On Indigo in the Urine

Article V.? -On Indigo in the Urine. By W. Gilchrist, M.D., T orquay. There are several cases on record in which a blue deposit lias been observed in the urine, but these are so few in number that I believe the following notes of such a case may not be uninteresting. The patient is a poor woman residing at Chris tow, a small village in Devonshire. For some years she has been under the care of my friend Dr Lillies of Chudleigh, through whose kindness I have been enabled to see the patient, to obtain specimens of the urine for examination, and to give the following notes of her case :? I shall first describe the urine. The urine is of a dirty greenish yellow colour, strongly ammoniacal; Sp. grav. 1010. On standing some time it deposits a dirty greenish blue sediment, which to the naked eye seems to be com- posed?1 st, Of a heavy white crystalline deposit; 2d, Of whitish flakes of organic matter; and 3d, Adhering to or mixed with the latter, particles or patches of a deep blue colour. Microscopic in- ? spection proves the white deposit to consist of the triple phosphates the flakes of organic matter to consist of tessellated epithelial cells, which are swollen, granular and opaque, so that the nucleus is in- " visible. These cells are in the state which Virchow terms cloudy swelling." The blue matter under the microscope appears amorphous, and presents two distinct shades?a light and a dark blue?both in brightness of tint resembling rather the shades of Prussian blue than those of indigo. Besides the blue matter there are little masses of a yellowish brown colour, which are finely molecular in structure. Neither the blue nor the brown matter is altered by water, acetic acid, ammonia, or cold alcohol. In warm alcohol both are soluble. Strong nitric acid dissolves both, destroying the colour. On adding sulphuric acid to a small portion of the clear urine (after Carter's method), a faint pink or copper coloured tint is pro- duced, thus proving that only a small amount of uroxanthin is present. Heat or nitric acid produce no coagulum. The following notes of the case are given me by Dr Lillies of :? Chudleigh" Mary Clampit, tetat 58, a labourer's wife. Has been the subject of rheumatism since the age of 19. About twenty-four years 536 Dlt W. GILCHRIST ON INDIGO IN THE URINE. ago, by a fall from a liorsc, she was pitched on her back, and lias never been quite well since. Two years after this accident she suffered from what appears to have been a severe attack of hema- turia, which continued more or less for two years and a half. " Fourteen years ago she was seized with acute pain over the region of the heart, when she consulted a physician, who, on examining lier chest, pronounced that organ to be diseased. At or about this time she first remarked a blue deposit in her water, which became at the same time very offensive; and this condition has continued more or less ever since. For the past four years her sight has been from amaurosis. impaired" incipient At present she suffers at times at night from slight dyspnoea and palpitation. She sleeps very badly from the frequent desire she lias to micturate, and the pain about the neck of the bladder, which she experiences just before and during the act. At times she is obliged to get up every five or ten minutes, sometimes passing two tea-spoonfuls, sometimes two table-spoonfuls, but seldom more. The total amount of urine passed in twenty-four hours is about three pints. She is very weak, and has an antemic appearance. clean; She fancies that after Tongue appetite capricious. 1 taking salt fish or salt bacon there is always more blue stuff' in the water, and more pain in passing it. When the water is 'very blue,' she feels as if gravel or something rough was passing. Bowels are regular. There is considerable oedema of the lower extremities, and some puffiness under the eyelids. A bellows mur- mur accompanies the first sound of the heart. It is loudest at the base, and is heard along the course of the larger vessels. Pulse 84, rather jerking. The veins are everywhere full, in the neck particularly so ; but there is no venous pulse. The treatment which has been most beneficial has consisted of the administration of opium and the mineral acids." Remarks.?Although, on account of its small quantity, I have not been able to obtain a positive chemical identification of this substance with indigo, I have little doubt that it is so. By physio- logical and chemical writers, uroglaucin is classed with urolisematin as one of the colouring matters of the urine.1 But it is not proved that either of these substances exists as such in the healthy urine. Both are products of decomposition, and it has not been satisfactorily shown that they have any share whatever in producing the orange tint of healthy urine. Very little is known about the true colouring matters of urine; and the inquiry is found to be a very difficult one, both on account of their ready decomposition, and also of their intimate connexion with other constituents of the secretion. Re- garding indigo or uroglaucin, the following may be remarked. From the researches of Heller, Kletzinsky, and Schunck, it appears that a neutral substance, capable of being resolved by treatment 1 See Lehrbuch der Phys'ologie, by 0. Funke, 1860, vol. i., p. 500; Anleitung zur pathologisch-chemischcn Analyse, von Dr Hoppe, 1858, p. 120. DR W. GILCHRIST ON INDIGO IN THE URINE. 537 with acids into red and blue indigo and sugar, exists in tlie natural urine. This substance was first described by Heller under the name of uroxanthin, and it is now known as indican (Schunck); it is identical with the indigo-yielding substance of the isatis tinctoria. In an interesting paper by my friend Dr Carter,1 it is shown that this indican may be regarded as a constant and normal element of the urine, and that it also exists in the blood. Dr Hoppe of Berlin has looked for indican (using Schunck's method) in the cerebro-spinal fluid, and in other transudations, but has met with negative results.2 Carter, however, once detected it in an acute pleuritic effusion. I am inclined to agree with the latter in regarding indican as an entirely excrementitious product. But the question occurs, What is it which, in certain cases of disease, deter- mines the resolution of this substance into indigo ? and where does the change occur ? I can find only other two cases of indigo (or of a blue deposit) in the urine. One of mentioned Dr Prout " these, " by in on his work Stomach and Urinary Diseases (3d edit., p. 96), is that of a middle-aged man of a nervous temperament, in whose urine indigo appeared after taking a seidlitz powder. No details of the case are given. The other case occurred in the practice of Dr Eade of Norwich, and is related by Dr Beale in his " Archives " (No. IV., p. 311). This patient was an elderly man, and the most prominent symptoms were great frequency of micturition, and pain before and during the act. The urine was of sp. grav. 1015 ; con- tained pus, phosphates, blue particles, which, like those of the above case, were of two shades?a light and a dark blue. The latter had the form of crystalline spicule. The urine was also highly ammoniacal. No cause could be assigned for the ailment. What occurs in these cases is probably this. Indican is a very unstable compound?a low temperature being sufficient to decom- pose it into indigo (red and blue) and sugar. A ferment or a mineral acid produces the same effect. One or other of these causes effects the transmutation, probably when the urine is in the bladder, and a sediment of indigo, with but a small amount of indican, is the result. This I believe to be the pathology of such cases. It has been observed that a greenish or blue colouring matter is formed on the surface of pus and other albuminous substances when they have been allowed to stand for some time exposed to the air.3 Probably this is also a similar transmutation of indican, by the action of a ferment, into uroglaucin. But a few exact chemical observations are required fully to elucidate the subject. 1 Edinburgh Medical Journal, August 1859. 2 Yirchow's Archiv, bd. xvi., p. 393. 3 See Hoppe, loc. cit., p. 121. VOL. VII.?NO. VI. DECEMBER 1861. 3 Y .

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