William Henry Porter.

A practical treatise on renal diseases and urinary analysis online

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(/) Feathers or fragments of them coming from the bedding or
dust brushes are frequently found. If a single shaft is examined, it
is knobbed and resembles a series of fish-hooks broken off at their bases
ami joined point to base. In the feather, the point is attached to the
common stalk and bhe base is the free extremity. The fragment of a
stem and a few attached branches may occasionally be seen under the

(g) Cotton fibres appear at first as small fibres with nearly parallel
outlines and longitudinal striations, but by following along its course
it will be found to twist upon itself so that the right border will

Fig. 92.

a, Human hair; 6, cat's hair; c, flax fibre; d, cotton fibre; e, feather; /, knotted portion of
shaft; g, wool fibre; h, silk fibre; j, wood fibre; k, starch granule; 1, fat; m, air -bubble.

become the left, or vice versa. A piece of tape twisted upon itself
represents how this twisting is produced.

(h) Woollen fibres closely resemble hair, but as a rule are smaller
and not so dark in color. The irregular surface markings represent-
ing the ensheathing cells is very distinct, but they have no granular

(/) Flax or linen fibres resemble cotton, but do not twist upon
themselves. They are striated longitudinally and crossed at short
intervals by dark transparent lines, and are broken with an irregular
fracture similar to a round pencil broken sharply. These fibres are
usually round.

{j ) Silk fibres are small and glistening, with fine irregular Ion-


gitudinal markings and break nearly at a right angle similar to linen.
Their glistening appearance, however, is the chief point of difference
from linen.

All these fibres may be tinged blue by the indican of the urine, but
this is especially noticeable in the cotton fibres.

(k) Starch granules are frequently found in the urine when starch
powder has been dusted upon the genitals, as is frequently the case in
young children. They are readily recognized by their elevated por-
tion or hilum, and the surrounding dark and light-colored rings.
The application of a little iodine will turn them blue.

(I) Tea-leaves also find their way into the urine and appear as
irregular masses, having two or three light spots with a dark centre
from which a spiral thread springs, looking like a partially uncoiled
wire spring or the simple spiral may be all that will be found. There
are, however, many other vegetable substances that have this spiral

(m) Wood and vegetable. — Small fragments of wood fibres and all
kinds of vegetable substances occasionally find their way into the

(n) Finger markings are not of infrequent occurrence upon the
glass circles and are often thought to be indicative of some urinary
change until they are recognized as foreign elements.

Out of the preceding list the substances which are most commonly
found in connection with urinary analysis are air, oil, hair, cotton,
wood, linen, and feathers. The substances most frequently mistaken
for casts are hair, wool, cotton, linen, and dirt. Therefore, these are
the foreign bodies which every examiner should become as familiar
with as those of intrinsic origin.



Echinococcus; Filaria Sanguinis Hominis; Bilharzia ILema-
tobia; Trachin^e Cystica; Eustrongylus seu Strongylus
gigas; Tetrastoma Eenalis; Spurious Entozoa; Pediculus

animal organisms.

There are only a few parasites which infest the human body and
make their escape by the urinary channel, and there are a few that
may get in the nrina from the outside after it has been voided.

Ecchinococcus. — The scolices and booklets of this parasite may oc-


(Delafleld and Prudden, " Handbook of Pathological Anatomy and Histology.")

casionally find their way out of the body with the urine. Such cases
are recorded, and are probably due to the rupture of an hydatid cyst
in the kidney. When viewed under the microscope with a low power,
the scolices appear to be about the size of a millet seed, and are either
round or oval, and have at one end a dark colored zone or disk. The
body is small and granular, upon one extremity of which minute
suckers can be made out; with a higher power, their circle of hook-
lets can be seen, and the four suckers placed laterally and behind the
hooklets are now distinctly visible. Free hooklets are often found in
the urine at the same time.

(b) Filaria sanguinis hominis, F. Bancrofti. — In the embryonic


state, they are about yfg- of an inch (G mm.) long, pointed at one
end and blunt at the opposite. When fully developed, they are hair-
like and from three to four inches (7 to 10 centimetres) in length.

