A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
[Illustration: FIG. 22.--Horismascope: adding the reagent.]
This is an extremely sensitive test, but, unfortunately, both mucin
and albumose respond to it; urates when abundant may give a confusing
white ring, and the reagent is {73} comparatively expensive. It is not
much used in routine work except as a control to the less sensitive
tests.
A most convenient instrument for applying this or any of the contact
tests is sold under the name of "horismascope" (Fig. 22).
(2) Robert's Test.--The reagent consists of pure nitric acid, 1 part,
and saturated aqueous solution of magnesium sulphate, 5 parts. It is
applied in the same way as the preceding test.
Albumin gives a white ring, which varies in density with the amount
present. A similar white ring may be produced by albumose and resinous
drugs. White rings or cloudiness in the urine above the zone of
contact may result from excess of urates or mucus. Colored rings near
the junction of the fluids may be produced by urinary pigments, bile,
or indican.
Robert's test is one of the best for routine work, although the
various rings are apt to be confusing to the inexperienced. It is more
sensitive than Heller's test, of which it is a modification, and has
the additional advantage that the reagent is not so corrosive.
(3) Purdy's Heat Test.--Take a test-tube two-thirds full of urine, add
about one-sixth its volume of saturated solution of sodium chlorid and
5 to 10 drops of 50 per cent. acetic acid. Mix, and boil the upper
inch. A white cloud in the heated portion shows the presence of
albumin.
This is a valuable test for routine work. It is simple, sufficiently
accurate for clinical purposes, and has practically no fallacies.
Addition of the salt solution, by raising the specific gravity,
prevents precipitation of mucin. Albumose may produce a white cloud
which disappears upon boiling and reappears upon cooling.
(4) Heat and Nitric Acid Test.--This is one of the oldest of the
albumin tests, and, if properly carried out, one of the best. Boil a
small quantity of filtered urine in a test-tube and add about
one-twentieth its volume of concentrated nitric {74} acid. A white
cloud or flocculent precipitate (which usually appears during the
boiling, but if the quantity be very small only after addition of the
acid) denotes the presence of albumin. A similar white precipitate,
which disappears upon addition of the acid, is due to earthy
phosphates. The acid should not be added before boiling, and the
proper amount should always be used; otherwise, part of the albumin
may fail to be precipitated or may be redissolved.
* * * * *
_Quantitative Estimation_.--The gravimetric, which is the most
reliable method, is too elaborate for clinical work. Both Esbach's,
which is very widely used, and the centrifugal method give fair
results.
* * * * *
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