MEYER. The present status of dental bacteriology. Collected Reprints, Hooper Foundation Med. Research, 1916-17, ii, No. 5; Jour. Nat. Dent. Assn., 1917, iv, 966. MILLER, W. D. The human mouth as a focus of infection. Dental Cosmos, 1891, xxxiii, 689. MOOREHEAD. Prevalence of chronic mouth infections and management. Jour. NEVITZSKY. Septic teeth: etiology and surgical treatment. Am. Jour. Surg., ODENTHAL. Therapie des maladies infectieuses, p. 256. OSBORNE. The menace of chronic mouth infections. Jour. Am. Med. Assn., Oct. 20, 1917, lxix, 1313. Tooth infection. New York Med. Jour., March 2, 1918, 385. The menace of tooth infection. Jour. Am. Med. Assn., Oct. 20, 1917, lxix, 1313-1315. OSLER. On the visceral complications of erythema exudativum multiforme. Am. Jour. Med. Sc., 1885, cx, 629. OSMOND. Relations between systemic disease and focal infection in the upper respiratory tract. Cleveland Med. Jour., Sept., 1916, xv, 559. PATTERSON. Diseases of the eye from infection in the mouth and throat. Colorado Jour. Med., July, 1917, xiv, 197. PICKERELL AND CHAMPTALOUP. Bacteriology of the mouth in the Maori children: investigation into cause of immunity to dental disease in the Maori. Abs. Brit. Dent. Jour., 1913, ii, 1482. Internal secretions and dental caries: with specific reference to thyroid insufficiency. Brit. Med. Jour., 1914, i, 1406. POTTER. The vicious circle in mouth infections. New York Med. Jour., Feb. 10, 1917, cv, 243. POTTER, NATH., BOWDITCH, MCNEIL, ARCH., AND BRADBURY, SAM. Streptococcus oral sepsis. Med. Rec., Jan., 1918, xciii, 135. PRICE, W. A. The relation of dental operations and dental lesions. The prevention of systemic diseases arising from mouth infections. Cleveland Med. Jour., Oct., 1915, xiv, 657. Electrolytic medication. Jour. Nat. Dent. Assn., June and August, 1918, v, Nos. 6 and 8. The relative efficiency of medicaments for the sterilization of tooth structures. Jour. Nat. Dent. Assn., Mar., 1918, v, No. 3, 27-303. Dental aspect of the relation of endameba to pyorrhea alveolaris. Surg., Gynec. and Obst., Jan., 1916, xxii, 37-43. PRINGLE, G. K. L. Oral sepsis. Lancet, 1914, ii, 60. REEDE. Mouth infections and goiter. Washington Med. Ann., Aug. 11, 1917, cvi, 256. RHEIN. Retention of devitalized teeth without danger of focal infection. Jour. Am. Med. Assn., Sept. 22, 1917, lxix, 974. The dental aspect of oral infection. Med. Rec., 1914, lxxxv, 604-608, Jour. Am. Med. Assn., 1913, lx, 503. Deep-seated alveolar infections. Surg., Gynec. and Obst., Jan., 1916, xxii, 33. ROLERTS. Diagnostic teeth. New York Med. Jour., Aug. 11, 1917, evi, 256. ROSENBERGER. Oral sepsis and possible dangers. New York Med. Jour., 1913, xcviii, 809. ROSENOW, E. C. Immunological and experimental studies on pneumococcic and streptococcic endocarditis (chronic septic endocarditis). Jour. Infect. Dis., 1909, vi, 245. Transmutations within the streptococcus-pneumococcus group. Ibid., 1914, xiv, 1. ROSENOW, E. C. Bacteriology of appendicitis and its production by intravenous injection of streptococci and colon bacilli. Ibid., 1915, xvi, 240. The etiology and experimental production of erythema nodosum. Ibid., 367. Iritis and other ocular lesions on intravenous injection of streptococci. Ibid., xvii, 403. Bacteriology of cholecystitis and its production by injection of streptococci. Jour. Am. Med. Assn., 1914, lxiii, 1835. The etiology and experimental production of herpes zoster. Ibid., 1915, lxiv, 1968. Mouth infection as a scurce of systemic disease. Ibid., 1914, lxiv, 2026. neuritis and myositis. Jour. Immunol., Aug., 1916, i, 363. Etiology of acute rheumatism, articular and muscular. Jour. Infect. Dis., 1914, 61. SCHOMBERG. The surgical treatment of chronic alveolar abscess. Dental Cosmos, 1906, xv. SCHOTTMÜLLER. Die Artuntersuchung der fur Menschen pathogenen Streptokokken durch Blutagar. München. med. Wehnschr., 1903, 1, 849. SMITH. Pruritis in oral sepsis. Canadian Med. Assn. Jour., Aug., 1916, vi, 724. SMITH AND BARRETT. Dental Cosmos, lvii, 1201. SMITH, MIDDLETON AND BARRETT. Tonsils as a habitat of oral endamebas. Jour. Am. Med. Assn., 1914, lxiii, 1746. STEADMAN. Pyorrhoea alveolaris as a predisposing cause of cancer of the alimentary canal and associated parts. Internat. Cong. Med., 1913. Sect. xvii, Stomatol., Part II, 145-168. TALBOT, JOHN E. Theory on the etiology of the toxemia of pregnancy with or without convulsions. Surg., Gynec. and Obst., Feb., 1919, xxviii, No. 2, 165. THOMAS, K. H. Relation of teeth and jaws to medicine, effects of infection, bacteria and bacterial poisons, subperiosteal and subgingival abscesses, dental granulomata, cysts, pus pockets and pyorrhoea alveolaris. Med. Clin. N. America, Jan., 1918, i, 1069. Chronic diseases of the mouth of interest to the physician. Am. Jour. Surg., April, 1918, xxxii, 81. TOUSEY. Dental infections in systemic disorders. New York Med. Jour., 1916, civ, 1269. ULRICH. Blind dental abscesses. Jour. Am. Med. Assn., 1915, lxv, 1619, 1621. WALLER. Dental diseases in nursing women. Lancet, Nov. 4, 1916, ii, 785. WRIGHT. Pathological conditions of the mouth. Pennsylvania Med. Jour., Nov., 1916, xx, 105. Teeth in relation to the body. Boston Med. and Surg. Jour., 1912, clxvii, 799. Ibid., 1913, elviii, 232. ZENTMAYER. Dental diseases in relation to diseases of the nose and throat. Boston Med. and