They vary in width from -gfar ( 8 mm -) to rfo of an incn ( 4 mm -)-

Their growth and development is quite peculiar. The parent
worm lives in the lymphatics; the embryo escapes from the uterus of
the mature worm, and finds its way along the lymphatic channels to
the thoracic duct, and in this way ultimately reaches the blood-
vessels. They originate more frequently in the lymphatics of the
scrotum and leg, and appear in the blood most abundantly in the
evening and up to midnight; after this hour, they gradually disappear
until 8 or 9 o'clock a.m., when they are entirely absent from the blood
for the remainder of that day.

Fig. 94.— Scolices op T-enia Echinococcus. X 60.

In one, the rosteUum is projected, in the others it is withdrawn. (Delafield and Prudden,
1 Handbook of Pathological Anatomy and Histology.")

"This phenomenal filarial periodicity is apparently an adapta-
tion of the habits of the parasite to those of the female of a peculiar
species of mosquito, which preys on the blood at night, and thus
imbibes the young filaria, to which it acts as an intermediate host.
Having entered the stomach of the mosquito, the filaria undergoes a
metamorphosis, eventuating in'its becoming possessed of an alimentary
canal, rudimentary organs of generation, increased size, great activity,
and a circumoval crown of papillae. The latter is the boaring appa-
ratus, which enables the animal to leave the body of the mosquito
when this insect dies, after depositing her eggs on the water, and
to traverse the ^human tissues to which it gains access, probably by
being swallowed in drinking water." This history is probably more
ingenious than real.



The tilaria has been found in the blood, however, in cases of chy-
luria. nevoid elephantiasis, <>r lympho-sarcoma, varicose and indu-
rated groin glands, galactocele, ascites with milky fluid, craw-craw,

lymphatic fever, and certain kinds of lymphatic abfi - -

It has been found in the urine in connection with chvluria and
nevoid elephantiasis. It may possibly find its way into the urine of

Fig. 95.— Filaria Sanguinis Hosirxis or Bancrofti.

a. Female (natural size i : b. head and neck ( X •">."> diam. : <•'. t ail : il. free embryo X 400 iliam. :
e. egg containing embryo; /, egg showing the yolk. After Cobbold. (London Lancet, Octo-
oer6th. 1877, p. 49E

the other enumerated diseases, but, up to the present time, has not
been so recorded.

(c) Bilharzia hmmatobia. — This name was given to this parasite
bv Professor Cobbold in 1851, from the fact that Dr. Bilharz,



of Cairo, was the first to discover the entozoon. The worm was
first found in the portal vein of a man, next in the corresponding
vein of a monkey, and at first was supposed to be a distoma, but it is
now generally known as the Bilharzia hmmatobia. Later on, it
was found in the mesenteric and vesical veins, and also in other
parts of the body, producing formidable diseases, and, finally, the
parasitic hematuria.

Dr. John Harley next discovered that a form of epidemic hasma-
turia at the Cape of Good Hope was due to a parasite which he con-
sidered a new species. Later researches, however, go to prove that
it was the same Bilharzia described by Dr. Bilharz, and this conclu-
sion is now pretty generally accepted. But the researches of Dr.

Fig. 96.— Filaria'in Human Blood.
After a photograph published by Dr. MacKenzie.

Harley showed a much wider geographical range for this parasite than
had previously been supposed.

It differs from all the varieties of flukes in having separate sexes.
The female is a very slender worm resembling filaria-form nematoids.

During copulation, the female is lodged in a long slit-like grove or
gynEecophoric canal with which the male is furnished. The ova mea-
sure from 1 | 1J to y^q of an inch in length, and are sharply pointed at
one end. They are a form of ciliated embryo, and an extended de-
scription will be found by Dr. Cobbold, British Medical Journal,

Both the mature worm and ova are found in the urine in this pecu-
liar form of hematuria.

