stronger heat, it becomes cloudy, the turbidity commencing in the upper, hottest stratum of fluid, and gradually extending itself. Urate of ammonia is recognized under the microscope as an 176 THE SECRETIONS : amorphous mass, in which large, well-defined globules, some- times united two and two, are often observed. Fig. 28a and 6 exhibit these forms. It is obvious from a comparison of fig. 28 a, and fig. 26, that the urate of ammonia, in consequence of its form, may easily be mistaken for phosphate of lime. The following points enable us to distinguish them. Phosphate of lime occurs as a sediment only in neutral and alkaline, never in acid urine. Phosphate of lime when examined under the microscope disappears instantaneously on the addition of a little hydrochloric acid, which usually develops numerous air- bubbles. The sediment of urate of ammonia does not disappear so rapidly under similar treatment, and in a short time, fre- quently only a few minutes, its place is occupied by rhombic crystals of uric acid, as shown in fig. 28 ¢. The quantitative determination of urate of ammonia pre- sents no difficulty when no other constituent is present in the sediment. The weight of the urine and the amount of solid-re- sidue are accurately determined : the sediment is collected in a filter of known weight, washed with a little ice-cold water, dried, and weighed. The ratios of the amount of. sediment to that of the whole urine, and to that of the solid residue are thus obtained. In order to separate the urate of ammonia from uric acid, earthy phosphates, or mucus, with which it may be mixed, the sediment must be collected, and the quantity of urine from which it was deposited, carefully ascertained. The sedi- ment must then be placed in a test-tube with a little of the urine, and gradually raised to the boiling point (if we are pre- viously assured that no albumen is present): it must then be filtered, and the residue washed with a little hot water, while the clear fluid that passes through the filter must be artificially cooled, and the urate of ammonia allowed to separate. It must be collected on a filter, dried, weighed, and its ratio de- termined in reference to the urine, and to the solid residue. The determination of the urate of ammonia as uric acid, from which the amount of the salt might be calculated would, per- haps, give safer results, since uric acid is less soluble than urate of ammonia. The fluid which, by the application of heat, has taken up the urate of ammonia from the mixed sediment, must be concen- trated by evaporation, and treated while still warm with hydro- URINE. 177 chlorie acid. Upon cooling, the uric acid will separate and must be collected. ce. Increase of urate of soda. Lam not certain whether urate of soda exists in normal urine. I shall, however, proceed to state in what manner its presence may be recognized in certain pathological conditions. Deposits of urate of soda alone are not often to be met with; this substance is, however, frequently associated with uric-acid and urate-of-ammonia sediments. Urate of soda is detected chemically in the same manner as urate of ammonia; like that salt it dissolves on the application of heat; and when warmed on a porcelain capsule with a little nitric acid, it develops the same purple colour. It differs, how- ever, from that salt, in not developing an odour of ammonia when rubbed with caustic potash, and in leaving a white ad- hesive residue, when heated on platinum foil. This residue when moistened with water, colours red litmus paper blue, and froths when treated with hydrochloric acid,— (carbonate of soda.) It may be distinguished in the same manner as the urate of ammonia from uric acid, earthy phosphates, mucus, or pus. Under the microscope it presents the form of globules, min- gled with small prisms arranged in stellar groups: at least it is in this form that I have always seen it when obtained artificially; and I have detected such globules, only of g more opaque appearance, in certain urinary sediments. ‘These. forms are exhibited in fig.29a@ and 6. Certain forms described by Vigla and Quevenne are given in fig. 29c¢. This peculiar crystalline arrangement is sufficiently characteristic to enable the urate of soda to be detected when mixed with urate of ammonia, or other sedimentary matters, either crystalline or amorphous. For a quantitative analysis of a sediment consisting of pure unmixed urate of soda we must proceed in exactly the same manner as for urate of ammonia. If, however, it is mixed with uric acid, earthy phosphates, or mucus, the same method must be adopted as for urate of ammonia under similar circumstances, If urate of ammonia is mixed with urate of soda, they are both held in solution when the urine is warmed, and are thus sepa- rated from the other constituents of the sediment. The solution is then slightly concentrated by evaporation, and afterwards thoroughly cooled. The alkaline urates separate them- II. 12 178 THE SECRETIONS: selves, are collected on a filter, dried, and weighed. If the filter with its contents is then incinerated in a platinum crucible, the urate of soda will leave carbonate of soda, which must be con- verted into a sulphate, and determined in that form. From the sulphate of soda we can reckon the urate, and by deducting the latter from the whole amount of alkaline urates, we obtain the amount of urate of ammonia. d. Decrease of uric acid, A relative and an absolute decrease of uric acid has frequently been observed. In diabetes mellitus I have sometimes been unable to obtain any trace of it, while in other cases I have found it. If the method described in page 116 fails in yielding any traces of uric acid we are not jus- tified in assuming its entire absence. In doubtful cases we must evaporate a large quantity of urine, and treat the residue with alcohol. The portion of the residue which is insoluble in alcohol must be dissolved in acidulated water, and there is then an insoluble residue left, consisting of mucus, silica, and uric acid (if this constituent be present.) If the nitric-acid test be then carefully applied, we may convince ourselves with certainty whether there is an entire absence of uric acid. 5. Increase or diminution of the extractive matters and . ammonia-compounds. An increase or diminution in the quantity of the extractive matters,! of the chloride of ammonium, and lactate of ammonia, 1 [At the meeting of the German Association of Natural Philosophers, held at Nuremberg last September, a paper was read by Scherer, on the extractive matters of the urine. The following are the principal facts he has ascertained. The greater — portion of the extractive matters is merely a pigment analogous to those of the blood and bile. It may be thrown down from the urine by acetate of lead, and by treating the precipitate with alcohol and hydrochloric acid, it may be obtained in a state of purity. In healthy individuals it yields from 62 to 63 per cent. of carbon, and from 6°2 to 6°4 of hydrogen. In fevers, when there is rapid waste of tissue, and the fune- tions of the lungs and liver are inactive, the carbon may amount to 66 or 67, and the hydrogen to 7:2 per cent. An increase in the quantity of extractive or colouring matter may be detected by boiling urine in a test-tube, and adding alittle hydrochloric acid to it. Urine containing an excess of this colouring matter becomes of a dark colour, and on cooling deposits a brownish, blackish, or frequently an indigo-blue sediment, freely soluble in alcohol. Scherer believes that this colouring matter is formed from the hematin of arterial blood, and that the amount of carbon contained URINE. 179 in pathological conditions of the urine can only be ascertained by the analytical proceedings described in pages 118 and 137. 6. Increase or diminution of the fixed salts. The qualitative and quantitative variations occurring in the mixture of the fixed salts of the urine in disease are deserving of much attention. Some of these changes may be recognized without difficulty. a. Increase or diminution of the earthy phosphates. There are certain diseased states of the system in which the earthy phosphates are absolutely increased to a very marked degree ; there are others, again, in which they decrease in an extraordinary manner, or even altogether disappear. a. It is no very rare occurrence for the free acid of the urine to become neutralized by the formation of ammonia, and the urine thus becoming neutral or even alkaline, the earthy phos- phates are precipitated. Urine in which these events occur is most commonly light-coloured ; sometimes, however, dark. Blue litmus paper is not at all reddened by it, in fact red litmus is usually rendered slightly blue, and in some cases a powerful alkaline reaction is manifested. Generally speaking, the urine is clear and slightly acid at the period of its emission, but in a very short time it undergoes the change we have stated; a change which also occurs in normal urine, but not till after the lapse of several days. It becomes turbid, a film is formed on the surface in which minute crystals may be frequently detected ‘with the naked eye. A sediment shortly begins to form, and at the same time the inner surface of the glass which contains the urine becomes covered with a stratum of salts; at least I have observed this to occur in several instances. Sediments of this kind are sometimes scanty, sometimes very copious. I have seen a case in which the sediment, which consisted almost in this pigment varies inversely with the degree of oxidation of the blood; that its formation is analogous to the formation of uric acid and urea; that the carbon and hydrogen contained in it do not increase in an equal ratio ; and that, finally, a long- continued secretion of urine, rich in this colouring matter, usually induces anemia and emaciation. (Med. Times, Oct. 11, 1845.) ] 180 THE SECRETIONS: entirely of earthy phosphates, occupied, when it had entirely settled, one third of the volume of the fluid. I received from a physician of this city, a portion of dried urinary sediment which consisted almost entirely of pure earthy phosphates. This fragment bore evident traces of the form of the glass in which the urine had been kept, and it was of the extraordinary thickness of nearly an inch and a half. Earthy-phosphate sedi- ments are seldom perfectly pure; their colour is white, gray, yellow, or reddish. White and gray sediments consist princi- pally of earthy phosphates and mucus; yellow and reddish sedi- ments contain a greater or less admixture with urates. That the sediment is composed of earthy phosphates we are assured by the following chemical facts. The urine from which it is precipitated is neutral, or more commonly alkaline; the sediment does not dissolve on the application of heat, like the urates; it is, however, readily dissolved by the addition of an acid (hydrochloric, nitric, or acetic,) to the urine; a property which is not enjoyed by sediments of the urates, of mucus, or of pus. If the sediment contain so large a proportion of urates and mucus that the addition of an acid does not produce any obvious degree of clearing, the acidulated urine must be gently warmed and filtered from the insoluble constituents. Upon the addition of free ammonia to the clear, filtered fluid, the earthy phosphates will be precipitated. The nature of the sediments may be still more quickly ascer- tained by the microscope. If the sediment consists of earthy phosphates, we observe the beautiful crystals of ammoniaco- magnesian phosphate depicted in fig. 27, and also amorphous” masses of phosphate of lime, fig. 26. Upon the addition of a minute quantity of free acid to the objects on the field of the microscope the crystals and amorphous masses immediately dis- appear, and at the same time numerous air-bubbles are liberated. If the earthy phosphates have been dissolved by a little acidu- lated water from the urates and mucus or pus, with which they were associated, and are then precipitated from the filtered solution by free ammonia, the precipitate exhibits other forms under the microscope. I have represented these forms, which seem to vary according to circumstances, in fig. 30. Fig. 30a exhibits the different forms under which the ammoniaco-magnesian phosphate is pre- URINE. 181 cipitated, in which the predominating character is the forked arrangement of the crystals. Fig. 30 6 exhibits the forms in which the phosphate of lime appears. The quantitative determination of earthy-phosphate sedi- ments presents no difficulty, if other constituents are not also present. The method of proceeding is exactly the same as for the quantitative determination of the urate-of-ammonia sediment in page 176. Its amount must be determined in reference to the whole quantity of urine, and to the amount of solid residue. In order to separate the earthy phosphates from urates, and mucus or pus, the sediment must be collected, washed with a weak solution of ammonia, the earthy phosphates taken up by water acidulated with hydrochloric acid, precipitated from the filtered solution by free ammonia, collected on a filter, dried, and weighed. Upon submitting the dried precipitate to a strong heat the ammonia is given off, and the weight proportionally diminished. The ratio of the earthy phosphates to the solid residue of the urine enables us to determine whether an increase in this particular class of constituents has occurred. If the re- lative quantities of phosphate of lime and ammoniaco-magnesian phosphate are required, the separation must be conducted on the principles described in page 139. 3. Diminution of the earthy phosphates. There can be no doubt that in certain diseases the earthy phosphates are much diminished, and that occasionally they altogether disappear. If the amount of earthy phosphates in the urine should be so slight that, upon the addition of free ammonia no precipitate is ob- served, it will be necessary, in order to be assured of the entire absence of this constituent, to evaporate a large quantity of urine, to incinerate the solid residue, to dissolve the ash in water containing a little nitric acid, and then to add ammonia. If no precipitate is formed after the fluid has been warmed and allowed to rest for some hours, the absence of earthy phosphates may be considered as proved. b. Increase or diminution of the chloride of sodium and of the jixed alkaline sulphates and phosphates. The quantity of fixed alkaline salts almost always decreases 182 THE SECRETIONS: during disease, principally in consequence of the diminution of the chloride of sodium, which, however, is by no means one of the most important of the saline constituents, and whose weight may be determined in the manner described in page 140. It is different, however, with the alkaline phosphates and sulphates, which (more especially the sulphate of potash,) appear to fluc- tuate considerably in disease. We may readily be convinced of the presence or of the total absence of the aforesaid salts in urine which has become modi- fied by disease, by the application of certain tests, or by the methods which have been enumerated in page 130, under 9, 10, and 11; indeed the practised experimenter will be able to judge from the specific gravity whether there is any decided increase or diminution in the amount of the fixed alka- line salts. As, however, it is of importance to know the exact amount of the alkaline sulphates and phosphates in certain diseases, we must adopt the method described in page 140, and determine the relation of these salts to the solid residue. 7. Increase of mucus. In catarrhal affections of the bladder the amount of mucus in the urine is often very much increased. The urine in these cases is acid or neutral, but frequently exhibits a strong ten- dency to become ammoniacal in a short time. The colour is usually unaffected, and seldom higher than ordinary. If there is a very large proportion of mucus in the urine, a diffuse sedi- ment of a viscid consistence, and of a white, yellowish, or dirty yellow colour, will separate itself. If the urine exhibits a strong tendency to the formation of ammonia,the mucus will become very tough, and almost thready. The supernatant fluid is somewhat turbid, but heat induces no coagulation unless albumen be present. The mucus may be recognized under the microscope by the peculiar mucus-granules, which are usually rather larger and less granular than those from the mucous membrane of the lungs or nose. | I have represented the mucus of the bladder, as it occurs in certain pathological states, in fig. 31 @. URINE. 183 Mucus frequently accompanies sediments of the urates and earthy phosphates, and its presence in these cases may be de- tected by the microscope. When mucus is separated in large quantity, (as in vesical catarrh,) carbonate of ammonia is soon formed, and we always find numerous crystals of ammoniaco- magnesian phosphate. The quantitative estimation of the mucus must be effected in the manner described in page 135. The ratio of its weight to that of the solid constituents must be determined. In order to ascertain the quantity of mucus in a sediment of urates and earthy phosphates, the sediment must be collected, the urates dissolved in hot water, and the earthy phosphates then taken up by acidulated water. The mucus will remain on the filter, and must be dried and weighed. The method of conducting the quantitative analysis of diseased urine is precisely the same as for the healthy secretion, provided the changes are only dependent upon an increase or diminution of one or more of the normal constituents: indeed it may be still more simplified by omitting the exact determination of the lactic acid, the lactates, the chloride of ammonium, and the extractive matters. The proportions of water and of solid residue must be de- termined, in the manner already described, from a weighed quantity of filtered urine. The residue, after being dried over sulphuric acid, must be moistened with a little warm water, and then thoroughly extracted with anhydrous alcohol. The undissolved portion must be dried, weighed, and incinerated. The extractive matters and uric acid are consumed, and there remain the earthy phosphates, the alkaline sulphates and phos- phates, and the chloride of sodium, which must be separated. and determined. The anhydrous alcoholic solution must be gently evaporated, dried over sulphuric acid, weighed, and dissolved in a little water. The urea must be then precipitated as a nitrate, which must be separated and dried in the ordinary manner, weighed, Sean THE SECRETIONS: and the weight of urea calculated from it. By subtracting the weight of urea from that of the whole of the alcohol-extract, we obtain as a residue the lactates, chloride of ammonium, alcohol- extract, and lactic acid, if any should be present. The uric acid must be determined from a separate portion of urine. Ifany sediment occurs in the urine, it must be separated, and its weight ascertained in relation to the weight of the urine. After having ascertained its general nature, its various consti- tuents must be determined by the methods already given. _ If the morbid urine contains substances which do not occur in the healthy secretion, this method will even then often hold good, since the abnormal ingredients are sought for by inde- pendent processes. In many cases, however, a change is requisite; and I shall proceed to notice the various cases that may occur. 1. Qualitative and quantitative determination of substances which do not occur in normal urine. Albumen is frequently present in the urine of persons suf- fering from disease, and indeed I once found it ‘in the urine of a healthy vigorous young man, aged twenty-six years. If there is a considerable amount of albumen, nitric acid or bichloride of mercury will cause a precipitate, and the urine will become turbid on the application of heat, and deposit flocculi of coagu- lated albumen. Urine of this sort is usually pale and slightly turbid from containing mucus in suspension: its colour may, however, be high, as in the phlogoses; it may have an acid, neutral, or alkaline reaction, a high or a low specific gravity. When the quantity of albumen is very small, the application of heat is the most efficient test, and the most minute quantity of albumen may be readily detected by observing the uppermost part of the column of the fluid as it is being gently heated in a test-tube. When the temperature is sufficiently elevated, the coagulation begins to occur in the form of small white nebule, which are dispersed by the rising of large bubbles, and the general turbidity of the whole fluid is often so slight that unless the de- velopment of these nebule has been observed at the commence- ment of the process, it becomes a matter of difficulty to decide upon the presence of albumen. It is only in cases in which URINE. 185 the urine has a decidedly alkaline reaction that nitric acid is preferable for the detection of small quantities of albumen, as in these instances the albumen is held in solution by the free alkali. A turbidity may occur on the application of heat from the precipitation of earthy phosphates, or possibly of carbonate of lime, when no albumen is present; but in this case it is directly removed on the addition of nitric acid: similarly, nitric acid may throw down a deposit of uric acid, which may be mistaken for albumen, but in this case no precipitate is caused by the application of heat. Dr. G. O. Rees has observed, that after the use of cubebs or balsam of copaiva, the urine is rendered turbid by nitric acid, although it contains no albumen ; it is, however, not affected by heat. Hence, if there should be a tendency to the deposition of phosphates, a precipitate might ensue both on heating, and on the addition of nitric acid, and yet no albumen be present. I have confirmed the accuracy of the above observation ; the precipitate consists of minute oil- vesicles readily soluble in alcohol, and possessing an odour of balsam of copaiva. The quantitative analysis of albumen is best effected by boiling the urine, collecting the albumen on a filter, washing, drying, and weighing it, and ascertaining its weight in relation to that of the urine which was boiled, and to the solid residue. The portion of urime from which the albumen has been separated by boiling, may also be used for the determination of the other solid constituents and of the urea, if the quantity of albumen is not very large, and if the coagulated albumen is carefully washed. If the proportion of albumen is so large as to cause the urine to gelatinize on being heated, which, however, is very seldom the case, it may be feared that the coagulated albumen will entangle many other substances ; in that case, the amount of solid constituents may be determined from a fresh quan- tity of urine, about 500—600 grains ; the coagulated albumen must be treated several times with hot water before it is dried. When the quantity of albumen is very small, as for in- stance when the urine becomes only slightly turbid on heating, its amount cannot be determined with accuracy. It is then contained in the water-extract, and it is sufficient to state that the urine contains traces of albumen. If the amount of albu- 186 THE SECRETIONS: men is very considerable, certain changes must be made in the method of determining the other constituents. The albumen itself must be always separated by boiling. In determining the urea we must see whether, when the albumen is very abundant, the greater quantity of it cannot be precipitated by alcohol. The albumen thus separated must be washed with alcohol. If we were to attempt to determine the urea in very albuminous urine in the manner described in page 136, there would be reason to apprehend that the albumen pre- cipitated by the application of heat would entangle too large an amount of urea. The determination of the uric acid is usually regarded as very uncertain in strongly albuminous urine. I have, however, convinced myself that this constituent may be separated from very albuminous urine by the careful addition of extremely di- luted hydrochloric acid, [or acetic acid may be used, which — precipitates uric acid without affecting the albumen.| It-must also be observed that urine which is very rich in albumen always contains only mere traces of uric acid, and a very small pro- portion of urea. In the determination of the water-extract, it must be borne in mind that albumen is present in it. As its quantity is known, it must be subtracted from the combustible portion of the water-extract. The spirit-extract is obtained from the portion of urime pre- cipitated by alcohol, where it occurs in a state of solution, This solution must be filtered, evaporated, and all substances insoluble in anhydrous alcohol precipitated by the addition of that reagent. These are spirit-extract with chloride of sodium, and a certain quantity of albumen which remains insoluble on the addition of water. The watery solution of the spirit-ex- tract and of the salts must be filtered, again evaporated, weighed, and then treated in the manner described in page 137. If we wish to avail ourselves of the alcoholic solution which remains after the precipitation of the spirit-extract by anhydrous alcohol, for the estimation of urea, we must take another por- tion of urine for the determination of the alcohol-extract and ammonia-compounds, and proceed in the same manner as for the determination of the urea. In the determination of the fixed salts it must be remembered URINE. 187 that the earthy phosphates are increased by the phosphate of lime associated with the albumen, and as this generally amounts to 6 or 7 per cent., a corresponding amount must be deducted from the earthy phosphates. In other respects the method de- scribed in page 140 must be adopted. [The following method for determining the amount of albu- men has been recently proposed by Heller,! and offers several advantages. A small quantity of the urme (from 20 to 10 grains) must be carefully weighed, and its solid residue accurately determined. In this way we estimate the per centage of solid residue, Another portion must be rapidly heated to incipient ebullition in a small narrow-mouthed flask. The mouth must be then closed, in order to prevent the escape of vapour, and the liquid when cold strained through a moderately fine linen cloth. The strained fluid is thus obtained perfectly clear, the albumen re- maining on the linen as a snow-white magma. By treating a small quantity with nitric acid, we may be certain that the albumen is completely separated. The amount of the solid residue yielded by the strained fluid is determined, and the per centage calculated. The difference gives the per centage of albumen. If extreme accuracy is required, the flask with its contents may be weighed both before and after ebullition, and a correction made for the escaped vapour. In _case the fluid should be alkaline, it must be previously acidulated with acetic acid. | 2. Constituents of the blood with the exception of fibrin. Bloody urine is not of very unfrequent occurrence; it is distinguished by a more or less marked blood-red colour, some- times being of a brown-red, and on other occasions even of a brownish black tint. No certain conclusions regarding the presence of blood can, however, be deduced from the colour alone. I have seen urine in colour strongly resembling bloody urine which contained not a trace of hematoglobulin. Various resemblances to the colour of blood may be induced by mix- tures of considerable quantities of hemaphzin, of uroerythrin, Archiv fir phys. und patholog. Chemie und Mikroskopie, vol. 1, p. 192. 188 THE SECRETIONS: and of biliphzin. The presence or absence of the constituents of the blood may, however, be easily determined by the micro- scope, and by certain tests. If undissolved blood-corpuscles remain in the urine, as is frequently the case, they sink to the bottom and form a dark brown-red sediment, in which their forms may be recognized by the microscope. The dark-red supernatant fluid coagulates on the application of heat, m the same manner as ordinary albuminous urine; the coagulated matter, however, in this case is not white, but of a dirty brown colour. Similar appearances are produced by the addition of nitric acid. If the blood-corpuscles are perfectly dissolved in the urine, as I have sometimes observed to be the case, the microscope affords us no assistance. The application of heat, and the addition of nitric acid will, however, be sufficient to convince us directly of the presence of albumen and hemato- globulin. The quantitative determination of blood in urine, and the changes which must be made, in consequence of the presence of a considerable quantity of that fluid, in the determination of the normal constituents are precisely similar to those already described in speaking of albuminous urine. It must be ob- served that the ash becomes reddened by the peroxide of iron which occurs in the hematin; and the fixed alkaline salts, as well as the earthy phosphates, are increased by the fixed salts of the blood, which usually amount to about 8 per cent. 3. The constituents of the blood generally. Fibrin has been found associated with the other constituents of the blood which we have described as occasionally occurring in the urme.!_ Urine of this sort resembles blood in appear- ance; assumes, on being allowed to rest, a gelatinous consis- tence ; trembles on the movement of the vessel; and, finally, separates into two portions, a clot, and thin fluid serum. On examining, under the microscope, a little of the fiuid obtained by pressing a portion of the clot, blood-corpuscles are ‘ [Fibrin has been detected occurring in a state of solution in urine, independ- ently of the other constituents of the blood. Zimmerman describes seven cases of this nature, some of which are noticed at length in a future part of this chapter, (Zur Analysis und Synthesis der pseudoplastischen Prozesse. Berlin, 1844, p. 129.)] URINE. 189 observed: and upon kneading the clot in water we obtain fibrin, which may be washed perfectly pure. Under these circum- stances there is no difficulty in ascertaining the presence of blood. If the blood has coagulated in the bladder, the urine will be of a blood or brown-red colour, or even of a brownish- black, and will contain gelatinous flocculent coagula of fibrin, which, after remaining for some time in the urine may acquire a degree of transparency by the solution of their colouring matter. It is only necessary, in these cases, to make sure that the coagula are not composed of mucus, a point which can be readily settled by the microscope, under which coagula of fibrin, upon compression between thin glass plates, present an amorphous granular appearance, while in the mucus-flocculi we recognize the well-known mucus-granules. The quantitative determination of the constituents of the blood must be conducted in the manner described in 2. A method perfectly similar to the one which I have given for the analysis of blood may, however, be adopted, and in order to determine the urea in a certain quantity of bloody urine, the protein-compounds must be precipitated with alcohol, in the same manner as in albuminous urine. 4, Urine may contain fat either as an independent extra- neous constituent, or associated with albumen, or with casein and the other constituents of milk. To distinguish these three morbid forms of urine we may term them, for brevity, fatty urine, chylous urine (Prout), and milky urine. In addition to these forms, urine containing blood always contains, of course, a relatively corresponding quantity of fat. Fatty urine. We occasionally observe that the urine of persons labouring under consumptive disorders becomes covered over with a glistening film. It would be precipitate to consider this, without further investigation, as a fatty coat, since I have observed a similar appearance on the surface of urine which had been standing for some time, and was just becoming ammoniacal. The microscope will immediately disclose the nature of the film : if it is composed of fat, we observe, on the microscopic exa- mination of a small portion, an immense number of fat-globules ; 190 THE SECRETIONS: in the other case, we observe an amorphous granular matter. Cases have however occurred in which the urine has contained so large a quantity of fat that the oil-vesicles could be observed even with the naked eye, and formed a perfect stratum on the surface ;—-such cases have been recorded by Elliotson and Bachetoni.! The microscope is always sufficient for the recognition of fat in urine. If a quantitative determination of the fat is required, a weighed portion of urine must be evaporated and the residue repeatedly extracted with ether. The ether must then be eva- porated, and the fat separated from the urea, and other con- stituents which may have been also taken up by means of water. This separation should be effected in a small porcelain basin, in which the fat must be heated till all aqueous moisture is dis- sipated, and then weighed. If the amount of solid residue is known either by this, or a separate experiment, the proportion of fat to the urime, and to the solid residue, can be at once obtained. ‘The residue, after the separation of the fat, will serve for the determination of other constituents, as urea or extractive matters; it must however be remembered that the water in which the fat was washed, contains some little urea. Chylous urine. Chylous urine contains both fat and albu- men; it is usually turbid, curdy, sometimes even resembling milk in point of colour. Under the microscope it exhibits numerous fat-vesicles. On the addition of a small quantity of acetic, or dilute sulphuric or hydrochloric acid, no coagulation occurs, even when gentle heat is applied; but on the addition of nitric acid a white precipitate is observed. Upon the ap- plication of heat to chylous urine, the albumen coagulates in flocculi. The methods of determining the amount of albumen and fat have been already given. 5. Casein. Casein has never yet, so far as I know, been observed as a single extraneous constituent of the urine, as albumen some- times seems to occur, but has always been found in combination with fat, and, in all probability, also with sugar, forming milky urine. } Urinary Diseases and their Treatment. By Robert Willis, m.p. p. 166. URINE. 191 Milky urine is always turbid, of a yellowish-white colour, sometimes like milk, and when examined under the microscope, exhibits a quantity of fat-vesicles. Upon the application of heat to urine of this nature, coagulation will take place if a considerable amount of lactic acid is present, and then only a moderate tem- perature (86° to 104° F.) is sufficient. If it does not coagulate at this temperature, neither will it do so at the boiling point, as I have proved in an experimental mixture of milk with urine. If, however, albumen should also be present, the urine will coagulate on being boiled. On the addition of a few drops of acetic, or dilute sulphuric or hydrochloric acid to a little of this urine, flocculi of coagulated casein will be formed if a moderate heat is applied. In order to determine the quantity of casein we must add a little acetic acid to a weighed portion of mode- rately warmed urine, and allow it to digest till the white flocculi of acetate of casein have separated themselves, and the urinary fluid has become clear. The flocculi must be collected, washed, dried, and weighed. This is most readily effected on a light filter of known weight, which must be deducted, in order to give the true weight of the casein. The fat becomes entangled in the precipitated acetate of casein, and the filtered fluid exhibits only a few scat- tered fat-vesicles swimming in it. The fat may be separated, and its amount determined, either from the dried residue of the urine, or from the dried casein, by extraction with ether. The casein must be determined from a separate portion of urine ; after this constituent has been separated the urine may be evaporated, and the urea and water-extract determined from the residue. 6. Brown pigment of the bile. (Biliphein.) It is no uncommon occurrence to find the urine tinged with this substance; in icterus it is always present. Urine of this sort is of a saffron, dark yellow, or yellowish-brown colour, and its sediment, if it contains one, is usually of a yellow or brown colour also. We cannot, however, always decide upon the presence of biliphzin from the colour of the urine, since hemaphein (the peculiar colouring matter of the urine) is capable of producing a similar tint. It is a peculiarity 192 THE SECRETIONS: of urine coloured dark by biliphzin, that it exhibits in thin layers a characteristic saffron yellow colour. The presence of biliphzin may be at once detected with certainty by the addi-. tion of nitric acid, by which the well-known transitions in colour, from green to violet, red, and yellow are produced. It is only when there is a considerable quantity of biliphein present that these transitions can be distinctly observed, and the best method of proceeding is to pour a layer of urine care- fully over nitric acid, and to continue the mixture of the two fluids gradually. When the quantity of biliphein is very small, the only changes that we are certain to observe on the addition of the nitric acid, are the transition of the yellow colour of the urine into green, which usually reverts to a yellow, without the intermediate colours being observed. Hydrochloric acid con- verts the yellow or brown colour of the urine into green, but does not develop the other tints. —— An exact quantitative determination of the biliphzein in urine appears, with our present resources, hardly practicable, for its amount is usually very minute, and, like the animal colouring matters generally, it possesses the property of combining very intimately with other constituents. Thus we find uric acid, when it occurs as a sediment in icteric urine, mucus, the ex- tractive matters, &c. always tinged yellow by bilipheimn. We must therefore be content, in our estimation of the amount of the biliphein, to draw our inferences from the intensity of the colour of the urine, and from the degree of change that it undergoes on the addition of nitric acid. 7. Bilin and bilifellinic acid. The quantity of bile in urine is occasionally so large as to communicate to that fluid a decidedly bitter taste: in these cases biliphzein is always present. Whenever biliphzin occurs in urine, we are justified in suspecting the presence of bilin and bilifellinic acid, although they are not always found. When the taste of the urine does not decidedly indicate the presence of bilin and of the acids of the bile, we must, in order to be assured of their existence, evaporate the urine, extract the residue with anhydrous alcohol, and then expel the alcohol by URINE. 193 evaporation ; the residue will contain bilin and bilifellinic acid, in addition to urea, alcoholic-extract, and the IRE ; their presence may be recognized by the taste. [The best method of ascertaining the presence of _bilin (or choleic acid) is one recently published by Pettinkofer.! A small quantity of the urine or other fluid, supposed to. contain bile, must be poured into a test-tube and treated with about two thirds of its volume of sulphuric acid, added by drops. Considerable heat is evolved, and the mixture must be kept below 144°, otherwise the bilin will be decomposed. A few drops of a solution of cane-sugar (five parts of water to one of sugar) are ~ added, and the mixture shaken. If bilin be present, a violet- red colour will appear, the distinctness of which will vary with the amount of bilin. The following precautions must be at- tended to :—Ist, the temperature must not exceed 144°, other- wise the colour, although formed, will\be again destroyed: 2dly, the quantity of sugar must not be too large, lest sul- phurous acid should be formed, and the solution become of a dark brown colour: 3dly, the sulphuric acid must be free from sulphurous acid: 4thly, if albumen be present, it is advisable to coagulate and remove it before applying the test, since it — gives origin (when present in a large quantity) to a tint some- what resembling that produced by bilin: 5thly, a great excess of chlorides produces a brownish-red colour. In liquids where the bile is in very small quantity, as in the urine and other secretions, it is often necessary to make a spirituous extract, to evaporate this nearly to dryness on the water-bath, and to transfer the moist residue into a watch- glass. When quite cold, sulphuric acid and a very small quan- tity of syrup are added, so that the temperature of the solution ~ remains low. In the course of a few minutes, if the most minute trace of bile is present, the colour is produced. In em- ploying this test grape-sugar, or any substance convertible into grape-sugar, may be substituted for cane-sugar. The nature of this reaction is unknown ; it was at first con- sidered that the peculiar violet tint might be dependent on the decomposition of the bile-pigment, but it was found to occur, 1 Liebig’s und Wohler’s Annalen, vol. 52, part 1. II. 13 194 THE SECRETIONS: even in a more marked degree, with decolorized bile, and with pure bilin. Another test has been recently proposed by Schwertfeger. He recommends that the urine should be treated with basic acetate of lead. When bile is present the precipitate is yellow. On treating this precipitate with alcohol containing some sul- phuric acid, we obtain a green solution, to which (as has been suggested by Dr. Griffith) Pettinkofer’s test may be applied with advantage. | For the purpose of forming a quantitative analysis of the bilin in the urime, we must evaporate a weighed portion, pre- cipitate the water-extract and the salts insoluble im alcohol with spirit of 0°85, evaporate the spirituous solution, and extract the residue with anhydrous alcohol. The alcohol of this last solution is expelled, the residue dissolved in a little water, and some hydrochloric acid added; it is then allowed to digest ill the resinous matter of the bile has separated itself, which must be washed, dried, and weighed. The presence of bile offers no impediment to the determination of the urea, for which purpose, however, a different portion of urine must be used. When icteric urme contains a sediment, it is usually of a yellow or brown colour, and in addition to the ordinary con- stituents of urinary deposits, it contains biliphein. The sedi- ment, in these cases, must be separated, and extracted with alcohol. This alcoholic solution must be united with the spi- rituous solution of the residue of the urine, from which the bilin was determined. The sediment must be analysed according to the rules already laid down for the separation of uric acid, the urates, and earthy phosphates. 8. Sugar. In diabetes mellitus the urine frequently contains a large ' quantity of grape or diabetic sugar, while the urea is at the same time either absolutely or relatively diminished. When the quan- tity of sugar is considerable its presence can be detected without difficulty. The urine must be evaporated, ‘and the syrupy residue treated with alcohol of 0°83. The alcoholic solution must then be evaporated till a yellow and very sweet syrup is left. Trommer, of Berlin, has discovered that the smallest quantity URINE. 195 of grape-sugar may be detected in a fluid by the addition of a solution of sulphate of copper and of caustic potash.’ On heating the mixture we do not obtain a black precipitate of oxide of copper, but the fluid becomes turbid, and a more or less consi- derable yellow, or yellowish-brown precipitate of reduced sub- oxide of copper is thrown down. According to the statements of Trommer, this method is particularly applicable to the de- tection of very minute quantities of diabetic sugar in urine; but since the ammonia-salts, the urea, and nitrogenous extractive matters, when heated with caustic potash, develope free ammonia, which impedes the action of the test, it is better to proceed in the following manner. The urine must be evaporated and the syrupy residue treated with anhydrous alcohol. Dry carbonate of potash must be added to this solution, and the mixture well shaken. The carbonate of potash dissolves and forms a layer beneath the alcohol. Upon the addition of some dissolved sul- phate of copper, and the application of heat, there is produced in the lower portion of the fluid, a yellow or yellowish-brown turbidity, if sugar is present. Trommer states that this method. is equally applicable for the detection of sugar in the blood. The quantitative determination of sugar in urine is not very easy: I proceed in the following manner. A weighed quantity of urine is evaporated on the water-bath to the consistence of a thin syrup, and the residue treated with alcohol of 0°85, which precipitates the mucus, the salts insoluble in.spirit, the water-extract, uric acid, &. The spirituous solution is then evaporated to the consistence of a thick syrup, and anhydrous alcohol added, which precipitates the greater part of the sugar in the form of a yellowish-white magma. On pouring off the supernatant yellow alcohol, and repeatedly treating the magma with anhydrous alcohol, it gradually assumes a tough pasty form : it must then be warmed for some time on the water-bath, until all the alcohol is expelled, and be subsequently placed under a receiver over sulphuric acid, to dry. ther is then added to the alcohol, in about the proportion of one volume of the former to two of the latter, by which an additional quantity of sugar is precipitated, whose weight must be determined 1 See Vol. I, p.68. Additional observations on the application of this test will be found in the remarks on the urine in diabetes. ~~ 196 THE SECRETIONS: separately. The substances now remaining in solution in the etherealized alcohol are urea and alcohol-extract. The fluid must be evaporated or distilled, and the urea determined from the residue by nitric acid. The sugar separated in this manner is not perfectly pure; it still contains chloride of sodium, extrac- tive matters, and, in most cases, a small quantity of urea. From the portion precipitated from the urine (after it has been reduced to a thin syrup) by alcohol of 0°85, and which consists of water-extract, earthy phosphates, uric acid, and mucus, the water-extract may be taken up by water, and determined after evaporation. The earthy phosphates may be taken up by water slightly acidulated with hydrochloric acid, from which they may be precipitated by ammonia: uric acid and a little mucus remain. The uric acid should be determined from a separate quantity of urine, according to the method described in page 137, for by this process we frequently obtain mere traces of it, and sometimes no indication whatever of its presence. The determination of the fixed salts in diabetic urine is of importance. Hunefeld has observed that diabetic urine frequently contains more chloride of sodium than the healthy fluid, a circumstance probably arising from the diet which is most commonly observed during the dis- ease in question. In order to determine the fixed salts, a portion of urine must be evaporated, and the residue incinerated. The perfect incineration of the residue is a matter of some difficulty: it may be facilitated by moistening the carbonaceous residue with nitric acid, and then submitting it to a red heat; or nitric acid may be added to the syrup at once, in which case a very large amount of carbon is burnt off immediately upon the resi- due being submitted toa red heat. The salts must be determined by the method described in page 139. The exact determination of the solid residue of diabetic urme presents certain difficulties. A very small quantity of urine (from about 150 to 230 grains) should be evaporated in the water-bath, and the residue spread over the evaporating basin, which should then be placed under a receiver over sulphuric acid, for the perfect removal of the water. The quantities of sugar, urea, uric acid, &e. must be brought into relation with the amount of solid residue as well as with the whole quantity of urine. Diabetic urine may also contain a tasteless species of sugar, URINE. 197 which, according to Bouchardat,! corresponds exactly in its be- haviour towards yeast, and in its solubility in spirit, with sweet sugar, and may be separated in the same manner. I have had one opportunity of examining diabetic urine, containing a slightly sweet sugar which was soluble in spirit, and also a considerable amount of insipid matter which was precipitated by alcohol, and appeared to resemble gum mixed with water-extract and mucus. I could not separate it from the water-extract, which is usually very scanty in diabetic urine. 9. Carbonate of ammonia. In some diseases, especially in affections of the brain and nervous system, and of the bladder and kidneys, the urine pos- sesses the property of becoming quickly alkaline; indeed I have observed instances in which it was alkaline at the period of its being passed. In these cases it has a very disagreeable, am- moniacal odour, and changes red litmus paper to a bright blue. In colour it may be either light or very dark ; it ordinarily forms, in the course of a short time, a sediment of a grayish- white, and occasionally of a yellow or red colour, consisting of earthy phosphates. A certain test for the presence of car- bonate of ammonia is afforded by holding a glass rod moist- ened in non-fuming hydrochloric acid over the urine; its existence is indicated by the formation of dense white vapours. On the addition of nitric acid to the filtered urine, numerous bubbles of carbonic acid gas are briskly developed. After a little practice the odour will be a sufficient indication of a very minute quantity of carbonate of ammonia. The quan- titative analysis of this substance is seldom undertaken, but without doubt it is of importance, especially for the purpose of ascertaining whether an increase in the quantity of carbonate of ammonia necessarily involves a decrease in the amount of urea. I have satisfied myself that in diseases of the spinal cord, when the urine often contains much carbonate of ammonia, it is formed at the expense of the urea. In four experiments, instituted with this object, I found scarcely a trace of urea in the urine, An approximation to the amount of carbonate of ammonia 1 [Bouchardat now regards this tasteless sugar as a compound of the ordinary diabetic sugar with salts. ] 198 THE SECRETIONS: may be made in the following manner. Dilute hydrochloric acid of known strength must be added guttatim to a weighed quantity of gently warmed urine, till, from being alkaline, the fluid becomes slightly acid. This point being attained, the warmth is continued for some time in order to make sure that the acid reaction is not due to the carbonic acid that has been liberated. The amount of carbonate of ammonia is then esti- mated from the quantity of hydrochloric acid which has been used. 10. Oxalate of lime. Oxalate of lime not unfrequently gives rise to urinary caleuli. A compound resisting a solvent power of the moderate acidity of the urime cannot, of course, occur in it in a state of solution : it has, however, been detected several times in urinary sediments, for whicli reason I refer to it here. Prout and H. Brett’ have observed these sediments. The latter writer states that the urine was very high-coloured, and that the sediment was of a brownish tint. He ascertained its nature by its ready solubility in dilute nitric acid without any indication being afforded of the presence of uric acid, by its becoming white on incineration, by the ash then dissolving in hydrochloric acid with considerable effervescence, and by oxalate of ammonia producing an imme- diate precipitate, while no marked effects followed the addition of ammonia in excess: by these characters the oxalate of lime was thoroughly and satisfactorily made out. I once found ox- alate of lime in the urine of a man with induration of the pancreas and suffering from great acidity of the stomach. The urine was neutral, or all but alkaline, and contained the minute prismatic crystals represented in fig. 36d. They were insoluble in acetic, but dissolved in hydrochloric acid ; and a further in- vestigation left no doubt of their real nature. After some days the urine became remarkably acid, and deposited a sediment devoid of oxalate, but containing carbonate of lime. [I have already mentioned that oxalate of lime is a much more common ingredient of urinary sediments than was formerly supposed. (See Vol. I, p. 85.) In order to detect it, place urine, passed a few hours after a full meal, in a large test- 1 Urinary Diseases and their Treatment. By Robert Willis, m.p. p. 118. URINE. 199 tube, and allow it to stand for some hours. Decant the upper 6-7ths, pour a portion of the remainder into a watch-glass, and gently warm it over a lamp; in a few seconds the heat will have dissolved any urate of ammonia that may be present, and will (by rendering the fluid specifically lighter) induce the deposition of the crystals of oxalate of lime. Having allowed the urine to repose for a minute or two, remove the greater portion of the fluid with a pipette, and replace it by distilled water. A white powder, often of a glistening appearance, will now become visible, and this, under a microscope furnished with a half-inch object-glass, will be found to consist of crystals of oxalate of lime in beautifully-formed transparent octohedra, with sharply-defined edges and angles. (Fig. 36a.) This process is the most satis- factory, and, after a little experience, can be performed in a few minutes. But even this may be avoided by placing a drop of the lowermost stratum of the urine on a plate of glass, placing over it a fragment of thin glass or mica, and then submitting it to the microscope; the crystals diffused through the fluid becoming very beautifully distinct. In this way, however, it is obvious that very much fewer are submitted to examination than by the former process. This salt never (or scarcely ever) subsides to form a distinct deposit; remaining for days diffused through the fluid, even when present in so large a quantity that each drop of the urine, when placed under the microscope, is found loaded. with the crystals. A large quantity of the oxalate, when present, may escape the eye, in consequence of its refractive power ap- proaching that of the urine; for whenever we meet with a specimen in which the salt has partially subsided, and replace the decanted urine by distilled water, the crystals often become readily perceptible to the unaided eye, resembling so many glistening points in the fluid. The crystals of the oxalate, when collected in a watch-glass in the manner above directed, are unaltered by boiling either in acetic acid or solution of potash. In nitric acid they readily dissolve without effervescing, and the act of solution can be observed with the microscope. When the oxalate is allowed to dry on a plate of glass, and then examined, each crystal re- sembles two concentric cubes with their angles and_ sides opposed; the inner transparent and the outer black, so that each resembles a translucent cube set in a black frame. (Fig. 200 THE SECRETIONS : 36 6.) This is best observed under a half-inch object-glass ; as with a higher power this appearance is lost. In a very few cases the oxalate is met with in very remarkable crystals, shaped like dumb-bells, or rather like two kidneys with their concavities opposed, and sometimes so closely approxi- mating as to appear circular, the surfaces being finely striated. (Fig. 36 c.) The greatest possible variation in the size of these crystals is met with not only in different specimens of urine, but often in the very same portion. Ina single drop of urine octohedra of oxalate of lime may be frequently observed mixed with others four or six times their size. Dr. Golding Bird has given the following measurements of some of his preserved Kae - inch. Length of a side of the largest octohedra ; 4 . ah ss smallest ditto ; rs ; 3650 Long diameter of large ‘ dumb-bell”’ crystals F - ses Short diameter of ditto . “whe Long diameter of the smallest “ dumb-bells” ; - ws Short diameter of ditto ; A P ! In the urine of the horse they are much larger, often bemg 1-150th of an inch long. Many specimens of oxalic urine give a precipitate with salts of lime, insoluble in acetic acid, and consisting of oxalate of lime. This is often dependent on the presence of oxalate of ammonia, and delicate acicular crystals of this salt may be occa- sionally noticed, during spontaneous evaporation, on the border of the capsule. Lehmann states that he has very frequently met with oxa- late of lime in healthy urine, and that it often occurs in large quantity in cases of tuberculosis, arthritis, and especially of osteomalacia or softening of the bones. He has likewise met with it in endocarditis and other acute diseases. He states that the crystals are neither octohedra nor cubes, but four-sided double pyramids, which in their projection under the microscope appear as very minute cubes, or as somewhat larger octohedra. He further believes that a portion of the oxa- late of lime is held in solution by lactic acid, and advises that if the urine be very acid, it should be neutralized, boiled, and — allowed to cool slowly, before looking for the crystals. URINE. 201 For further information on this subject I must refer to the © excellent little work by Dr. Golding Bird on ‘ Urinary Deposits,’ from which the above observations are chiefly taken. | 11. Carbonate of lime. [Carbonate of lime is a rare ingredient of urinary deposits. Dr. Griffith’ describes it as consisting “of nuclei which were almost colourless, and studded with minute acicular crystals all over their surfaces.” It is occasionally met with in the alkaline urine common in cases of paraplegia following injury to the spine. In the majority of cases it forms an amorphous deposit mixed with prisms of ammoniaco-magnesian phosphate. More rarely it is met with regularly crystallized, in compound spherical crystals, apparently built up of an infinite number of close-packed needles, radiating from a common centre. The outline of these masses is irregular, and their periphery is often apparently serrated. (Fig. 30*c.) The carbonate of lime is normally present in the urine of many of the graminivora, especially of the horse. The dense deposit which forms in the urine of this animal consists of a mixture of carbonate and oxalate of lime. ‘The former series form large spherical crystals like glass beads, which, when immersed in balsam, present the radiated acicular structure above described. (Fig. 830* ab.) Very beautiful evidence of structure is exhibited in these crystals of carbonate of lime when examined by polarized light; a series of coloured rings traversed by a black cross being visible. | 12. Cystin. [Cystin, when present in the urine, forms a nearly white or pale fawn-coloured pulverulent deposit, resembling the pale variety of urate of ammonia.” It appears to be merely diffused through the urine whilst in the bladder, as at the moment of emission the secretion is always turbid, and very soon deposits a copious sediment. On applying heat to the urine, the deposit undergoes no change, which serves to distinguish it from urate 1 Med. Gaz., March 1844. 2 It is, however, always crystallized, a few regular six-sided lamin being often seen, but the great mass consisting of numerous superposed plates, so that the com- pound crystals thus produced appear multangular, as if sharply crenate at the margin, (fig. 324.) They thus resemble little white rosettes, when viewed by reflected light. 202 THE SECRETIONS : of ammonia; its insolubility in strong acetic acid prevents it from being mistaken for earthy phosphates. The best cha- racter of cystin is its ready solubility in ammonia, mere agita- tion of some of the deposit with liquor ammonie being sufficient to dissolve it, and a few drops of the solution evaporated on a slip of glass leaving six-sided tables of cystin. (See fig. 32 a.) A certain portion of cystin exists in a state of solution in the urine, as the addition of acetic acid always precipitates a small quantity. Urine containing cystin usually develops a peculiar odour resembling that of the sweet-briar, and often exhibits a peculiar greenish tint. (See Urinary Deposits, p. 111.) ] 13. Pus. Pus is not easily detected in the urine, especially when a small quantity is mixed with a much larger amount of mucus. I must refer to what has been already stated in page 100 re- garding the distinctions between pus and mucus; it must at the same time be remembered that the mucus of the bladder differs in its properties from the bronchial mucus, and is less easily distinguished by the naked eye from pus. Urine con- taining pus may have an acid, neutral, or (and that not un- commonly) an alkaline reaction; at least it exhibits m most cases a strong tendency to the development of ammonia, The colour and amount of solid constituents are subject, according to Willis, to great variations, There is only one property of purulent urine that can be considered specific, and that is the invariable presence of albumen; too much stress must not, however, be laid upon this point, since urine is frequently albu- minous without containing a single particle of pus, and we may very easily mistake albuminous urine containg mucus for puru- lent urine. In order to detect the presence of pus with the greatest degree of certainty, the urine should be analysed as soon as it is discharged; it is then turbid, and very soon de- posits a sediment, which, on the least motion of the glass, mixes with the fluid, and is again as quickly deposited. It forms an uniform substratum of a yellow, pale yellow-green, or yellowish- white colour, in which the presence of blood may also some- times be recognized. On examining the sediment with the microscope, we find that it consists of pus-globules (fig. 17), which, by inclining the stage of the microscope, may be readily caused to move; and if the colour should lead us to infer the —~— URINE. . 203 presence of blood, the flattened blood-corpuscles may probably be observed. The pus-globules usually appear rather larger than the pus-globules of the lungs, and less granular; and I have observed that the nucleus can be more frequently recognized with clearness ; the blood-corpuscles also appear tumid. The filtered urime always contains albumen, sometimes in such quantity that flocculi separate on the application of heat. If the urine is allowed to stand for some time, and develops car- bonate of ammonia, the pus becomes so viscid as to form a tena- cious jelly. In these cases small quantities of albumen might escape notice on the application of heat, being held in solution by the carbonate of ammonia ; to assure ourselves of the presence of albumen in these cases, we should make use of nitric acid. In catarrhus vesice, in which a considerable quantity of mucus is frequently discharged, and where the urine is either thick and viscid at the time of emission, or very soon becomes so, a small quantity of pus may be easily overlooked. URINE IN DISEASE. On the general relations of the urine in disease. Although I have, in the preceding pages, made many remarks on the general constitution of the urine in disease, I believe it will not be unacceptable to the practical physician if I offer some additional observations on the variations in the composi- tion of this secretion, when it is pathologically changed. The quantity of water in urine is always fluctuating, and may vary toa great extent ; this poimt has been already referred to in our remarks on the physiology of the ure. The urine may exhibit remarkable differences in its external physical characters in persons suffering from the same disease,—a circumstance that analysis will enable us to trace to the dif- ferent proportions of water that may be present. Frequent recourse to fluids, and the degree of activity of the process of transpiration must obviously have a very great influence on the amount of the watery portion, and therefore on the amount of the urine itself, and this is a point which the physician should never lose sight of in forming his opinion on the quantity of the discharged urine and on its degree of concentration. Itis well known that the morning ‘urine is more concentrated than that which is discharged during the day. 204 THE SECRETIONS: In consequence of the fluctuations, arising from various causes, in the amount of water in healthy urine, Becquerel? has come to the conclusion that its increase or diminution can- not be referred to the action of disease, except less than twenty- seven or more than fifty-two ounces are secreted in twenty-four hours, the average quantity in health being about forty-four ounces in that period. The diseases in which the quantity of water separated by the kidneys is absolutely or relatively increased are diabetes in its different forms, and certain hysterical or nervous disorders in which a perfectly liimpid and thin urime is discharged in large quantity: thus Becquerel relates a case of a young chlorotic girl who ordinarily secreted daily about thirty-seven ounces of water by the kidneys, but in whom the amount rose to ninety ounces upon the accession of a severe hysterical attack. The amount of water separated by the kidneys is diminished in inflammatory affections, in which Becquerel has seen it fall as low as twelve ounces in twenty-four hours. In these cases the urine is of a very dark colour, of a high specific gravity, and possesses a strong acid reaction. Asthe quantity of water increases, the solid constituents relatively, but not always abso- lutely, diminish, as may be found by comparing them with the amount secreted in twenty-four hours in a state of health. The quantity of urea was found by Nysten to be increased in inflammatory affections, and my own analyses of the urine during inflammation, on the whole, tend to confirm his state- ment; for I found it either absolutely or relatively increased, or equal to the quantity separated in a healthy state, or at any rate but slightly diminished. If we remember, however, that in these acute diseases only very small quantities of nitrogenous food are taken, and that the quantity of urea must naturally decrease under such a diet, we may regard it as increased even if it falls below the physiological average. Becquerel also found the amount of urea in acute diseases very little below the phy- siological mean. The quantity of urea is diminished in diseases in which there is either an absolute deficiency of blood, or the blood is poor in corpuscles ; thus Becquerel found the urine in chlorosis defi- cient in urea, and I have observed the same to be the case in the latter stages of typhus. ' Séméiotique des Urines, &c. p. 19. URINE. 205 The relative proportion of uric acid varies much in dif- ferent diseases. We may conclude from the observations which have been made that the amount is increased by disturbances in the circulating system, as in the paroxysms of fever, in in- flammations, &c. The following pathological conditions lead, according to Becquerel, to an increased quantity of uric acid : fever; great general functional disturbances, such as arise from oppressive dyspnoea in pulmonary emphysema or cardiac dis- ease, acute pain, convulsions, delirium, &c. especially when attended with fever; and diseases of the liver, as hepatitis, cancer, or cirrhosis. The amount of uric acid is diminished in those cases in which there is a deficiency of blood, or where the blood is poor in corpuscles. Becquerel found this to occur in cases of chlorosis and anemia, and in persons in whom the vital juices seemed dried up. The amount of the salts in the urime fluctuates extremely during disease. Generally speaking, we may assume that the quantity of salts decreases in most pathological states of the system; the cases in which the salts increase during disease being very rare. Becquerel states that in those diseases in which the amount of urea is only slightly diminished, the proportion of salts is not materially affected; but that in those cases in which the urea suffers a considerable reduction, the same takes place with regard tothe salts. Analyses of inflam- matory urine are, however, opposed to this statement, since in these cases the urea sometimes exceeds the normal amount, while the salts are decreased in an extraordinary manner. It is to be regretted that Becquerel has not undertaken an exact quantitative separation of the different salts, as the increase or decrease of the fixed salts collectively is a circumstance of much less importance than the varying relative proportions of the individual compounds. ON THE CONSTITUTION OF THE URINE IN DIFFERENT DISEASES.! Urine in the Phlogoses. In inflammatory affections, and in those diseases which are accompanied by that form of fever which is termed sthenic 1 Becquerel has attempted to classify every form of morbid urine under one of the 206 THE SECRETIONS : or synochal, the urine differs greatly in its properties from normal urine. In speaking of the probable cause of the changed constitution of the blood in the phlogoses, (see Vol. I, four following heads: 1st, Febrile urine; 2d, Aneemic urine; 3d, Alkaline urine; 4th, Urine differing but slightly from the normal standard. Ist. Febrile urine presents three distinct varieties : a. Febrile urine, in the strict sense of the word, is passed by persons suffering from fever, or with severe functional disorders. This urine is characterized by a con- siderable diminution in the quantity of the water discharged by the kidneys in twenty- four hours, and by aslight diminution in the amount of the solid constituents, the urea and inorganic salts being below the daily healthy avcrage, while the uric acid is in- creased. It is of higher specific gravity than normal urine, its colour is deeper and redder, it is frequently turbid, and often contains a small quantity of albumen. Becquerel gives the following analysis as a type of this form of urine: I place his analysis of healthy urine by its side, in order to render the differences in the two fluids the more striking : True febrile urine. | Healthy urine (Becquerel.) Quantity of urine in twenty-four hours 23 ounces 45 ounces Specific gravity ‘ j 1021°8 10170 Water : ; , 964-0 972-0 Solid constituents . F 36:0 28:0 Urea yp ; - 13°2 12°1 Uric acid 4 15 0°4 Other organic matters 3 14°7 8°6 Fixed salts : ; 71 6°9 The urine is stated to assume the true febrile character in severe functional derangements, in chronic and acute inflammations, in general hyperasthenia, in dis- eases of the liver, the heart, and the lungs; in hemorrhages during their continuance, and in such organic degenerations of the different organs as result pales fever or functional derangement. 8. Febrile urine, accompanied with great debility. In this variety of urine the water is likewise diminished. The specific gravity of the urine and the amount of solid constituents are considerably less than in the former case. With the exception of the uric acid, which remains normal, all the other constituents are absolutely, although not relatively, diminished. The following analysis is given by Becquerel as a type of this variety of urine: Quantity of urine in twenty-four hours é ‘ 21 ounces Specific gravity é g é - 10147 Water : : ‘ ; -, 9740 Solid constituents ‘ ‘ . 26°0 Urea . ; . ‘ ‘ 7°3 Uric acid ; 4 ‘ 0°8 Other organic matters : ‘ . 10°5 Fixed salts ‘ é ° 4:2 This form of urine is less concentrated than the normal secretion, is deeply coloured, and often turbid from the spontaneous deposition of uric acid. It occurs in those cases of fever in which there is great prostration and debility arising either from the URINE. 207 _p. 284,) I showed that it is not to be referred to the diseased organ, but to the reaction which manifests itself through- out the vascular system. If the change in the constitution of disease itself or from very energetic treatment, rg as free venesections or repeated purgations. y- Febrile urine in which the quantity of water is not affected. In this variety the daily amount of water is not less than in health; the urea and fixed salts are diminished ; the uric acid and other organic matters are normal. The composition is illustrated by the following analysis : Quantity of urine in twenty-four hours ° ; 45 ounces Specific gravity . : : - 10105 Water : ; : 2 . 982°8 Solid constituents . ‘ x ; 172 Urea 3 4 \ ‘ ‘ 6°8 Uric acid ; V ; 0°3 Other organic matters 3 A - 7°5 Fixed salts 3 2°6 The specific gravity is low, although the elit is anal deep. It does not deposit any sediment, and even, after the addition of an acid, there is often no precipitation of uric acid. 2dly. Anzmic urine. This form of urine usually occurs in anemia, chlorosis, &c. It is divided by Becquerel into the two following varieties : a. True anemic urine. The amount of water discharged by the kidneys in twenty- four hours is almost normal, while the solid constituents are considerably less than in healthy urine; the urea, uric acid, and fixed salts being much diminished, and the other organic matters decreased in a slighter degree. Its specific gravity is low, it is not deeply coloured, and it deposits no sediment. Its constitution is well represented in the following analysis : Quantity of urine in twenty-four hours ; ; 38 ounces Specific gravity . R : - 1010°3 Water : ‘. ‘ ; - 9828 Solid constituents : : 2 : 17°2 Urea . ‘ : ‘ , 6°51 Uric acid 2 a ; ‘ 0°25 Other organic matters : : . 6°23 Fixed salts ; : \ 4:20 B. Concentrated anemic urine. In this form “ urine the water discharged in twenty-four hours is much diminished, and the amount of solid constituents, although rélatively increased, is absolutely diminished also. The urea, uric acid, and fixed salts are the most diminished ; the other organic matters less so. This urine is of a green or livid tint, and is never red or yellow. 3dly. Alkaline urine. This variety is distinguished by its alkaline reaction on test- paper and by its ammoniacal odour. (When the urine has become alkaline by the use of bicarbonate of soda there is no ammoniacal odour developed.) It has been observed by Becquerel in acute and chronic nephritis, in diseases of the bladder accompanied with purulent secretion, in certain diseases of the brain, and sometimes in Bright’s disease. 4thly. Urine not differing from the normal type occurs in slight non-febrile affec- tions. 208 THE SECRETIONS: the blood bears an accurate and inseparable relation to the fever, there can be no doubt that the change in the constitution of the urine must be in relation to the same cause, for the urine is separated from the blood, and was previously an integral con- stituent of it; and because, further, every alteration in the con- stitution of the blood must mvolve corresponding changes in the secretions and excretions, and more especially in the urine. Since like effects follow lke causes, and since in inflammatory affections the vascular system similarly participates in the dis- turbance, we may assume @ priori that similar changes will occur in the urine,—a point confirmed by experience. The urine discharged during inflammations is usually termed febrile urine. There is no objection to this term, since the cause of the change in the urine must be sought for in the fever: I shall, however, not introduce the term ‘ febrile urine’ here, since it is more than probable that the changes in the composition of the urine vary according as the character of the fever is synochal or torpid. My analyses show, in fact, that the rela- tive proportions of urea in fevers of a torpid and of a synochal character are different; and although the analyses are not yet sufficiently numerous to establish the difference with certainty, it still appears to me to be a point of sufficient importance to demand attention, and one that should be carefully worked out. In order to take a correct view of the composition of the urine, we must bear in mind the composition of the blood, the reaction of the vascular system, and the diet, since the mixture of the proximate constituents is dependent upon these circum- stances. The following are the general characteristics of the urine in inflammatory affections: The urine is darker than usual, and is of a yellow, brown, or reddish-brown tint ; it has an acid reac- tion, and is generally of a high specific gravity. With respect to its most important constituents, the urea is either absolutely increased, or is at the ordinary physiological average, or may be a little below it; the uric acid is always absolutely increased, and so are the extractive matters, especially the alcohol-extract. — The salts are always absolutely diminished, especially the chlo- ride of sodium ; the sulphates, on the other hand, either ap- proximate to the physiological average, or are not far below it. Assuming, as the mean of numerous analyses, that the urea ~ URINE. 209 constitutes 392 of the solid residue of normal urine, I have found it as high as 46°8 in inflammatory affections. (In abdominal typhus, with a quick small pulse, I have seen it as low as 22.) The physiological average of uric acid may be placed at 1°52 of the solid residue ; in the phlogoses I have observed it amount to nearly 3°, and Becquerel even found it rise as high as 5°92. The quantity of extractive matter &c., which in normal urine amounts to 23°59 of the solid residue, rises in inflammations to 43°. The fixed salts, which, in healthy urine, constitute about 25° of the solid residue, diminish here to 12%. The sulphate of potash, which, in healthy urine, forms about 102 of the solid residue, I found to vary in inflammation between 72 and 98. The composition of the urine becomes changed if much blood is abstracted during the progress of the inflammation. It be- comes clearer, specifically lighter, and the amount of urea decreases absolutely and relatively. At the height of the inflammation, or (perhaps it would be better to say) at the time when the fever puts on the synochal type most strongly, the urine is usually clear and deeply coloured; it subsequently forms a sediment of a yellow or red colour, composed of uric acid and urates. Pericarditis. 1 have had an opportunity of examining the urine in peri- carditis. A man aged 36 years entered the hospital with the symptoms of very acute pericarditis; the pulse was 108, very full and hard. The urine obtained for analysis was clear, of a deep fiery-red colour, had an acid reaction, a specific gravity of 1023°5, and, on being heated, gave indications of the presence of albumen. The chemical analysis gave : ; Analysis 98. Water ; . ‘ . ; 937°50 Solid residue . : ; Fie ; 62°50 Urea ; ; ; : : 29°30 Uric acid - ‘ ; : F 1°50 Extractive matters . é - 22°70 Earthy phosphates ; é ‘ ‘ 0°55 Sulphate of potash é . , ‘ 4°89 4 Phosphate of soda a . 0°56 Chloride of sodium and carbonate of soda . ‘ 1°40 A strict antiphlogistic regimen with bloodletting was ordered. The blood taken at the first venesection exhibited, after coagu- II, 14 210 THE SECRETIONS : lation, an inflammatory crust three fourths of an inch thick. At the fourth bleeding, when five pounds of blood had been abstracted, the inflammatory crust was one fourth of an inch thick, and the clot very firm. The urine now discharged (about thirty-six hours after the first bleeding) could hardly be consi- dered darker than in health: it had an acid reaction, was devoid of albumen, and had a specific gravity of 1018. It was composed of the following constituents : Analysis 99. Water ‘ ‘ ‘ ‘ 960°10 Solid residue ; ; ; ; 39°90 Urea = : 5 s 17°50 Uric acid m : : 0-99 Extractive matters 7 é 15°10 Fixed salts . ‘ : 3°65 If we calculate the ratios of these constituents in relation to 100 parts of solid residue, and compare the numbers with the normal average, we shall detect in the first analysis the elements of a true inflammatory urine: the urea considerably exceeds the physiological average, the fixed salts collectively are dimi- nished, while the sulphates are only a little below the normal standard, and the uric acid and extractive matters are increased. We see, at the same time, the effect produced upon the consti- tution of the urine by decided venesection. 100 parts of solid residue : In Analysis 98.. In Analysis 99. In Normal Urine. Urea ‘ ; 46°8 43°8 39°0 Uric acid . : ; 2°4 2°5 15 Extractive matters . , 36°2 37°8 23°5 Fixed salts ‘ 4 12°0. 89 - 25°8 Sulphate of potash. . 78 10°3 [Zimmermann' found fibrin in the urine of a patient with “endocarditis of the right ventricle at the period of the com- mencement of hypertrophy.” The urine was very variable in its characters, sometimes normal, sometimes sedimentary, and sometimes coagulable. In the latter case it was pale, and ic | became alkaline. ] Phlebitis uterina. I have had several opportunities of examining the urine in phlebitis uterma. In one instance occurring in our hospital I found it of a dark colour, an acid reaction, and depositing a ' Zur Analysis und Synthesis der pseudoplastischen Prozesse, p. 129. URINE. — 211 slight sediment of urate of ammonia and uric acid. In another case (that of a woman aged 380), I likewise found it dark- coloured, but it had a slightly alkaline reaction with a disa- greeable ammoniacal odour. It deposited a dirty yellow sedi- ment, which appeared to the naked eye to be purulent, but which was shown by the microscope to consist of an immense number of mucus-granules, of a few crystals of ammoniaco- magnesian phosphate, and of an amorphous precipitate of phos- phate of lime and urate of ammonia. The clear urine developed some carbonic acid on the addition of nitric acid, and became turbid, from which the presence of albumen was inferred. Meningitis. In the acute form of meningitis the urine assumes the in- flammatory type. Schodnlein describes it as being of a dark-red colour, very like brown beer. The secretion is usually scanty, (frequently only from eight to nine ounces in twenty-four hours,) it has a strong acid reaction, and the specific gravity and con- sequently the amount of solid residue is high. In four cases of meningitis observed by Becquerel, the mean specific gravity was 10252; sediments of uric acid sometimes occurred sponta- neously, and were sometimes induced by the addition of nitric acid. In two of the cases he observed albumen. Schonlein observes that at the crisis towards recovery the urine is secreted more abundantly, and sometimes deposits purulent sediments. Encephalitis. The urine in encephalitis appears to be much the same as in meningitis. It sometimes deposits a sediment, and contains a small quantity of albumen. Becquerel found the specific gra- vity to be 1020°2. [Considerable attention has recently been paid to the urine in the different forms of insanity. The most characteristic fea- ture seems to be the excess of ammonia excreted as carbonate, urate, hydrochlorate, or ammoniaco-magnesian phosphate. The reader may consult Erlenmeyer,’ Heinrich,? and Sutherland and Rigby,? on this subject. ] ! Observationes physiolog.-patholog. in morotrophio Sigburgensi institut. de urina maniacorum. 2 Ueber die Wichtigkeit mikroskopischer und chemischer Untersuchungen fiir die Psychiatrik, mit besondrer Riicksicht auf Harnsemiotik. (Hiaser’s Archiv, vol. 7, 2.) 3 Med. Gaz., June 1845. 212 THE SECRETIONS : Delirium tremens. In delirium tremens the urine has more or less of the inflam- matory type ; sometimes, however, it resembles normal urine in its colour and reaction. In a man aged 40, who had a very severe attack, Becquerel found the urine acid for the first five days, with a mean specific gravity of 1017-2. It deposited a sediment either spontaneously or on the addition of nitric acid. In another man aged 40, who was also in the third stage of phthisis, and died three days afterwards, the urine possessed the characters of inflammation ; it had a specific gravity of 1021°8, and deposited a sediment. Myelitis. In inflammation of the spinal cord the urine in many cases is much the same as in inflammation of the brain; it is red, acid, and sometimes thick and sedimentary. Becquerel, how- ever, has observed cases of affections of the spinal cord in which the urine was not much removed from the normal type. In two persons aged 32 and 50 years respectively, who were suf- fering from a slight degree of paralysis of the lower extremities, the urine did not differ materially from the healthy secretion, although it varied on different days; it had an acid reaction, and contained a little more mucus than healthy urime. In inflammatory affections of the brain, and still more in those of the spinal cord, especially in chronic cases, the kidneys and bladder sympathise in a high degree; the latter is some- times paralysed. The character of the urine then changes ina very peculiar manner ; it loses its acid reaction, and its colour becomes clearer; at the period of its excretion it is either slightly acid or neutral, and in a very short time it becomes alkaline, in consequence of the formation of carbonate of ammonia. When first discharged, the urine is clear, generally of a bright yellow colour, and possesses rather an unpleasant odour. If allowed to stand, a glistening pellicle often forms very quickly on the surface, consisting partly of crystals of ammoniaco-mag- nesian phosphate, and partly of amorphous phosphate of lime, as may be seen by the microscope. The presence of ammonia may also be recognized at once by the odour, and by test-paper. After a time, the urine becomes turbid, and deposits a sediment ~ URINE. 