A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart.

Caird, Francis Mitchell, 1853-1926

Date:: 1889

Credit: A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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$must be noted. The materials of some of the deposits are formed in the urine before it cools, while those of others only appear afier cooling. Those which appear hefori; are jius, and occasionally crystals of uric and oxalic acid, wiien in excess, entangled in mucus. In an alkaline urine, crystals of ammonio-magnesian phosjihate may be seen. Where a dejjosil occurs before cooling, there will be gr(!aler risk of calculus formation within the body, although, as V. Carter has shown, it is jjrobable that calculi are not the result of aggregation of the ordinary crystalline fcjrms of the various sul)stances, but of the com- bination of a modified crystalline form with nmcus in a way not as yet clearly imderstood. fw'zw^'-the commonest deposit is one of amorphous urates of soda, ammonia, lime, or magnesia. These may be seen under many conditions—such as excessive mus- cular exercise, congestion of the liver, any feverish condition, errors of diet, and from dyspejisia. When visible continuously for some lime they indicate liver derangement, and Ijeing premonitoiy of gout and uric acid formation, recjuire treatment [Miirchisoii). If eo-existent with piles they would call for an improvement in the hepatic circulation. Besides urates, crystals of uric acid or oxalate of lime may be deposited, one or both, generally with urates also. Their dejiosit will depend partly on the quantity of acid jiresent, partly in the acidity of the urine. In an alkaline urine, jihosphate of lime in an amor- phous or partly crystalline form may be seen, alsr) crystals of triple phos|)hate ; in animoniacal decomposition the triple phosphate is always present. More or less viuiits is always associated with any of the above depcxsit, and holds them together. After urine has stood for a time, a stum often appears on its surface. This may consist of urates, phosphate of lime, triple ])hos])hales, micro-organisms, or of oil- globules. The latter may be seen after severe fractures attended by crushing of the medulla, and, according to some authors, to a certain extent in most fractures. Oil-globules are jjresent in the circulation, and are excreted by the kidneys. They occasionally give rise to the seven- symptoms associated with fatty embolus, in the later stage of diabetes, and in the rare and obscure disease called chylous urine. (The observer must, of course, exclude the possiliility of the oil having been introduced into the urine by the lubrication of instruments.) C. Examination of the Urine. Where possiljle, for reasons alre.-idy given, the whole urine passed in the preceding twenty-four hours should be collected and measured ; failing tliis, morning and evening urine may be mixed when the specific gravity is wanted. Urine after fasting is most acid ; that after meals will have the highest specific gravity, and will reveal the smallest traces of albumen. Where pus is suspected, urine from a single micturition should be collected in separate vessels. Preliminary Examination.—After the total (luantity of urine for$