In how far such a belief is sustained by facts, it is our purpose to enquire briefly.

Healthy urine is an amber-colored, watery fluid, holding in solution a great variety of substances, both organic and inorganic, and containing also a small quantity of mucus derived from the bladder and urinary passages.

Its specific gravity varies from 10.03 to 10.30, depending on the amount of solid and liquid food taken, the period at which it is passed and other circumstances, such as the active or passive condition of certain organs at the time.

The average specific gravity of the whole amount secreted in twenty-four hours is about 10.15. The following analysis by Berzelius, may be taken as a standard for comparison:

Water,......
Urea,

.933.00

30.10

Uric Acid,..

1.00

Lactic Acid, Lac. of Ammonia and extractive,....................

17.14

In addition to the above it may contain foreign substances that have been introduced into the system as medicines. It is now admitted by the best authorities that the urine always contains a small quantity of sugar. Morbid urine is almost invariably more or less altered in its composition, and frequently presents physical peculiarities, as of color, opacity, &c., which are at once apparent on examination. The variations in its chemical composition may be very properly divided into two classes: 1st, Those in which no abnormal ingredient is present, but in which one or more of the normal constituents is present in greater or less proportion than in healthy urine, or is altogether absent. 2d. Those in which one or more ingredients are present which

are not found in the healthy secretion. Any one of the normal constituents of the urine may be in excess and still the organism may be in a healthy condition-for instance: during indulgencies in a rich animal diet, and also while a rapid metamorphosis of the muscular tissues is taking place, there is an excess of the urea and the urates. In active states of the brain and nervous tissues there is an excess of the phosphates. The introduction into the system, with the food or alone, of any one or all the salts contained in the urine will be followed by their appearance in that fluid in like proportion. The chlorides are always diminished in an extraordinary degree, and at times are totally absent in certain pathological conditions, such as acute dropsy, copious diarrhoea, typhus, the acute form of Bright's disease, pneumonia and all inflammations accompanied with copious exudations. The determination of the condition of the urine in reference to the excess or deficiency of any one or more of its normal constituents, is of itself valueless; but taken in conjunction with other facts and observations may materially assist in making a correct diagnosis. Similarly the specific gravity of this fluid determines nothing, for though there may be a superabundance of the salts secreted, this fact may be masked by a corresponding increase of the watery portion. Likewise a decrease in the proportion of water will give a high specific gravity when there may be even an amount of the salts below the average.

The abnormal constituents of the urine are of two kinds: 1st. Those which are conveyed to the body from without, and which, after remaining only a short time within it, pass into the urine either wholly unchanged or in a slightly modified form, chief among which are the various medicinal agents. 2d. Those organic substances which usually are only found when some disease is in progress. Of the first I do not propose to speak at present.

Albumen is always present in the urine in Bright's disease, however, where it is accompanied with active inflammation of the kidneys, the proportion is very much diminished, and sometimes apparently entirely absent. It is also frequently present in all those diseases with which uræmia is associated particularly in scarlatina and other acute exanthemeta, and especially in cholera.

Less frequently it is found in the urine in dropsies, organic diseases of the throacic and abdominal organs, of the spinal chord, in hectic fevers and diabetis. Sometimes it is found in the urine of persons with only slight fevers, and unaffected with any other disorder. A few cases are on record in which the urine was albuminous when there was perfect health. Albuminous urine, therefore, is not pathognomonic of any disease, and is of value in diagnosis only as one witness in the case. Without entering into details, the same may be said of fibrine, sugar, caseine, the billiary acids, fat, &c. It is remarked by Lehman, that "if we endeavor to name and distinguish the constitution of the urine in individual diseases in accordance with the present condition of pathology, and to collect and arrange the results of the numerous investigations which have been made on this subject during the last twenty years, we are led to the unexpected and discouraging conclusion that all our knowledge regarding it is alike incomplete and obscure" The reason for for this is suggested by an inquiry into the object and purposes of this secretion in the animal economy.

