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SUGAR IN URINE. 803
page 214. This test may lead to very great mistakes in urine poor in
sugar, especially when they have at the same time normal or increased
amounts of physiological constituents, and therefore it cannot be recom-
mended to physicians or to persons inexperienced in such work. Normal
urine contains reducing substances, such as uric acid, creatinine, and others,
and therefore a reduction takes place in all urines on using this test. A
separation of copper suboxide does not generally occur, but still if one
varies the proportion of the alkali to the copper sulphate and boils, there
takes place an actual separation of suboxide in normal urines, or a peculiar
yellowish red liquid due to finely divided cuprous hydroxide. This occurs
especially on the addition of much alkali or too much copper sulphate,
and by careless manipulation the inexperienced worker may therefore
sometimes obtain apparently positive results in a normal urine. On the
other hand, as the urine contains substances such as creatinine and
ammonia (from the urea), which in the presence of only a little sugar
may keep the copper suboxide in solution, the investigator may easily
overlook small quantities of sugar that may be present.
The delicacy of Trommer’s test can be increased by the suggestion made by
Worm-Muller. 1
As "by this rather complicated and tedious method small
amounts of sugar cannot be detected in certain urines, and also as special urines
from healthy persons readily give inconclusive results, and finally as Schondorff
has shown in numerous cases that the physiological sugar content of the urine
responds to this test in perfectly healthy persons because of its extreme delicacy,
it does not seem advisable in Hammarsten’s opinion to recommend this test to
the physician. Bang and Bohmansson 2
have recently also shown its unre-
liability.
Almen’s bismuth test, which has been incorrectly called Nylander’s
test, is performed with the alkaline-bismuth solution prepared as described
on page 214. For each test 10 cc. of urine are taken and treated with
1 cc. of the bismuth solution and boiled for a few minutes. In the
presence of sugar the urine becomes dark yellow or yellowish brown;
then it grows darker, cloudy, dark brown, or nearly black, and non-
transparent. After a longer or shorter time a black deposit appears,
the supernatant liquid gradually clears, but still remains colored. In
the presence of only very little sugar the test does not become black or
dark brown, but simply deeper colored, and not until after some time
is there seen on the upper layer of the phosphate precipitate a dark or
black layer (of bismuth?). In the presence of much sugar a larger
amount of the reagent may be used without disadvantage. In a urine
poor in sugar only 1 cc. of the reagent for every 10 cc. of the urine must
be employed.
1
In regard to this test see Pfluger, Pfluger’s Arch., 105 and 106; Hammarsten,
ibid., 116, and Zeitschr. f. physiol. Chem., 50.
2
Schondorff, Pfluger’s Arch., 121; Bohmansson, Bioch. Zeitschr., 19.
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