(5) To exclude traces of glucose which might be overlooked in the preliminary examination a control test should be carried out in the same manner with omission of step (1).
8. Drugs.—The effect of various drugs upon the color of the urine has been mentioned ([p. 50]). Most poisons are eliminated in the urine, but their detection is more properly discussed in works upon toxicology. A few drugs which are of interest to the practitioner, and which can be detected by comparatively simple methods, are mentioned here.
Acetanilid and Phenacetin.—The urine is evaporated by gentle heat to about half its volume, boiled for a few minutes with about one-fifth its volume of strong hydrochloric acid, and shaken out with ether. The ether is evaporated, the residue dissolved in water, and the following test applied: To about 10 c.c. are added a few cubic centimeters of 3 per cent. phenol, followed by a weak solution of chromium trioxid (chromic acid) drop by drop. The fluid assumes a red color, which changes to blue when ammonia is added. If the urine is very pale, extraction with ether may be omitted.
Antipyrin.—This drug gives a dark-red color when a few drops of 10 per cent. ferric chlorid are added to the urine. The color does not disappear upon boiling, which excludes diacetic acid.
Arsenic.—Reinsch's Test.—Add to the urine in a test-tube or small flask about one-seventh its volume of hydrochloric acid, introduce a piece of bright copper-foil about one-eighth-inch square, and boil for several minutes. If arsenic be present, a dark-gray film is deposited upon the copper. The test is more delicate if the urine be concentrated by slow evaporation. This test is well known and is widely used, but is not so reliable as the following:
Gutzeit's Test.—In a large test-tube place a little arsenic-free zinc, and add 5 to 10 c.c. pure dilute hydrochloric acid and a few drops of iodin solution (Gram's solution will answer), then add 5 to 10 c.c. of the urine. At once cover the mouth of the tube with a filter-paper cap moistened with saturated aqueous solution of silver nitrate (1:1). If arsenic be present, the paper quickly becomes lemon-yellow, owing to formation of a compound of silver arsenid and silver nitrate, and turns black when touched with a drop of water. To make sure that the reagents are arsenic-free, the paper cap may be applied for a few minutes before the urine is added.
Atropin will cause dilatation of the pupil when a few drops of the urine are placed in the eye of a cat or rabbit.
Bromids can be detected by acidifying about 10 c.c. of the urine with dilute sulphuric acid, adding a few drops of fuming nitric acid and a few cubic centimeters of chloroform, and shaking. In the presence of bromin the chloroform, which settles to the bottom, assumes a yellow color.
Iodin—from ingestion of iodids or absorption from iodoform dressings—is tested for in the same way as the bromids, the chloroform assuming a pink to reddish-violet color. To detect traces, a large quantity of urine should be rendered alkaline with sodium carbonate and greatly concentrated by evaporation before testing.
Lead.—No simple method is sufficiently sensitive to detect the traces of lead which occur in the urine in chronic poisoning. Of the more sensitive methods, that of Arthur Lederer is probably best suited to the practitioner: