VIII Tuberculosis, The Limitations of by 609 Graduated .606 Tuberculosis, The Treatment of Renal. 613 611 Stropanthin and Digitalin, Hemolytic Action of.. 289 Stuttering, On the Nature, Causes and Tuberculosis to Tuberculin by the Cu- 672 202 Tuberculosis, The Transcutaneous In- 624 189 Successful Physician, The. 50 Tuberculous Immunity, A Contribution .619 Supra-Renal Body, The Surgery of Tuberculin, The Ophthalmo-Reaction Blood-Cysts of the. 415 With 622 Surgical Experiences in the Country, Some 197 Synthetics, Dispensing of, in Tablet Form Not Advisable.. 99 the United Tuberculin Reaction, Cutaneous, A New 627 615 284 Typhoid Fever, The New Conception of T Tabes, Difficulty in Urinating in Due to. 321 Not Advisable. 99 Tannate of Quinine in Malaria. 10 Teaching and Encouragement of Legal Fatal Hemorrhage 153 187 333 Temperature, Rectal, Observations on, .397 Unofficial Preparations, Advertising of.116 330 Testes, Some Remarks on Tuberculosis 74 Therapeutics, Applied, The X-Ray in..183 Therapeutics, Destructive and Con- Urethra, Female, Prolapse of the. 397 459 structive 563 Thermal Death-Points of Pathogenic .521 Urinalysis, The Vital Importance of, in 187 Time of Death. 200 Toxic Effects of Quinosol, Cresol and Urinating, Difficulty of, in Tabes. .321 1 Lysol 33 Tragedy, Human. 195 Urine, Pancreatic Reaction in the, Clin- 338 Transcutaneous Inoculation of Tuber- culosis, The. Traumatic Rupture of the Urethra. 624 Treatment, Guaiacol in Pneumonia. 236 Treatment of Acute Dysentery 360 Treatment of Erysipelas, The.. .199 281 15 194 223 Treatment of Gastric Ulcer.. Vaccination. The Prophylactic Value of. 161 613 155 Urogenital System, Congenital Unilat- 523 V 226 Venereal Diseases, The Prophylaxis of.175 ..609 Tuberculosis, The Duration of the Ac- 606 608 Ventro-Suspension and Unsafe Opera- Vocation or Avocation. 520 621 Vomiting Intractable, Acetyl-Salicylic 39 W 612 Tuberculosis. Pulmonary, The Occur- rence of, in the Children of Tuber- Witness, Expert Medical, Reform of the. 285 650 610 Witness, The Medical Expert. 629 Tuberculosis, The Open-Air Treatment Where Are We Drifting?. .140 of 421 Why Not Administer the Best Remedy Tuberculosis, The Sixth International First? ..516 595 Why Variable Results Are Obtained...196 Tuberculosis, The International Con- gress on.. .593 Χ Tuberculosis and Tubercle Bacilli, In- vestigations to the Relations of Human and Bovine. .619 Tuberculosis of the Testes, Some Re- X-Ray, The, In Applied Therapeutics..183 marks on.. 74 Tuberculosis, Treatment of, by the Ad- Y 331 Tuberculosis, The Transmissibility of 649 Young Doctor, Hints to the.. 273 .342 1913 LIBRARY. The Medical Brief A Monthly Journal of Practical Medicine. VOL. XXXVI. ST. LOUIS, Mo., JANUARY, 1908. 1345 BLUE AND GREEN URINES. BY WILLIAM MURRELL, M. D., F. R. C. P., No. 1. Joint Physician to the Westminster Hospital and Lecturer on Medicine and Clinical [Written for the MEDICAL BRIEF.] Specimens of blue urine are by no means uncommon. The explanations usually given, especially by those who have a minimum of physiological knowledge, is that they are due to duodenal indigestion. Trypsin, it is argued, in the small intestine, breaks up proteids into peptone, peptone into leucin and tyrosin, and, further, into indol, phenol and other bodies. Indol, by the putrefactive action of bacillus coli in the intestines, forms indican, which is potassium indoxyl sulphate. This theory is ingenuous and destitute of foundation. The great majority of the blue and green urines are produced artificially by taking methylene-blue. Cases of methylene-blue urine are recorded by Parkes Weber, Hughes, A. E. Garrod, Morley Fletcher, Good, A. P. Beddard and Bauman. One of the best papers on the subject-by Professor Ralph Stockinan, of Glasgow-was published in the Edinburgh Medical Journal of August, 1902. For some years Dr. Walsh Hake and I have devoted attention to the subject, and some of our results appeared in the Edinburgh Medical Journal of June, 1906. As already stated, the majority of blue urines are methylene-blue urines. Methylene-blue is tetramethylthionine hydrochlorate. In doses of from one to three grains three times a day it is given in cases of chronic nephritis, cystitis, and gonorrhea, and also in the treatment of patients suffering from bilharzia hematobia. It has antiseptic properties, and is said to be useful in the elimination of uric acid. A quarter of a grain twice a day imparts a pea-green color to the urine, whilst the same dose more frequently repeated turns it a peacock-blue. These urines keep well, undergoing decomposition slowly. After a time, under the influence of bacterial action, they lose their color, which, however, is speedily restored on shaking, owing to the absorption of oxygen. The addition of a few drops of formic-aldehyde to a methylene-blue urine will prevent decolorization almost indefinitely. Not uncommonly there is a deposit of urates which retains a blue color after the fluid itself shows no indication of either a green or blue tint. A blue urine which had kept well for weeks became turbid and lost its color. A fortnight later it was filtered, and the mere act of filtration at once restored its color. Two months later, when every trace of the blue had disappeared, withdrawing the cork and shaking vigorously for a few minutes produced at first an olive-green color, then a sage-green, and finally a well-marked blue. Sometimes the restored blue tint is confined to the upper layer of fluid, gradually merging below into the amber of normal urine. This is the explanation of the multi-colored urines sometimes seen. A deep blue urine, mixed with tincture of iodine, is either decolorized or assumes an olive-green tint. From repeated observations, it appears that these blue and green urines are not discharged or altered by exposure. to X-rays for ten minutes, or by the action of a powerful Finsen light in thirty minutes. The majority of patients who pass these green and blue urines are not aware that they have taken any drug. In some cases the methyleneblue has been administered surreptitiously as a practical joke, and pinkcoated sweets are sold for this very purpose. In other cases the methyleneblue has been introduced into confectionery as a coloring agent; this, however, is probably not very common, for in the "Report of the Departmental Committee on the Use of Preservatives and Coloring Matters in Foods (1900)," no reference is made to it. A largely advertised remedy for kidney troubles contains this ingredient. Nine-tenths of the blue and green urines are due to the action of this drug. The color gradually disappears from the urine, the process of elimination being usually completed in from two to three days. In some cases, however, traces of color are observed as late as the sixth day. The scale of coloration from the maximum to the completion of elimination is as follows: Blue, Prussian blue, bluish-green, emerald green, bright grass green, pale grass green, pale olive green, faint green, shadow, normal. Green urines may be due to biliverdin, easily recognized by its characteristic tests, but they are not common. There is no possibility of confounding methylene-blue urine with carboluria. White mice injected with methylene-blue exhibit blue ears and blue tails, and pass blue urine. Dr. Blaxall, of the Government Lymph Laboratories, furnished us with specimens of the urine, and we found that it gave the usual tests. When epileptics are given large doses of methylene-blue, the ears, nose and nails assume a blue color, which soon disappears on discontinuing the drug. I find that in patients suffering from ascites, the administration of methylene-blue causes the ascitic fluid to become blue, or more |