(d) TrachincB cystica of Dr. Saulsbury. — In this case, the exact



species have not been fully determined, having been met with in only
a few cases. By some it is thought to be identical with the filaria
piscam; by others, the spiroptera hominis.

Fig. 97.— Bilharzia ILsmotobia. X about 15 times.

a, b, and c, the female, partly placed in the gynaecophorous canal of the male; a, anterior
extremity; c, posterior extremity; rf, body seen within the canal; c, /, g, h, and i, the male; e,/»
gynaecophorous canal, from which the female has been partly extracted; i, buccal sucker; k,
ventral sucker; between t and fc, the trunk; after fc, the tail. After Bilharz.

(e) Eustrongylus or Strongylus gigas. — This form of entozoa is
more frequent in lower animals than in man. The worm is commonly


-Strongylus sea Eustrongylus Gigas.

found in the kidney or pelvis, and may possibly find its way down the
ureter, and in this way make its escape from the body through the

Tetrastoma renalis. — This entozoon was found in the urine in one
case by Lucarella, and described by Dellechiaji.




There are a number of animal organisms which may find their way
into the urine from the outside, such as the vorticella, the amoeba,
and various forms of the infusoria.

Under this heading may also be included the spiroptera hominis of
Eudolphi, the disposoma crenata of Farre, and the dtctylius aeuleatus
of Curling.


The pediculus pubis also finds its way into the urine, as illustrated

Fig. 99.— Pediculus Pubis found in Urine. X 125.

by a drawing from one found in the urine.






A careful review of each sample examined, in conjunction with the
clinical history, will usually make the diagnosis clear and positive.
This is especially true in reference to the lesions so long grouped
together under "the common term Bright's disease. It is positively
affirmed that, by a close observance of the laws already advanced in
reference to the methods of production and the rules given for diag-
nosis, the existing lesions can in every instance be diagnosticated with
great accuracy. It may be argued that such precision in diagnosis
does not materially change the method of treatment; in which there
is perhaps much truth, but it enables a more positive prognosis to be
made and renders the treatment less empirical, and offers a far more
certain prospect for recovery by a proper selection of remedial agents.

By reviewing closely the clinical history and the urinary findings,
both at the bedside and at the necropsy, in over a hundred cases, an
accurate diagnosis has resulted in every instance. A striking case in
point is recalled where, by the application of these rules to the urinary
analysis alone, an accurate diagnosis was made without seeing the
patient until the necrops}', which fully confirmed the opinion pre-
viously expressed. This instance was an accidental injury in which
no renal lesion was suspected, and was apparently developed as the re-
sult of the surgical accident, and caused the death of the patient.

This case is cited to show what accuracy in diagnosis can be at-
tained, and how often an unobserved renal lesion may be a prominent
factor in reference to prognosis.

To accomplish this accuracy in diagnosis, the examiner must make
himself thoroughly familiar with the microscopic histological changes
wrought in the kidneys and liver in connection with the different renal
lesions. He must also be thoroughly familiar with the microscopic
appearances of the urine, as it is by this careful microscopic examina-


tion, and a proper interpretation of what is formd, that lie is enabled
to determine with positiveness the existing renal lesion.

A chemical examination alone yields comparatively little informa-
tion in relation to the physiological phenomena of the body and their
abnormal workings; but in conjunction with the microscopic results, a.
wonderful degree of precision is obtained, not only in connection with
diseases of the kidneys, but in all diseases, and especially in con-
nection with those originating in a faulty physiological function of
the liver.


A thorough study of urinary analysis, and especially the microscopic
part, will often make a diagnosis sure, which otherwise would remain
obscure. This is true not alone in reference to renal lesions, but
equally so in hepatic diseases.

Having obtained an accurate diagnosis, with a clear conception of
the pathological processes and the interrupted or modified physiologi-
cal phenomena, a critical study of the clinical symptoms will enable
the examiner to prognosticate with a wonderful degree of accuracy.

Treatment based upon such knowledge enables the prescriber to
anticipate pathological processes, to strengthen the enfeebled physio,
logical functions, and in many instances enable or cause the system
to completely repair the damage, thus effecting a cure where other-
wise a fatal issue would be the result.

