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Elliott Proctor Joslin.

A diabetic manual for the mutual use of doctor and patient online

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1916 40 per cent. Gluten Biscuit

Lister Bros., New York:

1915 Diabetic Flour ....

1916 Loeb's Genuine Gluten Bread
1916 Gluten Luft Bread . . .
1916 Pure Gluten Flour . . .
1916 Diabetic Bread Sticks .
1916 Gluten Noodles ....
1916 Diabetic Sponge Cookies
1916 Diabetic Almond Macaroons
1916 Diabetic Butter Cookies
1916 " " " . .
1916 Diabetic Lady Fingers .
1916 Gluten Cracker Meal

1916 Gluten Almond Zwncback .
1916 Gluten Zwieback . . .

Thos. Martindale & Co., Phila.:
1913 Special Gluten Flour . .

Mayflower Mills, Ft. Wayne, Ind.
1913 Bond's Diabetic Flour . . .

Theo. Metcalf Co., Boston, Mass.
1913 Soja Bean Meal, 18 per cent

starch

1913 Vegetable Gluten, 8.1 per cent,
starch

Pieser Livingston Co., Chicago:

1913 Gluten Flour

Pure Gluten Food Co., New York

1911 Gum Gluten Flour . . . .

1914 Flour, 50 per cent

1914 Flour, Ground






rt a — o^



b



u



CO



U



49.1 12.7 21.3 (i.O 396

27.3 1.2 59.8 42.6 359

31.4 2.0 56.7 48.5 370
42.3 18.2 25.8 0.0 435



40.1 1.4 50.2 40.9 374



27.06


0.02


63.03


51.24


36.88


1.43


52.10


48.04


45.56


1.11


44.57


36.50


84.19


0.81


9.36


6.77


81.00


0.83


7.71


4.02


45.13


0.98


48.83


36.98


84.5


3.6







35.40


0.17


34.99


26.37


44.50


9.78


37.29


29.93


47.81


1.01


41.69


35.78


46.31


0.29


42.19


35.02


45.19


1.03


43.69


33.19


44.63


37.17


8.66


1.91


34.25


45.01


10.46 trace


39.31


14.93


37.25


32.18


31.38


22.29 37.05


30.66


48.00


32.79


9.71


2.14


42.63


8.92


38.97


31.59


44.00


6.10


39.56


33.10


45.44


2.39


41.06


35.72



372



40.3 1.5 49.1 41.4 371

40.2 1.3 48.3 40.6 366

41.0 20.0 25.0 .. 444

80.4 1.5 9.8 5.9 374

43.3 1.3 46.2 38.4 370

38.3 1.6 50. S 42.4 371

49.7 1.2 41.5 37.1 375

41.9 0.9 48.1 42.6 36^



DIET TABLES 165

S. H ■





So-called Diabetic Prepara-


a

. 0)


a




a


^ £ 2






a S




J3 o




d'C M




tions.


'S u


U


S ^


4u


"3.30






■H o


. <u


.p <o


t. <»


o cjO






on





Sa


a a


•3' -






P4


^


o


CO


O




Flours and Meals. — Continued.












1914


Self-raising Flour ....


42.7


0.8


45.0


39.0


357


1914


Special Flour

Sprague, Warner & Co., Chicago:


90.7


0.7


1.7


2.2


- 376


1913


Richelieu Gluten Flour .
G. Van Abbott & Sons, London:


47.7


1.2


39.7


31.6


368


1913


Almond Flour


24.6


58.6


7.9


0.0


657


1913


Gluten Flour

WUson Bros., Rochester, N. Y. :


75.1


0.9


12.6


12.4


359


1913


Gluten Flour, f Standard .


20.8


2.1


64.6


54.6


361


1913


Self-raising, ^- Standard


n A


2.0


63.5


51.8


342


1913


Waukesha Health Products Co.,
Waukesha, Wise. : Hepco














Flour


42.9


20.8


22.31


trace


448




Breakfast Foods.














