to his opinions. There is a way of simplifying any subject, by denying all that has been said upon it; but such a procedure would soon reduce all science to a negation. Another important point on which Dr. Bennet entertains peculiar views is the amount of scientific knowledge requisite for the examination of the urine in reference to pathological inquiries; and here also his tendencies are in the negative direction. "Divested of minute scientific development, that examination, as we have seen, is a most simple matter, and does not require any very extensive knowledge either of chemistry or of the microscope." (p. 126.) But, as if startled at his own assertion, he endeavours to modify it in some degree by the following truism-"The greater the knowledge possessed, however, the more certain are the results obtained; and there is therefore every inducement to the student and the practitioner to pursue their researches." At page 117, he has the temerity to affirm that a practical acquaintance with the principal salts and morbid products revealed by the microscope may be acquired in a few hours! We have always regarded the analysis of urinary deposits as requiring extensive and accurate chemical knowledge. Again, we believe that the very first requisite for any effective use of the microscope is a thorough practical acquaintance with the instrument-its construction, powers, and management, and we are convinced that, in the absence of such knowledge, the results obtained are very likely to be a series of blunders, often of a ludicrous description. We must therefore express our entire mistrust of all examinations of the urine "divested of minute scientific development;" and we cannot help thinking that if Dr. Bennet will bring to his aid a little more chemical and microscopical science, he may arrive at conclusions more satisfactory (to the profession, at least) than the generalities with which he appears at present to be so well contented. Such, however, being the small amount of scientific acquirement which our author deems essential to the investigation of urinary deposits, we do not wonder at his being occasionally disposed to delegate the inquiry into the patient's own hands. After occupying some pages with remarks on the variety of constitution in different individuals, respecting the kinds of food which agree best, the frequency of meals, and the time of day at which these may be most advantageously taken, and after stating that the inspection of the urine will throw important light on such points, and that the presence or absence of urate of ammonia in this fluid is the most delicate test of good or bad digestion, he proceeds as follows: "The above facts, which are deduced from the careful investigation, during many years, of the urine of large numbers of dyspeptic patients, show clearly that it is impossible to lay down general dietetic rules: each case must be studied by itself, and the advice given must be modified according to the results of the study of each individual. The existence of urate of ammonia in the urine a few hours after the ingestion of food, presents, however, in most cases of disordered digestion, an easy means of arriving at the required knowledge. The circumstance of this salt rendering the urine turbid when it cools, makes it quite possible for the patient himself to carry on the investigation, once the physician has ascertained that the turbidity is owing to the presence of a lithatic deposit, and not to pus, &c. Thus an Ariadne thread is placed in the hands of the dyspeptic patient, which may enable him, with some slight assistance from his medical attendant, in the way of explanation and direction, to guide his own path though the dietetic labyrinth. He may thus learn to a certain extent what kind of food suits him individually, what amount he can take, and at what intervals and hours it is required in his own particular case: should, however, uric acid, oxalate of lime, or the triple phosphates be present without the urate of ammonia, this information could of course only be obtained by microscopic examination. The same mode of study may be applied to beverages, and their influence on digestion. If alcoholic stimulants are beneficial, they will not disturb digestion, and the urine will remain as clear, as free from morbid deposits, as if they had not been taken; but if, on the contrary-as sometimes occurs, even with the healthy and very frequently with the weak and dyspeptic-beer or spirits, even when taken in moderation, render the urine turbid and lithatic, evidently disturbing digestion, they assuredly can do no good indeed, far from doing good, they are a snare and a delusion, owing to the temporary feelings of strength and comfort which they give rise to at the very time that they are in reality poisoning the economy." (pp. 153-155.) We consider this as a very first-rate specimen of ad captandum writing. We fancy we see some elderly gentlewoman anxiously poring over the oracular fluid -calling in the aid of the microscope, the management of which has been represented as so simple and easy-and, when she has puzzled and frightened herself nearly into fits, sending for her medical attendant to give some slight assistance. Of course, such assistance in making out the urinary deposits will be accompanied with the deposit of a fee in the palm of the obliging gentleman who renders it. By the way, a Greek motto is an imposing sort of thing; we will suggest one to our author for the title-page of his next edition, which aptly associates the pleasures of the table with the means of inquiry into their effects on the system: Ἔγχει πιεῖν μοι· καὶ τὸ πέρδικος σκέλος, Jesting apart, we would earnestly recommend Dr. Bennet, and all who profess to have the honour of the profession and the welfare of the public at heart, neither to instigate nor to encourage the laity to dabble in medicine, always excepting that useful common-sense