ALBUMIN IN THE URINE. 495 



drinking of fluids), either for a considerable time or as a transitory phenomenon, 

 particularly in association with hypostatic hyperemia attending diseases of the 

 heart, emphysema, chronic pleural effusions, infiltrations of the lungs; and after 

 compression of the chest that causes stasis in the pulmonary circulation, and 

 finally extends into the renal veins. (3) After division or paralysis of the vaso- 

 mptor nerves of the kidney, in consequence of which intense hyperemia of the 

 kidney is brought about. In this category belongs the albuminuria following 

 severe and protracted painful affections of the abdominal viscera, as, for instance, 

 strangulated hernia, in consequence of which reflex paralysis of the nerves of the 

 renal vessels is induced. After severe muscular exertion, as in marches, parturi- 

 tion, or convulsive seizures, in cases of epilepsy, eclampsia, the convulsions attend- 

 ing suffocation and strychnin-poisoning. The albuminuria observed in conjunc- 

 tion with concussion of the brain, apoplexy, and spinal paralysis, severe emotional 

 disturbances, excessive mental activity, and morphinism, is possibly attributable 

 to a disorder of the vasomotor centers. (4) Inability en the part of the epithelial 

 cells to restrain the albumin may cause albuminuria; and, as it appears, in conse- 

 quence of defective nutrition and functional debility of the secretory elements. 

 In this category belongs the albuminuria attending ischemia, and that following 

 hemorrhage and attending anemic conditions, scorbutus, icterus, diabetes, and 

 the death-agony. (5) In association with many acute febrile diseases, especially 

 the acute exanthemata (as, for instance, scarlet fever); further, typhoid fever, 

 pneumonia, and pyemia. It is probable that under such circumstances the secre- 

 tory apparatus of the kidney has undergone changes (cloudy swelling of the epithe- 

 lial cells of the urinary tubules, inflammation of the glomeruli) ' that render these 

 incapable of preventing the escape of the albumin. (6) Degeneration of the kidneys, 

 such as contraction of the kidneys, amyloid degeneration, further inflammatory 

 processes in their various stages, are generally attended with albuminuria. Sem- 

 mola has shown that the albuminuria attending nephritis is not rarely dependent 

 rather upon the state of the blood than upon the disease of the kidneys. He 

 believed that the renal lesion occurs in general as a secondary phenomenon, while 

 the albuminuria is primary, except the form that is a result of the inflammation 

 of the kidney itself. (7) Finally, inflammatory and suppurative processes in the 

 tirinary passages, from the pelvis of the kidney to the extremity of the urethra, 

 may cause albuminuria. Under such circumstances, however, leukocytes are 

 always found in the urine; not rarely, also, erythrocytes or the products of their 

 solution, and fibrin-coagula. Certain substances that give rise to irritation and 

 inflammation of the urinary apparatus should finally be mentioned, such as can- 

 tharides and carbolic acid. (8) The appearance of albumin in the urine after 

 sodium chlorid has been entirely eliminated from the food is noteworthy. The 

 albumin disappears when the salt is resumed. 



Demonstration of Albumin in the Urine. (a) After strong acidulation with 

 acetic acid, a few drops of a concentrated solution of potassium ferrocyanid causes 

 a precipitate. 



(b) Urine to which is added one-third its volume of pure nitric acid exhibits 

 a precipitate. A resulting turbidity may be due, apart from albumin, to the 

 precipitation of urates. Slight heat, however, causes solution of the latter, while 

 albumin remains turbid. 



(c) Urine to which a few drops of acetic acid are added and which is then 

 mixed with an equal volume of concentrated sodium sulphate and boiled yields a 

 precipitate. 



(d) The urine is acidulated with a few drops of concentrated acetic acid, and 

 filtration is practised for the removal of mucin. The urine is then cautiously 

 overlaid, drop by drop, in a test-tube held obliquely, by the following mixture: 

 Mercuric chlorid, 8; tartaric acid, 4; glycerin, 20; water, 200. Turbidity results 

 at the line of contact. Albumose is disclosed by the same reaction, but it is 

 redissolved by heat. Jolles recommends the following mixture: Ten parts of 

 mercuric chlorid, 20 parts of succinic acid, 10 parts of sodium chlorid, and 500 

 parts of water. Five cubic centimeters of filtered urine are acidulated with i 

 cu. cm. of 30 per cent, acetic acid and 4 cu. cm. of the reagent described are 

 added. 



(e) A few drops of 30 per cent, sulphosalicylic acid are added to filtered urine. 

 This reaction discloses also the presence of albumoses, but the precipitate due to 

 the latter is cleared up on heating. 



Boiling, by driving off the carbon dioxid. may cause a precipitate of earthy 

 phosphates in alkaline urine, and this may simulate albumin. If. however, a 

 small amount of acetic acid be added, the phosphates are redissolved, while albu- 



