92 



PRODUCTS, ADVENTITIOUS. 



independently of red corpuscles, in a case 

 of purpura. In the worst forms of malig- 

 nant liaemorrhagic fever, however, no trace 

 of albumen may be discoverable, a fact 

 recently exemplified in our wards at Uni- 

 versity College Hospital. The notion that 

 purulent deposits may be carried oft" through 

 the kidneys is one of long-established popu- 

 larity among surgeons ; Ambroise Pare, De- 

 sault, and others held the doctrine : the fact 

 is, however, far from being established. M. 

 Rayer has for some years sought in vain for 

 pus in the urine of individuals, in whom the 

 absorption of purulent depositions of various 

 kinds was effected under his own immediate 

 observation. An abundant precipitation of 

 phosphates with mucus and epithelium will, 

 as we have ourselves witnessed, sometimes 

 produce an appearance most strangely like that 

 of pus, the microscope and the addition of 

 a little acid readily settle the nature of the de- 

 posit. Pus may, however, actually appear in 

 the urine in cases of secondary abscess from 

 purulent impregnation of the blood ; but it is 

 then produced, we believe, in the renal struc- 

 tures themselves, and is not composed of the 

 originally formed fluid translated (with its pro- 

 perties unaltereJ) through the circulating sys- 

 tem into the renal passages. It is for this 

 reason that the narratives of cases of " ab- 

 sorbed empyema" (with elimination of pus, in 

 substance, through the kidneys,) are, without 

 the test of actual examination of the kidneys, 

 altogether unsatisfactory. Cotunnius* en- 

 deavoured to explain the presence of albumen 

 in the urine of a dropsical patient, whose 

 anasarca was rapidly diminishing under the 

 use of diuretics, by supposing it due to the 

 direct passage of the serous fluid through the 

 kidneys. But he had not established the ab- 

 sence of albumen from the urine, before 

 diuresis set in ; M. Rayer (as also we our- 

 selves), avoiding this source of error, has 

 failed in detecting albumen in urine, passed 

 concomitantly with the disappearance of drop- 

 sical effusion, whenever the fluid had pre- 

 viously been free from that principle. 



Secondly : Albuminuria from morbid states of 

 the genito-urinary organs. (1. Functional.) 

 On the presence of albumen in cases of simple 

 hjematuria it is only necessary to observe, that 

 the albuminuria rarely persists for more than 

 a few days after the discharge of blood-diks 

 has ceased ; concerning its appearance in dia- 

 betic urine, we shall presently have occasion 

 to speak. (See SUGAR.) The urine of healthy 

 individuals may become albuminous for a 

 short while (for instance, four-and-twenty 

 hours,) after direct or indirect excitement of 

 the urinary passages. We are not quite sure 

 of being right in ascribing the action of certain 

 articles of food and medicinal agents to such 

 intermediate irritation of the kidneys ; it is 

 perhaps equally tenable that an altered con- 

 dition of the blood is, in these cases, the direct 

 cause of the excretion of albumen with the 



* De Tschiade Nervosa Comment. Vienna 1 , 1770, 

 p. 30. 



urine. Dr. Christison* "has occasionally 

 known a temporary albuminous impregnation 

 produced in healthy individuals by eating freely 

 cheese, pastry, and such other indigestible 

 articles as are known to have in general the 

 effect of increasing the usual solid ingredients 

 of the urine, and occasioning a large deposit 

 of lithic acid and lithate of ammonia." We 

 agree with M. Martin- Solon -j- that when such 

 consequences follow, individual predisposition 

 must be admitted to exist. Dr. Christison has 

 repeatedly seen the same condition of the urine 

 induced for a time (and we have ourselves had 

 cognisance of the same fact) by the action of a 

 cantharides blister, when it excited symptoms 

 of renal irritation. That hyperaemia of the 

 kidney of the simple kind may produce albu- 

 minuria, was very strongly maintained by M. 

 Martin- Solon, on the evidence of cases which 

 wanted but the test of post-mortem examina- 

 tion to render them conclusive : the valuable 

 experiments of Mr. Robinson give full war- 

 ranty to the opinion. (2. Organic.^ It may 

 be considered as yet undetermined clinically, 

 whether the urine becomes albuminous in 

 cases of simple nephritis unattended with any 

 of the anatomical changes peculiar to "Bright's 

 disease ;" if it does so, the impregnation is not 

 constant, and is slight in amount. J The 

 connection of albuminuria with the disease of 

 the kidney described by Dr. Bright is, on the 

 contrary, after much disputation, thoroughly 

 established. While the error of supposing 

 mere albuminous impregnation pathognomonic 

 of that affection is, on the one hand, perfectly 

 understood ; on the other, the great import- 

 ance of permanent albuminous impregnation, 

 as a sign of the disease, is recognised. We 

 have never ourselves seen a case of Bright's 

 disease in which the urine was permanently 

 free from albumen ; but the amount to which 

 it is present is, of course, extremely variable ; 

 we have frequently treated cases in which the 

 coagulation was so complete, that not a single 

 drop of fluid escaped, when the test-tube was 

 turned upside down after ebullition. On the 

 various affections of the urinary passages 

 causing impregnation subsequently to the act 

 of secretion (e.g. pyelitis), it is unnecessary 

 to dwell ; of albuminuria depending on ence- 

 phaloid disease of the urinary organs, we have 

 spoken in another work.|| 



Thirdly : Albuminuria from accidental admix- 

 ture of genital products. The urine becomes 

 impregnated with semen under a variety of 

 circumstances. The secretion of the testes 



* On granular Degeneration of the Kidneys, 

 p. 36, 1839. 



f De PAlbuminurie, 1838. 



j Becquerel (Semeiologie des Urines) found a 

 little albumen in the urine in one of five cases of 

 simple nephritis. 



Dr. Graves (Dublin Journal of Medical Science, 

 No. Ix.) maintains that the renal alteration may, 

 however, exist without albumen appearing in the 

 urine, an idea to be explained probably, by the 

 occasional temporary disappearance of that principle 

 (as we have more than once seen) even in cases 

 pretty rapidly tending to a fatal issue. 



II the Nature and Treatment of Cancer, p. 386. 



