166 THE MICROSCOPE. 



jority of physicians as the index of a pathological condition, although 

 Bernard, Hoffman and others have pointed out that albuminuria 

 may be met with in persons whose health is perfect, and under cer- 

 tain conditions of alimentation." M. Marcacci has proved that 

 albumin may be found in a physiological urine, by a series of obser- 

 vations on himself. Albumin, therefore, denotes nothing except 

 when found in connection with the different tube casts. But albu- 

 min means casts ; n the vast majority of cases. It is the small 

 quantities of albumin that may lead to an error, which may not only 

 confuse the physician, but complicate the patient's chances for re- 

 covery. The small quantities of albumin may come from the blood 

 or pus, or possibly from the prostate or urethra. Albumin is also 

 found in the urine when lithic acid is eliminated. 



Now, noting some of the diseases of the kidneys wherein the 

 microscope reveals the signs whereon the diagnosis is based, we 

 shall begin with those in which tube casts are found in the sediment. 

 The urine should be fresh for a microscopical examination, and 

 from the nature and the character of the casts the differential diag- 

 nosis is made. In an article in the London Lancet we find this 

 proposition: "Neither dropsy nor albumin is usually present in 

 chronic Bright's disease, and when present they denote acute or 

 epithelial change." The most generally accepted account of the 

 disease and its symptoms fail to recognize it in by far the larger 

 number of cases in which it already exists. One of the most fatal 

 forms of Bright's disease is where there is intestinal inflammatory 

 destruction, with little or no albumin, but with tube casts, which are 

 hyaline and pale granular, and which tell to the physician of an end- 

 ing which, if the patient but knew it, would make his heart sink 

 within him. 



In the acute form of the disease, or acute nephritis, we have 

 narrow hyaline casts, epithelial casts and cells, and blood casts, 

 which all signify the acute catarrhal stage of nephritis, such as fol- 

 lows scarlet fever or exposure to cold and wet. These are accom- 

 panied by much albumen, the urates and uric acid, and sometimes 

 even oxalates. Fatty and waxy casts belong to the chronically en- 

 larged kidney, and a preponderance of any kind affords an indica- 

 tion of the exact state of the kidneys. Broad hyaline casts, and 

 dark, granular, epithelial casts — the urine at first highly albumin- 

 ous, but further along in the disease slightly so — are usually found 