Brusson Jeune Villemur, France:












1913


Farine au Gluten ....


33.9


0.6


53.8


48.8


356


1910


Gluten Semolina ....
Farwell & Rhines, Watertown,
N. Y.:


17.2


0.5


71.6


64.9


360


1913


Barley Crystals


11.5


1.3


75.2


62.7


359


1913


Cresco Grits


17.8


1.4


68.6


54.1


358


1908


Hazard's Wheat Protein Break-














fast Food


40.1


1.0


49.7


?


368




Health Food Co., New York:












1913


Manana

Pure Gluten Food Co., New York:


37.6


1.9


46.8


31.0


355


1914


Gum Gluten Breakfast Food


45.4


0.9


46.4


39.2


375


1914


Gum Gluten Granules .


42.7


0.7


48.8


41.9


372


1901


Pure Gluten Breakfast Cereal .
Waukesha Health Products Co.,
Waukesha, Wise: Hepco Grits^

Macaroni, Noodles, etc.
Brusson Jeune, Villemur, France :


43. r


1.6


44.4


?


367


1910


Pates aux Oeufs Macaroni .


13.9


0.4


76.2


69.2


364


1910


Pates aux Oeufs Nouillettes


14.4


0.5


75.7


68.9


365


1913


Petites Pates au Gluten . .


18.6


1.0


70.4


61.2


365


1910


Vermicelle au Gluten


18.4


0.4


72.4


65.8


367



Jireh Diabetic Food Co., New
York:
1913 Macaroni 16.9 0.9 71.4 58.8 361

1 Chiefly derived from Soy bean and therefore non-assimilable, and for
patients can be considered carbohydrate-free.

2 Said to be identical with Hepco Dodgers.



IGO



DIET TABLES



1913

1914
1913
1913
1914



1914
1914



1914



1913
1914



1915



So-called Diabetic- Phkpaka-

TIDNS.



Macaroni, Noodles, etc. —

Continued.

Loeb"s Diabetic Bakery, New York:

Home-inade Noodles . . . 41.8
Pure Gluten Food Co., New York:

Gum Gluten Noodles . . 40.. 5

Gust,<iv Miiller & Co., New York:

Dr. Boinua Sugar-free Fat-milk' 2 . 4
D. Whiting & Sons, Boston:
Sugar-free Milk (ave. 3

analyses) 5.7

Sugar-free Milk 6.4



Soft Bre.\ds.

Health Food Co. :

Protosac Bread 29 . 8

Glutosac Bread 27 . 2

J. Heinbockel & Co., Baltimore,
Md.:
Diabetic Bread for Diabetes . 8.6

Loeb's Diabetic Bakery, New York :
P. & L. Genuine Gluten Bread 10.4
P. & L. Genuine Glubetic Bread 38.8

Lister Bros., New York:
Casein Bread 36.6



■^i


a


•?,








JS o






^fe




■3,


'5^


S3 0.


OS


O


(n


U






5.5 41.7 36.7 384

1.2 49.1 41.8 369

5.3 . . . . 57



7.2 trace .. 88

9.3 0.2 .. 110



1.8 35.2 27.7 276
2.1 31.1 22 . 2 252



1.5 52.1 40.4 256



2.6 .53.7 44.2 280
4.1 25.7 19.2 294



18.4



322





Hard Breads and Bakery














Products. 2














Callard, Stewart & Watt, London :












1909


Almond Biscuit, plain .


28.3


28.0


36.8




512


1909


Almond Shortbreads


19.5


52.1


27.0




630


1913


Casoid Biscuits, No. 1 . . .


66.8


18.8


5.8


4.0


460


1909


Casoid Biscuits, No. 2 . . .


57.8


25.5


5.6


0.0


483


1909


Casoid Biscuits, No. 3 . . .


54.3


25.0


7.8


trace


473


1909


Casoid Dinner Rolls . . .


78.0


11.1


2.1




420


1909


Casoid Lunch Biscuit


25.5


44.9


21.6




593


1909


Casoid Rusks . . . . .


