Part 19

URINE ANALYSIS.

Normal urine is a clear, watery fluid, with an acid reaction and a specific gravity of from 1018 to 1020. It is composed of inorganic salts, organic constituents, together with some coloring and a small amount of mucus.

The most important of these inorganic salts are chlorid of sodium, phosphate of potassium, and the sulphates of calcium and magnesium. The inorganic constituents are chiefly urea, uric acid, and poisonous inorganic substances found in the body. The normal amount of urine voided by an adult weighing 160 pounds is from 40 to 70 ounces in twenty-four hours. The amount may be increased by drinking large quantities of fluid, especially water, and diminished by perspiration, emotion, and copious bowel movements.

Normal urine is aromatic. In health it may be faintly alkaline at certain times of the day. Urine passed in the morning has an acid reaction, a high specific gravity, and a dark color. After a hearty meal it may be turbid—perhaps alkaline, and of low specific gravity. Large quantities are pale, and vary with concentration. When just passed it is clear; then it collects a cloudy material made up of mucous corpuscles, which can be easily shaken up. Concentrated urine, when it cools, deposits a pinkish (brick-dust) precipitate. Gentle heat clears it up. When highly concentrated the crystals are red. When they collect and adhere together they become stones; if all precipitate on heating it is normal urine.

Alkaline urine throws down phosphates that are held in solution and clears up on addition of any acid; if urine is cold and acid in reaction, sediment, if present, may be urates, but is not phosphates; if urine is alkaline, they are normal phosphates.

TO TEST REACTION.

Litmus-paper is used. Acid changes the blue to red. Alkaline changes red to blue. When urine does not affect litmus-paper it is said to be neutral.

Pus in urine is turbid or milky in appearance; after standing a while it settles down.

Albumin in urine is held in solution, and therefore cannot be seen.

A SIMPLE AND RAPID TEST FOR ALBUMIN.

Fill an ordinary test-tube half full of urine, and add a half dram or more of potassium ferrocyanid solution (1 to 20). After thoroughly mingling the urine and the reagent, add a few drops of acetic acid (50 per cent.); then pause for a half minute and note the change. If albumin be present it will come plainly into view within half a minute to a minute, in the form of white, milk-like opacity, diffused throughout the whole contents of the tube. The above method precipitates all modifications of albumin. On the other hand, it gives no reaction with phosphates, peptones, mucin, the alkaloids, urates, or the pure acids. The reaction that sometimes occurs on long standing between the acid and potassium ferrocyanid should not be mistaken for albumin. The albuminous reaction appears within half a minute or so, while the other occurs only after ten minutes to half an hour, and is mingled with more or less blue coloration.

TO OBTAIN A 24-HOUR SPECIMEN OF URINE.

Begin early in the morning. Throw away the first urination. Save all further urinations for the next twenty-four hours. For instance: Patient urinates at 6 A.M. This first urination is thrown away, or saved for an A.M. specimen if required and patient’s bladder is empty. Save all succeeding urinations for the next twenty-four hours, at the end of which time (6 A.M.) request the patient to urinate, and save the last urination also, to complete the specimen. This gives us twenty-four hours’ secretion.

The addition of solution of formaldehyd (fʒij) to a twenty-four hour specimen of urine will preserve it, and prevent fermentation before the analysis is made.

INFANT FEEDING.

1. If the bowel movements are curdy, we may take it as an indication of an excess of proteids.

2. Sour vomiting often indicates too much fat.

3. Stools that are very watery but without curds may result from too much sugar or too much fat.

4. Vomiting of hard, curdy masses may indicate too much proteids.

5. Should the child seem to do well on its food in every way except that it does not gain in weight, it may be that the sugar is too low.

6. Vomiting may mean that the child has eaten too much.

7. Breast milk is the best infant food.

8. No artificial food can or should be trusted which does not contain the essentials of breast-milk—viz., fat, proteids, and sugar.

9. The elements named are to be found only in milk, cows’ milk being the only one available for general use.

10. Cows’ milk must be modified, because it does not contain the same proportions of the elements named.

CONSTITUENTS OF GOOD MOTHER’S MILK.

Reaction Alkaline.

Contains 3 to 4 per cent. of fat } Sp. gravity “ 6 to 7 “ “ of sugar } 1030. “ 1 to 2 “ “ of proteids}