Surg. Jour., July 4, 1918, clxxix, 17. Ocular lesions as a result of mouth and pharyngeal lesions. Am. Jour. Ophth., Apr., 1918, i, 247. CHAPTER X PRACTICAL URINALYTIC METHODS AND THEIR SIGNIFICANCE BY MARTIN H. FISCHER, M.D. Introduction p. 423-The importance of urinalysis, p. 424-The collection of the urine, p. 424 The preservation of the urine, p. 425Physical characteristics of the urine, p. 426-Acidity determinations, p. 433-Acetone bodies, p. 440-Reducing substances in the urine: Sugar, p. 445-Proteins in the urine: Albuminuria, p. 455– Microscopical examination of the urine, p. 465-Summary, p. 469. INTRODUCTION It is not the purpose of these pages to add to the already long list of chemical manuals available on the examination of the urine by physical, chemical and other scientific means. They express, rather, an attempt to state what the general man in medicine or surgery can do in the way of urinalysis and will do for the patients committed to his care. What is suggested here is, in a certain sense, the irreducible minimum which must be done for every patient if an approximation, even, of correctness in diagnosis, guide to treatment, and a fair knowledge of what is happening to the patient is desired. The interests of the general man in medicine or surgery have been alone considered. The points touched upon are, therefore, in no sense exhaustive, and the methods. described are often not the best that could be employed. But they are the simplest that can be used and so little time-consuming that no conscientious worker in medicine will neglect them. There will be launched against what is here written the criticism that many more or better procedures could have been followed. This is cheap knowledge not to be gainsaid, for to know and to do much for a patient is obviously better than doing less. This is, however, not the matter at dispute. The following pages are intended to bring home that it is better to do what is here outlined than that which is done more commonly-namely, nothing at all. It is a fair statement that several approximately correct analyses made by the attending physician himself will be more informing to the physician and will be a better guide to treatment in certain diseases than a single more careful analysis made at a distant laboratory by a man who has not access to the patient. An analysis of the urine to the distant laboratory worker is, of necessity, too much of an end in itself; and the author knows, through experience, that the cryptic tables mailed to the attending physician are, in most instances, mis understood or misinterpreted and so of no value whatsoever to either him or the patient committed to his care. The only way out is for the analyst and the physician to consult over the patient or else for the physician to become enough of an analyst to discover for himself the elementary things so necessary for his guidance. The latter ideal is in no sense an impossible one and it is in this spirit, of accomplishing more for the patient, of giving more help to the busy practitioner and this in such manner as not to make inordinate demands upon the patient's purse or the physician's time, that the following pages are written. THE IMPORTANCE OF URINALYSIS Proper examination of the urine derives its great practical importance from the fact that through it we obtain not only an index of various changes which may be occurring in the kidney or in the genitourinary organs which connect this viscus with the outer world, but because in the urine we also find the evidences of changed body chemistry as incident to poisoning of various sorts and to the different diseases like the "metabolic" disorders which accompany improper utilization of proteins, of carbohydrates or of fats in the body. But from the fact that so many and such widely varying changes in all or a part of the human mechanism may thus mirror themselves in the physical or chemical properties of the urine, there arises a difficulty-that of judging properly the real significance of any given urinary finding. But even in this, knowledge of and proper utilization of a few guiding principles clear a main road which any one may follow and one which the traveler may subsequently decorate with as many exotic shrubs as may please his special fancy. The experienced traveler and the safe guide is not the man who knows every path, but he who is sure of the main one. The serious errors of our profession are not those which are incident to the non-discovery of rare and unusual types of disease; as every one knows who follows his patients. beyond the bedside and through the autopsy room, our errors are more gross, and cover long-known and well-marked pathological disturbances. Pregnant women with milk-sugar in the urine are treated as diabetics when anything but a restricted diet should be their share; diabetics are tortured with the false interpretations placed upon the fractional "per cents." of reducing substance which they show in the urine; and the well-to-do in expensive hospitals die of as real starvation as the famished of India, because the meaning of acetone bodies in the urine is not clear to the attending physician. THE COLLECTION OF THE URINE Since the twenty-four-hour period is the unit cycle of our physiological existence, it is for most purposes the best unit of time to choose. |