37.0


32.3


20.8




522


1909


Cocoanut Biscuit — Saccharin .


16.6


61.3


16.4




684


1909


Ginger Biscuit — Saccharin .


17.1


58.6


18.1




668


1913


Kalari Batons


43.2


39.0


7.4





553


1909


Kalari Biscuits


56.9


31.4


1.7




517


1909


Prolactic Biscuit ....


42.9


27.5


19.3




496


1913


Charrasse Biscuits Croquettes au














Gluten


34.3


5.4


52.3


30.6


395


1913


Biscottes Lucullus ....


11.4


5.7


73.4


59.2


391


1913


Gluten Exquis Biscuits aux














Amandes


18.1


23.8


50.6


25.5


489



1 Water, 91.8 per cent.



2 See footnotes, pages 151 and 163.



DIET TABLES



167



So-called Diabetic Prepara-
tions.

Hard Breads, etc. — Continued.
1913 Gluten Fleur de Neige Pain
1913 Mignonettes au Gluten .

1913 Pain de Gluten

1913 Tranches Grillees pour Potage

Health Food Co., New York:

1913 Alpha Best Diabetic Wafer

1914 Alpha Best Diabetic Wafer

1913 Diabetic Biscuit

1914 Diabetic Biscuit
1906 Glutona . .
1906 Glutosac Rusks
1906 Wafers, Plain
1906 Salvia Sticks .
1914 Gluten Nuggets
1914 Gluten Butter Wafers .
1914 Gluten Rusks . . .
1914 Gluten Wafers, Plain .

Gluten Zwieback
1914 No. 1 Proto Puffs . .
1914 No. 2 Proto Puffs . .
1914 Protosac Rusks .
1914 Protosoy Diabetic Wafers
1914 Salvia Almond Sticks

Heinz Food Co., Chicago:

1913 Gluten Biscuits

Heudebert, Paris:

1914 Pain d'Aleurone pour Diabet-

iques

1914' Pain de Gluten pour Diabetiques
1914 Pain de "Essential" en Bis-

cottes

193 4 Hoyt's Gum Gluten Biscuit Crisps
1916 Huntley & Palmer, Reading,

England:

Akoll Biscuits

Johnson Educator Food Co.,

Boston:
1913 Educator Gluten Bread Sticks

1911 Gluten Cookies

The Kellogg Food Co., Battle

Creek, Mich.:

1912 Avena-Gluten Biscuit . .

1913 Potato Gluten Biscuit .

1909 Pure Gluten Biscuit . . . .



a
a o

*J CD



O



"I

ci p.



05 "

o



35.9 12. .5 42.8 25.1 427

40.1 5.7 43.6 27.3. 386

40.8 5.3 43.5 27.2 385

40.6 3.6 45.5 28.8 377





66.1


13.6


11.3


trace


432




67.1


8.4


11.7


1.3


391




25.0


9.2


54.2


46.5


400




35.9


8.8


46.5


39.8


409




22.1


11.8


58.5


54.9'


429




36.5


3.8


51.6


42.51


387




29.4


9.6


49.9


41.61


404




39.2


20.8


24.0


18.71


440




31.7


14.3


45.7


34.9


438




31.1


13.9


47.0


38.9


438




39.3


3.4


47.0


33.6


376




42.6


1.7


44.3


29.6


363




36.4


7.7


46.6


32.5


401




72.3


2.8


13.0


9.2


366




58.8


2.1


27.0


20.7


362




39.7


3.0


46.7


35.9


373




37.1


23.5


29.3


14.4


477




22.3


29.9


41.0


28.3


523



12.8 18.3 57.7 21.4 447



76.1
80.7



26.4

52.7



1.5

0.8



1.2
0.5



9.2
6.5



4.2
3.4



62.2 49.9
38.0 31.2



354
356



365
368



53.6 28.3 6.2 trace 494



35.9


7.2 45.8 37.5 392


26.4


16.0 49.8 37.8 449



21.4 12.7 55.5 41.1 422

41.5 0.5 48.0 39.5 363
48.3 3.3 39.1 .. 379



1 Determined by the diastase method, without previous washing with
water, and calculated as starch.



168



DIET TABLES



So-called Diabetic Prkpaha-

TIONS.