213 of earthy phosphates and mucus, which sometimes assumes a purulent appearance, and becomes tough and viscid in proportion to the quantity of mucus which is present. The odour is then strongly ammoniacal, and often stinking and putrescent; and on the addition of hydrochloric acid to the urine, a well-marked effervescence is produced by the liberation of carbonic acid. Cases have however been observed in which the urine was am- moniacal at the period of its emission from the bladder. A man aged about 40 years was brought into our hospital with a severe cerebral affection ; he soon sank into a,state of deep coma, and the urine was emitted involuntarily. On collecting the urine in a bottle, it had an unpleasant ammoniacal odour, an alkaline reaction, and soon deposited a sediment of mucus and earthy phosphates. Upon the addition of nitric acid after filtration, brisk effervescence took place, and the urine became turbid, in consequence of the presence of a slight quantity of albumen. Becquerel observed much the same in,four cases of chronic affection of the spinal cord, in which the functions of the bladder were impaired. The urine was discharged involuntarily, was of a dirty-yellow pale colour, of the ordinary specific gravity, and soon became alkaline; in those cases in which the urine was clearer, the specific gravity was lighter. The urine always contained a considerable quantity of mucus, muco-pus, or true pus, some albumen, ammoniaco-magnesian phosphate, phosphate of lime, and carbonate of lime. In a former part of this work, attention has been directed to a peculiar arrangement which the elements of urea assume, when an aqueous solution of that substance is allowed to stand for a considerable period, or when it is treated with strong acids or alkalies. 1 atom of urea takes up 2 atoms of water, and becomes carbonate of ammonia, for 1 Atom of Urea . ‘ H,N,:.. C0, 0, + 2 Atoms of Water ‘ . H, 0, 2 Atoms of Carb. Ammon. i H, N, + C, O, = 2 (NH,, CO,) We have sufficient reason to justify the assumption that an arrangement of the elements of urea which occurs in pure water will also occur under certain circumstances in the kidneys or in the bladder, if the nervous activity, which has a very marked effect on the composition of the animal fluids, is changed, and if the urine contains mucus or muco-pus, which facilitate the 214 THE SECRETIONS: new arrangement of the atoms in the same manner as yeast resolves sugar into alcohol and carbonic acid. Inflammatory affections of the brain and spinal cord are not the only diseases in which carbonate of ammonia is formed in the urine: I shall subsequently show that alkaline urine is fre- quently observed in diseases of the kidneys and the bladder, and in nervous fevers. In inflammation of the respiratory organs the urine generally exhibits the inflammatory type in a high degree, varying, how- ever, with the development, extent, and intensity of the dis- ease. Bronchitis. In bronchitis, if the attack is severe, and accompanied with much.synochal fever, the urine is scanty, of a dark-red colour, strongly acid, and of a high specific gravity. Becquerel observed an appreciable amount of albumen in the urine in such cases. The urime deposited a sediment, and had a mean specific gravity of 1025°2. During convalescence, the urine either returns to the normal state, or assumes the anzemie type (of Becquerel), i. e., it is pale, of low specific gravity, and deficient in solid constituents, especially in urea. In milder forms of acute bronchitis Becquerel found the urime highly co- loured, sometimes sedimentary, and of a mean specific gravity of 1024°3. In the mildest forms, the urine scarcely deviates from the normal state. Pneumonia. In pneumonia the urine is subject to considerable variations dependent upon the extent of the disease, and the degree of in- flammation. In severe inflammations, the urine is very dark, of high specific gravity, and frequently sedimentary, especially at critical periods and during the fever; Becquerel, however, once found that the urine deposited a sediment on the day when the fever ceased. An appreciable amount of albumen is by no means rare, ‘The urine remains acid during the whole period of inflammation, and Becquerel found the same to be the case during the period of convalescence also. The mucus is URINE. 215 increased during the febrile period, and this is observable in a more marked degree in women than in men. : Andral' has communicated some observations regarding the urinary sediments in pneumonia. Out of thirty-three cases, in twelve the urine remained perfectly clear throughout the whole course of the disease, and was not rendered turbid either by nitric acid or by heat; of these cases in six even the colour was not affected, and two sank under the disease. In nine of the thirty-three cases the urine was alternately clear and turbid or sedimentary. The sediments were for the most part spontaneous, and composed of amorphous uric acid. In one of these nine cases the urine contained albumen. The sedi- ments occurred, as might be expected, in the different cases, at different periods and under different modifications. In one the urine was clear and of a reddish brown colour till the tenth day, and then formed for the first and only time a grayish white precipitate. In another case, the urine, which was of a brown- red colour, did not become turbid till the ninth day, when, as well as on the two following days, it formed a brick-red sedi- ment. It then became clear, and remained so. In a third case, the urine, which was deep-coloured, deposited a grayish-red sediment on the seventh day, and then became clear and amber- coloured. In the other twelve cases that remain from tlhe thirty-three, the urine was always turbid or sedimentary, either spontaneously or on the addition of a few drops of nitric acid, from the period of admission to the termination of the disease. Three of these twelve cases terminated fatally, and in these the urine remained turbid to the last. In the nine other cases the urine returned to its transparent state at the cessation of the disease. Becquerel has arrived at the following results respecting the constitution of the ure in pneumonia. In a case of acute pneumonia at the period of the crisis, the. quantity of urine passed in twenty-four hours was 26 ounces, its specific gravity 1015-1, and its amount of solid residue 24°9 © in 1000. The patient was depressed, his pulse 96, and the urine, as well as the skin, had a bilious tinge. In a second case, in which there was intense fever, and the pulse was 120, 22 ounces of dark red urine of specific gravity ' Becquerel, Le Séméiotique des Urines, p. 332. 216 THE SECRETIONS : 1021°8 were passed in twenty-four hours: there were 86 parts of solid residue in 1000 of urine. In a third case in which the patient had been much depressed by venesection and large doses of tartarized antimony, and where the pulse was 104, there were 30 ounces of dark-yellow, turbid, acid urine, of specific gravity 1015-9, and containing 26°3 of solid residue in 1000 parts, emitted in twenty-four hours. Becquerel has made one complete analysis of the urine m a case of pneumonia in which the pulse was 100. He found The quantity of urine in twenty-four hours : : 36 ounces Specific gravity : ‘ ‘ é - 1011-7 Water . ‘ ; ; eM . 980-6 Solid residue ; " ; ‘ ; 19°4 Urea . . a ‘ , ‘ 73 Uric acid : ; : ; : 0-4 Fixed salts ‘ d ‘ . y 2°7 Extractive matters . eas : . 8°8 I have made two analyses of urine passed in pneumonia. Analysis 100 represents the urine of a man aged 35 years; it was of a fiery-red colour, clear, and strongly acid; the pulse was full, 108 in the minute. Analysis 101 represents the urine of a man aged 40 years; it was of a dark yellow colour, had an acid reaction, and con- tained a considerable quantity of mucus. In both cases there was a good deal of albumen. Analysis 100. Analysis 10}, Specific gravity : ‘ ‘ 1017-0 1020-0 Water ; ‘ . ‘ 959-60 947-90 Solid residue 3 z é 40°40 52°10 Urea A ; ; 15°79 19°35 Uric acid . 0°71 1°50 Alcohol-extract with lnctic acid and ammonia-salts 9°34 9°65 Spirit-extract _ ‘ ; ‘ 110 3°18 Water-extract , > Fe 5°64. =: 6°40 Albumen. A ; ‘ 1°47 0°50 Earthy phosphates P : : 0°42 0°56 Sulphate of potash. 3°70 Phosphate of soda, chloride of sodium and carbo- 3.98 loos 6°74 nate ofsoda . : If we calculate the amount of the more important consti- tuents in relation to 100 parts of solid residue in these three analyses, we shall find that they exhibit very close approxi- mations to each other, and on contrasting them with the nor- mal standard, it will appear that the urea is a little diminished, URINE. 217 that the uric acid is increased, that the salts are diminished, and that the extractive matters, especially the aleohol-extract are increased in the urine of pneumonia. 100 parts of solid residue of 100 parts of solid residue of pneumonic urine contain : normal urine contain : Becquerel. Simon. Caen. Urea. ‘ 37°6 39:0 37:2 39:0 Uric acid : 2°0 1:7, 28 1:5 Fixed salts ; 14:0 18:3 14:0 25°8 Extractive matters 45°4 40:0 37:0 23°5 Sulphate of potash 9-0 10°3 According to Schoénlein, the crisis in pneumonia shows itself in the urine by the secretion.becoming turbid and sedimentary ; after ten or twelve hours a crystalline micaceous deposit-forms, — above which the urine becomes clear. The following instance is strongly confirmatory of Schénlein’s opinion. In a case of pneumonia that recently occurred in his own wards, the urine, during the height of the inflammatory stage, was dark, very acid, and deposited no sediment; at the period of resolution it became paler and neutral; one morning I found it yellow, neutral, and with a sedimeut of white crystals visible even to the naked eye. The microscope at once revealed the beautiful shapes assumed by the ammoniaco-magnesian phosphate. I was much struck with the singular relations of the urine itself. It was perfectly neutral; and any acid, even dilute acetic, threw down a white precipitate, which led to the supposition that a caseous matter was present; I soon, however, found that this was not the case, for on treating a portion with . hydrochloric acid and allowing it to stand for some time, very beautiful, nearly colourless crystals of uric acid were deposited. Alcohol threw down a tolerably copious white precipitate, which was collected on a filter and washed with more alcohol. A portion of this precipitate was taken up by warm water, and left as a residue after evaporation ; it was entirely consumed when heated on platinum foil ; rubbed with caustic potash, it developed ammonia ; warmed with nitric acid, it gave indications of the presence of a large amount of uric acid. The portion insoluble in warm water was readily soluble in hydrochloric acid, from which it could be again precipitated by ammonia, and on examining this precipitate under the microscope, I found that 218 THE SECRETIONS: it was composed of ammoniaco-magnesian phosphate. Hence it follows that the white precipitate which I at first mistook for casein, consisted of uric acid combined with ammonia, which existed dissolved in the urine to an unprecedented amount. Heller’ has recorded a singular case in which the urine emitted an odour of hydrosulphate of ammonia, and deposited a sedi- ment of urate of soda, during this disease. The patient was a boy aged 14 years, with pneumonia of the right lung. The peculiar odour of the urine was first observed on the tenth day of the disease. The secretion on that day was copious, of a light-yellow colour, very turbid, and deposited an abundant clay-colour sediment. This sediment when ex- amined under the microscope was ‘found to consist of clear and beautifully defined large globules studded with numerous spines, mixed with smaller star-like objects of the same form. (See fig. 29 a.) There were also a few epithelium-scales and mucus- corpuscles. The urine had a strongly alkaline reaction: its specific gravity was 1018. Heller noticed the following reactions : 1. Acetate of lead produced at once a very dark brown colour, and, finally, a~blackish-brown precipitate of sulphuret of lead. 2. Perchloride of iron (which seems to be the best test for sulphuretted hydrogen in urine, since pure sulphuret of iron is thrown down, while the precipitate, caused by the former test, contains the chloride, &c.) rendered the secretion almost black. 3. Nitrate of silver showed that the chlorides were in great €XCess. 4. Nitrate of baryta indicated an abundance of sulphates. 5. Ammonia showed that the earthy phosphates were normal, 6. Nitric acid and heat indicated the existence of traces of albumen. The urine contained in 1000 parts: Water and hydrosulphate of ammonia ‘ ; ; 951-98 Solid constituents. : : 7 é 48°02 Urea. i . , ; é 12°21 Free uric acid : ‘ : 7 no trace Albumen A . ; traces Urate of soda (in the sediment) : 1:80 Extractive matters, with a large amount of hydrochlorate and carbonate of ammonia . ; ; é 27°40 Fixed salts 4 ‘. : F j 6°61 ' Archiv fiir physiolog. und patholog. Chemie, vol. 1, 24. URINE. 219 As the fixed salts contained a mere trace of chloride of so- dium, and nitrate of silver added to the urine showed that the chlorides were in excess, it is clear that nearly all the chlorine must be referred to the hydrochlorate of ammonia. That the sediment consisted of urate of soda was proved chemically as well as microscopically. The uric acid was determined by the ordinary test; and the soda by incinerating a portion in a platinum spoon, dissolving the white residue in dilute sulphuric acid, evaporating, and obtaining crystals of sulphate of soda. On the following day, (the eleventh,) the odour remained nearly unchanged, but acetate of lead and perchloride of iron showed that the amount of hydrochlorate of ammonia was diminished. There was a small flocculent sediment composed of urate of ammonia, mucus, and fragments of epithelium, but entirely free from urate of soda. The urine now contained a normal amount of uric acid, and about as much albumen as on the preceding day. On the twelfth day the peculiar odour was very faint, and on the thirteenth it altogether vanished. The urine was still alkaline, but gradually resumed its normal characters. There was nothing in the treatment to account for the pro- duction of the sulphuretted hydrogen, and it can hardly be ascribed to the decomposition of the small quantity of albumen in the urine. Zimmermann once detected fibrin in the urine ofa patient with pneumonia on the third day. The secretion was of a fiery red colour, but deposited no sediment. | Pleuritis. In pleuritis the urine comports itself much the same way as in pneumonia. It exhibits, especially at the height of the in- flammation, all the signs of inflammatory urine, and sometimes contains albumen. In order to form a correct opinion regarding the urine in this disease, it is of especial importance to pay attention to the various circumstances that may modify the nature of the secre- tion, as for instance whether the disease is simple or compli- cated, acute or chronic, whether there is much or little fever, to what extent the inflammation has proceeded, and whether there is any effusion. Becquerel observed several instances of 220 THE SECRETIONS: pleuritis associated with pulmonary phthisis, and in fifteen out of seventeen cases observed by him, there was considerable effusion. In a man aged 36 years, with acute pleuritis, deli- rium, and certain typhoid symptoms, and whose pulse was 112 in the minute, the urine was of an orange-red colour, and on the addition of a drop of nitric acid, deposited a sediment of uric acid ; it also contained a little albumen. The quantity of urine in twenty-four hours was 17 ounces, the specific gravity 1021, and in 1000 parts there were thirty-four of solid residue. In a man aged 23 years, who had sub-acute pleuritis, whose skin was slightly jaundiced, in whom there was slight anasarca of the lower extremities, (it being a case in which peritonitis was also suspected,) and who was much weakened by the free application of leeches, the urine was of a deep orange-colour and clear ; on the addition of nitric acid it deposited an abundant sediment. In the course of twenty-four hours there were 26 ounces of urine passed, of specific gravity 1014°2. 1000 parts of urine contained : Water : é . i 976°5 Solid residue . ; : ‘ 23°5 Urea E é ieee | Uric acid ‘ “ : j 0-6 Fixed salts . ; ‘ , 6°4 Organic matters é ; ‘ 10:2 Becquerel attributes the small amount of urea in this case to the debilitated state of the patient. He found the mean specific gravity of the urine in seventeen cases of pleuritis to be 1021-8; in those cases im which there was a spontaneous sediment, it was 1024°8; and in those in which a sediment was produced by the addition of nitric acid, it was 1022°7. _ Albumen was present in three out of the seventeen cases. The amount of mucus was frequently increased, espe- cially in the urine of women, but pus could never be detected. Urine, which before the crisis is‘ of a reddish colour, at that period deposits copious sediments. {Zimmermann observed fibrin in the urine of a patient with pleuritis, from the third to the fifth day. The urine was of a dark yellow colour, and very frothy. | Pleuropneumonia. ‘IT have had an opportunity of observing a case in which urine of a very peculiar nature was emitted during pleuropneumonia. =~ URINE. 221 The urine of a man of about 30 years of age, who was re- covering from an attack of pleuropneumonia, and whose renal secretion had always previously been rather dark-coloured, be- came lighter and neutral. It was found one morning of a citron colour, and had deposited a white crystalline sediment, which, when observed under the microscope, was found to consist of beautifully-formed crystals of ammoniaco-magnesian phosphate, recognizable even by the naked eye, perfectly free from any mixture with phosphate of lime, urates, or mucus. The urine, which was filtered off, had a slight alkaline reaction, but did not become turbid on heating: the addition, however, of any acid, even acetic, produced a copious white turbidity, which did not disappear on the addition of an excess of the acid, but slowly vanished on the application of heat. In the acid urime thus cleared by heat ferrocyanide of potassium produced no effect. On evaporating the urine a sediment was deposited, and on mixing the residue with alcohol, a large quantity of a white substance was precipitated, which did not dissolve in water, and consisted of phosphate of magnesia, urate of ammonia, and a little extractive matter. Since the precipitate induced by the addition of acids to the urine gradually crystallized, and ex- hibited all the properties of uric acid, it is clear that the turbidity and precipitate had been caused by the decomposition of an urate which must have been present in a state of solution, to a very large amount. The urine had a specific gravity of 1022. 1000 parts were composed of : In 100 parts of Analysis 102. of solid residue. Water. ‘ é ‘ 951°10 Solid constituents . 4 48°90 Urea P , . 20°80 42°0 Uric acid! ‘ : : 1°48 30 Extractive matters : 13°50 Ammoniaco-magnesian phosphate and 10-20 other fixed salts On the following day the alt et of the urine were en- tirely changed. The colour certainly was the same, but it no longer had an alkaline reaction, nor did it form a crystalline sediment, nor was any turbidity induced by the addition of an acid. Free ammonia alone produced a slight cloudiness. In a case of peripneumonia that recently occurred in Schonlein’s 1 The uric acid existed in the urine as urate of ammonia. 229 THE SECRETIONS : wards, the urine at the period of resolution exhibited precisely the same characters as in the above case, and as in the case of pneumonia noticed in page 217. There was a beautiful crys- talline sediment of ammoniaco-magnesian phosphate, and any acid threw down a copious precipitate. Cases such as these suggest two important questions, one of which may be readily answered by a series of careful observa- tions: viz. whether these peculiar phenomena in the urine are connected with the process of resolution after inflammation of the respiratory organs ?—and if so, what is the nature of the connexion ? The solution of the former question would afford material service in the prognosis of these affections. The phenomena persisted for three or four days, and in both cases recovery took place. There was a man in Schonlein’s wards with very extensive and intense peripneumonia, whose urine presented all the ap- pearances of a saccharine fluid in which fermentation had been induced by yeast. It had a yellowish, turbid appearance, and its surface was covered by a thick layer of foam, in which nu- merous air-bubbles were developing themselves. Gas was like- wise developed in the fluid itself, and in the amorphous yellow sediment that had been spontaneonsly deposited. The frothy covering and the sediment were composed of an amorphous matter, numerous crystals of ammoniaco-magnesian phosphate, and mucus-corpuscles. On treating the sediment with a free acid, the crystals and a portion of the amorphous matter (con- sisting of phosphate of lime) were dissolved: the remainder was insoluble, and resembled coagulated albumen in its behaviour towards reagents. The urine contained no trace of sugar, but a considerable amount of carbonate of ammonia. On evaporating some of the filtered urine to which hydro- chloric acid had been added, there remained a large quantity of hydrochlorate of ammonia. Very little urea was present, the greater part having been converted into carbonate of ammonia through the influence of the proteim-compound. Vesical mucus exerts a similar action, and consequently in catarrh of the bladder the urine rapidly gives off a very disagreeable odour, and the amount of urea diminishes in proportion as the car- bonate of ammonia increases. URINE. 223 Martin Solon! states, that in twenty-four cases of pleuropneu- monia, he found albumen in twenty-two; it was especially observed at the period of the crisis. Empyema. It was known to the ancient physicians that effusions of pus into the thoracic cavity are, under certain circumstances and peculiar treatment, carried away by the kidneys. Schonlein has observed several such instances, and I have had several opportunities, in the clinical wards of our hospital, of seeing cases of pleuritis with empyema, in which, after a proper course of treatment, turbid urine was discharged for some days. This urine contained albumen, and deposited a sediment, which, under the microscope and in its general physical relations resembled pus, or (in one case,) mucus mixed with pus. The urine, which after some time became clear above the sediment, was of a dark colour, only slightly acid, and soon became alkaline. The symptoms of empyema gradually dis- appeared, in proportion as the urine continued to form purulent sediments. Emphysema. Becquerel has examined the urine in eight cases of pulmo- nary emphysema. When the emphysema produces violent dyspnea, frequent cough and much general disturbance, the urine assumes the inflammatory type. Becquerel made one analysis of urine of this nature; it was of a dark brown colour, had an acid reaction, but deposited no sediment. Its specific gravity was 1016°8. It consisted of— In 100 parts of solid residue. Water ; 3 j 972°3 Solid residue : : 27°7 Urea : ; ; 13°0 47°0 Uric acid . 5 , 0°4 1°4 Fixed salts : al 4°3 15°5 Organic matters : : 10°0 36°71 ' Urinary Diseases and their Treatment. By Robert Willis, m.p. p. 157. 224 THE SECRETIONS: In a man aged 60 years, who had emphysema with bronchitis, the urine deposited a sediment, and had the high specific gravity of 1025-6. After he had taken purgatives for seven con- secutive days, the urine became very aqueous and the specific gravity was only 1009:2. In two other cases in which emphy- sema was combined with cough and dyspneea, the specific gravity was 1025°2 and 10222. Angina tonsillaris. In angina tonsillaris, when associated with synochal fever, the urie presents the inflammatory type. Becquerel ob- served a case in which the urine possessed the characteristics of inflammation in a high degree. It was red, and had the high specific gravity of 1029°7. In another case, which was combined with violent fever, the urine was dark-coloured, and had a specific gravity of 1023-9. In neither of these instances was there any sediment; but in the second case, on the seventeenth day, an abscess which had formed in one of the tonsils opened into the mouth, and on that day alone there was a spontaneous sediment of uric acid, and the specific gravity rose to 1025-2. In three other cases, in which the fever was not so high, the specific gravity remained lower. Gastritis, Becquerel has made some observations on the urine during gastritis, especially the chronic form. Of three cases, two got worse, and merged into the acute form. The other case was unaccompanied by fever, and the urine did not appear to differ materially from the normal type. Of the two cases, one was that of a woman who was free from fever at the period of her admission into the hospital. The urine was pale and the specific gravity low. Continued fever subsequently came on, and assumed a typhoid character. The urine immediately became denser, darker in colour, and turbid (urina jumentosa). After some time the patient returned to her former state, and the urine again became clear. In the third case, that of a man aged 35 years, chronic gastritis sud- denly merged into the subacute form; he had frequent bilious URINE. 225 vomiting and fever. The urine retained the inflammatory type until the condition of the patient improved. In a case of very acute gastritis with green watery vomiting, I found the urine scanty, of an extremely dark-red colour, acid, and forming a dull yellow sediment of urate of ammonia and uric acid: in fact, exhibiting all the characteristics of the urine of inflammation. Enteritis and Dysentery. In a severe case of enteritis, with obstinate constipation, violent pain on pressure, green acid vomitings, and wiry pulse, only a small quantity of urine was excreted. It was of a fiery- red colour, acid, and, after some time, threw down a copious reddish sediment of urie acid and urate of ammonia. Becquerel has observed the urine in enteritis and dysentery: when the diarrhea is only trifling, and unaccompanied by fever, there is hardly any deviation in the urine from the normal state. If, however, severe diarrhoea and fever are present, the urine may assume the inflammatory type. In a case of simple en- teritis with diarrhoea the urine was at first very turbid, of specific gravity 1023-1, and deposited a sediment of uric acid: it was afterwards normal, and finally became anemic, the specific gra- vity fallimg to 1010-0. In another case it was invariably high-coloured and very concentrated, its specific gravity being 1024°3 ; in this instance there was a daily sediment. In eight cases of mild enteritis and diarrhoea, Becquerel only on one occasion detected a small quantity of albumen. In two cases of a more chronic form of diarrhcea in persons who had long suffered from disease and from insufficient food, the _ urine was very light-coloured, and of low specific gravity, 1011°7. According to Schdnlein, in purely inflammatory diarrhea, the urine is of a fiery-red colour, causes scalding in the urethra, and forms, at the crisis, a crystalline sediment of uric acid. In catarrhal diarrhoea, the urine is rather dark, and becomes more so in the evening: at the crisis, a mucous sediment is deposited. In bilious dysentery the urine is of a dark-red colour, tending to a brown; during the crisis it yields a fawn-coloured precipitate. Finally, in typhous dysentery, the urine is dark, turbid, and fetid. During the crisis it forms no precipitate, but becomes clear and loses its smell. II, 15 226 THE SECRETIONS: Hepatitis. Very different opinions have been expressed regarding the constitution of the urine in hepatitis. Rose! asserts that, in several cases of acute and chronic - hepatitis, he found the urea entirely absent. In the acute forms the urine was dark, in the chronic it was clear. It possessed no urinous smell, and the specific gravity was lower than that of healthy urine. Henry? found the urine, in a case of chronic in- flammation of the liver, to be devoid of smell and colour, and of a specific gravity of only 1003. The extract obtained by evapo- ration gave no indications of urea on the addition of nitric acid. Rose puts the question, which can only be answered by farther analysis, whether the deficiency of urea arises from the actual in- flammation of the liver, or from the dyspepsia that accompanies it. According to Coindet,? the urine, in inflammation of the liver, instead of urea, contains a substance resembling bilin. The analyses made by Becquerel and myself of the urine in hepatitis do not correspond with these statements. I analysed the urine of a man aged 36 years, who was suffering from acute hepatitis. The urine was scanty, had an acid reaction, was of a dark reddish-brown colour, and deposited a copious red sediment of urate of ammonia and uric acid. On the addition of nitric acid the brown colour of the urine changed into a decided green. It likewise became turbid on the application of heat, so that it contained both biliphzin and a little albumen. A quantitative analysis gave : Analysis 103. Water ‘ ‘ ‘ , : 939-70 Solid constituents ‘ ; P e 60°30 Urea 3 : ; ; ; 22°50 Uric acid. ‘ i . ‘ 1:70 Alcohol-extract : : . 9°70 Water- and spirit-extracts and albumen ‘ 6°30 Earthy phosphates ‘ : ‘ : 0°84 Sulphate of potash ; ; . ; 5°30 Phosphate of soda : : : 3°13 ; Chloride of sodium and carbonate of soda. ; 9°50 The urate of ammonia was not estimated in that form, but ; was reduced to uric acid by the addition of hydrochloric acid, ' Thomson’s Annals of Philosophy, vol. 5, p. 423. 2 Ib. vol. 6, p. 392. 3 Stark’s Allg. Pathologie, p. 1152, URINE. gay and weighed as such. The carbonate of soda associated with the chloride of sodium, arose from the reduction of the lactates. Becquerel analysed the urine of a man (A) aged 33 years, who was attacked with icterus accompanied with fever and diar- rhea, after being in a violent rage. He was soon reduced to a state of great debility. The urine was very bilious, depo- sited a yellow sediment of uric acid, and had a specific gravity of 1013-0. The urine of a woman (B) who had a chronic affection of the heart, and was attacked with acute hepatitis without very well-marked icterus, was of a deep yellow colour, but not tinged by bile. It deposited a spontaneous sediment, and had a specific gravity of 1018-9. The composition of the urine in these two cases was as follows: A. B. Water . a ‘ 978°50 968°90 Solid constituents . ; 21°50 31°10 Urea ‘ P : 6°15 13°10 Uric acid ; j 1°14 - 1:57 Fixed salts ¢ F 5°15 4°31 Organic matters . ‘ 8°01 11°88 Ix, we calculate the relative proportions of the various con- stituents in relation to one hundred parts of solid residue in these analyses, and compare them with the corresponding numbers in healthy urine, we find the proportions much the same as we have already found in pneumonia, except that in Beequerel’s first case in which there was great debility accompanied with typhoid. symptoms, the urea is very much diminished, whilst, in his second case, it is very much increased ; in my case the salts were present to a large amount. 100 parts of the solid residue of 100 parts of the solid residue the urine in hepatitis contained of healthy urine contained. Becquerel. Simon. 1, 2. Urea é 29°6.. 42:2 37°5 39°0 Uric acid ' 5:4 5°6 2°8 sig Fixed salts . 24:0 13°9 31°3 25°38 Extractive matters, &c. 41:1 38:2 26°6 23°5 Sulphates : 9°0 10°3 Pao - Schénlein states that the urine in hepatitis is of a dark-red colour, approaching a brown, that it usually contains biliphein, and that at the crisis a rose-coloured precipitate is formed. 228 THE SECRETIONS: [Herzog' has recorded the case of a woman aged 44 years, in whom the principal symptoms were pain in the left lobe of the liver, and vomiting. The urine was of a saffron colour, but contained none of the ingredients of the bile. Its specific gra- vity was 1035-7, and 1000 parts yielded 68-84 of solid residue, 55°15° of which were urea. | Peritonitis. I have had one opportunity of analysing the urine in peri- tonitis puerperalis. It was passed by a woman aged 29 years, was of an acid reaction, and somewhat turbid, but not particu- larly dark: when examined with the microscope it was found to contain mucus-corpuscles, membranous shreds and other fragments, which could only be taken for epithelium composed of many regularly-formed, large, and elongated cells. On the application of heat the presence of a small quantity of albumen — was detected. The specific gravity was 1020-0. The urine was composed of— Analysis 104. Water : “ ‘ 2 951°80 Solid constituents . ¥ ; 48°20 Urea ; z j : 20°10 Uric acid é ; + : 0°83 Extractive matters ;, é é 16°36 Fixed salts * : c : 9°20 By calculating the various constituents in relation to 100 parts of solid residue, we at once see that this urine is of a decidedly inflammatory type. We obtain: Urea 5 ‘ ‘ ‘ 42-7 Uric acid ‘ ; ‘ ; 1°7 Fixed salts : $ ; 19°1 Extractive matters : ‘ 36°71 The urea even exceeds the physiological average, the salts are diminished, and the extractive matters increased. [Scherer? analysed the urine in three cases of febris puer- peralis. The urine was usually of a fiery-red colour, sometimes neutral, and often alkaline (or at least it rapidly became so ;) it deposited a mixed sediment of pus, mucus, and urate of ammonia. 1 Buchner’s Repert. 1844. * Untersuchungen, &c. p. 72. URINE. 229 Two analyses gave the following results : ‘i 2. Water . : a 956°63 960°24 ‘Solid residue P 5 46°37 39°76 Urea . ' i‘ 10°00 12°42 Urate of ammonia 5 2°04 0°84 Alcohol-extract . : 12°54 9°34 Water-extract . 3 8°40 10°23 Soluble salts ; 5 6°69 6°34 Earthy phosphates ‘ 0-80 0°62 Albumen and mucus é 2°60 Mucusalone 0°54 In the third case the urine resembled butter-milk, and was loaded with urate of ammonia; it contained : Water v i 2 937°00 Solid residue . J ‘ 63°00 Urea . : ‘ é 6°70 Urate of ammonia ‘ F ‘ 3°20 Alcohol-extract 3 3 A 19°02 Water-extract " ; 27°20 Salts : ‘ 3 ‘ 6°31 Bouchardat’ has published an analysis of milky urine passed by a woman with this disease. It contained no traces of sugar of milk or casein, the appearance being due to a large amount of urate of ammonia. It.is moreover remarkable for the large quantity of fat and of albumen. It contained : Water . * . ‘ 940°9 . Solid constituents é : = 59°1 Urea ; : ‘ . 12°4 Uric acid . . P - 15 Albumen and mucus . * ‘ 29-2 Fat : 2°5 Alcohol-extract with lactates, Re. ° 5°3 Alkaline sulphates. 2°7 Phosphate of soda, and biphosphate of ammonia 4:2 Alkaline chlorides 0°8 Earthy phosphates. z 0°5 It must be observed that this urine was clear on emission, and only became turbid on cooling. | Nysten2 analysed the urine of a person aged 23 years, suf- fermg from peritonitis. He found it of a dark-red colour, perfectly transparent, of the ordinary odour of urine, and of an acid reaction. An albuminous pellicle formed on the surface during evaporation, and the whole finally coagulated into a trem- bling gelatinous mass. Nysten states that this urine contained thrice the quantity of urea that “ urina sanguinis” contains. The ' Journ. de Connaiss. Méd. Aott 1843, 2 Recherches, &c. p. 240. 1811. 230 THE SECRETIONS: numbers which he gives do not, however, make out so large a ratio. I1 calculate from the figures quoted in Meckel’s Archiv,’ that Nysten’s “urina sanguinis” contains 40 parts of solid residue, of which 12 are urea, in 1000 of urine, whilst on the other hand, in 1000 parts of his inflammatory urine there are 76 of solid residue, of which 22 are urea. The urine in the latter case was evidently much more concentrated than in the former, but the ratio of the urea to 100 parts of solid residue is the same in both, and coincides with my own analysis and those of Becquerel. It amounted to 30 parts of urea in 100 of solid residue. Nephritis. In nephritis acuta the urine is, according to Schdnlein, of a dark red or claret colour, and contains hematin; according to Rayer the secretion is very scanty, especially when both kidneys are diseased: it contains a certain quantity of blood or albumen, and has an acid, a neutral, or even an alkaline re- action ; it occasionally contains pus, as when an abscess com- municates with the pelvis of the kidney, or when the nephritis is accompanied by inflammation of the mucous membrane of the urimary passages. Becquerel analysed the urine in five cases of acute nephritis, and in none of them was blood present. The urine of a man who had acute nephritis possessed the properties of inflam- matory urine, but contained neither pus, mucus, nor albumen, and deposited no sediment. In two cases accompanied with hectic fever, the urine assumed the inflammatory type, but contained no pus, and only, in one of the cases, a little albu- men. In a woman who had, at the same time, disease of the heart, chronic gastritis, and incipient cirrhosis of the liver, the urie was highly inflammatory; it was acid, formed a copious uric-acid sediment, and contained some mucus and albumen. ~ In a woman aged 23 years, who had an anemic appearance, and was suffering from slight polydipsia, and in whom the symp- toms of acute nephritis showed themselves by violent pain in the right kidney, by continual vomiting for above ten days, by great anxiety and some fever, Becquerel observed that the 1 Vol. 2; p. 648. URINE. 231 urine remained quite unaffected ; it was pale, clear, of low spe- cific gravity, and very abundant. Willis directs attention to the sediment in simple nephritis, which distinguishes the dis- ease from arthritic attacks; it usually consists of an amor- phous powder of phosphate of lime with crystals of ammoniaco- magnesian phosphate, (if the urine is neutral or alkaline,) or of urates. If any crystals of uric acid are present, they are only in small quantity. In speaking of the urinary crisis at the commencement of recovery, Schdnlein observes that the urine is secreted copiously and forms a creamy, and often a brown sediment, which afterwards separates itself into flocculent mucus; this mucous sediment will often go on for some weeks, In nephritis arthritica the urine possesses very peculiar pro- perties : Sch6nlein describes it as being of a fiery-red colour, very acid, and soon after emission depositing glistening red crystals of uric acid. In one instance Schénlein found that the sediment occupied half the volume of the urine. Sometimes the sediment is of a yellow colour, and occasionally there is gravel, mixed with mucus and blood. According to Willis, the urine in arthritic nephritis contains crystals of uric acid, even at the moment of its emission. If the disease terminates in convalescence, Schdnlein ob- - serves, that either copious sediments of a sandy micaceous appearance present themselves, or gravel of varying size is dis- charged with the urine, In nephritis albuminosa, or Bright’s granular degeneration of the kidneys, the urine differs materially from the normal type in always containing albumen; in other points, as for instance colour and composition, it may also be changed, or may more or less resemble normal urine. During the first stage of the disease, hematuria sometimes occurs; I have witnessed a case of this sort in our hospital, and have analysed the urine, which was of a blood-red colour and contained blood-corpuscles but no fibrin. I subsequently ana- lysed the blood of this patient. (See Analysis 37, Vol. I, p. 322.) The urine was neutral, and when allowed to stand, formed a sediment which was shown Py the microscope to consist of blood-corpuscles. 232 THE SECRETIONS: On the application of heat, there was a considerable coagu- lation of albumen, which was tinged brown by hematin. The specific gravity was 1017°0. The analysis gave: Analysis 105. Water " 5 ; § . 948°14 Solid residue . : . ; . 51°88 Urea : * ‘ ‘ 5 7°63 Albumen \ 2 ; 5 % 15°00 Globulin 3 E 1-00 % Heematin, extractive matter with salts, and hematoglobulin 23°80 I have in several cases made qualitative examinations of the urine in Bright’s granular degeneration of the kidneys, and have always found it albuminous, usually pale, and of an acid or neutral reaction. The amount of albumer varies exceedingly. Rayer,! who has long and accurately studied this disease, asserts that, in the acute form of the disorder, the urine is at first discharged scantily, that it is coloured red or brown by the presence of blood, that it has an acid reaction, and has — usually a higher specific gravity than normal urine; when al- lowed to stand, fibrous-looking red flocculi of blood, (fibrin ?) are precipitated which, when examined under the microscope, appear to consist of blood-corpuscles and mucus-granules mixed with epithelium. After some days the urine becomes of a citron- yellow colour, but upon the recurrence of the paroxysms the blood-red tint reappears, and disappears during the remissions. The amount of albumen discharged in twenty-four hours often fluctuates considerably. The amount of the other constituents, — with the exception of the urea, does not seem to vary so much from the normal standard in the course of twenty-four hours in acute nephritis albuminosa as in the chronic form of the disease : the amount of urea is often only slightly decreased, and that of uric acid hardly at all, and consequently the specific gravity is not much affected. In the chronic form of the disease, Rayer usually found the urine rather acid at the period of its discharge, but sometimes — neutral or alkaline; it was always pale, often turbid, and at times had a curdy appearance from the presence of small white floceuli swimming in it, which, under the microscope, appeared as mi- — ! Maladies des Reins. URINE. 233 nute whitish lamelle, (epithelium ?) frequently mixed with an amorphous mucous substance. Sometimes the turbidity arose from the presence of fat. Rayer states that the amount of albumen is larger in chronic than in acute albuminous nephritis, while, on the contrary, the amorphous urates and the phosphates are diminished in the former affection. In the chronic form of this renal affec- tion, before the commencement of dropsy, the ratio of the quantity of urine to the drink which has been taken, hardly differs at all from the normal proportion. This state may con- tinue for several months, during which period the presence of albumen affords us a certain means of diagnosis. Becquerel found the urine anemic in the majority of his cases, (in sixteen out of twenty-two.) After the separation of the albumen, it appeared clear, pale, and of a greenish colour. Its specific gravity varied from 1006°3 to 1014°7. The mean specific gravity was 1011°3; sediments were not often observed, and the reaction was alkaline. The amount of urine differed very little from the normal quantity, and the relative proportions of the most important normal constituents to each other did not seem to be altered, but the urine was usually deficient in the amount of solid constituents. In those cases in which Bright’s disease was accompanied by other inflammatory attacks, by cardiac affections, by cirrhosis of the liver, or by pulmonary emphysema, Becquerel found the urine to possess the inflammatory type: it was of a dark colour, high specific gravity, an acid reaction, and not unfrequently deposited a sediment. Out of twenty-two cases of Bright’s disease, Becquerel observed four in which the urine corresponded - with the above description, and had a mean specific gravity of 1023°5. In two cases the urine was alkaline throughout the whole course of the disease, and deposited sediments composed of the phosphates of lime and magnesia, and carbonate of lime. The urine also contained in these cases a very large quantity of carbonic acid, which was combined with various bases (but chiefly with ammonia); the urea was at the same time considerably diminished, having yielded the elements for the formation of carbonate of ammonia. (See page 213.) = In some cases Becquerel found that the urine hardly differed “at all in its physical characters from the normal type. He ob- 234 THE SECRETIONS : tained the following results from seven analyses. They are calculated for 1000 parts : - 2. 3. 4, Be 6. 7. Specific gravity . 101693 1010°0 1007°5 1008-4 1005°4 10126 1010°0 Amount of urine in F F } ; : : ys ugg poe 28-0 35:2 62:0 780 1060 253 Water . i ; 965°0 981°5 987°5 986°3 989-1 975°5 981°5 Solid constituents . 35:0 18°5 12°5 13°7 10°9 24°5 18°5 Urea 2 : 11°6 6°3 6°3 18 3°8 75 5°9 Uric acid . 3 0°3 0°6 0°3 0°2 0:2 0°4 0°4 Albumen . 5 11°9 2°5 01 3°4 2°6 59 Fixed salts . 6°6 41 2° 2°9 1:7 4:9 3°7 Extractive matter 4°6 4:8 3°2 55 2°5 57 4°7 The urine in the Ist analysis was taken from a person suf- fering from Bright’s disease without any complication. There was a little fever present. It-was of a greenish yellow colour, very acid, and contained a little mucus. In the 2d analysis the urine belonged to a patient in whom the disease had as- sumed a chronic form; it was greenish, clear, and acid. In the 3d analysis the ure was taken from a person in a state of convalescence, and who afterwards recovered. The 4th analysis represents the urine of a man aged 35 years who was suffering from polydipsia, with cedema of the feet, and ascites. The urine was clear, alkaline, formed a diffuse, whitish sediment, and effervesced briskly on the addition of acids. The man from whom the urine of analysis 5 was obtained, had tubercles im the lungs and Bright’s disease in the first stage. There was infiltration of the feet, and slight ascites; the urine was acid, pale, clear, and very abundant. The urine in the 6th analysis was taken from a man who also had tubercles in the lungs and Bright’s disease in the first stage: there was no infiltration or dropsy : the urine was bloody and very acid. If we compare these analyses of morbid urine with that of the healthy renal secretion, (the composition! of which is water 971-9, solid constituents 28:1, urea 12-1, uric acid 0°4, fixed salts 6°9, extractive matters 8°6,) we shall find that, with the exception of analysis 1, the solid constituents are less than im healthy urine, that the urea, with a single exception, only amounts to 1-3d or less of the solid constituents, whereas, according to Becquerel, it constitutes nearly one half in healthy ! It must be remembered that this is Becquerel’s analysis of normal urine. See p. 145. URINE. 235 urine, that the quantities of fixed salts, and also of extractive matters, are likewise less than in the normal secretion ; that, on the other hand, the morbid urine contains albumen, which is altogether absent in a state of health. My own analyses give a similar result, at least as far as the urea is concerned. I have recently analysed the urine of a young man 21 years of age, suffering from Bright’s disease, which was remarkable for the large quantity of albumen it contained. He had been attacked with anasarca and ascites, and the urinary secretion was diminished to about 12 ounces in twenty-four hours ; the urine was of a dark-yellow colour, had an acid reac- tion, and formed a whitish mucous sediment, which, when examined under the microscope, appeared to consist, at least for the most part, of long, articulated tubes, similar to those of the conferve, which were in part filled with a dark granular matter; there were, moreover, many globules filled with the same matter, which resembled Gluge’s inflammatory globule; there were also mucus- or pus-granules, and in one instance a slight quantity of very beautifully-crystallized yellow uric acid. I have since examined the sediment in various cases of this disease, and find that this appearance is by no means uncommon. ‘To the naked eye sediments of this nature resemble a little mucus, but on carefully pouring off the urine and examining the deposit under the microscope we observe : Ist. Mucus-corpuscles of the ordinary size, more or less granular, and decidedly nucleated. Fig. 31, a. a. 2dly. Pavement epithelium, from the mucous membrane of the bladder. Fig. 31, 0.0. 3dly. Blood-corpuscles. Fig. 31, c.c. 4thly. Round dark vesicles apparently filled with granular matter, and varying in diameter from 0006 to ‘0009 of a French inch. They strongly resemble Gluge’s inflammatory globule. Fig. 31, d. d. 5thly. Tubes composed of an amorphous matter, resembling coagulated albumen. Fig. 31, e.e. That these tubes have in most cases an actual*capsule and are cylindrical may be seen by inclining the stage, when they will rotate in the fluid in which they are floating. In some the capsule appears to be absent, and we can then see an amorphous, finely granular mass, adhering in a cylindrical form. Some of these tubes are 236 THE SECRETIONS : full, others empty ; the former contain a granula? matter, darker at some points than others, and containing cells and vesicles, similar to mucus-corpuscles. The diameter of these tubes vary from ‘0011 to :0006 of a French inch. I have satisfied myself, beyond a doubt, that they are derived from the epithelium investing the tubes of Bellini. Whether they are present as a consequence of Bright’s disease, or whe- ther they occur in other renal affections, must be decided by — further observations: my present experience leads me to believe that they are cotemporaneous with a certain amount of albumen in the urine, but that blood-corpuscles need not necessarily be present with them. [These tubes occasionally present the twisted appearance represented in fig. 31, f, copied from Scherer. The diagnostic value of this form of sediment is uncertain ; Schoénlein regards it as an undoubted sign of Bright’s disease ; Scherer! has, however, observed it ‘during the period of des- quamation succeeding scarlatina ; the same observation has been made of Lehmann, and I have myself observed it in various cases associated with a congested or irritated condition of the kidneys. | On the fifth day from the commencement of treatment,” the urine was much diminished in quantity; it amounted to only from 2 to 2} ounces in twenty-four hours, was of a dark- brown colour, continued to exhibit an acid reaction, and depo- sited a very copious sediment in relation to the small quantity of fluid. The quantity of albumen was so great that per- fect coagulation took place on boiling some of the urme m a test-tube; the tube could be inverted without any fluid escaping. On the seventh day the amount of urine increased, and it subsequently became still more abundant ; its properties remained much the same till the eleventh day, after which the albumen decreased to such an extent that on boiling a portion of the urme, only about half its volume became coagulated. The first occasion on which the urine was analysed, was when the secretion was reduced to a few ounces ; the second occasion was on the day when it again became more abundant. In the latter case the solid constituents were much more abun- 1 Untersuchungen, &c., p. 57. ibe URINE. 237 dant, although the urine was clearer, and as much as 12 ounces was passed in the twenty-four hours. The following are the results of the quantitative analyses : Analysis 106. Analysis 107. Specific gravity ; 2 1014°0 1022-0 Water ; - * 966°10 933°50 Solid constituents ; x 33°90 66°50 Urea : ; p 4°77 10°10 Uric acid i é ‘ 0°40 0°60 Fixed salts . ‘ . 8°04 10°00 Extractive matters fi ‘ 2°40 Albumen ‘ ‘ F 18°00 33°60 If we bring the quantities of urea and of albumen in these analyses in relation to 100 parts of solid constituents, we shall see that in both cases they occur in nearly equal ratios: for in the first we have 14° urea, and 54° albumen ; and in the second 15° urea, and 512 albumen. The amount of urea is very much diminished ; if we brought it in relation with the solid consti- tuents exclusive of the albumen, it would even then be below the normal average, and would amount to only 308. The observations of Bright, Christison, and others, on the properties of the urine in this disease, correspond in general with the account which we have given. [Some excellent cases of Bright’s disease with chemical ex- aminations of the urine, are given in the work of Scherer, to | which we have already referred. Dr. Percy has published a case of Bright’s disease, and given an analysis of the urine. Its specific gravity was 1020. In 1000 parts there were contained : Water : z . ; . 946°82 Solid constituents 53°18 Urea = 3 . > 7°68 Uric acid and indeterminate animal matter . 17°52 Fixed soluble salts . : ; ae Earthy phosphates ‘ ‘ : é Albumen a 22°64 Schlossberger has recently published a case in which, as the disease progressed, cerebral symptoms with maniacal paroxysms and perfect unconsciousness supervened, the paroxysms usually lasting for about twelve hours. The urine excreted before one of the paroxysms, and likewise that excreted during the first hour after the same paroxysm was submitted to analysis. BE 238 THE SECRETIONS: The urine, in both cases, was of a pale-yellow colour, faintly acid, somewhat turbid, and deposited a sediment of epithelium mixed with the tubes already described ; in the course of eight hours there was also a considerable deposit of uric acid. The specific gravity of the former urme was 1011°6, and the secre- tion contained in 1000 parts : Before the After the paroxysm. paroxysm. Water 3 ; : ; 942°0 931°3 Solid residue ; F 58-0 68°7 Urea ‘ 3 7°6 4°5 Uric acid with mucus a ‘ 2°6 5-2 Alcohol-extract with salts . 19°5 20°5 Water-extract with earthy phosphates 10°1 21°9 Albumen ; : ; 17°9 17-0 In the second specimen there was a very large quantity of mucus. | With respect to the analysis of very albuminous urine I must again refer to page 184, and I would expressly remark that the urine must be treated with absolute alcohol for the determi- nation of the albumen and the urea, since we obtain inaccurate — results in attempting to determine the urea from the evaporated solid residue. For the determination of the uric acid we must employ hydrochloric acid pretty freely diluted with water; it must be added carefully, in order not to precipitate any albu- men. When blood occurs in the urine, we must adopt a pre- “cisely similar course. Albuminous urine has now been so frequently observed in numerous diseased states of the organism independent of Bright’s disease, that the idea has long been abandoned that granular degeneration of the kidneys always occurs when we have albumi- nous urine: the presence of albumen in the urine is, however, in no case a favorable symptom, and invariably indicates serious dis- ease: I once, however, found a considerable quantity of albumen in the urine of a blooming and apparently quite healthy young man, and the only cause to which its presence could be assigned was that he had suffered from intermittent fever six years pre- viously. There are various conditions under which this con- stituent may be present. During a catarrho-rheumatic affection I once observed a little albumen in my morning urine, but in the urine secreted in the middle of the same day not a trace URINE. 239 could be detected. I noticed the following case of albuminuria in Schénlein’s wards. A man suffering from pneumonia passed very turbid urine till the period of incipient resolution ; it had a very acid reaction, and after several hours’ rest deposited no sediment. The turbidity arose from urate of ammonia in sus- pension, it disappeared on the application of heat, and again became apparent as the urine cooled. The urine presented this jumentous appearance for six days; on the seventh there was a slight flocculent amorphous deposit of urate of ammonia. On gently warming the urine the sediment perfectly dissolved, but at a boiling heat it became turbid from the separation of a considerable amount of albumen. On the following day the urine was very turbid in consequence of the presence of urate of ammonia, the amount of albumen remaining much the same. From that date the urine became clear, but remained albu- ~ minous till convalescence was established, the albumen gradually disappearing as the health improved. During the whole of this period the patient complained of no pain in the region of the kidney, even on strong pressure; neither was there any depo- sition of mucus. A man treated antiphlogistically for a severe attack of arti- — cular rheumatism passed, for a considerable time, urine of a dark colour and very acid reaction, which, however, threw down no sediment. During the period of convalescence, when the swelling and pain had diminished, the urine became less acid, without any appearance of a sediment; the sweat, however, was still extremely acid, and one morning the urime contained a very considerable amount of albumen. This abnormal constituent occurred in the whole of the urine excreted that day; on the morrow it was nearly gone, and on the third day had quite disappeared. No renal irri- tation could be detected, neither was any sediment ob- served. The urine of a young man with all the signs of general dropsy contained a considerable amount of albumen, and de- posited a light mucous sediment contaiming a considerable number of colourless blood-corpuscles (recognizable by their discoid form), numerous exudation-globules, mucus-corpuscles, and a few of the tubes described in page 235. The urine had the pale, green, opalescent appearance indicative of the presence 240 THE SECRETIONS: of albumen, and did not contain a trace of hematin, which must consequently have been perfectly separated from the blood- corpuscles before leaving the kidneys. The patient complained of no pain (even on pressure) in the lumbar region. I received a specimen of urine from Dr. Broun, which had been passed by a patient who for a long time had suffered from considerable cedematous infiltration of the extremities. It gave no indication of albumen, neither did it contain any of the peculiar sediment which seems especially associated with renal irritation. That in certain forms of dropsy the urime is albuminous, while in others not a trace of albumen can be detected, has been thoroughly demonstrated. In hydrothorax, and in dropsy dependent on disease of the heart or the liver, there is generally no albumen, whereas, if the dropsy arise from disease of the kidney, albumen is generally present. In Bright’s disease, as far as my personal observations extend, it is always found, although the opposite opinion is held by Graves.’ Cystitis. Two deviations from the normal-condition are frequently observed in the urine in cases of cystitis; these are, its rapid tendency to alkalinity, in consequence of the formation of car- bonate of ammonia, so that it is sometimes alkaline even at the period of emission ; and the large amount of mucus or muco- pus. In the first stage of the disease the urine is, however, red, possesses all the characters of genuine inflammatory urine, and usually contains only a little mucus. In cystitis acuta the urine was observed by Schénlein to be of a dark-red colour, and frequently to contain hematoglobulin. When the inflammation was caused by vesical calculi the urine had a pale greenish colour. 3 In a case of inflammation of the bladder, which was brought on by the use of stimulating injections, Becquerel found that the urine at first possessed the characters of the inflammatory type, but these in part disappeared in consequence of the quan- tity of the fluids drunk by the patient ; it was acid, of average 1 Dublin Journal, No. 60. URINE. . 241 specific gravity, and deposited, after some time, a stratum of transparent mucus. In another case in which the inflammation had been brought on in a similar way, the urine was alkaline, had a specific gra- vity of 1022°6, deposited a thick layer of purulent mucus, contained albumen and some fat which was removable by ether, and exhibited pus-corpuscles under the microscope. In a third case of acute cystitis, which speedily came to a fatal termination, Becquerel found the urine, at the period of its discharge, turbid, thick, and viscid. On allowing it to stand for some time, there was formed a layer which occupied nearly the lower half of the vessel, and consisted of almost pure and white pus: the fluid above the sediment was pale, clear, and alkaline. As the disease terminates i in convalescence copious sediments are deposited, or, if a sediment had been formed during the height of the disease, it is now more abundant. In arthritic cases the sediment is, according to Schénlein, of a crystalline micaceous appearance; in non-arthritic cases (and in the latter stage, in arthritic cases also,) very bulky mucous sediments occur, which are often tough and fibrous, from the action of carbonate of ammonia. Sediments of this latter form frequently continue for a long time, so as to constitute genuine catarrhus vesicze. Schénlein states, that in cystitis erysipelacea the urine is of a dark reddish-brown colour, mixed with fibrous, flocculent, or bran-like mucus. Metritis. In acute metritis the urine possesses all the characters of the inflammatory type. Becquerel found it acid, of a reddish colour, of average specific gravity (1018-O—1021:0), and some- times containing albumen. A sediment of uric acid was always thrown down either spontaneously or by the addition of nitric acid : during convalescence it became paler and less dense, and ceased to deposit sediments. The leucorrhcea which accompa- nies metritis, or appears towards the period of convalescence, renders the urine turbid and cloudy. ; In chronic metritis, and in uterine congestion, the urine is much the same, except that the inflammatory signs are less II. 16 242 THE SECRETIONS: marked: In these cases, especially in chronic metritis, it is frequently mixed with the leucorrhceal uterine discharge. [In a case of endometritis' and pericarditis with purulent exudation, occurring thirteen days after delivery, the urine was passed in very small quantity, evolved a disagreeable odour, was turbid, and deposited a rather copious sediment. The sediment consisted for the most part of pus, mixed with a few blood-corpuscles, epithelium-scales, and fat-vesicles. , The reaction of the urine was acid; its specific gravity 1020. It appeared on analysis that the urea was much diminished, that there were only traces of uric acid, that there was a little albumen, no bile-pigment, and scarcely any trace of chlorides. The sulphates were slightly, and the earthy-phosphates much increased. | Urine in typhus. We formerly had occasion to remark that less was known of the actual condition of the blood in typhus than in inflam- matory diseases; the same observation is equally true with regard to the urine. Very little light has yet been thrown upon the varying nature of the urine in this disease: sometimes we find it of a brown colour, acid, and of high specific gravity, in fact, like inflammatory urine ; sometimes it is clear like the urine after copious drinking; on other occasions it does not appear to differ from normal urine: it varies between an acid, an alkaline, and a neutral reaction. It is to. be presumed that these changes in the relative constitution of the urine correspond with certain reactions: in the organism; the connexion, however, is not always very clear, even to the observant physician. This much is, however, certain, that in the first stage of the disease a dark, specifically dense, acid urine is often excreted, and that in proportion as the fever assumes a torpid character, and the vital powers become depressed, the urine becomes clearer, loses its acidity, becomes neutral, and in a very short time (often after one to two hours) alkaline, containing carbonate of ammonia. Sometimes a yellowish eng turbid, fetid, and alkaline urime is excreted. 1 Heller’s Archiv, vol. 1, p. 23. URINE. 243 The difference between the urine in typhus and in inflam- matory disorders is sufficiently great to be determined with certainty. In the phlogoses when the fever assumes a synochal character, we observe that the urine, with some few exceptions (as occasionally in cases of injury of the spinal cord, and in dis- eases of the kidneys and bladder,) is of a red colour, acid, usually clear, and only forms sediments of a yellow, red, or brown colour, and consisting of uric acid and the urates, on the occurrence of a crisis; the quantity of the urine is diminished, and the specific gravity increased ; the urea is either absolutely increased, or is equal to, or very little below the physiological average; the quantity of salts is in general diminished, (the sulphates, how- ever, in a much less proportion than the chlorides;) and the quan- tity of extractive matter increased. In typhus the quantity of urine is decreased; it varies ex- tremely in colour and reaction; the red tint of inflammatory urine is, however, very seldom observed, but more commonly a brown or reddish-brown colour; the more the fever assumes the erethismic character or approximates to the synochal form in con- sequence of being complicated with inflammation of the respira- tory organs, the more also does the urine approximate in its physical characters to the inflammatory type; and in proportion to the torpid character of the fever and to the prolapsus virium, does the urine become less dense and acid, and the more readily does it assume the alkaline state. The urine may resemble the normal type as far as the specific gravity and the amount of solid constituents are concerned ; it is usually, however, less dense, and it frequently happens that the deeply-coloured urine of typhus has a much lower specific gravity than we should have been led, from its tint, to expect. The amount of urea never reaches the physiological mean, and is often far below it; the uric acid, on the other hand, is often increased, especially on the occurrence of the urinary crisis. The salts, including the sulphates, are very much diminished, so that sometimes hardly a trace of them can be detected. We have seen that in the phlogoses the urea ordinarily attains the physiological average of 392% of the solid residue, and that it sometimes even exceeds it; while in the urine of typhus I found that the: maximum proportion of urea amounted to only 31°8;, the minimum to 225, and the mean of 7 analyses to 26°63 of the 244 THE SECRETIONS : solid residue. Hence it would appear that this decided decrease of the urea below the physiological average is a characteristic peculiarity of the urine in typhus. I found the maximum pro- portion of uric acid amount to 4°89, and the minimum to 0°92 of the solid residue; and with respect to the fixed salts, the maximum was 132°, and the minimum 3°4° of the solid residue. With regard to the state of the urine in typhus, and especially in abdominal typhus, Schénlein observes that it is altogether in- constant, that it is sometimes pale, sometimes apparently normal, and sometimes jumentous. In the first stage it is usually of a dark brownish-red colour, tolerably clear in the sthenic form of fever, but darker in the erethismic and very torpid forms. A turbidity in the urine, together with other symptoms of a crisis, frequently indicates the transition into the second stage. In this nervous stage of the disease the urine is of a dark brown colour, and very acid.. A perturbation is observed in the urine on the seventeenth day, (occasionally it occurs on the eleventh or twelfth day), and at the period of. the actual crisis, (the fourteenth or twenty-first day,) the urine becomes clearer and more abundant; sediments also occur, not of a crystalline form, as in the phlogoses, but of a diffuse, flocculent, mucous nature: the urine sometimes becomes as clear as the urina spastica. If the typhus disappears fremantuely 0 on the fourth or ee day, we frequently observe, in addition to other acute critical symptoms, a discharge of turbid, and often purulent urine. In the form to which the term ‘ febris nervosa putrida’ has been ap- plied, when the decomposition of the blood is particularly striking, we meet with blood in the urine, which becomes very quickly decomposed, and is of a dark brown or blackish colour. Con- valescence after typhus can never be considered as safely esta- blished until the urine becomes perfectly yellow and pale. As long as it remains of a dark brown, or even high colour, there is still danger. The more brown, decomposed, and fetid the urine is during the course of the typhus fever, the more unfa- vorable is the prognosis. In petechial typhus during the first stage, the urine is not very highly coloured ; on the seventh day there is frequently a turbidity; during the nervous stage the urine is of a dark brown URINE. 245 colour; and at the ee of the crisis, sediments are also Miciited: Willis! remarks, that the state of the urine in typhoid fevers, especially in regard to its acid or alkaline reaction, may be studied with advantage, as affording an indication of the progress of the disease. During the early stage it is acid; as the disease advances, it becomes neutral, and then alkaline ; as the disease decreases it again becomes neutral, and ‘ultimately acid. The return to the acid state is always a good symptom, and will sometimes enable us to offer a favorable prognosis. The observations made by Pelletan in Bouillaud’s clinique, perfectly coincide with the above statements ; he observes that, during the first days of typhus, the urine is of a dirty yellow colour, and transparent ; during the whole of the first stage it is always more or less acid, and the darkest kind, which has an odour like gingerbread, is usually the most acid. At a later period it changes, resembles turbid whey or putrid broth, and is usually neutral ; it is also sometimes found of a dark colour, with an odour like cow-dung. At a still later period, it is turbid, putrid, and smells rather ammoniacal, assuming at the same time a corresponding reaction. If the disease takes a favorable turn from this period, the urine goes through the same changes in a reversed order. The observations which I have made in Schénlein’ s clinical ward correspond entirely with those already communicated. In two men aged between 20 and 30 years, who had very severe attacks, I observed that the urine became alkaline to- wards the seventeenth and twenty-fourth days of the disease : it was then discharged in greater quantity than before, and was clearer; it was pale, somewhat turbid, and soon deposited a dirty or a bright-red sediment composed of earthy phosphates, urate of ammonia, and mucus. Test-paper and a rod moistened in hydrochloric acid, afforded indications of ammonia, and by the addition of an acid the presence of carbonic acid, but not of al- bumen, was demonstrated. Both men recovered, but convales- cence, especially in one of them, was very slow. The urine then became gradually clear, yellow, and acid, as before: the period ' Urinary Diseases and their Treatment, p. 128. 246 THE SECRETIONS: during which, in one of these cases, the urine continued unin- terruptedly alkaline, was above eight days. In another case, in which I followed the variations of the urine through the course of the disease, it became alkaline at noon on the third seventh-day period, but the next day it again became acid, and remained so till death, which soon occurred. [Schénlein’ s opinion that the urine in the regular course of typhus is at first dark and very acid, subsequently neutral. and. even alkaline, and finally again becomes acid at the commence- ment of convalescence, has received further confirmation from the following observations quoted by Simon in his ‘ Beitrage.’ In one case the urine became faintly alkaline on the seventh day after admission ; it remained either alkaline or neutral for seven or eight days; and then became faintly acid and gradually clearer, as soon as the patient exhibited symptoms ¢ con- valescence. In a second (very severe) case the urine remained acid till the twenty-first day; it then became neutral, and afterwards alkaline, for the space of ten or eleven days, when it returned to its normal reaction. In two other cases the urine became alkaline previously to the fourteenth day of the disease ; in one of them the secretion was so thoroughly saturated with carbonate of ammonia, and evolved so disgusting an odour as to be perceptible over the whole ward. ‘This urine deposited a considerable sediment of pus or mucus, mixed with the phosphates of lime and magnesia, and effervesced briskly on the addition of an acid. In one of these cases the urine rémained alkaline for fourteen, and in the other, for twenty-one days, before it resumed its acid reaction. Both cases recovered. It is worthy of notice, that a deposition of urate of ammonia not unfrequently precedes the occurrence of alkalinity and the appearance of the earthy phosphates, which, as Schénlein re- marks, may be regarded as the precursors of a favorable change. During the mild form of typhus recently (1843) prevalent in Berlin, he noticed these changes in several cases, and in fact, when from being alkaline the urine again became acid, and at URINE. 247 the same time clear and abundant, there was scarcely any risk in giving a favorable prognosis. | In some cases in which the patients recovered, the dark urine did not become alkaline quickly enough to be perceived during the hospital-visit, but by the evening it would deposit a con- siderable dirty viscid sediment composed of earthy phosphates and mucus, and would have a well-marked alkaline reaction: subsequently it retained its acidity for a longer period, until at length it resumed its normal condition. On the other hand, I observed one case in which the urine was dark, had an acid reaction, and only became slightly alkaline for a short time before death ; it continued throughout of this dark colour, was turbid, and threw down a mucous sediment. In another case the urine, which was of a dark, muddy colour, remained acid till death. 7 Lastly, I will refer to two cases of typhus in girls, where the urine continued of a dark colour, and exhibited an acid reac- tion, throughout the course of the disease, which lasted from three to four weeks. During convalescence it became turbid, and deposited an imperfect sediment; although it did not entirely lose its acid reaction, it now became sooner ammoniacal than before. Ps: 240 20m In a child the urine was clear and almost amber-coloured ; it became, however, quickly alkaline, and deposited a viscid, white sediment of earthy-phosphates. Dark acid urine I have frequently found to be slightly albuminous. From these observations, as well as from those of Willis, Pelletan, and others, we arrive at the conclusion that in a regular and favorable case of typhus the urine loses its acid and assumes an alkaline reaction; that it then again becomes gradually acid, although not perhaps in the exact reverse proportion, and that it does not necessarily reassume the dirty-brown colour which it possessed during the first period: consequently the transition of the urine in typhus from the acid to the alkaline condition need not be so much dreaded as has been generally supposed. I cannot positively assert that the urine in typhus is alkaline at the moment of its emission from the bladder. Becquerel expresses himself opposed to the idea; he considers that alka- 248 THE SECRETIONS : line urine is only passed in those cases in which it has re- mained for a very long time in the bladder. I shall now give the facts which he has collected regarding the urine in typhoid fever. He observed the urine in thirty-eight cases of abdominal typhus, eleven of which were very severe, eighteen of ordinary intensity, and nine were mild cases. Purgatives, especially Seidlitz waters, formed the basis of the general treatment. Seven of the eleven severe cases recovered; two, however, subsequently died from tubercular phthisis. Of the four fatal cases, one died on the eighth day, the second at a more advanced period, the third on the fifty-third day, and the fourth from perio of the intestines. In all these cases Becquerel found the urine to deviate con- siderably from the normal type. While the fever was intense, and before the adynamic period was established, the urme was scanty, highly coloured, dense, and charged with uric acid; it sometimes contained blood, albumen, or mucus in considerable quantity, but seldom pus. In many cases, it exhibited a more marked tendency to decomposition than is observed in other diseases, and the rapidity and facility of this spontaneous decomposition usually corresponded with the severity of the dis- ease. But when, in the progress of the disease, the adynamic period comes on, the quantity of the urine will be diminished im consequence of the intensity of the fever, the colour will be high but the specific gravity low, and at the same time there will be frequent deposits of uric acid either spontaneous or after the addition of an acid, or: else the urine will as- sume the anzmic type and be pale, of low specific gravity, and only slightly acid. The urine of this latter form differs widely from that which was passed at an earlier period of the disease, and is diagnostic of the asthenic state and of its degree of in- tensity... But exceptions to this general rule have been observed both by Becquerel and myself; on the one hand, the urine has been slightly coloured, clear, and of low specific gravity in cases of typhoid fever in which the patients were far removed from the asthenic state, and on the other hand the latter state (the asthenic) is not incompatible with turbid, sedimentary urine. We must not overlook the circumstance of the urine having possibly remained for a long time in the bladder, in which case URINE. 249 it may undergo decomposition there, and by its irritative action on the vesical mucous membrane produce an excessive secretion of mucus or even pus. Becquerel found that the density of the urine, except in those cases in which there was great prostration of strength, was above that of normal urine, and amounted on an average to 1023°5. This, as I have already observed, is opposed to my own obser- vations. The mean specific gravity of the urine which threw - down a spontaneous sediment was, according to Becquerel, 10247. The colour of the urine increased with the concentra- tion. The colour of the spontaneous sediments in some cases resembled the brick-dust tint of the sedimentum latericium ; the precipitates thrown down by acids were usually of a yellowish or gray colour. In the thirty-eight cases of typhus abaerved by Becquerel, pus occurred in the urine of only one individual, and in this case the secretion was alkaline; in all the others it was acid. In avery extensive series of observations made by Andral the urine was found to have an acid reaction, except in the following cases, viz. when pus was present, when the urine had remained for a long time in the bladder, when the patient had taken a great quantity of alkaline fluids, or, lastly, when the secretion was not examined for some hours after its discharge. | The precipitate which Becquerel observed in the urine of typhus, whether thrown down spontaneously or after the addi- tion of an acid, consisted of amorphous or crystalline uric acid ; the latter was only seen twice, once after the addition of a little nitric acid, and in the other instance forming a portion of a spontaneous sediment. These spontaneous deposits were usually of.a gray or reddish colour. The important questions, whether urinary sediments i in typhus occur at any fixed epochs of the disease ?—-whether there is any connexion between their appearance and a favorable result ?— and whether their presence is prognostic of such a result ?—are answered by Becquerel in the negative. From a table communicated by Becquerel it appears that some persons died in whom the urine deposited a sediment either spontaneously or on the addition of an acid, almost un- interruptedly from the fifth or seventh day ; while others, under similar circumstances, recovered: im a case, in which the 250 THE SECRETIONS: urine threw down a sediment spontaneously on the third day of the fever, and after the addition of an acid on the eleventh, twelfth, and thirteenth days, death occurred on the fifteenth day; in other cases, in which sediments appeared at intervals, convalescence took place. Out of twenty-seven observations, a sediment first occurred in one case on the third day of the dis- ease (death); in one case on the fifth day (death); in one on the sixth (recovery) ; in three on the seventh (two deaths, one re- covery) ; in one on the eighth (recovery) ; in four on the ninth (recovery); in five on the tenth (recovery); in four on the eleventh (recovery) ; in three on the twelfth (recovery) : in four cases the sediment first appeared after the twelfth day (recovery). Amongst Becquerel’s thirty-eight cases, he only found blood in the urine in two cases: in one the patient was: dangerously ill, and a small quantity of blood was found in the urine every morning ; in the other, the patient was recovering from fever when he was attacked with small-pox. Albumen was found in eight cases, in which neither pus nor blood was present. Of these eight cases, four had the fever very severely, three mode- rately, and one slightly. Of the severe cases, two terminated in death; in one of these albumen was only found during the last eight days; in the other it occurred first on the twenty- fourth or twenty-fifth day, and subsequently from the thirty- first to the thirty-eighth day, when death took place. In the other cases the albumen only appeared at intervals. Andral examined the urine in forty-one cases of abdominal typhus, of which seven died. They were all treated by copi- ous bloodletting. In eleven out of the thirty-four who re- covered the urine did not differ in appearance from the normal type, and nitric acid threw down no precipitate. In the other twenty-three cases, the urine was generally deeply coloured, (of a reddish tinge,) and became turbid either spontaneously or after the addition of nitric acid. In some cases it remained turbid throughout the whole course of the disease; in others it presented no turbidity at first, even after the addition of nitric acid ; but as the febrile symptoms attained their greatest height, it became clouded, and as they disappeared, it gradually regained its original appearance. In other cases the appearances of the urine possessed no regularity, and it was clear and turbid or sedimentary by turns. URINE. 251 The urine during the convalescence of the thirty-four cases, was usually pale and transparent; but in some it remained turbid or sedimentary for a considerable time after the termina- tion of the fever. Albumen was only observed in one instance. In these thirty-four cases the urine was acid during the whole course of the disease, and remained so during convalescence, except in two cases, in which it was invariably strongly alkaline, light, watery, pale, and transparent; the persons from whom the urine, in these cases, was derived, were very weak, and in a state of well-marked anemia, having had the fever very se- verely, and having been repeatedly bled. The urine in these cases did not appear to have been retained in the bladder longer than usual. After several days, it became neutral; it then became gradually more deeply coloured, and ultimately regained its acid reaction. _ With respect to the seven fatal cases, the urine in one re- tained its normal appearance; in four it assumed from the com- mencement till death a deep colour, and became turbid from an excess of uric acid which deposited itself; and in all the seven was invariably acid. I shall now communicate the results of my own analyses of the urine in typhus, which enter more into minutiz. I have made several analyses of the urine in abdominal ty- phus, but have only determined with accuracy the most impor- tant of the constituents. The urine in analysis 108 was taken from a man aged 30 years, who had been dangerously ill for three weeks; delirium, subsultus tendinum, pulse frequent and small; the urine was moderately dark, turbid without a sediment, and strongly acid. He died two days afterwards. It is worthy of remark that the urine had on one occasion, about eight days before death, an alkaline reaction; it returned to its acid condition the fol- lowing day. Analysis 109 represents the urine of a typhus patient, who was lying in a state of deep coma; it was pale, and had an acid reaction. Analysis 110 represents the urine of the same patient three days afterwards, when he was in a state of great general debility ; it was pale, transparent, and slightly acid, but after some time became alkaline, and de- posited a sediment of earthy phosphates. The patient subse- 252 THE SECRETIONS: quently recovered after a tedious convalescence. Analysis 11] represents the urine of a typhus patient on the eighteenth day of the disease; it was dark, tolerably clear, threw down no sediment, and had an acid reaction. The urine in analysis 112 belonged to a person who had been suffering from typhus for some weeks; delirium, subsultus tendinum, stupor, rapid and very small pulse ; it was brown, turbid, of an unpleasant odour (like the urine of horses), slightly alkaline, and deposited in a short time a very copious, flocculent, reddish sediment of urate of ammonia. Analysis 113 represents the urine of a girl suffering severely from typhus, who lay in a state of great prostration and coma, and afterwards died; it was of a dark brown colour, slightly alkaline, rather turbid, and without a sediment ; a deposit of earthy phosphates was, however, subsequently formed. Analysis 114 represents the urine of a girl who had had typhus for four weeks: coma, subsultus tendinum, pulse 120 and small. It was rather dark, was turbid, and had an alka- line reaction and ammoniacal odour. The urine in analysis 115 was taken from the same girl two days afterwards: her general condition much as before, pulse 112, urine neutral, of a yellowish- brown colour and rather turbid. Analysis 116represents the urime of a girl aged 20 years, in whom the fever was less severe than in the previous case: there were symptoms of bronchitis, pulse as high as 108, urine of a yellowish-brown colour, and slightly acid. The urine in analysis 117 was passed by a man aged 380 years, who had been ill fourteen days. Coma; pulse 108, and small. Anal. 108. Anal. 109. Anal. 110. Anal. 111. Anal. 112, Specific gravity é - 1016:00 1010°00 1009°00 1017-00 1016-00 Water . ; . 