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Bactroban (Mupirocin)

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Other names: Null
EXCRETION: EXAMINATION OF URINE
A great deal of information as to the bodily health can undoubtedly be obtained by an intelligent examination of the urine. For centuries urine examinations have been done, although there is distinct doubt as to the associated intelligence until modern times. Sir William Osier, Regius Professor of Medicine at Oxford, showed a group of us about the university in 1917, and pointed out on one of the walls a statue of a “urine caster,” a bearded man holding up to the light a glass of urine. Such statues were common on buildings of medieval Europe.
For urine-casting, in those days, was considered without a rival for purposes of diagnosis. Through the centuries, differing and wondrous deductions have been made from the appearance of the urine held up to the light. From “the colours, the quantities and the qualities,” the “learned and expert physician might better judge of the diseases signified,” wrote Hamand in a popular work on uroscopy. “Urine running like silver, of women betokeneth she is with child, if she cast often and have no appetite. Water colour with a dark sky betokeneth death. Urine watery and thin in the aged signifies gout in the feet and joints, proceeding from same. Greenish signifies abduction of blood, inducing yellow jaundice. Red or bloody urine may come from the liver or from a vein or the bladder, which signifies the stone.” Although the physicians of medieval times made these diagnoses seriously, they were the sort that played into the hands of the quack doctors and charlatans, who by the middle of the sixteenth century traveled the country, preying on the credulity of the ignorant. So the early visual examinations were of little real value.
In modern times, the first and simplest examination is for specific gravity, or the relation of the weight of urine to that of water (which has a specific gravity of 1000). If material heavier than water is in solution, the figure is raised. Thus sea water, which has much salt in it, registers higher than fresh water. The normal figure for urine is about 1020, but this can vary greatly. For instance, a copious amount of beer taken by the patient shortly before the test will dilute the patient’s urine so much that his specific gravity will be close to 1000. In diabetes, where much sugar is passed, a high reading is found.
Another test is for albumin in the urine. This is a part of the protein of which the cells of the body are largely formed.
When the kidney is not doing its work perfectly, some of the albumin may show in the urine. As in all laboratory procedures, the test is of value according to the medical intelligence with which it is interpreted. This is illustrated in a story told by the late Dr. James B. Herrick of Chicago. A dignified elderly lady came to him for an examination. He found her in good shape but mentioned that she had a little albumin in her urine. In answer to her questions he tried to reassure her by saying that it was one of the changes of advanced age, just as gray hairs are. Not long after Dr. Herrick met a doctor friend who said: “I met Mrs. Blank recently. She insists that you told her that she has gray hairs in her kidneys.”
Even a little more glimmering of medical knowledge than the lady possessed may lead to health worries. Many people have been disturbed by noticing in their urine a lot of cloudiness or small flakes of material floating about. This is particularly so when the urine is cold. It is caused by what we call urates, or phosphates – perfectly harmless, normal material which disappears on heating, but, of course, patients do not heat up their urine as a physician would. The medieval urine caster has developed into a highly resourceful physician using innumerable clinical and laboratory procedures.
As the urine is entirely formed in the kidneys and undergoes no change in its progress to the outside world, it seems best to discuss its characteristics at this stage. As a matter of fact modern urologists frequently pass fine tubes known as catheters right up to the kidneys and gather the urine there for examination. One great advantage of the procedure is that the urine from each kidney can be examined separately.
The multum in parvo apparatus usually described as two kidneys is occasionally found as one horse-shoe-shaped kidney when the upper poles have fused together. But whatever the shape presented to our rough senses of shape and touch, essentially, as stated above, there are millions of these complete apparatuses, each with the adaptability of a modern electronic device. The blood is carried to them in enormous volumes, as many a surgeon has found to his perturbation, and from it is selected, with great discrimination, water, albumin, salts, poisons, and many other substances hard to classify. All these substances are worked over and sorted and resorted as it were.
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