kind of medicine which every good housewife knows how to administer without any lessons from the doctor. The extract just made, though germane to the matter of the fourth chapter, is taken from the fifth, which is headed "Practical Deductions." On the contents of this chapter we have no particular remarks to make; neither does the sixth and concluding chapter, on "Confirmed Dyspepsia," demand any especial notice; the topics commented on are those to be found in most treatises of a similar character to that now before us, and the views inculcated do not differ from those generally received. In some parts of this book the writer falls into inaccuracies from which a moment's reflection would have preserved him, and makes statements which are at variance with common observation. For example, at p. 33, we are told that "The animal creation are satisfied with water; indeed they show dislike and repugnance to all other beverages." Whereas many horses will drink wine and malt liquors with avidity, some monkeys delight in strong drinks, and a cat will seldom take water when it can get milk. The work abounds also with defects of style-the misuse of some words, and the employment of others which have no existence save in the writer's own vocabulary. Thus, at page 64, we meet with "media obtained by acting on numbers." These words, as they stand, are entirely destitute of meaning; but the writer evidently intends to express averages obtained by the use of numbers." In several places he calls starch amydon instead of amylum-a mistake which shows an entire unacquaintance with the derivation of the word. The word dietary is continually used in the sense of diet. Nor do we approve of the employment of so obsolete and certainly strange-sounding a word as "activate," for which the author has a special penchant. We wonder the more at the occurrence of such strange mistakes as these, because many passages in the book are written in a correct, easy, and agreeable style. 66 On the whole, Dr. Bennet's work may afford some interesting information to the general reader, for whom it appears to be chiefly intended. If we have treated it for the most part in rather a jocose manner, this has been in order to avoid the censure which a graver criticisin might have called upon us to pro nounce. *Athenæus Deipnosophist, lib. i. REVIEW XIII. 1. A Treatise on the Pathology of the Urine, including a Complete Guide to its Analysis. By J. L. W. THUDICHUM, M.D.-London, 1858. 2. Urinary Deposits-their Diagnosis, Pathology, and Therapeutical_Indications. By GOLDING BIRD, M.D., F.R.S. Fifth Edition. Edited by EDMUND LLOYD BIRKETT, M.D., Fellow of the Royal College of Physicians, &c.-London, 1857. SOME months ago we purposed drawing up a notice of several theses which had recently. been published on various points connected with the physiology and pathology of the urine, and we had begun to arrange our scattered materials when we received the volume which stands first at the head of the present article. A perusal of Dr. Thudichum's volume at once showed us that he had been so carefully over the ground that we had intended to occupy, that there were little, if any, gleanings left us, and we have consequently abandoned our original intention, and shall content ourselves with the easier task of culling freely from his rich harvest. His work, which extends over considerably more than four hundred pages, is divided into no less than forty-six chapters, the headings of which we shall briefly give, for the sake of affording our readers some idea of the extensive plan which the author has proposed for himself. In the "General Characters of the Urine" we have a full description of the various colours and tints that this fluid may assume, from which we extract the following remarks: "The urine may be very deeply tinted by the colouring principle of coffee, when a tolerably strong infusion of the unadulterated roasted berry is taken even in moderate quantity. The colouring matters of several drugs, such as the chimaphila or pyrola, hæmatoxylum, senna, rhubarb, enter the urine very readily, and [in] a short time after having been taken into the stomach. Urine coloured by rhubarb is sometimes mistaken for bilious urine. The error can be at once detected by the addition of liquor ammonia, which converts the dark orange into a crimson colour. Vogel recommends the addition of mineral acids to the urine in cases where the presence of the pigments of either rhubarb or senna is suspected. The acids change the brownish or dark-red colour into a bright yellow; while uræmatine, if changed at all, is rather darkened by their influence. Black or blackish urine has several times been observed after the internal use of creasote and the inunction of tar over the whole surface of the body."* Greenish or even grass-green urine has occasionally been found in cases of cystitis and Bright's disease, and blue or violet-coloured urine has more frequently been observed in the same diseases. The odour of the urine is due to the presence of minute quantities of certain volatile acids, such as phenylic (or carbolic), taurylic, damaluric, and damolic acids, which have been detected by Städeler in the urinary secretion of man and cattle. "The odorous acids (occurring in the urine) develope their flavour on the tongue to great advantage!"