THE LONDON LANCET; A JOURNAL OF BRITISH AND FOREIGN MEDICAL, SURGICAL, AND CHEMICAL SCIENCE, CRITICISM, LITERATURE, AND NEWS. HALF YEARLY VOLUMES. VOLUME II.-1858. EDITED BY THOMAS WAKLEY, SURGEON, J. HENRY BENNET, M.D., AND T. WAKLEY, JR., M.R.C.S.E. New York: 1858. R. CRAIGHEAD, Printer, Stereotyper, and Electrotyper, 81, 83, and 85 Centre Street. 1740 THE LANCET. Journal of Medical, Surgical, and Chemical Science and Practice, Criticism, A PRACTICAL Course of Lectures ON URINARY DISORDERS; EMBRACING THEIR DIAGNOSIS AND MEDICAL TREATMENT. Illustrated by numerous Engravings, displaying the Principal Forms and Modifications of Urinary Deposits. BY A. H. HASSALL, M.D., F.L.S., PHYSICIAN TO THE ROYAL FREE HOSPITAL, AUTHOR OF "FOOD AND ITS ADULTERATIONS," ETC. ON THE DISCRIMINATION OF CERTAIN ORGANIZED droplets when agitated with hot water, and its solubility in ether. It is not very often that a urine is met with containing only fat, for when this is present it is usually derived from chyle, some of the constituents of which are generally present in the urine with it. But minute quantities of fat may be present in urine, independent of chyle, as in certain forms of Bright's disease, and also without occasioning the slightest turbidity. In this case, the fatty matter is found in the cells and renal casts thrown off, and which have become deposited from the urine after it has stood for some hours. The microscope affords the only means by which the presence of oily matter in connexion with the renal cells and tubules can be ascertained. In the Mauritius, fatty urine is epidemic, and it accompanies a peculiar form of irritative fever. On the Determination of Fatty or Oily Matter. A peculiar kind of fatty matter, to which its URINE containing fatty or oily matter is usu- discoverer, Dr. Florian Heller (Heller's Arch., ally, but not always, more or less turbid, and if 1844 and 1845), gave the name of uro-stealith, the fat occur in connexion with chylous matter, has been detected in one instance in the urine. it will not only be turbid, but it will possess a The patient, a weaver, twenty-four years of age, whitish and milky appearance more or less laboured under all the symptoms of calculus, and marked. Usually when a drop of such urine, passed some small concretions, which, on examiespecially if it has been allowed to stand at rest nation, were found to be composed of the peculiar for some time, and if it be taken from the surface, fatty matter in question. These concretions posis examined under the microscope, droplets or sessed the following characters:-When fresh, spherules of oil will be seen, which are readily they were soft, becoming, when dry, hard, yellow, distinguished by their strongly refractive proper-wax-like, brittle, and amorphous, and presenting ties, as well as by their solubility in ether. by transmitted light a greenish-yellow colour. Should the presence of fat be suspected, and On the application of heat, they puffed up, inno globules of oil be visible under the microscope, flamed, emitted a peculiar pungent odour, bea portion of the urine should be agitated with tween that of shellac and benzoin, and left a ether, which will dissolve out any oily or fatty voluminous ash. In hot water they softened, but matter which may be present, and which may be did not dissolve; they were readily soluble in obtained in a separate state on the evaporation of ether; the residue, on the evaporation of the the ethereal solution. etherial solution, assumed a violet colour. That the substance thus obtained consists really the application of a gentle heat, nitric acid disof fat is known by its greasy appearance, its inso-solved them with a slight effervescence, forming lubility in cold water, by its breaking up into a colourless substance. 1-VOL. IL On Now, almost constantly, albumen is voided at the same time with the fibrin: whenever, therefore, the latter is present in the urine, the former is almost sure to be found. On the Determination of Fibrin. Fibrin is distinguished from albumen by its undergoing solidification when effused from the blood vessels. It usually occurs in the urine in The principal forms of renal tubules and fibrinconnexion with blood, but not always so. Some-ous casts observed in the urine are represented in times it exudes from the blood vessels of the kid- the engraving (Fig. 18). neys, and solidifies in the renal tubules, in the form of casts. In other, but very rare cases, the effused fibrin does not solidify until after the urine has been voided. When the fibrin solidifies in the kidneys, the casts are usually met with in the urine. Whenever, then, these casts are observed under the microscope, or the urine becomes at all gelatinous on cooling, and this whether it contain blood or not, fibrin is present. There is a form of deposit of frequent occurrence in the urine, with which I have been familiar for years, and which, since it bears much resemblance to a renal cast, may here be noticed. It consists of long threads of very variable diameter, but which are all more or less striated, showing that they are made up of fibrilla of fibrin. I have met with them in the greatest abundance in urines depositing oxalate of lime; also in those containing excess of earthy phosphates and mucus, or COMPOUND FIBRILLE OF FIBRIN, intermixed with octohedral and dumb-bell crystals of oxalate of lime, from human urine, depositing oxalate of lime. Magnified 220 diameters. July 6th, 1853. which contain semen; indeed, I have found them, day), a fatty-looking pellicle forms upon the surto occur wherever irritation of the bladder from face, which at the end of two or three days, when any cause exists, and as an evidence of which the urine is becoming alkaline, gradually breaks irritation they are to be regarded. They are up, and falls to the bottom as a sediment, frefound alike in the urine of men and women, quently evolving at this stage a powerful odour of (Fig. 19.) On the Determination of Keistein. Another substance of great interest, met with in the urine of pregnant women, and with the characters of which it is necessary to become acquainted, is that known by the names of keistein and gravidine. After the urine of a pregnant woman has been exposed to the air in a cylindrical glass vessel for two or three days (and never later than the sixth cheese. This scum or pellicle, viewed under the microscope, is seen to be constituted of three distinct elements, and to consist of a granular base in which are imbedded well-defined crystals of the ammonio-magnesian phosphate, and droplets of oil. The only essential and distinctive constituent of keistein is therefore the granular matrix. This is not acted upon by acetic acid, but is dissolved by ammonia, and this it is that evolves during decomposition the cheesy odour above referred to. When this scum is collected in any quantity, it |