CHARACTERS OF THE URINE IN CHYLURIA.
Macroscopy.—The milky appearance of the urine is due to the es cape into it of the contents of the lacteals and intestinal absorbents through some accidental communication. Unless some renal degen eration is also present, the urine is normal except that it contains a large amount of fat in a fine molecular condition, albumin, and fibrin.
In some cases the urine assumes a pinkish color from the pres ence of colored corpuscles like those of blood. This is so frequent and occasionally so abundant in certain cases as to justify the use of the term hemato-chyluria Commonly—at least in India—says Lewis, the blood-like admix ture, when present, is seen forming a shreddy, adherent coagulum at the bottom of the vessel after it has stood for some time. Fresh chyluric urine emits a strong milky or whey-like odor, which is in creased by warming. If the urine be allowed to stand, it behaves in a similar fashion to blood; it coagulates into a semi-solid mass like blanc-mange, which then gradually contracts and separates into clot and a liquid. Should the clotting process take place in the kidney or—as it more often does—in the bladder, renal and vesical colic may ensue from mechanical obstruction.
The amount of urine is increased, being 80 to 100 oz. per diem, but this increase may be due in some measure to the addition of the chyle. The specific gravity varies between 1.007 and 1.020. If ether be added the fat is dissolved and the milky appearance is lost.
But the fatty matter is not constant in amount. It varies from 0.2 to 2 per cent. It is increased after meals. It also changes with the posture and the amount of exercise taken. Casein has not been discovered. The urea is not increased. If the urine be heated or nitric acid be added, albumin falls.
It must be recollected, however, that sometimes the urine is not chylous and milky, but lymphous and merely albuminous ; it coagu lates spontaneously into a substance which has been likened to " size," "calf's-foot jelly," or "currant jelly," a condition which much re sembles the fibrinuria of Ultzmann (cf. Hematuria).
The chyluric and lymphuric urines are derived from chyle-bearing and lymph-bearing channels respectively, and it is ad mixture of these two fluids which has probably caused so much de viation from the average which the published researches of the per centage constituents of chylous urine show. Thus Sir W. Roberts, whose careful work on the subject I have freely consulted, gives an abstract of nine analyses of chylous urine by different authors, no two being alike.
Microscopy . —The microscope reveals fat in a finely molecular con dition, blood corpuscles, and often the nematoid entozoon the filaria sanguinis horninis. The filaria sanguinis hominis may generally be discovered in the urine at any time of the day, and in the blood of the patient if drawn at night (between 9 P.1)1. and 6 A.M.) . In the urine the parasites are quickest found by taking up and teasing out gently one of the small clots. Patrick Manson says a better plan consists in breaking up the coagulum in the urine with a glass rod as soon as it is formed, and then searching the sediment which, after an hour or two, collects at the bottom of the vessel, in the same way as is customary to examine for "casts." As large a slide as is practicable ought to be examined, and a low power employed in the first in stance, as it often happens that the filarile are present in very small numbers, and may readily be overlooked if a small quantity of the sediment only is examined or if a high power is employed.