960700 971°00 975°00 950°00 953-50 Solid constituents . ‘ 40°00 29-00 25°00 50°00 46°50 Urea : ; ‘ 9°47 7°30 6°70 —- 10°50 Uricacid . , ; 1:10 0°62 0°40 os 1°50 Earthy phosphates ts a trace trace — trace Sulphate of potash : — trace trace _— — Sum of fixed salts ; 2°50 1-00 1-00 6°50. 5°20 Anal. 113, Anal. 114, Anal. 115. Anal. 116. Anal. 117. Specific gravity . - 1015°00 1016:00 101350 1018°00 1026-00 Water j ; - 958°40 952°80 956°830 941°50 930-00 Solid constituents. : 41°60 47°20 43°20 58°50 70°00 Urea ; ; : 9°30 13°20 12°60 18°60 22°50 Uric acid . ; ‘ 0°40 1°50 2°10 0°92 1:47 Earthy phosphates - —_ — trace — 0-90 Sulphate of potash : —- — 0°64 Fim Pe Sum of fixed salts , —_ — 2°76 2°80 2°90 URINE. 253 If we calculate the ratios of these constituents to 100 parts of solid residue, and compare them with the average ratios in normal urine, we shall arrive at the results noticed in page 343, viz. that in the urine in typhus the urea falls below the physio- logical average, the uric acid is increased, and the fixed salts are much diminished. In 100 parts of the solid residue of the urine in ‘phos 100 parts of the solid there are contained : residue of normal urine contain Analyses e ~ 108. 109. 110. 112, = 113. 114. 115. TR TEs Urea 236 25:0 268-226 22:0 287 312 318 323 39-0 Uric . . : ; s oars : : : acid | 27 21 16 32 09 32 48 216 21 15 Fixed] 4, ‘ ; " , : ‘zy e aia} Oe Os 46 a 8 a ee 25:8 [Scherer! has made several analyses of the urine in typhus, which differ in some points from those of Simon. He observes that, in many cases, the urine is tolerably abundant in lactic acid and extractive matters, and continues so throughout the case, whether it terminate fatally or not. In a few cases the urine was alkaline, and this generally occurred when the fever assumed a very low or putrid form, or when the contents of the bladder had not been discharged for some time; and that not unfrequently, after being acid, it became alkaline, and then again acid. In the most severe cases it usually contained a little albumen. : The urea was never increased except in those cases in which the secretion was much diminished, and was often much below the normal standard. As a general rule, the fixed salts were considerably diminished, and the ammonia-salts increased. There was always an excess of uric acid, which usually sepa- rated, after standing, in the form of small red crystals, on the sides of the vessel; this was especially observed when there was much pulmonary congestion. No critical phenomena indicated the commencement of reconvalescence. Scherer has published the following analyses : 1. A woman aged 38 years, with slow nervous fever. The urine on the ninth day contained, in 1000 parts :— ' Untersuchungen, &c. p. 65. 254 THE SECRETIONS : Water eo n m . 945°48 Solid constituents > F 3 54°52 Urea : ; ‘ 8°60 Uric acid . 0°60 Alcohol. extract with lactic acid and lactates 27°50 Water-extract ‘ 7°40 Albumen . tii : 1°80 Fixed salts soluble in water : > 6:20 Earthy phosphates . : . 2°30 On the 12th day of the disease it contained : Water - x c ; 951°26 Solid constituents : q : 48°74 Urea . - P . 10°40 Uric acid . 0°70 Alcohol-extract with lactic acid and lactates 21°80 Water-extract with ammonia-salts . 7°90 Albumen. . o5. Fixed salts soluble in water : . 5°30 Earthy phosphates. . , 1:20 On the 15th day it contained : es Water Z a 5 ; 959-29 Solid constituents ; ; F 40°71 Urea ‘ 4 : ; 11°40 Uric acid . a 0°80 Alcohol-extract with lactic acid and lactates 15°70 Water-extract 4 ; ; 6°20 Albumen and mucus ; ‘ 0°90 Fixed salts soluble in water é i 4:50 Earthy phosphates . ‘ ° 0°60 Convalescence occurred very slowly, without any critical phenomena. ‘The urea gradually increased and the extractive matters diminished. 2. A man aged 66 years, of a muscular frame and good con- stitution, but of intemperate habits. The disease developed itself with great rapidity. The urine contained : On the 4th day. On the 6th day. Water ; " ; ‘ 939-30 934-60 Solid constituents 3 é . 60°70 65°40 Urea > ‘ : : 22°84 34°52 Uric acid 1:70 1-62 — Alcohol-extract with lactic acid and lactates 20°73 20°20 Water-extract ‘ ; 7°20 8°51 Fixed salts soluble in water . - 4-02 ‘ oa Earthy phosphates : 7 0°72 1-02 3. In a case of typhoid fever of a very putrid character, the URINE. 255 urine was of ared colour and an acid reaction. It contained in 1000 parts : + Water a a ‘ 4 983°5 965°3 Solid constituents . 4 : 16°5 34°7 Urea j : F 3 i2 5°3 Uric acid . ‘ m ; 0: Alcohol-extract, with lactic acid and lactates 6° Water-extract and ammonia-salts 5 6° Fixed salts soluble in water . ‘ : Earthy phosphates : 0° 0: on @nm ow Albumen and mucus The specific gravity in these cases was 1007 and 1011. Analysis 2 was made after the patient had taken phosphoric acid for some days, and the septic tendency had diminished. ] Urine in intermittent fevers. The urine varies considerably in its physico-chemical relations in this class of fevers. An abundant lateritious sediment at the period of the crisis was formerly regarded as an acknowledged characteristic ; recent investigations have, however, shown that this is by no means an invariable occurrence. Schénlein observes on this point that he feels bound to con- tradict the old physicians—that the lateritious sediment in the urine discharged at the termination of the paroxysm is a signum pathognomonicum of intermittents, and that it may serve for the purpose of distinguishing masked intermittents from similar forms of disease,—because the urinary crisis exhibits itself in various forms, and in many epidemics is either altogether absent, or only forms the exception and not the rule. For instance, when the whole tendency of the disease is directed towards the skin, the crisis is uniformly exhibited through that medium, and an urinary crisis is either altogether absent or only occurs subsequently, during the non-febrile state; so that while a perfectly clear urme is discharged at the termination of thie paroxysm, the sediment which has been noticed occurs on the following day. Becquerel examined the urine in fourteen cases of intermit- tent fever, ten of which were of the tertian, two of the quartan, and two of the quotidian type. During the intermission the urine resembled the normal secretion, and the resemblance was 256 THE SECRETIONS : closer in proportion to the shortness of the paroxysm and the length of the intermission: the average specific gravity was 1018-9. In many of the cases, the urine during the paroxysm assumed the inflammatory type, that is to say, it was scanty in quantity, highly coloured, and very acid, with or without sedi- ments (either spontaneous or produced bynitric acid), and having a mean specific gravity of 1023°5. In other cases, in which the febrile paroxysms had been re- curring for a length of time, the appearance of the urine changed with the prolongation of the disease; it became paler and less acid, and its specific gravity fell to 10147. The changes produced in the urine by the prolongation of the disease was very striking in the case of a man aged 49 years, who was attacked with a quartan fever during convalescence from acute articular rheumatism. As long as the first disease lasted the urine was inflammatory, but, on the accession of the second, it became paler, less dense, contained a good deal of mucus, and finally became alkaline; the return of the paroxysm did not produce any change in the character of the urine, which remained the same until the recovery of the patient. In a young chlorotic girl who was attacked with quotidian fever, Becquerel found that the urine was pale, as is the case with chlorotic persons, and was rendered turbid by a large quantity of mucus equally during the intermissions and the paroxysms; but, at the same time, the acidity and density (1021-8—1023°1) were more considerable than is usually the case in chlorosis; and, on cooling, a copious white a of uric acid was thrown down. Becquerel frequently observed turbidity or anweale (either spontaneous or by the addition of an acid) towards the close of intermittent fever, but not earlier. During the paroxysms themselves, the urine was observed to present several modifi- cations. In the majority of cases it seemed to undergo no ~ change during the three stages, that is to say, the urine passed towards the end of the cold stage closely resembled that which was passed during the other stages; sometimes in the cold stage it was deeply coloured, acid, and of rather high specific gravity, and it would retain these characters in the hot stage; sometimes it would be slightly coloured, faintly acid, and of low specific gravity (1013°4) in the cold stage, URINE. 257- and would be darker, more acid, and of higher specific gravity (1021-°8) in the hot stage. Becquerel occasionally observed sediments in the urine at the termination of the paroxysm, but they were by no means of constant occurrence: Andral observed the same. He only noticed them in those cases in which the fever was intense and prolonged, and terminated in a very abundant perspiration, or when it was complicated with functional derangements, or with congestion of certain organs. The sediment formed in intermittent fevers is always com- posed of uric acid and urate of ammonia, in most cases combined with red colouring matter (uroerythrin). A very perfect crisis by the skin and kidneys is said to indi- cate an erethismic type of fever; an imperfect and slight one, occurring through only one of the secreting organs, a synochal type; and a colliquative crisis, a fever of a torpid character. In a young man aged 23 years, who was treated in our hos- pital for quartan fever, the urine, at the end of the paroxysm, always threw down a copious, yellowish-red sediment. During the intermission it was secreted more copiously, was clear, of an amber-yellow colour, contained a few mucous flocculi, and had a slight acid reaction. : [The following table, drawn up by L’Heretier,! represents the mean composition of the urine in the different stages of this disease, as deduced from the analyses of the urinary secre- tion of twelve patients : : Cold stage. Hot stage. Sweating stage. Specific gravity . -. 1017°330 1020°304 1022°820 Water. ‘ ‘ 967°520 964-680 961°845 Solid constituents . s, . $2:480 35°320 38°155 Urea. ; ‘ 9°845 9°015 7°624 Uric acid é : 0-660 0-980 1-029 Salts and organic matter. 21°975 25°325 29°502 In all these cases the physical characters of the secretion were affected by the disease; in six other cases the urine re-« mained apparently normal. | . 1 Traité de Chimie patholog. p. 528. II, 17 258 THE SECRETIONS : Scorbutus et Morbus maculosus Werlhofii. (Land-scurvy.) In scurvy the urine is ordinarily of a dark, reddish-brown, and sometimes of an almost black colour. Although it is slightly acid as it passes from the bladder, it very soon be- comes alkaline, and develops a strong and disagreeable ammo- niacal odour. According to Schonlein, blood is frequently discharged from the urinary organs, and the urine then assumes a dark reddish-brown colour, in consequence of the presence of hematoglobulin; in this case, it develops hydrosulphate of ammonia, and soon becomes -putrid. I have examined the urine in three well-marked cases of scurvy occurring in Schonlein’s clinical wards; two were men between thirty and forty years of age, and the third, a woman who had been delivered a few weeks previously. In the men, not only were the gums attacked, and the peculiar scorbutic odour observed in the breath, but the lower extremities were covered with numerous ecchymosed spots and petechie. The woman had a very cachectic appearance; her face was somewhat swollen; the gums nearly destroyed, livid, and hemorrhagic ; the teeth loose (one having fallen out the preceding night), and the breath almost unbearable. In its physical characters the urine was very similar in these three cases. At first it was scanty (eight to twelve ounces), and of a deep dark-brown colour, as if bile-pigment or decomposed blood were present, which, however, was not the case. It was devoid of the pecu- liar sweetish odour of typhus-urine, but, after standing a few hours, developed a disagreeable ammoniacal odour. The addition of ammonia produced a very slight turbidity ; and, on the addition of chloride of barium to the urine acidu- lated with nitric acid, the precipitated sulphate of baryta was much Jess than in healthy urme. The addition of ammonia (after the removal of the sulphate of baryta) produced a com- paratively slight precipitate, showing that there was a deficiency of the phosphates. Infusion of galls, basic and neutral acetate of lead, and acetate of copper, produced considerable turbidity, and the urie was similarly affected (but.in a much less degree) by bichloride of mercury. In their chemical characters, these three specimens closely resembled each other, and were found URINE. 259 to approximate to the urine in typhus. The amount of urea was much less than in normal urine, not exceeding 25—-302 of the solid residue. The fixed salts were diminished in the urine of the men, forming 14-182 of the solid residue, while in the woman they amounted to 27%, a little above the normal average (25%). The uric acid was slightly above the healthy standard in all the cases, ranging from 1—39 of the solid re- sidue. The men rapidly improved under proper treatment ; the urine became more abundant and clearer, and, in the course of six days, was apparently normal. The woman recovered more slowly. In a girl aged 20 years treated in Schénlein’s clinical wards for morbus maculosus Werlhofii, I found the urine, during a period of a fortnight, of a dark brown colour, of a dis- agreeable ammoniacal odour, and with an alkaline reaction. It deposited a viscid sediment of earthy phosphates, urate of ammonia, and mucus. The addition of nitric acid indicated the presence of a small quantity of bile-pigment. Blood (of which the composition is given in Vol. I, page 316) issued from the mouth, exuding from red patches situated above the uvula. The odour of the breath was putrid. During her recovery, the urine returned to its original state. [The urine in this disease has likewise been analysed by Heller and Martin. The two following cases are recorded by Heller :1 1. A girl aged 19 years, marked over the whole body, was admitted into the clinical ward of Professor Lippich. The urine was of an intensely yellowish-brown colour, rather turbid, and deposited flocks of mucus. The odour, at first ordi- nary, rapidly became ammoniacal ; and the same tendency was observed throughout the course of the disease. Reaction faintly acid. Specific gravity 1021. The urine contained in 1000 parts: Water = : : - : 949°28 Solid constituents ‘ ‘ ‘ ; 50°72 Urea : " A - ‘ 16°21 Uric acid P ‘ ; ‘ F 1°27 Extractive matters with much hydrochlorate of ammonia 23°24 Fixed salts : : : z 9°80 ' Archiv fiir physiologischen und pathologischen Chemie, vol. 1, p. 12. 260 THE SECRETIONS: The fixed salts consisted almost entirely of earthy phosphates and sulphate of potash, there being a mere trace of chloride of sodium. No albumen was present. 2. In a youth aged 16 years, the urine, during the progress of the disease, was of a brownish-yellow colour and turbid ; and when an improvement manifested itself, the secretion became of a lighter tint, and clearer. A sediment of ammo- niaco-magnesian phosphate and urate of ammonia was depo- sited during the disease, but gradually disappeared during con- valescence. The urine had a faintly acid reaction, but, not- withstanding, evolved a putrid odour, and very rapidly became alkaline. The specific gravity was at first 1017, and subse- quently varied from that number to 1012. Traces of albumen could always be detected till symptoms of convalescence ap- peared. In its chemical characters it resembled the preceding case. The hydrochlorate of ammonia was much increased, while the chloride of sodium was diminished to a mere trace. The uric acid was much increased, amounting to 2 in 1000 parts. The urine remained abnormal for six days, and then appeared to have resumed its ordinary character. Heller observes that the augmentation of the ammonia (in the form of hydrochlorate) and of the uric acid, together with the diminution of the chloride of sodium,—characters seem- ingly associated with this disease,—indicate that the blood must be in a state of dissolution. In Martin’s' case, the secretion was very scanty, about one or two ounces being passed at a time, and the daily amount being from twelve to twenty ounces. In its physical characters it resembled the urine described in the preceding cases. On evaporating the urine, and allowing the solid residue to — remain for some hours at a temperature of 212°, there was re- marked on the surface of the brown, and (for the most part) saline mass, a copious, reticulated, dendritic efflorescence which, when examined with a lens, was found to consist of long, traps- parent, four-sided needles, with double-sided sharp extremities. They were proved to be neither hydrochlorates, sulphates, or phosphates, and were presumed to be crystals of hippuric acid. Three analyses were instituted. ’ Neue med.-chir. Zeit. 1845. URINE. 261 ie 2. 3. Specific gravity ‘ a ‘ 1013°40 = 1021°26 =1010°31 Water : ‘ ‘ : 984°42 973°74 985°730 Solid constituents ‘ ‘ : 15°58 26°26 14°270 Urea ; 6°43 6:07 5°430 Green colouring matter (thrown down by : H . hydrochloric acid in place of uric acid) ikl wie 006 Extractive matters with ammonia-salts, &c. 2°34 2°25 0°650 Fixed salts soluble in water . : 6°30 17:00 7°794 ee insoluble in water é 0°42 0°84 0°390 Analysis 1 was made on Oct. 22d, before the administration of any remedies. The urine was faintly acid. The soluble salts consisted for the most part of chloride of sodium. Analysis 2 was made on the 3d of November with the mixed urine of the preceding twenty-four hours. It had a strong ammoniacal odour, but was perfectly neutral. The patient had taken sul- phuric acid, iron, and other tonics, in the interval, without any obvious improvement, and traces of iron were found with the earthy phosphates. Analysis 3 was made with the morning urine passed on the 25th of November. The same treatment had been pursued with very decided benefit. The urine was clear, slightly yellow, and devoid of the unpleasant odour it previously evolved. Its reaction was faintly acid, and it con- tained traces of iron. The green colouring matter is probably a compound of uric acid and biliphein. A compound of this nature has been ob- served and described by Heller."] Chlorosis. The urine of chlorotic persons is usually pale, of low specific gravity, and of a mildly acid reaction: in these respects it re- sembles the urine of persons who have lost a considerable quan- tity of blood, or the form of urine termed nervous, which we sometimes observe in hysterical attacks. | Becquerel applies the term anemic to this form of urine, and, as in the majority of cases in which it occurs, there is either an absolute deficiency of blood or a scarcity of the truly vital por- tion—the blood-corpuscles, no objection can be raised to such a designation. - The urine in chlorosis has, however, other dis- ! Archiv fiir phys. und pathol. Chemie, vol. 1, p. 99. 262 THE SECRETIONS : tinctive properties, as has been clearly shown by the researches of Becquerel; for it is very poor in urea, and in that respect resembles the urine in typhus, while it differs from the latter in containing only a small quantity of uric acid, and a large - amount of fixed salts. I may perhaps be allowed to refer once more to the intimate connexion subsisting between the action of the metamorphosis of the blood-corpuscles (or of their development and vitality) on the one hand, and on the production of urea on the other. The proportion of the urea to the solid constituents of the urine in inflammatory diseases, in those forms of typhus which assume a torpid character, and lastly in chlorosis, affords us sufficient illustration of this connexion. In the form of typhus to which we have alluded, as well as in chlorosis and anemia, the urea is diminished; but, as we have already remarked, in that case the uric acid, which is a product peculiar to febrile action, is increased, and the salts (partly in consequence of the diet) are diminished; while in chlorosis, in which a nutritious nitrogenous diet is allowed, the diminution of the urea plainly indicates that the seat of the disease must be sought for in the production of the blood-cor- puscles. I shall now give Becquerel’s account of the chemico-physical relations of the urine in chlorosis. The quantity of urine emitted in twenty-four hours amounts to about 34 ounces. It is pale and of a greenish tint, and only becomes dark when the urine is very concentrated: the acid reaction is weak ; uric-acid sediments are seldom formed ; when they do occur, they are of a white or gray colour. If, as is not unfrequently the case, leucorrhca is associated with chlorosis, the urine is more or less turbid in consequence of the mixture of the morbid product with it; in these cases a little albumen is generally observed. | The quantitative analyses which Becquerel made of the urine of chlorotic persons gave the following results : Anal.l, Anal. 2. Anal. 2. Quantity of urine in 24 hours ; 41°3 ounces 50°8 ounces 27:5 ounces Specific gravity ; - 1011°3 1012°6 1016°8 URINE. 263 1000 parts contained : Water : ‘ 981°28 979°21 972-28 Solid residue ‘ ‘ 18°72 20°79 27°72 Urea . ‘ ‘ 6°03 ~ 7°38 6°83 Uric acid : ‘ 0-08 0°26 0°23 Fixed salts ‘ 4°80 8°05 8°45 Extractive matters d 7°79 5°14 11°16 If we calculate the amount of urea, uric acid, and fixed salts in these analyses in relation to 100 parts of solid residue, and compare the results with the physiological average which Becquerel has given, the proportions to which I have already alluded will plainly appear, that is to say, there is an absolute anda relative diminution of urea and of uric acid, and an in- crease of the fixed salts: 100 parts of solid residue contain : Anal. 1, Anal. 2. Anal. 3. Normal Urine. Urea ‘ ‘ 32°0 33°0 24°0 42°0 Uric acid . 3 0°4 1:2 0°38 1°4 Fixed salts ‘ ‘ 26°0 38°0 30°0 24:0 The urine may exhibit some differences in its chemico- physiological properties if other diseases are associated with chlorosis, or if the latter is not very fully developed. The persons from whom the urine in analyses 1 and 2 was taken were slightly feverish. In analysis 3, the chlorosis was combined with pul- monary emphysema. In analysis 4, there was some affection of the nervous system. With the exception of a considerable diminution in the quantity of urine discharged’ in twenty-four hours in analyses 1 and 3, and the increase of uric acid in analysis 2, there are no particular deviations in the relative proportions of the solid con- stituents from the statement that we have previously made ; for the urea is both absolutely and relatively diminished, and the salts occur in a higher proportion than in normal urine. 2 3 4. 1. ‘ . Quantity of urine passed a 23°3 oz. 24°5 oz. 17°8 oz. 38°5 oz. 24 hours, in ounces é Specific gravity 2 1014°2 1017°6 1016°8 1016°8 1000 parts contained: Water : . 976°43 970°89 972°28 972:28 Solid constituents < Goose 29°11 27°72 27°72 Urea ‘ 8°37 7°81 8°64 6°95 Uric acid . . 0:20 0°81 — 0-22 Fixed salts : 4°74 0°09 8°36 8°89 Extractive matters . 10°34 11°47 10°24 12°10 264 THE SECRETIONS: Becquerel has made some interesting remarks on the influ- ence of ferruginous preparations on the urine in chlorosis. In the majority of cases the iron is partially carried off by the urine ; sometimes, without any apparent reason, it is absent from urine in which it is found on the preceding and suc- ceeding days. The quantity of iron thus carried off in the urine of the same individual is subject to great variations ; sometimes it can only be detected after the incineration of a portion of evaporated urine, while, on other occasions, the simple addition of a test is sufficient to indicate its presence. The iron begins to pass off by the urine from the commencement of the administration of the medicine, and it occurs in all the urine that is emitted; so that there is no necessity for the system to be saturated with it before any portion can pass off by the kidneys; as the assimilation of the iron is a very slow process, large doses merely derange the digestive organs without bemg. of more service than smaller doses. [Herberger! analysed the urine of the chlorotic girl referred to in Vol. I, p. 3138, and his analyses indicate the simultaneous diminution of the blood-corpuscles and urea. The urine was analysed on three occasions before the use of iron, and twice afterwards. Urine before the use of iron. 1. 2. 3. Specific gravity . - 1010 1009 1012 Quantity in 24 hours . ‘ 32 02. 42 02. 35 02. Water f A : 975°43 978-21 971:98 Solid constituents . ; 24:57 21:79 28°02 Urea é § : 7°04 7°00 7°12 Uric acid 3 é i: APIS 0:21 0°19 Extractive matters . £% 10°48 9-00 13°99 Fixed salts : = 6°80 5°50 6°62 Urine after the use of iron. | ‘2 2. Water z j : - 940°16 938-70 Solid constituents é é 59°84 61°30 Urea ‘ : ; ; 26°84 27°36 Uric acid ; 4 é 0°94 0°96 Extractive matters. aie : 18°62 16°28 Fixed salts ‘ é ~~ 13832 15°71 ? Buchner’s Repertorium; vol. 29. URINE. 265 Traces of iron were detected both in the sweat and urine during the period of treatment. ] Donné states that normal urine always contains a certain quantity of iron which disappears during chlorosis, and only reappears after the use of ferruginous preparations. This state- ment is contradicted by Bécquerel, who has never been able to discover iron in the incinerated residue of normal urine, although ferrocyanide of potassium would evolve a blueish shade, —an effect which this test sometimes has on chlorotic urine. [L’Heretier! gives the mean of eight analyses of the urine in uncomplicated chlorosis : In 24 hours. Quantity of urine 3 ‘ ; 1000 38 oz. Specific gravity ; ; : 10119 . — Water ° : ‘ : 983°1 18372 grains Solid constituents. F , 16°9 316 Urea . : ‘ : 6°6 123 Uric acid : ‘ ; 0:2 5 Fixed salts ; : : 4°] 77 Organic matter : ° 6:0 lll I am indebted to the kindness of Dr. Golding Bird for the following cases : 1. A girl aged 18 years, of anzemic appearance, and who had suffered from anasarca for six months, passed 30 ounces of acid urine of specific gravity 1024, in twenty-four hours. The water amounted to : ° 12690 grains. The solids. ; : : 750 Urea . : : : 162 Uric acid 3 ‘ : 9 She then commenced taking ferri sulph. gr. ij, ter die. In the course of a week the urine was again examined ; it amounted to 20 ounces, had a specific gravity of 1029, and deposited urate of ammonia. The water amounted to : : 8392 grains. The solids . . . : . 608 Urea ‘: : ; ; 137 Uric acid é ae : 20 1 Traité de Chim. patholog. p. 551. 266 THE SECRETIONS : The anzemia was now disappearing. At the end of the second week the amount of urine was 30 ounces, and the specific gravity 1023. The water amounted to : : 12690 grains. The solids . ; ; 720 Urea F ; 5 : 242 Uric acid . : - a 5 2. The urine of a girl aged 15 years, of chlorotic appear- ance but menstruating regularly, amounted to 25 ounces, and had a specific gravity of 1020. The water amounted to ‘ , ; 10637 grains The solids ‘ ’ ; : 519 Urea ; ‘ : . 231°25 Uric acid ° ; : ; 25°00 The amount of uric acid in this case is very remarkable. ] Hemorrhages. The properties of the urine in hemorrhages are entirely de- pendent, during the period of the discharge and for some short time afterwards, upon the degree in which the vascular system participates in the general disturbance. In many cases, as for instance, in cerebral and pulmonary hemorrhages, we find that the quantity of urine is diminished, its colour becomes deepened, its acidity and its specific gravity increased,—that is to say, it en- tirely resembles inflammatory urine. When there is hemorrhage from the kidneys, uterus, or any portion of the generative sys- tem, the urine will naturally contain blood, either in a state of solution or undissolved. If the hemorrhage is succeeded by a state of anzemia and great prostration of strength, the urme then becomes pale, of slight acidity, and of low specific gravity, as in chlorosis. | Becquerel made three examinations of the urine in cerebral hemorrhage, and in two of these cases he found it analogous in its physical relations to the urine of inflammation: in the third case, in which the patient had imperfect hemiplegia of the right side, but in other respects seemed well, the urine could hardly be considered abnormal. 7 In one of the first two cases, the urine was taken from a man aged 43 years, who was affected with perfect paralysis of ; URINE. 267 the left side, and died on the fifteenth day from the seizure. It exhibited in a high degree, both in its physical properties and in its chemical constitution, the characters of inflammatory urine. The quantity was diminished ; the specific gravity, the urea, and uric acid exceeded the physiological average. Quantity of urine in 24 hours, in ounces > ‘ 25°7 Specific gravity ‘ ‘ ‘ - 1023°1 Water : : 4 ; : 960°40 Solid residue . ; ; : 39°60. Urea i ‘ : ; ; 17:10 Uric acid . z i ‘ F 0°65 Fixed salts . ‘ ‘ ; * 10:00 Extractive matter , : ; ; 11°80 In 100 parts of solid constituents there are 43-0 of urea, and 1°6 of uric acid. The urine of a man aged 31 years, who was treated in Schénlein’s clinical wards fora severe attack of pulmonary hemor- rhage, was of a dark red colour, very acid, and exhibited the other symptoms of the inflammatory type, from the period of admis- sion to the eleventh day. On two occasions I found its specific gravity to be 1023 and 1022. On the eleventh morning the urine was rather turbid, and on the twelfth it became jumen- tous from the urate of ammonia which was suspended in it; it still had a strong acid reaction, but did not form any sediment ; on the next day, the sediment was very considerable. The pulse was quick and feverish till the urine began to deposit sediments ; subsequently, the vascular excitement almost en- tirely disappeared, and the urine became clear and pale, and contained only a few mucous flocculi. In a girl aged 20 years, with severe hematemesis, who had brought up nearly a quart of coagulated blood, the urine which was passed almost immediately after the attack scarcely differed from the normal secretion; but, on the following day, it was pale, and scarcely acid, and it continued in this state for several days. In hematuria the urine contains blood, either in a coagulated state or devoid of fibrin; in the latter case, the blood-corpuscles may be either perfectly dissolved or not; and when they are found floating in the urine, they form, after a short time, a red sediment. More minute observations on this subject have been given in page 187. 268 THE SECRETIONS: Rayer has published a very interesting communication on an endemic hematuria that occurred in the Isle of France. Children of very tender age discharged blood with the urine; he relates for instance, the case of a boy, who from his seventh year lost nearly an ounce of blood daily: uric-acid gravel was combined with the hematuria. A man aged 21 years, from the Isle of France, who was under Rayer’s care, had had hematuria from his youth, The urine which he passed in Rayer’s presence formed, in the course of seven hours, a cream-like layer on the surface; two distinct strata were afterwards formed, the upper being of a yellowish- white colour, and the lower red: the latter contained two clots of coagulated matter, one was the ordinary blood-clot, the other was white and loose. The upper milky stratum contained much albumen and fat (chylous urine), the lower one contained blood. No casein was present. It is worthy of remark that the hema- turia never came on till about noon, the urine passed in the earlier hours being always clear. Rayer and Orfila also observed a similar case of bloody and milky urine in a Brazilian. The disease commenced with a discharge of milky urine, the hematuria coming on a year after- wards. Catarrhs. In simple catarrh the state of the urine corresponds with the degree of vascular reaction. If the catarrh terminates without any perceptible fever, the urine scarcely deviates at all from the normal state : if the fever is accompanied by much excitement, the urine, according to Schonlem, becomes rather red, and forms a mucous sediment. At the commencement of convalescence from a feverish catarrh the urinary crisis shows itself by a mucous sediment. In influenza the urine assumes a reddish tint, and assumes more or less of the inflammatory type in proportion to the — synochal character of the fever. Schénlein states that the nature of the urinary crisis at the approach of convalescence is dependent on the character of the fever : in erethismic fever the sediment is mucous, in synochal fever it is earthy, and in gastric fever it is of a yellowish-gray colour. . URINE. 269 In measles, which are considered by Schénlein as the most highly-developed form of catarrhal disease occurring in the northern hemisphere, the urine changes with the varying stages of the disorder. In most cases it more or less resembles the inflammatory type, it is red (as in inflammatory measles), acid, and sometimes jumentous (as in gastric measles), or deposits a mucous sediment during the course of the morning (as in catarrhal mea- sles). Becquerel states, as the result of his observations, that the urine is generally inflammatory at the commencement of the febrile period. It becomes very dark and of high specific gravity, and frequently deposits a sediment of uric acid: a small quantity of albumen was found in a few of the cases. During the eruptive period the character of the urine changes ; if the eruption is slight, and there is not much fever, it resumes the normal type; if the contrary is the case, the urine retains the inflammatory appearance. Becquerel did not meet with any case in which the urine was turbid or sedimentary towards the close of the eruptive stage. During the period of desquamation and of convalescence, the urime either returns at once to the normal state, or continues turbid and sedimentary for some time, or becomes pale, clear, and anzemic. : In three cases anasarca came on during convalescence, but the urine did not contain albumen. During the catarrhal affection of the mucous membrane of the stomach, or the status gastricus (as it has been called), which when more fully established, becomes gastric fever, the urine is generally more or less turbid, and earthy sediments appear as symptoms of a crisis. Becquerel found that the urine in “lembarras gastrique” was often of a deep colour, and sedimentary, as in the phlo- goses: sometimes, however, it hardly differed from the normal secretion. Out of twelve cases, the urine in two scarcely differed at all from the normal type, in the other ten it approximated more or less in its characters to the urine of inflammation: the deepness of the colour appeared to be always in relation to the intensity of the disorder, and to the presence of some degree of 270 THE SECRETIONS: fever. In the twelve cases, with two exceptions, the urine was constantly acid. In one of the exceptions the urine was alka- line, and contained numerous crystals of ammoniaco-magnesian phosphate. In six cases sediments of uric acid were formed either spontaneously, or on the addition of an acid: in two in which the symptoms were very intense, a little albumen was present, but in each case it lasted only one day. The mean specific gravity of the urine was 1021°4; the highest, and in this case a sediment was deposited, was 1025: 2. In gastric fever the urine is frequently turbid and jumentous: it usually contains urate of ammonia in suspension, and has an acid reaction. An earthy flocculent sediment occurs as a urinary crisis at the commencement of convalescence, the supernatant fluid being clear. (Schénlein.) In mucous fever the urine is red and fiery, if the fever (which at the commencement assumes the intermittent type, and which only at a later period becomes continuous,) takes on a synochal character. It is not unfrequently limpid and clear, as in hysterical cases, and forms, especially if the affection has extended to the genito- urinary mucous membrane, a mucous sediment. In those cases in which the urine is limpid, it assumes the normal colour during the progress to convalescence, and sediments are deposited which gradually become thicker, and pass from a mucous to an earthy- purulent character. (Schonlein). The urine in bilious fever is usually impregnated with bile- pigment; it is of a more or less brownish colour, and when a thin layer is seen it appears of a citron-yellow tint: it differs, however, with the degree of vascular excitement; if the fever has a synochal character the urine is dark and of a fiery-red colour, if the fever is erethismic, which is frequently the case, it is of a dark yellow or yellowish-brown zolour, and in torpid fever it is more or less brown, and not unfrequently mixed with blood. The presence of bile-pigment may always be recog- nized by the change of colour which succeeds the addition of nitric acid. URINE. 271 Cholera. In sporadic cholera, as well as in the Asiatic form of the disease, the urinary secretion is very scanty, and sometimes altogether suppressed. Any urine that is discharged is usually of a dark colour, and has a feeble acid reaction, but its specific gravity is below the healthy average. In a case which I observed in our hospital, where the symptoms were exhibited with great severity in a woman 36 years of age, there were frequent evacuations by stool, but only about one ounce and a half of dark acid urine, with a specific gravity of 1011-0, in the course of twenty-four hours. I only determined the amount of solid constituents collectively, and of the urea. In 1000 parts I found : Analysis 118. Water 5 : 3 4 975°90 Solid constituents ; ‘ : 24°10 Urea : . ; ‘ 7°10 The urea in this case amounts to rather more than 292 of the solid residue, which is considerahly below the normal pro- portion. At the approach of convalescence the urine was discharged more copiously, but it continued to be deeply co- loured: it was only after some days that it became pale and anemic. I never observed any sediment. [The urine of a man aged 30 years, attacked with sporadic cholera, was analysed by Heller.’ There was excessive diar- rhea and vomiting, and the patient died on the fourth day. During the first forty-eight hours of his illness only one ounce of urine was discharged; it had a deep golden-yellow colour, and deposited earthy phosphates although strongly acid. Its specific gravity was 1018. It contained in 1000 parts: Water and free carbonic acid ‘I . 955°67 Solid constituents i , : ‘ 44°33 Urea A ° é . : 10°50 Uric acid ‘ . ‘ : ; 0°10 Extractive matter, with a large quantity of a peculiar sub- stance apparently originating from the bile . 27°32 Fixed salts : : ; ; 6°41 | ' Archiv fiir phys. und pathol. Chemie, vol. 1, p. 15. ae me 279 THE SECRETIONS: We are unfortunately not possessed of any trustworthy in- formation respecting the urine in Asiatic cholera. R. Herrmann! has communicated the following remarks. _ As no opportunity occurred for obtaining urine passed during the more urgent stages of the disease, that which was first dis- charged by a patient who was just getting over a severe attack was analysed: it was yellowish, turbid, deposited no sediment, had a neutral reaction, and by the application of appropriate tests, the presence of phosphates, hydrochlorates, and ammonia- compounds was indicated ; on the addition of nitric acid, crystals of nitrate of urea were obtained ; but only small quantities of all those substances were present. Its specific gravity was very low, being only 1006. Wittstock? has likewise instituted some researches on the urine which was passed immediately after an attack of cholera. It had a specific gravity of 1008-5, was neutral, of a pale yellow colour, but not perfectly transparent in consequence of micro- scopic crystals (consisting, in all probability, of ammoniaco- magnesian phosphate,) held in suspension. The sides of the glass were also covered with minute glittering crystals, which were supposed by Wittstock to consist of uric acid, but which, in all probability, were composed of ammoniaco-magnesian phosphate also.3 An interesting investigation regarding the urine in cholera has also been made by Vogel. The urine was passed after the most violent symptoms had abated: it was-of a deep brownish- yellow colour, was rather turbid, deposited no sediment, had a specific gravity of 1008-0, and indicated a strong acid reaction. The salts of lime and magnesia were entirely wanting, and the quantity of chloride of sodium was very minute, while on the other hand the sulphates were found in a larger proportion than in normal urine. The existence of bile-pigment and of albumen was proved by ' Poggendorff’s Annalen, vol. 22, p. 176. 2 Cholera Archiv, vol. 1, p. 428 3 It is by no means probable that urine, with so low a specific gravity, and espe_ cially when it is alkaline or neutral, should throw down a precipitate of uric acid; a sediment of urate of ammonia would be much more probable. The neutral state of the urine would favour the separation of crystals of ammoniaco-magnesian phosphate, as suggested in the text. URINE. 273 the addition of nitric acid to the urine. Urea, uric acid, mucus, and a good deal of phosphoric and lactic acid were present. Sub- sequently the albumen and bile-pigment disappeared, and the earthy phosphates returned. In vesical catarrh the urine is generally very pale, and always contains a greater or less amount of mucus. The feeble acid reaction which it possesses at the period of its emission is fre- quently lost in a very short time, and it becomes neutral or valkaline, and a quantity of the earthy phosphates, (especially of crystals of ammoniaco-magnesian phosphate,') becomes mixed with the mucus. The quantity of mucus which is separated is sometimes very bulky. Schonlein remarks that we may possibly be able to -deter- mine the seat and the extent of the blennorrhcea from the quality and the amount of mucus. Mucus secreted from the mucous membrane of the bladder forms an uniform mass, and is tenacious and thready, while that secreted by the mucous membrane of the ureters and of the pelvis of the kidney is, on the contrary, flocculent: if the tenacious and the flocculent forms of mucus are both found at one and the same time, we are jus- tified in assuming that the bladder, ureters, and pelvis are simul- taneously affected. Willis,” in speaking of cystorrhea, states that in acute vesical catarrh accompanied by inflammatory fever, the urine is scanty and highly coloured, and precipitates a much greater quantity of tenacious mucus than usual ; also that in the earlier stages of the disease it is sometimes ammoniacal, but more frequently when the disease has continued for a long time. In chronic vesical catarrh the urine is flocculent when it is passed ; the flocculi increase with the advances of the disease, and collecting at the bottom, form a tenacious mass which may be drawn out into threads; this mass sometimes assumes the.consistence of bird-lime, and exhibits spots of blood. As the disease advances still further, we often find a fourth or even a third part of the urine to consist of mucus, so that six to eight or even ten ounces are daily thrown off. Willis ' [It is worthy of observation that beautiful crystals of ammoniaco-magnesian phosphate may be occasionally found in urine with a decidedly acid reaction. } ? Urinary Diseases and their Treatment, p. 399. II. ; 18 274 THE SECRETIONS: inquires whether this secretion is always composed of actual - mucus, or whether pus in a modified form is not always present. In the urine of a man who was being treated for catarrhus vesicee in our hospital, I found a very bulky sediment composed of mucus and earthy phosphates: the quantity of ammoniaco. magnesian phosphate was also very considerable. The urine upon becoming clear above the sediment, was of a faint yellow colour, and contained much carbonate of ammonia; it constantly had an alkaline reaction. The sediment for a pe- riod of eight days assumed a faint grayish-blue colour; when washed (for the purpose of separating the urine from it as com- pletely as possible,) and dried, it was treated with anhydrous alcohol, which took up the blue colouring matter, and on evapo- ration left it as a beautiful blue substance insoluble in water, but dissolving in ether with a reddish tint ; I can only compare it to Braconnot’s cyanourin. 7 Rheumatism. We have already seen that the blood in rheumatism perfectly corresponds with the blood in the true inflammations; hence we are led to infer that the urme will also present the inflammatory type—an inference confirmed by experiment. The urine in acute rheumatism, (when the reaction is accom- panied by synochal fever,) exhibits in a high degree those cha- racters of inflammatory urine which I have already so often described. The colour is sometimes deep purple-red, like claret, its acid reaction is very strongly developed, and very bulky, fawn-coloured or lateritious sediments consisting for the most part of urate of ammonia, but occasionally of crystallized uric acid, are deposited. The extent to which these properties of the urine are exhibited depends upon the violence, and the more or less synochal character of the fever. Vauquelin and Henry found free phosphoric acid, and the latter also free acetic acid, in the urine. In chronic rheumatism without fever, the characters of inflam- matory urine may be altogether absent, and instead of the earthy sediments we shall have merely a cloudiness and tur- bidity, as I have observed in my own case. The urine which I have passed during the night has frequently remained perfectly URINE. 275 clear, while that discharged in the course of the day often formed only slight deposits. As the urine in rheumatism often throws down sediments even at the height of the disease, the deposits which are formed can only be regarded as significant of a true crisis when the supernatant urine is perfectly clear. Eisenmann! remarks that the properties of the urine may un- dergo a change if the disease continues for a long time; for instance, if it should take a hypodynamic character, the urine, instead of being acid, will assume an alkaline reaction, and will give off a fetid ammoniacal odour. | When the disease takes on the hypodynamic type, without _having previously exhibited a hyperdynamic character, the urine instead of being red, is then, according to Stork’s observations, pale, frequently thick, turbid, and fetid. Becquerel has made quantitative analyses of the urine in several cases of rheumatism. He found the relative proportions of the solid constituents the same as in inflammation—a fact that had been previously observed by Henry? who found a large amount of urea in his own urine during rheumatic fever. The urine of a man aged 30 years (Anal. 1), who had been bled for acute rheumatism, was very deeply coloured, and on the addition of a little nitric acid threw down a copious sedi- ment. It also threw down a spontaneous sediment of a reddish colour after standing for two hours. The specific gravity was 1017-2. The urine of the same man was analysed another day, (Anal. 2). It was of a very dark colour, almost like blood, and had a specific gravity of 1018-0. The urine in the third analysis was taken from a man aged 38 years, whose pulse was 104 in the minute. It was of yellowish-red colour, and threw down a sediment of uric acid on the addition of a few drops of nitric acid. 7 1. 2. 3. Water . i ; 971°80 970°20 981°10 Solid constituents . ‘ 28°20 29°80 18°90 Urea : . 12°20 9:00 8:00 © Uric acid ; 1°70 1°04 0°50 Fixed salts : ; ‘ 5°59 2°34 Extractive matter : 14°70 8-00 ' Die Krankheitsfamilie Rheuma, p. 51. 2 Journ. de Pharm. 15, p. 228. 276 THE SECRETIONS: If we calculate the amount of urea and of uric acid in pro- portion to 100 parts of solid residue, we obtain 43° urea and 6° uric acid in the first, but only 312 urea, and 3°52 urie acid in the second analysis; so that in the first analysis the physio- logical average is exceeded, while in the second it is not reached, _ at least as far as the urea is concerned. In the third analysis the numbers approximate closely to the physiological average, viz. 42° urea and 2°62 uric acid. In eighteen cases of rheumatism, in which the renal secretion was examined by Becquerel, it always assumed to a greater or less degree the characters of inflammatory urine during the con- tinuance of the fever: the very deep colour was general, as also the acid reaction, except in one case, in which for a single day an alkaline reaction was observed. The mean specific gravity was 1022-6: in those cases which threw down a’ spontaneous sediment it was 1025-2. In twelve out of the eighteen cases, a spontaneous sediment was thrown down during the febrile period : these sediments usually alternated with dark but clear urine, or with urine that was precipitable by nitric acid. Albumen was detected in seven of the eighteen cases. During the period of convalescence the urine was anemic, or returned to its normal state. [The following analysis of the urine of a man aged 22 years, suffermg from acute rheumatism, was made by Dr. Baumert.’ The urine submitted to analysis was passed on the fourteenth day of the disease. It was of a deep yellowish brown colour but perfectly clear. In the course of twenty-four hours it de- posited a copious sediment of urate of ammonia, but did not become alkaline. It presented the normal degree of acidity, and its specific gravity was 1028°3. It contained in 1000 parts: Water ‘ ‘ ‘ - 928°68 Solid constituents ; : ; 71°32 Urea 3 . ; : 18°65 Uric acid : 0°86 Extractive matter with a large quantity 37-61 of hydrochlorate of ammonia . Fixed salts . ee ; 14:20 ' Archiv fiir phys. und patholog. Chemie, vol. 1, p. 45. URINE. 277 The fixed salts contained no trace of chloride of sodium, the normal amount of earthy phosphates, a slight excess of alkaline phosphates, and an augmentation of the sulphates. Hippuric acid was sought for without success. Oxalate of lime is of frequent occurrence in cases of acute rheumatism. | In chronic rheumatism, if the pains are not very acute, and the night’s rest is not disturbed, the urine retains its normal properties. Out of thirty-seven cases observed by Becquerel, the urine remained unaffected in twenty, while in seventeen it assumed the inflammatory type, and in nine of these threw down a spontaneous sediment. Gout. I have made four analyses of the urine in two cases of gout, with the view of determining the effect of benzoic acid on that secretion : Before After Before After administration. ditto. administration. ditto. Anal. 119. Anal. 120. Anal. 121. Anak 122. Water ‘ ‘ 976°73 ~ 978°84 965°25 962°43 Solid constituents ‘ 2s'27 21°16 34°75 37°57 Urea ; . 7°02 6°10 9°23 10°00 Uric acid. ; 0°50 0°48 0°58 0°60 Earthy phosphates ; 0°35 — 0°28 — Sulphate of potash ‘ 2°67 —_ 2°08 — Phosphate of soda . 1:60 a= 4°53 — Hippuric acid : — 0°65 — 0°69 If we determine the per centage of the urea and uric acid in relation to the solid residue, we find in the first case, that be- - fore the use of benzoic acid the urea amounted to 30°162 and the uric acid to 2°14°, and afterwards they amounted to 28°21 and 2:22 respectively. In the second case the urea and uric acid amounted to 26:562 and 1°66° before the use of the acid, and 26°612 and 1:59° afterwards. These analyses are insufficient to show that benzoic acid exerts any influence on the amount of urea or uric acid. The clinical experiments of Froriep and others indicate, however, that it is a valuable remedy in various forms of arthritis. Froriep! has published a notice of twenty cases of gout and ' Simon’s Beitrage, p. 294. Sie eee 278 THE SECRETIONS : chronic rheumatism in which he administered benzoic acid. During the first twenty-four hours the symptoms are always aggravated, but they usually subside on the second day. The Exanthemata. In all the acute exanthemata the urine very frequently pre- sents, as Schonlein remarks, a peculiar character, which is due, in many cases, to an admixture of bile-pigment: it has a dark- brown colour, and resembles badly-fermented beer in appear- ance. At the commencement of the crisis the urine becomes clearer, and forms a pulverulent sediment consisting of uric acid*(and perhaps urate of ammonia). In the fever which accompanies erysipelas, and is usually of an erethismic or synochal character, the urine is frequently loaded ~with bile-pigment, and is of a reddish-brown or red colour. At the urinary crisis, fawn-coloured precipitates are deposited, and the ure becomes clear. (Schoénlein.) Becquerel has examined the urine in several cases of erysipelas. When the erysipelas is accompanied by fever, as is most com- monly the case, the urine assumes the inflammatory type. Becquerel made two quantitative analyses of the urine of a man aged 39 years, who had erysipelas of the face, and a good deal of fever (pulse 112). The urine of the first analysis was of a deep yellowish-red colour, and clear; its specific gravity was 1021-0. The urine of the second analysis was so deeply coloured as to appear almost black ; it threw down a reddish sediment of uric acid, and had a specific gravity of 1023°1. The first analysis was made on the fourth, and the second on the sixth day from the commencement of the disease. These analyses gave : Anal, 1. Anal. 2, Quantity of urine passed in 24 hours, in ounces : 27°0 , 308: 23 Water ; ; : ; ‘ 965°5 961°9 Solid constituents . : : g 34°5 38°1 Urea. ‘ ; ; ; 12°5 12°7 Uric acid 5 ‘ 4 : 1:2 13 Fixed salts ‘ j ge é ns 8-2 Extractive matter Z . 3 — 15°9 In a woman aged 45 years, with erysipelas of the face, SX. URINE. 279 whose pulse was 104 and full, the urine was very scanty, of a dark-brown colour, strongly acid, threw down a yellow sediment spontaneously, and had a specific gravity of 1023-1. It contained : Water. : : 961-7 Solid constituents , : : 38°3 Urea 7 ; : - Ri:7 Uric acid : i f 1:3 Fixed salts i Z 9-2 Extractive matters : ‘ 1-7 In five cases in which the morning urine was daily examined with care, the characters of inflammation were present in a very high degree: the specific gravity varied from 1021 to 1025. In four of these cases the urine threw down a reddish sediment, and in two a little albumen was occasionally present. In scarlatina, the urine at the commencement, while there is considerable fever, is of a deep dark-red colour, and possesses all the properties of inflammatory urine. In children the urine is always less coloured than in adults, and its colour in this disease is proportionally less dark. It almost always has an acid reaction, and only exhibits a tendency to become rapidly ammoniacal, when the disease is associated with a nervous or septic condition of the system. Any sediments that may be formed consist, for the most part, of urate of ammonia and uric acid mixed with a greater or less quantity of mucus: blood-corpuscles are occasionally noticed. When the urine is ammoniacal, viscid whitish sediments of the earthy phosphates are deposited, and if there is much gastric disturbance the urine becomes jumentous. Albumen is com- monly but not always found in the urine during the period of desquamation. - Dropsy may even supervene without the urine becoming albuminous: it is sometimes preceded by the occur- rence of hematuria. Becquerel found that the urine during the febrile period was generally very high coloured, and, if severe angina was present, was very acid, and was either turbid, or became so on the addition of an acid: it frequently also formed a gray or lateri- tious sediment, and the presence of a small quantity of albumen 280 THE SECRETIONS : was by no means rare. Becquerel only observed blood in the urine in the single case of a child five and half years old, who was attacked with anasarca. In a girl whose nervous system was very much deranged during the period of the febrile in- vasion, the urine was very deeply coloured, turbid, and deposited on the sides of the vessel a copious precipitate of a bright red colour. The sediment disappeared when the eruption was fully established. Blood was frequently observed in the urme when there were symptoms of impending dissolution during the ner- vous form of scarlatina; the quantity was sometimes very consi- derable, and the corpuscles could be readily detected by the ‘microscope. The appearance of blood in this state must be distinguished from that in which it arises from a renal affection (Bright’s disease) in which Becquerel has frequently observed it, and where, in the fatal cases, the existence of Bright’s disease was proved. ‘The amount of albumen in the urine is, in these cases, constant and larger than is frequently found in inflam- matory diseases, without the occurrence of any simultaneous dropsical symptoms.' During the period of desquamation symp- toms of dropsy frequently supervene, and the urine often contains albumen, in larger amount and more continuously than is usually the case in inflammations. The observations regarding the presence of albumen during the period of desquamation after scarlatina are so contradictory that it has become a matter of very great interest to settle these conflicting statements by further researches. We have dropsical symptoms with albuminuria, dropsical symptoms without albu- minuria, and albuminuria without dropsical symptoms. Solon found albumen in the urine in twenty-two out of twenty-three cases of scarlatina, On the other hand, Philipp? observed, in Berlin where scarlatina was recently very prevalent, and ana- sarca could not be warded off, at least sixty cases in which the urine was tested both with heat and nitric acid, and no trace of albumen could be detected. In two cases of scarlatina that were being treated in Romberg’s 1 When the urine contains no blood-corpuscles visible by the microscope, dissolved hematoglobulin may be present, which can be estimated in the manner described in p. 187. * Casper’s Wochenschrift, 1840 ; No, 35. URINE. 281 clinical ward for children, and in which there were no drop- sical symptoms, I could find no albumen. In the case of a man aged 20 years, which occurred in Schénlein’s clinical wards, the urine was very albuminous during the period of desquamation, and continued so for four days without the occurrence of dropsy ; in another man, in whose urine I found no albumen, there were also no dropsical symptoms. In a boy aged 5 years, who was suffering from septic scar- latina just then at its acme, (putrid odour from the mouth and nose, and disturbance of the cerebral faculties,) the urine was of a dark-yellow colour, had an alkaline reaction, a very dis- agreeable ammoniacal odour, and threw down a dirty white sediment of earthy phosphates, urate of ammonia, and urate of soda;—the latter occurring in the form of opaque globules. The specific gravity was 1022, and about 16 ounces were dis- charged in the course of twenty-four hours. There were contained in 1000 parts : Analysis 123. Water . ‘ ‘ ‘ 943°60 Solid constituents ‘ . = 56°40 Urea 3 . ‘ 4 19°35 Uric acid . 3 : 1°69 The uric acid was combined with ammonia and soda. I ex- amined the urine of the same boy afterwards, and found that it possessed precisely similar characters: it was of a straw- colour, had an alkaline reaction, and an ammoniacal odour ; the sediment was more copious than on the former occasion, and there were considerably more of the large opaque globules, which I consider to be urate of soda. During the period of des- quamation I found a greater number of mucus-corpuscles in the sediment than is usual, but nitric acid gave no indication of albumen. The urine above the sediment remained turbid in consequence of holding in suspension a very large quantity of epithelium, which was swimming about, partly in single scales, and partly in fragments of 8-12 scales connected with each other, and all of which were acted on by some chemical agent, probably by the carbonate of ammonia in the urine. This sediment should always be sought for with as much care as albumen. It is an indication of the desquamation of 282 THE SECRETIONS: the mucous membrane, and is frequently a precursor of the desquamation of the cuticle. The tubes described as occurring in Bright’s disease are occasionally found in this form of sediment. In variola and varicella the urine changes with the various stages of the disease, and with the nature of the fever which is present. 1 Urine of a synochal character is, however, often met with, especially during the first stage of the disease, when the fever has a synochal type. : | Becquerel examined the urine of eleven persons with variola, and of ten with varicella. In a case of varicella in which the early symptoms (les prodromes) were extremely severe, the urme was passed in very small quantity, of a deep red colour, and a specific gravity of 1022-7. puke. In a case of varicella in which the early symptoms were scarcely perceptible, the urine remained normal. Schénleimn states that in the first stage of this disease the urine is often as limpid as in hysteria. During the eruptive stage, the state of the urine depends upon the intensity of the fever which accom- panies the appearance of the exanthema. In five out of the eleven cases of variola observed by Becquerel the symptoms accompanying the eruption were very severe; the urinary secretion was diminished, and amounted on an average to only 23°5 ounces in twenty-four hours. The specific gravity had not, however, increased so much as might have been supposed, being only 1020°6. It frequently threw down uric-acid precipitates, either spontaneously, or on the ad- dition of nitric acid, and im one case a little albumen was ob- served. : M. Solon found the urine coagulable in five out of eleven cases of variola. When the inflammatory symptoms, during the eruption, are slight, the urine hardly differs from the normal state. During the suppurative stage of variola, Becquerel ob- served that the urine retained the synochal character as long as’ the febrile symptoms continued, in all the eleven cases. In three of these cases which terminated fatally, it continued in this state to the last. URINE. 283 During the period of desquamation the urine is either normal or anemic. Becquerel states that although the urine during desquamation after variola resembles, in its chemical constitu- tion, the urine during desquamation after varicella, it differs in respect to colour, the former being of a greenish, the latter of a yellowish tint. According to Schénlein, in the first stage of variola it is of a reddish brown tint; on the third or fourth day a sweat of a peculiar and strong odour is observed, and the urine contains a turbid, apparently purulent, mucous sediment, of an unpleasant odour. During the period of suppuration sediments, and frequently purulent mucus, are thrown down. In the nervous form of variola the urine is even more changeable, being sometimes spastic, and sometimes dark. In the putrid form the urine appears decomposed, ammoniacal, and not unfrequently of a dark red colour from the presence of heematin. | Scrofulosis. The urine of children with the scrofulous diathesis differs considerably in the majority of cases from the normal secretion. It is usually pale, but if there is much vascular excitement it becomes more or less deeply coloured ; its specific gravity is lower than in a state of health, and in many cases it is much more acid than the urine of children is generally observed to be; it has, however, been found neutral.! I have found the urine of rickety children only slightly acid, and once, after it had been passed some hours, it had an alkaline reaction. There are differences of opinion with regard to the nature of the free acid ; some state that it is phosphoric acid, others hydrochloric acid, while others, again, are of opinion that it is lactic acid. The urea and uric acid are frequently found to exist in a di- minished proportion ; on the other hand, the salts, especially the phosphates, are increased; moreover, we not unfrequently find in the urine of scrofulous children an acid which is foreign to the normal organism, viz. oxalic acid. According to Schénlein, the principal chemical changes in the urine of scrofulous persons consist in the diminution of the 1 Stark Allg. Patholog. p. 1147. 284 THE SECRETIONS: nitrogenous constituents,—the urea and uric acid, and in the appearance of the non-nitrogenous oxalic acid, and occasionally but more rarely of benzoic acid. The acids are frequently so abundant that the urine, upon cooling, deposits copious sedi- ments of the oxalates, and these sediments sometimes form renal and vesical calculi within the organism itself. The fre- quent occurrence of oxalate-of-lime or mulberry calculi in chil- dren is well known; indeed, Prout is of opinion that half the stone-cases occur hefore the full age of puberty. Becquerel has examined the urine in many cases of scrofula, in some of which it showed itself in the form of caries, ne- crosis, &c. ; while in others it appeared in suppuration of the glands. A number of these children were in an anemic state, while others were apparently in good condition; in the former cases the urine was anzmic, in the latter it was normal. The specific gravity varied from 1010 to 1022. The lowest specific gravity occurred in the anemic cases. The colour was lighter than that of normal urine, and was frequently of a greenish tinge; the degree of acidity varied extremely, the urine fre- quently becoming alkaline after a very short time. No uric- acid sediments were observed, either spontaneous, or after the addition of an acid. When febrile symptoms were combined with those of scrofula, the urea approximated to the inflamma- tory type; its specific gravity became higher, (the average of twelve cases being 1026,) the colour deeper, it had a very acid reaction, and threw down a sediment of uric acid. In scrofulosis of the osseous tissue or rachitis the urine varies very much in its composition from the normal type. These deviations principally consist in the diminution of urea and of © uric acid, and in the increase of the salts. The colour of the urine is generally either pale, or else it differs but little from the normal appearance; the free acid sometimes increases to an extraordinary degree, and some (Fourcroy) maintain that it is free phosphoric acid. The phosphates exceed the physiolo- gical average, and moreover a considerable sediment of oxalate of lime is byno meansrare. This extraordinary and morbidly- increased capacity of the kidneys for the removal from the blood of those salts which are so essential for the structure of the osseous tissue, and the consequent tendency to the formation of calculi in rachitic children, is regarded by Walther as a URINE. 285 vicarious act of the kidneys in connexion with the formation of bone. The urine of a child aged 5 years, who was being treated. for rachitis in Romberg’s clinical ward for children, was sent: to me for analysis. It was of a pale yellow colour, turbid, and neu- tral; its specific gravity was 1011. As the determination of the salts was the principal object that I had in view, it was allowed to stand for two days before the analysis was undertaken; hence the determination of the urea may not have been perfectly ac- curate. The urine in the other analyses was passed by chil- dren aged 3 and 4 years respectively. It was much about the same colour as, or perhaps rather darker than in the first case, was slightly acid, and the specific gravity varied from 1015 to 1020. The proportion of the most important constituents was found as follows : Anal. 124, Anal. 125. Anal, 126. Anal. 127. Water ‘ ‘ - 978-40 968-50 964-90 962°80 Solid constituents. ‘ 21°60 31°60 35°10 37°20 Urea. F ‘ 3°50 6°70 6°17 7°36 Uric acid ‘ : =) 0°26 0°35 0°26 Fixed salts ‘ : 8°53 8:60 14:71 16°70 Phosphate of soda ‘ /2°82 4:0] 4°27 3°74 Sulphate of potash : 1°90 1°80 1°31 ' 1°80 Earthy phosphates ‘ 0°48 0°52 0°58 — On calculating the ratios of these constituents to 100 parts of solid residue, and comparing them with those that occur in healthy urine, we find that the quantity of urea has con- siderably decreased, while that of the salts is increased. In analyses 124, 126, 127, the increase of the fixed salts is very considerable, especially of the phosphate of soda and earthy phosphates. In analysis 125 this increased ratio is less striking. 100 parts of solid residue contain : Anal. 124. Anal. 125. Anal.126. Anal. 127. Normal Urine. Urea F ‘ 16°1 21:2 17°6 19°8 39°0 Uric acid é ; — 0°8 Pos OY 15 Fixed salts. =e 39°4 27°3 41°8 44°8 25:0 Phosphate of soda ‘ 13°0 12°7 12°1 10°0 10°0 Earthy phosphates ; 2-2 1-6 1°6 — 15 Sulphate of potash > 8°7 5°7 3°8 4°8 8:0 1 The uric acid was not determined. % 286 THE SECKETIONS : In order, however, to arrive at a correct conclusion from these figures we must bear in mind that the urme of children natu- rally contains a less proportion of urea and of salts than the urine of adults. In osteomalacia the urine is much the same as in rachitis ; it is very acid, and often contains an excessive amount of earthy phosphates. [Marchand! analysed the urine of a child with osteomalacia three days before its death. The fluid was invariably acid, and contained in 1000 parts : Water ve : . 9382 Solid constituents é 3 a 61:8 Urea i ¥ ‘ . 27°3 Uric acid ; ; : 0-9 Lactic acid and lactates é 5 14-2 *, = Phosphates of lime and magnesia ; 57 Other substances, and loss ‘ ; 13°7 The earthy phosphates in this instance are five or six times as abundant asin health. In one of the cases recorded by Mr. Solly,? there was found in the urine between three and four times the amount of phosphate of lime that occurs in the healthy secretion. | Tubercular pulmonary phthisis. In tubercular phthisis the urine varies in accordance with the progress of the disease and the degree of fever which is present. I have observed in the majority of cases that after the febrile symptoms have become continuous the urine has assumed the inflammatory type; that is to say, it is not so deeply coloured as at the height of acute inflammation, but is’ of a yellowish brown colour, has a tolerably acid reaction, and is above, or at any rate attains the ordinary specific gravity. _ In the early stages of the disease I have not found the urine to differ much either in colour, density, or acidity from the normal secretion. I have only observed that form of urine to ' Lehrbuch der physiolog. Chemie, p. 338. ? Transactions of the Medico-Chirurg. Society, p. 448, 1844. URINE. 287 which the term anemic has been applied when considerable hemoptysis has occurred in the second or third stage. After hemoptysis the urine is generally turbid, and for the first day or two throws down slight sediments of urate of ammonia; it afterwards becomes pale and clear, and continues acid, gradually returning to its normal state. When the febrile symptoms be- come continuous and the colliquative stage has fairly commenced, I have found the urine approximate in its composition to the urine of inflammation. Becquerel has examined the urine in a great number of phthisical cases, When the disease is progressing beyond the first stage, the urine is often of higher specific gravity, darker, and secreted in less quantity than usual,—a symptom that the tubercles are extending, and that a state of continuous fever is supervening. The subsequent phenomena of the morning sweats and colliquative diarrhoea further contribute to the con- centration of the urine. When, however, a state of decided asthenia has been brought on by these extraordinary drains upon the system, it rapidly assumes opposite properties, and becomes anemic. Thus the urine of a woman, in whom the tubercles ‘were beginning to soften, and who had at the same time certain symptoms of disease of the heart, was found by Becquerel to amount to 20 ounces in twenty-four hours. It was of a deep yellow colour, threw down a sediment of uric acid, had a specific gravity of 1022-2, and 1000 parts contained 36:5 of solid residue. | In a woman in the third stage of phthisis with great pros- tration of strength, the urine, three days before her death, was of a deep colour, acid, and threw down a spontaneous sediment. The specific gravity was 10147, and 16-2 ounces were discharged in twenty-four hours. 1000 parts contained : Water : 3 975°95 Solid constituents ‘ : 24:05 Urea : : ; 9-00 Uric acid 5 - ~ 1°25 In another precisely similar case the urine, three days before death, was of a deep colour, acid, and threw down a sediment spontaneously. The specific gravity was 10147, and there were only 7°2 ounces passed in twenty-four hours. 288 _ THE SECRETIONS: 1000 parts contained 24°25 of solid residue, of which 9-01 was urea, and 2:2 uric acid. In the first of these cases the urea amounted to 37:42 of the solid residue, and the uric acid to 5:12; in the second the urea amounted to 37-22, and the uric acid to 9°,—proportions which, as far as the amount of urea is concerned, approximate to those of inflammatory urine. An analysis of the urine of a man aged 30 years, who was in the colliquative stage of tubercular phthisis, gave very similar - results, except as regards the specific gravity. The urine was brown and turbid, had a very acid reaction, and deposited a purulent-looking yellow sediment of urate om ammonia. The specific gravity was 1026-6. 1000 parts contained :- Analysis 128. Water 2 ; : 935°92 Solid constituents ; : 64:08 Urea ; A 3 23-90 Uric acid. é : 2°40 Fixed salts . i : 10°85 Of these 10°85 parts of fixed salts 1:3 were earthy phos- phates, and the sulphates formed only a small part. The urea amounted to 37:32, and the uric acid to 3°72 of -the solid con- stituents, the urea being as nearly as possible the same as in Becquerel’s analyses. The increase of uric acid is of great interest; it is particularly striking in Becquerel’s analyses: other observers have noticed this fact in adults sufferimg from tubercular phthisis, and Schonlein, moreover, has directed attention to it. [I am indebted to Dr. Golding Bird for the following case. A man aged 24 years, in the early stage of phthisis, (tubercular depositions but no cavities,) passed in the course of twenty-four hours, forty-five ounces of urine of specific gravity 1020. The water amounted to . ‘ - 19125 grains. The solids : ; : i 936 Urea ; : - . 328°5 Uric acid. : ; 3 4°5 ] In renal and vesical phthisis the urine contains a ereaies or less quantity of pus. It is usually pale, turbid, and very quickly takes on an alka- line odour, especially in phthisis vesice, in which, even on URINE. 7 289 emission, it is ammoniacal, and of an unpleasant odour. . The pus is sometimes mingled with blood. That the clear filtered urine always contains albumen may be shown by the addition of nitric acid, or by the application of heat. The urine immediately on its discharge is turbid, but on being allowed to rest, the pus separates in a clearly-defined layer at the bottom ; on shaking, it easily mixes again with the urine, and if that fluid have an alkaline reaction the pus becomes tough and fibrous. Pus-corpuscles may be detected by the microscope, and if the urine has an alkaline reaction they will be mixed with crystals of the ammoniaco-magnesian phosphate and with an amorphous precipitate of phosphate of lime. In order to determine with certainty whether a uriary sedi- ment consists of mucus or of pus, urine which has been just discharged should be examined: the rapid descent of the pus- corpuscles from urine which is turbid at the period of its dis- charge, and the formation of a sediment which is frequently discoloured, or mixed with blood, together with the presence of a considerable amount of albumen in the urine, leave no doubt respecting the diagnosis. (See page 202.) Diabetes mellitus. In diabetes mellitus it is well known that the urine undergoes a very peculiar change ; it contains a certain quantity of sugar which, in its ultimate constitution is perfectly identical with grape-sugar, and in consequence of which the urine possesses the property of deflecting the polarized ray to the right. Dia- betic urine differs moreover in its physical relations from the normal secretion ; it is paler, has a turbid wheyish appearance with a greenish dings, and a higher specific gravity,—according to Willis, from 1025 to 1055. Henry drew up a table for the determination of the solid constituents of diabetic urme by the mere application of the urinometer. ‘The results, as far as my experience goes, come sufficiently near to the truth to give fair approximate values ‘to the solid residue from the specific gravity. G. O. Rees recom- mends the table, having confirmed it by his own experiments ; I have somewhat extended its limits, and shall give it here. II. 19 290 THE SECRETIONS: Spec. grav. Solid residue Spec. grav. Solid residue at 60°. in 1000 parts. at 60°. in 1000 parts. 1005 11°7 1028 69°1 1006 14:2 1029 71°5 1007 16°7 1030 73°9 1008 19°2 1031 76°4 1009 21:7 1032 78°8 1010 24°2 1033 81:4 1011 26°7 1034 83°9 1012 29°2 1035 86°4 1013. 31:7 1036 88°8 1014 34°2 1037 91°3 1015 36°7 1038 93°8 1016 39°2 1039 96°3 1017 41°7 1040 98°7 1018 442 1041 - 101°2 1019 46°7 1042 103°7 1020 49°2 1043 106°2 1021 51°6 1044 108°7 1022 54°1 1045 111-1 1023 56°7 1046 113°6 1024 59°1 1047 11671 1025 61°6 1048 118°7 1026 64:0 1049 121°2 1027 66°5 1050 123°6 [In my paper! on the specific gravity of the urine in health and disease (founded on 200 observations), I have shown that Christison’s formula, A x 2°33, gives more correct results than the above table. A indicates the excess of the specific gravity over 1000. Thus, supposing it is desired to ascertain the amount of solid matter in 1000 parts of urine whose specific gravity is 1035, A is here represented by 35, and 35 x 2°33=81°55, the required number. | According to Schénlein there is no sugar in the urine in the first stages of the disease, but albumen; and as the albumen subsequently disappears the formation of sugar in the urine commences. | The quantity of ure increases in an extraordinary degree. P. Frank mentions a case in which fifty-two pounds were dis- charged during twenty-four hours. According to Bouchardat, * ! Lancet, June 15, 1844. URINE. | 291 the average quantity discharged in the course of the day amounts to from ten to seventeen pounds. Opinions regarding the composition of the urine are very contradictory, and sufficient analyses have not yet been insti- tuted to enable us to regard any one view as positively correct. Some assert that as the sugar increases in the urine the urea and uric acid decrease, while others maintain that although the absolute quantity of urea in a given amount of urine is actually diminished, yet that on account of the large quantity of urine discharged, the amount of urea is not less than, and in fact exceeds the normal average. Thus M‘Gregor shows that the urine of twenty-four hours in one case of diabetes contained 1013 grains of urea; in_another case he found 945 grains, in a third 810 grains, and in a fourth 512 grains, whereas, according to the same authority, the quan- tity excreted by a healthy person in twenty-four hours does not exceed from 362 to 428 grains. Kane also found in diabetic urine as large a proportion of urea as in the normal secretion. My own analyses certainly tend to show that the ratio of urea to the solid residue is always much less than in health, and that this ratio is diminished in proportion to the increase in the quantity of the sugar; bearing in mind, however, the increased secretion of urine, it is very possible that in some cases the urea is not absolutely diminished: the apparent connexion between the urea and the sugar may then be simply explained by the mere increase of the sugar, which, by increasing the solid residue, causes a relative diminution of the urea.' The same is probably the case with respect to the uric acid ; when no crystals of uric acid are separated after the addition of free hydrochloric or nitric acid to diabetic urine, the cause may lie in the proportion 1 Tn connexion with this subject, we may refer to the experiments of Henry. On mixing the residue of six quarts of diabetic urine with the residue of one quart of healthy urine, and adding nitric acid, only a small quantity of nitrate of urea was obtained after the mixture had stood for twenty-four hours; and on mixing the re- sidue of eight quarts of diabetic urine with that of one quart of healthy urine, and treating it in a similar manner, not a crystal of nitrate of urea could be observed after it had stood for forty-eight hours. Hence it is indispensably requisite that the sugar should be first removed (as completely as possible) before we attempt to determine the urea. 292 THE SECRETIONS : of water being so large as to retain the uric acid in solution. I have frequently observed this to be the case, for on the ad- dition of free hydrochloric acid to the urine no uric acid has been separated, when upon treating that portion of the residue of the urine which is insoluble in alcohol with nitric acid, I have always obtained the red colour which is characteristic of uric acid. Becquerel, however, has observed a spontaneous sediment of uric acid thrown by diabetic urine. | [In this country a sediment of uric acid is by no means rare ; I have observed it in at least six cases, usually in the form of bright yellow lancet-shaped crystals. | I have observed cases in which I have convinced myself that the absolute quantity of urea was diminished. A man aged 52 years, treated for diabetes mellitus in our hospital did not pass more than from two to two and a half quarts of urine in the twenty-four hours. In its external ap- pearance it was perfectly normal ; it contaimed, however, 8°63 of sugar, and only 0°026° of urea, so that while a healthy man excretes about an ounce of urea in the twenty-four hours, in this case there were only thirteen grains excreted in an equal time. In another man who was being treated by Dr. Lehwess, and who indulged freely in sugared drinks, the quantity of urine in twenty-four hours amounted to between four and five quarts, and contained mere traces of urea. The urine was very pale and turbid, its specific gravity was only 1018, and it contained 42° of solid residue, 3°9 of which were sugar. After the dis- continuance of the sugar, and the adoption of a proper diet, the specific gravity became lower and the urine contained as much urea as constituted a fifth part of the solid residue: the sugar had also decreased to one half its original amount. — Subsequently the sugar almost entirely disappeared from the urine ; the urea, on the other hand, had increased to such an extent as to constitute a third part of the solid residue. Bostock is of opinion that diabetes mellitus is not unfre- quently preceded by a diseased condition, (in fact a kind of diabetes,) during which a large quantity of urine very rich in URINE. 293 urea is excreted. As the diabetes becomes developed the urea gradually diminishes as the sugar increases. Willis! states that the urine is occasionally rather turbid on emission, and has then been found to contain a quantity of albuminous matter in the caseous form. According to Schénlein the urine during the early stage of diabetes contains albumen, and in proportion to its increase the urea diminishes: in the second stage the albumen disappears either totally or partially, and sugar takes its place. I have only detected albumen in two cases of diabetic urine, viz., in the case to which I have already referred, in which I analysed the urine at a time when the patient took a good deal of sugar in his drink ; in this case, however, the disease had made consi- derable progress: and in the urine of a girl a few days before her death ; in this instance it existed in considerable quantity, amounting to 0:22 of the urine, or 3°72 of the solid residue. Brett? found casein and butter in a case of diabetic urine. Diabetic urine sometimes contains an insipid species of sugar, which, however, according to Bouchardat,*? corresponds in all other properties with the ordinary sweet diabetic sugar, pos- sessing the capability of fermenting, and being convertible by acids into sweet sugar. I have had only one opportunity of observing sugar of this nature. | A girl with diabetes mellitus discharged an abundant quan- tity of very saccharine urine, and the sugar which was obtained from it had all the properties of grape-sugar. Subsequently the strength of the patient, which had been long giving way, decreased to such an alarming extent as to cause apprehensions of her speedy dissolution. Two days before her death the urine was again sent to me for examination; and I was not a little surprised to find in it a perfectly tasteless sugar soluble in hot spirit, and mixed with a considerable quantity of a gummy matter insoluble in spirit which, on the application of heat, emitted a peculiar odour not unlike that of burned paper. The salts in diabetic urine are stated by Gueudeville, Bostock, ' Urinary Diseases and their Treatment, p. 200. * London Medical Gazette, July, 1836. * Revue Médicale, 1839. 