•ga






-3^5











■5S.


i^


■P 5


rt ft -3 "-






PL,


(^


o


OT O




Hard Breads, etc. — Continued.








1913


Taro-Gluteii Biscuit


. 31.3


0.5


57.7


48.2 361


1913


40 per cent. Gluten Biscuit


. 37.2


O.S


53.2


45 . 369


1912


SO per cent. Gluten Biscuit


. 82. 4


0.9


4.4


4.7 355




Loeb's Diabetic Bakery, New York:








1913


Gluten Luft Bread . . .


. 27.9


9.2


54.2


44.1 411


1914


Gluten Luft Bread


. 52.4


13.2


26.0


22.9 433


1914


Chocolate Almond Bars


. 16.3


41.0


31.8


5.7 561


1914


Diabetic Almond Macaroons


. 46.5


37.7


8.0


0.6 558


1914


Diabetic Bread Sticks .


. 50.4


3.4


34.5


24.6 371


1914


Diabetic Chocolates


. 14.9


51.4


23.0


6.9 614


1914


Diabetic Ladjf Fingers .


. 56.6


28.3


6.0


1.8 505


1914


Diabetic Sponge Cookies


. 54.7


30.1


5.0


1.2 510




Pure Gluten Food Co., New York:








1913


Gum Gluten Biscuit Crisps


. 42.9


0.7


48.5


39.3 372


1914


No. 1 Dainty Fluffs . . .


. 79.9


0.5


11.3


10.7 370


1914


No. 2 Dainty Fluffs . . .


. 66.3


0.5


24.9


21.9 369




G. Van Abbott & Sons, London:








1913


Caraway Biscuits for Diabetics 35.6


37.5


15.9


8.6 544


1913


Diabetic Rusks for Diabetics


. 70.9


0.8


16.0


12.6 355


1913


Euthenia Biscuits


. 35.8


40.7


13.2


6.9 562


1913


Gluten Biscottes or Rolls


. 51.6


2.3


33.0


29.8 359


1913


Gluten Bread or Slices .


. 54.1


2.2


30.9


27.4 361


1913


Gluten Butter Biscuits for Dia-










betics


. 44.1


33.2


12.7


9.0 526


1913


Ginger Biscuits for Diabetics 34.6


39.4


16.7


10.9 560


1913


Midolia Biscuits ....


. 17.6


36.4


31.6


13.4 524


1913


Walnut Biscuits for Diabetics 20.9
Waukesha Health Products Co.,


57.2


12.3


trace 648




Waukesha, Wis.:










1913


Hepco Dodgers. . .


. 41.6


21.3


20.7


trace 441




Callard, Stewart & Watt, London








1913


Casoid Chocolate Almonds

Wines :


. 22.3
Dry.


51.8


16.1


trace 620

Grams reduc-
ing sugars, per
100 c.c.


California, red, Bordeaux or Claret


(range


0.04- C


.63)


0.16




" Burgundy .


(range


0.03- 0.42)


0.15




' " Zinfandel .






(range


0.03- 0.35)


0.15




' white, Rhine






(range


0.06- 0.63)


0.15




' " Burgundy






(range


0.10- 0.45)


0.23




' " Sauterne






(range


0.07- 3.57)


0.64


French, red






(range


0.11- 0.84)


0.23


"


white . .






(range


0.65-


1.02)


0.84



' Natural wines contain from 6 to 12 per cent, of alcohol; "fortified" wines,
such as port, sherry, madeira and marsala (and certain champagnes), con-
tain from 15 to 20 per cent.



DIET TABLES



169



Wines: Dry. — Continued. Grams reduc-
ing sugars, per
100 c.c.

