150 THE TREATMENT OF DISEASES. 



whether we regard it as a purely local disease, like stone in the bladder, or as a 

 disease of the whole system, like gout or rheumatism. 



It is a recognised fact that there are several different though closely-allied 

 diseases included under the general name of Bright's. They have, however, one 

 symptom in common, and that is that the urine contains albumen. Albumen is the 

 substance which we know familiarly as "white of egg," and, normally, in a state of 

 health it is not found in the urine. It is impossible to tell simply by looking at the 

 urine whether it contains albumen or not. White of egg before it is boiled is a 

 clear glairy-looking fluid, and if we were to mix a little of it with urine it would 

 produce no change in its appearance. To ascertain the presence of albumen in 

 the urine, we must submit it to examination. If we take a fresh egg, and break it, 

 we obtain the yolk and the white. If we mix a little of the white with water, and 

 put it in what chemists call a test-tube, and boil it over the gas, or a spirit-lamp, it 

 coagulates, and forms a thick white deposit. When we wish to examine urine for 

 albumen, we submit it to a similar procedure. We take a test-tube, half fill it with 

 the urine, and then boil it. If we obtain a deposit we may suspect the presence of 

 albumen, but cannot be positive about it, because naturally the urine contains 

 certain salts called phosphates, which if present in large quantities are precipitated 

 on boiling. The presence of phosphates in the urine is of not the slightest con- 

 sequence, but the presence of albumen is a serious matter ; hence the importance of 

 distinguishing between these two bodies. This is easily done by adding a couple of 

 drops of strong nitric acid (aquafortis) to the boiled urine. If the deposit is due to 

 phosphates it will at once disappear on the addition of the acid ; but if it is owing to 

 the presence of albumen it will remain unaltered. The quantity of albumen in the 

 urine in Bright's disease varies very much. We have examined urine which became 

 instantly and absolutely solid on boiling, so that the test-tube could be inverted. 

 As a rule, however, the quantity is much smaller, and sometimes it amounts to little 

 more than a distinct cloudiness. If on boiling a little of your urine in a test-tube, 

 and then adding a few drops of nitric acid, you get no deposit, you may feel pretty 

 sure that you are not suffering from Bright's disease. As a rule, albumen in the 

 urine is of no moment unless it be in some quantity, or is detected on several 

 different occasions. From the almost constant presence of albumen in the urine in 

 Bright's disease, this complaint is often known as "albuminuria." 



Even if you find albumen in the urine it does not mean of necessity that the 

 kidneys are diseased, or that the person is suffering from Bright's. Albumen appears 

 temporarily in the urine in the course of many fevers, disappearing as soon as the 

 temperature returns to the normal. In women it frequently occurs during the later 

 months of pregnancy. It is caused partly by the altered condition of the blood, which 

 is natural to the pregnant state, and partly by the pressure of the womb on the 

 veins which carry the blood from the kidneys. It does not, as a rule, show itself 

 until the seventh or eighth month, and often not until the approach of labour. It 

 is generally attended with swelling of the lower extremities, and sometimes also of 

 the face and upper parts of the body. Under these circumstances it is usually of 

 little importance, for in the large majority of cases it all disappears in forty-eight, 

 and sometimes in twenty-four, hours after delivery. 