294 THE SECRETIONS : and Henry, to be diminished, while they retain their normal proportion to each other. I have found the amount of earthy phosphates not much below the normal average. Lehmann! was the first who directed attention to the occurrence of hippuric acid in diabetic urime: it has since been detected by Ambrosiani, Miller, and very recently by myself. I obtained it in the same manner as Lehmann did, from the etherial solution of the dried residue: after evapora- tion there remained a slight brownish-yellow residue, in which, with the help of the microscope, I observed heaps of long acicular crystals. The residue was warmed with a few drops of _ a weak solution of potash, which neutralized the acid reaction, — and the solution was then filtered. On the addition of a solu- tion of perchloride of iron a cinnamon-yellow precipitate was obtained, which on being warmed contracted itself into red floeculi. wis On allowing diabetic urine to stand for a considerable time a sediment forms which consists for the most part of fermenta- tion-globules. If the urine above this sediment is allowed to remain for some time longer at a suitable temperature, it begins to undergo fermentation. I have frequently observed the fer- mentation-globules, and have represented them in fig. 35. I have made several minute analyses of the urine in diabetes mellitus. The three following analyses were made with the urine of a man aged 50, to whose case reference has been pre- viously made. The first analysis was made at a time when the patient indulged freely in sugared drinks. The urine then contained a mere trace of urea. After the patient had been properly dieted for some time, I obtained the urme for the second analysis, which in its results differs very little from the first. Eight days from this time I again analysed it, and found that the sugar had almost entirely disappeared. About three months afterwards I received some more of his — urine for analysis; it was then very rich in sugar, while urea was present to only a very small amount. Albumen was only detected in the urine of the first analysis. Uric acid was always present, but only in very small quantity. : 1 Journ. fiir prakt. Chem. vol. 6, p. 114. ae URINE, 295 Anal. 129. Anal. 130. Anal. 131. Specific gravity : ‘ . 1018-00 1016:00 1007:00 Water. 4 Pais . 957°00 960°00 982-00 Solid constituents . ; ; 43°00 40°00 18°00 Urea . ° : ; traces 7°99 4°63 Uric acid x ; a traces a trace a trace Sugar ; 39°80 25°00 a trace Extractive matter and salta” i 2°10 6°50 8°60 Earthy phosphates ‘ , 0°52 0°80 1:00 Albumen was present. The urine of the first two analyses was of a pale-yellow co- Jour, and slightly acid ; in the third case it was as clear as water, and produced. no change on test paper. The two following analyses were made with the urine of a girl aged 20 years, who was being treated for diabetes mellitus in Prof. Wolff’s clinical wards. The first analysis was made eight weeks before the second ; I made an analysis of the blood at the same time. (See Analysis 42, Vol. I, page 327.) The second analysis was made two days before death; it re- vealed the fact that the diabetes sapidus had changed into dia- betes insipidus ; moreover, at this period, the urine contained a considerable quantity of albumen. Analysis 132. Analysis 133. Specific gravity : j ‘ 1032-00 1021-00 Water : j . i 921-85 947-20 Solid constituents. : r 78°15 52°80 Urea. ee ‘ ‘ 0°54 1°47 Sweet sugar : : : 72°00 — Insipid sugar ‘ F : — 27°61 Extractive matter and salts ; 4°20 2°80 Earthy SRT RY : : 0°92 0°40 Albumen ; : — 2°00 Gummy matter . — 17°30 Analysis 1384 was made otk the urine of a man aged 52 years, who was being treated in Schonlein’s clinical wards for diabetes. The urine was not passed in very large quantity, but it con- tained a remarkably large proportion of sugar. The composi- tion of the blood, which also contained sugar, is given in Analysis 41, Vol. I, page 327, Analysis 134. Specific gravity : : z 1036-00 Water ‘ j ‘ : 909°60 Solid constituents : P . 90°40 Urea : : : ; 0°26 Uric acid : ; j a trace Sugar : 3 ; 86°30 Extractive matter and salts . : 2°10 Earthy phosphates’. ; ‘ 150 296 THE SECRETIONS: I have recently had an opportunity of making a careful ex- amination of the excretions of a diabetic patient. He was a man aged 40 years, who had suffered from intense thirst and had observed a great increase in the amount of his urine for the pre- _ceding ten months. At the period of his admission into the hospital, the colour of his urine was normal, and an acid reac- tion always observed, which, however, became more decided some time after emission: in the course of ten or twelve hours it usually became turbid, and deposited a light viscid sediment consisting of amorphous urate of ammonia and mucus-corpuscles; on two occasions (during the use of a very animal diet) crystals of uric acid were noticed in the sediment. During the period of my investigations I never detected albumen in the urine. The specific gravity varied from 1039 to 1030. It was highest at the commencement of the treatment. On admission the daily amount of urine averaged nearly five quarts, but while under treatment it was reduced to three quarts. The daily amount of sugar gradually diminished to one third, but was never so thoroughly reduced as to afford hopes of a permanent cure. ‘The daily excretion of urea was at first much diminished, but subsequently reached the healthy average. Uric acid was always present, but not in so considerable a quan- tity as would have been found in the urine of healthy persons living on a similar diet. The amount of fixed salts varied con- siderably, but was always larger than in a state of health. After the use of the ordinary hospital diet for a few days, he was placed on a very nitrogenous diet, consisting of beef-tea, eggs, meat, milk, and white bread. Subsequently coffee was substituted for the milk, and the amount of bread diminished. And still later gluten-bread containing only one-half the amount of starch, but three times the amount of nitrogenous matter, was given in its place. During his last three weeks he consumed daily, one pound of gluten-bread, two of beef from which a quart of beef-tea had been made, besides a quarter of a pound of ordinary boiled beef, three or four ounces of roast veal, six eggs, and two quarts of coffee prepared from an ounce of the beans. Although this quantity was (according to his own statement) sufficient to satisfy his hunger, he was occasionally detected in appropriating the farinaceous diet of other patients. With regard to medical treatment, opium and its various compounds were first given ; FE URINE. 297 hewas then treated with astringents, the nitrogenous diet being at the same time increased, and the saccharine and farimaceous mat- ters diminished. After this course had been pursued for some time without any decided benefit, he took daily two ounces of cod-liver oil, and after this had been continued for twelve days, - he took, additionally, four grains of iodide of iron. Finally, (these medicines being continued) the gluten bread was or- dered, and the milk and white bread stopped. Under this treatment the daily amount of sugar fell from twelve ounces to seven and three-quarters ; it subsequently, however, rose to nine ounces and one drachm. The urea, which on his admission amounted to only three drachms in twenty-four hours, was now increased to one ounce and three drachms, and the uric acid rose from a mere trace to twelve grains. During this course of treatment the digestion seemed good, the thirst diminished, and he occasionally perspired consider- ably ; he had become, however, very emaciated. The saliva was slightly alkaline, and I examined it for sugar unsuccessfully. Sugar was, however, detected in the perspiration. The an- alysis of his feeces will be found in Chapter X. In the determination of the sugar and urea there are certain difficulties which I shall briefly notice. On treating diabetic urine evaporated to the thickness of a syrup with warm spirit, the mucus, uric acid or urates, and earthy phosphates are pre- cipitated. On evaporating the filtered spirituous solution to the consistence of a thin syrup, and adding anhydrous alcohol, - an insoluble semifluid mass separates, which, when repeatedly treated with anhydrous alcohol, becomes finally thick and tough. On dissolving this saccharine mass in warm spirit, and again precipitating it by anhydrous alcohol, it will still be found to contain a certain amount of urea; in fact, I have detected urea after the operation has thrice been effected, and I find that sugar can only be obtained free from urea by allowing it to crystallize spontaneously from its spirituous solution. In con- sequence of the difficulty of separating these substances, I pro- ceed in the following manner: the solid residue of the urine is first accurately determined ; a weighed portion of urine is then evaporated, mixed with spirit, and the solution filtered. The filtered solution is evaporated to the consistence of a syrup, and, when cold, mixed with a sufficient quantity of concentrated 298 THE SECRETIONS: nitric acid to allow of a few drops remaining on the surface of the crystalline mass. It must then be submitted to a low tem- perature, and the crystals placed on blotting paper and com- pressed till they cease to communicate moisture. The fixed ‘salts must be determined from a separate portion of urine. If we deduct from the known quantity of solid residue the portion insoluble in spirit (from which the uric acid is determined), the urea, and the fixed salts, we obtain, as the difference, sugar and alcohol-extract which appears to decrease in diabetic urme in ~ proportion as the sugar increases. The following are the special results of my analyses of the urine of this man. No. 135 represents the analysis of the urine before the com- mencement of the animal diet ; No. 186, shortly after its com- mencement; No. 137, during the same diet, shortly before the use of the cod-liver oil; No. 138, after the oil had been taken for eight days; No. 139, after the iodide of iron had been used for eight days; No. 140, after the gluten-bread had been tried for eight days; No. 141, two days subsequently to the preceding analysis, there being a considerable increase in the secretion. In twenty-four hours there were discharged : Anal. 135. Anal. 136. Anal. 137. 43 quarts 3 quarts 4 quarts Specific gravity . . 1037-1 1038-9 1029-7 Solid constituents . ; 14°5 oz. 9°9 oz. 10°0 oz. we lg aoe gap } 12'5 ,, 7-5 ,, 85 ,, Urea , ; ; 3 drachms 5 drachms 7 drachms- Uric acid | ‘ ‘ -— 5 grains 8 grains Fixed salts ; a — 6 drachms Anal. 138. Anal. 139. Anal, 140. Anal. 141. 4 quarts 4 quarts 34 quarts 45 quarts Specific gravity . - 1030-2 1030°4 1032°37 1032°97 Solid constituents 4 10°5 oz. 10°5 oz. 10°2 oz. 12°5 oz. Sugar and extractive Mm a ‘| 8°9 ,, 7°25 5, 8h 4 9°6 5, Urea as ; ‘ 7°8 drs. 10°0 drs. ~ BY 54 L°Si55 Uric acid : : 10 grs. —_ 5 grs. 15 grs. . Fixed salts. : 6 drs. 8 drs. 6°8 drs 1 oz. 9 grs. The composition of the urine appears from my observations to undergo a rapid modification as soon as there are decided indications of convalescence. The sugar decreases to a very > ‘URINE. | 299 great extent, and is replaced by albumen, a substance of fre- quent occurrence at the commencement of the disease, and apparently alternating with the sugar. When the sugar is no longer perceptible to the taste (either in the urine or in the spirit-extract), it can always be readily detected by Trommer’s test. I usually take a test-tube of about seven inches in length, fill three fourths of an inch of it with urine, and heat it with zss or Dij of carbonate of potash ; I add five or six times the volume of spirit of ‘845, and again boil; a few drops of a solution of sulphate of copper are then added, and heat again applied. If much sugar is present, the reduction of the oxide of copper to a state of sub-oxide occurs very quickly in the lower stratum of solution of carbonate of potash, and the fluid becomes of a yellow, red, or copper colour ; if the quantity of sugar is very small, the reduction still takes place, but much more gradually. If, however, no sugar is present, the solution of potash remains of a blue or blueish-green colour. I have recently analysed a specimen of diabetic urine con- taining only a very small amount of sugar, although previously that constituent had been present in large quantity. A short time previously to the last analysis, no sugar could be detected, but albumen was present. The urine passed at different periods of the day was analysed separately. The quantity of urine passed between noon and evening contained most sugar, and was most abundant; that passed during the night contained the least. The three analyses gave the following results : Anal. 142. Anal. 143. Anal. 144, Urine from Urine during Urine from Noon the early Morning till Evening. Night. to Noon, Quantity of urine : : 34°3 02. 6 02. 10°7 oz. Specific gravity . é - 102602 1024°38 1027°76 In 1000 one there were contained : Water - 943°00 946°43 934°47 Solid counties G : 57°00 53°57 65°53 Urea : - : 14°12 17°50 16°21 Uric acid - ‘ 0°34 0°80 ~ 0°50 Chloride of sodium, with a little carbonate and ‘sulphate of 11:27 8°60 10°50 soda Alkaline sulphates and phosphates 5°80 4°65 5°70 Earthy phosphates. 1:20 0°80 0°90 Extractive matters, with am- 24°51 21:94 32°18 monia-salts and traces of sugar ; : % 300 THE SECRETIONS: The whole amount of the different constituents discharged in twenty-four hours was as follows : Solid constituents : : . 30z Urea : ‘ 365 gers. Uric acid , . ‘ . 11-2 grs. Fixed salts. ‘ F ; 425 grs. Extractive matters ; ‘ - loz. 139 grs. (The followimg analysis of diabetic urine has been made by Dr. Reich.! The particulars of the case are not recorded : Water ; i - 907-88 Solid constituents : ~ 98-12 Urea ; ; : 8°27 Hippuric acid ‘ ‘ 0-04 Sugar ° : ‘ 56°00 Water-extract ‘ : 5°60 Alcohol-extract : ; 16°36 Mucus re . : 0°54 Albumen 4 : ; 0°58 j Chloride of potassium . 3 0°30 Se Chloride of sodium ; J 0-84 Chloride of ammonium : 0°66 Sulphate of potash : . 0°26 Phosphate of soda a ‘ 2°15 Phosphate of lime : , 0°46 Silica g 0°86 The hippuric acid was determined by evaporating the urine to one eighth of its volume and treating it with hydrochloric acid, when that constituent was thrown down as a white deposit. An instance in which diabetic urine occurred in a state of extraordinary concentration has been observed by Bouchardat. Its composition is given below. The three other analyses were _ made by Dr. Percy; the cases are fully recorded in the London Medical Gazette for 1844. : Bouchardat. Percy. en ee ITEEE = Spec. grav. 1042-00 1035-00 10°39 Water : ; 837°58 894-50 918°30 898-90 Solid constituents 162-42 105-50 81°70 101-10 Urea ast ; 8°27 12°16 30°32 2°39 Uric acid : —_— 0°16 0°26 not isolated Sugar ; ‘ 134-42 40°12 17°15 79°10 Extractive matters and salts 20°34 06 32°59 19°52 Earthy phosphates . 0°38 aS 1°30 0-09 ] Lehmann? has made two minute analyses of diabetic urine ; he found neither albumen, urea, nor uric acid in it, but a ' Simon’s Beitrage, p. 545. * De diabetica urina. Dissert. inaug. URINE? 301 considerable amount of hippuric acid. The urine of a man aged 18 years had a specific gravity of 1029-5, was pale, when fresh, had a milky smell, and subsequently became acid. The solid constituents amounted to 62°05, of which 58°15 were sugar. Ether took up 0°187, which was chiefly hippuric acid. . The urine of a man aged 38 years was turbid, of a straw colour, contained neither albumen, urea, or uric acid, had a specific gravity of 1028°5, and contained 56°24 of solid constituents, of which 50:9 were sugar. There were also found 0°31 of hippuric acid, 0°169 of salts soluble in alcohol, 0°21 of water-extract, 0:39 of salts soluble in water, 0°31 of salts insoluble in water, and 0°23 of mucus. An interesting case of diabetes in a girl aged 8 years was observed by Cantin.! The urine which she discharged was of a blue colour, and impregnated with sugar. The colouring matter appeared to possess the properties of Prussian blue. Diabetic urine has been observed in children as well as in adults, and during the period of puberty. The female sex is not exempt from this disease. It is impossible in the present state of our knowledge on this subject to state with certainty in what part of the system the ’ sugar is formed, which is produced and excreted in such ex- traordinary quantity. It is either directly formed in the chy- lopoietic system or it is produced in the peripheral vascular system, or it is generated by a morbid action of the cells of the kidney, or finally its origin may be due to a combination of these agencies. To decide this point satisfactorily, (and for the science of medicine it is most important that it should be decided,) the following points should first be established by experiments: on a sound and certain basis : (1.) Is the correspondence of the absolute diminution of the urea with the absolute increase of the sugar, an invariable rule? (2.) May not the nitrogen be removed from the system in some other way, probably in the form of ammonia-compounds ? (3.) Do the other secretions undergo a change, especially the bile? (4.) Does the air which is exhaled from the lungs differ in its composition from that which is expired by healthy persons? ' Journ. de Chim. Méd, vol. 9, p. 104. 302 THE SECRETIONS: (5.) Do the kidneys, liver, or lungs undergo any change ? and if so, what is their nature? If the connexion between the appearance of the sugar and the diminution of the urea is constant, that is to say, if, without exception, the urea invariably decreases in the same ratio as the sugar increases, then we must assume with Berzelius, that in place of the metamorphosis of the protein-compounds into urea which occurs as a normal process, these compounds are in this case, from certain causes which are unknown to us, transformed into sugar, ammonia, and perhaps into nitrogenous extractive matters. This hypothesis is, however, opposed by the facts which were observed by M‘Gregor: in his cases the daily secretion of urea equalled, and in fact exceeded the healthy average. It has been established by the researches of Rollo, Bouchardat, myself, and others, that the blood really contains sugar. It exists, however, in an extremely minute quantity, and my own observation confirms the remark of Bouchardat, that it is most abundant a short time after meals: the blood of a girl in whom the disease had made considerable progress, when taken before a meal, exhibited a mere trace of sugar. Hence we are led to infer that the formation of sugar occurs in the chylopoietic viscera alone, or there and in the blood simultaneously. From experiments made by M‘Gregor,' he infers that the sugar is formed in the stomach alone. After having con- vinced himself of the existence of sugar in diabetic blood by having induced fermentation, he sought for, and found it in the matters vomited both by a healthy man and a diabetic pa- tient, three hours after dinner. Upon treating the healthy man and the diabetic patient with an initiatory course of emetics - and purgatives, and then for three days feeding them with no- thing but beef and water, no sugar was found in the matter vomited by the healthy man, whilst there was still sugar in the other case. M‘Gregor also found sugar in the feces of diabetic patients: no sugar was, however, found in the sweat. It is well known that persons with this disease do not readily per- spire ; on the contrary the skin becomes dry, rough, and peels ' London Med. Gaz., May 1837. URINE. 303 off. Willis! relates a case of diabetes that fell under his own observation, in which the furfuraceous exfoliation of the cuticle had a decidedly sweet taste. From pathological anatomy we learn that the kidneys in death from diabetes are very frequently softened, and according to Meyer (who refers the formation of sugar to the kidneys), even disorganized, their blood-vessels much enlarged, and the substance of the papille and the tubuli very permeable; the kidneys have also been found inflamed, atrophied, suppurating, and containing caleuli. The condition in which the liver has been found is also various: the bile is, however, usually very far from being in a normal condition ; it is of a pale yellow colour, very fluid, and, instead of being alkaline, has usually an acid reaction, The veins which form the portal system are over- loaded, and the mesenteric vessels are generally congested. As the disease becomes further developed the lungs participate in the general disturbance, for, according to Willis, pulmonary phthisis is the immediate cause of death in two thirds of the cases of diabetes. Traces of morbid action have also been found in the nervous system. It is of great importance in reference to the etiology of dia- betes mellitus to ascertain whether the changes which are revealed to us by the prosecution of the morbid anatomy of the disease, are consequences of the disease itself, or whether they had a previous existence in those blood-metamorphosing organs, the kidneys, liver, and lungs, and whether the formation of the sugar is due to them. The questions which I have already suggested are of much importance in elucidating these points. Taking into consideration all that is known of the origin of diabetes mellitus, it appears very probable that the sugar is formed not in any single organ, but that it is produced by a diseased condition of the whole system, and we are almost led to adopt the opinion expressed by P. Frank, that a specific in- fluence is exercised upon the nerves of the fauces by a sponta- neously-generated virus diabeticum, which occasions an insatiable Urinary Diseases and their Treatment, p. 205. ee 304 THE SECRETIONS: desire for drink, and at the same time exerts a peculiar influence upon the nerves of the lymphatic system, exciting them to extraordinary activity. This activity of the lymphatic system, when associated with an excessive absorption from all the secreting surfaces of the body causes the premature elimination of raw and unassimilated chyle, which, not being adequate to the formation of blood, must be again removed from it. When we consider what an extraordinary quantity of sugar is carried off, even in those pa- tients who are restricted to animal food, we cannot doubt that the sugar is formed from the protein-compounds,’ and in all pro- bability, future and more accurate analyses of the urine, the bile, and the expired air, will enable us to understand in what manner the nitrogen is removed from the system, a point upon which we are at present in the dark. For although we can well con- ceive the possibility of the proteim-compounds being, under peculiar circumstances, resolved into sugar of grapes, and cer- tain nitrogenous compounds similar to protein itself, yet these latter must be capable of being detected. Periodic symptoms have been occasionally observed in diabetes mellitus. A physician in Berlin has a patient who, at certain times of the year, had periodical attacks of diabetes mellitus, which after continuing for some time, and with the application of proper diet, would disappear: although the amount of sugar which was excreted during these attacks was by no means inconsiderable, the patient did not exhibit that meagerness which usually suc- ceeds a prolonged continuance of the disease ; on the contrary; he became corpulent, and complained of no disturbance of his general health. * Diabetes insipidus. Under the term “diabetes insipidus” are included seve- ral diseased states, in which the urinary secretion is very much increased, but where the urine contains no sugar, either sweet or insipid, which is capable of fermentation.. Willis ' [Budge’s views on this subject may be seen in my Report on the recent progress « of Animal Chemistry, in vol. 2 of Ranking’s Half-yearly Abstract.] URINE. 305 treats of these different states under the heads Hydruria, Anazoturia, and Azoturia. Hydruria, which is also known as_ diuresis, polyuresis, and polydipsia, seems to be capable of continuing sometimes for several years, without being accompanied by any ‘other morbid symptoms than a frequent desire to micturate, and an insatiable thirst. Willis mentions several cases of the kind : amongst others, that of an artisan 55 years of age, who from his sixteenth year had upon an average drunk nearly two pails- ful daily, and who, during the same period, passed on an average thirty-four pounds of urine and one of feces. The urine was scarcely denser than pure water and contained no sugar. A similar case is recorded of a woman aged 40 years, who from her infancy experienced constant thirst, and an enormous secretion of urine. She enjoyed good health, and was the mother of several children. Becquerel observed a case of polydipsia or hydruria in a servant girl aged 23 years. After recovering from an attack of acute nephritis she lapsed into a state of anzmia, for which fer- ruginous medicines were exhibited, but without success. 0°20 Fat : ; : . 0°12 Extractive matters, much cee : . 12°14 of ammonia, &c. . : Fixed salts > : > 14°44 consisting of : Earthy phosphates . ‘ ; 2°60 Chloride of sodium . ° A 5°40 Sulphate of potash . ° 0°08 Phosphate and carbonate of soda, &c . 6°36 From these analyses we may conclude that in herpes zoster the chief peculiarities of the urine are: 1, A marked increase of the chlorides and phosphates, and a corresponding diminution of the sulphates. 2. An excess of hydrochlorate of ammonia. 8. A large amount of fat. 4. A diminution in the amount of uric acid. An increase only occurs when the disease is accompanied with fever. The presence of oxalate of lime may always be suspected in these cases. The urine in a case of pompholix has also been analysed by Heller. The patient was a woman aged 40 years; the attack was very severe and proved fatal. The urine deposited a light cloudy sediment consisting principally of mucus, but also con- taining fat-globules, urate of ammonia, and a few epithelium- scales. It was acid, and its specific gravity was 1017°5. It contained in 1000 parts : Water . : . 955°80 Solid constituents . 2 44°20 Urea ; ‘ 24°63 Uric acid " 0°58 Extractive matters ‘ 11°79 Fixed salts . ‘ 7°20 Of the fixed salts the earthy phosphates were normal, the ‘sulphates much increased, and the chloride of sodium propor- ‘tionally diminished. The urea is considerably above the norms average. | URINE. 323 ON SOME OTHER MODIFICATIONS OF THE URINE INDUCED BY DISEASE. Fat in urine. There are certain morbid conditions in which fat is excreted in a free state with the urine, which, at the same time, is neither chylous nor milky, nor contains any large amount of albumen or casein. Urine of this sort most commonly occurs in those diseases in which there is a very rapid loss of substance and force. I have on several occasions detected fat in the urine of phthisical persons, and on two occasions I have found it during tabes. I have already (see page 190) explained in what manner the presence of fat may be detected with certainty; I would here add a word of caution, that the presence of fat from extraneous sources, as improperly cleaned glasses, &c. must be carefully guarded against. Such cases as that which is related by Bachetoni,’ in which a noble young lady is reported to have discharged two ounces of olive oil with the urine on different occasions, must at least _be regarded as mysterious; Elliotson? also witnessed the daily discharge of about one third of an ounce of oil with the urine of a woman suffering from biliary calculi. [A case of fatty urine has been recently described by Dr. Golding Bird (Urinary Deposits, page 263.) An analysis of this form of urine has likewise been given in page 229 of this Volume. | Milk in urine. In speaking of diabetes I adverted to chylous urine, and said a few words regarding milky urine. It appears from an essay of Rayer, in which he enters fully into the subject, that this form of morbid urine is extremely rare; but that the term ‘milky urine’ has frequently been applied incorrectly to the ! Comment. Bonon. Pars I, ad ann. 1787. 2 On the discharge of fatty matters from the alimentary and urinary passages. (Medico-Chirurg. Transactions, vol. 18, p. 80.) 324 THE SECRETIONS: fiuid simply from its having a turbid or emulsive appearance, while there has been no trace of casein, but the fat has been suspended by means of albumen. The only recorded case of actual milky urine containing casein and fat are one by Canubio, of a woman who was suck- ling ; one by Alibert, of a healthy young widow; and, lastly, a case by Graves. Excess of hippuric acid in urine. [There are certain conditions of the system in which an excess of hippuric acid occurs in the urine, independently of those cases in which benzoic or cinnamic acid is taken either in the food or as medicine. The following case is recorded by Bouchenlaks 1 A lady aged 53 years, suffering from lassitude, dry skin and tongue, occasional pain in the region of the liver, loss of appe- tite, and great thirst, passed a large quantity of limpid urme possessing an odour of whey. Its specific gravity varied from 1006 to 1008; it slightly reddened litmus paper, and contained in 1000 parts : Water . ; - 986°00 Solid constituents . : 14°00 Urea . ‘ 3 1°56 Hippuric acid . . 2°23 Lactate of soda . ‘ 2°96 Albumen ‘ ‘ 1°47 Mucus ee 0:20 Chloride of sodium ; 2°75 Phosphate of soda ‘ 0°97 Alkaline sulphates : 1°44 ’ Earthy phosphates : 0°42 Dr. Garrod? has narrated the case of a man suffering from pain in the loins and symptoms of atonic dyspepsia, with flabby, white, furred tongue, who excreted a considerable amount of hip- puric acid, When examining the urine for the purpose of ascertainil the proportion of uric acid by the-addition of a small quantity of hydrochloric acid, he found the tube filled with crystals of hippuric acid, and on these large crystals smaller ones of uric 1 Annuaire de Thérapeutique, 1842, p. 285. 2 Lancet, Nov. 16, 1844. “eA URINE. 325 acid were deposited. For several days he found as much as half a drachm in six ounces of urine, or about 10 of hip- puric acid in 1000 parts. It afterwards gradually diminished, requiring considerable evaporation before crystals were depo- sited, and ultimately disappeared. The patient had previously suffered from voicing an excess of urea, and his urine had con- tained a deposit of ammoniaco-magnesian phosphate. Dr. Pettinkoffer' has also published an analysis of urine con- taining an excess of hippuric acid. The patient was a girl aged 13 years, suffering from chorea. The urine was limpid and acid on emission, but soon became alkaline and deposited crystals of ammoniaco-magnesian phosphate. After pouring nitric acid on the evaporated alcoholic extract with a view of determining the amount of urea, Dr. Pettinkoffer was surprised to find that instead of the usual crystalline plates of nitrate of urea, brownish yellow needles made their appearance. Under the microscope the needles were found to be six-sided prisms, in some places intermingled with plates of nitrate of urea. The urine evi- dently contained a large amount of hippuric acid in combination with potash or soda, from which the nitric acid separated it. When the alcoholic extract of the urine was evaporated, mixed with hydrochloric acid, and allowed to stand, four-sided pris- matic crystals of hippuric acid were deposited. 1000 parts of urine contained 40-668 of solid residue, of which 31°251 were soluble in spirit, and consisted of hippurates, urea, extractive matters, and chlorides; while the remaining 9°417 were composed of urates, phosphates, and sulphates, to- gether with mucus and water-extract. The solid residue yielded, on incineration, 10°599 of fixed salts. : On the following day, 1000 parts of urine yielded 49-825 of solid residue and 12°985 of ash, consisting of : Carbonates of lime and magnesia F 1153 : ; isd phioiighates 8 0-713 \ 1866 insoluble in water. Carbonate of soda. ‘ ‘ 3°996 Chlorides of sodium and potassium ; 6181 Phosphate of soda. ‘ ; 0°128 Sulphate of lime ‘ : ‘ 0°814 1 Liebig’s und Wohler’s Annalen, vol. 50, No. 1. 326 THE SECRETIONS: If we consider that the alkaline carbonate in the ash corre- sponds with the hippurate in the urine, then 1000 parts of urine must have contained 12°886 of anhydrous hippuric acid, and 100 parts of solid residue 25:8 of the same constituent. During this period the only food taken by the girl was bread, apples, and water; she, however, gradually resumed her ordinary diet, and the excess of hippuric simultaneously disappeared. | Urostealith in urine. [ Heller’ has recently announced the discovery of a new con- stituent of urinary calculi, to which he has given the name urostealith. It is soluble in carbonate of soda; and when that remedy is administered, urostealith in a state of solution is found im the urine. The patient was a man of tolerably good constitution, aged 24 years ; he complained of pain in the region of the right kid- ney, and difficulty in micturition, occasionally passing small elastic soft concretions. These were examined by Heller, and found to be perfectly soluble in alkalies, with which they formed a soap. Analysis of the urine before the administration of carbonate of soda.—25th Feb. The urine had a light yellow, whey- like appearance, no odour, and deposited a sediment of ammo- niaco-magnesian phosphate. Fat-globules were detected under the microscope. The reaction was neutral ; the specific gravity 1017°5. It contained in 1000 parts: Water ’ 4 . > - 965-800 Solid constituents 3 3 : : 34°200 Urea s é ‘ ‘ . 12°631 Fat é 0°320 Extractive matters with much hydrochlorate of ammonia 87569 Fixed salts ‘ a, ‘ 12-680 consisting of : Earthy phosphates Pe “ ‘ 2°040 Chloride of sodium 5 : oe 12-680 Sulphate of potash . 2°296 Basic phosphate of soda and peroxide of i iron ° 8-181 Moreover, every 1000 parts of urine threw down 0-62 of pure ammoniaco-magnesian phosphate. Not a trace of uri¢ acid could be detected. ' Archiv fiir phys. und patholog. Chemie, vol. 2, p. 1. URINE. 327 28th Feb. The day after the carbonate of soda had been | given, the urine was neutral, of a pale yellow colour, and had a specific gravity of 1006. Fragments of urostealith were de- tected in the sediment, mixed with ammoniaco-magnesian phosphate. . No uric acid was present. By the 2d of March the calculus of urostealith was almost entirely dissolved. The reaction of the urine was neutral; the addition of ammonia produced a reddish brown tint; (this is regarded by Heller as a test for urostealith ;) uric acid was still absent. The specific gravity was 1020. The urine contained in 1000 parts : Water " “ . s - 959°90 Solid constituents ¥ . : 40°10 Urea P ‘ ‘ ‘ : 11-20 Fat and urostealith . ‘ é j 3°40 Extractive matters and hydrochlorate of ammonia . 8°29 Fixed salts he ‘ : : 17°21 No sediment was deposited. In order to obtain the uro- stealith, a large quantity of urine was evaporated, and sulphuric acid added in order to decompose the soap. The urostealith was taken up by boiling ether, which, on evaporation, yielded a violet tint. For further information on the chemical charac- ters of this substance I must refer to Chapter x11. | Semen in urine. It may sometimes be of importance to ascertain whether the urine contains any seminal fluid. This point can be best set- tled by the microscope. We find mucous floccules in the urine ; and if semen is present, the spermatozoa will be detected amongst them. ‘They are represented in fig. 33. Urine of peculiar colours. Some cases have been recorded in which the colour of the urine has deviated extremely from the normal type. A case is related by Janus Plaucus, in which a dark blue sediment was precipitated from the urine of a man 60 years of age, a short time before his death. He had formerly suffered from 398 THE SECRETIONS: dysuria and vesical calculus, and subsequently from typhus fever. ; Marcet, Prout, Braconnot, Babington, Garnier, Spangeberg, and others, have observed blue and black urine. I have re- lated a case in which the urine deposited a blue sediment, in page 274. I have made an examination of the urine passed by a man at Grafenberg, who had spent many years in the East Indies, and returned to Europe for the benefit of his health. It had a strong ammoniacal odour, was of a clear blue colour, and de- posited a somewhat copious dark blue sediment, which ap- peared, from a microscopic examination, to consist of very fine amorphous matter (on which the blue colour was dependent) and a few crystals of ammoniaco-magnesian phosphate. On treating a portion of the washed and dried sediment with caustic potash the colour did not disappear; hence it was not de- pendent on the presence of iodide of starch or prussian blue. Dilute organic acids and hydrochloric acid neither dissolved it nor destroyed its colour; but on digesting it in nitric acid, the tint changed from blue to yellow. Digested in concentrated sulphuric acid, it dissolved, forming a solution of an indigo colour. On warming a portion of the sediment on platinum foil, it first evolved an urinous odour, and subsequently vola- tiliized, going off in deep violet-coloured vapour. The most convincing proof that the blue tint was due to indigo, was that on warming a portion of the sediment with dilute alcohol to which grape sugar and potash had been added, the fluid lost its blue tint, and assumed a yellowish red colour, which, on shaking, was converted into an intense blood-red, and then rapidly into a green. On allowing it ‘to rest the green tint disappeared, and the fluid assumed a yellowish-red colour. All these phenomena led to the conclusion that the colouring mat- ter was indigo. Ihave since heard that specimens of the same urine were sent to Bouchardat, Liebig, and Prout, who coin- cide in the opinion that the pigment was not indigo, but a dis- tinct organic compound. No indigo, or indeed medicine of any sort had been recently taken by the patient. Dulk! has observed and analysed black urine passed by a per- ‘son suffering from derangement of the liver and portal system. ‘Archiv der Pharmacie, vol. 18, p. 159. URINE. 329 [Dr. v. Velsen'. has published the case of a man aged 84 years, with chronic cystitis, who passed very fetid urine of a deep violet colour, after the use of lime-water mixed with warm milk. After the omission of the draught for a few days, the peculiar colour disappeared. | Urine during pregnancy, at the period of delivery, and after , delivery. Since Nauche’s announcement (a few years ago) of the dis- covery of a peculiar substance to which he gave the name of kystein, in the urine of pregnant women, the renal secretion during this state has been carefully examined by numerous chemists. Nauche describes kystein as a white mass that, after the urine has stood for some time, separates, partly rising to the surface, where it forms a somewhat tough pilous membrane interspersed with glistening crystals, and partly sinks to the bottom, forming a creamy precipitate. Nauche regards kystein as an indubitable sign of pregnancy. It is also considered a certain test by Eguiser ; he states that it appears after the urine has stood two to six days, depositing itself as a white opaque body, and then rising to the surface and producing a film like the solid fat that settles on cold broth. From an extensive series of observations, Dt. Kane concludes that kystem does not appear sooner than thirty hours, or later than eight days ; that on its first appearance it forms a scarcely perceptible membrane, which gradually becomes firmer and thicker, and after a time, breaks up, the fragments sinking to the bottom ; that a kystein-like membrane may also appear in the urine of persons with phthisis, arthritis, metastatic abscesses, vesical catarrh, &c. but that it differs from true kystein, both in the manner of its formation and of its destruction ; it appears later than the true kystein, but, having once appeared, develops it- self more rapidly and possesses less tenacity. The urine is neutral or ammoniacal on the appearance of the kystein, which, under the microscope, appears as an amorphous matter cor- sisting of minute opaque corpuscles, intermingled with crystals ' Casper’s Wochenschrift, 1844, No. 18. 330 THE SECRETIONS : of ammoniaco-magnesian phosphate. Dr. Kane convinced himself that the occurrence of kystein was independent of the presence of albumen ; he likewise ascertained that it occurs not only during pregnancy but also during the period of lactation, especially when the secretion of milk is at all checked. He concludes with the observation that “when pregnancy is pos- sible, the exhibition of a clearly-defined kystein-pellicle is one of the least equivocal proofs of that condition, and that when, in a case of suspected pregnancy, this pellicle is not found, if the female be healthy, the probabilities are as twenty to one that the prognosis is incorrect.”' It appears from a review of Kane’s cases, that the kystein most commonly appears on the third day; in one case, however, it could not be observed till the eighth day after the urme had been passed; and in some cases it appeared during the first twenty-four hours. During the first weeks of pregnancy, Kane only rarely ob- served it; it was most commonly noticed during the seventh, eighth, and ninth months, and up to the period of delivery. In eighty-five cases of pregnancy it was absent eleven times, and was present in thirty-two out of ninety-four cases examined during lactation. I have examined the urine during the second, third, fourth, fifth, and sixth months of pregnancy, but have not invariably detected kystein. In the cases in which it was formed, as in the second, fifth, and sixth months of pregnancy, the urine on emission was clear, yellow, faintly acid, and not affected either by nitric or acetic acid, or by heat. Usually, in about twenty- four hours, the whole urine became slightly turbid, the acid reaction disappeared, a white viscid sediment was deposited, and soon afterwards the surface of the fluid became covered with a pellicle at first extremely delicate, but after from twelve to twenty-four hours becoming tough, thick, opaque, and with a glistening appearance in consequence of the light reflected from numerous minute crystals of ammoniaco-magnesian phosphate with which it was studded. On examining this pellicle in its early state under the microscope, it appeared (when magnified 300 times) to consist of an amorphous matter composed of minute, opaque points, such as are presented by sediments of phosphate of lime or urate of ammonia, except that in the latter the in- 1 American Journal of Med. Science, July 1842. URINE. 331 dividual particles are usually darker, more clearly defined, and larger than in kystein. The whole field of vision was likewise bestrewed with numerous vibriones in active motion, and crystals of ammoniaco-magnesian phosphate. When the pellicle became thicker, precisely similar phenomena were observed, but the vibriones were supplanted by a considerable number of monads ; on the addition of acetic acid the crystals disappeared, while the amorphous matter remained unaffected. On digesting the pellicle in acetic acid, and adding ferrocyanide of potassium to the filtered solution, a comparatively slight turbidity ensued, but on macerating the pellicle in a dilute solution of pot- ash, acidulating the filtered solution with acetic acid, heating, and adding ferrocyanide of potassium after a second filtration, a more decided turbidity was observed. From these experi- ments I concluded that a protein-compound was present. The _ white sediment, that occurred after the urine had stood for some days, possessed a disagreeable, pungent, caseous odour: under the microscope it presented the same appearance as the pellicle. After repeatedly washing a portion of the sediment with water, and then heating it with alcohol and a little sulphuric acid, it developed a disagreeable fruit-like odour, reminding me of butyric ether. [We shall presently show that the accuracy of this observation has been thoroughly established by Lehmann. | It results from the above observations, that kysteim is not a new and distinct substance, but a protein-compound, whose formation is undoubtedly and closely connected with the lacteal secretion. From the observations of Kane and myself, it seems to follow that pregnancy may exist without the occurrence of kystein in the urine ; if, however, there is a probability or pos- sibility of pregnancy, and kystein is found in the urime, then the probability is reduced almost to a certainty. We are un- able to draw any positive inferences respecting the stage of pregnancy from the appearance of the kystein. A deposit of caseous matter and earthy phosphates was fre- quently observed by Golding Bird in the advanced stages of pregnancy. The sediment is probably similar to Nauche’s kystein. Every urine left to itself forms a pellicle, more or less re- sembling that of kystein. If formed soon after the urine is discharged, it consists of earthy phosphates, which, from the 332 THE SECRETIONS: urine being alkaline, are, for the most part precipitated, but hkewise form a delicate film on the surface. When this -is the case, the pellicle is very thin and readily sinks to the bottom. Under the microscope crystals of ammoniaco-magnesian phos- phate, and an amorphous matter very similar to kystein, but consisting of phosphate of lime, are observed: this likewise differs from kystein in being soluble in free acids. A pellicle of fat on the surface of urine may sometimes be mistaken for kystein: films of this nature are very thin and usually irides- cent, and the microscope reveals the presence of numerous fat-globules. The membrane formed on the surface of urine six or eight days after emission, usually consists of a species of mould ; under the microscope there may be seen innumerable filaments matted together, and interspersed with sporules. I once observed a pellicle on the surface of a man’s urine three days after emission, which both in chemical and micro- scopical characters presented the closest analogy to kystein.! (Lehmann? frequently examined the urine of a pregnant woman from the second to the seventh month. It was of a dirty yellow colour, and more inclined to froth than usual; it generally became turbid in from two to six hours ; but the morn- ing urine, after standing for thirty-six or forty-eight hours, was always covered with a grayish-white film, which often, in two or three days, sank and mixed with the sediment that formed when the turbidity appeared, but sometimes was a longer period before it broke up. By means of ether he could always re- move from this film a considerable quantity of viscid fat, which formed a soap with potash, and then, on the addition of sul- phuric acid, developed a well-marked odour of butyric acid. ‘On treating a large quantity of this urine with sulphuric acid, and distilling, he obtained, after treating the distillate with baryta water, brilliant crystals of butyrate of baryta. The substance taken up by ether, when gently evaporated with nitric acid and exposed to the vapour of ammonia, was not in the least reddened ; with concentrated hydrochloric acid, on the ' [A similar appearance has been observed by Prout in the urine of a delicate child, fed chiefly on milk. (On Stomach and Renal Diseases, 4th edit. p. 555, note.) ] ? Lehrbuch der physiologischen Chemie, vol. 1, p. 252. URINE. 333 other hand, it assumed a blue tint; dissolved in potash, boiled, and treated with hydrochloric acid, it developed sulphuretted hydrogen ; it dissolved tolerably freely in acetic acid, from which it was precipitated by ferrocyanide of potassium. These reactions left no doubt of its being a protein-compound. The portion of the film insoluble in potash consisted chiefly of phos- phate of magnesia, [ammoniaco-magnesian phosphate ?] with a little phosphate of lime. Hence Lehmann concludes that the kystein of Nauche is not a new and distinct substance, but a mixture of butyraceous fat, phosphate of magnesia, and a pro- tein-compound very similar to casein. He likewise mentions that, in examining the urine of a woman who was not suckling, and was kept on very low and sparing diet, on the third, fourth, sixth, and ninth days after delivery, he found a large quantity of butyric acid taken up by ether from the solid residue; and on dissolving the ethereal extract in water, adding sulphuric acid, and distilling, he obtained a further quantity. The urine in this case was always rather turbid, of a dirty yellow colour, very acid, and contained a very small amount of uric acid. Moller! relates two cases in which the urine of women who were not pregnant was covered with a film exactly resembling kystein : im one case there was considerable hypertrophy of the uterus ; in the other, no affection of the generative organs could be detected. The film of kystein consists, according to his observations, of fat, earthy phosphates, and a caseous matter, which differs, however, from the casein of milk in being held in solution by a free acid. When the urine becomes neutral or alkaline, the caseous matter ceases to be held in solution, and separates askystein. Everything checking the decomposi- tion of the urine hinders the formation of the pellicle, and if the recent secretion is treated with a free acid (mineral or organic) ; no separation of kystein takes place even if ammonia be added to saturation, or decomposition allowed to proceed to any extent. In a case of decided pregnancy, no kystein was formed during the period of a severe cold, attended with a copious deposition of urates ; but when the urine became natural, the kystein re- appeared. He twice detected cholesterin in kystein. ' Casper’s Wochenschr. Jan. 11-18, 1845. 334 THE SECRETIONS : Kleybolte! has examined the urine in ten cases of pregnancy, and invariably found kystein on the fifth day. The morning secretion was used, and, after being slightly covered to protect it from dust, was allowed to stand, at an ordinary temperature, for ten days. The followmg appearances were observed in the tenth week of pregnancy: urine peculiarly yellow, with a green- ish tint. 2d day, mucous sediment; 3d day, no change; 4th day, turbidity ascending from the bottom; 5th day, white points and leaflets on the surface, turbidity ascending from all parts of the bottom, and the sediment almost gone; 6th day, kystein distinctly observed on the surface, like lumps of fat on the surface of cold broth; 7th day, no change. From the 8th to the 10th day, the kystein disappears, the turbidity again de- scends, and the sediment noticed on the 2d day is reproduced. The nine remaining cases are in most respects similar to the above. . A few observations on kystein have been recently published by Audouard,? but contain nothing of importance, except that in six specimens of urine passed by young women suffering from amenorrheea, he found kystein in five.3] I shall now give a short abstract of Becquerel’s researches. During pregnancy, the general state of the system is liable to great variations, and the urine presents differences of corre- sponding importance. If good health is enjoyed during preg- nancy, the urine remains normal ; if, however, anything should happen to excite the vascular system, it readily changes, be- coming dark-coloured, acid, sedimentary, and diminished in quantity. During the latter stages of pregnancy the urine often assumes the anzmic type, that is to say, it becomes pale, contains only a small amount of solid residue, and the spe- cific gravity does not exceed 1011. The observations which were communicated by Donné in a letter addressed to the Academy of Sciences, dated May 24, 1841, in reference to the urine in pregnancy containing less free acid, and less of the phosphate and sulphate of lime than normal urime, were not ! Casper’s Wochenschrift, April 26,1845. * Journal de Chimie Méd. May 1845. $ Many other communications have recently been published on this subject, which — I do not deem necessary to notice, as they are, for the most part, simply confirmatory of the above observations. URINE. | 335 confirmed by Becquerel. Neither could ra Rt observe kystein. After delivery, mucus, tinged with bieed; is mixed with the urine; this is succeeded by the discharge which is known as the aed During the period that intervenes between deli- very and the commencement of the milk-fever, the urine either assumes the inflammatory type, and is scanty, high-coloured, acid, and dense, as, for instance, in those cases in which the labour has been very difficult and painful, and the vascular system is much excited; or it takes on the anemic form, as in those cases in which the labour is followed by great debility and prostration. Becquerel gives two analyses: one was made with the urine of a woman aged 33 years, who, the previous evening, had been delivered of a dead child; pulse 96, strong; urine of a deep red colour, acid, and sedimentary; the sediment was mixed with sanguineous mucus, and there was a little albumen in the urine. | The second analysis was made with the urine of a woman aged 22 years, who had been delivered forty-eight hours pre- viously of a seven months dead child. Pulse 92, rather weak ; urine wasvery red, and held in suspension a cloud of sanguineous mucus and a considerable quantity of albumen. 1. 2. Quantity of urine in 24 hours in ounces © 30 26°5 Specific gravity ‘ ‘ ta 1012°6 1018°0 1000 parts contained : Water. epee r : 979°5 970-2 Solid constituents . ‘ : 20°5 29°8 Urea . Pr F : 6°5 78 Uric acid ; ‘ é 0°5 0°5 Fixed salts : ’ 4°6 7°4 Extractive matters i 4 9°5 10°6 Albumen F . 2 — 3°3 We see from the ratio of the urea and also of the uric acid to the solid residue, that the urine in neither of these cases can be regarded as inflammatory, but that it rather approxi- mates to the anemic type. In the first analysis the urea amounts to only 312 and the uric acid to 2:4 of the solid re- sidue ; in the second analysis, the former amounts to 27 and the latter to 28. ; oe aia 3 336 THE SECRETIONS : In most of the cases in which Becquerel examined the morn- ing urine of women who had recently been delivered, he found it anemic; the specific gravity varied from 1006 to 1014, the average aie 1011. As the milk-fever comes on, the chemical composition of the urine appears to undergo some modification, at least we are led to infer so from an analysis of Becquerel. It was secreted in diminished quantity, contained a larger proportion of urea and uric acid, was darker, and deposited a sediment. — He examined the urine of a woman aged 22 years, four days after delivery, while suffering from the milk-fever. It was of a saffron-yellow colour, deposited a sediment on the addition of nitric acid, and also spontaneously, after the lapse of some hours. In the course of twenty-four hours there were 15°5 ounces excreted. The specific gravity was 1031-5. 1000 parts contained : Water ; ‘ : .¢ :oae2 Solid constituents . ‘ ¢ ‘4 51°8 Urea ; ; ‘ : 18°7 Uric acid . facie Ps ; 2°7 Fixed salts . 3 4 11°3 Extractive matter ‘ ; j 18°3 Albumen . ; : : 0°7 Here the urea amounts to 36%, and the uric acid to no less than 52 of the solid residue. On the passage of medicinal and other substances into the urine. [All substances incapable of assimilation that enter the cir- culation are removed by the kidneys, either in the state in which they entered the organism, or in a modified condition. Inorganic, non-metallic bodies. Iodine appears rapidly in the urime in combination with ammonium, (Lehmann,) sodium, and potassium. Bromine has been detected by Glover and — Heller, and chlorine by Orfila. Iodide of potassium, the alkaline borates, silicates, chlorates, — and carbonates, as also chloride of barium, ferridcyanide of — potassium, and sulphocyanide of potassium, were found by ~ ‘Wohler’ in the urine ; the ferrideyanide was, however, converted — into ferrocyanide in the system. ' Tiedemann’s Zeitschr. fiir Physiol. vol. 1, p. 305. - Tet ae aA eae Te REIT 8 URINE. 337 Sulphur has been found (after administration) in the urine by Wohler and Orfila; and after the use of liver of sulphur, free sulphur, and an excess of sulphate of potash were found in the urine. In four experiments made by Laveran and Millon, sulphur neither appeared in the urime, nor was the quantity of sulphates increased. Metallic substances. Arsenic and antimony may be readily detected in the urine, and have been observed by many che- mists. The detection of mercury is by no means easy; it has been sought for in vain by Lehmann, L’Heretier, and Rees, but has been found by Buchner, Cantu, Jourda, Venables, Orfila, Gisterlen,! and Audouard.2 Iron is almost always present in the urine during its administration as aremedy. Nickel was found by Wohler in the urine of a dog to whom he had given half a drachm of tartrate of nickel and potash. Gold, silver, tin, lead, and bismuth, were found in the urine of dogs to. whom Orfila had given large doses of the soluble salts of those metals. Copper and manganese have been detected in the urine by Kramer. 7 Inorganic acids. Orfila has detected nitric, hydrochloric, and sulphuric acids in the urine. As nitric acid is not a con- stituent of normal urine, there was no ambiguity in this ex- periment. In dogs poisoned with dilute hydrochloric or sul- phuric acid, about six times as much chloride of silver and sulphate of baryta were obtained as are found in ordinary urine. In none of these cases was the urine more acid than usual, the acids having formed neutral salts by combining with the alkalies of the blood. Organic acids and their salts. It appears from the inves- tigations of Wohler, that many of the organic acids, adminis- tered in a free state, enter the urine in a state of combination ; as, for instance, oxalic, citric, malic, tartaric, succinic, and gallic acids. To the above list Orfila has added acetic acid, and con- firmed Wohler’s statement regarding oxalic acid. According to Pereira meconic acid may be occasionally detected in the urine of animals poisoned with opium. L’Expérience, Aug. 1844. ? Journal de Chim. Méd. 9, p. 137. 3 Giornale dell’ Instituto Lombardo. * Elements of Materia Medica, Ist ed. vol. 2, p. 1299. II. * 22 338 THE SECRETIONS: One of the most important of Wohler’s discoveries is, that the neutral vegetable salts become modified in their passage through the system, and are found in the urine as carbonates. A few hours after the use of these salts, the urine becomes alkaline, is frequently turbid from the deposition of phosphates, and effervesces briskly on the addition of an acid.' If the dose is very large, oxalate of lime may frequently be detected, Similar results follow from the use of alkaline lactates ; Lehmann found, that two hours after taking two drachms of lactate of soda, alkaline urine was excreted. That this change is effected after the salt has entered the blood, and not in the intestinal canal, is proved by an experiment performed by Mr. J. Goodsir, at my request. A drachm of acetate of potash was dissolved in an ounce and a half of water, and injected into the femoral vein of a dog, whose urine had been previously ascertained to be acid. The urine passed about an hour after the operation was alkaline. A similar experiment has been since made by Lehmann, who injected a drachm of lactate of potash into the jugular vein of a dog, and found the urine alkaline an hour afterwards. The process is one of simple combustion: each atom of acetic acid (of the acetate of soda) combines with eight of oxygen, and yields four atoms of carbonic acid and three of water, or C, H, O, + 80 = 4CO, + 3 HO, and each atom of lactic acid combines of twelve of oxygen, forming six of carbonic acid and four of water, or C, H,O, + 120 = 6CO,- + 5 HO. In a series of 268 experiments instituted by Millon and Laveran, with the tartrate of potash and soda, (Sode potassio- tartras. Ph. L.) they found the urine more for less alkaline in 175, acid in 87, and neutral in 6 cases. This apparent dis- crepancy was doubtless dependent on the degree of concen- tration of the saline solution. (See page 149.) We have already mentioned that benzoic and cinnamic acids © are converted in the organism into hippuric acid, and then ex- creted by the kidneys. Vegetable bases. Quinine, when administered in large doses, has been noticed in the urine by Piorry, Landerer, and others. 1 Some excellent observations on the physiological action of these salts will be found in Dr. Pereira’s Treatise on Food and Diet, p. 29. URINE. 339 The best test for its presence is the iodated iodide of potassium, consisting of four parts of iodide of potassium, one of iodine, and ten of water. The precipitate afforded by this reagent with disulphate of quinine is very insoluble in water, not affected by an excess of the test, and readily soluble in alcohol. It is of a yellowish-brown colour, and forms a turbidity or sedi- ment, according to the amount of the alkaloid in the urine. When the quantity is very small there is merely an olive tint produced on the addition of the test. The disulphate of quinine may be reobtained from the sediment in a state of purity by a simple chemical process.! Morphia is stated to have been once detected by Barruel in the urine of a person under the influence of a poisonous dose of laudanum, and it was likewise discovered by Orfila, in the urine of dogs. None of the other alkaloids have yet been de- tected in the urine. Indifferent organic substances. According to Wohler, most colouring matters and many odorous principles passed unchanged. or slightly modified into the urine. In the former class we may place indigo, gamboge, rhubarb, red beet-root, madder, logwood, mulberries, black cherries, &c. ; in the latter, valerian, asafcetida, garlic, castoreum, saffron, turpentine, &c. Alcohol is placed by Wohler amongst the substances that do not enter the urine, and Liebig has recently affirmed that it has never been found in that secretion. It has, however, been detected by Percy in the urine of a dog, into whose sto- mach four ounces of spirit of ‘85 had been injected, and in the urine of a man in a state of intoxication who had taken about a bottle of whiskey. In both cases he obtained, by careful distillation, an inflammable fluid that dissolved camphor.2 In order to ascertain whether alcohol, taken in moderate quantity would enter the urine, my friend Dr. Wright instituted the following experiment on a man whose ureters opened ex- ternally. Three ounces of whiskey were administered, and the urine collected by applying a test-tube to each ureter. The tubes were corked and replaced every two minutes, for the space of half an hour. ! Journal de Pharmacie, Sept. 1843. ? On the presence of Alcohol in the Brain, 1839, p. 104. 340 THE SECRETIONS: The following table represents the amount of fluid in the tubes. | ist two minutes ; : 3 a drachm. 2d % " : 2 drachms. 3d* s . : 5 drachms. 4th A : > 1 drachm. 5th* os : Sf 6 drachms. Our i ; 2 drachms. 7th 5) : ; 4 a drachm. 8th 3 : A 3 a drachm. 9th + . : 3 drachms. 10th* ss. : ; 6 drachms. llth ey ‘ : 4 drachms. 12th ‘5 > : 8 drachms. oun? t, ¥ : 7 drachms. M4th*. ,, . : 6 drachms. 15th* ‘ : ‘ 4 drachms. The contents of the tubes were analysed separately, according to Dr. Percy’s method, * and in those marked with an asterisk the presence of spirit was distinctly recognized. In another experiment upon the same individual, in which two ounces of whiskey diluted with three times its volume of water were administered, no trace of the spirit could be obtained.” Lehmann has sought in vain for salicin, phloridzin, caffein, theobromin, asparagin, and amygdalin. As the modifications that these substances undergo in the organism are of extreme interest, let us see what are the most probable changes that can take place. We select salicin, by way of illustration, as a substance whose chemistry is pretty well established. Is salicin converted in the organism into sugar and saliretin 73 —a change that occurs on digesting salicin in dilute acids: or is it converted into salicylous acid and water?*——as occurs on treating salicin with bichromate of potash and sulphuric acid. Or, in- stead of salicylous acid, is hydrated benzoic acid (which is . Op. cit. p. 8. 2 These experiments were originally recorded in my Heresies Prize Essay on the Chemistry of the Urine in Health and Disease; 1842. 3 This change is illustrated by the equation— Salicin. Sugar. . Saliretin. C4 Hyg On = Cy Hy, O14 + Cyo Hy, Og Salicin. Oxygen. Salicylousacids Waters Symbolically—C,, H., O.. + O = 3C,, He O, + 11HO. URINE. 34] isomeric with it) produced,! and the benzoic acid then converted in the ordinary manner into hippuric acid? Or does the salicin yield salicylous acid which appears to be isomorphous with, and convertible into oxide of omichmyle?? Or, finally, does the salicin undergo the same changes as when oxidized by fusion with caustic potash, and become converted into salicylic, oxalic, and carbonic acids, and water ?3 In sixteen experiments made by Lehmann with salicin in doses of 20 or 80 grains, he never detected saliretin, but always salicylous acid, which was taken up by ether with the oxide of omichmyle, and yielded the characteristic violet tint on the addition of nitrate of iron; in most of the experiments there was also a small quantity of hippuric acid, and of oxalate of lime. Similar experiments have been made by Laveran and Millon. After taking phloridzin, Lehmann also found hippuric acid and oxalate of lime in the urine. After taking a scruple of thein at bedtime, no trace of it could be found in the morning urine, but the urea was considerably increased, amounting to _ 58°1952 of the solid residue. He did not remark any un- pleasant symptoms, but two of his pupils, after a similar dose (obtained from coffee) experienced great excitement of the nervous and vascular systems generally, and especially of the generative organs. ‘This is perfectly in unison with Mulder’s5 statement, that it produced abortion in pregnant rabbits. | Salicylous acid. | Hydrated benzoic acid. 1 Symbolically—C,, H,;O0, == HO, C,, H, 0,. ? It appears from the researches of Scharling that the oxide of omichmyle belongs to a series having a compound radical analogous to that of oil of spirza, or salicylous acid; at least he found that chloromichmyle is isomeric with chloride of salicyl or chlo- rosalicylic acid, C,, H; O,, Cl. Oxide of omichmyle does not produce a violet colour with nitrate of iron in the same manner as salicylous and salicylic acids ; moreover, salicylous acid and salicin do not enter the urine as oxide of omichmyle, but as sali- cylous acid, as has been found by Lehmann in eight experiments. Scharling hints at the existence of a widely-diffused radical, which, in the vegetable kingdom, in warm climates, is the starting point of the benzoyl and cinnamyl series; in cold climates, of the salicyl compounds; and, in the animal kingdom, presents itself as omichmyle. 3 These changes may be thus explained symbolically : Salicin. Oxygen. Salicylic acid. Oxalic acid. Carbonic acid. Water. Co Hy On. + 290 = 2C,, He Og + 60,0, + 200, + 17HO. * Lehrbuch der Physiolog. Chemie, vol. 1, p. 97. 5 Natuur en Scheikundig Archief, 1839, p. 458. 342 THE SECRETIONS: Urine of Animals. The chemistry of the urine of animals is still in a very defi- cient state. I shall here give the little that is known on the subject. The urine of carnivorous animals is, at the period of its dis- charge, acid, but speedily becomes alkaline, in consequence of the formation of ammonia. This observation of Hieronymi’s is confirmed by Hiimefeld, who found that the urine of the bear retained its acid reaction for a considerable period. Vauquelin found a large proportion of urea, but no uric acid in the urine of beasts of prey. Hiinefeld also missed the uric acid, but it was detected by Hieronymi. Hieronymi carefully analysed the urine of the lion, the tiger, and the leopard, and its compo- sition appeared much the same in these three animals. The spe- cific gravity of the urine of each animal varied between 1059 and 1076. It was clear, of a bright yellow colour, had a pungent disagreeable odour, an acid reaction, and a nauseous bitter taste ; after standing for a short time, it became alkaline. On collecting and evaporating the urine, there was a coagula- tion of some white flocculent matter; and as the concentration increased, the greater part of the urea began to separate in a crystalline form. The mixed urine of these three animals gave the following result : Water ‘ : ; é - 846-00 Solid constituents . - 154:00 Urea, alcohol-extract, and free lactic sia «> -dB2-20 Uric acid . , P é , 0°22 Vesical mucus ; ‘ > ; 5°10 Sulphate of potash . 1:22 Chloride of ammonium, and a little dlietie of sodium 116 Earthy phosphates . ‘ 1°76 Phosphates of soda and potash — ° ; 8:02 Phosphate of ammonia ‘ ‘ : 1-02 Lactate of potash. ; : é 3°30 The urine of herbivorous animals likewise contains a large — quantity of urea, but no uric acid,’ there being in its place hip- — puric acid. The urine of the horse was analysed by Foureroy and Vauquelin: they describe it as of a yellow colour, often A [Traces of uric acid have been occasionally detected by Fownes and other chemists’ in the urine of the graminivora. See Vol. I, p. 53.] URINE, 343 turbid, of an unpleasant smell, and a saltish bitter taste. When allowed to rest, a quantity of the carbonates of lime and mag- nesia was deposited ; it had an alkaline reaction, frothed on the addition of an acid, and had a specific gravity of from 1030 to 1050. 1000 parts contained : Water . ‘ : 940°0 Solid constituents . é ; 60°0 Urea . ; z 70 Hippurate of soda ‘ ; 24:0(?!) Chloride of potassium ‘ : 9-0 Carbonate of soda > ‘ 9°0 - Carbonate of lime ; i 11:0 This analysis probably requires further confirmation. I found a larger amount of urea in the urine of a horse suf- fering from ozna; for from 1000 parts I obtained 50 of urea; and after the horse had fasted for four days, I still found 24°1. In the urine of another horse, the solid constituents amounted to 10°79 of the urine, and the urea to 5-062, or about one half of the solid residue. From my own observations, I should say that the urine of horses is generally of a straw colour, is at first acid, but soon becomes ammoniacal, and then emits the peculiar penetrating odour which is doubtless caused by the formation of a volatile fatty acid, although I was unable to isolate it. The urine, after it has become alkaline, is often so tenacious and viscid that it can be drawn up in long threads. The microscopic examination of the urine of the horse exhibits a great number of rounded corpuscles, from the size of mucus-corpuscles to four times that size, which burst upon pressure of the glass slips between which the fluid is examined. Fourcroy and Vauquelin, after evaporating the urine of the horse, separating the urea as a nitrate, and neutralizing the acid by an alkali, found a small quantity of reddish fat, which volatilises over the water-bath, and is considered to be the cause of the smell and colour of the urine. [The urine of the horse has been recently analysed by Von Bibra’ and Boussingault. In two analyses of the urine of the same horse, made at dif- ferent periods, Von Bibra found : ' Annalen der Chemie und Pharmacie, 1845, No. 1. % THE SECRETIONS : 1. 2. Water i - 885°09 912°84 Solid constituents 114°91 87°16 Urea é 12°44 8°36 Hippuric acid . 12°60 1°23 Water-extract . 21°32 19°25 Alcohol-extract : 25°50 18°26 Mucus ; ; 0°05 0°06 Salts soluble in water ‘ ‘ 23°40 40-00 Salts insoluble in water . js 18°80 On two occasions the individual salts were determined, and > 1. it was found that in 100 parts of the saline residue there were : 2. Carbonate of lime 12°50 31°00 Carbonate of magnesia 9°46 13°07 Carbonate of potash 46°09 40°33 Carbonate of soda 10°33 Sulphate of potash ‘ 13°04 9°02 Chloride of sodium ” 6°94 5°60 Silica ; d 0°55 Loss. .. ie aie Traces of iron were always observed, but he could never ascer- tain the presence of fluorine. The mean specific gravity resulting from numerous observations was 1045. The horses, in these cases, were used for agricultural purposes, and fed on hay and oats. ‘The prevailing opinion that, by excessive work, the hip- puric is replaced by benzoic acid, is stated by Von Bibra to be incorrect. Benzoic acid was scarcely ever observed, and, when present, was only recognizable under the microscope. The hippuric acid varied in different analyses from 15 to 5 or even ~ less in 1000 parts of urme. The secretion was always alka- — line, and in a few minutes deposited a sediment, consisting (as seen under the microscope) of compact vesicles. The deposit consisted of the carbonates of lime and magnesia, with an or- ganic compound that could not be removed by the most careful washing. In three analyses there were found : Carbonate of lime » 809 87°2 87°5 Carbonate of magnesia 12°1 75 8-2 Organic matter ; 7:0 53 4°3 er RT 1000 = 1000 =~ 1000 | Boussingault’ has likewise analysed the urine of a horse — feeding on trefoil and vetches. It was very alkaline, had a specific gravity of 1037-3, and contained in 1000 parts: . ' Annal. de Chimie et de Physique, Septembre, 1845. URINE. 345 Water and indeterminate matters. » 910°76 Urea , : . . 31-00 Hippurate of adit R ‘ : 4°74 Lactate of potash . ‘ A ‘ 11:28 Lactate of soda : ° : . 8°81 Bicarbonate of potash ‘ ‘ ‘ 15°50 Carbonate of lime . . ‘ , 10°82 Carbonate of magnesia , . . 4°16 Sulphate of potash . ‘ ‘ 1:18 Chloride of sodium : ‘ ‘ 0°74 Silica ‘ ; ‘ “ : 101 Phosphates ‘ , : + absent. As several chemists have noticed, amongst the constituents of the urine of the herbivora, ared oil on which the colour and odour of the secretion are dependent, Boussingault endeavoured to isolate it. He distilled upwards of 26 gallons at a single ex- periment, but did not obtain a trace of the oil, a colourless fluid passing over which evolved the peculiar odour of horses’ urine: hence he concluded that the odorous principle is a volatile acid. ‘The only means by which anything like a red oil can be obtained consists in carrying on the distillation to dryness, in which case an oily substance is obtained, analogous to, if not identical with some of the products of a of the alkaline hippurates. | Horses are not unfrequently subject to a disease which cor- responds with diabetes insipidus, or hyperdiuresis, in man: it has also been observed in sheep and cattle. The following analysis of the urine of cattle was made by Sprengel: 1000 parts contained : Water : ; - 926°24 Solid constituents é j 73°76 Urea ; ‘ a ‘ 40°00 Albumen . : ; ‘ 0°10 Mucus - : : : 1:90 Benzoic acid ; : . 0°90 Lactic acid ‘ j x 5°16 Carbonic acid é ‘ ; 2°50 Potash. > : . 6°64 Soda . ; ‘ j 5°54 Silica ‘ ; : 0°36 Alumina . " ‘ : 0°04 Oxide of manganese . : : 0°01 Lime F A : : 0°65 Magnesia , ; é , 0°36 Chlorine . . ‘ * 2°72 Sulphuric acid : : . 4°05 Phosphorus . : é 0°70 This analysis requires further confirmation. 346 THE SECRETIONS: The urine of cattle, just after it is passed, is clear and acid ; it soon, however, deposits crystals of the carbonates of lime and magnesia. It contains hippurate of soda, and a larger propor- tion of urea than is found in human urine. [The urine of oxen employed for agricultural purposes was analysed by Von Bibra. The specific gravity varied from 1040 to 1032. The urine was of a dark yellow colour, perfectly clear, and of a peculiar odour. The following analyses were made with the urine of the same animal at different times : i. 2. Water % “ . . 912°01 923-11 Solid constituents . : 87:99 76°89 Urea . 3 ; 19°76 10°21 Hippuric acid . . 5°55 12-00 Mucus . ‘ 0°07 0:06 Alcohol-extract . ? 14°21 10:20 Water-extract ; _ 22°48 16°43 Soluble salts “ a 24°42 25°77 Insoluble salts E 4 1:50 2°22 The saline residue contained: Carbonate of lime ; : ; 1:07 Carbonate of magnesia . j : 6°93 Carbonate of potash j . See fe Sulphate of potash , : - 13°30 Chloride of sodium ‘ ‘ P 0°30 Silica A ; ; ’ 0°35 Traces of iron, and loss Z ; 0°77 100-00 Although these salts are liable to considerable quantitative variations, (for instance, Von Bibra, in two analyses, found 14°22 and 16% of chloride of sodium,) yet, as a general rule, the urine of oxen contains more alkaline and less earthy carbonates than the urine of horses. The urea and hippuric acid varied extremely in different analyses. The food of the oxen consisted of fresh clover and a little hay. e Boussingault found that the urine of a cow feeding on after- math and potatoes, effervesced briskly on the addition of an acid, and deposited numerous crystals of hippuric acid. Its specific gravity was 1040, and it contained in 1000 parts: URINE. 347 Water and indeterminate matters. ~ 921:32 Urea ‘ A . is 18°48 Hippurate of pabial ; ; . 16°51 Lactate of potash R : : 17°16 Bicarbonate of potash ; ; ; 16°12 Carbonate of magnesia ein Sstten : 4°74 Carbonate of lime : : ; 0°55 Sulphate of potash ‘ ‘ ; 3°60 Chloride of sodium : ‘ : 1°52 Silica ; ‘ ; ‘ ° traces Phosphoric acid . : : . absent ] Vogel found the urine of the rhinoceros turbid, and having an odour like that of crushed ants. It grew darker after ex- posure to the air, and became covered with a film of carbonate of lime; it effervesced on the addition of acids. As it cleared, it deposited a yellow sediment composed of earthy phosphates with a little peroxide of iron and silica, which amounted to 2°72 of the weight of the urine. It then remained of a dark yellow colour, and formed, on evaporation, a new sediment of car- bonates of lime and magnesia, which were previously held in solution as bicarbonates. On evaporating the urine to two thirds of its volume, and then treating it with hydrochloric acid, a precipitation of hippuric acid took place, amounting to 0-452 of the weight of the urine. The urine also contained urea and the ordinary salts. Vogel found the urine of the elephant turbid from the presence of carbonates of lime and magnesia in suspension ; it contained a larger amount of urea than the urine of the rhinoceros, but, on the other hand, was devoid of hippuric acid. Brandes, however, detected the latter constituent, partly combined with an alkali and partly with urea. In the urine of the camel, Chevreul found a large quantity of urea, but no uric acid; it contained, however, chloride of sodium, hippurate of soda, carbonate of soda, sulphate of potash together with a little sulphate of soda, carbonate of ammonia, and a trace of peroxide of iron: no phosphates were found in it. On mixing it with sulphuric, nitric, or hydrochloric acid, the urine became red,—a property due to its containing a vola- tile oil, to which, moreover, it owes its odour. The urine of the pig has been analysed by Lassaigne. He describes it as being of a pale yellow colour, clear and trans- 348 THE SECRETIONS : parent, and containing urea, sulphates of potash and soda, chlo- rides of potassium, sodium, and ammonium, and traces of car- bonate and sulphate of lime. Van Setten’ has communicated a special analysis of the urine of a pig. It was yellow, almost imodorous, and had a specific gravity of 1003. There were contained in 1000 parts: Water : 5 « 990-028 Solid constituents ; ‘ 9°972 Urea : : ‘ é 0°750 Uric acid. ; : : 07195 Water-extract ; ; 1:708 Alcohol-extract : / : 1:105 Resinous matter ; ; : 0°425 Albumen and mucus . a F 0°721 Lactic acid . ‘ : é 0°490 Stearin ‘ F > ‘ 0:092 Sugar ; f ; 0°375 Phosphate of soda 1:376 Sulphate of potash, chlorides of sodium & potassium 2-075 Sulphates of lime and magnesia . 0°425 Sulphate of ammonia . ‘ " 0°196 Chloride of ammonium > ~ 0:010 [The urine taken from the bladders of pigs immediately after they were killed is described by Von Bibra as clear, nearly devoid of odour, alkaline, and having a specific gravity of 1012 to 1010. In two cases in which he analysed it he found in 1000 parts : 1. gee“ Water ; ; . 981-96 982-57 Solid constituents , % 18-04 17°43 Urea Pe 3 a-7s)- 2°97 Alechol-extract ‘ ‘s 3°87 3°99 Water-extract ‘ . 1:42 1-12 Mucus : é 5 0°05 0°07 Soluble salts . ‘i ‘ 9-09 8-04 Insoluble salts * a 0-88 0°80 The salts in the first of these analyses consisted of : Chloride of sodium and a little chloride of potassium 53:1 Sulphate of soda . 5 J ‘ 7°0 Carbonate of potash ‘ r ree Ys | Phosphate of soda os, Phosphates of lime and magnesia, with traces of silica and iron * 8°8 100-0 1 Natuur en Scheidekundig Archiv, Deel 2. URINE. 349 In both the above analyses he searched in vain for hippuric or benzoic acid in three ounces of the fluid. In two other analyses he obtained microscopic crystals of hippuric acid on the evaporation of the ethereal solution. He never detected even a trace of uric acid, which, considering the mixed nature of the food of these animals, is extraordinary. Boussingault analysed the urine of a pig feeding on potatoes and water slightly impregnated with salt. The urine was alkaline, very limpid, and of an extremely pale yellow colour. Its specific gravity was 1013-6. It contained in 1000 parts : Water and indeterminate organic matter 979°14 Urea é ‘ : 4:90 Bicarbonate of potash. ‘ ; 10°74 Carbonate of magnesia . ' , 0°87 Carbonate of lime ‘ : ‘ traces Sulphate of potash ° : , 1:98 Phosphate of potash ; ; ; 1:02 Chloride of sodium . . - 1:28 Alkaline lactates . . undetermined Hippuric acid! ‘ . ‘ absent Silica ; ; . . 0°07 The urine of the goat has been analysed by Von Bibra. The animals from whom the fluid was obtained were confined in a stable and poorly fed, getting sour hay, &c. The urine was clear, of a peculiar but pungent odour, and alkaline. The spe- cific gravity was generally 1008 or 1009. In two instances it contained in 1000 parts: 1. . Water . : » 980-07 983-99 Solid residue , ‘ ; 19°93 16°01 Urea : : : 3°78 0°76 Hippuric acid : > 1°25 0°88 Alcohol-extract ; > 4°54 4°66 Water-extract ; 5 1:00 0°56 Mucus j : 0°06 0°05 Soluble salts = ‘ 8°50 8°70 Insoluble salts id . 0°80 0°40 1 Thinking that the absence of hippuric acid might be dependent on the diet, Boussingault mixed green trefoil with the potatoes: the result was, however, still the same. 350 THE SECRETIONS: The ash consisted of: Carbonate of magnesia with a little carbonate oflime 7°3 Sulphate of soda . . . « 25°0 Chloride of sodium ; : i ee Carbonate of soda with a little carbonate of potash 53°0 100°0 Here we remark, as in the urine of oxen, a considerable excess of the alkaline carbonates over the alkaline earths. The hip- puric acid seemed very variable, sometimes equalling the urea in amount. | Vauquelin analysed the urine of the beaver. He found in it the bicarbonates of lime and magnesia, and hippurate of soda, but no phosphates or uric acid. He also detected the un- decomposed colouring matter of the bark of the willow (the ordinary food of the beaver) in the urine; for he found that a piece of cloth which had been previously saturated with alum, took up the same colour from soaking in the urine as from lying in a decoction of the aforesaid bark. The urine of rabbits and guinea-pigs is much the same: it has an alkaline reaction, froths on the addition of an acid, and, when exposed to the air, throws down a sediment of carbonate of lime: it contains urea and the salts which are generally met with in the urine of the herbivora. [The urine of the hare has been examined on two occasions by Von Bibra. The first analysis was made in December. By external pressure on the region of the bladder he was enabled to collect about three pints from seven or eight hares. This was divided into two portions, one of which was evaporated and — incinerated, the other tested for hippuric acid, which was found to be present in small quantity, forming 0°0072 of the urine. The ash contained : Chloride of sodium with a little chloride of potassium 7:12 Sulphate of soda . : : - 16°82 Carbonate of soda ‘ : : 9°84 Phosphate of soda ee oe « , $905 Phosphates of lime and magnesia ; - 1317 100-00 URINE. 351 The urine was turbid and alkaline, depositing a white sedi- ment of minute globules, much smaller than those occurring in the urine of the horse, and consisting, for the most part, of phosphate of magnesia. The urine similarly obtained in the month of June had a faint alkaline reaction, and, in the course of six hours, crystals of ammoniaco-magnesian phosphate were observed on the surface. Its specific gravity was 1050, and it contained in 1000 parts: Water . y > - 912°86 Solid constituents . ; : 87°14 Urea . ‘ x 8°54 Hippuric acid . ; microscopic crystals Alcohol-extract . é : 9°58 Water-extract g ; i 32°68 Soluble salts J ‘ 5 23°70 Insoluble salts . Z 5 12°64 The ash consisted of : Chloride of sodium with a little chloride of potassium 22°49 Sulphate of soda 4 ‘ ‘ 29°97 Carbonate of soda - ee ‘ 8°73 Phosphate of soda ° ‘ : 4°39 Phosphate of lime . é ; 12°00 Phosphate of magnesia. : : 22°42 100°00 The difference in the amount of earthy phosphates in these analyses is easily accounted for when we consider the different nature of the food in winter and summer. Von Bibra obtained a minute quantity of a substance closely allied to humic acid in most of his analyses of the urine of the herbivora. | The urine of birds, which is discharged from the cloaca as a white pulpy mass and soon hardens when exposed to the air, is remarkable for the large quantity of urate of ammonia which it contains. The urine of birds of prey contains urea, and a peculiar green colouring matter which is not found in the urine of graminivorous birds. Vauquelin and Fourcroy found that, in the ostrich, the uric acid amounted to one sixtieth of the weight of the urine; there were also present sulphates of potash and lime, chloride of ammonium, an oily substance, a peculiar animal matter, and probably acetic acid. The urine of the parrot is, according to J. Davy, very similar to that of serpents. Be 352 THE SECRETIONS: The urine of serpents is excreted as a white, pultaceous, earthy mass, which soon stiffens when exposed to the air. It is composed, for the most part, of uric acid in combination with potash, soda, and ammonia, together with a little phosphate of lime. It contains no urea, since, upon digesting it in alco- hol, a yellow extractive matter is taken up, in which no crystals of urea can be detected. On the other hand, Berzelius directs our attention to the circumstance that Cap and Henry have obtained urea from that source, after having saturated the uric acid with hydrated baryta. [For an analysis of the urine of the rattle-snake, see Vol. I, p. 53, note. | The urine of the bull-frog (rana taurina) consists, according to J. Davy, of a fluid of specific gravity of 1003, which con- tains urea, chloride of sodium, and a little phosphate of lime in solution. The urine of bufo fuscus had a specific gravity of 1008 ; it contained a larger proportion of urea than the urine of the frog, together with chloride of sodium and phosphate of lime. In the urine of testudo nigra, which was examined by Magnus and J. Miller, there was no uric acid; on the other hand, there was 0°12 of urea, with a brown colouring matter which was soluble in water, spirit, potash, and hydrochloric acid. [The urine of a land-tortoise (testudo tubulata), which had been kept without food for some months, has been recently examined by Marchand.’ It had a faintly acid reaction, and resembled pus in appearance. He collected 1337 grains, con- sisting of ; Or in 1000 parts; Water ; A , 1271 950°64 Solid constituents ‘ : 66 49°36 Urea ‘ ; : 8°5 6°40 Uric acid. : ‘ 23°0 17°25 Hippuric acid ° ‘ none Salts and indeterminate organic matter 34°5 25°70 ] A small quantity of brown liquid fat, with a strong urinous odour, was taken up by ether. ] * Erdmann und Marchand’s Journ, 1845, iv, 4, 353 CHAPTER VIII. THE SECRETIONS OF THE LACHRYMAL, MEIBOMIAN, AND CERUMINOUS GLANDS. The Tears. Tue glandule lachrymales are two conglomerate acinous glands which secrete a limpid fluid, containing a very small proportion of solid constituents, and forming the tears. ~ They. are for the purpose of preserving the cornea of the eye in a state of moisture, and their secretion is much increased by in- tense feelings either of joy or grief. The tears have not yet been subjected to an accurate analysis, partly perhaps from the subject being one of little interest in a scientific point, and partly from the difficulty of obtaining a sufficient quantity. When examined under the microscope, the tears exhibit a small quantity of pavement epithelium and a few mucus-cor- puscles swimming in a clear fluid. They have a slightly saline taste, (much like that of the perspiration that exudes from the forehead,) and change red litmus-paper to a pale blue. The only chemical examination of the tears that can be de- pended on is that of Fourcroy and Vauquelin, who assert that they resemble in their constitution the aqueous humour of the eye. The solid constituents amount to only 19, and consist prin- cipally of chloride of sodium and of a yellow extractive matter which is not perfectly soluble in water: it is not improbable that the insoluble portion arises from the fatty-mucous secretion of the meibomian glands. The mucus also into which, accord- ing to those chemists, the extractive matter of the tears is con- verted previously to its being perfectly dried, may be, as Ber- zelius conjectures, the secretion of the meibomian glands. With regard to this latter secretion,—the gummy secretion of the eyes, we know even less than of the tears: it seems to consist principally of a mucous matter and of fat. II. 23 354 THE SECRETIONS: Cerumen. The glandule ceruminose, which are situated in the external skin of the meatus auditorius externus, secrete the ear-wax (cerumen), a peculiar salve-like matter, which is thrown out as a yellowish milk. If a small portion of ear-wax is pressed between two slips of glass and observed under the microscope, we shall find a quan- tity of variously-grouped lamellz lying in a tolerably homoge- neous yellow mass. In these lamellz, the practised observer will easily recognize pavement epithelium. On mixing the ear- wax with water, which may be readily done, a sort of yellowish milk is obtained, in which, with the microscope, we may observe colourless fat-vesicles, epithelium-scales, and sometimes rhombic crystals, very like cholesterin. The yellow colour of the cerumen does not belong to the fat, but to the matter which is soluble in water. Berzelius has made the following observations on the cerumen. Ether takes up fat from the mass which swells in it, and becomes as soft as goose-grease ; it has not an acid reaction, consists of stearin and olein, and contains a substance which, after saponification, gives off a strong smell of sweat. The fatty acids which are liberated on the addition of hydrochloric acid melt at 104°. After the fat has been removed, alcohol takes up a yellow substance from the ear-wax, which, on eva- poration of the alcohol, is left as a glossy matter, perfectly soluble in water, and of a very bitter taste. It may be en- tirely thrown down from its aqueous solution by the neutral acetate of lead and by chloride of tin; on the other hand, nitrate of silver does not even render it turbid; hence there can be no chlorides present. Upon incinerating this mass, there remains an ash, which consists of the carbonates of pot- ash and lime. The portion not dissolved by alcohol yields to water a small amount of yellowish matter, which is very similar to the soluble matter obtained in a similar manner from the other fluids of the animal body, and has a piquant taste; but it is distinguished by the circumstance that neither lime-water, basic acetate of lead, bichloride of mercury, nor tannic acid preci- pitate it. : The portion of the ear-wax which is insoluble in ether, CERUMEN. 355 alcohol, and water, is, next to the fat, the largest: acetic acid causes it to swell, and only takes up a very small portion of an albuminous matter. The residue (consisting evidently of nothing but epithelium-cells) is partly soluble in free potash, from which it cannot be again precipitated by acetic acid; ferrocyanide of potassium causes no precipitate in the acid solution, but infusion of galls a very copious one. Another portion of the residue, when heated with a concentrated solution of potash, enters into combinations which are not soluble in that fluid, but which are soluble in water, similar to what is observed in the urine. This investigation shows that the ear-wax is an emulsive com- pound, which contains a soft fat, albumen, a peculiar extractive bitter matter, epithelium-scales, lactate of lime, and an alkaline lactate, but no chlorides and no phosphates soluble in water. 356 CHAPTER IX. SECRETIONS AND FLUIDS OF THE GENERATIVE ORGANS. 1. Secretions of the male generative organs. SEMEN. Tue seminal fluid which is formed in the testicles and is conveyed along the vas deferens, is a thick, whitish, glutinous mass possessing a peculiar odour, and when examined under the microscope is found to be composed of a clear fluid, in which an immense number of minute caudate molecules, the spermatozoa, appear to be moving about at will. (Fig. 33.) In addition to the spermatozoa, seminal granules are likewise to be seen, which, according to Wagner, are rounded, fine granular corpuscles of ,1; — 4, of a line in diameter, and a few epithe- lium-scales. The spermatozoa occur in the semen of nearly all animals: they are elliptic in man, but assume various forms in different classes of animals, The chemical analysis of the semen, although not an uninter- esting subject, seems little calculated to throw any light upon the remarkable process that is recognized in the term impregnation. We cannot even form any conjecture regarding the connexion and the reciprocal effect that must take place between the fructifymg semen and the ovum which is to be fructified ; and although we cannot doubt that there are certain chemical pro- cesses going on, since the act of impregnation is succeeded by — a change not only of form but of matter, we have as yet but little prospect of investigating the subject successfully, in con- sequence of the insufficiency of our resources. The seminal fluid at the period of emission is somewhat turbid, and is mixed with the mucous secretion of the prostate, from which it cannot be separated. It has not always the same SEMEN. 357 consistence, and the longer it remains in the vesiculz seminales, the more consistent it becomes. The investigations of Vauquelin, Jordan, and John have elicited the following results, which, however, do not sufficiently explain its chemical relations. When the seminal fluid has been allowed to rest for some time, it becomes clear, more fluid, transparent, and almost entirely soluble in water; if, on the contrary, it is at once dropped into water it sinks, and instead of perfectly dissolving, it coagulates in threads, in the same manner as if it had been treated with alcohol. This coagulated matter is readily soluble in acetic acid, and the solution gives a copious precipitate on the addition of ferro- cyanide of potassium. On allowing the coagulum to remain in water, it gradually dissolves therein, leaving a residue of a few flocculi. The so- lution, if rapidly evaporated, gives off the peculiar odour of ‘semen, and leaves a clear glossy residue, which is opaque in water, and only partially dissolves in that fluid. From the portion which is insoluble in water, alcohol takes up extractive matter; and the portion insoluble in alcohol dissolves in boiling water, leaving a mucous residue : the solution is precipitable by acetate of lead, chloride of tin, bichloride of mercury, nitrate of silver, and infusion of galls. In semen which had stood for some time, Vauquelin found four-sided prisms arranged in stellar groups, and terminating in long four-sided pyramids, which Berzelius considers to have been ammoniaco-magnesian phosphate. Ifthe semen is allowed to evaporate it becomes covered with a film, in which white points may be observed, which are supposed by Vauquelin to be composed, as well as the before-mentioned prisms, of phosphate of lime. When the whole of the water has been removed by evaporation, there remains a yellow, transparent, elastic mass, which amounts to 102 of the weight of the semen. Vauquelin, moreover, states that fresh semen is soluble in all acids, from which it cannot be precipitated by alkalies, and conversely, that it is soluble in the alkalies, from which it is not precipitable by acids: chlorine-water, however, coagulates it to such a degree as to render it insoluble in water or acids. If the semen at the moment of emission is allowed to fall into alcohol, and to remain in it for some time, it coagulates tho- 358 THE SECRETIONS: roughly, becomes opalescent, and resembles a long thread: it is now incapacitated from returning to a state of solution like fresh semen, but remains, on being dried, fibrous, snow-white, and opaque. It gradually softens in water, but even at the boiling point only a very small portion dissolves in that fluid ; it swells, however, like mucus. If the water in which it has been boiled is evaporated, a white matter remains, which is partly soluble in cold, partly in boiling water, and the solution is freely precipitable by tannic acid. That portion of the semen, after coagulation by alcohol, which is not soluble in boiling water, will also resist the action of dilute solution of potash at a moderate temperature; it will, however, dissolve on being heated with a concentrated solution of caustic potash, and it cannot be again precipitated from this solution by acetic acid. With concentrated sulphuric acid it forms a yellow fluid, with- out the application of heat; on the addition of water it is pre- cipitated with a white colour, and the precipitate is not soluble in an excess of water. With acetic acid the coagulum becomes gelatinous and trans- parent ; on being diluted and warmed it dissolves, but does not form a perfectly clear fluid: this is only rendered turbid by fer- rocyanide of potassium, is not precipitated by bichloride of mercury or carbonate of ammonia, but by tannic acid is thrown down in light floccules, which continue for a long time in suspension. From these researches Berzelius concludes that the semen contains a peculiar matter which may be obtained in two sepa- rate states depending upon whether it be projected into water or alcohol. When coagulated by alcohol it has an external re- semblance to fibrin, and, moreover, like that substance, it can be precipitated from its acetic-acid solution by ferrocyanide of potassium : on the other hand, it differs from it in its solubility in nitric acid, and in its power of resisting the soluble action of a cold solution of potash. On heating the residue of the semen it becomes yellow, emits an odour of burnt horn, gives off a considerable quantity of ammonia, and leaves a carbonaceous mass which is not © easy of incineration, and contains carbonate of soda, chloride of sodium, and phosphates of lime and magnesia. Vauquelin assigns the following composition to the seminal fluid. SEMEN. 359 In 100 parts there are— Peculiar extractive matter - P 6 Phosphate of lime . ° P 3 Soda ‘ s ‘ . 1 Water : ; ; . 90 According to John, the seminal fluid contains a substance resembling mucus, with small quantities of a peculiar form of al- bumen, of a substance slightly soluble in ether, of soda, phosphate of lime, chloride of sodium, sulphur, and a volatile odorous principle. The prostatic fluid which mixes with the semen of the male, at the moment of emission, has never yet been procured in sufficient quantity for analysis: it forms an almost clear fluid, which may be drawn out in threads. 2. Secretions of the female generative organs. LIQUOR AMNII. The liquor amnii surrounds the foetus: at the period of de- livery the membranes which contain it give way, and it escapes externally. Although it has been submitted to numerous ana- lyses, its nature, even now, is not clearly understood. Human liquor amnii is turbid, and holds in suspension flocculi of caseous matter, arising from the vernix caseosa with which the foetus is covered. Its specific gravity is 1005, and it contains from 1-22 to 1°62 of solid constituents; but according to Fromherz and Gugert, as much as 3°, It has avery decided alkaline reaction, but the indications of this reaction disappear when the test paper is dried ; it is consequently dependent on free ammonia. Alcohol took up extractive matter from the residue of the liquor amnii, and there remained, according to Fromherz and Gugert, a quantity of albumen, salivary matter (ptyalin), and casein. When evaporated to the consistence of a syrup, and treated. with hydrochloric acid, acid flocculi separated themselves, which were recognized, after a careful analysis, as benzoic acid. Berzelius, however, supposes that it might have been hippuric acid. After the fluid had been filtered, and the above matter removed, nitric acid was added and the mixture submitted he 360 THE SECRETIONS: to the action of cold. Verrucose crystals then separated them- selves, which were assumed to be composed of nitrate of urea, without being further analysed. The salts of the liquor amnii are described as consisting of chloride of sodium in large quantity, phosphate, sulphate, and carbonate of soda, sulphate of lime, and a small amount of potash-salts. The analyses of Voigt, which were made with the liquor amnii of women who had died in various stages of pregnancy, give discordant results, probably as Berzelius supposes from the cir- cumstance of the fluid at the full time being different from what it was in the early stages of pregnancy. The liquor amnu at the fourth month was not turbid, had an insipid taste, a specific gravity of 1018°2, a neutral reaction, frothed upon being shaken, coagulated on boiling, was precipitated by bi- chloride of mercury and tannic acid, and less copiously by perchloride of iron and acetate of lead. After coagulation by boiling, the fluid which had been cleared by filtration, was strongly precipitable by nitric acid, while it was very little affected by chloride of barium, lime-water, ammonia, or oxalate of ammonia. Perchloride of iron, and chloride of platinum, produced no effect upon it. The liquor amnii at the sixth month was turbid, yellowish, viscid, had a specific gravity of 10092; when heated to the boiling point gave a mucous coagulum which could not be se- parated by filtration, and its behaviour towards reagents was the same as in the former case. As to casein, ptyalin, urea, benzoic and hippuric acids, Voigt was as unable to find them as carbonate of ammonia or sulphuret of ammonium, and he conceives that at least some of these substances may arise from the fetal urine which becomes mixed with the liquor amnii previous to delivery. Voigt’s view of the composition of the liquor amnii is as follows : At the 4th month. At the 6th month. Water ‘ ‘ - 979°45 990°29 Aleohol-extract and lactate of soda 3°69 0°34 Albumen ; ‘ 10°77 6°67 Chloride of sodium ; Ee 2°40 Sulphate and phosphate of lime. 0°14 0°30 LIQUOR AMNII. 361 [Four specimens of liquor amnii examined by Dr. Rees', ex- tracted from four individuals in the 74 month of pregnancy, contained the same constituents. The specific gravity varied from 1008°6 t01007. They were alkaline, contained urea, and the same salts as occur in the blood. One specimen contained : Water ; é ; : : - 984°98 Solid constituents ; E k : ‘ 15°02 Albumen with traces of fatty matter , ‘ : 1°80 ; Salts. ’ x 2°80 ‘ Extract soluble in water Organic matter, chiefly albumen 3°22 6-02 Salts 7 é 2°80 Do. soluble in water and alcohol 4 Organic matter, chiefly 7:20 lactic acid and urea 4°4 The caseous matter floating in the liquid contained cho- lesterin. i The liquor amnii at the full time has been recently analysed by Mack,? who obtained two specimens for examination from Dr. Mikschik. The fluid in both cases was perfectly pure, the membranes being ruptured as they projected from the external organs. The quantity of the fluid in the first case amounted to a little more than an ounce and a half; it was turbid, with white flocculi of vernix caseosa in suspension; it had a sickly odour, and a faintly saline taste. Under the microscope there were seen isolated mucus-corpuscles, with pavement and ciliated epithelium. The specific gravity was 1006'3, and the reaction faintly alkaline. The fluid coagulated slightly on heating, and became covered with a thin membrane during evaporation. The amount of fluid obtained in the second instance was slightly above two ounces ; the specific gravity was 1004°7 ; the reaction alkaline; and the other physical characters the same as in the former case. In 1000 parts there were contained : 1. 2. Water é j 985°147 988°123 Solid constituents ‘ 14°853 11877 Fat F ‘ 1°250 0°132 Alcohol-extract ; 5°251 4°752 Water-extract : 4°651 4°352 Matter insoluble in water 3°701 2°641 Sulphate of lime . 1:722 1°672 Chloride of sodium and : 9°333 : 9-236 fixed salts. carbonate of soda 7611 7-564 1 Phil. Mag. (3d series) vol. 13, p. 395. 2 Heller’s Archiv fir physiol. und pathol. Chemie und Mikroskopie, vol. 2, p. 218. 362 THE SECRETIONS: Urea and hippuric acid were carefully, but unsuccessfully, — sought for in both specimens; neither could carbonate or hy- drosulphate of ammonia be detected. It is suggested by Mack that the discrepancies in the results obtained by other chemists may be owing to their having ex- amined the fluid mixed with blood, mucus, or urine. Two years ago he analysed a specimen (under the superintendence of Dr. Ragsky) which contained much blood and mucus. The fluid was of a dirty yellow colour, and deposited a sediment. Under the microscope there were seen blood- and mucus-corpuscles, with epithelium-cells. The specific gravity was 1011°2. In 1000 parts there were contained : Water . . - 984131 Solid constituents - 15°869 Fat . 4 0°4984 Alcohol-extract ‘ 0°8529 Water-extract . 4:0998 Substances insoluble in water 10°4177 ] Several analyses have been made of the liquor amnii of animals. A very remarkable observation on this subject was made by Prout. The liquor amnii of a cow in an early stage of pregnancy was of a yellow colour, and opaque in consequence of holding a large quantity of glittering particles in suspension ; its taste was like that of fresh whey, it smelt like fresh milk, and was neutral to test paper. Upon heating it to the boiling point it coagulated; coagulation was, however, prevented by the addition of acetic acid: with chloride of barium it gave a copious pre@i- pitate. The fluid which had been boiled gave, after filtration and evaporation, crystallizable sugar of milk, from which alcohol took — up a yellow extractive matter with some lactates. Berzelius remarks that the presence of sugar of milk in the liquor amnii at an early period, is of the greatest physiological interest, since it doubtless contributes to the nutrition of the foetus. Prout gives the following as the composition of 100 parts of this fluid : Water ‘ ‘ p ;. 97°70 Albumen i ss ‘ ‘ 0°26 Alcohol-extract and lactates o ‘ 1°66 Water-extract, salts, and sugar of milk ‘ 0°38 In the liquor amnii of a mare which Voigt examined, he also aa FLUID OF THE ALLANTOIS. 363 found no urea. It had a specifie gravity of 1005:1, and left a solid residue of 1:452, half of which was soluble in alcohol : the portion which was not soluble in it consisted of albumen, chloride of sodium, and sulphate of lime. In the liquor amnii of a cow, which was viscid, very thick, of a yellow colour, and had a saltish taste and an alkaline reac- tion, Lassaigne found albumen, mucus, a yellow matter analo- gous to bile, chlorides of sodium and potassium, carbonate of soda, and phosphate of lime: no extractive matters are enu- merated amongst the constituents. The flocculi which are suspended in the liquor amnii of the cow are said by this che- mist to be composed of albumen with 0°27 of their weight of oxalate of lime. I have already treated of vaginal mucus, menstrual blood, and the secretion of the mammary glands ; it still remains for me to offer a few remarks on the fluid of the allantois. The allantois with its inclosed fluid is absent in the human em- bryo: it is found, however, in many animals. It is situated above the amnion, and it is between these two membranes that the urine of the foetus collects, being conveyed there by the urachus from the urinary bladder, and constituting the fluid of the allantois. | It has several times been the object of chemical. investiga- tion; it is clear, of a brown-yellow colour, of a bitter and saltish taste, and reddens litmus paper. Its specific gravity, according to Dzondi, fluctuates between 1003 and 1029. On evapora- tion flocculi are precipitated, which consist of albumen and phosphate of lime. The residue left after evaporation is very slightly soluble in alcohol, which takes up a yellowish-brown acid extractive matter, and white nacreous crystals which retain their form upon mixing the residue obtained by evaporation with water, and constitute allantom, which was first termed by Vauquelin, amniotic acid, and by Lassaigne, allantoic acid. The substances remaining in the watery solution, are chloride of sodium, alkaline lactates, a salt of ammonia, and extractive matters. From the portion insoluble in alcohol, water takes up sulphate and phosphate of soda, phosphates of lime and mag- nesia, and a brown extractive matter which is copiously precipi- tated by infusion of galls. Whether the fiuid of the allantois 364 THE SECRETIONS : contains urea as well as allantoin is a point not yet ascer- tained.’ In speaking of the liquor amnii we mentioned that the floccules which are seen swimming in it are derived from the peculiar caseous matter, the vernix caseosa, which invests the foetus. I shall avail myself of this opportunity of offering a few remarks upon this substance. Upon examining this ca- seous investment with the microscope, I found, especially when it had been previously diluted with water, a very large quantity of pavement epithelium, numerous fat-vesicles, and some but not a great many crystals, which in part resembled cholesterin, and in part distinctly assumed the form of ammoniaco-magne- sian phosphate. Upon examining the vernix caseosa by the microscope, with- out previously diluting it with water, indications of a large number of crystals presented themselves; they disappeared, however, on the addition of water, and I concluded that this peculiar appearance was caused by epithelium-cells. According to Fromherz and Gugert the vernix caseosa con- sists of a mixture of fat resembling cholesterin with coagulated albumen. Microscopic investigation at once shows that what was considered by these observers as albumen, was at any rate for the most part epithelium, and that a considerable quantity of fluid fat must be present besides cholesterin. They also state that ether takes up from the vernix caseosa a fat which crystallizes in glittering leaves, which does not admit of sapo- nification, and does not melt in boiling water. Cold water takes up a little of the portion which is insoluble in ether, and boiling water takes up a yellowish substance with an alkaline reaction, which they regarded as ptyalin, but which Berzelius conceives to be most likely albuminate of soda. The residue is evidently epithelium, since it is insoluble in a cold, but soluble in a boiling solution of potash. [The most recent observations on the vernix caseosa are those of Dr. Davy.” He states “that its specific gravity (after the air that is entangled in it is removed) is 1003-9. It is very ! See vol. I, p 57. 2 Medico-chir. Trans. 1844, p. 193. ens tid ope H rit OATS oe ae 1 a > » ae ayant , E ; eer a PEN ER ene Te eae ape ne et ji bd? d VERNIX CASEOSA. 365 retentive of water. It required ten hours’ exposure over the steam-bath, to expel from eight grains the whole of the water belonging to it, when it was reduced to 1:77 grain. A spe- cimen of great purity taken from a healthy infant immediately after birth was found to consist of : Water . : a 77°87 Olein . ’ “ 5°75 Margarin ch . 3°13 Epithelium-scales . ‘ 13°25 100-00 “ A portion of the same was incinerated: it burned with a bright flame and left a very small quantity of white ash, hardly 3th of a grain, although 40 grains was the quantity con- sumed, weighed before drying. This ash, in a drop of dilute muriatic acid, dissolved, emitting a distinct smell of sulphuretted hydrogen ; and the solution was clouded by adding a little am- monia, indicating the presence of a minute portion of phosphate of lime and sulphur—the latter in union probably with lime or potash.” | } 366 CHAPTER X. THE INTESTINAL EXCRETIONS. Tuat portion of the food which is not taken up by the absor- bents which are everywhere distributed between the stomach and the large intestine is again discharged from the system as feeces. The feeces must materially vary with the species of food that is taken, and with the energy of the digestive powers. When we see that many men are kept in a better and more desirable con- dition on a very small quantity of food, than others who take a larger amount of nutritious aliment, we must necessarily conclude that in the former case everything which could possibly serve for nutrition was extracted and suitably employed, while in the latter we must suppose that only a small portion of nutritive matter was taken up from the large quantity of food, and that the greater portion was discharged with the feces. In accordance with what I briefly stated respecting the fluid secretions of the chylopoietic viscera in relation to the process of digestion, it follows that after food has been taken the feeces must contain (]) that portion of the food which has not been absorbed, and (2) the addition which is received in the form of secretion from the intestinal canal and its appendages, between the mouth and the anus. These consequently are, those sub- stances which are altogether insoluble in the digestive fluids, as for instance, vegetable fibre; those which, although capable of digestion, have from various causes not been digested, as for instance, the flesh of old animals, sinews, ligaments, fat, &c. ; the bile, more or less modified, together with biliphzin and cholesterin, the mucus of the intestinal canal, and a consi- derable amount of salts, amongst which ammoniaco-magnesian phosphate is especially distinguished by its well-defined crystals. The feeces of adults are, however, different from those of the RP ee eee eee , a a poe ee? we eee Lk . x et en A eR od: ia Se) Gee ee ee ee he, eee ee Pe oe ie ailre Tis FACES. , 367 foetus and the infant at the breast, as the following analyses will show. I have made an analysis of the feces of the fcetus,—the meconium; it constituted a thick, glutinous greenish-black mass, had a sweetish insipid odour, and a corresponding taste : when examined with the microscope, after being diluted with water, a very large number of epithelium-cells and numerous rhombic plates, resembling crystallized cholesterin could be seen, besides a green-coloured amorphous mass which was pre- sent in considerable quantity. A small number of minute rounded corpuscles, which upon floating about, allowed me to recognize their flattened shape, appeared to be discoloured blood-corpuscles. Ether took up, from the dried meconium, a firm white fat, —cholesterin ; alcohol took up some extractive matter with bilifellinic acid; spirit took up a substance reacting exactly lke casein, together with some bilifellinic acid ; finally, alcohol aci- dulated with sulphuric acid took up some green bile-pigment. There remained cells, mucus, and probably albumen. 100 parts of the dried meconium contained : Analysis 149. Cholesterin ; 16:00 Extractive matter and bilifellinic acid e 14:00 Casein ‘ : ‘ 34°00 Bilifellinic acid and bilin ‘ : 6°00 Biliverdin with bilifellinic acid . ‘ 4°00 Cells, mucus, albumen ‘ ; 26°00 The ash of meconium consists, according to Payen, of an alkaline carbonate, and phosphate of lime. [Dr. Davy! has recently examined the meconium both micro- scopically and chemically. “ It may be advantageously examined. by the microscope, either mixed with water or in a saturated solution of common salt, or merely compressed between two plates of glass. Using either method, its appearance is much the same,—it exhibits a confused mixture of globules, plates, and molecules. «The globules, about 1-3000th of an inch in diameter, are very ' Medico-Chirurg. Trans. 1844, p. 189. 368 _ THE EXCRETIONS : abundant, and form the principal mass of the whole. Judging from their form and size, their insolubility in water and alcohol, they may be inferred to consist chiefly of mucus. “ The plates, which are tolerably abundant, are of two kinds: one kind is of irregular form, somewhat granular, varying in size from about 1-2000th to 1-1000th of an inch in diameter, insoluble in water, alcohol, whether hot or cold, and the dilute acids and alkalies after the manner of epithelium-scales, which we believe them to be. The other kind are of a regular form, chiefly rhomboidal, of great thinness and perfect transparency, insoluble in water and acids and cold alcohol, but readily so- luble in hot ;—properties sufficiently indi¢ative of cholesterin. “The molecules vary in size from 1-8000th to 1-20,000th of an inch in diameter ;—and, as they are insoluble in water, and in most part soluble in an alkaline ley, they may be considered as consisting chiefly of fatty matter. They constitute a very small part of the whole. “ Besides these ingredients admitting of being distinguished by the microscope, to which the meconium owes its thick con- . sistency and viscid nature, there is another portion, the soluble part, with which they are imbued, and from which the mass derives its colour and taste, and probably its power of resisting putrefaction, and which seems identical with the colouring and sapid matter of bile, being soluble in water and alcohol.’ “The specific gravity of meconium, deprived of air, exceeds that of water. It sinks in a saturated solution of common salt of the specific gravity of 1148. “This mixture of meconium and brine affords, after standmg for some time, a kind of mechanical analysis or separation of its ingredients. The mucus-globules and epithelium-scales, dyed of a dark green by the colouring matter, find their place of rest at the bottom, whilst in the supernatant fluid, slightly turbid, and of a bright greenish-yellow hue, numerous plates of cholesterin, and a smaller number of fatty globules and mole- cules are found suspended.” ! This property of meconium is remarkable. After more than three months a portion put by in a bottle containing a good deal of air, closed to prevent the drying of the substance, was found unaltered in colour, and presenting the same appearance under the microscope as when first examined ; the only perceptible difference was that its upper surface was covered with a mould or mucor, like that of cheese, formed of connected globules, each about 1-5000th of an inch in diameter. Sr abs Od Araki SRA ee os OS cd TURE rik ko, ort ey a FACES. 369 Every specimen examined by Dr. Davy, (some voided just | after birth, others taken from the intestines of still-born chil- dren,) was very similar, composed chiefly of mucus-globules and epithelium-scales, and of biliary matter containing, besides the colouring and sapid matter of the bile, a small portion of cho- lesterin, of margarin, and olein, with a little free acid, probably the carbonic, judging from the absence of a precipitate on the addition of nitrate of silver, and from the circumstance that the redness imparted to litmus paper was removed by heat. A specimen obtained from a healthy child immediately after birth, contained : Water , : j 727 Mucus and epithelium- at ‘ ‘ 23°6 Cholesterin and margarin P 0-7 Colouring and sapid matter of bile, aid olein . 3°0 100-0 A portion of the same meconium was incinerated. It burned, after becoming semifluid, with a bright flame, and left -699 of reddish ash, chiefly peroxide of iron and magnesia, with a trace of phosphate of lime and chloride of sodium: the magnesia seemed to be the predominant ingredient and uncombined. | I have likewise analysed the feces of an infant six days old, nourished on its mother’s milk. They were pultaceous, of a yellow colour, had a strong acid odour, and both smelled and tasted like sour milk. When the mass was diluted with water, I could observe through the microscope an extraordinary number of fat-vesicles; there were no epithelium-cells, but I found an amorphous consistent matter resembling coagulated albumen or casein. The proportion of fat was so large that on evaporation the whole mass became fluid. Ether took up this fat, which appeared to be more solid than butter, but contained no cholesterin, since it was perfectly saponifiable. After the removal of the fat, the feeces did not yield any extractive matter to alcohol, but gave’ biliverdin to alcohol acidulated with sulphuric acid. On extracting this colouring matter with ether, a considerable quantity of green fat was taken up. II. 24: 370 THE EXCRETIONS: 100 parts of the dried fecal mass contained : Analysis 150. Fat ‘ 5 - 52°00 Bile-pigment with fat . - 16°00 Coagulated casein with mucus . 18°00 Moisture and loss ° - 14:00 No accurate analysis of the excrements of the healthy adult has been made, that I am aware of, since 1804, when Berzelius investigated the subject : I shall therefore give his results. The excrements mix very gradually with water, which they render — mucous and turbid, and which is a long time clearing itself : on decanting the mixture, there remains a grayish-brown re- sidue consisting of insoluble vegetable matter, through which a thick grayish-green fluid permeates, depositing a copious sediment when placed in a corked bottle. The thinner supernatant portion can only be filtered with difficulty. If the fluid is very concentrated, and is at the same time clear, it will soon be observed to become dark, a change of colour apparently due to the action of the atmosphere. When this fiuid is evaporated, crystals of ammoniaco-magne- sian phosphate gradually form on the surface; as they were not previously apparent we may conclude that the ammonia is sub- sequently produced. On extracting with alcohol the residue left after the evaporation of the water, a substance of a reddish- a brown colour is taken up, while a grayish-brown matter (A) ~ remains undissolved. The alcoholic solution yields on evaporation a residue which — 1 forms a resinous precipitate with sulphuric acid, consisting of bilifellinie acid with an excess of bilin, which may be separated a by oxide of lead into bilifellinate of lead and bilin. On distilling the mixture with sulphuric acid we obtain a fluid which yields traces of hydrochloric but not of acetic acid: on saturating the sulphuric acid in the residue with baryta, after the separation of the biliary resin, and then evaporating, and treating the dry mass with alcohol, an extractive matter of e: a reddish-brown tint is taken up, which is apparently the cause of the change of colour to which we have already alluded m the concentrated aqueous solution of the feces. This sub- : stance is soluble in alcohol and in water, is almost entirely precipitated by the salts of tin, lead, and silver, and on the addi- i sid aca ga Pe ae ee ae en ee sa A A ae Sahih Laas asi = ¥ ‘ a ian EF ee, et, Bee ce ee, ee a ae Tog het . I a ha os a Nae Pee ae, Teen aes FACES. 371 tion of an acid a bright red deposit is formed. On adding a little tannic acid it is precipitated in the form of a red powder, and by an excess of that reagent, in greyish-brown flocculi. The substance (A) which is soluble in water but not in al- cohol, consists of albumen coloured brown by bile, containing, mixed with it, alkaline sulphates and phosphates, and phosphate of lime. That portion of the feeces which is insoluble in water, and remains floating on its surface, consists of a mixture of intes- tinal mucus and of the substances precipitated by the bile: it is very viscid, clogs up the pores of filtering paper, and dries upon it as a glistening, brittle, and elastic coating; on being again placed in water it softens, and, especially if any free alkali is present, becomes viscid as before. This mass is perfectly soluble in caustic potash, and may be again thrown down by the addition of an acid; the fluid then gives off an odour of bile. Ether and alcohol take up fat and biliary resin, and yield greenish extracts. The ethereal solution becomes turbid on the addition of alcohol in conse- quence of the precipitation of fat; the residue left after eva- poration melts in boiling water, leaves spots of fat on filtering paper, and dissolves in caustic potash; hence it contains no cholesterin. The portion left after the aforesaid extractions with ether and alcohol, imparts to water a peculiar yellow matter, which soon changes to a darker tint after exposure to the air; it is devoid of odour or taste, and rapidly becomes putrid. It is at first insoluble in alcohol, but it becomes soluble as decay commences ; moreover when fresh it is hardly rendered turbid by the addition of infusion of galls, but is strongly precipi- tated by that reagent after the commencement of putrefaction. If this substance, when quite fresh, is mixed with the solution of fat and biliary resin which we have just described, we observe a grayish-green precipitate which deposits itself as slowly as the precipitate from which these substances were originally obtained. Hence, as Berzelius remarks, we may conclude that the excre- ments contain an insoluble combination of the constituents of the bile, with other materials which have been added to it in the course of the digestive process. The analysis of human feces, sufficiently consistent to form & 372 - ‘THE EXCRETIONS: consistent masses, yielded to Berzelius the following results in 1000 parts : Water | Z ; ; ‘ 733°0 Solid dhigcanata’ 3 : ; : 267°0 Bile eo . i é 9:0 Albumen r ‘ . J 9-0 Peculiar extractive matter % ; ‘ 27°0 Salts ‘ ; ; 12°0 Insoluble residue of food : , 70°0 Substances added in the intestinal canal, as much, biliary resin, fat, a peculiar animal matter, &c. ‘ é 140°0 The salts in this analysis were determined by a separate experiment: three ounces of fresh excrement were repeatedly extracted with water, and the residue obtained by evaporation was incinerated. The ash was composed of : Carbonate (lactate) of soda ; ‘ 3°5 Chloride of sodium ; : : 4:0 Sulphate of soda . ‘ ‘ 2:0 Phosphate of magnesia. ; : 2°0 Phosphate of lime ‘ é ‘ 4-0 15°5 We observe that there is a considerable proportion of phos- phate of magnesia, and a much larger of phosphate of lime; the former constituting 13°32 and the latter 26°62 of the salts. The comparatively large amount of phosphate of magnesia may _ be partly accounted for by the use of coarse bread, which con- tains a considerable quantity of this salt. 2 From dried excrements Berzelius obtained 15-0° of fixed salts, of which 10° were earthy phosphates with a trace of _ sulphate of lime, 0°88 carbonate of soda, an equal quantity of sulphate of soda with sulphate of potash and phosphate of soda, and 1-69 silica originating from vegetable matters. — a Nothing is said regarding the chlorides ; they were probably _ not determined. i. [Enderlin has instituted numerous observations on human S feeces, chiefly in reference to the salts. A. Fresh excrements of a yellowish-brown colour, a pulpy appearance, and an alkaline reaction, were dried and incinerated. FACES. 373 The resulting ash was white, alkaline, effervesced on the addition of an acid, and contained : Tribasic phosphate of soda (a little). Chloride of sodium. Alkaline sulphates. Phosphates of lime and magnesia (in abundance), Carbonate and sulphate of lime. Phosphate of iron (a trace). s. Another portion of the same excrement was extracted with water, and the brown, alkaline solution evaporated on the water-bath. During the process of evaporation there was formed on the surface a tenacious, yellowish-brown film, which, when removed, was speedily replaced. a. One half of the evaporated aqueous extract was incine- rated. The ash was very alkaline, effervesced briskly on the addition of an acid, and contained : Alkaline carbonates. Alkaline sulphates. Alkaline phosphates. Chloride of sodium and earthy phosphates. b. The other half of the evaporated aqueous extract was treated with alcohol, which assumed a tint varying from a red to a - green, and had an alkaline reaction. On evaporating the al- coholic solution, an alkaline ash was obtained, consisting, for the most part, of tribasic phosphate of soda and chloride of sodium. The membrane and other matters not taken up by alcohol, yielded a neutral ash consisting of phosphates of lime and magnesia, with traces of chloride of sodium and alkaline phos- phates. | c. The portion of excrement not taken up by water, yielded a neutral ash consisting of : Phosphates of lime and magnesia, Sulphate of lime. Traces of chloride of sodium and alkaline phosphates. With a solution of baryta, the alcoholic solution yielded a very bulky, yellowish-green precipitate; and, on the addition of basic acetate of lead, there was a considerable sediment so- luble in acetic acid, decolorization of the fluid, &c.; hence un- changed choleate of soda was present. The occurrence of this constituent was, however, by no means invariable ; and, gene- 374 THE EXCRETIONS: rally speaking, choleate of soda (or bile) may be expected to be absent when the feces have remained for some time in the large intestine, and there has been full opportunity for re- sorption. It follows that the carbonate of lime is a product of the double decomposition that occurs between the sulphate of lime and the carbonate of soda resulting from the incinerated cho- leate of soda, or bile. The formation of the membrane during evaporation indicates the presence of a certain amount of albumen. In 100 parts of the ash yielded by the excrement of another individual, there were contained: — Chloride of sodium and alkaline sulphates 1°367 ; } soluble in water. Bibasic phosphate of soda ‘ . _2°633 Phosphates of lime and magnesia . 80°372 Phosphate of iron . F - .,2°090 |. P : Sulphate of lime. soe pale Silica. ‘ - . 7940 98-932 From the absence of carbonate of lime in this imstance, it may be concluded that no choleate of soda or bile was present. - The excrement was very firm and solid. I am indebted to the kindness. of Dr. Percy for the follow- ing analyses of the feces. 1..The individual, who was about thirty years of age, had taken the ordinary diet of this country, and appeared to be in the enjoyment of perfect health. In 100 parts of dried residue there were contained : Substances soluble in ether (brownish yellow fat) 5 11°95 -" in alcohol of-'830 ¢ : 10°74 9 in water (brown resinoid matter) ‘ 11°61 Organic matter insoluble in the above menstrua , 49°33 Salts soluble in water ‘ ; ; ; 4°76 Salts insoluble in water : : ; ; 11°61 An ultimate analysis of the feces in this case was also insti- tuted. “I may here premise,” says Dr. Percy, “ that I have invariably used chromate of lead as the oxidising body, and have occasionally sheathed the combustion tube with thin sheet copper, in order to enable me to attain a high degree of heat EE oe oe PAR EROS, Pe ee ee eS eT Ce aL ee See ee pen ee — i a he Ae sal Ae iia tle an Ce ore oe fe a ta rie ie it ae a : aa 2 ee a iT : he ; Pre PME nd Eta garste ans Ayr Nee tenet aitPe ea ta Ti OSL 4 a | es Rome eae ee FACES. 379 towards the close of the combustion, a precaution essentially ne- cessary in the analysis of these matters, as the last trace of carbon cannot, without this precaution, be completely burned. In corroboration of this statement I may mention that the perfect incineration of feeces at a red heat requires a considerable time. The matter was prepared for analysis by first drying over the water-bath, and then either in an oven at the temperature of 212° or some degrees above, or in the salt-water bath and by a current of air desiccated by chloride of calcium. I was extremely particular in respect to the drying, and, generally, in a second analysis, employed matter which had been subjected to the drying process for a much longer time than in the first, so that the correctness of the proportion of hydrogen should be satis- factorily tested. Ist Analysis: 7°41 grs. gave—of water 4:43 or of hydrogen 6°648, of CO, 12°55 or of C 4671898. 2d Analysis: 7°24 grs. gave—of water 4°44 or of hydrogen 6°81, of CO, 12-28 or of C 46°23$. Incineration : 50°13 grs. gave—of ash 8°21, or 16°37$. Nitrogen—not yet determined. _ Taking the mean, we have: Ose ooate te SSO : H . . ° 6°72 1 . Neo at does Wie gs. 4-3. 1632 “ These results are very nearly the same as those obtained by Dr. Playfair,! at Giessen. His analysis gives C 45-24, H 6:88, N & 0 34°73, ash 13°15. These facts are worthy of attention, as they seem to show that, under ordinary circum- stances of health, the composition of the feces is more uniform than we might @ priori have anticipated. The first analysis, it will be borne in mind, was of the feces of a man in this country; the second, of a soldier at Giessen. «2. A man undergoing the curious and rigorous discipline of training for prize-fighting. This individual, it will not be doubted, was in the possession of the most perfect health. [He had been in training for about a week. Age, 22; height, 5ft. 6in.; weight, 8: stones. I request particular attention to the diet. He breakfasted at 9 a.m., and took one pound of mutton weighed before cooking. He dined at 1 p.m., took the same quantity of 1 Liebig’s Animal Chemistry, 2d edition, p. 285. Me 396 THE EXCRETIONS : mutton, and about two ounces of bread. He had the same quan- tity of mutton for supper at 8 p.m. At each meal he drank halfa pint of ale, and no other liquid during the day ; nor, it must be remembered, had he any other vegetable matter besides the small quantity of bread mentioned. He walked seventeen miles daily. Ist Analysis: 5°35 grs. gave—of HO 3°43 or H 7:12§, of CO, 9°73 or C 49°608. 2d Analysis: 5°74 grs. gave—of HO 3-62 or H 7-018, of CO, 10°52 or C 49.985. The difference between these two analyses, in respect to the carbon, is greater than should be allowed, but I had not time to make a third analysis. Incineration: 31°42 grs. gave—of ash 4°56, or 14-518. Mean—C 5 ; . 49°79 H . : iy: ges N&O : . 28°64 rr Ash . : ; oe. “T should observe that, in drying this specimen, towards the __ end of the process a small quantity of liquid condensed on the surface of the tube communicating with the vessel of water, which was clear and colourless, had a peculiar and extremely offensive odour, and which powerfully reddened litmus. 1 had not sufficient leisure to examine it more minutely at the time.””] The feces during disease. In certain pathological conditions, the feeces frequently un- dergo very important modifications. These changes cannot be due to any peculiarities in the ingesta; they must originate in an alienated mixture or separation of the secretions of the chylopoietic viscera. This irregularity may lead to imperfect chymification, in which case matters will be carried off with the feeces, which, if they had been properly digested, would have _ entered the vascular system ; or, in consequence of the changed _ process of secretion, substances which are normal secretions may be separated in too large a quantity, as, for instance, water; or substances which ought to be present, are entirely ! I strongly suspected the matter to be butyric ‘acid, and my suspicion has since been much strengthened by my examination of a specimen of pure butyric acid which Thad an opportunity of seeing in London, at the Pharmaceutical Society. Besides, Dr. Erwin Waidele, whom I had the pleasure of meeting at Professor Graham’s, __ informed me that Dr. Ragsky of Vienna has discovered this acid in the feces. FASCES. 377 absent, as, for instance, bile; or, lastly, substances which are altogether foreign to the normal secretions, are mixed with the feeces, as albumen, blood, &c. In the case of diabetes alluded to in p. 296, I carefully ex- amined the feces. They contained no sugar, and were chiefly remarkable for their large amount of solid fat. Two or three pultaceous stools, averaging collectively 18-5 ounces, were passed daily. They gave off a very disagreeable odour, and were of a grayish clay colour. Alcohol digested with this fecal matter became coloured brown, and extracted a large quantity of fat, extractive matter, and a little bilin. On treating the portion insoluble in alcohol with water, a small amount of water-extract, almost devoid of taste, was taken up. The insoluble residue yielded, on incine- ration, an odour of burned horn or glue, and contained a large amount of nitrogen.’ A quantitative analysis showed that the 18°5 ounces of fecal matter contained : Analysis 15]. Whole quantity. In 100 parts. oz. grains. Water . : . > 12 312 Solid constituents ‘ ‘ ; 5 408 ’ Fat 2 0 34°0 Bilin and extractive matter ‘soluble in : alcohol é ‘ x O66 2°0 Water-extract 0 56 2°0 Alkaline salts 0 182 6°5 Carbonate of lime . 0 70 +364 2°5 Earthy phosphates and peroxide of iron 0 112 4:0 Insoluble nitrogenous matters 2 359 470 I have attempted, in accordance with the plan laid down in the appendix to Liebig’s ‘ Animal Chemistry,’ to compare the amount of carbon, nitrogen, and hydrogen in the food and in the excretions. The ingesta consisted of : 8 oz. of dry gluten bread. 11:5 ,, dry meat. 2 yp ary egg. 2 4 cod-liver oil. 23°5 ounces. ! [This is entirely opposed to the experience of Lehmann, who states that the feces of diabetic patients frequently yield a mere trace of nitrogen. Lehrbuch der physio- logischen Chemie, 1842, p. 312.] . 378 THE EXCRETIONS: There were discharged : By the urine. From the bowels. 8°8 oz. of sugar. 2 oz._of fat. 1°3 oz. of urea. 2°5 oz. of nitrogenous insoluble feecal 15 grains of uric acid. matter & protein-compounds. 100 grains of extractive matter & bilin. p Tae ae A Pisa. a 15. ounces. There is then an excess of 8! oz. of food. In the food there are contained ; In the excretions there are contained : 12 oz. of carbon. 6°6 oz. of carbon. 1 oz. 6 drms. of hydrogen. 1 oz. of hydrogen. 2°5 oz. of nitrogen. 410 grains of nitrogen. 700 grains of fixed salts. 710 grains of fixed salts. Hence there are carried off, by respiration and transpiration, 5*5 ounces of carbon, 0°75 of hydrogen, and 1°62 of nitrogen. This quantity of carbon and hydrogen is much less than is generally supposed to be carried off by the lungs; and with — respect to the nitrogen, although we may assume that some is carried off by the skin, the disproportion is still very great. An accurate examination of the expired air might throw much light ~ on this obscure and remarkable morbid process. : [I am indebted to Dr. Percy for the following analyses of — diabetic feeces : a 1. “ Feces of a boy aged 7 years. It was found impossible in this case to enforce a rigid system of animal diet, so that we may regard these feces as the feces of diabetes uncheclal a or modified by treatment. They were hard, and not of the | natural consistence of health. . Ist Analysis: 5°44 grs. gave—of HO 3°35 or H 6°838, of CO, 8°76 or C 43°94. 2d Analysis: 4°72 grs. gave—of HO 3-01 or H 7-092, of CO, 7°58 or C 43°798. — Incineration: 30°76 grs. gave—of ash 6°18, or 20-099. Mean—C ‘ é . 43°86 H . 6 - 6°96 N&O - . 29°09 _— Ash . = . 20°09 The proportion of saline matter is here much greater than rc usual, and, doubtless, depended upon constipation. : The fat taken up by ether amounted to 16-162 of the hess feces. ; FECES. — 379 2. “The feces of a man (Flint) aged 48 years, who was labouring under diabetes of long standing. He.was restricted principally - to animal food, a small quantity of bread only being allowed. Consistence moderate. This analysis was executed under my own supervision by my former pupil, Mr. Stallard. Ist Analysis: 8°22 grs. gave—of HO 5:61 or H 7:588, of CO, 16°43 or C 54:519. 2d Analysis: 8°57 grs. gave—of HO 5°84 or H 7°572, of CO, 17-03 or C 54:202. The nitrogen was determined by Wills’s method. Nitrogen : 6°29 grs. gave—of metallic platinum 5°33 grs., which corresponds to 12-018 of nitrogen. Incineration: 61°01 grs. gave of ash 5°71, or 9°368. Mean—C j ‘ . 54°35) Re tino OO Bes oS FES e600 Ro ae eee Ash . , . 936) Proximate Analysis : Substances soluble in ether ° <4 : 22:00) pe alcohol . : 11°13 * water . . ‘ 12°02 . 100-00 Organic matter, insoluble in these menstrua ‘ é 45°49 Ash. ‘ . . ‘ ‘ 9°36 | 3. “Feces of the same individual some weeks afterwards, while taking about three ounces of fat bacon daily, in addition to his usual animal diet. It was evident after drying, that these feeces abounded in fat from their appearance on the ap- plication of heat. It was impossible to reduce them per se to fine powder. Ist Analysis: 5°06 grs. gave—of HO 4:22 or H 9°22, of CO, 11°20 or C 60°36. 2d Analysis: 6°28 grs. gave—of HO 5:25 or H 9°28§, of CO, 13°89 or C 60°32. Incineration: 55°93 grs. gave—of ash 7°40, or 13°235. Mean—C ‘ ‘ - 60°34 H - a F 9°25 coc ae Ash . ; eS Ree Ether took up a quantity of fat amounting to 51°552 of the dried feces. 4. “ Feces of the same individual a few weeks afterwards, while restricted to an animal diet of the lean of meat: as far as it was practicable all fat was removed. 380 THE EXCRETIONS: Ist Analysis: 7-06 grs. gave—of HO 5°05 or H 7°959, CO, 13°72 or C 53-008. 2d Analysis: 6°62 grs. gave—of HO 4°77 or H 8-00§, CO, 12°93 or C 53-27$. Incineration : 16°81 grs. gave—of ash 2°96, or 17-608. Mean—C ; : . 53°09 H ; 4 it te | N&O : . 21°34 ee Ash . : » 3760 5. “ Feeces of a man (Roberts)' between 30 and 40 years, labouring under diabetes of some standing. Diet, exclusively animal, with the exception of a small quantity of bread. Ist Analysis: 4°53 grs. gave—HO 3°07 or H 7°538, CO, 7°64 or C 45°99$. 2d Analysis: 5°33 grs. gave—HO 3°67 or. H 7°658, CO, 8°92 or C 45°64. Incineration : 50°84 grs. gave—of ash 10°77, or 21°188. Mean—C % yi . 45°81 H ‘i ; ‘ 7°59 SAO Cc cee Ash . s 2118 6. “ Feces of the same individual, some weeks afterwards, while on a mixed diet. At this time also he was much emaciated a Vie oe ee FO aes Eee and exhausted, in consequence probably of having been obliged ~ to work, and to subsist on a mixed diet. Ist Analysis: 5°13 grs. gave—of HO 3°36 or H 7:28%, CO, 8°63 or C 45°888. 2d Analysis: 4°86 grs. gave—of HO 3-18 or H 7-272, CO, 8°21 or C 46-078. Incineration : 32°31 grs. gave—of ash 7°14, or 22°10. Mean—C : ; . 45°97 Wee gs N&O . . 2466 ¢ 100°00 | Mae Jo eons In dysentery the stools are thin, contain flocculent mucus, and are either almost colourless or milky, (dysenter. catarrh.) or they are coloured red by blood (dysenter. inflammat.). Ac- i cording to Schénlein they possess a peculiar smell quite cha- racteristic of the disease. On examining the white or slightly coloured mucous fluid — under the microscope, we observe numerous mucus-corpuscles floating about in it: the red, sanguineous discharges also con- tain an extraordinary number of mucus-corpuscles, numerous blood-corpuscles, but no (or very few) epithelium-scales. We sometimes find pseudo-membranous portions of exuded plastic lymph mixed with the stools, especially in the most in- flammatory forms of the disease. ' Roberts’s case has been published in the Medical Gazette. He has since died, and the sequel will shortly appear, together with the cases of the child a gece diabetes, and of the other patient Flint, “ ~~ he ad \. 2 a FACES. 381 In typhous diarrhcea the motions are frequently very bulky, of a chocolate colour, frothy, mixed with black dissolved blood, and not giving off the peculiar odour of dysenteric evacuations, but rather a cadaverous smell. In bilious diarrhea the bile- pigment is mixed with the fluid motions, which are less copious than in the former case. In enteritis mucosa the stools, especially those which are discharged during the night, are thin, and, in addition to the mucus and fecal matters coloured yellow by bile-pigment, contain a peculiar flocculent mass, like exuded lymph, which, on more accurate examination; seems to consist of purulent and fatty matter. Blood is likewise sometimes found in these stools. In abdominal typhus the stools are very characteristic; in the first stage they do not differ very much from the normal state ; they are sometimes very firm, sometimes very thin and watery. In a more advanced stage of the disease, they sepa- rate when shaken in a glass vessel into two strata; the lower one forms a slightly yellow flocculent mass, while the upper one is composed of a cloudy, whey-like fluid. On examining the flocculent material under the microscope, I found that it was composed, for the most part, of small lumps of mucus or pus, of an amorphous yellow matter—probably coagulated al- bumen with bile-pigment, of a comparatively small quantity of epithelium, and sometimes of extremely numerous and beau- tifully formed crystals of ammoniaco-magnesian phosphate, such as are depicted in fig. 27: sometimes we find, as also in phthisis intestinalis, small white masses about the size of a millet, or half as large as a hempseed; they are easily triturated and then have a greasy appearance ; when examined under the microscope they appear to be composed of cells similar to pri- mary cells or what are called the globules of inflammation. The contents of these spherical cells, which are inclosed in a very delicate membrane, are coarsely granulated and escape on the least pressure. In some of the larger parent cells, I found smaller cells with nuclei. I dried a portion of the flocculent precipitate ; on in- cinerating the residue I obtained 32% of salts, of which nearly one half, namely, 14°6 were earthy phosphates. The whey-like fluid which is above the sediment, is usually tolerably rich in albumen. It coagulates, or at any rate be- comes turbid on the application of heat or nitric acid. In 382 THE EXCRETIONS: most cases it has a strong alkaline reaction, and contains a large amount of carbonate of ammonia, which frequently in- terferes with the action of heat on the albumen. In some cases I observed that a beautiful rose-red tint was produced by the addition of nitric acid, of which I shall speak more fully in my observations on the stools in cholera. Typhous stools are sometimes tinged with blood. In melena blackish pitchy blood is mixed with the feces, which sometimes consist entirely of that substance. I have previously described the peculiarities of the blood. (See Vol. I, p: 317.) In catarrhus intestinor. the intestinal mucous membrane acts very much the same as the mucous membrane of the re- spiratory organs in pulmonary catarrh. The secretion is at first checked, then very much increased, and, finally, after secreting thick and tough mucus, returns to its normal con- dition. In simple diarrhoea a thin muco-aqueous yellow, or yellowish- brown discharge follows the evacuation of the true feces. In bilious diarrhoea the stools are also liquid, but they are generally of a greenish colour, and possess so strong an acid reaction as to produce excoriation of the anus. In dysenteric diarrhea a large quantity of gray or greenish mucus tinged with blood, is discharged. In diarrhcea lactan- tium, masses are discharged which are not unlike chopped eggs: they have a strong acid odour, and exert a corroding effect on — the vicinity of the anus. In Asiatic cholera it is well known that an extraordinary — quantity of watery fluid is discharged by the intestines. Dulk found that the evacuations in cholera had an alkaline — reaction, that they contained albumen, and that they were en- — tirely devoid of the ordinary odour of feces. _ Hermann,’ on the contrary, found that they had an acid reaction, and resembled the vomited matter, in which he de- tected free acetic acid. The ordinary reaction of the stools in cholera is, however, alkaline, and this was observed in a very severe case of sporadic cholera that fell under my own observation. According to Vogel’s observations, the stools in this disease resemble turbid whey : the fluid has a powerful alkaline reaction, and effervesces on the addition of an acid. On distilling a por- ' Poggend. Annalen, vol. 22, p. 161. ks FECES; 383 tion of the fluid he obtained in the receiver a liquid with an alkaline reaction, and having a fishy odour. On the addition of nitric acid this liquid assumed a beautiful red tint, which it retained during evaporation. The fluid, when concentrated, had an intense red colour, but was devoid of odour, which only be- came again apparent on neutralizing the free acid by an alkali. The portion that remains in the retort after the distillation of the fluid contains traces of albumen, some intestinal mucus, the ordinary salts of the animal fluids, and a large amount of carbonate of soda. Wittstock’s researches respecting the fecal discharges in cholera, coincide in most points with those of Vogel: he ob- served the beautiful rose-red tint that was produced by the ad- dition of nitric acid, and he ascribed it to the presence of an urate; it is however known, that the formation of purpurate of ammonia or murexid from uric acid, requires a greater de- gree of concentration of the reacting substances, and a height- ened temperature. The feces of a woman who had a very severe attack of sporadic cholera, (whose blood and urine I likewise analysed,) formed a turbid and colourless fluid, which had a strong alkaline reaction, and effervesced on the addition of acids, giving off carbonic acid and sulphuretted hydrogen, which, in all probability, arose from carbonate of ammonia and.-sulphuret of ammonium (hydrosulphate of ammonia). When allowed to stand for some time it formed a sediment, which consisted, for the most part, of mucus-corpuscles, with some crystals of ammoniaco-magnesian phosphate. No epi- thelium cells were observed. On treating the fluid with nitric acid, effervescence took place, and flocculi of coagulated albumen separated themselves ; moreover, the fluid in a short time be- came of a rose-red colour,—a phenomenon that was induced more rapidly by gentle warmth: when strongly heated for some time the colour entirely disappeared.’ The quantitative analysis of the feecal discharge in this case gave the following results, calculated for 1000 parts :— ' [In an examination of the feces in cholera, instituted by Heller, (Archiv i, p. 18,) a similar reaction was observed. The exact nature of the change that the bile-pigment undergoes in such cases is not clearly understood. ] 384 THE EXCRETIONS: Analysis 152. Water ‘ , : ; 980-00 Solid constituents ; ; 20°00 Fat . ‘ : 3 0°08 Extractive matter . . ‘ 4°80 Albumen and mucus : 0°52 Chloride of sodium, lactate and acetate of 13°40 soda, and alkaline phosphates le Phosphates of lime and magnesia ; 0°60 This analysis bears out the result of the investigation of the — blood, given in Vol. I., page 326. Landerer! has analysed the fecal evacuations of a child suf- fering from diarrhea infantilis. It was a yellowfluid, with an acid and bitter taste, and its specific gravity was 1038°2. Landerer found in it: carbonate of lime 1°50; phosphate of lime 2-00; chloride of calcium 1°50; chloride of magnesium 2°45; chloride of sodium 2°43; sulphate of lime 1:50; sulphate of magnesia 0°80; bilin, butyric acid, and extractive matter 3°00; spirit-extract 1-00; free lactic and hydrochloric acids 1-00. In enterophthisis, the feecal evacuations likewise separate into two strata: the lower is flocculent, and when examined under the microscope is seen to consist of mucus- or pus-corpuscles min- gled with remnants of food, or with an amorphous mass tinged with pigment. Sometimes we find, in the deposit from these evacuations, small white or yellow masses, which consist of cells, and can be easily crushed (such as I have already de- scribed in speaking of the evacuations in typhus), and mixed with them there are numerous fat-vesicles. A little blood is not unfrequently observed in these stools; they then have a chocolate or dark blood-red tint. The supernatant fluid is turbid, and of a yellow, brown, or bloody tint ; it always con- tains a considerable amount of albumen. In icterus the feces are generally devoid of all the consti- tuents of the bile: they are consequently of a white or grayish white colour; they are usually very firm, and deficient im moisture. [I am indebted to Dr. Percy for the following ultimate analysis of the feces in jaundice. | ' Journal f. prakt. Chemie, 1841, vol. 17, p. 62. : FACES. 385 A young woman affected with jaundice in a mild form, de- pending probably on functional derangement of the liver. The feces were brown, and not clay-coloured, as in severe jaundice. Ist Analysis—5°59 grs. gave of HO 3°66 or H 7°273, CO, 9°69 or C 51°425. 2d Analysis—5-12 grs. gave of HO 3°37 or H 7°312, CO, 9°69 or C 51°61. Incineration—28°18 grs. gave of ash 3°41 grs., or 127102. Mean—C ‘ ‘ of ee H ‘ , “ice eee ie N&O 5 ju ee ee | oo aie ; ¢) aa A physician of this city sent me a white, roundish, easily compressible mass, resembling caseous matter, which had been evacuated after an ordinary motion, by a lady who was suffering from bilious sensations. When observed under the microscope, this substance, which emitted a rather disagreeable odour, was found to be composed of an extraordinary quantity of fat ' The following table shows, at a glance, the results of the preceding ultimate analyses : oF leai/ss8 | 82 r88 188 | 83 | 8 7 &&s ea a = '3 = 2 = 2 3 a & ge} 48 |)SR | *a | "a | *a | 2a [ea | sa — =6 i 2. 3. 4. 5. 6. 7. 8. 9. C . . | 46:20] 49°79] 43°86 ]| 54°35] 60°34] 53-09] 45°81] 45-97]) 51-51 H . .| 672| 7:06] 6-96|| 7:57| 9-25] 7:97]] 7°59] 7-27|| 7:29 N&O . | 30°71] 28°64] 29-09 || 28-72] 17-18] 21°34 || 25:42] 24-66|| 29-10 Ash . | 16°37| 14°51] 20-09]| 9°36] 13-23] 17-60]| 21:18] 22-10|| 12-10 100-00 |100-00 |100-00 ||100-00 |100-00 |100-00 ||100-00 |100-00 |/100-00 TABLE of ComposITIOoN, exclusive of AsH. 1. 2. 3. 4, 5. 6. (fe 8. 9. C > . | 55°24| 58°24] 54°88 || 59°96] 69°53} 64:43 |} 58°11} 59°01 || 58°60 :: os -| 8°03} 825) 8°70|} 835] 10°66) 9°67 9°62} 9°33); 8°29 N&O . | 36°73] 33°51] 36°42 || 31-69] 19-81] 25°90|| 32°27} 31°66 || 33°11 100-00 {100-00 |100-00 ||100-00 |100-00 {100-00 |/100-00 |100-00 ||100-00 II. 25 & 386 THE EXCRETIONS: . arranged in a structureless, albuminoid mass; no tissues or cells were detected. The mass, when heated, gave off a very strong odour of butyric and acetic acids ; it melted and burned with a clear flame. Alcohol extracted a very large amount of fat, con- sisting of margarin, ole, and butyrin, with their acids, which partially separated on cooling. In the separated flocculi I detected, with the aid of the microscope, crystals of margaric acid, but none of cholesterin. After the evaporation of the alcohol, water dissolved some butyric and acetic acids from the residue. The portion insoluble in alcohol was digested for a consi- derable time in dilute acetic acid, and was precipitated from this solution by ferrocyanide of potassium. Water did not extract any matter that was precipitable by the last-named reagent. _ On incineration a considerable amount of ash was left which had an acid reaction, did not effervesce with acids, and con- sisted almost entirely of earthy phosphates: it contained no sulphates. Calomel stools. In certain morbid conditions of the system calomel is fre- quently given in considerable quantity: its administration is succeeded hy numerous, very green, bilious stools. I endea- voured to determine by an experiment whether the bile and its pigment is the actual cause of the colour of these evacuations. The fifth stool that was passed after the administration of a large dose of calomel, was made the subject of the analysis. It was fluid, perfectly green, had no fecal odour, exhibited a mild ; acid reaction, and showed, under the microscope, a great number — of mucus-corpuscles and epithelium-cells. On evaporation it gave off an odour resembling that of saliva or extractive matter under similar circumstances. Ether extracted from the solid — residue a considerable amount of fat which had an acid reac- tion, contained cholesterin, and was coloured with biliverdin. — All other substances which were separated from it by water and : alcohol were more or less coloured by bile-pigment. Bilin with bilifellinic acid and biliverdin were found in large — quantity ; by digestion with sulphuric acid the bilin became — entirely converted into biliary resin. From a quantitative FACES. 387 analysis it appeared that 100 parts of the solid residue of this evacuation were composed of : Analysis 153. Green fat containing cholesterin 10-0 Salivary matter soluble only in water, and slightly ciediaitathd by tannic acid and acetate of lead 24°3 Bilin with bilifellinic acid and biliverdin, collectively pees in anhydrous alcohol : 4 ‘ : p 21°4 Extractive matter soluble in spirit ; é . 11-0 Albumen, mucus, and epithelium-scales ; : 1771 Salts A ‘ 2 : ; 12°9 100-0 Various attempts that I made (by Smithson’s method) to detect mercury in calomel-stools proved unsuccessful. [Dr. Golding Bird has published an analysis of the green evacuations so frequently observed in children. The specimen examined by him “ was passed by a hydrocephalic infant whilst under the influence of mercury, and presented the following characters. It was a dirty-green turbid fluid which, by repose in a glass vessel, separated into three very distinct portions ;— 1, a supernatant fluid, of oil-like consistence, presenting a brilliant emerald-green colour; 2, a dense stratum of mucus, coagulated albumen, and epithelial debris, mixed with red par- ticles of blood ; 3, a deposit, occupying the lower part of the vessel, of large crystals of ammoniaco-magnesian phosphate, in fine prisms of an apple-green colour. The supernatant emerald-green fluid was decanted for examination. A. It was faintly alkaline, possessed a broth-like odour, and a density of 1020. B: The addition of a few drops of nitric acid did not alter the colour, even after ebullition. A larger quantity of the acid being added whilst the mixture was boiling, converted the emerald-green colour into a pinkish-yellow; the green colour was not restored by the subsequent addition of an alkali. c. Acetic acid scarcely affected the green fluid, producing no apparent coagulation of mucus. p. A solution of acetate of lead threw down a copious grayish-green, tenacious precipitate, leaving the supernatant fluid colourless. 358 THE EXCRETIONS: E. Bichloride of mercury produced a light-green precipitate, leaving the supernatant fluid pale, but not decolorizing it. It was analysed i in the following manner : 1. 1000 grains of the green fluid left, by caret evapora- tion, a deep olive-green, highly deliquescent extract, weighing 100 grains. 2. This extract, on being immersed in alcohol of ‘837 formed a mass like birdlime, which could not be mixed with the spirit. Even after long boiling, it appeared hardly to diminish in bulk. The clear tincture being decanted left, however, an extract weighing 30 grains. This residue possessed the yellowish- green colour of faded leaves, an odour -of fresh broth and a sweet sub-astringent taste, with a very slight admixture of bitterness. 3. The alcoholic-xtract being carefully incinerated, left 5-5 grains of ash, consisting chiefly of chloride of sodium mixed with mere traces of tribasic phosphate of soda (8NaO, PO,). It was alkaline, but did not effervesce with acids. 4, The portion left undissolved by boiling alcohol yielded to water 13 grains of nearly tasteless matter which, by incinera- tion, left a powerfully alkaline ash weighing 1°75 grains, not effervescing with acids, and consisting nearly exclusively of alkaline tribasic phosphate of soda. 5. The residue insoluble both in water and alcohol weighed 57 grains, and consisted almost entirely of coagulated albumen, dry mucus, and modified blood. It left by incineration one grain only of ash, consisting almost wholly of black-red peroxide of iron. The following is a view of the results of the examination : Organic Z A 24°50 Inorganic ; : 5°50 Organic ; , 11°25 Alcoholic extract { Aqueous extract { Inorganic ; ‘ 1°75 Organic , : 56°00 Insoluble matter thoriestiie 1-00 Water and volatile matter A . 900-00 1000-00 The organic portion of the alcoholic extract consisted chiefly Pe * Sa apes . P Soh Sac a be A eo FACES. 389 of fatty matter, cholesterim, and a green substance probably identical with biliverdin ; with these were traces of bile barely sufficient to communicate a bitter taste to the extract, and in too small a quantity to leave any carbonate of soda in the residue of incineration. The aqueous extract consisted chiefly of ptyalin and the extractive matters comprehended under the general term of “ extrait de viande,” by Berzelius. The com- position of the fluid part of the green evacuation may therefore be thus expressed : Water , ; ~ 900-00 Biliverdin, alcoholic rebie fat, dibieatéuin: ‘with traces of bile . 24°50 Ptyalin, @queous extract coloured by biliverdin ; aks See Mucus, coagulated albumen, and hematin . . — 56°00 Chloride of sodium, with traces of tribasic phosphate of soda F 5°50 Tribasic phosphate of soda ‘ : ‘ ; 1°75 Peroxide of iron ; ‘ : é ; 1:00 1000-00 Professor Kersten of Freiberg has recently published a paper on the cause of the green evacuations observed after a course of the Marienbad waters for fifteen or twenty days. The occurrence of these evacuations is regarded as critical and highly favorable. Kersten denies that the tint is in any degree dependent on the presence of bile, and ascribes it to the formation of green sulphuret of iron. In the paper referred to he first shows that on the addition of very dilute hydrochloric acid to an evacuation of this nature diluted with thrice its weight of water, there is a development of sulphuretted hydrogen, indicating the presence of a metallic sulphuret ; moreover, on the addition of ferrocyanide of potas- sium to the filtered acid solution a bright blue precipitate is observed, which becomes darker after exposure to the air, indi- cating the existence of protoxide of iron. This experiment shows that the green pigment is destroyed or decomposed by dilute hydrochloric acid, and further, that it is a compound-of _ sulphur and iron. He accounts for the presence of the sul- phuret of iron in this way. The sulphate of soda present in the water is reduced in the stomach to a sulphuret of sodium by the deoxidising power of the organic matters with which it is in contact, aided by a temperature favorable to such a change. 390 THE EXCRETIONS : The bicarbonate of iron in the water is decomposed at the tem- perature of the stomach, and the iron precipitated either as a protoxide or as a hydrated peroxide, and immediately redis- solved by the free acid of the gastric juice. This reacts on the sulphuret of sodium, and sulphuret of iron is the result. Since the publication of Kersten’s paper, a very similar view has been propounded by Dr. Bley, namely, that the green eva- cuations observed after the use of calomel are dependent not on the presence of bile, but of sulphuret of mercury. Unfor- — tunately for this theory the mercury cannot be detected by ana- lysis, and Pettinkofer’s test reveals the presence of bile. Dr. Frankl has published a paper containing various argu- ments in opposition to Kersten’s views, and criticising his conclusions. Berzelius, on the other hand, writes thus: “ It never entered my mind to suspect that this coloration arose from sulphuret of iron, but I always believed that it might be attributed to the black oxide of iron. It is, however, quite natural that as sul- phuretted hydrogen is usually produced during the progress of digestion, the oxide of iron present in the intestinal canal should be reduced to a sulphuret, no matter whether sulphates have been given or not.” Berzelius renders Kersten’s view more general, observing “that every chalybeate water, whether it contain sulphates or not, produces a similar appearance in the evacuations.” On this Kersten remarks: that “the coloration may be most intense when sulphates are present, because by their decompo- sition during digestion an excess of sulphuretted hydrogen will be generated.” Vomitus. (Matters discharged by vomiting.) It is well known that the fluid which is found in the stomach, and which is a mixture of gastric juice, saliva, and remnants of food, becomes much changed in its properties in certain morbid conditions of the system. I need scarcely refer to the excess of free acid, and to the presence of bile in certain conditions of the stomach. On the occurrence of the latter of these states we usually observe a separation, or peeling off, of the upper oe), a VOMITUS. 391 stratum of epithelium-scales from the tract of mucous membrane between the pharynx and the stomach, and this condition is recognized by the gastric furred tongue.' This fur or coating has been analysed by Denis: he found that one half consisted of phosphate and carbonate of lime, the other half of mucus. In gastrodynia, even when there is no food in the stomach, the gastric juice is secreted in such an acid condition as to set the teeth on edge. This is chiefly caused by free hydrochloric acid, but concentrated lactic and acetic acids will produce the same effect. In gastritis, colonitis, enteritis, and peritonitis, a grass-green liquid is often brought up; it is frequently mixed with green or white floceuli, and on other occasions is quite clear; it almost always has an acid reaction, and usually contains a considerable amount of fat. I analysed a fluid of this sort that was vomited during peri- tonitis: it had a greenish, viscid appearance, and contained — whitish flocculi that presented an amorphous character under the microscope. It did not affect blue or red litmus paper ; on the addition of nitric acid there was a separation of white floceuli, and the fluid became first of a pale blue and subse- quently of a reddish tint. On the application of heat some globules of oil separated themselves, and a small quantity of albumen became coagulated; it contained 2°92 of solid consti- tuents, from which ether took up a yellow liquid fat that was imperfectly soluble in cold, but dissolved easily in hot alcohol ; it contained a little cholesterin, and gave off a smell like that of a fatty acid. Alcohol took up extractive matter and bilifellinic acid, which latter could be separated by means of sulphuric acid; dilute alcohol took up spirit-extract with a little bilifellinic acid. A considerable amount of the portion that was insoluble in spirit dissolved in water, and was again precipitated by alcohol, tannic ' On examining the thick coating of the tongue in cases of abdominal typhus, I ‘have found that it is composed of matted epithelium-scales over which minute sporules are scattered. The sordes from the teeth exhibited similar characters. 392 THE EXCRETIONS: acid, and acetate of lead. The precipitate thrown down by alcohol was soluble in an excess of water, which was rendered turbid by the addition of acetic acid, and yielded a copious precipitate on the subsequent addition of ferrocyanide of Paes sium. As the ash, after incineration, consisted of carbonate of soda, I regarded the substance insoluble in alcohol as an albuminate of soda. 7 The quantitative analysis of this “vomitus ezruginosus seu herbaceus” yielded the following proportions in 1000 parts : Analysis 154. Water F ; ‘ ; ‘ 971:0 Solid residue . ‘ : : : 29-0 Fat ‘ 4:3 Bilifellinic acid, alcohol- extract, and bile- pigment ; 15 Spirit-extract with a little bilifellinic acid . ‘ 11-4 Albuminate of soda ‘ ‘ 5°4 Mucus and albumen . ‘ : ‘ 5°8 [Heller' analysed a brilliant green fluid vomited by a young woman aged 20 years, suffering from peritonitis. In quantity it amounted to about three ounces; it was slightly turbid, and threw down an inconsiderable sediment which was viscid, more of a yellowish tint than the supernatant fluid, and consisted of epithelium-cells and mucus-corpuscles. The fiuid had an acid reaction, but contained neither free hydrochloric nor acetic acid. Its specific gravity was 1006. On the addition of nitric acid it first became blue, and after- wards of a beautiful carmine red. It contained no albumen. In 1000 parts there were contained : Water ; ‘ ‘ ‘ : 990°50 Solid constituents 2 : p ; 9°50 Fat ; j ; ; ‘ 0°24 Water-extract 2 F ‘ ‘ 1°30 Biliverdin with a little biliphzin and a trace of 5:38 alcohol-extract ; ‘ ‘ Fixed salts * ‘ - j 3°75 The salts consisted for the most part of the chlorides of : sodium and calcium, associated with less quantities of phosphate of soda, sulphate of potash, and earthy phosphates. Urea and uric acid were sought for without success. ' Archiv, vol. 1, p. 226. i -VOMITUS. 393 The green colour seems undoubtedly due to the presence of biliverdin, which is probably formed in the stomach by the action of the acid solution of hydrochlorate of lime on the bili- phein. Hence the occurrence of green vomiting need not be regarded as indicative of any peculiar morbid change. A brief notice of a green fluid vomited during an attack of sporadic cholera, may be found in vol. 1, p. 18, of Heller’s Archiv. | : Vomitus with urinary constituents. It is stated that in those cases in which the formation and excretion of the urine are impeded its constituents are discharged with vomited matters. Nysten* and Barruel had an opportunity of analysing a vomited fluid which contained urea, uric acid, and the ordinary urinary salts. [Dr. Halliday Douglas has reported a case in which urea was detected in the vomited fluid. London and Edinburgh Monthly Journal of Medical Science, vol. 1, p. 410. ] Vomitus in carcinoma. In carcinoma of the stomach a fluid is vomited which de- posits masses of chocolate or coffee-coloured flocks on the bottom of the vessel, while others are observed on the surface of the fluid. On examining a few of them under the microscope we observe a considerable quantity of large rounded cells with yellow granular contents, and also avery great number of fat-vesicles, some larger and others smaller than the cells. Remnants of food, and especially undigested starch-granules, are likewise . frequently observed. The latter may be easily mistaken for fat-vesicles, but moderately strong compression causes their envelopes to break, and on the addition of a solution of iodine they assume a blue colour. By this test all ambiguity is avoided. [Dr. George Wilson has published a notice of the chemical and microscopical characters of the fluid ejected in pyrosis— ' Journ. de Chem. Med. 1820, Ser. III, p. 257. 394 THE EXCRETIONS: - the ordinary water-brash. The most remarkable of these is the appearance of a microscopic cryptogamic plant (sarcina ventriculi), and of acetic, lactic, and carbonic acids in the liquid. The first case in which these were found, occurred to Mr. Goodsir, and was published by him in the ‘ Edin- burgh Medical and Surgical Journal’ for April 1842. Since that period a case has occurred in the practice of Mr. Ben- jamin Bell of Edinburgh, who allowed Mr. Goodsir and Dr. Wilson to examine the fiuid ejected by his patient, in which the same organism and acids were discovered; and Mr. Busk, of the Dreadnought hospital ship, Greenwich, has published the history of three cases where the sarcina presented itself, but no analysis was made of the fluids in which it appeared. On examining the fluid with the microscope, the sarcina is found to present the following characters.1_ In every instance the organisms presented themselves in the form of square or slightly oblong transparent plates, of a pale yellow or brown colour, and varying in size from the 800th to the 1000th of an inch. They were made up of cells, the walls of which ap- peared rigid, and could be perceived passing from one flat sur- face to another as dissepiments. These dissepiments, as well as the transparent spaces, were, from compression of contiguity, rectilinear, and all the angles right angles; but the bounding ~ cells bulged somewhat irregularly on the edges of the organism, ~ by reason of the freedom from pressure, These circumstances — gave the whole organism the appearance of a woolpack, or of a — soft bundle bound with cord, crossing it four times at right © angles, and at equal distances. From these very striking pe- — culiarities of form, Mr. Goodsir has proposed for it the generic mame of SARCINA.? On examining the ejected fluid in the case recorded by Mr. : Goodsir, it was found to possess the following characters. It — was thick and viscid; on standing, it deposited a large quantity — of ropy matter mixed with portions of undigested food, and, — when filtered through paper, had a pale brownish yellow colour, — and was quite transparent. It still contained much animal — 1 The reader is referred to the ‘Edinburgh Medical and Surgical Journal’ for — April 1842, for a more minute description of the sarcina, and a detailed account of — the chemical analysis of the liquid containing it. 2 Sarcina, a pack or woolpack. —"< ae i ‘i ¥ = “ NETS Bh Pe VOMITUS. 