German, -white (range 0.09-1.96) 0.20

Hungarian, white (range 0.04- 0.86) 0.25

Italian, red (range 0.02-2.70) 0.16

" white (range 0.02- 2.15) 0.19

North Carolina (range 0.08-1.75) 0.49

Ohio (range 0.07- 1.54) 0..31

Portuguese, red (range 0.01- 1.21) 0.16

" white (range 0.10- 1.19) 0.32

Rhine, red (range 0.06-0.27) 0.13

" white (range 0.02- 1.02) 0.18

.Spanish, red (range 0.19-0.54) 0.35

" white (range 0.27- 0.62) 0.42

Sparkling, French and German . . (range . 13- 1 . 95) . 53

Swiss, red . . . . . . . . (range 0.10-0.27) 0.13

" white (range 0.08- 0.38) 0.10

Virginia (range 0.06- 1.2.3) 0.16

Wines: Sweet.

California Port (range 0.23-13.56) 4.76

Madeira and Sherry . . (range 0.12-17.21) 5.38

French (range 0.73-12.40) 5.38

German (range 0.64-12.13) 4.60

Madeira (range 2.48- 3.88) 2.95

Malaga (range 12.50-25.20) 18.32

Marsala (range 2.67- 8.24) 3.25

Port (range 3.76- 8.17) 6.04

Rhine (range 1.82-10.69) 6.35

Sherry (range 0.52- 4.80) 2.54

Sparkling, American (range 6.51-12.02) 8.28

French and German . . (range 8.00-18.50) 10.92

Tokay, true (range 1.86-20.50) 12.62

" commercial (range 2.70-40.70) 19.80

Vermouth (range 3.47-14.39) 9.46

Other Alcoholic Beverages. Carbohydrates,

per cent.

Brandy, gin, rum, whisky

Absinth Trace

Angostura 4.2

Beer 4.5

Weiss bier 4.6

Ale 5.1

Porter or Stout 7.0

Malt extract, commercial 10.6

Curacao 25.5

CrSme de menthe 27.7

Kiimmel 31.2

Benedictine 32 . 6

Anisette 34.4

Chartreuse . 34.4

Maraschino 52.3

Malt extract, true 71.3



CHAPTRR XIX.

SELECTED LABORATORY TESTS USEFUL IN
MODERN DL\BETIC TREATS [EXT.

EXAMINATION OF THE URINE, BLOOD AND EXPIRED

AIR.

An early diagnosis in diabetes is as important as in tuber-
culosis. The disease usually begins insidiously and its
prompt detection depends upon the routine examination of
the urine of all i)atients rather than upon the examination of
the urines of patients who present symptoms of the disease.
General practitioners should teach their patients, as a matter
of routine, to have their own urines and the urines of the
members of their families examined each birthday. This is
not fantastic; it is simply a part of the movement to have
each member of the community undergo a physical exami-
nation each year.

EXAMINATION OF THE URINE.

Examination of the urine should cost the patient little.
Formerly many deprecated the routine examinations made
in drug stores, but the value of such examination is now
recognized. The druggist is a trained chemist. He is con-
stantly doing quantitative work, and it is far easier and
cheaper for him to examine a urine than for a doctor. Drug-
gists will undoubtedly undertake such work with satisfaction.
It will be an agreeable relief from the many activities of a
drug store which have nothing to do with the profession of
a pharmacologist.

The examination of the urine of the diabetic patient is
usually a simple matter. It comprises a statement indicating
the volume in twenty-four hours, specific gravity, reaction,
(170)



EXAMINATION OF THE URINE 171

presence or absence of albumin, sugar and diacetic acid.
Frequently the ammonia, salt (sodium chloride), acetone and
nitrogen are determined and the urinary sediment submitted
to microscope study.

Although diabetic patients can test their own urines for
sugar and almo,st invariably are warranted in relying upon
the result of their examination, they should not feel that they
are expert analysts. More than once jjatients have arriN-ed
at erroneous conclusions, in part due to the preparation of
chemical reagents emplo.yed. It is therefore safer for all
diabetic patients to send their urines once a month to their
physician, for the simple tests for volume, color, reaction,
specific gravity, albumin and sugar. Such an examination
can be made by a physician within fifteen minutes. A quanti-
tative examination for sugar would require of an individual,
not daily accustomed to it not far from half an hour or more.

The Collection of the Twenty-four Hour Quantity of Urine. —
To collect the twenty-four hour quantity of urine, discard
that voided at 7 a.m. and then save in a cool place all urine
passed thereafter up to and including that obtained at 7 a. m.
the next morning.

Reaction. — The normal urine is acid. Urine voided after
a meal rich in vegetables and fruits is frequently alkaline,
due to the alkaline salts which they contain. Therefore the
report that the urine is acid does not imply in the slightest
degree that a patient has acid poisoning. (For detection of
acid poisoning, see Tests for Diacetic Acid and Ammonia,
pp. 181 and 182.)

Specific Gravity. — The specific gravity of the urine will be
best understood if it is recalled that the specific gravity of
w^ater is considered to .be 1000. Normal urine has a specific
gravity, on accomit of the solids contained in it, of about 1015
to 1020. Normal urme if concentrated would have a higher
specific gravity, and if dilute it would be lower. The specific
gravity of the urine in diabetes varies chiefly with the
percentage of sugar which it contams. It frequently is
above 1020 and may be above 1040, but sugar may be
present in the urine when the specific ^avitv is as low as
1007.



172 LABORATORY TESTS IN DIABETIC TREATMENT

Albumin. — IVo tests are usually employed, the one in
confinnation of the other.

1. Xitric Acid Test. — To 5 c.c. of filtered m-uie add one-
third the quantity of nitric acid by pourhig it down the side
of the glass so that it iniderlies the m-ine. A AA'hite precipitate
forms in the urine at the junction of the two fluids. A pre-
cipitate higher in the urine may be due to urates. Bile or
urinary coloruig matters may give a color to the urine or
precipitate at the junction of the fluids.

2. Heat Test. — Pour 10 c.c. of filtered lu-ine into a test-tube
and boil the upper half of the fluid. Add five drops of 10
per cent, of acetic acid and boil again. A precipitate appear-
ing on boiling which persists after the addition of the acid,
or appearing on the second boiling, is albmnin; one dis-
appearing with the acid is phosphates. The test may fail
with an excess of acid.

Sugar.— Sugar is absent from the m-ine of carefully treated
diabetics. If present it can be readily demonstrated if it
amounts to as little as 0.05 per cent., and it may rise to as
high as 9 or 10 per cent, when the diabetic diet is not followed.
Most imtreated cases show between 2 and 6 per cent, of
sugar. The total quantity of sugar in the urine in the twenty-
four hours is easily estimated by multiplying the percentage
of sugar which the lu-ine contains by the total amount of
urine voided. Thus, if the total quantity of urine is 3 liters
(3000 c.c, a little more than 3 quarts, which would equal
2838 c.c), and the percentage of sugar is 4, the amount of
sugar m the urine would be (3000 X 0.04) 120 grams, that is,
about 4 ounces or I pound. It is not very often that one
finds more than 1 pound of sugar excreted in the urine during
twenty-four hours. The food value of the sugar lost, if only
120 grams, is considerable. Each gram of sugar is the
equivalent of 4 calories, and the total would amount to 480
calories in a day, which is approximately one-fourth of the
total food value required b}^ an individual, with a quiet
occupation, who weighs 60 kilograms (132 pounds). Thus it
is evident that 4 untreated diabetics, even though the disease
is of very moderate severity, provided they eat enough to
make up the loss, will waste in a day enough food to supply



EXAMINATION OF THE URINE 173

the needs of a normal individual of equal weight for the same
space of time.

Tests of Sugar. — Qualitative Tests. — Many tests for sugar
in the urine are employed. At present I use the Benedict
test^ most. The Benedict solution employed has the advan-
tage of not decomposing even after months. Druggists occa-
sionally find difficulty in making it, and on many occasions
my patients have been sold unreliable solutions. The quali-
tative Benedict solution is made as follows:

Grams or c.c.