-a statement that we are quite willing to take Dr. Thudichum's word for, without repeating the experiment. The following points are of importance in connexion with alkaline urine. Ammoniacal urine is always fœtid, pale, and turbid, from the precipitation of triple phosphate and phosphate of lime. The smell, and the presence of the crystals of ammonio-phosphate, easily distinguish it from urine which is only turbid from alkalinity from fixed alkali, and contains a precipitate of phosphate of lime, or phosphate of lime and magnesia. Urine which is alkaline from the presence of bicarbonates (after Vichy water), is mostly clear, the earthy phosphates being soluble in the second equivalent of carbonic acid, which easily separates from the carbonate. A neutral or alkaline condition is frequently associated with the pale urine which is discharged in anæmia. The reason of the absence of acidity in these cases is not very well known, but it seems beyond all doubt that a constantly alkaline pale urine requires the employment of tonics, and especially of preparations of iron. Between thirty and forty pages are devoted to the consideration of urea, all the best methods of testing for this substance being very fully noticed. We can only notice his remarks on an excess or deficiency of urea in disease. Taking the normal daily quantity of urea at from 30 to 40 grammes (about 460 to 620 grains), we may observe that there is an excess in the stadium incrementi of all acute febrile diseases, such as typhus, pneumonia, &c.; while there is a diminution in diseases which are chronic, and accompanied by impaired nutrition. The lowest quantity which Dr. Thudichum ever observed to be discharged by a patient in twenty-four hours was 75 grains, in 200 fluid drachms of pale, faintly alkaline urine. The patient in question was a lady with ovarian tumour, who had become anæmiated after salivation. So low an amount as this generally only occurs towards the end of fatal diseases, when there is not only a diminished formation of urea in the system, but also a failure of the excretory powers of the kidneys. In his remarks on the determination of uric acid in urine, he recommends that if the secretion be normal, and contain no albumen, nitric acid should be used in preference to hydrochloric acid. A temperature of 98° Fahr. has the advantage. of not admitting the precipitation of any urates; and, further, crystals formed at this temperature are much larger and more easily collected than those produced at the ordinary temperature. He disapproves of the use of hydrochloric acid, because, 1st, uric acid is relatively soluble in it, and the accuracy of the result is thus affected; and because, 2ndly, hydrochloric acid favours the acid fermentation and the development of certain confervoid growths, which act as yeast-cells on the urates, and decompose them with great rapidity. If the urine contain albumen, acetic acid, or the common phosphoric acid, should be used. The following form of urinary sediment will probably be new to most of our readers: * Thudichum's Treatise, &c., p. 4 "When appearing as a precipitate in alkaline (ammoniacal) urine, urate of ammonia forms very slender dumb-bells. This form I have met with in perfectly black alkaline urine from a child suffering from dropsy after scarlatina. It was mixed with rosettes and hexagonal plates of urate of soda, the deposit being perfectly black after filtration."* The daily quantity of uric acid is liable to great variations, even in a state of perfect health. Our author gives 10 gramme as the maximum, 0.02 of a gramme as the minimum, and 0.5 of a gramme (or 7.72 grains) as the mean. Patients are often unnecessarily alarmed by observing a deposit of urates in the urine. The indication of such a deposit, however, only becomes important when we take into consideration the total quantity of urine and of dissolved urates discharged in twenty-four hours. There are two cases to be considered. (a) "If the bulk of the urine for twenty-four hours is the normal average, and if a sediment of urates continues to exist in that urine, it is tolerably certain that an excess of urates is present." (b) "If, on the other hand, the urine for twenty-four hours is below the average, a deposit may possibly be, and in most cases is, due to saturation only. The easiest process of ascertaining this, for ordinary practical purposes at least, is to dilute the urine with water to its average bulk, and to shake it well. If the deposit does not entirely dissolve, an excess of urates is present." Dr. Thudichum lays down the following therapeutic rule in connexion with the deposition of urates: The individual whose urine has deposited the urates does not drink water enough, and must drink more; and must drink so much that the urine (at the ordinary temperature of the air) shall remain clear. As far as we know, our author is the first chemist who has determined the quantity of creatine and creatinine in the urine. In the following table A and B represent two healthy persons (men), aged twenty-eight years, and weighing 154 lbs. and 159 lbs. respectively. The statement in p. 120, that creatine is absent in the brain, is incorrect, if we are to trust the statement of Lerch, who asserts that he has obtained it from this organ. The chapter on Hippuric Acid is confessedly unsatisfactory. It contains all, or nearly all, that is known on the subject, but leaves all the physiological and pathological difficulties untouched. Why, for instance, does hippuric acid occur in the urine of Herbivora and not of Carnivora? What is the source of the hippuric acid in the urine of the former? Why is it almost always in excess in the urine of diabetic patients, and in the very acid urine passed in some forms of fever? Why are no special symptoms associated with the presence of an excess of this constituent in the urine? The only investigations of any importance on this subject which our author has omitted to notice, are those of Weismann, and those of Kühne and Hallwachs;† the two latter observers seem by their experiments to have established the view (originally propounded, we believe, by Duchek), that it is the glycine (glycocoll of some chemists) of the bile or of the liver which is converted, either within the liver or in the blood, into hippuric acid. Hallwachst has subsequently published *Op. cit. pp. 88-89. + Archiv für pathol. Anat. und Physiol., Band xii., p. 386. Ueber den Ursprung der Hippursäure im Harn der Pflanzenfresser. Preisschrift. Göttingen, 1857. |