Treatment now becomes a fixed principle; a cause to be removed,,
and an abnormal and enfeebled system to be placed in a position to
restore its damaged tissues and organs to their normal state. Having"
fully comprehended these principles, a specific virus, drug, or mineral
water cannot be expected to cure these complex physiological and.
pathological problems. It must be clear to every one that this is im-
possible. The main object should be to discover where the physio-
logical action is most at fault, and rectify it if possible. In this way
each faulty action can be treated and removed in the order of its
importance, and many permanent cures will be effected which other-
wise would terminate in an early and untimely death.


Acid, benzoic, 268
fermentation, 210
hippuric, 269
kinurenic, 267
phenolic, 269
uric, 263, 294
Acidity of urine, 208
Acute atrophy of the kidneys, 132

definition of, 132

diagnosis of, 133

etiology of, 132

microscoDic examination of,

pathological anatomy of, 132

prognosis of, 133

symptoms of, 133

treatment of, 133
congestion or hyperaamia of the

kidneys, 111
diffuse nephritis, 45

definition of, 45

diagnosis of, 49

etiology of, 45

microscopic anatomy of, 47

pathological anatomy of, 46

prognosis of, 49

symptoms of, 47

treatment of, 49
parenchymatous metamorphosis
of the kidneys, 17

diagnosis of, 22

etiology of, 17

macroscopic appearances of,

microscopic appearances of,

prognosis of, 22

symptoms of, 21

treatment of, S3

urinary symptoms of, 22
sclerosis of the kidneys, 92
Adenoma of the kidneys, 151

definition of, 151

diagnosis of, 152

etiology of, 151

pathological anatomy of, 151

symptoms of, 152

Adventitious coloring matters of the

urine, 279
Air bubhles, 329
Alantoin, 267
Albumin, 221

clinical significance of, 2S2
precautions in testing for, 221
tests for (see Tests), 222
Albuminoid kidneys, 98
Albuminuria, adventitious, 217
intrinsic, 217
prognosis of, 232
treatment of, 232
Alcohol, 24

Alkaline fermentation, 210
Alkalinity of urine, 208
Ammonio-magnesium phosphate, 211
Amphoterous urine. 213
Amyloid kidneys, 98
Anaemia of the kidneys, 109
definition of, 109
etiology of, 110
macroscopic anatomy of, 110
microscopic anatomy of, 110
symptoms of, 110
treatment of, 110
Analysis of the urine, introductory-
remarks on, 194
of the case, 338
Anatomy of the kidneys, 1
Aneurisms, 62

Angioma of the kidneys, 153
Animal organisms, 332
Apoplexy, 64
Arcade of Flint, 10
Arteriaa recta?, 10
Arteries, intertubular, 10
Ascaris renalis, 163
Ascending limb of tubule, 5
Ascites, 62

Atrophy of the kidneys, chronic, 138
definition of, 133
etiology of, 133
pathological anatomy of, 138

Bacillus tuberculosis, 311

342 iM'i:.\.

Bacillus tuberculosis, method of Casts, nucleated, 319

staining, 138 preserving of, 328

Bacteria, micro or simple, 310 tubular. 331

sphero, 808 waxy. 322

desmo, 311 Cathartics in parenchymatous meta-

Balance, Mohr-Westphal, 215 morphosis of the kidneys, 37

Bancroft! iilaria. 332 Causes of diminished pressure in the

Bath, hut-air. 36 glomeruli, 13

Bathing the bick, 24 of increased pressure in the

Benzoic acid. 268 glomeruli, 13

Bertini, ducts of, 7 of increased temperature, 26
Bile pigments in urine. 280 Cells, epithelial, 302

tests for, 280 Chlorides, 276

Bilharzia hssmatobia, 160, 334 clinical significance, 277

definition of, 160 clinical symptoms of, 277

diagnosis of, 162 tests for. 27(5
etiology of, 160 Cholesterin, 326
microscopic examination of, Chronic atrophy, 133