Copper sulphate (pure crystallized) 17.3

Sodium or potassium citrate 17.3 .

Sodium carbonate (crystallized) (one-half the weight of

the anhydrous salt may be used) 200.0

Distilled water to make 1000.0

The citrate and carbonate are dissolved together (with the
aid of heat) in about 700 c.c. of water. The mixture is then
poured (through a filter if necessary) into a larger beaker or
casserole. The copper sulphate (which should be dissolved
separately in about 100 c.c. of water) is then poured slowly
into the first solution, with constant stirring. The mixture
is then cooled and diluted to one liter. This solution keeps
indefinitely.

Case No. 632 has written out the rules for the test, with his
customary military directness and precision:

Benedict's solution is used for testing the urine for sugar
as follows: To about 5 c.c. (one large teaspoonful) of the
solution add 8 drops of urine; the test may then be continued
in either of the two following ways:

1. Boil the mixture of the solution and urine for tliree
minutes and set aside to cool to the temperature of the room.

2. Place the tube containing the mixture of the solution
and urine in bubbling, boiling water, w-here it must remain,
with the w^ater actually boiling, for five minutes.

In either case if the solution remains clear the urine being
tested is sugar-free ; if one can read print through the solu-
tion the percentage of sugar is so slight that it can be dis-
regarded; if a heavy greenish precipitate forms it usually

' Benedict, S. R.: Jour. Am. Med. Assn., 1911, Ivii, p. 1193.



174 LABORATORY TESTS IX DIABETIC TREATMENT

means there is a trace of sugar; the appearance of a yellow
sediment indicates the j)resence of a few tenths per cent, of
sugar in the nrinc, and a red sediment more.

Upon removal from the boiling Avater shake the test-tnbe.
The discoloration which occasionally forms npon the snrface
is nnimportant and with shaking disappears.

Benedict's original des('rij)tion of the test is as follows:
Five cnbic centimeters, a trifle over one teasj^oonfnl, of the
Benedict solution, are placed in a test-tube and 8 to 10 drops
(not more) of the urine to be examined arc added. The mix-
tm-e is then heated to vigorous boiling, kejjt at this tcmpera-
tiu'c for three minutes, and allowed to cool spontaneously.
In the presence of glucose the entire body of the solution will
be filled with a precipitate, which may be greenish, yellow
or red in tinge according to whether the amount of sugar is
slight or considerable. If the quantity of glucose be low
(luider 0.3 per cent.) the precipitate forms only on cooling.
If no sugar be present, the solution either remains perfectly
clear or shows a faint turbidity that is blue in color, and
consists of precipitated urates. The chief points to be remem-
bered in the use of the reagent are (1) the addition of a small
quantity of urine (8 to 10 drops) to 5 c.c. of the reagent, this
bemg desired not because larger amoimts of normal urine
would cause reduction of the reagent, but because more
delicate results are obtained by this procedure; (2) A'igorous
boiling of the solution after addition of the luine, and then
allowing the mixtiu-e to cool spontaneously, and (3) if sugar
be present the solution (either before or after cooling) will be
filled from top to bottom with a precipitate, so that the
mixture becomes opaque.

Benedict (personal communication) states that the test as
performed above will detect glucose in as low concentration
as 0.01 to 0.02 per cent, provided the lu-ine is of low dilution.

Fehlincfs Test. — The solutions required are made uj) as
follows: Dissolve 34.64 gm. piue ("uSO, in water and make
up to 500 c.c. Dissolve 173 gm. Kochellc salt and 00 gm.
sodium hydrate each in 200 c.c. water and mik, and then make
up also to 500 c.c. ; 5 c.c. of each solution are used for the test.

In performing the test, 3 to 5 c.c. of ecjual quantities of the



EXAMINATION OF THE URINE 11 o

copper solution and the alkaline solution are mixed in a test-


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