176 



CLINICAL DIAGNOSTICS. 



does not necessarily indicate an affection of the 

 kidneys. 



Accidental albuminuria is rare and 

 of little importance. We assiiiiic that the albu- 

 minuria is accidental when the filtrate contains 

 large (luantities of blood and pus corpuscles and 

 epithelial cells and only a moderate quantity of 

 albumin. In that case the proportionately small 

 amount of albumin is supposed to result from par- 

 tial solution of the cellular elements. 



Chemical determination of albuminuria. For 

 this use freshly voided urine ; if not clear, filter. 



1. Koch's test. Fill test tube to yi its height 

 with urine — if alkaline add a drop of acetic acid — boil 

 and then g,dd 1-10 its volume of dilute nitric acid (sp. 

 gr. 1.18); a permanent precipitate indicates albumin. 

 if a precipitate or turbidity produced by boiling dis- 

 appears on addition of nitric acid it indicates phosphate 

 of lime. 



2. Heller's test. The cold, filtered (and, if 

 necessary, acidulated) urine is carefully poured on con- 

 centrated nitric acid, so as to form a layer on the same. 

 If albumin is present a white or cloudy ring is formed 

 in the test tube where the urine comes in contact with 



Ksba hs i\jQ nitric acid. 

 Albummi- . 



meter. 3. Acetic acid fcrro-cyanide of 



potash test. To the filtered urine add a quan- 

 tity of acetic acid and then a few drops of a 5% solu- 

 tion of potassium ferrocyanide; the presence of albumin produces 

 a white precipitate. 



If the addition of acetic acid produces cloudiness mucin is 

 present; in this case filter the urine. The mucin may also be pre- 

 cipitated with' acetate of lead before making the test. 



4. In case only a limited quantity of urine is obtainable, the 

 following method is recommended: Heat distilled water to boil- 

 ing point in a test tube, add the urine drop by drop. If albumin 

 is present the drops become turbid in the water, and by 

 continuing the addition of the urine,, the water also becomes 

 turbid. 



The methods here given suffice for the clinical demonstration 

 of albumin. For a quantitative determination of the albumin 

 preserve the tubes containing the precipitate and thus the sedi- 

 ment, which consists of albumin, may be compared from day to 

 day. For this purpose Esbach's albuminimeter is both simple 

 and practical. See fig. 40. [Similar tubes can be obtained in 