162 definition of. 133

pathological anatomy of, 161 etiology of, 133

prognosis. 162 pathology of, 133

symptoms, 162 diffuse nephritis, first variety, 51

treatment, 162 introductory remarks on, 51

Blank for urinary analysis, 198 definition of, 51

Blindness, uremic, 87 etiology of. 52

Blood-corpuscles, 287 microscopic examination of,

haemoglobin, 283 52

supply of kidneys, 10 pathological anatomy of, 52

Bowman's capsule, 7 prognosis of, 54

Bronchitis. 66 symptoms of, 53

Bubbles, air, 329 treatment of, 55

urinary symptoms of, 54

Calculi, renal, 129 second variety, 55

Calices, 4 etiology of, 55

Capsules, 3 microscopic anatomy of, 56

Bowman's, 7 pathological anatomy of, 56

layers of. 5 prognosis of, 58

Malpighian, 7 symptoms of, 58

microscopic appearances of, 5 treatment of, 58

Mxiller's, 7 third variety, 58

Carbonate of lime, 324 definition of, 59

Carcinoma of the kidneys, 149 diagnosis of, 60

definition of, 149 etiology of, 58

diagnosis of, 150 microscopic examination of,

etiology of, 149 59

microscopic examination of, pathological anatomy of, 58

150 symptoms of, 60

pathological anatomy of, 149 prognosis of, 60

prognosis of, 150 treatment of, 87

symptoms of, 150 dieting in, 89

treatment of, 150 parenchymatous metamorphosis

Carnin, 267 of the kidneys, 27

Case, analysis of, 338 cathartics, 37

Casts, 317 definition of, 27

blood, 317 diagnosis of, 32

coarsely granular, 321 diaphoretics in, 35

corkscrew, 321 * diuretics in, 35

distinguishing characters, 322 etiology of, 27

epithelial, 318 microscopic examination of,

fatty, 321 29

finely granular, 320 pathological anatomy of, 29

hyaline, 317 prognosis of, 33



Chronic parenchymatous metamor-
phosis of the kidneys

symptoms of, 31

treatment of, 33

urinary examination of, 32
sclerosis of the kidneys, 92
Chemical composition of urine, 190

examination of urine, 202
Clinical significance of bile pigments
in urine, 281

of blood-corpuscles in urine,

of blood-haemoglobin in urine,

of coloring-matters, 280

of fatty matter in urine, 283

of glycocholic acid, 270

of hippuric acid, 269

of indican, 271

of indigo, 271

of indol, 271

of leucocytes, 290

of oxalates, 296

of phosphates, 275

of taurocholic acid, 270

of tyrosin, 269

of urates, 274

of urea, 261
Coloring-matters of the urine, adven-
titious, 279
Color of urine, 204
Coma, diabetic, 185
Complications of renal lesions, 62

ascites, 62

aneurism, 62

apoplexy, 64

asthma, 65

bronchitis, 66

cardiac lesions, 67

cirrhosis of liver, 69

constipation, 69

diarrhoea, 69

eczema, 70

emphysema, 70

endarteritis, 64

endocarditis, 70

erysipelas, 70

gangrene, 71

gastric affections, 71

haemorrhage, 72

hepatic disease, 72

hydropericardium, 73

headache, 73

hydrosemia, 76

hydrothorax, 74

intestinal catarrh, 74

jaundice, 74

meningitis, 75

neuro-retinitis, 75

oedema, 76

oedema glottidis, 75
oedema of lungs, 75

Complications of renal lesions, peri-
carditis, 76

peril, onil is, 76

phthisis, 80

pleurisy, 81

pneumonia, 81

retina] lesions, 81

treatment of, 86

uraemia, 82

uraemic blindness, 87
Congenital rhabdo-sarcoma, 153
Congestion, acute, of kidneys, 111