395 matter in solution, becoming opaque and flocculent when boiled, and giving a very copious precipitate with infusion of galls. It also precipitated nitrate of silver densely, and, when evapo- rated to dryness and exposed to a full red heat in a platmum crucible, left an ash containing much chloride of sodium. It reddened litmus powerfully, and effervesced sharply with alkaline carbonates. It continued strongly acid after being twice dis- tilled, and did not precipitate nitrate of silver, but retained the sour smell, which could now be recognized as identical with that of vinegar. On neutralizing the twice distilled fluid with lime-water, and evaporating to dryness, a salt was obtained, which, on being decomposed in a tube-retort with sulphuric acid, yielded a volatile odorous acid, readily identified by seve- ral tests with the acetic. It was found by several trials, that, on an average, an ounce of the liquid neutralized 0:4 grain of carbonate of potash; a quart (32 oz.) would therefore neutralize 12°8 grains, which cor- respond to 9 grains of the hydrated (crystallizable) acetic acid, C,H,O,+HO. The liquid remaining in the retort continued to redden litmus powerfully after all the acetic acid had been distilled from it. This was traced in part to the presence of a small quantity of free hydrochloric acid; but it was chiefly owing to the existence in the liquid of a considerable proportion of lactic acid. The most remarkable feature of this case, in a chemical point of view, was the large quantity of acetic acid. found; the quantity of liquid ejected at once by the patient often amounted to more than two quarts, which would contain 18 grains of acetic acid. In Mr. Bell’s case the chemical cha- racters of the liquid were very similar. An additional point was, however, ascertained, namely, the presence of free carbonic acid in the liquid. | 396 CHAPTER XI. THE COMPONENT PARTS OF THE ANIMAL BODY.’ The Bones. THE bones are the least destructible of all the parts of the organism. Under favorable circumstances they remain as un- changed as mere inorganic matter, and the amount of cartilage has been found unaltered in bones three thousand years old.’ The external surface of bone is surrounded by a membrane richly endowed with nerves and vessels—the periosteum, which, as well as the cartilaginous portion, can be converted, by boil- ing, into gelatin. The interior of the cylindrical bones is lined in a similar manner: the flat and short thick bones are, how- ever, filled in the interior with delicate lamelle arranged so as to present a cellular appearance: in the flat bones, this is termed the diploe. Ifa bone is suspended in dilute hydrochlorie acid at a low temperature, all the earthy matter becomes gra- dually dissolved and the mere cartilage remains, retaining the precise form of the original bone. It is supple, transparent, and soft, but on drying it becomes of a darker colour, hard, and somewhat contracted. When boiled it becomes rapidly converted into gelatin, leaving the fibrous tissue and the vessels of the bone unacted on. These vessels may be exhibited by leaving the bone in dilute hydrochloric acid till about one half of the earthy matter is dissolved: it must then be washed with ' This has been observed in the bones of human and animal mummies discovered in Egyptian sepulchres. Apjohn and Stokes found in the bones of an extinct gigantic elk, 48°87 of ordinary cartilage, combined with 43-45 of the phosphates of lime and magnesia with fluoride of calcium, and 9°14 of carbonate of lime, &c. In the teeth of an Egyptian mummy, Lassaigne found 299 of organic matter; and in the teeth of a fossil bear, 14 of cartilage and 70 of phosphate of lime. Gimbernat prepared an edible jelly from the bones of the Ohio mammoth. BONES. 397 cold water, and afterwards kept for twenty-four hours in water, nearly at the boiling point. The cartilage, from which the earthy matter has been removed, is thus dissolved, and num- berless minute vessels may be seen issuing from the undecom- posed portion of bone, presenting a beautiful white velvety appearance, which is injured by the least motion, If the bone when immersed in dilute hydrochloric acid is exposed to heat, the chemical action is facilitated, and the bone develops car- bonic acid and separates into fibrous lamelle, divisible in a longitudinal direction, which, if they are sufficiently thin, possess the property of polarizing light in the same manner as mica. When bone is submitted to thorough incineration, all the organic portion is destroyed, and there remains nothing but the earthy matter mixed with certain salts which have been formed during the process of incineration, such as alkaline sulphates and carbonates, and with free lime formed by the expulsion of the carbonic acid from carbonate of lime. The carbonate of lime in bone is just the sarhe as the natural carbonate of lime; the phosphate, on the other hand, consists of 8CaO + 3 PO., according toBerzelius! ; and 3 CaO + PO,, according to Mitscherlich. In addition to these salts we find small quantities of phosphate of magnesia and fluoride of cal- cium,” and traces of the peroxides of iron and manganese. [An elaborate treatise on the Chemistry of Bone has been recently published by Von Bibra. We extract the following analyses :— 1 [Berzelius repeated the analysis of the salt last year, and found that its compo- sition is rightly expressed. (Ocefversigt af Kongl. Vat. Akad. Forhandlingar, 1844, No. 6; or Liebig’s und Wohler’s Annalen, Feb. 1845.] 2 [The presence of fluoride of calcium in bone has been denied by Rees (Phil. Mag. Jan. 1840.) The researches of Daubeny and Middleton (Memoirs and Proceed- ings of the Chemical Society of London, vol. 2, pp. 97 and 134) not only demonstrate its almost constant occurrence both in recent and fossil bones, but point out that ordinary water is the vehicle by which it is conveyed into the system. “ With regard to the statements of Rees,” observes Von Bibra, “I put them to the proof, and found, as was to be expected, that they were altogether incorrect. I used in these experi- ments the human femur, humerus, and teeth. On treating large quantities of bone- earth with sulphuric acid, I have obtained corrosions on glass sufficiently deep to be felt with the finger-nail.” (Chemische Untersuchungen iiber die Knochen und Zahne, p. 103, Schweinfurt, 1844.) ] &, 398 ANIMAL BODY : Male Foetus at the 6—7th month. z aa a es ee Femur. Tibia. Humetus, q phate of lime with barely recogniza a! traces of fluoride of calcium ‘} 53°46 pa-46 53°15 F % Earthy carbonates : : . 3°06 3:10 3°05 2 Phosphate of magnesia. , ° 2°10 2°00 1-96 a gee : ; : ? 1:00 1-07 102 "4 Cartilage : ; : ; 40°38 40°37 40°82 Fat ‘ ‘ ; ; : a trace a trace a trace . 100-00 100-00 10000 Female Feetus at the 7th month. 7 c vagal a \ : Ulna. Radius. Scapula. Clavicula. 4 Phosphate of lime with very little 4 ee ra 3 57638767 TB 5695 Carbonate of lime . : ; 5°86 5°89 5°99 oa oe Phosphate of magnesia ‘ é 1:10 0-99 1°12 1:07 Salts : ; ‘ : 0°60 0°67 0-62 0-73: Cartilage . ;" ; : 34°78 34:08 34°32 34°54 | Fat ‘ : ; ‘ 0°63 0°50 0°82 0°96 Child aged 2 months. — Tibia. Ulna, Phosphate of lime with a little fluoride of calcium : . 57°54 56°35 _ Carbonate of lime ‘ ‘ ‘ ‘ ‘ . 6°02 6°07 Phosphate of magnesia ‘ ‘ : ‘ - 103 100°°3 Salts. . . : - 073 Ts % Cartilage ‘ : ‘ ; ; ; - 33°86 34:92 ee : ; ¢ = . 082 10194 Child aged 9 months. is Femur. Humerus. Tibia. Radius. Ulna. Costa. Seapula. Phosphate of lime with a r little fluoride of calcium } 48-11 50°15 48°55 45°38 48°06 42°32 42°61 Carbonate of lime . 612 G13 579 514 620 5:00 508 Phosphate of magnesia . 0°97 1:00 1:00 0°93 101 0°89 0:92 Salts. . 123° 1300 «241070 1-24 109) 0 Cartilage = - 41°71 39°53 41:50 45°65 41:70 48°55 48°36 ee . 186 189° 192 183 179 215 193 ie 2 ' The “salts” in the analyses of Von Bibra are the salts soluble in water. BONES. 399 A child aged 5 years. A girl’ aged 19 years. Femur. Tibia. Femur. Humerus, Phosphate of lime with a little fluoride aha ‘| 5996 5974 05478 54°84 Carbonate of lime é 5°91 6°00 10°90 10°82 Phosphate of magnesia 1:24 1°34 1°34 1:26 Salts * : ; 0°69 0°63 0°83 0°79 Cartilage . ‘ ‘ a: Sa 31°34 31°15 81°37 Fat é 0°92 0°95 1:00 0°92 A woman aged 25 years. ct > Femur. Tibia. Fibula. Humerus. Ulna. Radius, Metacarpus. Phosphate of lime with ; a little fluoride oth rae 57°18 57°39 58°03 57°52 57°38 57°77 calcium < Carbonate of lime 8°92 893 8:92 9°04 8-97 8°95 8°92 Phosphate of magnesia 1:70 1:70 163 159 171 1°72 1°58 Salts ; 060 O61 0°60 0°59 0°67 0°63 0°61 Cartilage 29°54 29°58 29°49 29°66 29°14 29°43 29°23 a. ¢ . 182 2:00 1:97 1:09 199 1°89 1°89 es %, Os oc- Os inno- Clavicula. cipitis. Costa. Sternum. Seapula. Vertebre. minatum. Phosphate of lime with ; a little fluoride | 56°35 57°66 52°91 4263 54°76 44:28 49°72 calcium ‘ Carbonate of lime 8°88 875 8°66 7°19 8°58 8:00 8:08 Phosphate of magnesia 169 169 140 Ili 153 = 1°44 1°57 Salts 0°59 063 0°60 0°50 0°51 0°53 0°60 Cartilage = 30°66 29°87 33°06 46°57 32°90 43°44 38°26 Fat... ‘ 183 1:40 2°37 2°00 P93-* 231 1:77 A man 25 or 30 years of age. c een ea are 4 Femur. Tibia. Humerus. Ulna. Os occipitis. Costa. oo ogee ant 59°63 58:95 59°87 59:30 58-43 55°66 Carbonate of lime 7°33 7°08 7°76 7°35 8°00 6°64 Phosphate of magnesia 1°32 1°30 1:09 1:35 1:40 1:07 Salts ‘ : 0°69 0°70 0°72 0°73 0°90 0°62 Cartilage 29°70 30°42. 29°28 29°98 29°92 33°97 Fat 1°33 1°55 1:28 1°29 1:35 2°04 1 This girl died from phlebitis thirteen days after the operation of amputation of the upper arm for caries of the elbow-joint. % 400 ANIMAL BODY: Femur of a man aged 58 years. cating ae irs i: Compact substance. Spongy substance. Phosphate of lime with fluoride of \ ; 58°23 42°82 calcium ; ‘ Carbonate of lime ? . ; 8°35 19°37 Phosphate of magnesia. ° ; 1-03 1:00 Salts ‘ k ; ; 0°92 0°99 Cartilage ‘ 4 ; m 31°47 35°82 Femur of a woman' Femur of a woman aged 62 years. aged 78 years. Phosphate of lime with a little \ 63-17 57-36 fluoride of calcium A Carbonate of lime . : : 4°46 7°48 Phosphate of magnesia : ‘ 1-29 1:10 Salts . ; ; wine 0°90. 0°97 Cartilage . ‘ . 28°03 32°16 Fat , S ; " 2°15 0°93 These are the most recent, and probably the most accurate of any of the analyses of human bone yet published. We may omit, from absolute superfluity of matter, the researches of Schreyer, Rees, Thilenius, Sebastian, Davy, Frerichs, and Stark, which refer merely to the estimation of the organic and inorganic matters, and shall take a brief survey of the more perfect analyses of bone. Berzelius found in human bone: Phosphate of lime . , ‘ 51°04 Fluoride of calcium ‘ " ; 2°00 Carbonate of lime ‘ - 5 11°30 Phosphate of magnesia ; 1°16 Soda, with a little chloride of odin = 1:20 Cartilage .- : ‘ ; 32°17 Vessels > Se 113 Dr. Thomson found? in the human femur: 2. 2. Phosphate of lime . ‘ 43°67 51°12 Carbonate of lime ; . 14:00 9°77 Magnesia ‘ , : 0°49 0°63 Soda ‘ . . 2°00 0°59 Potash ‘ ‘ “ 0°06 a trace Cartilage ‘ s : 39°12 35°93 ' A cretin. The bones had been underground for four years. ? Animal Chemistry, p. 245. BONES. 401 The four following analyses were made by Valentin :—1 re- presents the cortical portion of the tibia of a man aged 38 years; and 2, the medullary portion of the same bone; 3 represents the external condyle of the left femur of a girl; and 4, the head of the left tibia of the same individual. l. 2. Basic phosphate of lime - 52°930 49°019 Carbonate of lime i 7 7°666 7°760 Phosphate of magnesia é 0°254 1°542 Chloride of sodium. : 0-911 0°441 Carbonate of soda ; ; 0-204 0:076 Cartilage, vessels, &c. . . 38°020 41:160 3. 37°012 5°038 0°874 0°645 1°331 55°180 4. 41°774 77109 0°874 1-677 48°560 Marchand found in the compact substance of the femur of a man aged 30 years: Basic phosphate of lime Fluoride of calcium . Carbonate of lime Phosphate of magnesia Soda : Chloride of sodium ‘ : Cartilage insoluble in hydrochloric acid . Cartilage soluble in hydrochloric acid Vessels ; . . Peroxides of iron and manganese, and loss 52°26 1:00 10°21 1°05 0°92 0:25 27°23 5°02 1-01 1°05, The most recent analyses of human bones, with the exception of those by Von Bibra, are those of Lehmann. Bones of a man aged 40 years who committed suicide. ae cr Humerus. Radius. Ulna. Femur, Fibula. Phosphate of lime and Masride of calcitun 56°61 53°25 53°98 58°93 52:99 Carbonate of lime : 9°20 9°76 9°51 9°28 9°33 Phosphate of magnesia . 1-08 1-06 1:07 1:09 1:06 Chloride of sodium ; 0°37 0°36 0°40 0°40 0°37 Soda . : 1°35 1°36 0-98 1:04 1:07 Organic matter : 3152 33°76 33:23 28°61 34:14 From the bones of a man aged 44 years he obtained : Femur. Tibia. Phosphate of lime and fluoride of calcium ~ 52°67 52°93 Carbonate of lime ‘ ‘ - 10°03 9°88 Phosphate of magnesia : i F 0°93 0°91 Soda ; : i 3 1:07 1°09 Chloride of sodium ; : ore 0°34 0°31 Organic matter. : : . 3415 33°94 II. 26 ~ Tibia. 53°12 9°35 1:07 0°39 0°99 34°10 Fibula. 52-04 10°13 0°89 1-12 0°39 34°51 | A402 ANIMAL BODY : BONES OF THE LOWER ANIMALS.! Mammalia. [ EpEenTATA. Common armadillo. Pasi a Be. the throat. the abdomen. the tail. Phosphate of lime with a little fluoride } 53°45 50°92 55°43 of calcium ; Carbonate of lime : 6°73 6°63 6:99 Phosphate of magnesia 1:30 1°23 1:07 Salts 0°89. 0°95 0°92 Cartilage 34°63 36°77 32°81 — Fat 3°00 3°50 2°78 GLIRES. Squirrel (old). Mouse. Rat. Hare. Ce Femur and tibia Femur. Humerus. together. Femur, Femur. Phosphate of lime with a : 4 ; : G little fluoride of iia | oF adios wicca wedi eo Carbonate of lime - 1045 # 10°50 9-62 6°72 9°07 Phosphate of magnesia . 1°36 1°32 1°10 1-91 0°99 Salts aie ‘ 0°90 0°91 0°83 0°91 0:82 Cartilage ; - waghe SiZi 36°84 28°98 29°60 Fat . A 0°80 0°79 1:30 1:10 1:07 RUMINANTIA. Sheep aged 4 years. He-goat. Bulli aged 4 years. Femur. Osoccip. - Femur. Tibia. Os occip. Phosphate of lime with a be little fluoride of calcium 55°94 47°07 54°07 54°03 52°51 Carbonate of lime 12°18 9:09 12-71 11-99 11-14 Phosphate of magnesia 1:00 1°59 142 1°44 1:05 Salts 0°50 1°02 0°30 §60°70 0°50 Cartilage 29°68 39°58 29°09 29°92 32:80 — Fat 0°70 1°65 1°91 Bony plates from the region of. “192 2°00 — ! The whole of these analyses, with two exceptions, were made by Von Bibra, as BONES. 403 PACHYDERMATA. Horse! (foetus of Castrated horse Mare about 3 months.) aged 6 years. aged 14 years. Humerus and tibia. Femur. Humerus. Femur. Phosphate of lime with a little fluoride of calcium } we? 54°37 aoe nave Carbonate of lime : 1°83 12°00 12:07 11°28 Phosphate of magnesia. 1-40 Leas ae 1:50 Salts ; ? a trace 0-70 = O71 0°40 Cartilage ‘ : 36°26 27°99 29°70 27:98 Fat ‘ — 3°11 2°91 4°21 Wild-boar. Costa.” Metatarsus.” Femur. Phosphate of lime with a 58°88 little fluoride of calcium baie aoSus Carbonate of lime ; 6°32 9°05 9°02 Phosphate of magnesia. 1:94 "69 117 Salts ‘ ‘ 1:22 1:78 0:92 Cartilage 28°00 ‘het } 47°30 34°16 pee CETACEA. PINNIPEDIA. Dolphin. Common seal. ene - A 5 Costa. § Vertebre. Os occipitis. Maxilla inf. Phosphate of lime bcs , ; 8° 54°11 little fluoride of calcium aaa aie ald Carbonate of lime . 9-99 937-52 7°23 7°20 Phosphate of magnesia. 110 0:98 . 118 0°93 Salts ; e724 SO 1-24 1°43 1°22 Cartilage ; : 30°46 33°97 30°11 35°24 Fat ‘ 3 — — 1:28 1°30 ' Von Bibra likewise analysed separately the compact and spongy substance of the femur of a horse aged 12 years, and obtained the following results : Compact Spongy substance, substance. Phosphate of lime with a little fluoride of calcium 54°65 41°14 Carbonate of lime ; : ae ied ee 18:93 Phosphate of magnesia AR ; . 148 1-32 Salts P ‘ ‘ . 0°86 0°94 Cartilage ‘ F ; ~ 327 37:67 ? These analyses were made by Valentin. 404 FALCULATA. ANIMAL BODY: Cat aged 6 years. Wolf. fo pata zs, % Humerus. Verteb. Os occip. Femur. Humerus. Costa. Verteb. Phosphate of lime with a little fluoride of cal- } 59°30 48°01 51°70 57°87 55°36 51°76 48°72 cium ; Carbonate of lime 10°69 84% 10:13 11:09 11°76 10:90 10-03 Phosphate of magnesia 1:70 = 0°97 107 +113 #£+1:07 +100 0°88 Salts ‘ 0°40 0°39 037 1:02 099 090 091 Cartilage . 27°21 40°79 35°83 27:44 29°51 33°78 37°53 Fat 0°70 1:40 0°90 1°45 131. =1°66°: 195 VOLITANTIA. Common bat. Femur. Humerus. Phosphate of lime with a little fluoride of calcium 57°45 56°90 Carbonate of lime 4°77 6°00 Phosphate of magnesia — 1:03 1:00 — Salts ¢ 0°75 0°80 Cartilage ; 34:20 34:27 Fat 1:80 1:03 POLLICATA. Cebus Capucinus (Capuchin ape). Poms; Humerus. Vertebre. Costa. Scapula. Os ili. Phosphate of lime with a little fluoride of cal- } 54°33 51°87 50°43 «95154 = 50°24 46°63 cium ar" . Carbonate of lime 7°99 7°33 6°92 7°00 7°31 6°03 Phosphate of magnesia 1°58 1:72 1°33 115 1-20 1:07 Salts 0°89 0°93 0°92 0°87 0°91 0-90 Cartilage 34°01 37°18 39°04. 38°37 =39°33. 44°16 Fat 1:20 0°97 1°36 1:07 1°01 121 BIRDS. ; Thrush. Sparrow 6 days old. Sparrow (aged). — Femur, tibia, & humerus Femur. Humerus. together. Femur, Humerus. Phosphate of lime with a little fluoride of ca} 58°64 62°65 39°78 59°46 60°04 clum-=..- . Carbonate of lime 5:07 «605 3°62 8:88 9-97 Phosphate of magnesia 0°83 0°90 0°40 1:03 1:09 Salts 0°77 0°84 0°30 0°90 0°90 Cartilage 33°43 =.28°02 55°80 27:20 26°14 Fat 1°26 1°54 0°10 2°53 1:86 BONES. Rana esculenta. REPTILES. Salamandra terrestris. Mixed bones. Femur. Phosphate of lime with a little fluoride of cal- } 53°89 59°48 cium P Carbonate of lime . 2°46 2°25 Phosphate of magnesia 1-07 0°99 Salts of soda é 0°82 1:78 Cartilage . d 38°64 30°19 Fat . : 3°12 5°31 FISHES. Eel. Pike. Vertebre. Vertebre. Vertebre. Phosphate of lime with a little fluoride of calcium ander Carbonate of lime : 3°64 Sulphate of lime : 1:09 Phosphate of magnesia. 0°78 Sulphate of soda : 0°83 Carbonate of soda & we et ride of sodium : Cartilage ; : 36°99 Fat ; ; 23°55 38°70 14°30 0°81 0°97 32°72 12°50 Tibia. 59°73 2°24 0°97 1-90 29°16 6°00 Salmon. 36°64 101 0°70 0°83 21°80 38°82 405 Coluber Anguis natrix. fragilis. Vertebree. Vertebre. 59°41 47°52 7°82 6°92 1:00 111 0°73 0°90 24°93 36°18 6°11 7°37 Cod. Vertebre. Os occip. 57°65 61°15 4°81 5°20 2°30 2°62 100 =—-:1-03 31°90 27°89 2°34 2°11 We have selected these individual cases from 143 analyses of the bones of mammalia (independently of man) ; 151 of birds, 31 of reptiles, and 23 of fishes. ] 406 [ Rachitis. several chemists. ANIMAL BODY: Morbid Bones. The bones in this disease have been analysed by * Lehmann examined the tibie of three rachitic children. He found : Phosphate of lime Carbonate of lime Phosphate of magnesia Chloride of sodium Soda. Cartilage Fat : Bs 2. 3. 32:04 26-94-2813 4-01 4:88 3°75 0-98 081 0:87 0-21 0:27 0°28 0:54 081 0-73 54:14. 60-14. 58°77 5°84 6-22 6-94 Ragsky found in the scapula and humerus of a rachitic child: Phosphates of lime and magnesia 15°60 Carbonate of lime 2°66 Soluble salts 0°62 Cartilage, vessels, and fat 81°12 In the ulna of a child aged 5—6 years, Von Bibra found: Phosphate of lime with a little fluoride of calcium 47°83 Carbonate of lime 7°42 Phosphate of magnesia 1:23 Salts : 1°82 Cartilage 35°61 Fat 6:09 Osteomalacia. Several analyses of bone in this disease are on record. Vertebra. Vertebra. Costa. (Bostock). (Prosch.) (Prosch.) Phosphate of lime 13°60 13°25 33°66 Phosphate of magnesia . 0°82 — — Carbonate of lime 113 5°95 * 4:60 Sulphate of lime and phosphate of soda 4:70 0°90 0°40 Cartilage , 79°75 74°64 49°77 Fat _ 5°26 11°63 An analysis by Bogner of the bones of a man aged 32 years, who died from osteomalacia, yielded the following results : Scapula. Radius. Phosphate of lime 26°92 28°11 Carbonate of lime 0°98. 1:07 Phosphate of magnesia 5°40. 6°35 Cartilage and vessels 65°85 63°42 Soda, iron, and loss 0°85 1°05 Femur. 23°50 0°97 5°07 69°77 0°69 Patella. 23°23 0°94 5°03 70°60 0°64 tin" MORBID BONES. 407 Ragsky has analysed bone in this disease. He found in arib : Phosphates of lime and magnesia ; 17°48 Carbonate of lime and salts ; ‘ 6°32 Cartilage, vessels, and fat : ‘ 76°20 After the removal of the fat, Lehmann found : 1. 2 3. Phosphate of lime . 36863 31-718 35871 Other salts. . 4968 7913 5684 Cartilage . 58169 60369 58445 and in two other cases of osteomalacia occurring in persons aged about 40 years, the same chemist found : I. 2. Femur. Costa. Femur. —Costa. Phosphate of lime : - 1756 21°02 _ 18°83 19°14 Carbonate of lime ee 3°04 3°27 3°83 4:08 Phosphate of magnesia ‘ 0°23 0°44 0°54 0°60 Soluble salts : ‘ 0°37 0°63 0°43 0°41 Cartilage ; . . 48°33 50°48 4154 42°43 Fat : : - 29°18 23°13 34:15 32°65 The three following analyses of bone in this disease were made by Von Bibra: => eS Tibia of a woman Femurofawoman Femur of a man aged 75 years. 83 years. aged 60 years. Phosphate of lime with a little fluoride of calcium f °°"? so19 a oa Carbonate of lime : 4:94 6°37 . 7°49 Phosphate of magnesia . 2°01 1-20 1:22 Salts é . 0°31 1°37 1:35 Cartilage : . 29°17 30°99 32°54 Fat ‘ ‘ 8°56 13°28 4°15 Marchand found the bones of the child whose case is noticed in p. 286 of this Volume, composed in the following manner : Vertebra. Radius. ‘Femur. Sternum. Phosphate of lime . : - 1256 15:11 14°78 21:35 Phosphate of magnesia ‘ F 0°92 0°78 0°80 0°72 Carbonate of lime. ‘ : 3°20 3°15 3°00 3°70 Sulphate of lime Sulphate of Saf wraorins of calcium, chloride of ot 1-00 198 100 2-01 iron, and loss . . Cartilage . : ‘ . 7522. 71:26. 72:00 61°20 Fat : . ‘ ‘ 6°12 7°50 7°20 9°34 The cartilage yielded neither glutin nor chondrin. 098 100 102 °& 1°68 408 ANIMAL BODY: Arthritis. Marchand analysed the upper part of the femur, and the bones of the fore-arm of a person with abundant to- phaceous deposits in the knee- and elbow-jomts. He found in these bones: Femur. Radius & ulna. Phosphate of lime ; A + eos 43°18 Carbonate of lime : ; - 8°24 8°50 Phosphate of magnesia. ; ; 1-01 0°99 Animal matter ; ; +: (4632 45°96 Fluoride of calcium, soda, chloride of ety ta 2-3} 137 and loss Lehmann analysed the bones of three persons with chronic gout ; their ages varied from 40 to 50 years. He found: 1. 2, 3. Phosphate of lime . - 95°16 35°83 37°22 Carbonate of lime . ; 8°41 9°82 8-99 Phosphate of magnesia os 105 - FI Soluble salts é " 2°93 2°03 1°82 Cartilage : ‘ . 38°14 38°26 40°03 | Fat : ? , ae 13°37 9°15 Caries. Valentin has analysed carious bones, and likewise an osteophyte incrustation surrounding the carious tibia of a man aged 38 years. ; Tibia ofaman Vertebra of a man aged 38 years. aged 20 years. Phosphate of lime A : 34°383 33°914 Carbonate of lime 2 é 6°636 7°602 Phosphate of magnesia ; 1-182 0°389 Chloride of sodium 3°157 Carbonate of soda } as ca 0118 Organic constituents. . 55°880 54°830 External condyle Head of tibia of the femur of a girl. of the same individual. Phosphate of lime ; 39°393 45°451 Carbonate of lime ; 4°620 5°683 Phosphate of magnesia. 0520 1180 Chloride of sodium ; 0°424 1°620 Carbonate of soda ; 0-647 0-446 Organic constituents : 54396 45°620 MORBID BONES. 409 In the osteophyte incrustation there were contained : Phosphate of lime Carbonate of lime Phosphate of magnesia Chloride of sodium Carbonate of soda Organic matters 29°424 4-201 0°317 5556 1°117 59°370 Von Bibra has also made several analyses of carious bones. Phosphate of lime with a little fluoride of calcium Carbonate of lime . Phosphate of magnesia Salts . Cartilage Fat Phosphate of lime with a little oe of calcium Carbonate of lime Phosphate of magnesia Salts. = Cartilage Fat > Bones of the hand of a man. J Its upper 3 Metacarpal bone. articulating portion. Phalanx. } 49°77 31:36 49°36 7°24 4:07 8:08 111 0°83 0°98 0°30 0°30 0°40 37°97 59°36 37°47 3°61 4:08. 3°71 Femur of a man. eee lg a Diwwanesi portion. Mass of the sitar, 51°53 54:98 5°44 5°97 3°43 3°70 0°91 0°89 35°69 31°44 3°00 3°02 Palate bone of a woman aged 40 years, with inveterate syphilis. Phosphate of lime with fluoride of calcium Carbonate of lime Phosphate of magnesia Salts Cartilage Fat Phosphate of lime with Sach of calcium Carbonate of lime Phosphate of magnesia Salts Cartilage Fat (The portion submitted to analysis was thrown off during her lifetime, and weighed 16-5 grains.) 45°14 5°03 We, 2°40 0°82 42°34 4:27 Tibia of aman Tarsus of aman aged 25 years. aged 40-50 years. 47°79 39°22 6°44 6°87 1°30 0°50 2°00 2°10 28°57 29°23 13°60 22°09 410 fluoride of calcium Carbonate of lime Phosphate of magnesia Salts Cartilage Fat Phosphate of lime, ap | Necrosis. Phosphate of lime, with fluoride of calcium Carbonate of lime Phosphate of magnesia Salts Cartilage . Fat This small amount of organic matter is not characteristic of necrotic bone, for in two minute portions thrown off after frac- tures Von Bibra found : ANIMAL BODY: Nasal bone of a girt aged 15 years. aged 40 years. 44°05 45°77 3°77 3°45 1°45 1°02 1:10 1:70 38°62 41°42 9°29 8°36 The following analysis was made by Von Bibra: Phalanx of a man aged 40-50 years. 72°63 4:03 1-93 0°61 19°58 1-22 Lumbar vertebra! of a woman |. 1. 2. Organic matter 37°87 31°58 Inorganic matter 60°77 67°33 Fat 1°36 1:09 Osteoporosis. Ragsky has analysed a specimen of osteopo- | rosis growing on the cranium of an aged person. It yielded gelatin when boiled. It contained: Phosphates of lime and magnesia 55°80 Carbonate of lime and salts 5°59 Cartilage, vessels, and fat 38°61 4 i Ki 5 ta os B ! In the cavity of this bone, produced by the caries, there was a thick, reddish a yellow matter, like inspissated pus. Albuminous matter Aleohol-extract and lactates . Water-extract Shreds of cartilage Fat ‘ Fixed salts The latter contained i in 100 parts : 19°7 0°9 2°4 51°0 ~ 7:2 18°8 containing 903 of phosphate of lime. ie It consisted of 81:3 parts of water and volatile ’ matter, and 18-7 of solid constituents. MORBID BONES. 41] Sclerosis. Ragsky has analysed bone in several cases of this affection. Simple sclerosis of the cranium of a madman. Phosphate of lime with fluoride of calcium 54°10 Carbonate of lime ; ‘ ‘ 10°45 Phosphate of magnesia ; ‘ 1:00 Soluble salts ; , J 1:04 Cartilage and vessels. ‘ : 33°41 Sclerosis consecutive on osteoporosis. (The bone not specified.) Phosphates of lime and magnesia : 48°20 Carbonate of lime : : : 7°45 Soluble salts . : : 0°25 Cartilage, fat, and vessels ¢ ieee Set Sclerosis more highly developed. Phosphates of lime and magnesia , 50°29 Carbonate of lime and soluble salts : 7°20 Cartilage and vessels. : , 42°51 Sclerosis in the highest degree. Phosphates of lime and magnesia ; 55°52 Carbonate of lime : ‘ ‘ 5°95 Soluble salts . ° : 0°26 Cartilage and vessels. ‘ ; 38°27 Sclerosis of the femur. Phosphates of lime and magnesia : 53°21 Carbonate of lime ‘ : : 8°30 Cartilage and vessels. : ° 38°49 Syphilitic sclerosis, highly developed. Phosphates of lime and magnesia of 87°20 Carbonate of lime ‘ : : 6°50 Cartilage and vessels.” : ‘ 36°30 Ezostosis. Lassaigne has analysed an exostosis, the thick- ened bone to which it was attached, and a healthy portion of the same bone. Thickened bone. Healthy bone. Exostosis. Phosphate of lime . . 36°3 41°6 > SOG Carbonate of lime . ‘ 6°5 8°2 14:0 Soluble salts ‘ . 14:2 8°6 10°0 Organic matter . é 43:0 416 46:0 Von Bibra has analysed an exostosis on the humerus of a 412 ANIMAL BODY: dog. In the second analysis the cempean of the healthy radius and ulna are represented. 1. 2. Exostosis. Radius and ulna. Phosphate of lime with fluoride of calcium ‘ ‘I 47°99 60°95 Carbonate of lime . : 1°00 2°84 Phosphate of magnesia : 1°55 1°39 Salts ‘ : : 0°91 0°93 Cartilage . é : 45°74 32°88 Fat : : a 2°81 101 We observe in both these cases that the exostosis contains a larger amount of organic matter than healthy bone. ] I have analysed a remarkable osteoid tumour that formed on the knee of a leucophlegmatic boy aged 14 years, who was suffering from oedema. ‘The tumour was ten inches long and twenty-five broad, and could be hardly half spanned with both hands. The limb was amputated and the tumour examined. I analysed separately three portions of the tumour, one hard and bony, a second softer, and a third perfectly soft. On ex- posing them to heat on an oil-bath, the first became white and earthy, while the other portions assumed a horny appearance. Ether took up a dirty yellow, non-phosphorized fat. The three specimens yielded on analysis : Anal. 155. Anal. 156. Anal. 157. Phosphate of lime j .. 35°85 8-00 9-20 Carbonate of lime : ; 2°70 0°62 0°64 Phosphate of magnesia ? ; 0°58 0°21 — Soluble salts ; é ; 0°52 Chloride of sodium ‘ " 0°26 sisi: doin FR . é ; 1°16 3°61 3°21 Cartilage and vessels ‘ . 98°91 87°04 86°20 The proportions of the fixed salts to each other in these cases, and as they occur in normal bone, are exhibited in the maieedie table: l. 2 3. Healthy bone. Phosphate of lime ; Tee gf 86°5 86°9 79°4 Phosphate of magnesia . ‘ 15 1°9 — 17 Carbonate of lime s ; 68 6°6 6°0 16°9 Soluble salts. ; 9 NT 1-4 Chloride of sodium ae } be ee 0-4: The most striking peculiarity is the relative diminution of the carbonate of limé. TEETH. ae [Callus has been analysed by Lassaigne and Von Bibra. Lassaigne examined the outer and inner portions of a mass of callus. He found: External portion. Internal portion. Phosphate of lime . ; ‘ 33°3 32°5 Carbonate of lime . 4 : 5°7 6°2 Soluble salts ; : 11:3 12°8 Animal matter ‘4 : : 50°0 48°5 The following analyses were made by Von Bibra : . Callus from the Callus from the tibia of a hare. rib of a horse. Phosphate of lime with fluoride of ee ee f 3262 43:9 Carbonate of lime : : 1°01 5°69 Phosphate of magnesia. ‘ 1°13 1°20 Salts 7 : i 1°79 0°74 Cartilage ; . : 61°41 46°97 Fat ‘ : : 2°04 1°50 Hence callus does not contain so large an amount of earthy salts as true bone. | The Teeth. The teeth, like the bones, consist of phosphate and carbonate of lime, fluoride of calcium and cartilage. The bony matter of the tooth is covered superiorly with enamel, while the fangs are coated with cement or cortical matter, which likewise over- lays the enamel of the crown. Of the three constituents of tooth, enamel, bone (dentine), and cortical substance, the last is the poorest in inorganic matter. Lassaigne found therein : Organic matter ‘ : : 42°18 Phosphate of lime : ; ‘ 53°84 Carbonate of lime : : : 3°98 ‘The osseous portion (dentine) hardly differs from true bone. Berzelius found therein : Cartilage and vessels : - 28°0 Phosphate of lime with fluoride of calcium . 643 Carbonate of lime ; ; oe Phosphate of magnesia. F oe Soda, with chloride of sodium 5 SS af 414 ANIMAL BODY: Pepys found : Cartilage ; : : si. 2B Phosphate of lime ; ; . 580 Carbonate of lime : : , 4:0 Water and loss fl : ct. ore From analyses made by Lassaigne of human teeth at dif- ferent ages, it appears that the phosphate of lime gradually increases, and that there is a corresponding diminution of the carbonate. Organic Phosphate Carbonate matter. of lime. of lime. Tooth of a child one day old ; 35°00 51:00 14:00 » Of achild aged 6 years . ‘ 28°57 60°01 11°42 » Of an adult man . ‘ 29°00 61-00 10:00 » Ofamanaged 8l years . . ; 33°00 66-00 1-00 In the enamel of human teeth, Berzelius found : Phosphate of lime with fluoride of calcium - 88°5 Carbonate of lime 4 é oe BD Phosphate of magnesia. P vi eS Membrane, alkali, and water . ae So that this substance seems almost destitute of organic combination. — [Von Bibra has made the following analyses of human teeth : Molar tooth of Molar tooth of a woman aged 25 years. an adult male, Enamel. Osseous portion. Enamel. Osseous portion. — Phosphate of lime with a : little fluoride of calcium 81°65 67°54 solic 66:72 Carbonate of lime j 8°88. se FSF 4°37 3°36 Phosphate of magnesia. 2°55 2°49 1:34 1:08 Salts ; : 0-97 1-00 0-88 0°83 Cartilage io é 5°97 20°42 3°39 27°61 Fat ‘ ‘ a trace 0°58 0°20 0°40 For a series of analyses of the teeth of the lower animals — I must refer the reader to the original work, (Chemische Untersuchungen iiber die Knochen und Zahne des Menschen — und der Wirbelthiere,) which may- be regarded as a pea monograph on the subject of which it treats.] tes oT - raches r Pa POE ae Tie eae ae ae CARTILAGE. 415 Cartilage. The cartilages are invested with a peculiar membrane, the perichondrium ; they are not so hard as bone, but are more elastic and supple. They are usually divided into two classes, the true and the fibrous cartilages. In addition to their re- spective microscopic appearances, they present well-marked che- mical differences. The true cartilages dissolve almost entirely in water, and yield chondrin (see Introduction, p. 25). If, however, the boiling is interrupted before the solution is per- fectly effected, it will be found that the cells have remained almost unchanged, and that only the basic substance has been dissolved. Even when true cartilage is perfectly dissolved the solution is somewhat turbid, owing, probably, to a partial change in the cells. Fibrous cartilage, in which the cells form the preponderating mass when continuously boiled for forty-eight hours, yields only a small quantity of extract, which exhibits all the ordinary reactions of chondrin, but does not gelatinize. The inorganic constituents of cartilage form only a small portion of their mass; Fromherz and Gugert! found in the costal car- tilage of a man aged 20 years, 3°402°2 of fixed salts, associated in the following proportions : Carbonate of soda : : 35°1 Sulphate of soda : : 24°2 Chloride of sodium ; ; 8-2 Phosphate of soda ‘ ‘ 0°9 Sulphate of potash S : 12 Carbonate of lime ; ‘ 18°3 Phosphate of lime Beng é 4°] Phosphate of magnesia. ; 6°9 Peroxide of iron and loss ; 0°9 In the corresponding cartilage of a woman aged 63 years, the same salts were observed, but to a smaller amount: there was also a larger amount of phosphate than of carbonate of lime. [The following analyses of cartilage are extracted from Von Bibra’s work :— 1 Schweiger’s Journal, vol. 50, p. 187. 416 ANIMAL BODY: Costal cartilage of a child Ditto of a child aged 6 months. aged 3 years. 100 parts yielded a ¢ a) 2-24 of the following ash: 3-00 of the following ash: Phosphate of lime ; ‘ 20°86 21°33 Sulphate of lime : . , 50°68 48°68 Phosphate of magnesia. ‘ 9°88 8:88 Sulphate of soda , . 9°21 10°93 Phosphate of soda 3°00 Carbonate of soda } , ; aased — Chloride of sodium : 9°37 7°18 Costal cartilage of a girl Ditto of a woman Ditto of a man aged 19 years. aged 25 years. aged 40 years. 100 parts yielded c \ 7°29 of the followingash: 3*92o0f the following ash: 6:1 of the following ash: Phosphate of lime . 5°36 6°33 13°09 Sulphate of lime - 92°41 87°32 79°03 Phosphate of magnesia 0°99 4:10 3°78 Sulphate of soda «Ss 1°24 0°95 1:22 Phosphate of soda . a trace a trace 0°93 Chloride of sodium . a trace 1:30 1°95 Carbonate of soda . — a trace a trace Carbonate of lime . — — a trace | Synovia. The synovial fluid is viscid, transparent, of a yellow or reddish colour, faintly saline, and resembles in its odour the serum of the blood. A specimen of this fluid, analysed by John, contained : Water : : g ‘ 92°80 Albumen é ‘ ‘ > 6°40 Extractive matter, with muriate and carbonate of } 0-60 soda 3 ‘ Phosphate of lime . ’ ‘ 0°15 Cellular Tissue, Tendons, Ligaments, Skin, Hair. These may be classified together as tissues that yield gelatin. They are distinguished more by their microscopical than their chemical characters, and we may refer to Henle for an excellent account of their minute structure. The elements of cellular or combining tissue (Bindegewebe) in whatever part of the body it occurs are long, fine, hyaline fibrille or cylinders, varying in diameter from ‘0003 to ‘0008 of a line, and lying in close ap- TENDONS, LIGAMENTS, SKIN. 417 position. They are firm and elastic, are not changed by cold water, nor dissolved by acetic acid; the latter reagent renders them gelatinous and tough, but takes up no protein-compound. The organs containing this tissue diminish when boiled, become harder and more rigid, but ultimately soften and dissolve into gelatin, forming a solution that stiffens on cooling. Alcohol, ether, and oil exert no action on cellular tissue, even when aided by heat. _ Tendons swell on being boiled, become yellow, aiid are gra- dually converted into gelatin. The solution is turbid in con- sequence of the flocculent appearance presented by minute vessels in suspension. In concentrated acetic acid they swell, become transparent and gelatinous, and in this state readily dissolve in hot water, from which neither an alkali nor ferro- cyanide of potassium throws down any precipitate. Ligaments consist partly of cellular and partly of elastic tissue, and these two structures present both chemical and physiological differences. True elastic tissue is not changed by acetic acid, is not converted by boiling into gelatin, but with the aid of heat dissolves readily in dilute mineral acids, from which it is not precipitated by ferrocyanide of potassium. As illustrations of the true elastic tissue we may refer to the liga- menta flava between the vertebre and the ligamentum nuche im the ruminants. The evtis, or true skin, is a contractile cellular tissue con- vertible, by boiling, into gelatin. It is permeated by a fluid, and contains also cellular tissue and vessels. Wienholt has endea- voured to determine their relative proportions; he obtained: Cutaneous tissue ee cellular tissue and vessels) . 32°53 Water « 57°50 in which were tieiskeed : ' Albumen : ; ‘ . ‘ 1°54 Alcohol-extract . - x ‘ * 0°83 Water-extract ‘ ; ; : 7°60 The skins of different nals require boiling for different lengths of time in order to be converted into gelatin, and the change is effected more rapidly in young than in old animals. The conversion of the cutis into gelatin is much facilitated by the action of dilute alkalies or acids; it then takes place at an ordinary temperature. The skin combines with basic sul- phate of iron, and with bichloride of mercury, when immersed in II, 27 418 ANIMAL BODY, solutions of those salts, and it then resists putrefaction. It likewise combines with tannin, forming a substance insoluble in water, and no longer tending to putrefaction (leather). The epidermis is affected by strong mineral acids: concen- trated sulphuric acid dissolves it, as also do the caustic alkalies. Many metallic salts combine with and colour it. The ter- chloride of gold communicates a purple, nitrate of the protoxide of mercury a reddish brown, and nitrate of silver a black colour : the volatile oxide of chrome (?) exerts a similar effect, and even the alkaline sulphurets communicate a brown or black colour to it. | [The hair has recently been examined by Scherer and Van Laer.1 By treating the hair with spirit, ether, and water, there were removed margarin and margaric acid, olein, a brown matter soluble in water, chlorides of sodium and potassium, and lactate of ammonia. By ultimate analysis there were then obtained : Scherer. Van Laer. r sree: ~ pee tea 1. 2. 3. 4, 1. 2. Carbon . . 51°529 50652 50622 49-935 50-12 50°65 Hydrogen . 6687 6:766> 6613 . 6-631 6:33. 6°36 Oxygen 21:03 20°81 Sulphur . 23848 24643 24829 25°498 499 500 Nitrogen - 17:963 17:963 17:963 17:963 17°52 (17°14 No. 1 was hair of the beard; 2, of the head of a fair person ; 3, was brown hair; and 4, black hair from a Mexican, The ash in 1 amounted to 0°72°; in 2, to 0°82; and in 4, to 2:08. . According to Van Laer, the inorganic constituents in 100 parts are: Colour. Ash. Soluble portion. Peroxide of iron. Insoluble portion. Brown hair ‘ 0°54 0°17 0°058 0-312 ” . 1°10 6°51 0°395 0°200 ” . 0°32 _ — sag Black hair ‘ 1:02 0°29 0°214 0°516 ” . 115 —_ — Sas Red hair - 1°30 0°93 0:170 0-200 is . 0°54 0-27 0°275 — ” . 1°85 —_ : —_ ice Gray hair : 1:00 0°24 0°232 0°528 A . 0°75 a5 soe sa ’ Scheik. Onderzoeck, 2° St. p. 75. THE EYE. 419 The soluble portion consisted of chloride of sodium, sulphate of lime, and sulphate of magnesia; the insoluble constituents were phosphate of lime and silica. From Van Laer’s investigations it appears that the hair con- sists essentially of : 1. A connecting medium consisting of a tissue yielding ge- latin and represented by the formula C,, H,, N, O, ;—and 2. Of bisulphuret of protein, C,, H,, N, O,, §,,. The large amount of sulphur in hair (averaging 5°) is the cause of its colour being affected by various metallic salts. As there is no constant difference in the results obtained by the analysis of hair of various tints, it is to be presumed that the colour is dependent on peculiar arrangements of the ul- timate particles. Hair further contains about 0:4° of peroxide of iron, which is supposed by Van Laer to be chemically combined with the protein. | Crystalline Lens and Fluids of the Eye. The crystalline lens is insoluble in boiling water, spirit, and acids; it does not even communicate any turbidity to them ; hence it consists neither of cellular nor elastic tissue, but is a distinct substance, approximating possibly towards horny tissue. The membrana Demoursii, the third layer of the cornea, pos- sesses similar properties, while the true horny layer which lies between the external layer of epithelium and the membrana Demoursii appears to be fibrous, and is converted by boiling into chondrin. The crystalline lens itself possesses a peculiar and very regular fibrous arrangement. Chevenix found the specific gravity of the human lens to be 1079, and that of the sheep 1180. I have observed that the crystallme lens in young animals is softer, and less resisting than at a more advanced age. : With respect to the chemical composition of the lens, I find that, in addition to albumen, it contains a substance closely resembling casein, to which I apply the term crys- tallin. I reduce the lens to a pulpy mass, stir it with water, and then heat the mixture to the boiling point: the albumen co- agulates, while the crystallin does not coagulate, but is entangled 420 ANIMAL BODY. in the albumen. In order to separate them I evaporate to dryness, pulverize the white residue, and boil it, first with ether in order to separate fat, and then with spirit of °915 as long as anything continues to be taken up. The albumen rapidly sinks from the hot, clear, spirituous solution, and the supernatant fluid which must be decanted from the sediment, soon begins to be- come turbid from the separation of numerous flocculi of erys- tallin. I evaporate to a slight residue, and then precipitate the crystallin by strong alcohol, in which it is only slightly soluble. The lactates and chloride of sodium remain dissolved in the alcohol. In this manner I analysed the crystalline lens of the ox and the horse. Anal. 158. Anal, 159. Crystalline lens of ox. Ditto of horse. Water é ; ; ; 65°762 60-000 Albumen. ; ; . 23290 25°531 Crystallin ‘ . ; ‘ 10°480 14:200 © Fat ‘ ‘ 0°045 *0°142 Extractive matter with chloride of sodium and lactates . 1 0°495 wtih Berzelius has not separated the albumen and crystallin ; m other respects his analysis approximates to mine, as far as the amount of the protein-compounds is concerned. He found it composed of : Water s f 58:0 Proteis bouipodiad , ‘ 35°9 Alcohol-extract with salts . é 2°4 Water-extract with traces of salts ( 13 Cell-membrane . ; 2°4 It has been shown by Wurzer aiid Lassaigne, that when the © lens is opaque (in cases of cataract) it contains an excess of phosphate of lime. This may be the cause of the opacity, or it may be due to the coagulation of the protein-compounds by the presence of a free acid. Wurzer determined the composition of an opaque lens from a bear. It contained (after the removal — of the water) : Phosphate of lime ; ; - 689 Carbonate of lime ‘ ‘ 96 8°59 10°19 12°18 14°82 Phosphorus é - 080 165 1:0 1-00 0°85 | According to Vauquelin, the medulla oblongata and the spinal cord contain the same constituents as the brain, but a larger pro- portion of fats and a less amount of albumen, extractive matter, and water. [L’Heretier found that the spinal cord of an adult was composed of : : ; Water ‘ ; ; 71:05 Albumen H ; ; 7°30 Fat ; : : 8°25 Osmazome . : ‘ 11:50 Phosphorus. : ‘ 1-90 The nerves, according to the same chemist, contain more albumen, less solid and more soft fat than the brain. | On boiling the nerves in alcohol a fluid fat exudes which sinks to the bottom of the vessel: on boiling them with water they swell but do not dissolve. The albumen of the medullary portion dissolves in a weak solution of potash, the fat swims on the sur- face, and the neurilemma remains. On treating the nerves with acetic acid the medullary portion is expressed by the contraction of the tubes, which are themselves unacted on. Fat. The fat contained in the fat-cells is a mixture of margarin and olein in man and the carnivora, of stearin and olein in the ruminantia. Human fat usually occurs in a fiuid or semifluid state, consisting of a solution of margarin in olein, from which the margarin separates on cooling into microscopic stellar groups. The Glands. Our knowledge of the chemistry of the glands is very defec- tive, and in all probability the analysis of these organs will never throw much light on the process of secretion in conse- quence of the utter impossibility of separating the nerves, ves- 428 ANIMAL BODY: sels, and cellular substance. Fromherz and Gugert attempted to analyse human liver. ee found in 100 parts : Water . ; 61:79 Solid residue . . 38°21 The insoluble parenchyma formed 28°728, and the portion soluble in water and alcohol 71:282 of the solid residue: 100 parts of dried liver contained 2°634 of salts, consisting of chlo- ride of sodium, phosphate and a little carbonate of lime, phos- phate of potash, and traces of peroxide of iron. In the liver of the ox Braconnot found water 55°50, soluble matter 25°56, walls of vessels and membrane 18°94. In certain morbid conditions of the system the liver becomes much affected. Its amount of fat is so extraordinarily increased in certain cases as to conceal the true structure, for the fat, as Rokitansky observes, not only occupies the place of the true glandular tissue, but all the tissues are permeated and the vas- cular substance perfectly overwhelmed. This morbid condition has been very frequently observed associated with pulmonary phthisis, and is a consequence of too luxurious a life, and the abuse of spirituous drinks. Fromherz and Gugert analysed a liver of this nature. It weighed twelve pounds, and had a soft caseous appearance. Its true organization appeared entirely destroyed. It contained a non-saponifiable fat with a small quantity of unco- agulated albumen, a little extractive matter, casein, salivary matter, a few shreds of vessels, chloride of sodium, and phosphate of lime: they found no cholesterin, fatty acids, or bilifellinic acid. [A fatty liver analysed ne Frerich,' yielded : Water ‘ : . 73°09 Solid constituents : ‘ - 26°91 Fat containing phosphorus ‘ - 17°26 Albumen . 5 ‘ 3°67 Vessels and hepatic cells ‘ ; 4-00 Water-extract ‘ ; ; 0°48 Alcohol-extract - 6 ‘ 1°50 A. waxy liver (a variety of the above) yielded: Water : ‘ ; - 80°20 Solid constituents : . 19°80 Fat containing phosphorus, and sania 2°20 Albumen . ‘ 3°50 Vessels and hepatic cells : ‘ 3°60 Water-extract : : , 7°00 Alcohol-extract ‘ ws ‘ 4:50 ' Schmidt’s Jahrbiicher, vol. 48, p. 148. OTOLITHES. 429 The two following analyses have been made by Boudet : Fatty liver. Healthy liver. * Water ; . 55°15 76°39 Solid constituents : 44°85 23°61 Animal matter dried at 212° 13°32 21-00 Saponifiable fat ; 30°20 1°60 Cholesterin é 1:33 0-17 | The thyroid gland has been analysed by Fromherz and Gugert, and the thymus by Morin. The kidneys have been submitted to analysis by Berzelius. From two experiments he concludes that the kidneys are made up of a congeries of minute vessels, and that the tubes contain a very albuminous acid fluid, in which there is no dissolved fibrin, and in which not a trace of urea can be detected. [According to Boudet, the parenchyma of the lungs, freed as much as possible from blood and extraneous substances, is formed of the following chemical elements :—1st, a substance susceptible of transformation into gelatin by ebullition in water, (cellular tissue ;) 2d, a substance soluble in cold water, pre- cipitated by nitric acid, coagulated by heat, containing albumen and hematin ; 3d, a substance analogous to casein ; 4th, fibrin ; 5th, free oleic and margaric acids; 6th, oleate and margarate of soda; 7th, cerebric acid; 8th, lactic acid; 9th, cholesterin amounting to ‘05° of the weight of the lungs dried at 212°; 10th, the water amounting to 82°. The ash contained a con- siderable quantity of chloride of sodium and sulphate of soda, a small quantity of phosphate and carbonate of lime, and traces of silica and peroxide of iron. | Otolithes. The membranous labyrinth of the ear contains a rather viscid fluid, which, however, never occurs in sufficient quantity to admit of chemical examination. In this fluid there are found minute six- or eight-sided crystals (otolithes), which, however, are generally soworn at the angles and borders that the crystalline form can be no longer recognized. They appear to consist for the most part of the carbonates of lime and magnesia combined with animal matters, and not unfrequently with phosphates. 4130 CHAPTER XII. SOLID MORBID PRODUCTS. Concretions. THESE morbid products are of frequent occurrence. They are found in various organs, especially in those through which fluid glandular secretions are discharged. They then consist for the most part of the most insoluble constituents of that fluid, although they occasionally contain substances foreign alike to the secretion and to the whole organism, and produced by a depraved formative process. Concretions are, however, also met with in other situations, as the brain, the cavities of the heart, the arteries, &c. The substances ordinarily entering into the composition of concretions are by no means numerous. Some concretions are formed of one constituent alone, while others have a mixed composition. The following substances must be viewed as true formative constituents, not as mere accidental admixtures: uric acid with its salts, uric oxide (xanthic oxide), cystin, hippurate of ammonia, basic and neutral phosphate of lime, ammoniaco- magnesian phosphate, oxalate of lime, carbonate of lime, car- bonate of magnesia, fibrin, cholesterin, and biliphzin: the accidental components are mucus of the urinary and gall- bladders, albumen, hematoglobulin, bilifellinic acid, fat, extrae- tive matters, chloride of sodium, and lactate of soda. The principal object in the analysis of concretions is to de- termine the nature of the leading constituents, and this may be easily effected even by persons little skilled in chemical mani- pulation. Medico-Chirurg. Transactions, vol. 10. ® Naturwissenschaftliche Abhandlungen. 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I now proceed to give one or two analyses of human calculi as illustrations of their general character. I analysed the remarkable calculus alluded to in pp. 439 and 449, I examined, Ist, the external layer ; 2d, the mner, tuber- ‘ culated nucleus; and 3d, the minute round nucleolus. I have likewise analysed (4th) a calculus of uric acid. i Anal.J60. An.161. An. 162. An. 163. E Cortex. Nucleus. Nucleolus. Uric acid caleulus. Water . 24°5 10-0 3°7 3°0 Solid residue ; . tue 90-0 96°3 97°0 Earthy phosphates . . 70°5 11 —_ —_— Oxalate of lime — 76°1 — —_ Urie acid _— —_— 91-2 92°8 Alkaline urates 1-0 0°5 13 3°2 Animal matter 3°5 12°8 3°5 — Fat and extractive matter atrace a trace — 1:0 The animal matter in the cortex contained a little silica and peroxide of iron; and in the nucleus, a large quantity of dark brown colouring matter. Uric acid calculi contain : According to r Fer af Taylor. Joss. Laugier. Von Bibra. 1 2 ‘a Uric acid 60°0 70:0 10:0 84°69 96°10 : Urate of ammonia —_ — 40-0 ” 9-03 a Urate of lime — 10°3 — — —_ a Phosphate of lime 10°0 — - -— Ammoniaco-magnesian phosphate 20-0 — oo 1:12 — Phosphate of ammonia —_ —- 5°0 —_— —_ Oxalate of lime ‘ , —_ — 15°0 0°95 — Ammoniacal matter and water 10°0 19°0 20°0 1:80 1:60 A substance soluble in ether — 0°5 — 0°81 0°50 . gy alcohol — —_ = -- 0-41 Calculi in which the earthy phosphates and carbonates pre-_ dominate have been analysed by Fromherz and Lindberson: Fromherz, Carbonate of lime 91°0 Phosphate of lime 3°0 Albumen and fat 4:0 Lindberson. Urate of soda , Basic phosphate of lime Ammoniaco-magnesian phosphate 38° Carbonate of lime 31 Carbonate of magnesia Albumen GRAVEL. 459 [Calculi in which oxalate of lime predominates have been analysed by Scharling : 1. 2. Oxalate of lime ot ‘ 37 63°5 Phosphate. of lime ‘ ‘ — 6°2 Ammoniaco-magnesian phosphate. 39 _ bteagial : ; ‘ 10 30-3 Organic matters d : 13 See also analysis 161, and the above analysis of Laugier. | Cystic calculi have been analysed by Taylor and Bley: . Taylor. Bley. Cystin . : : j 10:0 6°2 — Ammoniaco-magnesian phosphate é 10-0 36°6 75°0 Phosphate of lime . : 38°0 —_ 7:0 Carbonate of magnesia : ) — 571 — Uric acid : ‘ ‘ —_ ~- 18°0 Animal matter and loss , . 42°0 — = Both the calculi analysed by Bley were taken from the bladder of the same man; the first weighed 1:75, and the second 2 grains. : URINARY GRAVEL. Gravel has naturally the same composition as calculi; uric acid is, however, the most frequent constituent. In form, gravel is round-or angular, not unfrequently crystalline ; its colour is most commonly red, but sometimes pale yellow, gray, or brown. ‘The rules already given for the analysis of calculi apply equally to gravel. After having ascertained by the blow- pipe whether the gravel is perfectly destroyed by heat, or whether it leaves an ash that burns white, we then proceed in accordance with the directions given in p.431. Uric-acid gravel is frequently crystalline, and red or purple, but occasionally of a bright yellow colour, or white. The urine from which it separates is concentrated, highly coloured, and has usually a strong acid reaction. White gravel is usually composed of phosphate of lime with ammoniaco-magnesian phosphate, and occasionally of oxalate of lime. The ammoniaco-magnesian phosphate crystallizes in beautifully regular prisms, (often of considerable size,) as de- 460 . MORBID PRODUCTS. picted in fig. 25, and the oxalate in minute globules, or in octohedra, as represented in fig. 36. Phosphate of lime and ammoniaco-magnesian phosphate almost always occur together; oxalate of lime sometimes occurs by itself, and sometimes alter- nates with the earthy phosphates. Gravel consisting principally of the earthy phosphates is sometimes mixed with urate of ammonia, which latter readily dissolves when heated in water. I have alluded to the analysis of this kind of gravel in my remarks on urinary sediments in p. 181. The urme in which this white earthy gravel is formed, is either neutral or alkaline, — - never acid. Magendie describes a species of gravel containing hairs, (gravelle pileuse), consisting of phosphate of lime, ammoniaco- magnesian phosphate, and a little uric acid. It is possible that the hair may have been introduced from without, and thus be a mere accidental constituent. When cystin occurs as gravel, it almost always assumes the regular crystalline form _ that is so characteristic of that substance. Cystic gravel is of a yellow colour, and appears crystalline even to the naked eye. Lecanu! analysed Segala’s collection of 110 specimens of gravel. Seventy-nine of them (passed by 20 patients) con- sisted of uric acid with traces of ammonia and organic matter, which, however, in five cases were found only in the cortex, — the nucleus consisting of pure uric acid. One minute caleulus — passed at the same time with others of pure uric, hada nucleus ~ of oxalate of lime, and a thick cortex of uric acid. Five calculi E from different patients, consisted of oxalate of lime without — earthy phosphates, but with some uric acid} nine from different patients consisted of oxalate of lime and earthy phosphates; three from two patients consisted of phosphate of lime and — ammoniaco-magnesian phosphate, without uric acid; four from the same paticht consisted only of earthy phosphates; four from two patients consisted of ammoniaco-magnesian phosphate, without any appreciable traces of lime; three from two patients, of cystin. A calculus, the size of a pea, discharged with uric acid gravel from a man aged 62 years, was soft and white, soluble in water and alcohol, fusible, when heated evolving an odour of burned sugar, and containing a brown nucleus, formed ' Journal de Pharmacie, Sept. 1838. URINARY CALCULI OF ANIMALS. 461 apparently of a grain of corn. No cases of carbonate of lime were observed in this collection. [Schlossberger has recently directed attention to the fre- quent: occurrence of gravel (urate of ammonia) in the tubuli uriniferi of new-born children. He found it in 18 out of 49 cases. | Preputial and urethral calculi have been analysed by Romer: fifty-one concretions of this sort, weighing in all 158 grains, were removed from a child with natural phymosis. They con- sisted of uric acid, associated with phosphate of lime and some connecting animal matter. URINARY CALCULI OF ANIMALS. -Calculi are by no means uncommon amongst the lower animals, and it has been stated that rats are especially liable to this form of disease. . Generally speaking the constituents are much the same as in man, except that no uric acid occurs in the calculi of the herbivora, which consist for the most part of earthy phosphates and carbonates. In awild eat, Fourcroy and Vauquelin found a renal calculus of phosphate of lime. The vesical calculi of dogs consist for the most part of phosphate of lime and ammoniaco-magnesian phosphate, with a little animal matter. (Marcet, Brande, Wollaston, and Prevost.) Brande found 30 parts of ammoniaco- magnesian phosphate, 64 of phosphate of lime, and 6 of animal. matter. lLassaigne found 53 parts of oxalate of lime, 13 of phosphate of lime, and 39 of animal matter: in another calculus he found 972 of cystin. Two urinary concretions from these animals, examined by myself, were white and somewhat crys- talline ; they consisted principally of phosphate of lime with a little carbonate of lime. Im a renal calculus from a dog, Lassaigne found 58:0 parts of uric acid, 30°8 of urate of am- monia, 1*] of oxalate of lime, and 10:1 of phosphate of lime. Calculi from rats consist, according to Marcet, of ammoniaco- magnesian phosphate and phosphate of lime; according to Fourcroy, of oxalate of time; and, according to Morand, of phosphate, carbonate, and oxalate of lime. Vesical calculi of t ee 462 MORBID PRODUCTS. hares consist, according to Marcet and Brande, of phosphate and carbonate of lime. Vesical calculi of swine consist chiefly of carbonate and phosphate of lime, and ammoniaco-magnesian phosphate; according to Yellowly also, of oxalate of lime. The renal calculi of horses consist of carbonate and phosphate of lime in very variable proportions; Gurlt found 92-08 of the former, and 0°92 of the latter; while Brande found 22° of the former, and 76° of the latter: their vesical calculi are com- posed, according to Brande and Marcet, of the same consti- tuents: a specimen, analysed by Buchholz, likewise contained ammoniaco-magnesian phosphate, silica, sulphate of lime, and carbonate of magnesia: a calculus, analysed by Wackenroder, contained 72°47 parts of carbonate of lime, 3°52 of carbonate of magnesia, 3°25 of sulphate of lime, 1:91 of phosphate of lime, 17:10 of mucus, and 1:40 of water. Vesical and_renal calculi of oxen consist, according to Rapp, Brande, and Gmelin, ‘ m & of carbonate of lime. A calculus, analysed by Wurzer, con- — tained 81:4 parts of carbonate of lime, 6:2 of phosphate of lime, 4°3 of carbonate of magnesia, ‘009 of peroxide of iron, and °001 of peroxide of manganese. The same chemist found in a calculus taken from the urethra of an ox, 60 parts of carbonate and phosphate of lime, 38°2 of silica, and 1°8 of peroxide of iron. In a very hard concretion taken from the urethra of an ox, I found a large proportion of carbonate of lime, mixed with a little phosphate of lime and silica. Re Gh rr Vie Seals NE eal Mee LC ab cend | e el o fat Se Ree pe uw 2 ee [The following analyses have lately been made by Von Bibra: Calculi from ureter Calculus from bladder of a horse. of swine. Ln go ae x: 2. 3. Carbonate of lime > , 87°63 78°81 — _ Carbonate of magnesia : == 9°31 ante > Ammoniaco-magnesian phosphate 6°61 93°27 90°41 Phosphate of lime 3 3 — -— 2°10 6°31 Sulphate of lime ‘ : 1°64 _ — <— Phosphate of magnesia —- 0°90 _— _ % Organic matter taken up by isdtash 0:20 — 0°10 0-201 ” ” ; alcohol — : 0°30 sn Vans ‘> 2 Sit <- Rek Shy i te . A, i a = ae = re: Ss % INTESTINAL CONCRETIONS. . 467 cart-horse ; it was round, perfectly smooth, of a grayish-yellow colour, weighed about 123 ounces, was 3 inches and 7 lines in diameter, 11 inches in circumference, and consisted of 3 strata which were deposited round a fragment of granite. All three laminze were composed of ammoniaco-magnesian phosphate with a little of the alkaline phosphates, but without any phos- phate of lime. The second lamina had a radiating structure, and between the rays woody fibres might be detected. The central portion, about the size of a walnut, presented the appearance of a brown urinary calculus ; the outer layer closely resembled common jasper. Au analysis yielded : Analysis 164, Ammoniaco-magnesian phosphate ‘ 8111 Phosphates of potash and soda. i 1°50 Sand ‘ j : : 0°60 Vegetable fibre : ‘ j 0°58 Alcohol-extract j : ; 0°50 Water-extract : : ‘ 0°50 Water and loss : : 3 15°19 I have analysed some of the concretions in the museum of the Berlin Veterinary College. Some small, flat, reniform, grayish brown concretions from the colon of a horse con- sisted chiefly of pure ammoniaco-magnesian phosphate aggre- gated around very minute nuclei of metallic lead.._A flat, grayish brown concretion, of the size of a pigeon’s egg, taken from the colon of a horse, contained, in addition, some phos- phate of lime; the nucleus was a fragment of brick. The external layer of a gastric concretion from a horse, weighing 8 pounds, consisted principally of ammoniaco-magnesian phos- phate combined with some phosphate of lime, and the external - layer of a large calculus found in the intestines had a perfectly similar composition. Some small, triangular, smooth and white concretions fromthe stomach of a Dutch mastiff, when frac- tured, presented a beautiful, white, sparkling, crystalline cha- racter, and were composed of the same Constituents; the quantity of phosphate of lime was, however, very small. The external layer of an intestinal concretion from an ass exhibited white and chalky lamelle, with little firmness. It consisted of carbonate of lime, with a small admixture of phosphate of lime. | Carbonate of lime, such as I observed in the concretion 468 MORBID PRODUCTS. from the urethra of an ox, and in the above mentioned intes- tinal concretion from an ass, has been very rarely observed ; Pearson detected it in a gastric calculus from an ape; Kinast in a similar concretion from a cow; Pearson and John in the in- testinal concretion of a horse; and Vauquelin and Fourcroy in bezoars. Uric acid was observed by Fourcroy in the intestinal concretion of a horse. Concretions formed of agglomerated hairs are often observed especially in cows. They are usually brown and polished, but not hard. [Several analyses of intestinal concretions have been recently published by Von Bibra.’ We give the two following as illus- trations of their composition : Concretion from intestines of horse. Ammoniaco-magnesian phosphate yey ae Phosphate of lime . d : 1:18 Matters taken up by alcohol and ethier ‘ ; 0°43 mm potash : § ‘ 0°36 Chloride of sodium ‘ Sh ‘ 0°63 Phosphate of soda . ‘ i 0°31 Water, vegetable fibre, traces of iron, and eed ; 3°99 Concretion from stomach of a miller’s horse, Ammoniaco-magnesian phosphate - ‘ 93°02 Phosphate of lime ; a ‘ : 1-01 Matter taken up by alcohol . ; ‘ 0°41 by potash : : ; 0°33 Sand ; : : : . 0°40 Chloride of sodium and traces of phosphate of soda . 0°51 Water, traces of iron, vegetable fibre, and loss ; 4°32 The occurrence of phosphate of soda is remarkable, as that salt does not occur in the gastric juice. | Peculiar concretions are found in the intestinal canal of an herbivorous animal inhabiting Persia and Thibet. They are termed bezoar stones; they are round or oval; in colour they are dark green, brown, or black ; they are polished on the surface, — and consist internally of concentric lamine. Some are soluble, others insoluble in alcohol, but all dissolve in caustic potash. The researches hitherto made with these concretions throw very little light on their real composition. They are usually green ’ Simon’s Beitrage, pp. 404 12. GALL-STONES. 469 in the interior, do not fuse on being heated, and give off atiot disagreeable odour. Hot water extracts a yellow matter ; caustic potash dissolves them rapidly, forming a grayish brown solution, from which a dull green precipitate is thrown down on the addition of an acid. This precipitate dissolves in nitric acid, producing a red tint, which rapidly changes to a yellow. Berzelius is of opinion _ that the principal mass of bezoar consists of biliary fat and resin, mixed with other fatty matter, and held together by intestinal mucus.’ Gall-stones in Man. Biliary concretions are of very common occurrence in the human subject. They consist principally of cholesterin with a small amount of other fats, bilifellinic acid or biliary resin mixed with some bile-pigment, and mucus. In analysing a gall-stone, we first reduce it to a fine powder, which is a matter of no difficulty, and heat it on the water-bath in order to expel all moisture. The powder is then extracted with water, which takes up bilin with bilifellinic acid, and probably a little extractive matter ; these are obtained by evaporating the water. The portion not taken up by water must be again dried and treated with hot, pure ether, which extracts the fat. We eva- porate the ether, and dissolve the residue in hot alcohol, from which cholesterin crystallizes on cooling; after the removal of the cholesterin the evaporated alcohol yields the other fats as _ fatty acids. The residue insoluble in ether is now extracted with boiling anhydrous alcohol, which dissolves the biliary resin. On evaporating the alcoholic solution and treating the residue with cold alcohol, we obtain a solution of biliary resin (fellinic and cholinic acids, and dyslysin.) The portion unacted on by alcohol may still contain bili- phzein and biliary mucus ; the former is soluble in carbonate of ammonia, the latter in a solution of potash. Human gall-stones vary from the size of a hemp-seed to that of a pigeon’s egg; they are round, or, if several occur together, angular and flat-sided, each facette lying in close apposition with that of the adjacent calculus. Their surface is smooth, 1 [For further information on this subject the reader is referred to a paper by Guibourt, in vol. 16 of the ‘Comptes Rendus,’ and to observations ‘ on a new organic acid in benzoar stones,’ by Lipowitz, in Simon’s Beitrage, p. 462.1] 470 ~MORBID PRODUCTS. their colour brown or yellow. Internally they present a de- cidedly crystallme character, they are white or yellow, and often contain a minute cavity in the centre, of a darker colour than the rest of the concretion, and presenting an incrusted appearance. ee Witting! found in a human gall-stone cholesterin 50; resin and colouring matter msoluble in ether 35; carbonate of lime 8, water 5. The following analyses of human gall-stones were made by Glaube and Brande: Brande. Glaube. Chee 2. 3. Cholesterin : 56. . $125 6976 Sige Biliary resin. j , 8 3°12 5°66 3°83 Bile-pigment . ; 15 938 11°38 7°57 Albumen with mucus and sats extract- é oe able by water : : } Ba ae i ac. Coagulated albumen j 9 — — — Biliary mucus. ; 12 6°25 13°20 —_ In addition to the: ordinary constituents Von Bibra? found 1:52 of aluminawith iron, and 1°42 of carbonate of lime im a biliary Gillet ; and Witting, as I hive already observed, detected a considerable amount of the latter constituent in a concretion of — this nature. An extraordinary quantity of this earth was found — by Bally and Henry in a gall-stone; it consisted of carbonate — of lime with traces of carbonate of magnesia 72°70, phosphate — of lime 13°51, mucus, with a little peroxide of iron and bile- pigment, 10°81. [Schmidt and Wackenroder have recently published analyses — of human biliary calculi, consisting principally of colourmg — matter. Archiv der Pharmacie, vol. 41, p. 291.] Berzelius mentions another kind of gall-stone, consisting 2 principally of carbon ; at least it is insoluble in water, alcohol — and ether, acid and athe fluids ; when heated to redness in a retort, undergoes no alteration, but when burned in oxygen, — after giving off slight traces of smoke, takes fire, and burns — = Shy eats i Sy ah Be ‘ TOS alas TU a ais eta einer ae Sa area Sar as without flame or residue, with the formation of carbonic-acid gas. Ee I have recently examined a biliary calculus found in the ~ gall-bladder of an officer who died from cerebral and spinal — irritation, and incipient softening of the nervous tissue: mM 1 Archiv der Pharm. vol. 25, p. 292. ? Journ. fur prakt. Chemie, vol. 12, ps 3lies BILIARY CONCRETIONS. 471 contradistinction to the general rule, it contained mere traces of cholesterin, and was principally composed of biliary resin, and modified colouring matter. [ Bertazzi! has recently announced the discovery of copper as a constant ingredient of gall-stones. He analysed fourteen of these concretions sent to him by Polli, and found it in every instance. The amount of copper seemed to stand in a direct ratio to the amount of bile-pigment in the calculus. Thus, on incinerating an almost black spongy-looking concretion, so large a quantity of copper was present in the ash, that an iron eylinder, nearly a line in diameter and four inches long, after im- mersion for a few seconds in a dilute acid solution of the residue, was entirely coated. When, on the other hand, merely the nucleus or the external layer contained pigment, the indications of the presence of copper were comparatively slight, and he is of opinion that perfectly white concretions are entirely devoid of this constituent. With the view of ascertaining whether copper could be detected in the bile, Bertazzi analysed the fluid collected from the gall-bladders of ten persons. He could not, however, detect any indications of the metal. The above statement respecting the presence of copper in biliary calculi has been subsequently confirmed by Heller.?] Biliary Concretions in Animals. Biliary concretions are very common in cattle: Gurlt never observed them in horses, and only once detected a calculus of this nature in a dog. The biliary concretions of cattle differ considerably from those of man ; they consist for the most part of biliary pigment and resin, with a little cholesterin. In analysing the biliary concretions of oxen we must pursue the method already described, but at the same time we must not over- look the circumstance that an independent (lithofellinic) acid has been noticed by Gobel as occurring in them, which is not found - in human biliary calculi. It is soluble in boiling alcohol and crystallizes on cooling; on heating it fuses, becomes decom- posed and burns. It is insoluble in acetic and hydrochloric ' Polli’s Annali di Chimica. Milan. Juglio 1845, p. 32. * Archiv fiir physiolog. und patholog. Chemie, vol. 2, p. 228. 472 MORBID PRODUCTS. acids, but dissolves in caustic potash, with which it forms a soap that develops an odour resembling amber. It separates from this soap in a crystalline form on the addition of an acid, These crystals are of a rhombic-prism form, dissolve in alcohol and ether but not in water, fuse at a high temperature, and combine with alkalies to form soaps, which are slightly soluble in water, but dissolve readily in alcohol and ether. This acid has also been observed by Wohler, and I have lke- wise detected a substance in the biliary calculi of cattle, which, as far as I have yet been able to analyse it, seems to be identical with lithofellinic acid. It is probable that lithofellinic acid is of more frequent occurrence than has hitherto been supposed ; it ought, therefore, to be sought for in all biliary calculi, more especially in those of cattle. The biliary calculi of cattle vary from the size of a pea to that of a pigeon’ s egg; they may be easily pulverized, the powder varying in colour from a dull green to a clear brown, and possessing a decidedly bitter taste. On boiling the pul- verized calculus with alcohol, the alcohol becomes coloured yellow or green, and leaves on evaporation a small quantity of biliary resin and cholesterm. The powder, after extraction with alcohol, yields to caustic ammonia or to its carbonate, a certain amount of its colouring matter, but not so much as is taken up by an even very dilute solution of caustic potash. The alkaline solution is of a yellowish brown tint, but soon changes into a green. On the addition of hydrochloric acid to the alkaline solution the colouring matter is precipitated in the form of gray flocculi which dissolve readily in alcohol, leaving in an insoluble state the mucus that had been dissolved by the potash. Schiibler and Michel’ analysed a concretion found in a cystic tumour in the liver of 4 man. It was of a red colour, and was composed of 25 parts of yellow, slightly saponifiable fat soluble in ether, and of 75 parts of red colouring matter. This colourmg matter presented several remarkable characters, and Berzelius— regards it as a morbid form of the ordinary bile-pigment. ' Journal fir prakt. Chemie, vol. 8, p. 378. SALIVARY CALCULI. 473 Salivary Calculi, Tartar, &c. In man salivary calculi are of rare occurrence, but the forma- tion of tartar on the teeth is continually observed: it consists of earthy phosphates, epithelium-scales, a little ptyalin, and fat, and when examined under the microscope there are seen abundance of pavement epithelium and mucus-corpuscles with fat-vesicles, and, in addition to these, numerous long acicular bodies and infusoria of the genera Vibrio and Monas. According to Berzelius tartar is composed of earthy phos- phates 79-0, salivary mucus 12°5, ptyalin 1:0, animal matter soluble in hydrochloric acid 7:5. Vauquelin and Laugier obtained similar results, ae 66 parts of phosphate of lime with a little magnesia, 9 of car- bonate of lime, 13 of salivary mucus, and 5 of animal matter soluble in hydrochloric acid. Poggiale’ analysed a salivary calculus taken from a man; it was hard, round, tuberculated, of a yellow colour, and easily pulverized. It contained a large amount (94°¢) of phosphate of lime, with a little mucus and animal matter. Wurzer’ analysed a calculus from the maxillary gland of a man; it weighed three grains, was oval, of a grayish white colour, and consisted principally of carbonate of lime and earthy phosphates, with traces of iron and manganese. Salivary calculi are of frequent occurrence in the ass aud the horse, and are occasionally found in the dog. They consist for the most part of earthy carbonates mixed with a small amount of earthy phosphates and animal matters. The following analyses will give an idea of their composition : From an ass. Froma horse. From a horse. Caventon. Lassaigne. Henry. Carbonate of lime : : 91°6 84 85°52 Carbonate of magnesia . : — — 7°56 Phosphate of lime ‘ ° 4°8 3 4°40 Animal matter soluble in water. 3°6 9 2°42 Water ‘ é Fe — 3 —_ Similar concretions occur in many other parts of the organism. I shall notice a few instances. ' Journal de Pharmacie, 1839, p. 337. ? Archiv der Pharmacie, vol. 14, p. 254. 474 : MORBID PRODUCTS. Wurzer analysed a concretion formed in one of the tonsils: externally it was of a grayish white colour, marked with rose- red spots, and verrucose ; internally it presented no appearance of lamelle, although it contained an oval nucleus. It consisted of phosphate of lime 63°8, carbonate of lime 16°7, animal matter 13°3, ptyalin, with chlorides of sodium and potassium, 7-1, iron and traces of manganese, 0-1. Daniel has described a hard and dense tumour, containing, however, traces of fibrous tissue, that occurred in the anterior wall of the uterus of a single woman aged 72 years. It contained 35% of animal matter and water, 56° of phosphates of lime and magnesia, 5° of car- bonate of lime, and 4° of chloride of sodium and other salts. An earthy deposit in the uterus, analysed by Wiggers, contained 46°8° of earthy phosphates and carbonates, and 46°18 of fibrin, with a little fat. Poggiale has examined the muscular tissue of a man in whom ossification of the muscles had proceeded to such a length as almost entirely to prevent any voluntary motion. A portion of the ossified gastrocnemius contained 582 of organic matter, 32-099 of phosphate of lime, 1:25 of phosphate of mag- nesia, and 8°662 of carbonate of lime. Concretions in the brain are very rare. I obtained a con- cretion of this nature that had formed in the cerebellum; it was about the size of a nut, of an irregular angular form, very solid, and both internally and externally resembled a por- tion of bone. ‘The whole concretion was enveloped in a fine coriaceous capsule; it consisted principally of phosphate and carbonate of lime, with a little cholesterm. A similar con- cretion analysed by John consisted of 75 parts of the phos- phates of lime and magnesia, and 25 of animal matter; another, examined by Morin, was composed of cholesterin, coagulated albumen, and earthy phosphates. In a concretion taken from- the brain of a horse Lassaigne found 58 parts of cholesterin, 39°5 of coagulated albumen and cellular matter, and 2°5 of earthy phosphates. [Scherer found in the gritty matter contained in the pineal gland : , | : Organic matter x: : : 22°460 Phosphate of lime : ; P ; 60°321 Carbonate of lime ‘ , 17-219 | VARIOUS CONCRETIONS. 475 A concretion from the eye of a blind man contained, ac- cording to Wurzer, 47:9 parts of phosphate of lime, 9°5 of the carbonates of lime and magnesia, 20°3 of mucus, 0°9 of peroxide of iron, and 11°9 of clear fat resembling butter. A nasal concre- tion occurring in a woman aged 57 years was found by Brandes! to consist of 79°6 of phosphate of lime, 6°4 of carbonate of lime, and 14 of chloride of sodium, animal matter, and water. It consisted of five portions, weighing altogether 210 grains. It varied externally from a grayish white to a yellowish green colour, and its internal surface was gray and finely granular. A nasal concretion analysed by Regnard consisted princi- pally of carbonate of lime, with a little phosphate of lime and animal matter. A specimen analysed by Geiger consisted almost entirely of earthy phosphates and carbonates, while an- other examined by Herberger, yielded 46% of dried nasal mucus. A calculus of this nature weighing 81 grains, ana- lysed by Rémer, contained 90 parts of phosphate of lime, 5 of carbonate of lime, and 5 of animal matter with traces of car- bonate of soda.” Concretions formed in the lungs consist also principally of the earthy phosphates and carbonates. A pulmonary concre- tion analysed by Sgarzi, contained carbonate and phosphate of lime, carbonate of magnesia, cholesterin, fat, mucus, albumen, peroxide of iron, and silica. A concretion of this nature, that had been expectorated, was analysed by Brandes; it contained the above mentioned salts, cemented with mucus and albumen. On examining the lings of the boy with the osteoid tumour, noticed in p. 412, there was found in them an oval, solid en- cysted concretion, of the size of a hazel nut. Being anxious to ascertain whether it was allied to the osteoid tumour in its composition, I analysed it and found in 100 parts: : Anal, 165. Organic matter x s 38°89 In 100 parts of fixed salts. Fixed salts. ‘ ; 61°11 Earthy phosphates . : 53°33 87°20 Carbonate of lime. 3 7°04 11°50 Soluble salts ‘ ; 0°37 0°65 ! Archiv der Pharmacie, vol. ]1, p. 157. * [Much additional matter on the chemistry of nasal concretions may be found in a paper by Demarquay, in the ‘ Archives gén. de Médecine,’ Juin 1845,] 476 MORBID PRODUCTS. Hence this concretion, in relation to the proportions of its salts, differs only in this respect from the osteoid tumour—that it contains a larger amount of carbonate of lime and a smaller quantity of soluble salts. [A concretion found in one of the bronchi of a man who died from phthisis was analysed by Scherer. It had a knotty, white appearance, and was invested with a delicate membrane. It contained in 100 parts : Organic matter . ; : . 20°10 Phosphate of lime . ‘ a ; 69°92 Carbonate of lime . ‘ 9-09 Chloride of sodium, sulphate sail cbnieshaie of soda 0°89 A hard concretion of the size of a pea, attached to the pleura, was analysed by Schierenberg, and found to contain : Organic matter ; ; : 36°967 Phosphate of lime . : ‘ 55°924 Carbonate of lime . ; : 7°109 ] A concretion in the pericardium, analysed by Petroz and Robinet, consisted of 65°3 parts of basic phosphate of lime, 6°5 of carbonate of magnesia, 4°0 of sulphate of soda, with a little sul- phate of lime, and 24°3 of organic matter. Concretions in the mesenteric glands have been analysed by Wild: they contained 56-61 of phosphate of lime, 28 of carbonate of lime, and 26-28% of cellular membrane and fat. In a calcareous deposition on the peritoneum, Bley! found 34 parts of carbonate of lime, 27-66 of carbonate of magnesia, 10°32 of phosphate of lime, and 12-4 of albumen, mucus, and fat. A concretion from the prostate gland, examined by Lassaigne, contained 845° of phosphate of lime, with traces of carbonate of lime and animal matter. I examined an incrustation occurring in the aorta of an old man who died from phthisis pulmonalis; it consisted principally of carbonate of lime and earthy phosphates. [The ossified arterial membrane in the case of marasmus senilis, mentioned in p. 317 yielded, after careful preparation : 1 Archiv de Pharmacie, vol. 20, p. 212. GOUTY CONCRETIONS. 477 Organic matter ‘ . , 7°292 Phosphate of lime P ; 63°636 Phosphate of magnesia ‘ . 10-909 Carbonate of lime . ; - 18181 | Gouty concretions, which frequently form on the joints of the hands and feet, consist of urate of soda, with a little of the urates of potash and lime, chloride of sodium, and ordinary animal matter. Wollaston was the first to describe their com- position correctly. The two following analyses will illustrate their composition : Laugier." Wurzer. Uric acid ; é : 16°7 20:0 Soda . ‘ ‘ : 16°7 20:0 Lime . j ‘ : 8°3 10°0 Chloride of sodium ; F 16°7 18-0 Chloride of potassium - é _ 2:2 Animal matter. : ‘ 16°7 19°5 Water : ; : x ee 10°3 Some gouty concretions, about the size of a pea, were ana- lysed by Pauquy and Bor, and found to consist of urate of soda, urate of lime, and an albuminous substance, but no chlorides. | [In page 408 there is an analysis of bone in a case of arthritis, by Marchand. The same chemist analysed a gouty concretion on the lower articulation of the femur. It contained: Urate of soda ‘ F ‘ 34°20 Urate of lime : , ‘ 2°12 Carbonate of ammonia j ‘i 7°86 Chloride of sodium ‘ P 14:12 Water . : 3 ‘ 6°80 Animal matter . . ‘ 32°53 Lehmann analysed a tophaceous concretion that formed on the metacarpus of a man only 22 years old, but who had suf- fered from well-marked gout. It was, on its removal, soft and tough, white internally, and reddish-brown on its external surface. When dried, it formed a white chalky mass. Under the microscope there were seen innumerable foursided prisms 1 The loss in this analysis amounts to 16-6, t 478 MORBID PRODUCTS. arranged in stellar groups; these consisted of urate of soda. 4 The concretion, when dried, was found to contain : Urate of soda : i «$212 Urate of lime a a ; A 1:25 Chloride of sodium ; ’ : 9°84 Phosphate of lime d ‘ : 4°32 Cellular tissue ; 4 . 28°49 Water and loss 4 Ws Op ; 3°88 A concretion of this nature, analysed by L’Heretier, yielded : Urates of ammonia, soda, and lime . ; 49 Phosphate of lime ; ; ; 42 Organic matter and water , ; 9 Tubercle. Chemical analysis has hitherto thrown very little light on — the nature of tubercle, or on the mode of its formation. A tubercular mass, analysed by .Preus, contained 19°5 of solid constituents and 80°5 of water. The solid constituents were — composed of a substance resembling casein in its relations to- wards acetic acid and heat, a fat containing cholesterin, and a very small quantity of salts. In an analysis which I instituted of a mass of tubercle from a horse, I detected a little of the caseous matter noticed by Preus. The tubercular matter was deposited in masses from — the size of a nut to that of a pigeon’s egg; it varied from a — yellow to a flesh colour, and its consistence was such as to — admit of its ready division by the knife, Internally it was — green and resembled coagulated casein. , It was composed of: ‘ Analysis 166. Water 2 ; j 84°27 Fat containing chualdsterin ge 1-40 Spirit-extract with salts ; ; 1°52 Caseous matter with water-extract 4 1:14 Water-extract and salts p ? 3°80 Insoluble constituents . ; 5 4:44 [The following ultimate analyses of tubercle, by Scherer, — are highly important in tending to throw light on the che- — mistry of its formation. - Crude pulmonary tubercle yielded little fat or extractive matter, showing that the morbid process was not far advanced. TUBERCLE. 479 An ultimate analysis, after the most careful removal of foreign constituents gave : Carbon ; . 