Volume 1

A text-book of human physiology : including histology and microscopical anatomy with special reference to the requirements of practical medicine / by L. Landois ; translated from the seventh German edition with additions by William Stirling.

Landois, L. (Leonard), 1837-1902. Lehrbuch der Physiologie des Menschen. English

Date:: 1891

Credit: A text-book of human physiology : including histology and microscopical anatomy with special reference to the requirements of practical medicine / by L. Landois ; translated from the seventh German edition with additions by William Stirling. Source: Wellcome Collection.

554/602 page 514

$^4 BILE AND SUGAR IN URINE. [SeC. 266. 266. BILE IN URINE (CHOLURIA).—The physiological conditions which cause the bile constituents to appear in the urine are mentioned in part at § 180. Hematogenic or Anhepatogenic Icterus {Quincke), occurs when bilirubin (§ 20) i« f™ed from extra5asatecl blood by the action of the connective-tissue corpuscles, so that bile pigments, in addition to colouring the tissues, pass into the nrine. „ . ^ , , , ^ iTy v„^r.A\r.\ I Bile Pigments.-Their presence is ascertained by Gmelin-Heintz's test. (?r.e7r (Bi iverdm) is the^characteristic hue in the play of colours obtained with this test, which is iully described 'ModificationsoftheTest.-!. If icteric urine be filtered through filtering or blotting p^^^^^^^ a drop of nitric acid containing nitrous acid, when applied to the inner «^J'f^lif^^ out filter, gives a yellowish-coloured ring {Rosenhach) 2 In order that the ^^^J^ij ^n^^ ^^^^^^ take pla<;e too rapidly, add a concentrated solution of sodic nitrate, and then «j«^ Y ^^^^^^^ suluh nie acid [FleiscU). 3. On shaking 50 c.c. of icteric urine with 10 c^c of chlmofoim 1 e bilirubin is dissolved by the latter. On adding bromide water, a beautiful ;?g «f/«;« f is obtained {Mcdy). If the chloroform extract be treated with ozonised turpentine and dilute caustic potash, a green colour, due to biliverdin, occurs m the watery fluid ^f^^^lf)' [Marichal's Test.-Pour tincture of iodine (B.P.) on the surface of the urine m a test-tube. A green colour appears if bile pigments are present.] . In slight degrees of jaundice, urobilin alone may be ound (§ 261, ^nQi''^ncke) In pesistent high itver, the urine contains especia ly biliprasm {Huppf^). ^fit^ontains choletelin alone, add to the urine some hydrochloric acid, and examine it with the spectioscope, which gives a pale absorption-band between h and .F (§ 177, 3,/). _ Hsematoidin^-Sometimes crystals of hmnatoidin (§ 20, fig. 27) appear in the urine especially when blood-corpuscles are dissolved within the blood-stream ; oc^««\^^ly ^«^^^^^^^^^^^^ typhus, and sometimes in cases of periodic ha^moglobiniiria. The breaking ^^P oUl ^^^^^^^^^ clots in the urinary passages, as in pyonephrosis (^to.), or the ^^^^«olution ot necioüc aieas (Hofmannand £^/L'a7m) produces them, and similar crystals occnr m analogous cas^s in the spuUim (§_ 138). In jaundice due to congestion (§ 180), the identical crystalline substance, ^'ilMielcMs occur in largest amonnt in absorption jaundice but they are ever present to any extent. The test is described at § 177, 2, the cane-sugar solution consisting of 0 5 grm. to 1 litre of water. If the urine be dilute, it is advisable to concentrate it on a water-bath Lit is rare to get a satisfactory result with Pettenkofer's test in ordinary icteric urine ] Pettenkofer's test may be used with the alcoholic extract of the nearly dry residue, but no albumin must be present. DragendorlT found O'S grm. in 100 ^^^res of 7iormaZ urme^ Strassburg's Modification.-Dip filter paper into the urine, to which a little ^^^i^e-sugai has been added f dry the paper and apply to it a drop of sulphuric acid. A. violet red colou obtained after a short tiie. [Hays Reaction (§ 177). Icteric urine precipitates the albumm in a solution of acid-albumin (§ 181 G.).] 267 SUGAR IN URINE (GLYCOSURIA).—Diabetes MelUtus.—The exces- sively minute trace of grape-sugar or dextrose, which is constantly present m normal urine, sometimes becomes greatly increased and constitutes the conditions ot diabetes meUitus and glycosuria. The physiological conditions which determine this result are given at § 175. In this condition, the quantity of urine is greatly increased ; it may reach 10 or more litres. Many pints may be passed daily, [ihe usual abnormal amount of sugar is from 1 to 8 per cent., although 15 per cent, has been found, i.e., from 5 to 50 grs. per fluid oz., or 300 to 3000 grs m twenty-four hours.] The specific gravity is also increased (1030 to 1040). [In a case where a large amount of urine is passed of a pale colour and a specific gravity above lUdU, always suspect sugar.] A diabetic person gives off relatively more water by the kidneys and less by the skin (and lungs?) than a healthy person. The colour is very pale yellow, although the amount of pigment is by no means diminished—it is only diluted [the depth of the colour being inversely as the quantity passed] The amount of the nitrogenous urinary excreta is increased. The sugar is increased by a diet of carbohydrates and diminished by an albuminous diet. The uric acia and oxalate of lime are often increased at the commencement of the disease, while yeast cells are constantly present after the urine has been exposed to the air tor some time. p , • f rin diabetes insipidus there is a very copious secretion of watery urine without the presence of sugar. It may be produced experimentally by injury to a certain part$