INVALUABLE AIDS IN DETERMINING DISEASES OF THE KIDNEYS AND BLADDER.
The various forms of gravel, Bright's disease of the kidneys, hæmaturia, inflammation of the kidneys and bladder, diabetes, and other functional and organic diseases of the urinary organs effect characteristic changes in the urine, thus enabling us to distinguish them with certainty and exactness. Some of the various microscopical appearances of the urinary deposits in diseases of the kidneys and bladder, are represented in Fig. 3. In division A is represented pus and mucus, with decomposition, indicating suppuration somewhere along the urinary tract. In B pus globules are alone represented. In the division marked C are shown blood corpuscles as they are arranged in blood drawn from a vein or artery. D represents the same separated, as they always are when present in the urine. In E highly magnified oil globules are represented. If present in the urine, they indicate disease of the kidneys. In F are represented epithelial cells, the presence of which in large numbers is indicative of diseases of the mucous lining of the urinary organs.
Fig. 4 represents the microscopic appearance of phosphates in the urine. These are present in great quantity in cases of nervous debility and kindred affections. By attaching the camera lucida to the microscope we can throw an image of these urinary deposits upon paper. By the art of the engraver this may be faithfully traced, and thus we are enabled to produce an accurate representation of them. Some of the beautiful crystalline deposits shown in Fig. 4 represent less than a millionth part of a grain, yet their forms are delineated with geometrical precision. Earthy phosphates are often mistaken for pus and also seminal fluid. Phosphates are always found in decomposed urine, otherwise they indicate brain affections, acute cystitis, etc. Experience has taught us that the voiding of urine loaded with phosphates is a forerunner of cystitis, or enlargement of the prostate gland, or both. In fact, persons so affected are "prone to serious consequences from mild attacks of almost any and every acute disease."
Fig. 5 represents the microscopic appearance of mixed urinary deposits. In division A is represented fermentation spores as they appear in diabetic urine. Pasteur asserts that the germs of this fungus get into the urine after it has been passed. Urates appear in division B. These indicate waste of flesh, as in fevers, consumption, prolonged physical efforts, etc. Division C pictures urates of ammonia. These appear in alkaline decomposition of the urine; it is isomeric with uric acid in acid urine. In division D is represented urate of soda, which is present in the tissues of persons suffering from gout. The crystals shown in division E consist of the same salt.
In Fig. 6, division A, is represented purulent matter as it appears in the urine. The formation of pus in different parts of the genitourinary system is accompanied by the appearance of pus corpuscles in the urine. When fat globules, represented in division B, are found in the urine, they indicate fatty degeneration. In division C are representations of the cells found in the urine of persons suffering from cystitis or other inflammatory diseases.
Fig. 7, divisions A and B, represent different forms of cystine. Fortunately this substance is rarely found in the urine. When present however it indicates liability to, or the actual presence of, a calculus or stone in the bladder. In division C is a representation of the deposits seen in the urine of those who are greatly debilitated. In division D are seen epithelial cells mixed with mucus.
In Fig. 8, division A, are represented the caudated cells from the deep structure of the bladder. The cells represented in division B are amyloid concretions, found where there is an enlarged prostate gland.
Fig. 9 represents the appearance of spermatozoa as seen in the urine. When present, they afford indisputable evidence of the escape of semen in the renal excretions.
We might add many other illustrations of urinary deposits and state their several indications, but a sufficient number has been introduced to show the importance and practical value of microscopic examinations of the urine in revealing obscure diseases.
Although the microscope is of inestimable value in examining the renal excretion, it does not entirely supersede other valuable instruments and chemical re-agents in determining constitutional changes. By the urinometer we determine the specific gravity of the urine; by the use of litmus its acid or alkaline reaction, is ascertained; while various chemicals, when added to it, produce certain specific changes, according to the morbid alterations which it has undergone by reason of disease. By the application of heat, or the addition of a few drops of nitric acid, the albumen, which is invariably present in Bright's disease of the kidneys, is coagulated. By the employment of other re-agents we may determine the presence of sugar—a characteristic of diabetic urine. And thus we might mention almost innumerable chemical tests by which the several changed conditions of the urine, characteristic of different diseases, may be ascertained with absolute certainty.