53°888 Hydrogen : : 7°112 | which corresponds with the Nitrogen . ~ 17°237 formula C,, H,, Ng 0,5 Oxygen. : ~ 2h°767 Hence tubercle may be regarded as protein’ (C,, H,, N, O,,), from which five atoms of carbon, one of hydrogen, and one of oxygen have been removed. A mass of tubercle deposited in the liver, when examined under the microscope, was found to contain round, irregular, nucleated cells larger than pus-corpuscles, and numerous in- terspersed granules. In 1000 parts there were contained : Water . ; : : : 826°04 Solid residue ; 173°96 Fat taken up by ether, consisting of olein ind margarin ; , 18°63 Alcohol-extract . i 21°75 Water-extract with very slight traces of pyin. 8°34 Insoluble organic residue . ; 120°34 Fixed salts : : . 4°90 This insoluble portion contained : Carbon ‘ . §4°554 a Hydrogen ; . 7°121 | which corresponds with the Nitrogen ‘ . 16928, formula C,, H,, Ng 0,, Oxygen : ~~» 21:397 Hence it may be supposed to be dunived from protein that has lost three atoms of carbon and one of oxygen. In tubercular masses found in the abdominal cavity, resem- Sang coagulated albumen, there were found : Water ; i s . 893°82 Solid residue : : . 106718 Fat a 25°40 Casein and ‘alcohol-extract j : 12°39 Pyin and water-extract ; . 6°19 Salts ‘. : ‘ 7°43 Crude tubercular matter : 54°55 which yielded in — inaiyoal: 2. 3. Carbon : : 55° 299 55°069 55°137 - Hydrogen . ‘ 7098 7°004 6°944 Nitrogen. : 16°698 16534 16-476 Oxygen ; : 20°905 21°393 21°443 | This is Liebig’s formula. 480 MORBID PRODUCTS. These analyses correspond with the formula C,, H,, N, O,,; hence tubercle in this case may be regarded as protein from which two atoms of carbon and one of oxygen have been re- moved. In this instance, the surface of the liver was coated with a layer of plastic exudation a line and a half thick. This was separated and analysed in the same manner as the tuber- cular matter. It contained : Water ; ; ; - 73162 Solid constituents , ° - 268°38 Fat ° ° , . 15:47 Water-extract with pyin and casein ‘ 4°32 Spirit-extract ° ‘ : 6°23 Salts ; ‘ ; " 5°40 Insoluble organic residue ; - 237°96 Containing—Carbon ‘ : 55°190 Hydrogen . . 7186 Nitrogen ; . 16-602 Oxygen ‘ ; 21-022 This substance is consequently identical in its ultimate com- position with the tubercular matter found in the abdomen. Tubercular matter from the brain yielded, after purification : Carbon ; . 54410 Hydrogen ‘ ; 7°147 | which corresponds with the Nitrogen ; . 16°366{ formula C,, H,, N, Oj, Oxygen ‘ - 22°077 That is to say, two atoms of carbon less, and one atom of hydrogen more than occurs in protein. If in this and the preceding analyses the formule for the morbid deposits are calculated in relation to C,,, their connexion with the formula for protein will be more obvious to the eye. ‘We shall have: © ; 2 At. of tubercular matter from the lungs = 2Pr+NH,+2HO+H 2 At. of tubercular matter from the liver = 2Pr+NH, +H 2 At. of tubercular matter from the abdomen == 2Pr + NH, . 4 At. of cerebral tubercle 4Pr+JNH, + 4HO+3H Scherer has adopted a similar course of research with other morbid products. A scrofulous mass found in the abdomen of a child who died from general scrofula, was, after extraction with water, alcohol, - -MORBID TISSUES. 481 and ether, submitted to — analysis. Independently of salts, it yielded : Carbon ; 54°125 Hydrogen ; : 7:281 | which corresponds with the Nitrogen sat . 15°892 ( formula C,, Hj, Ng 01. Oxygen : - + 22°702 Hence the scrofulous matter may be regarded as formed from protein by the removal of two atoms of carbon and oxygen, and the addition of two of hydrogen, or making the amount of carbon the same in the scrofulous mass and the protein, we have : _ 1 At. scrofulous matter . = Pr + HO + 2H. ‘. Carcinoma uteri and scirrhus testiculi were examined by Scherer in a similar manner. L’Heretier has made the three following proximate analyses of scirrhus : Of breast. Of uterus. Of dorsal region. Water — ‘ : ~ 5 29°75 21°15 24°80 Albumen : é s: 28:10 29°85 21:70 Fibrin. . ‘ . 18°80 15°20 27°15 Gelatin : eS — 817 Fat é : : : 2°00 oa 8°05 Phosphorized fat . ; : — 6°00 — Peroxide of iron . . i 115 1°25 traces Yellow pigment . ‘ 2 — 7°00 —_ Salts. " F . 12°60 9°55 10°13 ] A fatty tumour analysed by Nees von Esenbeck’ contained 23:0 of solid fat, 12°0 of extract of flesh, 11-0 of gum-like animal matter, 23-0 of albumen, 19-0 of phosphate of lime, 2-0 of car- bonate of lime, and 1:5 of carbonate of magnesia. It is not stated whether this solid fat contained cholesterin ; in all pro- bability it did, as this fat is of frequent occurrence in fatty tumours. In a fatty tumour examined by J. Miiller there were acicular crystals mixed with a gray substance which was deposited in vesicles and dissolved in boiling water, from which it was not precipitated by acids or the ordinary metallic salts. The crystals were insoluble in acids, water, or alcohol, but dis- solved in ether; hence they probably consisted of cholesterin. ’ Kastner’s Archiv, vol. 12, p. 460. il, 31 482 MORBID PRODUCTS. Another fatty tumour contained some casein precipitable from the aqueous solution by acetic acid. Incrustations on the surface of the body. Sore surfaces from which the epidermis has been removed are covered by a fluid which usually consists, according to Ber- zelius, of serum. This fluid dries up and protects the exposed surface from the atmospheric influence. My own investigations lead me to believe that this fluid differs materially from serum, that it contains a much larger quantity of albuminate of soda, and that its solid residue consists, for the most part, not of coagulated albumen, but of epithelium- and pus-cells.! Lassaigne has analysed the crusts of small-pox; they contained 63—70 — parts of coagulated, and 15—14 of uncoagulated albumen, 2—1 of fat, 18—11 of extract of flesh, and 2—2°5 of salts. Wackenroder found uncoagulated albumen in the crusts of tinea capitis. I have analysed the crusts which formed on sores on the body of a man with a severe attack of icterus. They appeared as yellow or whitish-yellow scales, or as large shreds of skin, and were very difficult to pulverize. When rubbed with water they swelled, and ultimately formed an emulsive sort of fluid, which did not clear on standing, and in which a very large number of epithelium-scales were suspended. The filtered fluid coagulated very slowly on the application of heat, but became covered with a film during evaporation. It had a faintly alka- line reaction, and was rendered slightly turbid by the addition of an acid, but again became clear on the addition of an excess of the test. It was strongly precipitated by ferrocyanide of potassium, infusion of galls, and bichloride of mercury. On heating the residue, after evaporation with water, it was found to be almost insoluble; alcohol took up some extractive matter with a very little chloride of sodium. The residue yielded an ash which slightly effervesced on the — addition of nitric acid, and contained mere traces of the earthy phosphates and chlorides, but a considerable amount of phos- 1 [In connexion with this subject a paper ‘ On Pyinn, and its importance in the — Human Organism,’ by Eichholtz, in Rust’s Mag. fiir die gesammte Heilkunde, vol. bes p- 140, may be consulted with advantage. } INCRUSTATIONS. 483 phate of soda. The portion insoluble in water appeared, when examined under the microscope, to consist of epithelium-cells, for the most part more or less injured. Alcohol took up from these scales a little yellow fat which partly separated on cooling : this portion consisted of margaric acid and margarin, while oleic acid remained in solution. The ash left by the direct in- cineration of the scales contained scarcely appreciable traces of sulphates or chlorides, a little carbonate and a large amount of phosphate of soda, earthy phosphates, and a trace of iron. Hence these scales contained the ordinary fats and fatty acids, a little uncoagulated albumen, a large quantity of albuminate of soda, some extract of flesh, and a considerable amount of salts, in which the phosphate of soda and earthy phosphates predo- minated. No bilin could be detected, and only a trace of bile- pigment. I have recently examined the scales of a person with ichthyosis. They were of a gray or black colour ; when placed in water they softened, and on then placing a section under the microscope I found that the abnormal structure was formed of compressed epithelium-scales. On incineration the scales left an ash containing carbonate and phosphate of lime, and peroxide of iron ; the latter was in such abundance as to communicate a yellow colour to the ash. The ash yielded by the incineration of the ordinary thickened skin on the hands and feet is perfectly white, and contains a mere trace of peroxide of iron. 484 CHAPTER XIII. FLUID PRODUCTS OF DISEASE. Hypatips are round vesicles filled with fluid, sometimes but not always containing a minute animal (echinococcus) ; these vesicles occur most commonly in the brain and liver. Gobel analysed hydatids from the liver of a goat; the echinococcus was present in large numbers; the fluid contaimed im the vesicles was clear, yellow, neutral, gave off an unpleasant odour during evaporation, and blackened a silver spatula with which it was stirred. It yielded 1:54 of solid residue consisting of ‘04 albumen, 0°24 mucus, and 1:26 salts, namely, carbonate of soda, chloride of sodium, sulphate of potash, and phosphate of lime. The vesiele itself was imsoluble in water and alcohol, yielded a little fat to ether, swelled in acetic acid without dis- solving, but dissolved in a solution of caustic potash, from which it could be precipitated by the addition of acetic acid. Collard de Martigny has likewise analysed hydatids. The fluid contained in them was faintly yellow, and somewhat turbid from the presence of flocculi of albumen, which soon settled to the bottom. Boiling produced a marked turbidity in conse- quence of the coagulation of albumen. It contained water 96°5, albumen 2-9, and salts, for the most part chloride of sodium, 0°6. The membrane enclosing the fluid was divisible into five laminz, was insoluble in ether, alcohol, and boiling water, but dissolved, even without the aid of heat, in sulphuric, hydro- chloric, and nitric acids, from which it was not precipitated on neutralization with a free alkali; it was not dissolved by acetic acid, and was rendered leathery by infusion of galls. [Scherer has analysed the fluid contained in hydatids of the kidney. It was of a brownish yellow colour, threw down a FLUID PRODUCTS OF DISEASE. 485 light, floceulent, brown deposit, and evolved an ammoniacal odour. | In 1000 parts there were contained : Water . ; : . 934°762 Solid constituents ‘ ij i 65-238 Albumen é ‘ 3 157960 | Protein-compounds Albuminate of soda . 5 : 10°044 26°006 Alcohol-extract with lactates & ammonia-salis 22°312 Water-extract - : ‘ 3°797 ber ern meers - Fat ; ; f : Es 2°042 Inorganic salts , : , 10°615 . Uric acid : . mar 0°413 Not a trace of urea could be found; it had probably been converted into carbonate of ammonia. | Cysts may either be filled with a solid matter, as for instance, fat (in which case they form the fatty tumours of which we have already spoken), or they may contain a fluid. Collard de Martigny analysed the fluid contents of a cystic : tumour situated between the rectum and the uterus. The fluid was of the consistence of a syrup, of a dirty yellow colour, viscid, and of a sickly odour. When evaporated at a tempera- ture of 104°, it left a brown residue amounting to 12°8°, which softened in water without dissolving, and on heating gave off an odour of burned horn. On the addition of alcohol to the fluid a thick, elastic, yellow mass was precipitated ; which dissolved in water and was again thrown down on adding a dilute acid, but was soluble in an excess of the reagent. The alkalies, sulphate of iron, and nitrate of silver, exerted no in- fluence on this solution, but a yellow precipitate was thrown down by nitrate of the protoxide of mercury, tincture of iodine, tannin, and bichloride of platinum. From these imperfect data it is impossible to form any conclusion regarding the true nature of the fluid. I made an analysis of a thick chocolate-coloured, alkaline fiuid, obtained by puncture in a case of ovarian dropsy. Under the microscope there were a considerable number of pus-cor- puscles, and a few coloured blood-corpuscles visible. It con- 486 FLUID PRODUCTS tained so much albumen that on heating it coagulated, forming thick brown flocculi. The colouring matter is doubtless to be attributed to the presence of hematoglobulin : the fat abounded in cholesterin, It contained : Analysis 167. Specific gravity. : . 1030 Water . i ‘ ‘ : 925°00 Solid constituents : : i Bas 75°00 Fat containing cholesterin : : 1710 Albumen . : ‘ : 56°77 Alcohol-extract Spirit-extract 4°50 Water-extract Z Carbonate of soda, phosphate of lime, 8:89 ‘ chloride of sodium and lactate of soda ™ Albuminate of soda ‘ a : 7°50 [Scherer has made several analyses of the contents of ovarian cysts. . 1. A thick, viscid fluid of this nature, obtained from a woman aged 40 years, had an alkaline reaction, a specific gravity of 1022, and when allowed to stand, deposited a sediment com- posed of granules, inflammatory globules, and minute nucleated cells. In 1000 parts there were Water a « 952°2 Solid constituents i ie Protein-compounas thrown down Ae 33°6 alcohol . Extractive matters. 9-1 .q f consisting chiefly (nearly ree! ° ; es { 4: sie of chloride of sodium. On a subsequent occasion (about. two months afterwards) the fluid contained : Water z ra Sg - 940°90 Solid constituents . ‘ 59-10 Albumen precipitable by boing, after the addition ; of acetic acid 42°62 Extractive matters 5 ; z 12°03 Inorganic constituents 3 . ; 5°58 OF DISEASE. 2. In another instance a fluid was obtained containing : Water vs Solid constituents . Mucin with exudation-cells Albumen coagulated by ere Albuminate of soda Fat é Alcohol-extract Water-extract Fixed salts 867-57 132°43 27°65 55°70 30°26 4:70 3°52 2°35 7°81 487 The mucin and exudation-cells were precipitated from the fluid by acetic acid; they were then boiled with alcohol in order to remove any adherent fat, and submitted to ultimate analysis They yielded : Carbon 55°443 Hydrogen 7114 Nitrogen 18°305 | Oxygen 19°138 A little more nitrogen and hydrogen, and rather less oxygen than protein. In the following analyses, 1 and 2 represent the composition of the contents of two other cysts in the same ovary, 3 repre- sents the fluid in another case: : Water 903°11 Solid constituents 96°89 Albumen 40°38 Albuminate of soda 36°50 Fat < a 3°40 Extractive matters 6°07 Salts 8°54 2. 3. 839:904 799-85 160-096 200-15 150534 75.95, — 3°13 1-456 14:50 8-006 10°43 | _ Valentin has analysed a tumour (meliceris) containing a fluid of the consistence of honey, of a dirty yellow colour, devoid of odour, and leaving on evaporation, 11:3° of solid residue, which consisted of, in 100 parts : Coagulated albumen Olein and oleate of soda Cholesterin Stearin Uncoagulated albumen with a, little potash : Lime / ; : Magnesia 52°49 28°50 312 1-96 9°17 1-88 0-92 488 FLUID PRODUCTS [The contents of a strumous cyst analysed by Scherer contained : Water mn ‘ F 920°54 Solid constituents si 79°46 Albumen with a little blood f 61°23 Extractive matters : F 8°71 ) Transformed matters Fat (chiefly ry : 1-80 10°51 Salts 3 7°72 ] Fluid of pemphigus. I have examined the faintly yellow fluid occurring in the bulle of pemphigus. It had an acid reaction, and deposited a sediment of corpuscles resembling mucus- or pus-corpuscles in form, and in which a nucleus was very apparent, Its specific gravity was 1018. On evaporation it developed an acid odour similar to that which is observed on evaporating the saliva in cases of ptyalism and due to the presence of a little acetic acid. When submitted to a high temperature it deposited a quantity of very white albumen ; the acid reaction was then more powerful than before, but after evaporation to dryness it disappeared, for the alcohol with which the residue was extracted had scarcely a perceptibly acid reaction. It was composed of : Analysis 168. — Water $ ; ‘ é 940°0 Solid constituents ; , bts 60:0 Fat containing cholesterin ? : 2°6 Albumen with earthy phosphates : 48-0 Extractive matter soluble in alcohol, with lactate of soda and ehlorides of sodium 6°5 and potassium é A substance resembling ptyalin, soluble in 19 water . Free acetic acid and mucus-corpuscles . imponderable Five years afterwards I examined the fluid from the same patient during a fresh attack. In its physical characters it was much as before. ee. It contained in 1000 parts : Analysis 169. : Water : : : . 9598 Solid constituents ; 4 ‘ 40°2 Albumen with en ee ; 28°1 * Fat = ‘ 3°0 Alcohol-extract ee ; : 3°0 Fixed salts : : ; " 4°5 The fluid was strongly acid from the presence of acetic acid ; no indications of urea were detected. OF DISEASE. — 489 [Girardin has recently made an analysis of the fluid in cer- tain vesicles on the abdomen. In 1000 parts there were contained : Water A é ; . 939°500 Solid constituents : F i 60°500 Albumen ‘ - 3 49-200 Cholesterin i P a 6°475 Alcohol-extract : 1-075 Phosphates of soda and lime, and dae 3-750 ] of sodium Fluid of hygroma. I have examined the fluid of an hygroma situated on the lower jaw of a horse. The fluid was almost clear and transparent, but so extremely viscid that it could be drawn out into long threads. Its reaction was alkaline. Under the microscope a few very large mucus-corpuscles, three or four times the ordinary size, could be observed, occurring as round granular vesicles, in which, in consequence of the opacity of the investing membrane, the nucleus could not ‘be detected. } The fluid did not mix with water, but a separation of white flocculi took place ; white gelatinous flocculi were likewise pre- cipitated by alcohol. Ebullition rendered the fluid opaque, but did not altogether coagulate it. The gelatinous mass precipitated by alcohol was boiled in spirit of 848 and then warmed with water, in which it swelled and became viscid without dissolving. On the addition of acetic or hydrochloric acid to the swollen mass it coagulated immediately into opaque fibrils. It was perfectly soluble in a dilute solution of caustic potash with the aid of heat, and again precipitable by acetic acid, without being soluble in an excess of the reagent. Hydrochloric acid threw down a substance which was immediately redissolved, and a peculiar odour of sulphuretted hydrogen was evolved, just as when we add. hydro- chloric acid to an alkaline solution in which horn-shavings have been digested. The hydrochloric-acid solution was scarcely rendered at all turbid by ferrocyanide of potassium, but was strongly precipi- tated by tannin. From these experiments it appeared that the substance under examination was mucin. Alcohol took up a very small quantity of chloride of sodium and lactate of soda 490 FLUID PRODUCTS from this fluid. The mucin left, on incineration, an ash of phosphate of lime. Dropsical fluids. The fluids that collect in different parts of the body, especially im the cavities of the abdomen and thorax, and in the subcutaneous cellular tissue, in a certain class of disorders (dropsies), have been frequently submitted to chemical analysis. Fluids of this nature are usually of a faint yellow colour, and more or less turbid; flocculi of coagulated fibrin are some- times present, and occasionally, after acute inflammatory attacks, they contain so large an amount of that constituent as to assume a gelatinous consistence.. Their specific gravity varies from 1010 to 1020 or higher; their reaction is alkaline, and they some- times contain so small a quantity of albumen as only to be rendered slightly turbid by heating, while in other cases the amount is so large that the whole fluid becomes coagulated ; the quantity of salts, especially of chloride of sodium, is fre- quently also considerable. If the kidneys are affected, urea is generally present. ‘The fat usually contains cholesterin. The following analyses of the fluid found in the brain in cases of hydrocephalus approximate closely in their results : Marchand. ‘ eee molinge 3+ Berzelius. Mulder. ls z ; Water é : - 988°30 989°997 986°54 989°93 — Solid constituents , é 11°70 10:003 ~~ «=«+13'46 ©1007 © Albumen . ; : 1°66 0°549 163 sbOeae Fat ? ‘ ; — 0°070 0°05 0°33! Alcohol-extract with lactate of soda © 2°32 2°538° 2°10 4 Water-extract % : 0°26 — oils — 3 Chlorides of sodium and potassium 7°09 6°553 7°87 528 | Earthy phosphates. A 0°09 0°090 0°10 Sulphate of soda : : —- 07146). > 0-11 0°23 _ Carbonate of soda gee ae — 0°057 : Soda : ‘ : 0°28 tis. aa edie Marcet obtained similar results in his analyses of dropsical fluids. 3 : _ Marchand found an extraordinarily large amount of urea in the fluid, removed by tapping, from a woman with ascites. > Eee ! Of this, 0°21 was cholesterin. | OF DISEASE. 491 There were contained in 1000 parts : Water : ; : - 952:2 Solid constituents. : ; : 47°8 Albumen ; ; 23°8 Urea at - - : 4°2 Chloride of sodium | 81 Carbonate of soda 4 21 Phosphate and traces of sulphate of soda ‘ 0°6 A viscid substance } 8°9 [Several analyses of the fluid of ascites have been recently made, some of which we shall insert in a condensed form. The two following were made by Scherer : 1. A whitish turbid fluid removed from the abdomen by paracentesis, in a case of dropsy dependent on abscesses pro- ceeding to chronic suppuration, yielded in 1000 parts : Water . ; ° é - 986°71 Solid residue : : ; 13°29 Minute granules and soluble ‘albanien . Sot 3°61 Extractive matters “ 2 . 1:80 Salts | ; F ee ‘ 7°90 . The fluid evolved no odour, and was neutral. 2. The fluid obtained by tapping a patient with dropsy from ‘steatoma hepatis, carcinoma ventriculi, et perienteritis chronica,’ was examined on two occasions : 1. 2. Water . . : y= $B2-99 960°49° Solid constituents . é $ 47°01 39°51 Fibrin . : ; 0°32 — Albumen ; ‘ 11°88 — Albuminate of soda Z j 22-70 29°73 Extractive matters : P ‘ La02 zis ree: : : ‘ 1°26 1°63 Salts ; ; 7°22 5°94 Urea was sought for in analysis 1, but without success. Heller analysed the dropsical effusion in the case of ascites noticed in p. 311. The fluid hada milky appearance, was neutral, devoid of odour, and its specific gravity was 1007. Nitric acid and heat scarcely affected it, but an enormous precipitate was thrown down by nitrate of silver. 492 FLUID PRODUCTS . In 1000 parts there were contained : Water : : . . sf 950-00 Solid constituents . = 50°00 Extractive matters and sees of sibisain 2 5°97 Fat - : 0°84 Fixed salts ( almost exclusively chloride of sodium\ 44-00 Not a trace of urea or of bilespiemneat could be detected. The fat was perfectly saponifiable and contained no cholesterin. In addition to the enormous amount of chloride of sodium in the effusion, it was abundant in the urine (see page 312), and the sweat was so saturated with it that it crystallized in minute glittering particles on the skin. In a case of Bright’s disease, in which the walls of the abdomen were punctured, a fluid with an alkaline reaction and specific gravity 1007°5 was obtained. It was analysed by Heller, and found to contain : Water ; 7 ; . 980°640 Solid constituents ‘5 A é 19-360 Albumen : 8 3 8-121 Free fat ; § 3 ‘ 0:220 A soda-soap : ‘ ans 0°392 Extractive matters . j ‘ 2-546 Fixed salts z = ; 8-080 It yielded no indications of urea, bile-pigment, or cho- lesterin. Percy found in a fluid of this nature : Water ; : qe ; 952-0 Solid constituents ; € é 48°0 Albumen . , gates 38°0 Indeterminate organic matter . ; 3°2 Salts 76 | I made an analysis of the dropsical fluid obtained by puncturing the abdomen of a young man in whom the sub- sequent autopsy revealed suppuration of both kidneys. Urea — was present in this fluid, which was of a faintly yellow — colour, strongly alkaline, and threw down flocculi of albnaey on boiling. OF DISEASE. 493 It contained : Analysis 170. Specific gravity ; P et See Water : : j je 978°0 Solid constituents ; : . 12-0 Fat containing cholesterin ‘ ; 1:0 Albumen . ; ‘ E $ 8-4 Alcohol-extract ‘ ‘ ‘ 0°3 Spirit-extract s ‘ een: 17 Carbonate of soda and phosphate of lime 1:2 Chloride of sodium and lactate of soda. 6°8 Urea ; 3 4 I*2 Thoracic effusions. I have analysed the fluid obtained from the cavity of the pleura by paracentesis thoracis. It was of a yellow colour, devoid of odour, and consisted of two portions, viz., a thin liquid portion and a gelatinous clot floating on it. The fluid had a strongly alkaline reaction, a specific gravity of 1022-4, and showed, under the microscope, a few primary cells of the size of pus- or mucus-corpuscles. The coagulum™ was slight in its consistence, and when examined microscopi- cally was found to exhibit the structure of coagulated fibrin, with a few enclosed primary cells; when washed with water the fibrin was left perfectly white. In 1000 parts there were contained : Anal, 171. Water ; ; ; - 934°72 Solid constituents . * 63°28 Fibrin . 3 x : 1°02 Fat F : : = 1°05 Alcohol-extract with salts SR . 1:35 Spirit-extract with salts ; : 10°64 Albuminate of soda . ; 17°86 Albumen é 3 : 31-00 Fixed salts ; ; ; 9°50 The fluid, both in its physical and chemical characters, closely resembled lymph. [The following analyses of similar fluids have been made by Scherer. In 1 and 2 the fluid was taken at an interval of eight days from the same person. In 3, it should be observed, that the fluid was not analysed till a fortnight after the operation. 494 FLUID PRODUCTS 25 -# 3. Water. . : = ae 936°06 928-0 Solid constituents . . 64°48 63°94 72:0 Fibrin. ‘ 0°62 0°60 —_— Albuminate of coda ; 49°77 52°78 — Albumen ; — — 52°0 Fat’ * .. , 2°14 1°35 2°4 Alcohol-extract . ‘ 1°84 161 5'2 Water-extract . i 1°62 23 Salts - ° 7°93 7°40 10°2 ] I once analysed the fluid obtained from incisions in the lower extremities of a man with Bright’s disease. It contained a very appreciable amount of urea, and a considerable quantity of albumen, with much chloride of sodium. I give the results of this analysis : Analysis 172. ste Specific gravity . es aie’ : ~ 1012 Water ; ; é . 5) 976°0 Solid constituents é ; - 24:0 Fat containing cholesterin : ; 0°5 Albumen 7 Alcohol-extract with urea 2 Spirit-extract : ; : 1 Water-extract ; | Carbonate of soda and phosphate of lime 1 Chloride of sodium and lactate of soda 8 {Heller has recently published an elaborate essay on the chemistry of the fluids in Bright’s disease, including several analyses of the subcutaneous serum. His analyses of the blood — and urine will be found in Appendix IT. a, The subcutaneous serum from the body of a man who — died from Bright’s disease was of a pale yellow colour, alka- line, and had a specific gravity of 1011. It contained only a very small quantity of albumen, but a large amount of fixed a salts, viz. 10-1 in 1000 parts of the fluid. 6. Several ounces of fiuid were obtained by incisions in the leg of a man aged 40 years, with general edema. The liquid — was clear and almost as colourless as water, there being merely a very faint tint of yellow. On cooling there was formed at~ a tai ie ak eee ee i alle Py the bottom of the vessel a very light and delicate clot, which — was slightly pink from the presence of a few blood-corpuscles; OF DISEASE. — 495 the serum was then entirely colourless, had an alkaline reaction and a specific gravity of 1010. In 1000 parts there were ; Clot p . ; : 18°78 Serum a ‘ ij «(2 9@P23 And there were contained in the fluid : Water ; F : s 986-800 Solid constituents ; ‘ : 13°200 Fibrin. 0°134 Extractive matter, an imponderable quan 4-226 tity of albumen, and urea Fixed salts : ‘ > 8°840 c. The serous fluid obtained in another case, by incisions in the leg, was turbid, of a dirty yellow colour, and deposited a flocculent sediment, consisting for the most part of epithelium- scales, with a little pus and a few crystals of ammoniaco-mag- nesian phosphate. ‘The reaction was strongly alkaline, and the specific gravity 1010. There were contained in 1000 parts : Water j ‘ : . “97520 Solid constituents : S j 24°80 Albumen . 5:42 _ Extractive matters, salts, free and saponified : 3°76 fat, and urea : S Fixed salts ‘ ‘ P 15°62 We shall revert to this subject, in relation to the composition of the blood and urine, in the Appendix. | _I have analysed the fluid obtained from a hydrocele ; it was remarkable for the large amount of cholesterin contained in it; it was of a yellow colour, devoid of odour, alkaline, and sparkled when shaken, in consequence of the numberless crystals of cholesterin suspended in it. The amount of solid constituents was larger than I have ever observed in any other serous fluid of a similar nature. The amount of salts, composed principally of chloride of sodium, is also very remarkable. This fluid contained : 496 FLUID PRODUCTS Analysis 173. Water : ‘ ; . 860-00 Solid coosithnnate tat . 140°00 Cholesterin with a little margarin ‘ad oleic adi : 8°40 Albumen ; 5 48°30 Albuminate of soda with extractive matter : : 6°88 Extractive matter soluble in alcohol i 2°30 Chlorides of sodium and calcium, a little sulphate and 79:52 traces of phosphate of lime Phosphate of lime with traces of peroxide of i iron : 0:70 [Heller has recently published an essay on the fluid of hydrocele, founded on three analyses : 1. Nearly ten ounces of fluid were removed from a man aged 65 years, who had laboured under hydrocele for seven years. The fluid was of a dark-brown colour, alkaline, and of | specific gravity 1021. It contained a large amount of bile-pigment but no chole- sterin, and after standing deposited a sediment. In 1000 parts there were contained : | Water ; : : . wae Solid constituents * ; ; 80°8 Albumen. , ; ‘. 58°0 Free fat * ig 1°6 A soda-soap, bilipheein, heematoglobulin, 13-9 dissolved hematin, and extractive matters Fixed salts : ; 73 2. About three ounces were obtained from a man aged 30 years. The fluid was of a clear yellow colour, strongly alkaline, — and had a specific gravity of 1020. 3 It contained in 1000 parts: Water j ; ‘ ; _ « 934°00 Solid constituents . : Ki ; 66°00 Albumen ‘ 52°81 Fixed salts, chiefly chloride of sodium ‘ 7°68 Fat, but no cholesterin ‘é g 0°14 Water-exttatt j j 117 A soda-soap, biliary resin and pigment, urea, uric 4°20 acid, and alcohol-extract . 3. One ounce was taken from a man aged 50 years. It OF DISEASE. 497 was clear, of a dark yellow colour, alkaline, and had a specific gravity of 1020. It contained in 1000 parts : Water. ; ; 906°36 Solid constituents . ‘ , P 93°64 Albumen ; : ; 60-00 Fat containing cholesterin . : 0°23 Extractive matters, biliphein, and a soda-soap : 24°04 Fixed salts, chiefly chloride of sodium ’ 9°37 A specimen examined by Percy contained in 1000 parts : Water F be é : . -y 9294 Solid constituents ‘ d : Z 72°6 Albumen ‘ ; ; 59°2 Fat taken up by ether ; : . a trace Alcohol-extract ; . 3 ; 1:2 Water-extract " : Te Chloride of sodium with traces of chloride of potassium 6°0 Soda and lime, with eS can a and carbonic acids : @ 4:0 | A matter obtained from the scrotum in another case of hydrocele was of a brown colour, hardly fluid, but rather of a pulpy consistence. Under the microscope! it was found to con- tain an immense number of crystals of cholesterin, numerous blood- and pus-corpuscles, and a yellow substance resembling coagulated albumen. On heating, it coagulated like blood ; it yielded a large amount of cholesterin to ether, and of hemato- globulin to hot spirit. [The following analyses by Scherer, of fluid effusions found in the body after death, are worthy of notice. 1. The fluid found in the abdominal cavity after death from scirrhous degeneration of the chylopoietic viscera, con- tained :— 1 [According to Heller, on making a microscopic examination of the fluid of hydrocele, we may expect to find: 1, blood-corpuscles ; 2, fragments of epithelium ; 3, coagula of albumen or fibrin; 4, fat; 5, cholesterin; 6, globules of inflammation ; 7, pus; and 8, occasionally spermatozoa. ] II, S2 498 FLUID PRODUCTS Water ; j : j . 963-39 Solid constituents . : : : 36°61 Albumen ; 12°82 Albuminate of soda and heematiti ; d 7°13 Alcohol-extract . ; : ; 3°98 Water-extract : 2 3°72 Fat ‘ § y : ‘ 0°34 Salts. 8°58 The fluid was slightly bloody, and on sana deposited a yellow sediment. 2. Ina case of metroperitonitis and bronchopneumonia there was found in the abdomen a reddish-yellow fluid which de- veloped a little sulphuretted hydrogen, had a well-marked acid reaction from the presence of free lactic acid, and coagulated perfectly on heating. The fluid separated from the coagulum by filtration had an acid reaction, was of a yellow colour, and contained much extractive matter in solution. On warming it with carbonate of zinc, filtermg, and evaporating, crystals of lactate of zinc were readily obtained. In 1000 parts there were contained : Water ; ; . 909°83 Solid residue . ; . 90°17 Cells : ; - ~12°95 ; ; Albumen. 86°00 } Protein wale A substance resembling pyin ; 8°96 Fat and alcohol-extract . 14°105 | Transformed tissues Free lactic acid ‘ 1°05 33°41 Ammonia salts and water-exttact : 9°30 Fixed salts. ‘ : 8°88 The exudation in the pleural sac was of a blood-red colour, although no blood-corpuscles could be detected by the micro- scope. It was strongly acid. In 1000 parts there were contained : Water . ‘ . 936°718 Solid residue .~ ; . 63°282 Albumen ‘ . 81°746 Fat and extractive matter . 25°503)] Transformed tissues Free lactic acid ; ‘ 1°610 27°113 Fixed salts . s “ 7110 3. In another case of metroperitonitis the fluid in the abdo- minal cavity was of a yellowish-gray colour, neutral, and coagulated freely on heating. OF DISEASE. In 1000 parts there were contained : 499 Water ; : . 909°79 Solid constituents ; 3 St Albumen 2 é . 48°17 Alcohol-extract é 14°16 Fat . j E 1:97 | Transformed tissues Water-extract i 6°80 32°83 A substance thrown down by acetic acid 9-90 Fixed salts 5 . ij 9:00 4. In a similar case, the abdominal exudation separated ina short time into a purulent deposit, and a reddish-yellow super- natant fluid. The microscope revealed the presence of cells, organisms resembling minute algze, granules, and nuclei. The exudation had a faintly acid reaction and developed a consider- able quantity of sulphuretted hydrogen, In 1000 parts there were contained : Water ; ; - 902°70 Solid constituents . é s $9730 Pus- and exudation- corpuscles ‘ 13°81 : Albumen precipitable by water F 1298 Scat Sema ag Albumen coagulated by boiling = - 23°84 A substance thrown down by acetic : s . 12°41 acid and not soluble in an excess . Alcohol-extract 3 ° 14°96 cree nae tigsue Water-extract 2 ‘ 5°36 Fat ; : 6°20 Fixed salts ; 5 3 8°83 5. A similar fluid in a case of ‘ metritis septica’ was strongly acid, and contained in 1000 parts : Water j ; . 90574 Solid constituents . «, 94°26 Pus- and exudation-cells . 14°67] Protein-compounds Coagulable albumen. . 32°46 47°14 Fat ; ; “4 2] Lactic acid. 0 | A substance precipitable by acetic acid 10. Ps > Alcohol-extract oo BZOO I Water-extract : ; 7°45 J Fixed salts . : F 9°38 Metamorphosed tissue 6. The abdominal exudation in a case of metroperitonitis and endometritis differed from the preceding fluids in not depo- siting a purulent sediment, but after standing for a considerable time remained turbid and of a yellowish-red colour. Under 500 FLUID PRODUCTS OF DISEASE. the microscope there were seen free granules and nuclei, to- gether with exudation globules filled with granular contents. It was strongly alkaline. In 1000 parts there were contained : Water ‘ 5 ; | 966°10- Solid constituents : ; ‘ 33°90 Albuminate of soda ; § ¢ 18°72 Fat ; 5 5 J 1°35 Extractive matters ; : 6°12 ea : ’ ; 8°73 7. In a case of ‘ perimetritis, metritis, and endometritis,’ the microscopic characters of the fluid were similar to those in the preceding case. The exudation was neutral. When boiled it coagulated and deposited flocculi; the filtered liquid was rendered turbid by acetic acid, and the turbidity did not dis- appear on the addition of an excess of the test. The fluid was, however, rendered clear by the addition of hydrochloric — acid. These reactions show that the precipitated substance was not casein, but pyin. In 1000 parts there were contained” Water : . 941°27 Solid Staats ‘ . - SBF3 Albumen : . - 25°21 Unchanged protein Pyin ; ‘ , 4°37 Fat ; : 2°32 Metamorphosed tissue Alcohol- extract ; ; =F 27°17 Water-extract ‘ ; 8°11 Fixed salts~ . : : 7°93 8. We shall conclude this series of cases with a notice of the | analysis of the fluid found in the peritoneum of a boy aged 8 years, who died from perienteritis. The exudation deposited a sediment similar to those described as forming in the pre- — ceding cases of puerperal fever; it was neutral and coagulated on boiling. | It contained in 1000 parts : Water 2 : ee - . 980-00 Solid constituents : = z 20°00 Albumen . é f ; 6°49 Pyin : 3 , : 2°45 Extractive matters . ; x 4°74 Salts ; - ; 4 6°32 ] VAY Sse Be Fh ee Oy ee VOOS9 1 ee oe Note l. Carbon Hydrogen Nitrogen Oxygen APPENDIX I. 54°99 55°44 6°87 6°95 15°66 - 16°05 22°48 21°56 Ultimate composition of protein. (Mulder.) Vegetable albumen. Fibrin. Albumen. Atoms. Calculated. 55°30 40 55°29 6°94 31 7°00 16°02 5 16°01 21°74 12 21°70 Liebig’s formula C,, Hz, Ng O,, is founded on a series of analyses by Scherer, and gives C 55°742, H 6°827, N 16°143, O 21-228. Nore2. Ultimate composition of tritoxide of protein. (Mulder.) Carbon Hydrogen Nitrogen _ Oxygen 1. 9, 3. 5147 51°69 51°38 660 664 6:78 15°37. 15°09 15-01 26°56 26°58 26°82 4. Atoms. Calculated, 51°48 40 81°45 6°56 32 6°72 — 5 14:90 oer 16 26°93 1 was prepared from chlorite of protein, of which the chlorine had been removed by ammonia; 2, by boiling fibrin in water; 3, by boiling albumen in water; and 4, from an inflammatory crust. Nore 3. Ultimate composition of binoxide of protein. Carbon Hydrogen Nitrogen Oxygen 1. 2. 3. Atoms. Calculated. 53°69 »=53°64 53°44 40 53°36 6°90 6°88 -° 15°63 = 15°85 7°04 ol 6°75 14°51] 5 15°45 23°71 23°64 25°01 14 24°44 1 was obtained by boiling fibrin in water; it then remains behind insoluble; 2, is the albuminose of Bouchardat (Comptes Rendus, 20 Juin 1842). Von Baumhauer, in Scheikund. Onderzoek. Deel 1, p. 568; 3 was obtained from hair (see Vol. I, p. 11.) These analyses were made in Mulder’s laboratory. — 504 Note 4. Carbon Hydrogen Nitrogen Oxygen Norte 5. Carbon Hydrogen Nitrogen Oxygen Nore 6. Carbon Hydrogen Nitrogen Oxygen APPENDIX. 56°63 5°93 10°23 27°21 Atoms. 13 8 1 5 Calculated. 56°12 5°64 10-00 28°24 Ultimate composition of leucin. (Mulder.) I. os = 55°64 55°53 ’ 9°30 9°32 10°51 10°51 ' 24°55 24°74 Atoms. 12 12 zag | 4 Calculated. 55°79 9°11 10°77 24°33 Ultimate composition of protid. (Mulder.) fe 59°20 6°62 10°56 23°62 Atoms. 13 Calculated. 59°04 Ultimate composition of erythroprotid. (Mulder.) / OE Spee ee a ae oe ee ae aie ae Sai then Be Nore 7. Ultimate composition of albumen of the blood. (Mulder.) E: In a few instances (see Vol. I, pp. 1—3, 181, and Vol. II, pp. 8, 424, &c.) I find - that I have doubled the equivalent of phosphorus. Carbon Hydrogen Nitrogen Oxygen Phosphorus ° Sulphur Calculated. — ” Atoms. 54°84 400 54°70 ; : 7°09 310 6°92 3 3 15°83 50 15°84 ; E 21°23 120 21°47 0°33 1 0°35 0°68 2 0°72 the formula, instead of being 10 Pr + S,P, would become 10 Pr + S.P,. Albumen of eggs differs from the above in containing only half the amount of 3 sulphur, Mulder’s analysis gave: Carbon Hydrogen Nitrogen Oxygen Phosphorus Sulphur : ; , 54°48 cae ge 15°70 22-00 0°43 0°38 Atoms, 400 310 50 120 I 1 Calculated, — 54°90 6°95 15°89 21°55 0°35 0°36 Adopting this notation in p. 16, 5 ‘ Wee ‘ ‘ . CO, Re RE Sod EPR ey et APPENDIX. 505 Nore 8. Ultimate composition of fibrin from ox-blood. (Mulder.) Atoms, Calculated. Carbon 54°56 400 54°90 Hydrogen 6:90 310 6°95 Nitrogen 15°72 50 15°89 Oxygen 22°13 120 21°55 Phosphorus 0°33 1 0°35 Sulphur 0°36 1 0°36 Hence, in its composition, it is identical with the albumen of eggs. Nore 9, Ultimate composition of casein from cows’ mitk. (Mulder.) Atoms. Calculated. Carbon 54°96 400 55°10 Hydrogen 715 310 6°97 Nitrogen 15°80 50 15°95 Oxygen 21°73 120 21°62 Sulphur 0°36 1 0°36 Nore 10. Ultimate composition of crystallin from the eye. (Mulder.) Carbon 55°39 Hydrogen 6°94 Nitrogen 16°51 hence it closely resembles casein. Oxygen 20°91 Sulphur 0°25 Note 11. Ultimate composition of globulin, The analysis referred to in the text was published by Mulder in the ‘ Bulletin’ for 1839. In his recent work on the ‘Chemistry of Animal and Vegetable Physiology,’ he states that, although a protein-compound, its real composition is not yet known. Nore 12. Ultimate composition of pepsin. (Vogel.) Carbon : ; ; 57°718 Hydrogen : : ‘ 5°666 Nitrogen : ; : 21°088 Oxygen : : ‘ 16°064 506 | APPENDIX. Nore 13. Ultimate composition of chondrin. (Scherer.) Cartilage of the ribs of a calf. Cornea. Atoms. Calculated, coe Carbon ; 49°496 50°895 49°522 48 50°745 Hydrogen : 7°133 6°962 7°097 40 6°904 Nitrogen ‘ 14908 14908 14°399 6 14°692 Oxygen : 28°463 27°235 28°982 20 27°659 Mulder obtained from costal cartilage : Atoms. Calculated. Carbon : : 49°96 320 49°93 Hydrogen ; ; 6°63 260 6°61 Nitrogen ; ; 14°44 40 14:47 Oxygen : : 28°59 140 28°58 Sulphur 4 : 0°38 1 0°41 Nore 14. Ultimate composition of glutin. (Mulder.) Glutin from hartshorn. Glutin from isinglass. Atoms. Calculated. —_ 1. 2. Carbon : 50°05 50°05 50°76 13 50°37 Hydrogen . 6°48 6°64 6°64 10 6°33 Nitrogen. 18°35 18°39 18°31 2 17°95 Oxygen. 25°12 24°92 24°29 5 25°35 Nore 15. Ultimate composition of glycicoll or gelatin sugar. (Mulder.) Atoms. Calculated. Carbon . ‘ . 34°27 8 34°39 Hydrogen : : 6°51 9 6°32 Nitrogen ‘ Piet | ae 19-92 Oxygen : . 39°38 7 39°37 Nore 16. Ultimate composition of hematin, (Mulder.) 1. 2: 3. Atoms. Caleulated. Carbon. 66°49 66°20 65°73 44 65°84. Hydrogen _—_-530 5°44. 5:28 22 5°37 Nitrogen 10°54 10°46 10°57 3 10°40 Oxygen. 11‘01 11°15 11:97 ~ 6 11°75 Iron : 6°66 6°75 6°45 1 6°64 1 and 2 were prepared from arterial and 3 from venous ox-blood. APPENDIX. ° 507 Nore 17. Ultimate composition of cholic acid. (Dumas.) Atoms. Calculated. Carbon . : : 68°5 42 ——- 68°8 Hydrogen : : 9°7 36 9°6 Oxygen . ; , 21°8 10 21°6 Nore 18. Ultimate composition of urea. Prout. Liebig and Wohler. Atoms. Calculated. Carbon : 19°99 20°02 2 20°198 Hydrogen i 6°65 6°71 4 6°595 Nitrogen ; 46°65 46°73 2 46°782 Oxygen : 26°63 26°54 2 26°425 Nore 19. Ultimate composition of uric acid. Prout. Mitscherlich. Liebigand Woéhler. Atoms. Calculated. Carbon . 39°875 35°82 36°082 5 36°00 Hydrogen 2°225 2°38 2°441 2 2°36 Nitrogen 31°125 34°60 33°361 2 33°37 Oxygen . 26°775 27°20 28°126 3 28°27 Nore 20. Ultimate composition of hippuric acid. The hydrated acid contains : Mitscherlich, Liebig. Dumas. Atoms, Calculated. Carbon ‘ 60°63 60°742 60°5 18 60°9 Hydrogen : 4°98 4°959 4Q. 9 4:9 Nitrogen : 7°90 7816 7 1 7°8 Oxygen. ; 26°49 26°483 26°9 6 26°4 Nore 21. Ultimate composition of uric oxide. (Liebig and Wohler.) Atoms. Calculated. Carbon ; ; 39°28 5 39°86 Hydrogen : : 2°95 2 2°60 Nitrogen : : 36°35 2 36°72 Oxygen : ; 21°42 2 20°82 heres 508 APPENDIX. Nore 22. Ultimate composition of cystin. Prout. Thaulow. Atoms. — Calculated. Carbon 3 4 29°875 30°01 6 30°31 Hydrogen . : 5°125 5°10 6 4°94 Nitrogen . : 11°850 11°60 1 11°70 Oxygen } 53°150 28°38 4 26°47 Sulphur 25°51 2 26°48 Nore 23. Ultimate composition of glycerin. (Pelouze.) Hydrated. Atoms. Anhydrous. Atoms. Carbon ; \ 39°59 6 43°84 6 Hydrogen . A 8°61 8 8°35 7 Oxygen ‘ ; 51°80 6 47°84 5 Note 24, Ultimate composition of stearic acid. (Redtenbacher.) Atoms, Caleulated. Carbon é ; 76°71 68 76°76 Hydrogen é ; 12°86 68 12°90 Oxygen ets . 10°46 7 10°34 Ultimate composition of margaric acid. (Redtenbacher.) Atoms, Caleulated. Carbon : : 75°64 34 75°64 Hydrogen - > ; 12°86 35 12°71 Oxygen ; : 11°50 + 11°65 The former contains two, and the latter one atom of water. Nore 25. Ultimate composition of lactic acid, Lactic acid has been analysed by several chemists, who have all arrived at nearly the same results. ; Hydrated. Atoms. Anhydrous. . Atoms. Carbon ; ; 40°46 6 44-92 6 Hydrogen. . 6°61 6 6°55 5 Oxygen ‘ 52°93 6 48°53 5 Norr.—In vol. i, p. 222, it was inadvertently stated that hippuric acid is non- nitrogenous, The object of the author is to show that, compared with uric acid, it contains very little nitrogen. APPENDIX II. ADDITIONS TO VOLUME I. Pace 300. Blood in thoracic inflammation. Zimmermann! has communicated several observations respecting the blood in inflammatory affections of the respiratory organs. The fol- lowing are the results of his analyses, conducted according to the method of Andral and Gavarret : Water. Fibrin. Blood-corpuscles. Res. of serum. 1. 7900 3-0 127-0 80°0 784:0 4-0 - 126-0 860 796-0 6:0 119-0 79:0 810-0 7-0 106-0 77:0 "1805-0 5:0 103°5 85°5 4. 8060 9°6 109-9 74:5 7740 4-0 142°0 80-0 5. 17810 40 137°0 78-0 7860 4:0 1315 78°5 6 796-0 3-0 128-0 73:0 7. 7940 3-0 123°5 79°5 8. 792°0 3-0 120-0 890 9 800-0 4:0 119°5 765 10. 800-0 40 . 1080 88-0 11,7. £ 798.0 7-0 116-0 79-0 815°0 8-0 100°5 76°5 12. 806°0 35 100°5 90:0 If we compare the mean of these analyses with the average deduced by Andral and Gavarret from 58 analyses of the blood in similar cases, we have: | Zimmermann 7962 °° «4°75 118-10 80°85 © Andral - 799°0 7°30 114°10 81-00 1 Zur Analysis und Synthesis der pseudoplastichen Prozesse, pp. 1841-99, 510 APPENDIX. The leading difference in these averages occurs in the fibrin. Zimmermann suggests that probably Andral and Gavarret used only buffed blood. Pacer 302. Blood in intermittent fever In four cases in which the blood of persons residing in malarious districts, who were suffering from intermittent fever, was analysed by Cozzi, the fibrin occurred in its normal quantity, but the fat and albumen were diminished. In three of these cases there was a great excess of cholesterin, and scarcely any phosphates ; in the remaining case (No. 3) these salts were abundant, while no cholesterin was found. The following are the results of Cozzi’s analyses: 1. 2. 3. 4, Water and salts . 737°67 705°49 732°45 809°17— Fibrin . ; 2°20 2°06 2°29 1:96 font ; 15 21 13 16 Albumen ‘ 48°71 56°61 47°59 53°10 Blood-corpuscles . 211°27 235°63 217°54 135°61 The blood in (1) was taken from a soldier with severe inter- mittent fever, accompanied with considerable enlargement of the spleen and liver. The blood in (2) was taken from a man with a quartan fever, whose spleen and liver were much enlarged, and the latter the seat of excruciating pain. The blood in (3) was taken from an artilleryman, who for five years had been stationed in a malarious district. It was a case of intermittent fever, with slight enlargement of the liver, but extraordinary hypertrophy of the spleen. The blood in (4) was taken from a man with angina tonsil- laris, who had suffered from fever for a long time: spleen en- larged and very painful. In addition to the excess of cholesterin in the majority of these cases, bile-pigment was observed in the blood. The con- nexion between the occurrence of these constituents and the deranged state of the portal system is sufficiently obvious. Pace 804. Blood in certain diseases of the eye. Zimniene mann has published the following analyses of the blood in APPENDIX. 511 a peculiar form of endemic ophthalmia recently prevalent at Berlin. 1. In a case of ophthalmia of two days’ standing, accom- panied with much chemosis, the specific gravity of the blood was 1051. The specific gravity of the serum was 1027, and of the clot 1086. In 1000 parts there were : Water . ; : 798:0 Solid constituents : ; é 202°0 Fibrin. ; : ; 2-0 Blood-corpuscles_ . ; i 1175 Solid residue of serum ; é 82°5 The serum was of a blueish-red colour and opaque. 2. The blood drawn from a patient on the third day of the ophthalmia had a specific gravity of 1052.. The specific gravity of the serum was 1028 and of the clot 1090. In 1000 parts there were : Water F : ; ‘ 795°0 Solid residue ; F , 205°0 Fibrin. ; ‘ ; 2:0 Blood-corpuscles . ; ‘ 115°1 Solid residue of serum ; ‘ - 87°9 3. A patient on the second day of the disease yielded blood of specific gravity 1055. The specific gravity of the serum was 1030, and of the clot 1092. In 1000 parts there were contained : s Water ae = F ‘ 790 Solid residue . E ‘ 210 Fibrin ‘ ; ‘ ° 2 Blood-corpuscles. i : 115 Solid residue of serum , ; 93 4, In a similar case the blood had a specific gravity of 1054, The specific gravity of the serum was 1035, and of the clot 1088. In 1000 parts there were contained :— ail ake 512 APPENDIX. Water . ; : ; 794 Solid constituents ; M : 206 Fibrin S ; > ; 3 Blood-corpuscles . ; 4 105. Solid residue of serum ie 9 5. A soldier with conjunctivitis and sclerotitis of the right eye. The specific gravity of the blood was 1052. The specific — gravity of the serum was 1030, and of the clot 1084. In 1000 parts there were contained : Water i : ; : 795°0 Solid constituents ‘ ; : 205°0 Fibrin. : : , 2°5 Blood-corpuscles_. ; , 104:0 Solid residue of serum ‘ ‘ 98°5 6. In a case of conjunctivitis of both eyes without fever, the E specific gravity of the blood was 1055. The specific gravity — of the serum was 1036, and of the clot 1088. In 1000 parts there were contained : Water : : é 7860 Solid constituents F ; : 214°0 Fibrin . que ; : 2-0 Blood-corpuscles_ . ; 3 113°5 Solid residue of serum ‘ : 98°5 7. In a case of ophthalmia of the left eye, the specific gravity of the blood was 1055. The specific gravity of the — serum was 1031, and of the clot 1090. In 1000 parts of blood there were contained : Water .. : 5 d 790°0 Solid constituents : : ‘ 210-0 Fibrin. ; wen a 2:0 Blood-corpuscles_ . 5 : 114°7 Solid residue of serum : : 93°3 Three days having elapsed, venesection was again ordered. Z The specific gravity of the blood was then 1050°8. The spe- — cific gravity of the serum was 1027°7, and of the clot 1078. In 1000 parts there were contained : Water ; 5 = ; 802-0 Solid constituents ‘ " ‘ 198-0 Fibrin. ; 5 j 2°0 Blood-corpuscles. ; i 116-2 Solid residue of serum ‘ ; 89°8 APPENDIX. 513 8. The blood of a soldier on the third day of the disease had a specific gravity of 1052. The specific gravity of the serum was 1031, and of the clot 1080. In 1000 parts there were contained : Water ; , ‘ A 796°0 Solid constituents . Pe . 2940 Fibrin . 5 ; E 2°5 Blood-corpuscles : . 106°7 Solid residue of serum * is 93°8 Four days afterwards the specific gravity was 1050°5. The specific gravity of the serum was 1028, and of the clot 1078. In 1000 parts there were contained : Water 4 3 ‘ ; 800 Solid constituents : ‘ 200 Fibrin. -<* ‘é : 2 Blood-corpuscles é eae |. * Solid residue of serum : ‘ 90 After an interval of ten days he was again bled. The specific gravity was 1050. The specific gravity of the serum was 1027, and of the clot 1078. In 1000 parts there were contained : Water : ; : 804°0 Solid constituents . , : 196°0 Fibrin . 4 : me 3°5 Blood-corpuscles : , 97-0 Solid residue of serum ; ; 95°5 A glance at the leading characters of the blood in these eight cases, will show, that in these patients it was in a state of hypinosis. Pace 809. Blood in scrofula. _ The blood in this form of disease has been analysed by Mr. Nicholson.! The analyses were conducted on Andral and Gavarret’s method :— 1 Northern Journal of Medicine, Nov. 1845. II. 33 514 APPENDIX. Water. Fibrin. Blood-corpuscles. Resid. of serum. 1. 8165 3°0 101-0 795 2. 820°2 2°8 98-0 79°0 3. 820°5 2°4 98-0 79°71 4. 821:0 3°0 97-0 79-0 5. 823°0 2°5 96°5 78:0 6. 839°0 2°3 80°0 78°7 7. 843°0 2°0 79°0 79:0 8. 839-0 2:0 79°0 80:0 9. 855°3 12 63°5 80-0 10. 855°2 18 64:0 79:0 ll. 854°3 17 65:5 78°5 12. 855°0 2:0 64:0 79-0 The blood-corpuscles were few, light coloured, and irregular, and there was sometimes an appearance as if their circumfer- — ence was notched and divided. . Pacs 325. Blood in Bright’s disease. In a case of albu- minuria, in which the dropsy was only of a fortnight’s standing, the blood was analysed by Dr. Ayres.’ There was a firm buffy coat on the blood, a quarter of an inch in thickness. The coagulum itself was very firm, and so bulky as almost to fill the glass. There were contained in 1000 parts : Water ; : ¢ - 465°022 Solid constituents ; - 234-978 Fibrin and tritoxite of of protein . 11°450 Bee oe : : a trace Albumen - ; ; 65°875 Hematoglobulin . : - 138°185 Albuminate of soda and salts ‘ 13°940 Osmazome _ ; 5 1°510 No urea could be detected in this blood, the leading cha- racters of which were a great increase of sas and a diminu- tion of the water and fat. The following analyses have been recently published by Heller.” 1 Lancet, Aug. 2, 1845. 2 Archiv fiir Physiologische und Pathologische Chemie und Mikroskopie, vol. ii, p- 173. APPENDIX. _ 515 lst Case.—A man of tolerably robust appearance, aged 38 years. The disease was somewhat advanced, and there was considerable cedema. The blood was analysed on two occa- sions. On the first occasion it was taken by cupping from the region of the kidney. It was very fiuid but of the normal colour. The clot was small and presented no peculiarity. The serum was slightly coloured. Under the microscope the blood- corpuscles appeared large and swollen. The blood was tested for urea, and found to contain a considerable quantity. Five ounces were subsequently removed by venesection. The colour of the blood on this occasion was rather dark, and the coagulation was perfect. The clot was of a bright red colour on the surface, but otherwise dark, and there was no buffy coat. The serum was very pale and opalescent, and its specific gravity was only 1022, It contained no bile-pigment, and its reaction was strongly alkaline. In 1000 parts were contained : Water . 805°39 Solid oénatinabintis . 19461 - Fibrin $ i 3°52 Albumen P : 51°45 Fixed salts P 6°70 F ‘ : Pataki: vabibten ; 8-15 Solid residue of serum 68°15 Urea ; 1°85 Hamatoglobulin . 122°94 2d Case-—A woman, aged about 30 years, with the disease in an early stage. There was slight cedema of the feet and face, accompanied with pain in the region of the kidneys. Four ounces of blood taken from the arm presented no physical pe- culiarities. The specific gravity of the serum was only 1018, or 10° lighter than normal serum. ‘The clot was to the serum in the ratio of 544°75 : 455-25. In 1000 parts of blood there were contained : Water eo - 816°04 Solid sibnatatinatite : . 183°96 Fibrin ; 2°66 ger ee aap . little extractive Tc e Se Solid r es id c éf een Urea : ee 1:74 Hmatoglobulin : . 12457 _Heller’s general conclusions respecting the blood in Bright’s disease are that the specific gravity and the amount of solid 516 APPENDIX. constituents are diminished, and that the diminution is dependent alone on the decrease of the albumen, which, for the most part, is found in the urine, but to a less degree also in the dropsical | effusions. The appearance of the blood is normal, and in its — coagulation it presents no peculiarity. The serum is pale, of low specific gravity (as may be shown by the common urino- meter), and contains no bile-pigment. The fibrin and blood-corpuscles occur in the ordinary quan- tity. The solid residue of the serum is much diminished in consequence of the great decrease of the albumen. Urea is abundant in the blood; in the first analysis it amounted to 1°85 in 1000 parts: reckoning the whole amount of blood in the body at thirty pounds, this would contain about an ounce of urea. The presence of urea in the blood must not, how- ever, be regarded as peculiar to Bright’s disease, since it has been found in a large quantity in cholera, ischuria, and other diseases associated with suppression of urine. The fixed salts present no remarkable deviation from the normal standard, but are usually slightly below the healthy average. Pace 838. Menstrual fluid. Since the publication of the first volume, an analysis of this secretion has been made by Dr. Letheby.’ The menses were retained by an imperforate hymen, which, when cut into, permitted the escape of about forty ounces of a thick and almost black fluid, having the ap- pearance of treacle. When examined under the microscope, with a power of 300, it was found to be quite free from fibrin, but numerous corpuscles were observed floating in it. The greater number of them were altered blood-corpuscles, but there were also noticed the exudation or inflammatory globules (of Gerber and Gluge), lymph-corpuscles, mucus-corpuscles, epithe- lium-scales, and minute granules resembling mere dots. The fluid had an alkaline reaction, and was perfectly miscible with water; when heated a little below 212°, it HS a firm coagulum. It was analysed in ssevedanss with Simon’s directions, and was found to contain :— ' Lancet, Aug. 2, 1845. APPENDIX. | 517 Water : ; : f , . 857-4 Solid Constituents. ? ; ; «2 4426 Fat ‘ ‘ ; ‘ : : 53 Albumen : < ’ : : 69°4 Globulin : ; : : ; 49°] Heematin rs 4 ; ? ‘ 2°9 Salts ‘ : fc ; 8-0 Extractive matters 6°7 Another analysis was formed with the view of Se the quantity of mucus, blood-corpuscles, and soluble albumen, and gave the following results : Water . ‘ 857°4 Solid matters AMEE in cold water, oe consisting of mucous, lymph, and exudation globules with 22°6 epithelium Solid matters soluble in cold water, and inisitslthe of oJ 53-8 saponified fats and blood-corpuscles Albumen ‘ ‘ 52-7 Salts . : : ; , 70 These must be taken as the constituents of the fluid. It can, however, hardly be regarded as the normal menstrual se- cretion ; from the length of time in which it remained in the | vagina it became mixed with an excess of mucus, and, acting as an irritant, produced the inflammatory sages that were observed in it. 518 APPENDIX. ADDITIONS TO VOLUME Ii. Pacr 9. Saliva. Lassaigne has instituted a series of experiments in reference to the animal diastase of Mialhe. The results of these experiments are as follows : a. Human saliva, and that of the horse, at the temperature of 103°, exert no solvent power on starch, which remains quite unaltered in its physical and chemical properties. : 6. At a higher temperature (158° to 167°) maintained for — three hours and a half, horse’s saliva acts on starch exactly as water does; that is to say, the granules become tumid and dis- tended, without being changed into either dextrine or glucose. c. Human saliva obtained from the mouth has no action on starch at the temperature of the body ; but converts it rapidly into dextrine at a temperature between 158° and 167°, and subsequently converts the dextrine into glucose. d. During the digestion of raw amylaceous substances, the saliva, being at the temperature of the animal body, cannot exert the influence attributed to it by Mialhe; it can merely, as most of the older and modern shitologiete. maintain, con- tribute to moisten the alimentary bolus, and dissolve such of its principles as are soluble in water. Pace 12. Morbid saliva. Scherer has analysed the Saliva of a girl aged 15 years, suffering from a scorbutic affection of the mouth. There was copious ptyalism, the saliva amounting to about 40 ounces in twenty-four hours. The secretion was very liquid, fetid, and alkaline. The specific gravity was 1004. In 1000 parts there were contained : Water ‘ ; 988-8 Solid constituents ; : 11-2 A caseous-like substance precipitable Hid 6-5 acetic acid : Fat taken up by ether ‘ ° 0°6 Extractive matter and ptyalin® . : 18 Carbonate of soda _. : : 1-2 Chloride of sodium . : : 0-7 Phosphate of lime 04 APPENDIX. | 519 On examining with the microscope the fluid immediately after its discharge, there were found in it a large number of infusoria, and a peculiar confervoid-like vegetation. Pace 15. Fluid of ranula. Dr. Gorup-Besanez' has pub- lished an elaborate paper on this subject, in which, after dis- cussing at considerable length the question whether the tumour constituting ranula arises from an obstruction of Wharton’s duct, and contains retained and modified saliva, or whether it is a species of ordinary cystic tumour, he arrives at the latter conclusion. In 100 parts of fluid he found : Water .. ; . * 95°029 Solid constituents 3 4971 Alcohol-extract, traces of fat, al dada h 1-062 of sodium 3 j Water-extract (gluten ?) : : -0°923 Albuminate of soda 2 4 2°986 The microscope detected in the fluid some blood-corpuscles and globules which were at least twice as large as the corpus- cles of mucus or saliva, and resembled Gluge’s inflammatory globules. Hence the liquid differed entirely, both chemically and mi- croscopically, from saliva. Pace 19. The bile. Frerichs*® has recently analysed bile both in health and disease. He gives the following as the physical characters of healthy human bile. In colour it is always deep brown, but, when seen in thin layers, it has a brownish yellow tint. It is very fluid, being viscid only in new-born infants. . The specific gravity varies from 1032 to 1040. On examining with the microscope bile from the gall-bladder, with which, of course, a certain amount of mucus is mixed, there are observed :—1. Transparent or grayish round vesicles, about 1-700th of a line in diameter. They disappear on the addition of alcohol or ether, and are removed by filtration. 2. Conical yellow bodies, about 1-140th of a line in length, and about 1-300th or 1-400th of a line in breadth, apparently devoid of nuclei; these are epithelium-cells from the gall-bladder. 3. Here and there irregular dark granules, ' Heller’s Archiv fiir Phys. und Patholog. Chemie und Mikroskopie, vol. ii, p. 22. ? Hannov. Annal. | and 2, 1845. 520 APPENDIX. which disappear on the addition of a solution of potash, appa- rently pigment-cells. 4. Occasionally minute crystals of cho- lesterin, occurring as colourless rhombic tablets. The chemical characters are shown in the two following analyses. The bile in these cases was obtained from healthy men, killed by severe accidents : 1. 2. Water i : : 86°00 85°92 Solid constituents ; : 14:00 14°08 Bilate of soda : : 10°22 9°14 Cholesterin , inh ONG 0°26 Margarin and olein . : 0°32 0°92 Mucus . ‘ 4 2°66 2°98 Chloride of sodium . : 0°25 0°20 Tribasic phosphate of soda A 020 ~ 0°25 Basic phosphate of lime : ; s magnesia 0°18 0°28 Sulphate of lime ; . 0°02 0°04 Peroxide of iron : : traces _— traces Pace 23. Morbid bile. Frerichs has published the two following analyses of morbid bile: Bile in Bile in pneumonia. chronic meningitis. Water ‘ . 94°60 95°98 - Solid constituents ; 5°40 4°02 Bilate of soda ‘ 4:16 2°63 Fat ° ae 0°42 0°20 Mucus and salts - 1:00 1:21 Pace 27. For further information on the uses of the bile we must refer the reader to the recent work of Platner, ‘ Ueber die Natur und den Nutzen der Galle, Heidelberg, 1845. A summary of his views on this subject is given in Miller’s Archiv, No. 4, 1845. Pace 29. Gastric juice. Dr. R.D. Thompson has published an account of a series of experiments made with the view to. determine the acid or acids occurring in the gastric juice. In order to prevent complication of the phenomena, the animals were fed on vegetable food alone. His experiments tend to show that no free hydrochloric acid is present in the stomach of animals living on vegetable food, but that the free acid is the lactic. A little acetic acid was also generally present. 2286 Butter . i " . 7°32 Casein a ‘ e _ er ae Extractive matter ; ; 2 3°39 Soluble salts A ; 0°45 Insoluble salts : : 5 0°57 Not a trace of sugar could be detected in the latter specimen. His other analyses are merely confirmatory of the same fact. Dumas believes that the milk-globules are surrounded by a caseous investment; he found that if milk be shaken with pure ether, the two liquids which are at first mixed, separate on standing, and the milk preserves its ordinary appearance, whilst the ether dissolves scarcely anything. If, however, acetic acid is added to the milk, and the mixture is boiled, the whole of the butter may be removed by subsequent agitation with ether, and the milk ceases to be opalescent. Pace 119. Colouring matters of urine. Heller has re- cently published some observations on certain new colouring matters in the urine. He believes that there exists a yellow pigment (uroxanthin) which occurs in solution in very small proportion in healthy urme, but is much increased in certain forms of disease. It possesses the property of being converted by oxidation (either spontaneously or artificially) into two other pigments, one of which is of a ruby-red tint, (urrhodin,) while the other is of the colour of ultramarine, (uroglaucin.) These are both insoluble in the urine, and being deposited, form a purple or violet-coloured sediment. That uroxanthim and its products are derived from urea seems probable, from the circumstance that uroglaucin and urrhodin occur in diseases different in most of their characters, but similar in one—the presence of an excess of urea in the blood: thus they are found in Bright’s disease, in cholera, and in suppression of urine. Further, when these products occur in considerable quantity, (especially when the blue sediment is spontaneously formed,) there is always much carbonate of am- monia, and very little urea (perhaps mere traces) in the urine, as is often the case in Bright’s disease. Finally, Heller has APPENDIX. 523 observed the blue tint developed by nitrate of urea artificially prepared and kept moist, and has likewise produced it by adding nitric acid to an old solution of urea partially converted into carbonate of ammonia. The existence of a large quantity of uroxanthin in urine is indicated : 1. By the clear light-yellow colour of the urine when that secretion is acid, as in cholera, and sometimes in Bright’s disease. 2. By the presence of the products of its oxidation, uro- glaucin and urrhodin, which either of themselves form a violet- coloured sediment, or communicate that tint to a sediment already formed. On allowing urine abounding in uroxanthin to stand for some time, it is observed that after the formation of the sediment has ceased, the fluid from the surface downwards assumes a violet tint, and this change of colour takes place with a rapidity proportional to the amount of carbonate of ammonia produced by the decomposition of urea. Hence, on keeping such urine ina high cylindrical glass, three distinct strata are observed ; lowermost, a violet sediment; in the middle, yellow and nearly clear urine; and superiorly, a violet or purple turbid layer. On shaking the glass, the whole urine assumes a_bluish- green tint, because the urrhodin, formed principally at the surface, becomes converted, by agitation with a full supply of atmospheric air, into uroglaucin which, mixing with the central yellow layer of urine develops a green tint. The uroglaucin thus formed ultimately settles as a blue powder on the sides and at the bottom of the vessel. Hence there is obviously no fixed proportion between the quantities of uroglaucin and urrhodin. 3. If much uroxanthin is present, the crystals of uric acid (separated either spontaneously or by the addition of an acid) have a beautiful blue or amethyst tint. 4. Lastly, if much uroxanthin is present, it may be recog- nized by the addition of concentrated nitric acid, (ten drops to half an ounce of urine,) which at once communicates a brilliant violet colour to the fluid: if a smaller amount is present, the change of colour is developed more slowly. 524 APPENDIX. The nitric acid oxydises the uroxanthin, and converts it into uroglaucin and urrhodin. Sulphuric and hydrochloric acids act similarly, but with less activity. If albumen is present in urine treated in this manner, it is either precipitated blue at once, or assumes that tint gradually, according to the amount of uroxanthin. This is constantly noticed in Bright’s disease on treating urine abounding in uroxanthin with an acid, and allowing it to stand for a couple of days; uroglaucin separates in dark blue crystalline groups, visible to the naked eye, partly on the surface and partly at the bottom of the vessel. On taking a drop from the surface and examining it under the microscope, uroglaucin is seen in the form represented in Plate iui, fig. 37. : To separate the two products of oxidation of uroxanthin, we collect on a filter the sediment thrown down by nitric acid, and agitate it with cold spirit of ‘830, which takes up the urrhodin, (as also does ether ;) the residue is boiled for some time with spirit of the same strength, until the fluid becomes somewhat concentrated ; we thus get a bright blue solution of uroglaucin. To exhibit these substances in normal urine, the fluid must be so far evaporated as just to remain liquid. On adding concentrated nitric acid to the cold residue, a crystalline magma of nitrate of urea is at once formed ; on adding to this a few more drops of nitric acid (and sometimes even this is unnecessary) it assumes a violet tint. If the crystalline mass is allowed to stand for some time, and is then dissolved in the smallest possible quantity of distilled water, after being left at rest for some time, it deposits a sediment in which urrhodin and uroglaucin may be detected either by the microscope or by ex- traction with cold and then with boiling spirit. The action of nitrate of silver on uroxanthin is very singular. On precipitating the chlorine by an excess of nitrate of silver, from urine acidulated with nitric acid, and then carefully neu- tralizing the filtered liquid by ammonia, there is not only a pale yellow precipitate of phosphate of silver, but the fluid as- sumes a brown tint, and in a short time there is likewise a brown sediment. Heller has not yet succeeded in isolating uroxanthin. Uroglaucin associated with urrhodin, occurs in urinary se- diments in Bright’s disease, and im cases in which urine, APPENDIX. 525 abundant in uroxanthin, has become alkaline in the bladder. Heller has noticed it in these sediments forming groups of delicate prisms. (See Plate iii, figs. 37 and 38a.) It like- wise assumes this form when urine, abounding in uroxanthin, is treated with nitric, sulphuric, or hydrochloric acid. In this case it is principally found on the surface of the fluid. When allowed to crystallize from its cold spirituous solution, it forms groups which appear nearly black, but are blue and transparent at the edges. (See Plate iii, fig. 38 a, 6.) Urrhodin appears to be a less oxydised product of uroxanthin than uroglaucin, and usually occurs in much larger quantity. It is most commonly observed in cases in which the urine is alkaline before emission, in consequence of containing much vesical mucus, and its development in such cases is hastened by the addition of nitric acid. The method of isolating it has been already described. Heller has never succeeded in ob- taining it from its spirituous solution in a crystalline form. It occurs in granules, which, under the microscope, appear of a beautiful rose-colour. It is resinous in its nature, and burns with a clear flame. Heller concludes his paper (of which the above is but a brief abstract) with a notice of some experiments on uroerythrin, the ordinary pigment of inflammatory urine. On treating uric-acid crystals obtained from healthy urine with cold alcohol, the pigment formed a carmine solution, and the uric acid remained comparatively devoid of colour, being of a yellowish-brown tint from the brown pigment of the urine. The spirituous carmine solution on exposure to the air gra- dually became purple, and had all-the properties of uroglaucin, previous to which it appeared to be identical with urrhodin. On treating the red sediment common in inflammatory af- fections and tinged with uroerythrin, with hot and cold alcohol and ether, the red pigment remained unaffected, unless a little acid was added. ‘The difference of solubility in the above menstrua is thereforé sufficient to separate uroerythrin from urrhodin. ; Heller’s theory of the production of uroglaucin and urrhodin affords a satisfactory explanation of the occurrence of the blue sediments noticed in pp. 274, 327, and 329. Pace 137. Quantitative determination of urea. Two papers 526 APPENDIX. on this subject have appeared almost simultaneously during the last three months—one by Ragsky, the other by Heintz. With regard to the quantitative determination of urea, Ragsky! observes there is this great objection to its separation either as a nitrate or oxalate, that both those salts are per- ceptibly soluble, which prevents on the one hand their com- plete precipitation, and on the other hand their perfect wash- ing, on which latter account they retain a certain amount of extractive matter. No other compound of urea being known, adapted for its quantitative determination, Ragsky endeavoured to apply the products of its decomposition to this purpose. After several experiments made to this effect, with chlorine and with nitrous acid, he found that concentrated sulphuric acid answers the purpose best. For this purpose, a mixture of one part of urea, with from three to four parts of concen- trated sulphuric acid is introduced into a flask, and exposed to the heat of a sand-bath, which must not exceed 572° to avoid loss of ammonia. ‘The decomposition of urea commences at 383° and the evolution of carbonic-acid gas is very lively at 392°. In this process one equivalent of urea assumes the elements of two equivalents of water, and transposing with the latter is converted into two equivalents of carbonic acid which escape as gas, and two equivalents of ammonia which remain in combination with the sulphuric acid. C,N,H,0, + 2 HO + 2 (S0,, HO) = 2 (NH, 0, SO,) + 2 CO,. He determined, in this manner, accurately-weighed portions of pure urea dried at 212 degrees, and determined the ammo- nia subsequently in the form of ammonio-chloride of plati- num. ‘The following numbers will show how approximately urea may be determined in this way. 1. 0:2612 grammes of urea.yielded 1:9323 grammes of ammonio-chloride of platinum corresponding to 0°2598 grammes of urea.” 2. 0'3139 grammes of urea yielded 2°3175 grammes of ammonio-chloride of ay corresponding to 03116 grammes of urea. 1 Liebig and Wohler’s Annalen, Oct. 1845. — ? The English reader will see the accuracy of the result more clearly by reducing the grammes to grains. From 4°022 grains used in the experiment, 4‘001 were re- covered, APPENDIX. 527 3. 0:2716 grammes of urea yielded 2:0400 grammes of ammonio-chloride of platinum, corresponding to 0:2743 grammes of urea. , To ascertain how far the presence of extraneous matters might interfere with the accuracy of the results, sugar was mixed with the urea, but the results were unaffected. The next point was to ascertain whether the extractive matter would yield ammonia under these conditions. For this pur- pose Ragsky precipitated 120 grammes (nearly 4 ounces) of fresh and healthy urina sanguinis, with acetate of lead, after having previously separated the uric acid by means of some hydrochloric acid. The precipitate was mixed with water, decomposed by sulphuretted hydrogen, and the yellow fluid thus produced evaporated to a syrup, and charred with sul- phuric acid. The charred mass was subsequently extracted with water, the solution evaporated, and finally treated with alcohol and bichloride of platinum. This process gave no indi- cation of the presence of ammonia. Having thus ascertained. that the extractive matters, which are normally present in urine, exercise no adverse influence on the quantitative deter- mination of urea by means of sulphuric acid and bichloride of platinum, he next proceeded to determine by this method the amount of urea present in divers samples of urine, in order to compare the results with those obtained by the ordinary me- thods. He found, after several experiments, that 7 grammes (a little more than five drachms) of urine required about 3°5 grammes (or half the weight) of concentrated sulphuric acid. If less of the acid be taken the charred mass will readily dry up, and some loss of ammonia will be incurred in consequence. The mixture of urine and sulphuric acid is kept in a moderate state of ebullition, there is a great evaporation of water, and the fluid turns black. The temperature rises higher and higher, until at about 392° there ensues evolution of carbonic acid gas in small bubbles. The cessation of the disengagement of gas indicates that the urea present in the analysed urine is com- pletely decomposed. The black residue is then thoroughly ex- tracted with water and the solution filtered. The clear and urine-yellow filtrate is finally evaporated in the water-bath, and the sulphate of ammonia treated with alcohol and. bichloride of platinum. Since urine contains salts of potash and ammonia, which 528 APPENDIX. will of course likewise precipitate upon the addition of bichlo- ride of platinum, it is necessary to determine the exact pro- portion in which these salts are present in the urine under examination. For this purpose a separate weighed portion of urine is precipitated with bichloride of platinum, and the amouut of precipitate substracted from the former. Two samples of urine of 7 grammes each, treated accord- ing to this method, yielded 0:202 grammes of urea, or 2°88, and 0°199 grammes of urea or 2°842. Fourteen grammes of the same urine was treated according to the ordinary plan; they _ yielded 0°617 grammes of nitrate of urea, or 2°159 of urea. The extractive matters of the urme yielded no ammonia. These experiments prove that the method of determining urea in the form of ammonio-bichloride of platinum yields much more accurate results than the plan usually adopted ; it may, therefore, in many cases be advantageously employed, with this precaution, that all substances likely to interfere with the accuracy of the process (as uric and hippuric acids, albu- men, &c.) be previously removed. It might be advisable in certain cases to separate the urea in the first place by means of oxalic acid, and then to decompose the oxalate with sul- phuric acid. The following table may save trouble in calculation. atom of ammonio-chloride of platinum corresponds to 0°134498 of urea. ” ” ” ” 0°268996 ,, 0°403494 ,, ” ” ” ” 1 2 3 4° ” ” ” 0°537992 ,, 5 ” ” ” ” 0°672490 ” 6 ” ” ” 0°806988 _,, 7 cP) ” ” ” 07941484 ,, 8 ” ”? ” ” 1:075984 ” 9 ” ” ” ” 1°210482 ” The author concludes his paper by an acknowledgment of | the kind assistance of Liebig. In principle the method adopted by Heintz! is so similar to the above, that it is unnecessary to enter into the details. Both writers agree respecting the inaccuracy of the ordinary method. Pace 238. Urine in Bright’s disease. In Heller’s memoir already referred to, we find the following sin ht of the urie in this disease. ' Poggendorff’s Annalen, No. 7, 1845. APPENDIX. 529 a. In the case noticed in p. 515, of the man aged 388 years, the urinary secretion was much diminished. The urine was turbid, of a dark yellow colour, very acid, of specific gravity 1017, and deposited a slight, finely flocculent sediment con- sisting of albuminous fungi, pavement epithelium, the peculiar cylindrical forms observed in Bright’s disease, mucus-corpus- cles, and a tolerably large number of blood-corpuscles. On the addition of nitric acid, albumen with a violet tint was precipitated ; hence the urine contained a large amount of uroxanthin.} In 1000 parts there were contained : Water : j é 948-0 Solid constituents . ; 52:0 Urea ; : ‘ 61 Uric acid ‘ : : no trace Fixed salts. 5 ‘ 3°6 Extractive matters and uroxanthin 23°9 Albumen with some hzmatoglobulin 18°4 The greater part of the salts consisted of sulphate of potash; only slight quantities of chloride of sodium and phosphate of soda were present, and after the removal of the albumen not a trace of earthy phosphates could be detected. No hippuric acid could be obtained from the urine, and as uric acid was likewise absent, the acidity (which in this case was very marked) could not be dependent on these acids. Heller concludes from various observations that the acid re- action is dependent on the presence of the uroxanthin. A week afterwards the urine was again analysed. The se- eretion was still diminished, was very turbid, of a pale reddish colour, and formed a flocculent reddish sediment. The specific gravity was 1010, the reaction acid, and the composition of the fluid nearly the same as when previously examined. At the expiration of another week, and just before the patient’s death, the secretion continued diminished, and the urine rapidly became putrid. The specific gravity was 1011, urea was present in very small quantity, and the sediment contained much pus; in other points the urine remained the same as before. 3 | b. The patient was a man aged 40 years, with considerable oedema of the whole body. ' See page 522. Il. 34 530 APPENDIX. The urinary secretion was much diminished. It was ex- amined on several occasions, principally in reference to the salts. The urine was of a pale yellow colour, acid, and of specific gravity 1018. There was a slight deposit, consisting of colour- less uric-acid crystals, much pavement epithelium, cylinders, albuminous fungi, and a few mucus-corpuscles. The urme contained a large quantity of albumen, very little urea, and only traces of uric acid. The salts amounted to 7-4 in 1000 parts, and contained an excess of sulphates with a diminution of chloride of sodium. On the following day the organic constituents were similar ; the sediment, however, contained in addition some granular cells (the inflammatory globules of Gluge). The urine was subsequently analysed some days afterwards. It presented the same appearance as before, and the deposit was similar. The reaction was acid, and the specific fil 1017. | ; In 1000 parts there were contained :— , Water y ; : : 958°0 Solid constituents . 6 ; 42°0 Fixed salts . 7 é 9°4 c. A middle-aged woman with considerable cedema. The urine was diminished in quantity, was of a dull yellow colour, turbid, faintly acid, and of specific gravity 1017. It deposited a sediment consisting of numerous epithelium scales and cylinders, albuminous fungi, and a few uric-acid crystals. The urine contained a large amount of albumen, which when precipitated by nitric acid had a faintly violet tint, indicating the presence of uroxanthin. The urea, uric acid, and salts were much diminished ; the latter amounting to no more than 3 in 1000 parts of urine. Of the various constituents of the saline residue the chloride of sodium was the most diminished. d. The urine of a patient with considerable cedema, was analysed. It was of a faint yellow colour, turbid, acid, with a specific gravity of 1006, and deposited a slight sediment of pavement epithelium, cylinders, mucus-corpuscles, albuminous fungi, and afew crystals of uric acid. APPENDIX. 531 In 1000 parts there were contained : Water : : : 985°2 Solid constituents : : 14°8 Organic matter : ‘ 13°6 Fixed salts ‘ ‘ 1°2 containing hardly a trace of chloride of sodium. e. A patient aged 28 years, who first exhibited symptoms of Bright’s disease while in the hospital, in consequence of a broken arm from a fall. The spinal cord likewise appeared somewhat injured by the accident. The urine was much diminished in quantity, scarcely amount- ing to twelve ounces in the twenty-four hours; it-was of a bluish green (or very deep bottle-green) colour, ean and de- posited after a short time a flocculent light-blue sediment. After standing for a longer period, a dark blue sediment was gradually thrown down, while the supernatant fluid was yellow. The surface of the urime was covered with a stiff film of ‘uroglaucin, which presented a beautiful copper-like brilliancy when the light fell on it. With refracted light it appeared of a dark-blue colour, and arranged in stellar groups. The sedi- ment, when examined under the microscope, was found to consist of a great quantity of albuminous fungi and minute crystals of ammoniaco-magnesian phosphate, together with groups of uroglaucin, more or less crystalline in structure, and of a magnificent blue colour: a peculiar modification of payement epithelium was likewise observed,—oval or nearly circular, with large nuclei and nucleolar corpuscles, frequently arranged in groups; and lastly, cylinders with a little pus. The reaction of the urime was strongly alkaline, and its specific gravity 1018. On the addition of nitric net the urine became of a clear blue colour, and albumen with a violet tint was precipitated, which on standing became of a darker blue, while the super- natant fluid assumed a yellowish hyacinthine colour. - Alcohol slowly added, so as to form a layer on the surface, took up an azure colouring matter. On thoroughly mixing the alcohol with the urine, albumen with a beautiful blue tint was precipitated, while the fluid remained of a hyacinthine colour. Ammonia communicated a brown colour to the urine. 532 APPENDIX. On the addition of a salt of silver to the acidulated urine there was no precipitation of chloride of silver, but when added to neutralized urine a coffee-coloured tint was developed, indicative of uroxanthin. On the addition of a salt of baryta there was a slight violet- colour precipitate of sulphate of baryta. On evaporating the urine there was left a residue of a dark- blue colour, and bright blue spots were observed on the edges of the capsule. It was washed with water, in order to sepa- rate the urea, and then extracted with cold spirit of 0-830, which dissolved the urrhodin, and formed a carmine solution. On boiling the residue with spirit, a solution of uroglaucin was obtained, which, on cooling, formed beautiful ultramarine- blue crystals. | The amount of urea was very small, ee hiss was no uric acid or chloride of sodium; on the other hand, there was a large quantity of carloads of ammonia, and a moderate amount of albumen. ‘The earthy phosphates, phosphate of soda, and sulphate of potash were present in very diminished quantities. _Uroglaucin and urrhodin were present to a — amount. 