BRITISH MEDICAL JOURNALS. 
287 
times smaller, sometimes softer, sometimes harder; the prevailing 
character, however, being a deposition of granular matter, mingled 
with, or entirely obliterating, the cortical and tubular structure of 
the organ. Even this character, however, is not universal ; for in 
the early stages the granular structure is not perceptible, and con- 
gestion is the only morbid indication. Various as are the appear- 
ances of the kidneys after death, the symptoms during life are still 
more various and more obscure, the general indication being an 
anasarcous condition of the body, with a vague and undefined sen- 
sation of uneasiness ; or, more commonly, the disease is at first 
wholly latent, and its existence is only discovered after death has 
taken place from secondary disease. Such being the obscurity 
of this very common affection, it is interesting to inquire whether 
there exist any means of ascertaining its presence during life ; and 
I think that we may answer the question with tolerable certainty 
in the affirmative, the albuminous condition of the urine indicating 
'pretty clearly the existence of granular disease of the kidney. I 
am quite aware that albuminous urine may exist without such dis- 
ease ; but the causes are then transient, and the urine ceases to 
present the albuminous character. Hence, I make it a rule never to 
infer the disease from one or two examinations of the urine, but to 
test it repeatedly ; and if I find that the albuminous deposit con- 
stantly takes place, I have very little hesitation in determining the 
existence of granular disease. On the other hand, I have re- 
peatedly tested the urine of sick persons labouring under dropsy, 
and other diseases, and have found no albumen, and the absence 
of renal disease has been proved by post-mortem examination, or 
by the complete and permanent recovery of the patient. The dis- 
covery of albumen in the urine is not difficult. A small test-tube 
and a spirit lamp will suffice to produce a coagulum, if albumen 
be present ; and the addition of nitric acid to another portion of 
urine will produce a copious white precipitate. These two tests, 
taken together, are conclusive evidence of the existence of albumen; 
but without such tests it is wholly impossible to form any opinion; 
for albuminous urine presents no appearance whatever to the eye 
to distinguish its character; and in the early conditions of disease, 
even the specific gravity is nearly the same as in the healthy 
state.” 
*** The appearances indicative of this disease are “ either an 
unusually large or unusually small condition of the kidneys, flab- 
biness with paleness, in some cases increase of colour, of its 
substance ; its membranous tunic tearing off with unusual facility, 
leaving, perhaps, the surface beneath scabious and glandular, this 
shewing a granular state of its cortical substance. The tubular 
