THE REMOVAL OF BILE AND BLOOD FROM THE URINE

1921 Journal of the American Medical Association  
born after the seventh month. That is a wonderful result, probably unequaled. It certainly is not equaled by that practitioner who turns the babies around and draws them out by the feet when nature started them by the head. His mortality was nearly 8 per cent. Now, if a gross mortality of 2.5 per cent, can be accomplished by means of intelligent antenatal care and by means of conservative-we might say old-fashioned-methods of obstetric practice, we see no reason for introducing new methods
more » ... ng new methods carrying 8 per cent, mortality. Dr. Edward A. Schumann, Philadelphia : One of the great problems underlying antenatal hygiene, in our great centers of population, is that of the young woman illegiti¬ mately pregnant, with a low standard of mentality, and afflicted with venereal disease. In Philadelphia we have just established a prenatal clinic at the Philadelphia General Hospital, which I think is destined to begin at least to solve this problem. The clinic is conducted much as any other prenatal clinic, but there is in constant attendance on clinic days a psychiatrist and a technician from the laboratory of the hospital. Any case presenting the slightest evidence of mental abnormality is studied coincidently and concurrently by the psychiatrist and the obstetrician ; the necessary labora¬ tory work is done. We get a report quickly. The institu¬ tional care in mental deficiency cases can be carried on coin¬ cidently with ordinary prenatal care. We hope great things for this clinic, although not much has been accomplished yet. Dr. Hugo Ehrenfest, St. Louis : The majority of phy¬ sicians are more interested to know how far these very interesting rules for proper prenatal care as carried out by public clinics can be applied to private practice. Of course, there are distinct differences in the prenatal care of the private patients ; however, the general principles as laid down by Dr. Beck should be followed. Under present housing con¬ ditions people are forced more and more to seek hospital accommodations for confinement. With the limitation of such accommodations in all larger cities, obstetric patients are forced to apply to their physician rather early in preg¬ nancy. Probably 75 per cent, of my patients appear in the office about the third or fourth month of pregnancy. This is a factor which has some very important bearing on present day successful prenatal care also in private work. Outside of this rather beneficial effect on proper prenatal care, I have observed another influence of the housing problem, and that is on the development of hyperemesis. Young married couples are crowded into the so-called efficiency apartment, one or two rooms with a kitchenette off the supposed-to-be dining room. These women at the beginning of a pregnancy are forced to do their own cooking and smell the kitchenette odor while they are eating. I think that this represents an interesting and important factor in exaggerated vomiting now observed by me in more cases than ever before. It is a difficult problem to handle. I have made it a routine as soon as these patients begin to vomit to put them in a hospital under the care of the dietitian. Occasionlly I used a little bromid. In the main, all we have to do is to serve these patients very small meals at short intervals. It is remark¬ able how quickly they will get over the nausea and begin to eat. We test them out on bigger meals and let them go home. This, to my mind, is a very interesting observation in view of the unsettled state of the nausea question. In private practice the Wassermann test as a routine is neither desirable nor necessary. • Dr. Alfred C. Bf.ck, Brooklyn : Concerning the Wasser¬ mann reaction, our experience has been similar to that of Dr. De Lee. Recently I drew attention to the fact that in all probability we were being misled even in normal preg¬ nancy cases by the Wassermann test. It is hard to say what we should do with the patients who have two positive Was¬ sermann reactions and no other evidence of syphilis. Is it desirable to take the risk of having a child born with syphilis because we dislike to use intensive treatment in such cases? Dr. Schumann's suggestion is a very good one, and I hope that we may be able to get the cooperation of the depart¬ ment of psychiatry in our cases. With regard to nausea and vomiting: In all my work with clinic cases, I have noticed that the tendency toward this condition is very much less than with the private patients. So that while we have not had these cases in the clinic, I certainly have had them in my private practice. But when these measures are used prophylactically, it does not cut down the incidence of the really troublesome cases. As the phenolsulphonephthalein test for estimating renal function is based on a colorimetric determination, it follows that foreign coloring matter in the urine introduces an error, and that any considerable amount of coloring matter vitiates the test. Bile and blood are the two common sources of color in the urine that render the method inaccurate. Rowntree and Geraghty1 observed that the urine could be rendered free of bile pigments, without the loss of phenolsulphonephthalein, by the addition of basic lead acetate, and subsequent filtration. The addition of basic lead acetate, however, does not precipitate hemoglobin from aqueous solution,2 and no method has been as yet suggested which makes the test serviceable in the presence of hemoglobin. The method here described does, however, remove both bile and blood. It consists in the precipitation of bile and blood by zinc acetate, and their removal by filtration. This procedure permits practically 100 per cent, of the phenolsulphonephthalein to remain in the filtrate. This modification of the usual phenolsul¬ phonephthalein test is extremely simple, and should prove particularly applicable to cases of choluria and hematuria in which a study of the renal function is indicated. The modified test is tifus performed : Phenolsul¬ phonephthalein solution (1 c.c.) is injected into the deltoid muscle in the usual manner, and the urine col¬ lected after the usual interval of two hours and ten min¬ utes. This specimen of urine is diluted up to 500 c.c. with tap water. To 20 c.c. of this diluted urine are added 20 c.c. of a saturated alcoholic solution of zinc acetate, which precipitates out bilirubin and hemoglo¬ bin. Red cells are carried down with the precipitate. Filtration yields a clear solution, now free of bile pig¬ ments and hemoglobin. Twenty cubic centimeters of this clear filtrate is made alkaline with 5 c.c. of saturated sodium hydroxid solution to bring out the full color of the dye, and made up to 40 c.c. with tap water. This solution is clear and is read directly against a known standard solution of phenolsul¬ phonephthalein. In order to correct for dilution, the percentage reading is multiplied by 2. In order to establish the accuracy of this method it was necessary to show that the phenolsulphonephthalein was not removed by treating the urine with zinc acetate, and that bile and hemoglobin were entirely removed. The following determinations were accordingly made : From the Medical
doi:10.1001/jama.1921.02630320046013 fatcat:ciybk2ngfnf7zfls36u2ldh2ky