7 The urine eee on the Gtichvinss morning (amounting to a little above two ounces) was submitted to analysis. It was of a bottle-green colour, turbid, and deposited a sediment which, when examined under the microscope, was found to contain crystals of uroglaucin, and indeed all the constituents noticed the preceding day. a sinotig The urine was strongly adkalitig emitting an urmous ammo- niacal odour. The specific gravity was 1013, and the reactions, with nitric acid, alcohol, &c., the same as before. There was, however, a larger amount of albumen. Uroglaucin and urrho- din were likewise present in abundance. | The urine contained in 1000 parts : Water on ay . 971-20 Solid Peet a ‘4 : : 28°80 Urea i wih 5 : 3°81 Urie acid % 5 : . J no trace Fixed salts " eli F : 3°80 Uroglaucin, urrhodin, uroxanthin, extractive 14°30 matters, and carbonate of animonia Albumen ; j ; ; 9°89 APPENDIX. 533 Chloride of sodium was altogether absent ; the other salts were diminished in nearly similar proportions. Death occurred the same evening, about six o’clock. _ Shortly before that event, nearly two ounces of urine were removed by the catheter. The secretion had lost its previous colour, and was of a deep citron-yellow tint ; it was turbid, and deposited a perfectly white sediment, composed of all the previous ingre- dients with the exception of uroglaucin. It was acid, and re- mained so for twenty-four hours, although exposed during part of that time to the sun’s rays. Its specific gravity was 1012. From the examination of the urine it seems clear that the uroglaucin and urrhodin are products of oxidation of the peculiar yellow pigment—uroxanthin. For the ‘ native’ urine was in- tensely yellow, and did not contain, either in solution or in the sediment, a trace of either uroglaucin or urrhodin. On the addi- tion of nitric acid there was a white precipitate of albumen, which gradually assumed a violet tint, and after standing for some time became of a deep blue colour. On the addition of this acid the urine became first of a carmine tint, then of a violet colour, and ultimately of a rich blue; and during these changes it deposited uroglaucin presenting the appearance of bright powdered ultramarine, but under the microscope exhi- biting a crystalline form. On the surface of this urine there was formed the same coppery film that was noticed on the blue urine, and the microscope detected crystals of uroglaucin in it. Cold spirit, when added to the sediment, took up ur- rhodin, assuming a brilliant carmine tint. Hence it seems to follow that the acid urine, which was of a pure yellow colour, contained uroxanthin, and that this uro- xanthin, under the oxydizing influence of nitric acid, yielded uroglaucin and urrhodin in the same manner that it had spon- taneously done in the case of the bluish-green specimens. _T'o confirm this opinion a portion of the yellow urie was ex- posed for a length of time to the action of the atmosphere. The same products were slowly developed which had been rapidly produced by nitric acid. The same red metallic film was produced, the same blue tint gradually developed, and, subse- quently, the same blue sediment yielding uroglaucin and ur- rhodin, while the supernatant fluid became pale. 534 APPENDIX. The urine contained albumen, an extremely small quantity of urea, and not a trace of either uric or hippuric acid. Hence the acid reaction could not depend (as Liebig supposes) on those acids, and Heller believes that “the acid reaction of this urme, and, indeed, of the urine in Bright’s disease generally, (where uroxanthin is always present in large quantity,) and most pro- bably of the normal secretion, (at least in part,) is dependent on uroxanthin, which comports itself as an acid, being precipi- table by metallic salts.” The body was examined two days after death. A small quantity of ure, amounting to hardly a drachm, was found in the bladder. It had much the same properties as the urme removed by the catheter before death: it had the same acid reaction, and the same yellow colour. It deposited a copious sedi- ment, consisting for the most part of pavement epithelium, and the characteristic cylinders ; it likewise contained mucus-corpus- cles and oil-globules. The urine contained uroxanthin, but not a trace of uroglaucin or urrhodin, which were, however, subsequently obtained, both by nitric acid and by exposure to the atmosphere. J. A man under the care of Dr. Seibert. The disease was of considerable standmg, and had assumed a chronic form. There was much cedema of the feet, extending to the body, and the secretion of urine was diminished. The urime was of a pale wine-yellow colour, turbid, and threw down a slight deposit consisting of pavement epithelium, cylinders, mucus- corpuscles, and crystals of ammoniaco-magnesian phosphate. _ It was faintly alkaline and rapidly developed ammonia; its specific gravity was 1014. Nitric and hydrochloric acids com- municated a reddish violet tint to it. After a time albumen . with a violet tint was precipitated ; hence the urine contained _ uroxanthin. - In 1000 parts there were contained : Water ; ; te é é 969°25 Solid constituents ‘ ; ; é 30°75 Urea te : 7 Lies "et 2°50 Uric acid ee gee: as ‘ 0°60 Albumen ; : ; ‘ 6°25 Extractive matters, uroxanthin, and carbonate of ammonia 17°70 Fixed salts . ir 5 . 3°50 The fixed salts consisted for the most part of phosphate of APPENDIX. 535. soda ; they contained mere traces of chloride of sodium, and a very small amount of earthy phosphates and sulphates. g. A woman aged 30 years, an analysis of whose blood is given in p. 515. The urine, on the day on which venesection was performed, was tolerably copious, but had been scanty for some days pre- viously. It was of a faint clay-yellow colour, and threw down a flocculent precipitate consisting of pavement epithelium, very long cylinders, mucus- and pus-corpuscles for the most part containing two distinct nuclei, albuminous fungi, a few fat- globules.and blood-corpuscles, and a very few minute crystals of uric acid. The reaction of the urine was strongly acid, and its specific gravity 1017. After the removal of the albumen the specific gravity fell to 1013 ; there was consequently a con- siderable quantity of albumen present, and with it a propor- tionate amount of uroxanthin. The urea was much diminished. The uric acid was increased, which is always the case in the early stages, and as long as the disease retains the acute form. The phosphate of soda and sulphates were apparently un- affected ; there were mere traces of earthy phosphates, and chloride ‘of sodium was almost entirely absent. The urine likewise contained hematin in solution, which communicated a brown tint to the fluid, and especially to the albumen on drying. ‘On the following day the urine and its sediment presented similar characters. The specific gravity was 1012, and after the removal of the albumen 1010. In 1000 parts there were contained : Water . : ; . > 978°74 Solid constituents : P sae at 26°26 Urea ‘ : : ; 6°48 Uric acid ‘ : 0°70 Albumen . “sca : ; 6°03 Fixed salts : 5°05 Extractive and colouring matter 8°00 h. A man aged 20 years, who had been for a long time under the care of Dr. Bittner. The disease had assumed the chronic form, and there was great general cedema. The urine was turbid, of a very pale yellow colour, and de- 536 APPENDIX. posited a trifling sediment, composed for the most part of al- buminous fungi, cylinders, and pavement epithelium with a few mucus-corpuscles. The urine was faintly acid, but in the course of thirtyaaix hours became alkaline. The specific gravity was 1009. It did not contain much albumen, and only a very little uroxan- thin. In 1000 parts there were contained : E Water b : : . : Ss Solid constituents ; gee ; 21°5 Urea i ( E ‘ 2°5 Uric acid . ; rs . traces Aibumen . ; 4°6 Extractive and colouring matters ; 9°4 Fixed salts i z ; 5:0 On a further examination of the salts it was found that the chloride of sodium was extremely diminished. The urine was examined on two separate occasions, some days later, in relation to the solid constituents generally and to the albumen. There were found: 1. 2. Water ‘ : - 978°6 978°2 Solid constituents é ; 21°4 21°7 Albumen . : s 4°5 4°5 Hence in ines! eoaphoks it had remained constant. Some weeks later, and very shortly before the patient’ s death, the urine was again examined. It was red from the pre- sence of blood, had a putrid odour, and deposited a sediment, which, in addition to the ordinary constituents, contained nume- rous blood- and mucus-corpuscles, undoubted pus-globules, and a little uric acid. The reaction was acid, and the specific gra- vity 1010. A considerable amount of uroxanthin was present. In 1000 parts there were contained : Water ; a ; «+ 976°23.. Solid constituents ; ; 4 23°77 Urea : J ‘ , 1-76 Uric acid ; 0°24 Albumen with a little heematoglobulin s 8°75 Extractive and colouring matters : 8°54 Fixed salts é ; : 4°48 The chloride of sodium was much diminished. Hence we see that blood occurs in the urine, not only in APPENDIX. 537 the early stages but likewise towards the close of the disease. In the former case it arises from congestion, in the latter it is a consequence of incipient dissolution. i. A woman aged 40 years, with much cedema, under the care of Dr. Sterz. | The urine, in this case, was very remarkable for its ex- tremely high specific gravity, dependent on an enormous amount of albumen. The secretion was very much diminished. The urine was of a clay-yellow colour, turbid, and formed a tolerably abundant sediment, containing numerous cylinders and mucus-corpuscles, together with urate of ammonia. There were also a few granular cells (Gluge’s inflammatory globules) and numerous albuminous fungi. — The reaction of the urine was acid. Nitric acid caused a dense coagulation of albumen, which rapidly assumed a violet tint ; hence a tolerably large amount of uroxanthin was like- wise present. The specific gravity was 1047. In 1000 parts there were contained : Water ; 3 : é 860 Solid constituents ; : : 140 Albumen .. : ; : 57 The urine retained these characters for a considerable time, always holding hematin in solution. It subsequently became less dense, as the disease assumed a chronic character. ‘k. A girl aged ten years: cedema general and well-marked. The urine was very pale, and of a dirty clay-yellow colour ; a little fluid fat separated on the surface. There wasa very slight de- posit of epithelium and albuminous fungi. Reaction faintly acid ; specific gravity 1005.. A small quantity of albumen was present, which, on being precipitated by nitric acid, rapidly assumed a violet tint ; on the addition of hydrochloric acid the urine was rendered turbid, and likewise became of a violet colour ; a relatively increased quantity of uric acid was thus ee pariieed, and the crystals were of a beautiful deep blue tint. Hence, notwithstanding the low specific gravity, the urine con- tained a large amount of uroxanthin. Of urea there were only traces, and the salts were diminished to an extreme degree ; the phosphate of soda—the principal ingredient—being far below the average, the sulphates and chloride of sodium very trifling, 538 APPENDIX. while there was a mere trace of earthy phosphates. The sub- sequent dissection confirmed the accuracy of the diagnosis. J. An aged man, under the care of Dr. Folwaczny. The urine was extremely turbid, of a dark clay colour, and formed a sediment without itself becoming clear. The sediment was composed of albuminous fungi, numerous cylinders, pavement epithelium, and urate of ammonia. It was upon the presence of the last ingredient that the turbidity was dependent, for on the application of a gentle warmth the fluid became clear. The reaction was strongly acid, and the specific gravity 1029. After the removal of the albumen the specific gravity was only 1017. Hence a large quantity of that constituent was present. On the addition of nitric acid, albumen with a deep violet tint was precipitated ; consequently there was much uroxanthin in the urine. The urea was far below the average ; the uric-acid-and urate of ammonia were abundant. ‘The salts collectively were much diminished, but most especially the chloride of sodium. The subsequent dissection proved the accuracy of the diag- nosis. From these and five additional cases Heller draws the fol- lowing conclusions. | He divides the disease into three stages, in all of which the urine presents separate and distinctive characters. The first is the congestive stage, during which the urine is red from dissolved blood or hematin, but at the same time is acid unless neutralized by the presence of very much blood. In the second—the chronic stage—the urine is pale and of a clay-yellow colour, and frequently resembling whey. In the stage of dissolution which (frequently but not imvari- ably) shortly precedes death, the urine is ammoniacal, developes a putrid odour, and is again bloody. At this stage the drop- sical effusions give off an odour resembling that of rotten eggs. | In all three stages the urine is (with occasional exceptions) diminished.. The largest amount is passed during the chronic stage, when the oedema frequently diminishes for a short time. During the first and last stages, the daily amount of urime seldom. exceeds a few ounces, and blood is often present. The following are the physical characters of the urime. In the first stage it is red and turbid, forming either a red or APPENDIX. 539: white sediment, according as blood-corpuscles are or are not present. The urine is acid, neutral, or slightly alkaline, and has a low specific gravity. In the second stage the urine is of a clay-yellow colour and turbid, forming a brown sediment; subsequently the fluid be- comes of a paler colour, of very low specific gravity, and deposits a white flocculent sediment ; and at this period it exhibits a greater tendency to putrefaction than before. In the third stage the urine is of a dark red colour, and contains more or less blood; it also deposits a red or reddish- brown sediment containing numerous blood-corpuscles. It is either ammoniacal on emission, or rapidly becomes so, and its specific gravity is higher than in the other stages. The occurrence of blood in the first and third stages is de- pendent on totally different causes. | In the congestive stage the constituents of the blood enter the urine by the law of endosmosis, and it is not so much actual blood as serum reddened by hzematin in solution that passes over ; in the last stages, however, the capillaries are ac- tually corroded by the morbid process, and then the blood- corpuscles likewise find their way freely into the urine.e Hence in the latter stage the sediment is always of a reddish-brown tint, while in the former it is often white. The microscopic appearances are divided by Heller into— 1, those of constant occurrence, and 2, those occasionally present. . The constant constituents are: _1. Pavement-epithelium, which is always present, and fre- quently in the congestive stage forms a copious white sediment. 2. Epithelium from the tubes of Beilini, which usually forms only a slight portion of the sediment in the early stages, al- though sometimes present in large quantity from the com- mencement of the disease. 3. Albuminous fungi occurring as a clear dotted granular matter in all fluids containing albumen. When they are very abundant the urine developes a mouldy odour. 4. Mucus-corpuscles. 5. Granular cells (globules of inflammation) are always to be found during the congestive stage. 6. Fat-globules, especially in the chronic form of the disease. 540 APPENDIX. The occasional constituents are : 1. Crystals of uric acid, even when there is a deficiency of that constituent in the urine. 2. Urate of ammonia, generally in the early stages. 3. Pus-corpuscles, usually in the latter stages. 4. Blue crystals of uroglaucin, usnally after the urine has stood for some time. 5. Ammoniaco-magnesian phosphate, when the urine con- tains carbonate of ammonia. The specific gravity of the urine in this disease is variable ; its limits in Heller’s cases were 1006 and 1048. The reaction is usually acid, often strongly so. In some of the cases in which the acidity was most marked, the urine con- tained neither uric nor hippuric acid. Albumen (according to Heller) is always present ; the quan- tity is, however, very variable, and is smallest in children. Uroxanthin is always present in large quantity. The urea exists in diminished quantity. The uric acid is at first increased, but subsequently dimi- nishes, and almost disappears. The salts collectively are much diminished, the diminution corresponding with the progress of the disease. The earthy phosphates and chloride of sodium can sometimes hardly be detected. : We are now enabled to compare the composition of the blood, urine, and dropsical effusions in this form of disease. From a general view of the preceding analyses, (see pp. 494, 515,) it appears that these fluids are a state of antagonism. The water which is retained in the system in consequence of the partial suppression of urine, does not remain in the blood, but collects in the form of dropsical effusions. The albumen, which generally occurs in large quantity in the urine, is taken from the blood, which in the way loses a large quantity of this constituent. 7 This is the way in which most of the albumen is removed, for the subcutaneous dropsical effusions contain very small quantities of it. When, however, dropsy occurs independently of disease of the kidneys, albumen in large quantity is found in the effusions. APPENDIX. | 541 The inorganic salts, which are diminished (or are almost ab- sent) in the urine, do not remain in the blood, but enter the dropsical fluids, where they are often found in an extraordinary quantity. 2 Finally, the urea which is much diminished in the urine, occurs in large quantity in the blood, and in smaller quantity in the dropsical fluids. Pace 862. Liquor amnii. The following analyses of the liquor amnii of women ought to have been mentioned. They were made by Colberg.! 1. 2. Water x ; 2 980-0 977°0 Solid constituents . ‘4 j 20°0 23°0 Albumen : » ‘ 9-0 12°0 Urea. . j 0°5 — Alcohol-extract and lactates i 2°0 3:0 Fat . 4 3 i 2°0 3°0 Chloride of sodium 4 i 4°0 4°0 Phosphate of lime : : 0-2 _ ' Neue Zeitung fur Geburtskunde, 14. 1. 1843. Fig. Fig. 542. EXPLANATION OF PLATE II. 13. Saliva. 13* 4. Colostrum. B. B. Healthy milk. 14. Epithelium. 15. Nasal mucus. 16. Bronchial mucus, with the corpuscles seen in other forms of - mucus. 17. Pus from the lungs. 18. Tubercle. 19. Peculiar forms occurring in tubercle. 20. Pure urea from urine. - 21. Nitrate of urea from urine. 22. Oxalate of urea from urine. 23. Various forms of uric-acid crystals. 23* Various forms of. hippuric acid. 24. A. and B. Chloride of sodium as it crystallizes from urine. » EXPLANATION OF PLATE III. 25. Phosphate of ammonia and soda from evaporated urine. 26. Phosphate of lime from an urinary sediment. [The folia- ceous bodies are most probably urates.] . 27. Ammoniaco-magnesian phosphate from an urinary sediment. 28. Various forms of urate of ammonia from urinary sediments. 29. Various forms of urate of soda from urinary sediments. 30. 4. and B. Various forms in which an acid solution of the earthy phosphates is precipitated by ammonia. 30* Carbonate of lime. 31. The sediment occurring in Bright’s disease. 32. Cystin. 33. Seminal animalcules and granules. 34. Cholesterin. 35. The torula (the fermentation-globules) in diabetic urine. 36. Oxalate of lime in various forms. 37 and 38. Uroglaucin. HAdlard se. 0. ots ¢ ¥ IND EX. Acetic acid, i, 85; in fluid ejected from the stomach, ii, 395; in urine during rheumatism, ii, 274; its effects on the blood-corpuscles, i, 109; its presence in putrid urine, ii, 126. Acid, acetic, i, 85. allantoic, i, 56. alloxanic, i, 60. amniotic, ii, 363. benzoic, its effects in gout, ii, 277. bilic, ii, 20. bilicholinic, i, 48. bilifellinic, i, 48. butyric, i, 75 ; in kystein, ii, 331, 332 ; in the feces, ii, 376. capric, i, 75, 80. caproic, i, 75, 79. capryllic, i, 75, 80. carbonic, in urine, ii, 120. cerebric, i, 71, 81. chloroproteic, i, 9. choleic, ii, 19 ; Pettinkofer’s test for, ii, 193. cholic, i, 48. ultimate composition of, ii, 507. cholinic, i, 47. choloidiec, ii, 20. cyanoxalic, i, 56. dialuric, i, 60. fellinic, i, 47. hippuric, i, 61 ; a constituent of healthy urine, ii, 117; in diabetic urine, ii, 294; in excess in urine, ii, 323 ; to detect in an animal fluid, i, 94; its ultimate composition, ii, 507. humic, in urine of herbivora, ii, 351. hydrochloric, i, 2; in urine, ii, 130. hydrochloro-proteic, i, 8. hydrocyanic, its effects on the blood, i, 108. hydrofluoric, i, 2. lactic, i, 84; Enderlin’s observations on its non-existence in the animal fluids, i, 181, no¢e; in fluid in the abdomen, ii, 498; in urine, ii, 120; to detect in an animal fluid, i, 95; ultimate composition of, ii, 508. lithofellinic, ii, 471. margaric, i, 71; ultimate composition of, ii, 508. mesoxalic, i, 60. mucic, i, 66, note. mycomelinic, i, 60. oleic, i; 74. Acid, oleophosphoric, i, 81. oxalic, i, 84; in saliva, ii, 10. oxaluric, i, 58. parabanic, ib. phosphoric, in urine, ii, 130; determi- nation of, ii, 140. purpuric, i, 59. rosacic, i, 45. salycilous, ii, 341. salycilic, ib. sebacic, i, 74. silicic, in urine, ii, 131. stearic, i, 71; ultimate composition of, ii, 508. sulpho-bi-proteic, i, 8. sulpho-proteic, ib. sulphuric, in urine, ii, 130; determi- nation of, ii, 140. thionurie, i, 60. uramilic, ib. ; uric, i, 53; Bensch’s formula for, ii, 114 note; its origin, i, 149; quali- tative determination of, ii, 116; quantitative determination of, ii, 136; to detect in an animal fluid, i, 94 ; concretions of, ii, 431; ultimate composition of, ii, 507. - urobenzoic, i, 61. urous, i, 62. vaccinic, i, 75, 80. xanthoproteic, i, 8. Acidity of the urine, causes of, ii, 157. Acids, fatty, i, 71. inorganic, their passage into the urine, ii, 337. organic, their passage into theurine, ib. Active metamorphosis of the blood, i, 152. Age, difference of blood according to, i, 237. Air, amount of, inspired, i, 124; atmosphe- ric, its composition, i, 123; in swim- ming-bladder of fishes, i, 138; its amount in water, i, 137. Albumen, i, 15; its estimation in urine, ii, 184, its estimation in blood, i, 178 ; vegetable, i, 5; ultimate composition of, ii, 504. Albuminate of soda, to detect in an animal fluid, i, 94. Albuminose, ii, 503, Albuminous urine, cases in which it occurs, ii, 238 ; how to analyse, ii, 184. Alcohol-extract, i, 31; of blood, i, 36; of milk, i, 39; of urine, i, 37; to de- tect in an animal fluid, i, 97. 544 Alcohol, its effects on the blood-corpuscles, i, 109; its occasional passage into the urine, ii, 339. Alkaline reaction of the blood due to the presence of tribasic phosphate of soda, i, 182 note; of the lymph, chyle, and blood, cause of, ii, 148. Alkaline urine, ii, 207. nofe. sulphates, i, 3. Allantoic acid, i, 56. - Allantoin, i, 55, ii, 363; to detect in an animal fluid, i, 94. Allantois, fluid of the, ii, 363. ALLEN and Prpys’s experiments on re- spiration, i, 125. Alloxan, i, 57. Alloxanic acid, i, 60. Alloxantin, i, 60. Alumina, i, 4; in a gall-stone, ii, 470. Amniotic acid, ii, 363. Ammoniacal salts, i. 4. Ammonia in urine, ii, 132; its effect on the blood-corpuscles, i, 109; urate of, i, 55. Ammoniaco-magnesian phosphate, i, 2; its occurrence in decomposed urine, ~ ii, 133; li, 433. Ameeba rotatoria in blood of fishes, i, 350. Amphibia, blood-corpuscles of, i, 104. Amygdalitis, blood in, i, 268. Anzemia, blood i in, i, 308. Anzemic urine, ii, 207, note. Analysis, microscopic, of an animal fluid, i, 71; physical, i, 90; qualitative, i, 93 Anasarca, urine in, ii, 312. Anazoturia, ii, 306. «- : ANCELL on the blood in hydremia, i, 308; on the blood in- yellow fever, i, 320; on vomited blood, i, 318; on the production of animal heat, i, xii, preface. ANDRAL on urinary sediments in pneu; monia, ii, 215; on the urme in typhus, ii, 250. ANDRAL and GAVARRET, on the differences in pneumonic blood during repeated venesections, i, 260; experiments on respiration, i, 128. on the blood in acute rheumatism, i, 274 ; in angina tonsillaris, i, 268 ; in cerebral congestion, i, 304; in chlorosis, i, 310; in chronic rheu- matism, i, 276; in erysipelas, i, 277; in febris continua, i, 295; in febris intermittens, i, 301: in he- morrhagia cerebralis, i, 302; in in- flammation of the bladder, i, 273; in morbus Brightii, i, 321; in peri- tonitis, i, 270; in phthisis tubercu- test for, in concretions, INDEX. losa, i, 279; in pleuritis, i, 267 ; it pneumonia, i, 259; in rubeola, i 300; in scarlatina, ib.; in typhu fever,-i, 289; in variola, i, 299 their method of analysing blood, i 240. ANDRAL, GAVARRET, and DELAFOND 01 the blood of domestic animals it health and disease, i, 340. Angina tonsillaris, blood in, i, 268; urin in, ii, 224. Animalcules in blood; i, 335, 350; in milk, ii, 69; in pus, ii, 96. Animal diet, its effects on the urine, ii 57. Animal fluids, general method of a i, 90. Animal heat, i, 142. Animal sugars, i, 65. Animals, arterial and venous blood of dif ferent, i, 196; bile of, ii, 24 ; blood corpuscles of, i, 103; blood of, i 339; milk of, ii, 61 ; respiration of i, 136; temperature of, i, 142 ; urin of, ii, 342. ANSELMINO on the composition of the sweat, ii, 103. Antimony, its passage into the urine, ii 337. gigi Aorta, blood of, compared with blood o; the renal veins, i, 213; compare with portal blood, i, 201. Arsenic, i, 4; its passage into the urine, ii 337 Arterial blood, cause of its bright colour, i 193, note. Arterial and venous blood, comparative analyses of, i, 194; distinctive cha racters of, i, 192. Arteries, ii, 421. ASCHERSON on a peculiar form of blood. corpuscle, i i, 105. Ascites, urine in, ii, 309. Ass, chyle of, i, 356; lymph v i, 352 blood of} i, 349; colostrum of, i 5, 61 milk of, ii, 63. Atmospheric air, composition of, i, 123. AUDOUARD on kystein, i ii, 334. Ayres on the blood in Bright’s disease, i 502; onthe urine in Bright’s disease ii, 520. Baarp on the blood in plague, i, 320. BaRRUvEL on the detection of morphia in urine, ii, 339. BarsE on the existence of copper and leac in the human body, i, 4 nofZe. BAuMERT on the urine in rheumatism, ii 276. Bases, vegetable, their passage into urine li, 338. INDEX. Beaver, urine of, ii, 350. BrecavuEret and Ropier, their analyses of healthy venous blood, i, 233. on the blood in bronchitis, i, 258; in chlorosis,i,312; in fever, continued, i, 297; puerperal,i, 282; typhoid, i, 294—in icterus, i, 331—in inflam- mation generally, i, 251; in pericar- ditis, i, 255; in peritonitis, i, 272; in phlegmasiaalba,i, 254; in phthisis pulmonalis, i, 281; in pleuritis, i, 267 ; in pneumonia, i, 263; during pregnancy, i, 336; in rheumatism, i, 276. on the influence of sex on the blood, i, 235; of venesection on the blood, i, 248. BecQuEREL on the amount of urine ex- creted in a state of health, ii, 204 ; his analyses of healthy urine, ii, 145; his classification of morbid urines, ii, 200, note; on the specific gravity of urine as a means of ascertaining the amount of solid constituents, ii, 115. on the urine in angina tonsillaris, ii, 224; in bronchitis, ii, 214; in can- cer, ii, 318 ; in cerebral hemorrhage, li, 266; in chlorosis, ii, 262; in cystitis, ii, 240; in delirium tremens, ii, 212; after delivery, ii, 335; in diseases of spinal cord, ii, 213; in dropsy, ii, 310; in dysentery, ii, 225; in emphysema, ii, 223; in en- teritis, ii, 225 ; in erysipelas, ii, 278; in gastritis, ii, 224; in hepatitis, ii, 227; in intermittent fever, ii, 255; in meningitis, ii, 211; in ne- phritis acuta, ii, 230, no¢e; in n. albu- minosa, ii, 233; in phthisis pulmo- nalis, ii, 287; in pleuritis, ii, 220; in pneumonia, ii, 215; during preg- nancy, ii, 334; in rheumatism, ii, 275; in scarlatina, ii, 279; in scro- fula, ii, 284; in typhus, ii, 245; in variola and varicella, ii, 282. Benson, his formula for uric acid, ii, 114, note. Benzoate of ammonia, test for, ii, 431. Benzoic acid, its effects on gout, ii, 277. BERNARD and BarreEswit on the gastric . Juice, ii, 30. BERTAZZ1, his analysis of milky blood, i, 333; on the occurrence of copper in gall-stones, ii, 471. Bezoar-stones, ii, 468. Berze ius on the analysis of blood, i, 167; on the bile, ii, 17, 24; on the com- position of bone, ii, 400; onthe feces, li, 372; their black discoloration from the use of iron, ii, 390; on the gastric juice, ii, 28; on the nasal If. 545 mucus, ii, 75; on the saliva, ii, 4; on the urine, ii, 143; on the precipitates thrown down from urine by certain metallic salts, ii, 119; on the state inwhich uric acid exists in the urine, ii, 114. BrprA, his analyses of human bones, ii, 397; of cartilage, ii, 416; of pus, ii, 91; of teeth, ii, 414; on intestinal con- cretions in horses, ii, 468; on the urine of goat, ii, 349; of hare, ii, 350 ; of oxen, ii, 346; of pig, ii, 348; on urinary calculi in animals, ii, 462. Bile, ii, 17; analysis of human, by Berze- lius and Thenard,ii, 19; by Frerichs, ii, 519; formed from the blood-cor- puscles, i, 211; in icterus, ii, 21 ; in meningitis, ii, 520; in phthisis, ii, 24; in pneumonia, ii, 520; in scir- rhous pancreas, ii, 24 ; in syphilis, ii, 23. its action in digestion, ii, 25 ; its func- tions, ii, 26. methods of detecting in blood, i, 187 ; in urine, ii, 192. of animals, ii, 24; of coluber natrix, ib.; of cyprinus leuciscus and c. bar- bus, ii, 25; of ox, ii, 24; of rana esculenta, and r. temporaria, ii, 25 ; of python bivittatus, ii, 24. Bile-pigment, i, 43; in blood, i, 329; in urine, ii, 191. Biliary colouring matter, ScHERER’s re- searches on, ii, 23, note 1. ' concretions in man, ii, 469 ; in animals, ii, 471. resin, i, 48; test for, ii, 432. Bilic acid, ii, 20. Bilious fever, urine in, ii, 270. Bilicholinic acid, i, 48. Bilifellinic acid, i, 48 ; in urine, 2, 192. Bilifulvin, i, 44. Bilin, i, 45; its effects on blood-corpuscles, i, 106, 108, 111; its origin, i, 149, 161; tests for, i, 96; ii, 192; in urine, ii, 192. Biliverdin, i, 44; to detect in animal fluid, i, 96; iri urine, li, 314. Biliphein, i, 43 ; in pneumonic blood, i, 266; in urine, ii, 191; test for, i, 187, note; ii, 432. Binoxide of protein, i, 11. Brrp on calomel stools in children, ii, 387 ; on the composition of pus, ii, 91 ; on oxalate of lime and its frequent occurrence in urinary sediments, i, 85; ii, 200. on the urine in azoturia, ii, 307; in chlorosis, ii, 265 ; in marasmus, ii, 317; in phthisis, ii, 288; in polydipsia, ii, 306; during preg- nancy, li, 331. 35 546 INDEX. Birds, blood-corpuscles of, i, 103; process of digestion in, ii, 38; temperature of, i, 142 ; urine of, ii, 351. BLANDIN on pus in blood, i, 333. BLonpDLoT on the gastric juice, ii, 29. Blood, i, 100; alkaline reaction of, i, 182, note. analysis of, i, 167; of coagulated, i, 242. analysis, microscopic, of, i, 102; ¢che- mistry, special, of, i, 166; consti- tuents, proximate, of, ib.; extractive matters of, i, 35. general chemical relations of, i, 107; physical characters of,i, 101; phy- siological relations of, i, 191; meta- morphosis of,i, 139, 152; in nutri- tion, i, 147 ; pathological chemistry of, i, 239 ; specific gravity of, i, 101; temperature of, i, 102, 142. affected by age, i, 236; constitution, ib.; inflammation, i, 251; sex, i, 234; temperament, i, 236; vene- section, i, 248. arterial and venous, characters of, i, 192; before and after delivery, its difference, i, 342 ; of the capillaries, i, 217; of the hepatic vein, i, 208; of the placenta, i, 238 ; of the portal vein, i, 201; during pregnancy, i, 336; of the renal veins, i, 213; of the umbilical arteries, i, 238; of young compared with that of old animals, i, 238. changes of, during the circulation, i i, 198, 218; in the liver, i, 212; in the lungs, i, 191; colour of, i, 101 ; forces that circulate the, i, 122; for- mation of the, i, 118; nervous sys- tem, its influence on the, i, 200. animalcules in the, i; bile-pigment in the, i, 329; cercaria in the, i, 350; fat in the, i, 332 ; polystoma sangui- culum in the, i, 335; pus in the, i, 333; sugar in the, i, 327. in disease, i, 239; in albuminuria, i, 321, ii, 514; in amygdalitis, i, 268 ; in anzemia, i, 308 ; in angina tonsil- laris, i, 268; in Bright’s disease, i, 321; ii, 514; in bronchitis, i, 255; in carditis, i, 254; in carcinoma, i, 284, 309 ; in cerebral congestion, i, 302; in chlorosis, i, 310; in cholera, i, 325; in convulsions, i, 282 ; in cystitis, i, 273; in diabetes, i i, 327; in eclampsia, i, 282; in erysipelas, i, 277; in fever, continued, i i, 295— intermittent, i, 301, ii, 510 ;—puer- peral, i, 282— typhoid, i, 288—yel- low, i, 319; in hematamesis, i; in hematuria, i, 318; in hepatitis, i, 268; in hydremia, i, 308; in icterus, i, 329; in inflammations generall i, 251; in inflammation of the th racic viscera, ii, 509; in land-scury i, 316; in lienitis, i, 268 ; in measle i, 300; in melzena, i, 317 ; in metre peritonitis,i,272; in metrophlebiti i, 252; in morbus Brightii, i, 32] ii, 514; in morbus maculosus Wer hofii, i, 316; in nephritis, i, 273; ‘ ophthalmia, ii, 510; in pericarditi i, 235; in peritonitis, i, 269; | phlegmasia alba, i, 253; in phthis tuberculosa, i, 279; in plague, 319; in pleuritis, i, 266; in pne monia, i, 258 ; in pneumonia bilios i, 264; in purpura heemorrhagica, 319; in rheumatism, i, 2783.3 rubeola, i, 300; in searlatina, 300; in scrofula, i, 309, ii, 513; | scurvy, i, 315; in thoracic inflamm tion, ii, 509 ; in typhus abdominali i, 288; in typhus petechialis putt dus, i, 319; in variola, i, 298. © Blood, animalcules in the, i, 335, 530. of animals, i, 339; of ape, i, 349; | bufo variabilis, i, 348; of calf, 340, 349; of carp, i, 348; of cat, 346, 349 ; of dog, i, 342, 346, 34¢ of duck, i, 349; of eel, i, 350; of ee pout, ib.; of frog, ib.; of goat, i, 34 346, 349; of guinea-pig, i, 349; hen, ib.; of heron, ib.; of horse, 339, 341, 346, 349; of lamb, 342; of land-tortoise, i,350; of o i, 340, 341, 346 ; of pigeon, i, 351 of rabbit, i, 346, 349; of raven, 349; of sheep, i, 341,346, 349; | " swine, i, 341, 346; of tench, i, 34{ of trout, i, 350. Blood-corpuscles, general chemical rel tions of, i, 107; formation of, 153; of man, various measuremen of, i, 103; of various animals, ib of irregular form, i, 105; effects various reagents on, i, 104; er ployed in the secretion of bile, 21il; and fibrin, their antagonism, 1, 24 metamorphosis of, i, 159, Blood-corpuscles, nuclei of, i, 138; chen cal relations of, i, 112. Bloody urine, its character, ii, 187. Boa-constrictor, urine of, i, 53, note. Bones, i ii, 396; carious, ii, 408; in arth tis, ib.; in osteomalacia, ii, 401 in rachitis, ib.; necrotic, ii, 410. of armadillo, squirrel, mouse, rabb hare, sheep, goat, bull, horse, de phin, common seal, cat, wolf, be ape, birds, reptiles, and fishes, | 402. INDEX. Bostock on bone in osteomalacia, ii, 406; on the saliva in ptyalism, ii, 12. Bovucuarpart on the blood in diabetes, i, 327; on diabetic urine, ii, 300; on an insipid diabetic sugar, ii, 197, 293; on a case of milky urine, ii, 229; on urine containing an excess of hippuric acid, ii, 324. Bovuper on the fat in the blood, i, 188; on the composition of healthy and fatty liver, ii, 429; of the lungs, ib. BovussINGAULt on the urine of the cow, ii, 346; of the horse, ii, 344; ofthe pig, ii, 349. Brain, composition of, ii, 425; concretions in the, ii, 474. fats, i, 81. Briacut’s disease, blood in, i, 321, ii, 514; urinary sediment in, ii, 235, 539; urine in, ii, 231, 528. Bromine, its passage into the urine, ii, 336. Bronchitis, blood in, i, 255; urine in, ii, 219. BRUNNER and VALENTIN’s experiments on respiration, i, 130. Buffy coat of blood, i, 250; its nature, i, 13, note. Bufo variabilis, blood of, i, 348. Bull-frog, urine of, ii, 352. Burpacs on the forces that circulate the blood, i, 122. BusHMAN on worms in the blood, i, 335. Busxk on the blood in scurvy, i, 315. Butter, i, 75. Butyric acid, i, 75; in kystein, ii, 331, 332 ; in feeces, ii, 376. Butyrin, i, 78. Calculi, salivary, ii, 473. urinary, ii, 437. of animals, ii, 451. Calf, blood of, i, 340, 349. €allus, ii, 413. Calomel stools, ii, 386. Camel, urine of, ii, 347. Cancer, L’Heretier’s analyses of, ii, 481. CANTIN on a case of diabetes, ii, 301. Car and Henry on urea in the urine of serpents, li, 352. Capillaries, blood of, i, 217. Capric acid, i, 75, 80. Caproic acid, i, 75, 79. Capryllic acid, i, 75, 80. Carbonate of ammonia in urine, ii, 197,311. Carbonate of lime, i, 2; in urine, ii, 200; microscopic character of, ib. of magnesia, i, 3. of soda, ib. Carbonic acid, formation in the blood, i, 132. expired, quantity of, i, 128; how affected by disease, i, 127; causes affecting the amount expired, i, 130. 547 Carbonic acid, method of detecting in urine, ii, 120. Carcinoma, blood in, i, 309; urine in, ii, 317. medullare colli uteri, blood in, i, 284. Carditis, blood in, i, 254. Carp, blood of, i, 348. Cartilage, ii, 415. Casein, i, 19; ultimate composition of, ii, : 505 ; vegetable, i, 6 ; to detect in an animal fluid, i, 93; in urine, ii, 190, 324. Cat, blood of, i, 346, 349; chyle of, i, 357. Catarrh, urine in, ii, 268 CaTTranEI on the non-existence of copper in the bodies of new-born children, i, 4, note. Cattle, urine of, ii, 345. CaveENtTovu on the blood in chronic pleu- ritis, i, 267. Cells, nutrition of, i, 148; functions of, i, 140 Cellular tissue, ii, 416. Cephalot, i, 81. - Cerain, i, 70. Cercaria in blood, i, 350. Cerebral congestion, blood in, 1, 302. Cerebric acid, i, 71, 81. Cerebrot, i, 81, 83. Cerumen, ii, 354. Cetyl, oxide of, i, 70. CHEVALLIER and Henry on the composi- tion of the milk, ii, 53; on the com- position of morbid bile, ii, 23. CHEVREUL on the urine of the camel, ii, 347. Cut1AJE on the polystoma sanguiculum in the blood, i, 335. CHILDREN, on an intestinal concretion in, ii, 465. Chlorate of potash, its effects on the blood, i, 108 Chloride of ammonium in urine, determi- nation of, ii, 138. of calcium, i, 3. of iron, ib. of potassium, ib. of sodium, i, 2: amount excreted, ii, 167; in urine, increase or decrease of, ii, 182; the forms in which it crystallizes from urine, ii, 131. Chlorides of sodium and potassium in urine, determination of, ii, 140. Chlorine in urine, determination of, ii, 140. Chlorohzmatin, i, 43. Chloromichmyle, ii, 341, note. Chloroproteic acid, i, 9. Chlorosis, on a peculiar form of, i, 315; blood in, i, 310; saliva in, ii, 12; urine in, ii, 261. Cholemia, i, 329. Choleic acid, i, 48, ii, 20; PerrinKo¥FER’s test for, ii, 793. 548 Cholepyrrhin, i, 43. Cholera, blood in, i, 325; faeces in, ii, 382 ; urine in, ii, 271. Cholesterin, i, 82; its estimation in the blood, i, 88. in blood, its increase with age, i, 237 ; test for, ii, 432. ‘ in urine, ii, 313, 333. Cholic acid, i, 48, ii, 505. Choline-soda, ii, 21. Cholinic acid, i, 47. Choloidic acid, ii, 20. CHOoMEL On the blood in typhoid fever, i, 293. Chondrin, i, 25; ultimate composition of, ii, 506. CurisTIson on the blood in Bright’s dis- ease, i, 321; on healthy urine, ii, 145; formula for determining the solid constituents in diabetic urine, ii, 290. Chyle, i, 354 ; of dogs, i, 358 ; of horses, i, 354. influence of diet on, i, 358; formed from chyme, ii, 39. Chylous urine, ii, 190. Chyme, its conversion into chyle, ii, 39. Circulating fluids, the, i, 100. CxiemmM on milk, ii, 47, 51. Clot, inferences to be drawn from the size and appearance of, i, 292, note. Coagulated blood, analysis of,i, 190. Coagulation, acceleration of, i, 117; re- tardation or prevention of, i, 115. CoaTHuPE on the development of carbonic acid at different periods of the day, i, 127, Co1npET on the urine in inflammation of the liver, ii, 226. CoLBere on the liquor amnii, ii, 541. Colostrum, ii, 49; of women, composition of, ii, 50; of animals, ii, 61. CoLLarp DE Martieny on bile in the blood in icterus, i, 329. Colour of the blood in the lower animals, i, 101. Colouring matters, their passage into the urine, ii, 339. Colouring matters of the bile, blood, and urine i, 39. Colours of arterial and venous blood, causes of, i, 192, note. Comparison of the blood of the mother and foetus, i, 237. Composition of venous blood, i, 227. Coneine, its effect on the blood, i, 108. Constitution, differences of blood depen- dent on, i, 236. Continued fever, blood in, i, 295. Convulsions, blood in, i, 282. Copaiva, its effect on the urine, ii, 185. Copper, i, 4; in gall-stones, ii, 471. INDEX. Cow, colostrum of, ii, 61. Cozzi on the blood in intermittent feve ii, 510. . Cruorin, i, 170. Crystalline lens, ii, 419. Crystallin, ultimate composition of, i 505. Cubebs, their effect on the urine, ii, 185. Cutis, ii, 417. Cyanoxalic acid, i, 56. Cyanurin, i, 45. . Cysts, analyses of their contents, ii, 485. Cystic oxide, i, 64. Cystin, i, 64; a test for, ii, 431; in caleul ii, 445; in urine, ii, 201; ultimat composition of, ii, 508. Cystitis, blood in, i, 273; urine in, ii, 24 329 Davy on the composition of meconiur li, 367 ; on intestinal concretions, i 466 ; on the urine of the bull frog, i 352 ; on the vernix caseosa, ii, 364 Day, his analysis of healthy urine, ii, 14¢ on the specific gravity of the urin ii, 116. DELARIVE onthe blood in hematuria,i,3 1! Delirium tremens, urine in, ii, 212. Demarcay on the bile, ii, 19. Dents, his method of analysing blood, 169; on the blood of the capillarie i, 217; on venous blood, i, 230; the influence of age on the blood, 237 ; on the blood in icterus, i, 33¢ on the menstrual fluid, i, 337. Dentine, ii, 413. DEVERGIE on the presence of copper | the human body, i, 4 Deviations in the constitution of morbi blood, i, 246. DeryeEvux on diseased milk, ii, 59. Diabetes mellitus, amount of carbonic ac: expired in, i, 127; pathology of, 303; occasionally periodic, ii, 30: blood in, i, 327; feces in, ii, 337 sweat in, i, 66, note, ii, 297; uri in, ii, 289. chylosus, urine in, ii, 308. insipidus, urine in, ii, 304. Diabetic sugar, i, 66. Dialuric acid, i, 60. Diastase in saliva, ii, 9. Diet, its influence on the urine, ii, 156. Dierricu, his analysis of gluten, ii, li note. Digestion, artificial, ii, 27, 37; process ¢ li, 35; diseased, ii, 41. Diseased blood, i, 239. Diuresis, ii, 305. Diuretic action of salts explained, ii, 149. Dog, blood of, i, 342, 346, 349; chyle ¢ i, 358 ; gastric juice of, ii, 29; mil of, ii, 66, 521; saliva of, ii, 15. INDEX: Donné on ammonia as a test for pus in blood, i, 334 ; on animalcules in pus, ii, 96;.on the colostrum, ii, 49; on the milk in syphilis, ii, 59 ; on saliva, ii, 10; on iron in normal urine, ii, 265; on the urine in pregnancy, ii, 334. Dropsical fluids, ii, 490. Dropsy, urine in, ii, 308 ; saliva in, ii, 13. Dvusois on the blood in scrofula, i, 309. Duck, blood of, i, 349. Dov x on black urine, ii, 328. Dutone and Desprerz’s experiments on respiration, i, 125. : Dvumas’s experiment on respiration, i, 129 ; on the milk of the carnivora, ii, 521. Dumas and Prevost on the blood of va- rious animals, i, 349. _ Dumentt, his analysis of healthy urine, ii, 145 Duneuison on the gastric juice, ii, 28. Dysentery, urine in, ii, 225. Dyslysin, i, 47. Earthy phosphates in urine, determination of, ii, 139 ; increase or decrease of, ii, ; 79 ; microscopical characters of, ii, 80. Ear-wax, ii, 354. Eclampsia, blood in, i, 282. Eel, blood of, i, 350. Eel-pout, blood of, i, 350. Eguiser on kystein, ii, 329. ErcHHotrz on pyin, ii, 74 note. EIsENMANN on the urine in rheumatism, ii, 275. Electricity, its effect on the coagulation of a the blood, i, 116. Eleencephol, i, 81. Elephant, urine of, ii, 347. Emphysema, urine in, ii, 223. Empyema, urine in, ii, 223. Enamel of teeth, ii,.414. Encephalitis, urine in, ii, 211. ENDERLIN on the ash of human blood, i, 234; on the ash of the blood of various animals, i, 348 ; on the non- existence of lactic acid in the ani- mal fluids, i, 181, note; on the pre- sence of bile in the blood, i, 188, note ; on the salts in the bile of the Ox, li, 24; on the ash of saliva, ii, 8 ; on the feces, ii, 372. ‘Endocarditis, urine in, ii, 210. -Endometritis, urine in, ii, 242. Enteritis, urine in, ii, 225. Epidermis, ii, 418. . ‘Epithelium, various forms of, ii, 70, note. -ERLENMEYeER on the urine in insanity, ii, 211. Erysipelas, blood in, i, 277; urine in, ii, 278. Erythroprotid, i, 13 ; ultimate composition of, ii, 502. 949 Ether, its effect on the blood, i, 110. Exanthemata, urine in the, ii, 270. Excretions, intestinal, ii, 366. Exercise, its effect on the urine, ii, 164, 168. Expectoration, purulent, ii, 84. Exostosis, ii, 410. Extractive matters, i, 30; of blood, i, 35; their estimation, i, 181; of urine, i, 30, 37, ii, 118,178, note. Exudations, various, analyses of, ii, 497. Eye, fluids of the, ii, 421. Feces, ii, 366; of an infant, ii, 369; of adults, ii, 370; ultimate analyses of, ii, 385. during disease, ii, 376; green, in chil- dren, ii, 387; in abdominal typhus, ii, 381; in catarrh, intest., ii, 382; in cholera, ib.; in diarrhcea infan- tilis, ii, 384; in diabetes, ii, 377; in dysentery, ii, 380; in enteritis mucosa, ii, 381; in entero-phthisis, ii, 384; in icterus, ii, 384; in me- lena, ii, 382; in typhous diarrhea, ii, 381. Fat, ii, 112; human, i, 82; in the blood, i, 332; in urine, ii, 323. Fats, i, 69; method of separating from blood, i, 188; the non-saponifiable, i, 82; true, i, 70. and fatty acids, to detect in an animal fluid, i, 95. Fatty acids, i, 71. bases, i, 70. urine, ii, 189. matter discharged by the bowels, ii, 465. Febrile urine, ii, 206, note, 208. Febris intermittens, blood in, i, 301, ii, 510. continua, blood in, i, 295. puerperalis, blood in,i, 282 ; urine in, ii, 228. Fellinic acid, i, 47. Fermentation, test for sugar, i, 69. ' globules, ii, 294. Fever, Mulder’s theory of, ii, 12 nofe. Fibrin, i, 18 ; formation of, i, 157; its esti- mation in blood, i, 177. in urine, ii, 188, 210, 219, 220. ultimate composition of, ii, 505. Fibrin and blood-corpuscles, their antago- nism, i, 247. Freurer on the analysis of blood, i, 190. Fishes, blood of, i, 348 ; blood-corpuscles of, i, 104; respiration of, i, 137; temperature of, i, 143. Fixed ‘salts in urine, determination of, ii, 139; amount excreted, ii, 166. Flesh, analyses of, ii, 422. Fluid of ascites, ii, 490; of hydrocele, ii, 495; of hydrocephalus, ii, 490; of 550 subcutaneous effusions, ii, 493; of thoracic effusions, ii, 492. Fluoride of calcium, i, 2. in urine, ii, 131. a constituent of bone, ii, 397, note. Frericus on the bile, ii, 519; on the composition of fatty and waxy liver, ii, 428. Gall-stones, ii, 469; manganese in, i, 4. GARROD on urine containing an excess of hippuric acid, ii, 324. Gases in the blood, experiments relating to, i, 133. evolved by the skin, ii, 105. various, their effects on the tlood, i, 123. Gastric fever, urine in, ii, 270. Gastric juice, ii, 27 ; morbid, ii, 33. Gastritis, urine in, ii, 224. Geppines on the blood in hydremia, i, 309. Gelatin, i, 25. sugar of, i, 27; its ultimate compo- sition, ii, 506. Glands, composition of, ii, 427. Globulin, i, 22; its estimation in blood, i, 179. Glutin, i, 26; origin of, i, 28; ultimate composition of, ii, 506 Glycerin, i, 70; ultimate composition of, ii, 508. Glyceryl, i, 70. Glycicoll, i, 27; its ultimate composition, ii, 506. GMELIN, his analysis of human lymph, i, 351; on the detection of mercury in salivayii, 11; on the urine in cramp in the stomach, ii, 316. GMELIN and TiEDEMANN on the pancreatic fluid of the dog and sheep, ii, 16; on the saliva of the Sheep, ii, 15; on the gastric juice, ii, 28. Goat, blood of, i, 341, 346, 349; urine of, li, 349. GooDFELLOowW, his case of animalculz in the blood, i, 335. Goopstr, his discovery of the sarcina, ii, 394 Goose, blood of, i, 346. Gout, urine in, ii, 277. Gravel, urinary, ii, 459. Graves on the presence of carbonate of ammonia in urine, ii, 311; on the urine in Bright’s disease, ii, 240. GRIFFITH on a urinary sediment containing carbonate of lime, i ii, 201." GruBy on morbid mucus, ii, 79. Grusy and DELAFOND on vias in blood of the dog, i, 350. Guinea-pig, blood of, i, 349; urine of, ii, 350 GULLIVER an pus in blood, i, 333. INDEX. GiirERBocK on the composition of pus, 4 ii, 89. q Heemacyanin, i, 43. Hemaphzin, i, 42; origin of, i, 159. in urine, ii, 119 -its estimation in blood, i, 180. : Hematemesis, blood discharged i in, i, 318. : Heematin, i, 39; metamorphoses of, 159; general chemical relations of, i, 112. its estimation of blood, i, 180; ulti-- mate composition of, ii, 506. - Hematuria, urine in, ii, 267 ; blood in, i, 318. 7 Hemorrhagia cerebralis, blood in, i, 302. — Hemorrhages, blood in, i, 317; urine in, ii, 226. : HarpuEN on the analysis of milk, i ii, 46. on the composition of woman’s milk, ii, 52. Hair, ii, 418 ; a source of binoxide of pro-— tein, i i, 11; in concretions, ii, 432. — Hare, urine of, ii, “350. 4 Healthy blood in relation to 0 physiology, i, "191. : Heat, animal, i, 142. HEInricu on the urine in insanity, 4 i 211. HEINTz on a new constituent in urine, i 127. 3 HELLER on biliphzein in blood, i, 266; on the determination of albumen, ii, 187. 3 on the blood in Bright’s disease, i, 514; in sporadic cholera, i, 326; im convulsions, i, 283; in febris puerpe- ralis, i, 282 ; in peritonitis, i, 271 ;in metroperitonitis, i, 272; in erysi- pelas, i, 279 ; in pneumonia, i, 263; in pneumonia biliosa, i, 265. s on the fluid of hydrocele, 2, ee. ; on the subcutaneous serum in Bri; disease, i ii, 494, on the urine in ascites, ii, 311; Bright’s disease, i ii, 528 ; in cholera ii, 271; in herpes zoster, ii, 320 in morbus maculosus Werlhofii, i 259; in pneumonia, li, 218; pompholix, ii, 322; in syphilis, i 319. on urostealith, ii, 326, 452. on the composition of a green vo mit fluid, ii, 392. HeLmHonrz on the consumption of tissu during muscular action, ii, 424, E Hen, blood of, i, 349. a Henry, his table for diabetic urine, i 289; on the urine in rheumati ii, 275; in chronic inflammation ¢ the liver, i ii, 226. Henry and Souserran on the blood i | diabetes, i i, 328. aan Hepatic vein, blood of, i, 208. | INDEX. Hepatitis, blood in, i, 268; milky serum : in, i, 333; urine in, ii, 226. HERBERGER on diseased milk, ii, 59; on the blood in chlorosis, i, 313; on the urine in chlorosis, ii, 264. HERING’s analyses of the blood of the bullock, sheep, and horse, i, 196; experiments on the velocity of the circulation, i, 223. Heron, blood of, i, 349. _ Herpes zoster, urine in, ii, 320. HerRMAN on the urine in cholera, ii, 272. HeERz06 on the urine in hepatitis, ii, 228. Heterochymeusis, i, 321. Hewson on the functions of the spleen, i, 119. HieRoNyYMI on the urine of carnivora, ii, 342. Hippuric acid, i, 61. a constituent of healthy urine, ii, 107. of diabetic urine, ii, 294. in excess in urine, ii, 324. to detect in an animal fluid, i, 94. ultimate composition of, ii, 507. HorrMann on dried pneumonic blood, i, 264. Horse, blood of, i, 339, 341, 346, 349; gastric juice of, ii, 29; saliva of, ii, 14; urine of, ii, 342. _ Humic acid in urine of herbivora, ii, 351. Humour, vitreous, of the eye, ii, 421; aqueous, of the eye, ii, 421. Humso.upt and Proven¢at, their experi- ments on the respiration of fishes, i, 137. HuNEFELD, on a test for sugar, i, 67; on the composition of the blood- corpuscle, i, 113. on a peculiar form occasionally pre- sented by blood-corpuscles, i, 106. on the urine of carnivora, ii, 342. Hybernation, i, 145. Hydatids, ii, 484. Hydrzemia, blood in, i, 308. Hydrocele, fluid of, ii, 495. Hydrochloric acid, i, 2; in urine, ii, 130. Hydrochloro-proteic acid, i, 8. Hydrocyanic acid, its effect on the blood, i, 108. Hydrofluoric acid, i, 2. in urine, ii, 131, Hydrosulphate of ammonia in urine, ii, 218. Hydrothorax, urine in, ii, 308. Hydruria, ii, 305. Hygroma, fluid of, ii, 489. Hyperinosis, i, 250. causes of, i, 284. Hypinosis, i, 287; causes of, i, 304. ae hres characters of the blood in, i, 287. ‘chemical characters of the blood in, i, 287 551 Hysteria, urine in, ii, 316. Ichor, ii, 96. Ichthyosis, composition of scales of, ii, 483 Icterus, bile in, ii, 23; blood in, i, 329; urine in, ii, 313. Incineration, its effect in increasing the sulphates ‘and phosphates in ana- lyses of urine, ii, 141. Incrustations on the surface of the body, ii, 482. Indigo in urine, ii, 326. Inflammation, its effects on the blood, i, 251; Muxper’s theory of, i, 12, note. Inflammation thoracic, blood in, ii, 507. Inflammatory affections, saliva in, ii, 13. Influenza, urine in, ii, 268. Insanity, urine in, ii, 211. Insects, respiration of, i, 138. Inorganic acids, their passage into the urine, ii, 337. Intermittent fevers, urine in, ii, 255. Intestinal concretions, ii, 464. in animals, ii, 466. Intestinal fluid, ii, 34. Iodine, its passage into the urine, ii. 336 ; to estimate, ii. 319. Iron, i, 3; its effect on the blood in chlo- rosis, i, 312; its effect onthe urine in chlorosis, ii, 264 ; its passage into the urine, ii. 337. peroxide of, presence in urine, ii, 134. J GER on intestinal concretions, ii, 464. Jaundice,. blood in, i, 329; urine in, ii, 313. JENNINGS on the blood in chlorosis, i, 310, 314; in continued fever, i, 297; in typhoid fever, i, 293. KANE on kystein, ii, 329. Kei, his experiments on the circulation in the kidney, i, 256. Kemp on the bile, ii, 20. KERSTEN on green evacuations, li, 389. Kidneys, composition of, ii, 429 ; functions of, i, 215. KLEYBOLTE on kystein, ii, 334. Kreatin, i, 32, 35. Kystein, ii, 329; its uncertainty as a test for pregnancy, ii, 333, 334. LacuezeE on the blood in the plague, i, 320. Tachrymal glands, secretion of, ii, 353. Lactate of ammonia in urine, determination of, ii, 138. Lactic acid, i, 84; to detect in an animal fluid, i, 95, 96. in fluid in the abdomen, ii, 498. Enderlin’s observations on its non- existence in animal fluids, i, 181, note. a solvent of oxalate of lime, ii, 20 0. 552 Lactic acid in urine, ii, 120; increase or decrease of in urine, ii, 170. ultimate composition of, ii, 508. vy. LAER on the hair, ii, 401; on binoxide of protein, i, 11. LAGRANGE and HassENFRATZz on the for- mation of carbonic acid in the blood, i, 132.. Lambs, blood of, i, 342. LANDERER on the feces in diarrhea in- fantilis, ii, 384. Land-scurvy, blood in, i, 316; urine in, ii, 258. Land-tortoise, blood of, i, 350; urine of, ii, 352. Lassatenz, his analysis of lymph, i, 352 ; on the milk before delivery, i li, 48; on the urine of pigs, ii, 347. Laver on the blood in nephritis. i, 273; on turbid serum in pleuritis, i, 267. LAVERAN and MiILuLon on : ion passage of medicines into the urine, ii, 337. Lead, i, 4 Lrecanv, his analysis of milky blood, i, 333 ; venous blood, i, 229. on the blood in carditis, i, 254; in chlorosis, i, 314; in diabetes, i, 328; in icterus, i, 330; in scarlatina, i, 301; in typhoid fever, i, 292. on the effect of temperament on the blood, i, 236; his experiments on hematin, i, 39, nofe; on the fats in the serum of blood, i, 189; his method of analysing blood, i, 169; on amount of solid constituents in the blood in cholera, i, 326. his observations on the urine, ii, 165 ; on gravel, ii, 460. Lzrson on the fallacy of the polarizing test for sugar, i, 64, note. LEHMANN, his analyses of healthy urine, ii, 144; of diabetic urine, ii, 301 ; of human bones, ii, 401 ; of tophaceous concretions, ii, 477. his experiments on the effect of diet on the urine, ii, 156; on the effect of exercise on the urine, ii, 164; on the passage of various substances into the urine, ii, 340. on oxalate of lime in urine, ii, 200. on the presence of hippuric acid in diabetic urine, ii, 294; on the urine during pregnancy, ii, 332. on the presence of sulphur in bilin, i, 46. Lens, crystalline, ii, 419. LENZBERG and MorrTuHier on the blood in carcinoma uteri, i, 284. Leopard, urine of, ii, 342. Levcus on the action of saliva on starch, li, 9. INDEX. Leucin, i, 13; ultimate composition of, — ii, 504. : Levret and Lassaiene onthe pancreatic _ fluid of the horse, ii, 17. L’HERETIER on the composition of the brain, ii, 427; of lymph,i, 351; of woman’s milk, ii, 51. : on the changes produced in the milk by a prolonged sojourn in the breast, ii, 54; on the effect of temperament = on the milk, ii, 54. on the saliva, ii, 7 ; in chlorosis, ii, 13 ; in mercurial ptyalism, ii, 11. on the urine in chlorosis, ii, 265; in intermittent fever, ii, 257; in poly- — dipsia, ii, 306. ; LiesIe on the bile, ii, 20. on the influence of the salts of the food on the urine, ii, 147; on the 3 non-existence of lactic acid andl lac- tates in urine, ii, 121; on the pre- sence of ammonia in urine, ii, 132; on the presence of hippuric acid in the urine, ii, 117; on uric acid, ii, 115; his views on the absorp- a tion of oxygen by the blood, i, yi ‘_ note. Lienitis, blood in, i, 268. Ligaments, ii, 417. Lime, carbonate of, i, 2; its occurrence in urine, ii, 201 ; test for, ii, 434. oxalate of, its occurrence in urine, ii, 198 ; test for, ii, 433. : phosphate of, i, 1; ii, 397; test for, ii, 432. urate of, characters of,i, 51; test for, li, 434. Lime in urine, ii, 133; its determination, ii, 139 Lion, urine of, ii, 342. Liquor amnii, ii, 359, 541. =, sanguinis, general chemical ‘relation an of, i, 114. = Liver, composition of healthy, ii, 4283 ig F i of fatty, ii, 428; function of, i, 211. Lochial discharge, i, 338 ; ii, 81. Lymph, i, 350; a dilute serum, i, 3533 chemical characters of, i, 350 ; mo- tion of in absorbents, i i, 358. Lungs, analysis of, ii, 429. Mac Grecor on the amount of carbonic acid expired in disease, i, 127; ob- of waxy, ib.; a servations on diabetic urine, ii; = 291. MacLaGan on intestinal concretions, — 4 ii, 466. Mack on the composition of the liquor a ; _. amnii, ii, 361. Magnesia in urine, ii, 133; determination of, ii, 139. urate of, i, 55; test for, ii. 435. INDEX. MAGNus’s experiments on gases in the blood, i, 134; on the urine of tes- tudo nigra, ii, 352. MAtcorm on the amount of carbonic acid expired in typhus fever, i, 127. Manganese, i, 3. Marasmus senilis, urine in, ii, 317. Marcuanp, his analysis of healthy urine, ii, 146 ; of the urine in osteomalacia, ii, 286; of a land tortoise, ii, 352. on the composition of nitrate of urine, li, 136, note. on the salts of the blood, i, 234; ona gouty concretion, ii, 477 ; on the presence of urea in healthy blood, i, 183; on the presence of urea in the blood in cholera, i, 325. Marcuarp and CoLzere, their analysis of lymph, i, 350. Margaric acid, i, 71; ultimate composition of, ii, 508. Margarin, i, 73. Margary] and its oxides, i, 71. Mart nN on the urine in morbus maculosus Werlhofii, ii, 260. Martin Soton on the urine in peripneu- monia, ii, 223. MAYER on cercaria in blood, i, 350. Measles, amount of carbonic acid expired in, i, 127. blood in, i, 300. urine in, ii, 268. ; Meconic acid, its passage into the urine, ii, 337. Meconium, ii, 367. Medicines, their passage into the urine, ii, 336. MEGGENHOFER on the composition of woman’s milk, ii, 52; on the milk in syphilis, ii, 59. Meibomian glands, secretion of, ii, 353. Melzna, blood discharged in, i, 317, Melanurin, i, 45. Meliceris, analysis of, iiy487. Melitzemia, i, 327. MELseEns on the gastric juice, ii, 33. Meningitis, urine in, ii, 210. Menstrual fluid, i, 336; ii, 516. Mercurial ptyalism, composition of saliva in, li, 11. Mercury in saliva, ii, 11; in the urine, ii, 337. Mesoxalic acid, i, 60. Metals, their passage into the urine, ii, 337. Metamorphic actions, i, 165. Metamorphosis of the blood, i, 139; in nutrition, i, 147. Metritis, urine in, ii, 241. Metroperitonitis, blood in, i, 272. 993 Metrophlebitis puerperalis, blood in, i, 252. MIALBE on a new principle in saliva, ii, 9. Microscopic analysis of a fluid, i, 91. Milk, ii, 42 ; before delivery. ii, 47 ; imme- ’ diately after delivery, ii,49; changed by disease, ii, 57; changes in, cor- responding with the age of the in- fant, ii, 56. containing infusoria, ii, 69. ordinary healthy, ii, 50. physico-chemical character of, ii, 42. special chemistry of, ii, 44. method of analysing, ii, 44. effect of nutrition on the, ii, 54. effect of temperament on the, ii, 54. sugar of, i, 65. extractive matter of, i, 38. of animals, ii, 61. of ass, ii, 63; of bitch, ii, 66, 521; of cow, ii, 61; of ewe, ii, 66; of goat, ii, 65; of mare, ii, 64. medicines, their passage-into the, ii, 59. Milk in urine, ii, 323. Milky urine, ii, 191. Mineral constituents of the animal body, i, 1. MirscHer.icu on the saliva, ii, 4. Monads in kystein, ii, 331. Mo6LteER on the urine during pregnancy, ii, 33. Moorze’s test for sugar, i, 68. Morbus Brightii, blood in,i, 321; ii, 514; cutaneous serum in, ii, 496; urine in, ii, 231, 528. Morbus maculosus Werlhofii, blood in, i, 316; urine in, ii, 258. Morphia, its passage into urine, ii, 339. Mucic acid, i, 66, note. Mucin, ii, 74, 486; to detect in an animal fluid, i, 94. Mucus, ii, 70; bronchial and pulmonary, ii, 76. from gall-bladder, ii, 77; from intes- tinal canal, ii, 77; from urinary bladder, ii, 78; nasal, ii, 76; in urine, how determined, ii, 135 ; purulent, ii, 83. formation of, ii, 97. Mucus-corpuscles, ii, 72. Mutper, his discovery of protein, i, 5; on _ the action of thein on the economy, ii, 341; on the difference of colour in arterial and venous blood, i, 193, note. Mu tpepr’s views on the absorption of oxy- gen by the blood, i, 155, note. MiLteR on lymph, i, 350; on the action of various tests on the blood-cor- puscles, i, 107 ; on the formation of the blood, i, 121. 554 Murexan, i, 59. Murexid, i, 59. Muscle, ii, 422. Muscular tissue of man, ii, 423, note ; of ox, calf, swine, roe, pigeon, chicken, carp and trout, ii, 423. ossified, analysis of, ii, 474. Mycomelinic acid, i, 60. Myelitis, urine in, ii, 213. Nasse’s analyses of the blood of the calf, dog, goat, goose, hen, horse, ox, rabbit, sheep, and swine, 346. analysis of chyle of cat, i, 357; of healthy venous blood, i, 232. on the buffy coat in pleuritic blood, i, 266. on the composition of lymph, i, 350, 352. on the composition of pulmonary mucus, ii, 77. on the diseased blood of horses, i, 347. ‘of sheep, i, 347. serum of pus compared with that of blood, ii, 92. Navcueg, his discovery of kystein, ii, 329. Nephritis albuminosa, blood in, i, 273; ii, 512; urine in, ii, 230, 528. Nerves, composition of, ii, 427. NicHotson on the blood in secrofula, ii, 513. Nitrogen, expiration of, i, 135. Nitrogenous constituents of the human body, i, 5. Nitrate of urea, i, 52; its composition aCe ' cording to Marchand, ii, 136, note. Non-nitrogenous constituents of the human body, i, 65. diet, its effects on the urine, ii, 163. Nuclei of blood-corpuscles, to separate, i, 104; their general chemical rela- tions of, i, 112. Nutrition, metamorphosis of blood in, i, 147 NystTEn, his observations on the amount of urine in inflammatory affections, ii, 229 ;on the urine in ascites, ii, 311; in peritonitis, ii, 229. Objections to the. author’s views on the modifications of blood, i, 220. Odorous principles, their passage into the urine, ii, 339. Oil, olive, its effect on the blood-corpuscles, , GE Oleic acid, i, 74. Olein, i, 74. Oleophosphoric acid, i, 81. Omichmyle, ii, 119, 341. Ophthalmia, blood in, ii, 510. ORFILA on arsenic in healthy bone, i, 4; on bile in the blood in icterus, i, INDEX. 329; on a case of hematuria, ii, 268; on the detection of morphia in urine, ii, 339; on the passage of various substances into the urine, ii, 337. Organic “ES their passage into urine, ii, 337. : constituents of the animal body, i, 5 O’SHAUGHNEssy on the presence of urea in the blood in cholera, i, 326. Osteoid tumour, ii, 412. Osteomalacia, urine in, ii, 286. Osteoporosis, ii, 410. Ostrich, urine of, ii, 351. Otolithes, ii, 249. Ovarian dropsy, urine in, ii, 313; cysts, analyses of their contents, ii, 485. Ox, bile of the, ii, 24; blood of the, i, 340, 341; urine of the, ii, 346. Oxalate of ammonia in urine, ii, 200. Oxalate of lime, microscopical character of, i, 85, ii, 199; in caleuli, ii, 446; in urine, ii, 198; test for, ii, 4333 Bird on, ii, 200; Lehmann_on, ii, 200. Oxalic acid, i, 85; in saliva, ii, 10. Oxaluric acid, i, 58. Oxyprotein, i, 9. Pancreas, saliva in disease of, ii, 2. Pancreatic fluid, ii, 16; in disease i a; 17. Parameecium loricatum seu costatum in blood of frogs, i, 350. Parabanic acid, i, 58. Parrot, urine of, ii, 351. PayeEn, his error in the analysis of milk, ii, 44; on the composition of wo- man’s milk, ii, 52. PELLETAN on the urine in typhus, ii, 245. PreLouzeE and Getts on the best method of obtaining butyric acid from sugar, i, 78. Pemphigus, fluid of, ii, 488. Pepsin, i, 22; its ultimate compouliaall ii, 503. Pepys on the composition of the teeth, — ii, 414. Percy on the detection of alcohol in urine, ii, 339. on the effect of exercise on the urine, ii, 169. on diabetic urine, ii, 300. on the urine in Bright’s disease, ii, — 237. on urine in carcinoma of the liver, ii, 318. on the feces in health, ii, 374; in diabetes, ii, 378; in jaundice, ii, — 492; of — 384. on the fiuid of ascites, ii, hydrocele, ii, 497. ee ee mee Vande To INDEX. Pericarditis, blood in, ii, 209; urine in, i, 255 Peripneumonia, urine in, ii, 221. Peritonitis, blood in, i, 269; urine in, i, 228. Perspiration containing sugar in diabetes, : i, 66, note; ii, 297. PETTINKOFER, his test for bile, ii, 193; on a new constituent in urine, ii, 129; on urine containing an excess of hippuric acid, ii, 324. Purtrpp on the urine in scarlatina, ii, 280. Phlebitis uterina, urine in, ii, 210. Phlegmasia alba, blood in, i, 253. Phlogoses, urine in the, ii, 205. Phloridzin, its effect on the urine, ii, 341. Phosphate, ammoniaco-magnesian, ii, 433; of lime, its microscopic appearance, ii, 133. of lime (basic), test for, ii, 433. of magnesia and ammonia, i, 2. of lime (neutral), test for, 2, 432. Phosphate of soda (tribasic), the cause of the alkalinity of the blood, i, 182, note. : Phosphate of soda, i i, 3. Phosphoric acid in urine, ii, 130; its de- termination, ii, 140. Phthisis tuberculosa, blood in, i, 279 ; urine in, ii, 286. Physiology of healthy blood, i, 191; of healthy urine, ii, 147. Physical analysis of a fluid, i, 90. Piarhemia, i, 332. Pig, urine of, ii, 347. Pigeon, blood of, i, 350. Pineal gland, gritty matter in, ii, 474. Piurtt on morbid sweat, ii, 106. Placental blood, i, 238. Plague, blood in, i, 319. Plasma, genuine chemical relations of the, i, 114. PLATNER on the bile, ii, 20. PLayFarr on the feces in health, ii, 375. Plethora, Becquerel and Rodier on the blood in, 306, note. Pleuritis, blood i in, i, 266 ; urine in, ii, at Pleuropneumonia, urine in, ii, 220. Pneumonia, blood in, i, 258, 264; urine in, ii, 214. Polyuresis, i li, 305. Polydipsia, ii, 305. Pompholix, urine in, ii, 322. Porphyra hemorrhagica, blood in, i, 316. Portal blood, solid constituents of, i, 204; compared with arterial, i, 201, 203. Potash in urine, ii, 132. bibasic. phosphate of, its a ii, 148. 555 Potash, chlorate of, its effects on the blood, i, 108 urate of, i, 54; test for, ii, 434. Pregnancy, blood during, i, 335; urine during, ii, 329. PrEvuS the composition of tubercle, ii, 478. Prostatic fluid, ii, 359. Protein, i, 5; ultimate composition of, ii, 503. compounds, to detect in an animal fluid, i, 93; diagnosis of, i, 15. metamorphoses of sulphuric acid and protein, i, 7; of hydrochloric acid and protein,i, 8; of nitric acid and protein, i, 8; of chlorine and pro- —_ i, 9; of potash and protein, 1,13. binoxide of, i, 11; ultimate composi- tion of, ii, 503. tritoxide of, i, 9 ; ultimate composition of, ii, 503. oxides, their effect on the colour of arterial blood, 193, note. Protid, i, 14; ultimate composition of, li, 504 Prout on the composition of the liquor amnii, ii, 362 ; on the development of carbonic acid from the lungs at different periods of the day, i, 127 ; on the gastric juice, ii, 28; on the state in which uric acid exists in urine, ii, 115. Proximate oe general principles of, i, 8 Ptyalin, i, 24; to detect in an animal fluid, i, 98; Wright’s method of deter- mining, ii, 5. Purgative action of salts explained, ii, 149. Purpura hemorrhagica, blood in, i, 319. Purpurate of ammonia, i, 59. Purpuric acid, i, 59. Pus, ii, 86; containing infusoria ii, 96. formation of, ii, 97. in the blood, i, 333; in urine, ii, 202; in mucus, ii, 97. uric acid in, ii, 98. from the bladder, ii, 92, 94; from the cellular tissue, ii, 94; from the bones, ib.; from the liver, ib.; from pustules in smallpox, ii, 93; from synovial membrane of the knee, ii, 92; from syphilitic bubo, ii, 93. arthritic, ii, 94; ‘scorbutic, ii, 96; scrofulous, ii, 94. Pyin, i, 12, 29, ii, 74; to detect in animal fluids, i, 94, 98. Pyohzemia, i, 333. Pyrosis, analysis of the fluid of, ii, 393. 556 Quinine, its passage into the urine, ii, 339; sulphate of, its effect on the blood- corpuscles, i, 106. Rabbit, blood of, i, 346, 349; urine of, ii, 350. Rachitis, urine in, ii, 284. Ragsky on the composition of diseased bone, ii, 406; on the determina- tion of urea by a new method, ii, 523. Rarny on the presence of urea in the blood in cholera, i, 325. Rattlesnake, urine of, i, 53, note. Raven, blood of, i, 349. RayYER on a peculiar form of uric acid, ii, 173; on urine in nephritis acuta, ii, 230; on urine in Bright’s dis- ease, ii, 232; onan endemic hema- turia in the Isle of France, ii, 268. ReEs on the blood in diabetes, i, 328; on the chyle, i, 356; on the lymph, i, 352; on the liquor amnii, ii, 361; on the action of cubebs and co- paiva on the urine, ii, 185. ReicH on diabetic urine, ii, 300. . REIcHERT on the forces that circulate the blood, i, 122; on the formation of the blood-corpuscles, i, 122. Renal veins, blood of, compared with blood of aorta, i, 213. Renal phthisis, urine in, ii, 288. Resin, biliary, i, 48, ii, 432. Respiration of the foetus i i, 136; of worms, i, 139; of insects, i, 138 ; of fishes, i, 137. the process of, i, 123. Rheumatism, blood in, i, 273; urine in, ii, 274. Rhinoceros, urine of, ii, 347. Rinpskopr on the blood in pneumonia, i, 262; in rheumatism, i, 276; in erysipelas, i, 279. on the menstrual fluid, i, 337. RocHLEDER, his experiments on casein, i, 21 Rotto on the blood in diabetes, i, 327. Rosacic acid, i, 45. Ross on the urine in hepatitis, ii, 226. RosstGNoL on the sources of copper in the animal body, i, 4 nofe. Rovtrer on the blood in purpura hemor- rhagica, i i, 319. Rubeola, blood in, i, 300. Ruminantia, process of digestion i in, ii, 38. Sal microscopicum, i, 3, ii, 131. Salicin, its changes in the organism, ii, 340 Saliva, ii, {; daily amount of, ib.; compo- sition of, ii, 3. INDEX. Saliva in chlorosis, ii, 12 ; in dropsy, ii, 13; in inflammatory affections, ib.. mode of analysis of, ii, 3. of animals, ii, 14; of dog, ii, 15; of horse, ii, 14; of sheep, ii, 15. use of in digestion, ii, 8. Saliva, acid, ii, 10; bilious, ii, 14; fatty, ii, 13; morbid, ii, 9; sweet, ii, 13. ~ Salts in the blood, their functions, i, 151; their estimation, i, 181. how calculated from their proximate elements, ii, 140; their diuretic ac- tion explained, ii, 149 ; their purga- tive action explained, ib. in urine, the amount excreted, ii, 166 ; their amount affected by disease, i ii, 205. vegetable, their passage into the urine, ii, 338. Salycilie acid, ii, 341. Salycilous acid, its occurrence in the urine after taking salicin, ii, 341. SANSON on a yellow colouring matter in the blood, i, 43. é Sarcina ventriculi, ii, 394. Scarlatina, blood in, i, 300; urine in, a 279. SCHARLING, experiments on expired air, i, 129; researches on the urine, ii, 119; on omichmyle, ii, 341, nofe. ScHERER on the bile in a case of icterus, ii, 22; on the analysis of tubercle, ii, 478. on the blood in bronchitis, i, 257; in typhoid fever, i, 295; in pneu- monia biliosa, i, 264 ; in metroperi- tonitis, i, 272. on the difference of colour in arterial and venous blood, i, 192, note. on the hair, ii, 418. on the lochial discharge, i, 338. on the urine in anasarca, ii, 312; in Bright’s disease, ii, 236 ; in febris puerperalis, ii, 228; in icterus, ii, 315; in marasmus senilis, i li, 317; in typhus, ii, 253; in urticaria tuberculosa, ii, 320. ; on the extractive matters of urine, ii, 178, note. Schlerosis, ii, 410. ScHLOSSBERGER on the mammary secre- - tion of a he-goat, ii, 65; experi- ments to determine the ammonia in urine, ii, 132; on the urine in — Bright’s disease, ii, 237; on the composition of the flesh of various animals, ii, 423; on gravel in new- born children, ii, 461. Scumitz on polystoma-like animalcules in the blood of the horse, i, 350. INDEX. SCHONLEIN on the diagnosis of blenorrhcea from the examination of the urine, ii, 273; on the blood discharged in hzematemesis, i, 318; on the blood in erysipelas, i, 278. on the urine in cystitis, ii, 240; in dia- betes, ii, 290; in hepatitis, ii, 227; in hydrothorax, ii, 308; in inflam- matory diarrhoea, ii, 225; in influ- enza, ii, 268; in jaundice, ii, 313; in nephritis, ii, 230; in pneumo- nia, ii, 207 ; in scrofula, ii, 283; in typhus, ii, 244; in variola, ii, 283. ScHULTz on the action of various tests on the blood-corpuscles, i, 107; on the blood-corpuscles of a sala- mander suffocated in carbonic-acid gas, i, 106; on the capsule of the blood-corpuscle, i, 105; on the forces that circulate the blood, i, 122; on the formation of blood- corpuscles, i, 120; on portal blood, i, 202. Scuuttz and HENLE on the development of blood-corpuscles, i, 154. ScHWERTFEGER, his test for bile, ii, 194. Scorbutus, blood in, i, 315; urine in, ii, 258. Scrofula, blood in, i, 309, ii, 511; urine in, ii, 283. Scrofulous matter, analysis of, ii, 478. Scurvy, blood in, i, 315; urine in, ii, 258. Sebacid acid, i, 74. Secretions of the male generative organs, ii, 356; of the female generative organs, ii, 359. Sediment in Bright’s disease, ii, 235; of urate of ammonia, ii, 174. Semen, ii, 356. Serolin, i, 83. Serpents, urine of, ii, 352. Serum, milky, cases of, i, 268, 271, 273, 323, 332. yv. SETTEN on urine of the pig, ii, 348. Sex, difference of blood in, i, 234. Sheep, blood of, i, 341, 346, 349; morbid blood of, i, 344, 347; saliva of, ii, 15. Silica, i, 4; test for, ii, 435. Silicie acid in urine, ii, 131. Ston, his case of milky blood, i, 333. Skin, true, ii, 417. disease, urine in, ii, 320. disease, amount of carbonic acid ex- pired in, i, 127. Smallpox, amount of carbonic acid expired in, i, 127. Soda, bibasic phosphate of, its properties, ii, 148. Soda, in urine, ii, 131. urate of, i, 55 ; test for, ii, 434. 557 Solid constituents of urine, increase or di- ~ minution of, ii, 170. So.xy on the urine in osteomalacia, ii, 286. Soton on the urine in peripneumonia, ii, 223 ; on the urine in variola, ii, 282; on the presence of albumen in the urine in scarlatina, ii, 280. Spanzemia, chemical characters of the blood in, i, 306 ; physical characters of the blood in, ib. Specific gravity of blood, i, 101; of urine, ii, 165; how determined, ii, 135. Spermatozoa, ii, 356; in urine, ii, 325. Spinal cord, composition of, ii, 427. Spirit, explanation of term in contradis- tinction to alcohol, i, 21, nofe. Spirit-extract, i, 31; of blood, i, 36; of milk, i, 38 ; of urine, i,37, ii, 137. ~ to detect in an animal fluid, i, 97. Spleen, Hewson’s views of the functions of, i, 119. SPRENGEL on the urine of cattle, ii, 345. Sputa in bronchitis, ii, 82; in phthisis, ii, 84, 88. Stearaconot, i, 81. Stearic acid, i, 71; ultimate composition of, ii, 508. Stearin, i, 73. Subrubrin, i, 43. Sudor, ii, 101, Suet, i, 82. Sugar, its formation in diabetes, ii, 302; to detect in an animal fluid, i, 97; methods of detecting in blood, i, 185; in the blood, i, 327, 185; in the blood in diabetes, i, 302; tests for, i, 67 ; yields butyric acid, i, 78. of gelatin, i, 27. of milk, i, 65; of milk in the liquor amnii, ii, 362. in urine, ii, 194, 297 ; diabetic, i, 66. Sugars, animal, i, 65. Sulpho-bi-proteic acid, i, 8. Sulpho-cyanogen a constituent of saliva, ii, 26 Sulpho-proteic acid, i, 8. Sulphuric acid, its formation from trans- formed tissues, ii, 153; in urine, ii, 130, 140. SUTHERLAND and Riesy on the urine in insanity, ii, 211. Sweat, ii, 101; of animals, ii, 111. sugar in the, i, 66, nofe. morbid, ii, 106. Swine, blood of, i, 341, 346; urine of, ii, 348. Synovia, ii, 416. Syphilis, milk in, ii, 59 ; urine in, ii, 319. Taurin, i, 47; on the occurrence of sulphur in, ii, 20, note. Tears, the, ii, 353. 558 Teeth, ii, 413. Temperament, differences of blood in, i, 236. Temperature of the blood, i, 102. Temperature of different animals, i, 142. Tench, blood of, i, 348. Tendons, ii, 417. Testicle, analysis of milky fluid from, i, 65 note. Testudo nigra, urine of, ii, 352. tubulata, urine of, ii, 352. Thein, its effects on the urine, ii, 341. THENARD on the composition of the bile, ii, 19 THEYER and ScutossER on the bile, ii, 20. Thionuric acid, i, 60. THomson on the saliva in mercurial pty- alism, ii, 12. TIEDEMANN and GMELIN on blood in icterus, i, 331; on the comparison of chyle and chyme, ii, 39; on the saliva, ii, 4; on chyle, i, 357; on lymph, i, 350; their table of the temperature of birds, i, 142. TIEDEMANN and Rupo.peui, table of the temperature of animals, i, 142. Tiger, urine of, ii, 342. Tissues, formation of, from cells, i, 140. Torula, the, i, 69. TRAIL on milky serum, i, 269, 332. Tritoxide of protein, i, 9. TROMMER, his test for sugar, i, 68, ii, 195, 299; applied to the blood, i, 187. Trout, blood of, i, 350. Tubercles, ii, 4783 peculiar corpuscles in, li, 89. Tubercular phthisis, blood in, i, 279; urine in, ii, 286. Typhus, urine in, ii, 242. Typhus abdominalis, blood in, i, 288. Typhus petechialis putridus, blood in, i,319. Umbilical arteries, blood of, i, 238. Ureemia, i, 320, Uramil, i, 60. Uramilic acid, i, 60. Urate of ammonia, i, 55 ; increased quantity of, in urine, li, 174; miscroscopic test for, ii, 176; occurrence in cal- culi, ii, 431; occurrence in intes- tinal concretions, ii, 464, 465; resembling cystin in form, i, 64, note. Urate of lime, i, 55; test for, ii, 434. magnesia, i, 55; test for, ii, 435. potash; i, 54; test for, ii, 434. soda, i, 55; in urine, ii, 177 ; micro- scopical character of, ii, 177; test for, ii, 434. Urea, i, 49; amount excreted, ii, 165; amount in healthy urine, ii, 165 ; amount modified by disease, ii, 174, INDEX. 204 ;its conversionin the system into carbonate of ammonia, ii, 213. its presence in healthy blood, i, 182 ; its presence in the blood in Bright’s dis- ease, i, 322; its presence in the blood in cholera, i, 325; fallacies to be guarded against in searching for it in blood, i, 185; its action on the blood-corpuscles, i, 108 ; its qualitative determination in animal fluids generally, i i, 96, 99—in blood, i, 182—in urine, ii, 116. its quantitative determination in urine, ii, 135—by Ragsky’ s method, ii, 523 —in diabetes, i li, 297. its effect in modifying the crystalliza- tion of certain salts, i, 53. its origin, i, 149, 160; obtained from uric acid, i, 56; ultimate composi- tion of, ii, 507. Urea, hydrochlorate of, i, 53. Urea, nitrate of, its composition according to Marchand, ii, 136, note. Urea, oxalate of, i, 52. a Urea, sulphate of, i, 52. Uric acid, i, 53; amount excreted, ii, 166: af- fected by disease, ii, 205; Bensch’s formula for, ii, 114,no¢e; origin of, i, 149, 160 ; microscopic characters of, ii, 173 ; qualitative determination in an animal fluid, i, 194—1in urine, ii, 116. _ quantitative determination in urine, ii, 136; increased quantity in urine, ii, 172; diminished quantity in urine, ii, 178 ; its occurrence in uri- nary calculi, ii, 440—test for, ii, 431; ultimate compositionof, ii, 507. Uric oxide, i, 62; calculi of, ii, 444; test for, ii, 431; ultimate composition of, ii, 507. Uril, i, 56. Urinary calculi, ii, 437; gravel, ii, 459. Urine, ii, 113; composition of healthy, ii, 145 ; extractive matters of, i, 37; water-extract of, ib.; spirit-extract of, ib. ; alcohol-extract of, ib. zs pathological changes in, ii, 170. physiological relation of, ii, 147. qualitative analysis of, ii, 115; quan- titative analysis of, ii, 134, 141; quantity discharged in twenty-four hours, ii, 165; specific gravity of, ii, 115, 165; tabular view of analyses of, ii, 147. in disease, to analyse, ii, 170, 183. Urine, alkaline, ii, 207, note; anzemic, ib. ; bloody, ii, 187 ; blue, ii, 328 ; black, ib. ; chylous, ii, 190 ; fatty, ii, 189; febrile, ii, 206, note, 208 ; milky, ii, 191, 229. INDEX. Urine containing carbonate of ammonia, ii, 197; carbonate of lime, ii, 201; cystin, ii, 201 ; hippuric acid in excess, ii, 324; indigo, ii, 326; pus, ii, 202; semen, ii, 325; sugar, ii, 194. Urine during pregnancy, ii, 329. Urine of peculiar colour, ii, 325. Urine in disease, ii, 203; in angina tonsil- laris, ii, 224; in ascites, ii, 309; in bilious fever, ii, 270; in Bright’s dis- ease, ii, 231 ; in bronchitis, ii, 214; in carcinoma, ii, 317; in catarrh, ii, 268; in chlorosis, ii, 261; in cho- lera, ii, 271; in consumption, pul- monary, ii, 286; in cystitis, ii, 240; in delirium tremens, ii, 212; in diabetes insipidus, ii, 304; in dia- betes mellitus, ii, 289; in dropsy, ii, 308; in dysentery, ii, 225; in em- physema, ii, 223; in empyema, ii, 223; in encephalitis, ii, 211; in en- docarditis, ii, 210; in enteritis, ii, 225; in erysipelas, ii, 278; in fever, bilious, ii, 270—gastric, ib.—intermit- tent, ii, 255—mucous, ii, 270—puerpe- ral, ii, 228—typhoid, ii, 242; in gas- tritis, ii, 224 ; in hemorrhages, ii, 266 ; in hepatitis, ib.; in herpes zoster, ii, 320; in hydrothorax, ii, 308 ; in hys- teria, ii, 316; in icterus, ii, 313; in inflammatory affections, ii, 208 ; in in- fluenza, ii, 268; in insanity, ii, 211; in intermittent fever, ii, 255 ; in jaun- dice, ii, 313; in land-scurvy, ii, 258 ; in marasmus senilis,ii,317; in measles, ii, 268 ; in meningitis, ii, 211; in me- tritis, ii, 241; in morbus maculosus -Werlhofii, ii, 258 ; in mucous fever, ii, 270; in myelitis, ii, 213; in nephritis -acuta, ii, 230—albumiinosa, ii, 231; in osteomalacia, ii, 286; in pericar- ditis, ii, 209; in peripneumonia, ii, 221; in phlebitis uterina, ii, 210; in phlogoses, ii, 205; in phthisis tu- berculosa, ii, 286 ; in pleuritis, ii, 219 ; in pleuropneumonia, ii, 220 ; in pneu- monia, ii, 214; in pompholix, ii, 322; in rachitis, ii, 286; in renal phthisis, - it, 288 ; in rheumatism, ii, 274 ; inru- beola, ii, 268 ; in scarlatina, ii, 279 ; in scrofulosis, ii, 283; in scurvy, ii, 258 ; in skin diseases, ii, 320 ; in syphilis, ii, 319; in typhus, ii, 242; in urticaria tuberculosa, ii, 320; in varicella, ii, 282 ; in variola, ii, 282; in vesical ca- tarrh,ii, 273; in vesical phthisis, ii, 288. Urine of animals, ii, 342; of beaver, ii, 350; of birds, ii, 351 ; of boa constric-- tor, i, 53, note ; of bull-frog, ii, 252; 559 of camel, ii, 347 ; of cattle, ii, 345; of - elephant, ii, 347; of goat, ii, 349; of guinea-pig, ii, 350; of hare, ii, 350; of horse, ii, 342; of ostrich, ii, 351; of parrot, ii, 351; of pig; ii, 347; of rabbit, ii, 350; of rattlesnake, i, 53, note; of rhinoceros, ii, 347; of ser- pents, ii, 352; of tortoise, ii, 352. Urobenzoic acid, i, 61. Uroerythrin, i, 45, ii, 119. Uroglaucin, ii, 523. Urostealith, ii, 324, 452. Urous acid, i, 62. Uroxanthin, ii, 523. Urrhodin, ii, 523. Urticaria tuberculosa, urine of, ii, 230. Vaccinic acid, i, 75, 80. VALENTIN on the composition of pus, ii, 91; of human bones, ii, 401. Varicella, urine in, ii, 282. . Variola, blood in, i, 298 ; urine in, ii, 282. VAUQUELIN on the composition of the se- minal fluid, ii, 358; on the urine of the carnivora, ii, 342—of the beaver, ii, 350. Vegetable albumen, i, 5. bases, their passage into the urine, ii, 338. casein, i, 6. diet, its effects on the urine, ii, 161. fibrin, ii, 5. salts, their passage into the.urine, ii, 338. VELSEN on violet-coloured urine, ii, 329. Vena hepatica, blood of, compared with blood of vena portarum, i, 162. Vena porte, properties of the blood of, i, 201. blood of, compared with blood of vena renalis, i, 162. Vena renalis, blood of, compared with aortic blood, i, 162. Venesection, its effect on the blood in pneumonia, i, 260. its effect on the blood in rheumatism, i, 261; its influence on the blood generally, i, 248. Venous and arterial blood, comparative analyses of, i, 194; distinctive cha- racters of, i, 192. Venous blood, the author’s analyses of, i, 228; compared with the blood of the capillaries, i, 217 ; composition of healthy human, i, 227; Denis’s ana- lyses of, i, 230; Lecanu’s analyses of, i, 229. Vernix caseosa, ii, 364. Vesical catarrh, urine in, ii, 273.. Vesical phthisis, urine in, ii, 288. 560 Vibrio cyanogenus in milk, ii, 69. Vibrio xanthogenus, ii, 69. VIGLA on uric-acid sediments, ii, 173. VoceEt on the menstrual fluid, i, 338; on the saliva, ii, 12; on the urine in cholera, ii, 272 ; on the urine of the elephant, ii, 347—of the rhinoceros, ii, 347. Vomiting, matters discharged by, ii, 390. Vorict on the composition of the liquor amnii, ii, 360. WacGner, his experiments on the velocity of the circulation, i, 225; on the forces that circulate the blood, i, 122. Wasmann, his directions for obtaining pepsin, i, 23. Water, amount in urine affected by disease, ii, 204; determination of, in urine, ii, 135. : Water-extract, i, 31; of blood, i, 36; of milk, i, 38; of urine, i, 37, ii, 137. WIENHOLT on the composition of the skin, ii, 417. Wittts on the absence of urea in urine, ii, 172; on anazoturia, ii, 306; on the specific gravity of diabetic urine, ii, 289; on urine in arthritic nephritis, ii, 231; on urine in typhoid fever, ii, 245; on urine in vesical catarrh, ii, 273. INDEX. | Witson on the fluid ejected in pyrosis, ii, 393. Wirrtstock on the blood in cholera, i, 325 ; on the urine in cholera, ii, 272. Wouter on the passage of various sub- stances into the urine, ii, 336. Woop on the composition of pus, ii, 91. Worms, respiration of, i, 139. Waicut on the composition of pus, ii, 91; on the detection of alcohol in urine, ii, 339; on the saliva, ii, 5—in mer- curial ptyalism, ii, 11. Wurtz on the production of butyric acid from fibrin, i, 79. Wortzer, lymph described by, i, 350. Xanthic oxide, i, 62; test for, ii, 431. Xantho-hematin, i, 43. Xantho-proteic acid, i, 8. Yellow fever, blood in, i, 319. Young animals, characters of the blood of, i, 238 ZANARELLI on milky serum in pneumonia, i, 332. : ZIMMERMANN on the blood in ophthalmia, ii, 508; on the blood in thoracic in- flammation, ii, 507; on the occur- rence of fibrin in urine, ii, 188, note; on the specific gravity of the blood in pneumonia, i, 264; on the urine in endocarditis, ii, 210; on the urine in pneumonia, ii, 229. ; Zomidin, i, 32, 34. THE END. PRINTED BY C. AND J. 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