The kidneys stand in the same relation to the blood, that the safety-valve does to the steam engine. In order that life may continue, the blood must be kept pure within certain limits; whatever of morbid or of effete matters may have been introduced or incidentally generated in the blood are almost immediately eliminated by the kidneys. The composition of the urine, therefore, is dependent more upon the temporary condition of the blood, external influences, and simultaneously manifested groups of symptoms than upon the specific character of the morbid process. But though a knowledge of the condition of the urine will not of itself enable us to determine the existing disease, it is nevertheless not entirely valueless. It is an important witness in almost every disease, and the physician who does not rigidly interrogate it is guilty of culpable neglect. There is a species of testimony of a negative character which is sometimes quite as important as that of a positive nature.

We frequently by determining first what does not exist, are enabled to arrive at what does. In this sense the evidence furnished by the urine is sometimes invaluable. The ardor and

enthusiasm consequent upon a newly created or revived science, naturally led investigators to put down as facts much that was purely imaginative, and as a natural consequence pathological chemistry to-day-because the bright hopes of the past do not meet with fruition in the present-is looked upon as a comparitively useless branch of medical science. The next swing of the human pendulum may carry our opinions to the other extreme. However this may be, our duty is to give it credit for all that it has accomplished, to apply the knowledge it furnishes and to hope that new methods will be discovered by which analysis will be made more valuable and reliable.

ART. II.-A Case of Chorea. By L. HOUSTON, M. D.

On the 1st of February, 1868, I was called to see a boy, eleven years old, son of Mr. Levy, of this city, who had from childhood manifested a peculiar nervousness, being very timid and easily frightened at anything strange or unusual; very delicate about what he ate, and seldom tasting meat of any kind. Some two weeks before I saw him, he complained of weakness in his limbs and a general uneasiness of the whole body, with yawning and a disposition to be walking from one place to another in the city. A few days before I saw him, he was attacked by the usual symptoms of chorea, being unable to control the voluntary muscles of the right side of the body in walking or in keeping them still when sitting or laying down. I prescribed a cathartic which operated well, and ferri cyanuret, grs. xv, ext. valerian, grs. xlv, made into fifteen pills. Gave one every six hours, and a wine-glass full of infusion of valerian to drink immediately afterwards. Treatment continued two weeks; patient worse; could raise from his chair with difficulty, and had to be steadied until he had walked a few minutes, when he could walk alone.

We left off the first prescription and prescribed Vallet's mass in ten grain doses every six hours, followed by infusion cimicifuga, 3iij, after each pill. Continued prescription one week. At this time the patient had no control of himself whatever.

1

He could neither walk, speak or lay in any one position ten seconds at a time, except when asleep he rested well, but the instant he awoke the old symptoms all returned. When raised up to be fed he would be frequently thrown forward on his head or shoulders. When placed on his back he would be suddenly thrown upon his face, or his feet or head out of the bed, or against the wall; in fact every conceivable position imaginable. Gave strychnia, gr. ; iron by hydragen grs. 2; made into pills. Gave two pills every six hours, and the warm bath daily for one week; no improvement. Prescribed bromide potash, grs. x, every two hours, and after the first day, grs. xx, every three hours; continued one week with warm bath in the evening without the least amelioration of the symptoms. Electricity was applied several times but seemed to aggravate the symptoms. Prescribed oxide zinc, grs. x, every three hours during the night, and sulph. zinc, grs. iij, every three hours during the day. Under this treatment he improved a few days and relapsed into his former condition. We then prescribed sul. manganise, grs. v, and tr. canabis indica, grs. v; given every six hours. Under this treatment he soon began to mend, his speech soon returned, and in a month there was not a trace of his disHe is now more rugged and healthy than ever before.

ease.

ART. III.-Report on Surgery. By W. H. MUSSEY, M. D., of Cincinnati.

[Dr. Mussey has kindly furnished us with advanced sheets of his Report to the Ohio State Medical Society, which we take pleasure in presenting to our readers.]

Mr. President and Gentlemen:

I designed to present to you an epitome of the surgery of Ohio from the earliest date, with comments upon the operations as recorded, and such corrections as was in my power to make, but the work has accumulated on my hands to such an extent that I cannot do justice to the subject at this time. Therefore I defer the proposed report and present a hastily prepared commentary upon a few topics in surgery, mostly the result of my personal observation.