definition of, 1 1 1

etiology of, 111

macroscopic appearance of,

microscopic examination of,

prognosis of, 113

symptoms of, 113

treatment of, 113

urinary examination of, 113
chronic, of kidneys, 114

definition of, 114

diagnosis of, 116

etiology of, 114

microscopic examination of,

pathological anatomy of, 145

prognosis of. 116

symptoms of, 115

treatment of, 117
Convoluted tubes of first order, 5

second order, 6
Corpuscles, 285

Malpighian, 5
Cortical arch, 5
layer, 5
markings, 3
Cotton fibres, 330
Crystals of uric acid, 212
Cysts, echinococcus, 157

renal, 134
Cystin, 268
Cystica trichinae, 335

Daily quantity of urine, 203

Desmo-bacteria, 311

Descending loop of tubule, 5

Diabetes mellitus, 165

Diarrhoea, 69

Diathesis, uric acid, 265

Dieting in chronic diffuse nephritis, 89

in glycosuria, 193
Digitalis, 25

Distinguishing character of casts, 322
Diaphoretics, 35
Diuretics, 36

medicinal, 35
Ducts of Bertini, 7

Echinococcus, 332



Echinococcus cysts. 157
definition of, 157
diagnosis of, 160

etiology of, 157

pathological anatomy of, 157

prognosis of, 160

symptoms of, 159

treatment of, 160
Eczema. 70
Elaterium, 37
Emboli, pysemic, 1-45
Embolism, fat, of the kidneys, 143

renal, 141
Emphysema, 70
Endarteritis, (14
Endocarditis, 70
Entozoa, spurious, 337
Epithelial cells. 302
Epithelium, function of, 15
Erysipelas, 70
Eustrongylus gigas, 336
Excretory nitrogenous substances, 254
Experiments of Heidenhain, 15
of Nussbaum, 17

Fat embolism of the kidneys, 143

definition of, 143

diagnosis, 144

etiology, 143

microscopic examination, 143

pathological anatomy, 143

prognosis, 144

symptoms, 144

treatment, 145
Fatty matter, 325

in urine, 282
Faveola, 7
Feathers, 330
Fel bovis inspissatum, 26
Fermentation, acid, 210

alkaline, 210
Ferrein, pyramids of, 3
Fibres, cotton, 330
flax, 330
muscle, 329
silk, 330
woollen, 330
Fibroma of the kidneys, 153
Filaria sanguinis hominis, 332
Finger markings, 331
First form of large white kidney, 27
Flint, arcade of, 10
Floating kidney, 2
Foetal markings of the kidneys, 2
Foreign matter. 329
Fourth form of large white kidney, 51

of small kidney, 97
Fungi, 315

Gangrene, 71
Gastric affections, 71
Gigas Eustrongylus, 336

Glycosuria, 165

circulatory symptoms in, 185

clinical history of, 183

definition of, 165

diabetic coma, 185

diagnosis of, 188

diet in, 190

etiology of, 165

falling out of nails in, 187

gangrene in, 187

integumental lesion and symp-
toms. 186

nervous symptoms, 185

ocular symptoms in, 186

oedema in, 187

pathological anatomy of, 169

pathological considerations of,

physiological considerations of,

prognosis of, 188

respiratory symptoms in, 185

thrombosis in, 187

treatment of, 188

urinary symptoms, 187
Globules, oil, 329

Glomeruli, causes of diminished pres-
sure in, 13

causes of increased pressure in,

physiological action of, 12
Glomerulus, 8
Glottis, oedema of, 75
Glucose in urine, 235

experiments in testing for, 235

quantitative analysis of, 292

quantitative tests for, 244

tests for (see Tests), 234
Glycin. 268
Glycocholic acid, 270

clinical significance of, 270
Gonococcus, 311
Gouty nephritis, 97

definition of, 97
Granules, starch, 331
Gravity, specific, 214
Guanin, 267
Gummata of kidneys, 155

Haemoglobin, 283
Haamatobia Bilharzia, 334
Hasmatoglobinuria, 106

definition of, 106

etiology of, 106

microscopic examination of, 108

pathological anatomy of, 107

Online LibraryWilliam Henry PorterA practical treatise on renal diseases and urinary analysis → online text (page 31 of 32)