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appearance idiopathic; and among the other substances detected by chemical analysis, he adds, as regards the great quantity of albumen found in this urine, it will be necessary to analyse, and support them by the examination of dead bodies, in order to determine if the dropsy had any share in its developement, or if it was dependent upon a particular state of the urinary organs." He also, alluding to peritonitic urine, says, that "it contained much albumen, which leads to the supposition that the urine becomes albuminous in peritonitis." In 1812, Dr. Wells' likewise directed attention to the appearance of albumen in the urinary secretion.

Previous to bringing forward cases for the purpose of proving the frequent existence of albumen in the renal secretion, altogether independent of any change of structure oscurring in the kidney, it may, perhaps, be well, shortly to advert to the opinions expressed by various authors of eminence as to the extreme rarity of its occurrence. Dr. Osborne states in connection with this subject, "in no instance have I met with coagulable urine without diseased kidneys, or healthy kidneys with coagulable urine." Dr. Christison states, that, although coagulable urine may be found without kidney disease, it is, nevertheless, "very rare." M. Rayer is said to have examined the urine of 400 patients taken indiscriminately, the result of which was, that only three presented albuminous urine without granular kidney. M. Solon examined the urine of 500 or 600 persons either in health or full convalescence, and found only one with albuminous urine. And lastly, Professor Forget, on two different occasions, examined the urine of between forty and fifty patients in his hospital, and "found albuminous urine only in those affected with dropsy, and in whom, when they did not recover, the inspection proved the existence of diseased kidneys."

On the other hand, among those who strongly contend for the frequent appearance of albuminous urine without kidney disease, we may mention the name of Dr. Darwall, who illustrates his position by several cases, one or two of which we now call attention to. Talking of effusions which frequently attend diseased states of the heart, he observes:

CASE I.—In a patient who died in the Birmingham Hospital, during the present year, at a very early stage of the effusion, two months before his death, the urine was barely rendered turbid, but the evening he died it was nearly rendered solid by boiling. On dissection, the heart was found enormously enlarged, and the aorta very much diseased, the kidneys were perfectly sound.”

CASE II.-Another case "occurred in a lady who had been suffering from pulmonary symptoms, and symptoms of disease of the heart for nine months. When we first saw her, at this time, the urine coagulated strongly, and continued to do so till the period of her death, three months afterwards; yet, while the left lung, the pleura, and the heart, exhibited serious disease of long standing, and while the liver was also diseased, though in a slighter degree, there was no appreciable change whatever in the substance of the kidneys."4

The three following are cases of pneumonia, and occurred in our own experience.

CASE III.-John Guy, aged 25, a stout, sober, and healthy young man, by occupation a seaman, after having been exposed to cold, was seized with rigors, which were shortly afterwards followed with dyspnoea, cough, and copious rusty-coloured expectoration; crepitating rale heard all over the right side; passed about a pint of urine in the twenty-four hours, of a dark straw colour, specific gravity 1012. In this case, nitric acid gave an albu

1 Nysten, Recherches de Physiologie, 1811, p. 255, 260, and 262.

2 Transact. of a Society for the Improvement of Med. and Chir. Knowledge, vol. iii. p. 167. London, 1812.

3 See Christison on the "Granular Kidney," page 39.

4 Cyclopædia of Practical Medicine, vol. i. Article " Dropsy," p. 637 and 640.

minous precipitate to the extent of nearly one half of the volume of fluid employed, which precipitate withstood the action of heat. This occurred at an early period of reaction. The young man subsequently recovered.

CASE IV.-Alexander Ballingar, an old soldier, aged 68, stated that he enjoyed during his life the best of health, with the exception of a severe inflammation of the chest, which was brought on by lying three days and nights on the field of Waterloo, after having been wounded in that engagement. He had been ten days ill with dyspnoea, cough, and coloured expectoration before seen by me, at which time all these symptoms continued. In addition, the right side of chest upon percussion gave a sound as dull as that emitted by marble; percussion on left side tolerably natural; bronchial respiration and bronchophony were heard distinctly all over the right side, while mucous râles, with puerile respiration, were present in the left side of chest; passed about a pint of urine in the twenty-four hours, of the colour of small beer, specific gravity 1022, which yielded no precipitate by heat alone. After the addition, however, of a little nitric acid, a copious albuminous precipitate was the result, which effectually withstood the reapplication of heat, showing that the urine had been previously alkaline. This man died.

Upon dissection, the whole of the right lung was found to be in the state of gray hepatisation, with extensive old cellular adhesions between the pleura costalis and pulmonalis of both sides; the left lung was in a state of active congestion. The kidneys and other organs were perfectly healthy. This man, it should have been stated, was a drunkard.

CASE V. John Gray, aged 45, by profession formerly a soldier, had fought at Waterloo, and died the same day as the preceding case, labouring under all the symptoms of pleuropneumonia. Upon dissection, recent bands of lymph were found passing between the pleura costalis and pulmonalis of the right side, with some serous effusion into the corresponding pleural sac. Right lung in a state of red hepatisation, with small portions here and there having passed on to the gray, slight effusion into the pericardial cavity, with soft lymph between its serous coats. Kidneys perfectly healthy to all appearance, though rather pale in colour; both structures, however, quite distinct. Passed before death about eighteen ounces of pale coloured urine daily. Specific gravity 1012; heat and nitric acid gave an abundant precipitate of albumen.

Most of the following cases came under my own direct observation.

CASE VI.-Mrs. Ross, aged 63, of sober and temperate habits, before death had for some years been affected with all the symptoms of scirrhus of the pyloric extremity of the stomach, such as, almost constant pain, anorexia, and frequent vomiting of a dark coloured fluid, somewhat similar to coffee grounds. Upon dissecton, the pyloric extremity of the stomach was thickened and hardened, which arose from its cellular tissue having become hypertrophied. Kidneys perfectly healthy, as were all the other abdominal organs. The lungs were loaded with frothy mucus. Left ventricle of heart in a state of hypertrophy without dilatation; its other cavities were perfectly healthy and natural; the two serous surfaces of the pericardium were universally adherent, by means of old cellular bands. During life there was nothing remarkable in respect of the renal secretion, as regarded quantity. Then, it was not examined. After death, however, the quantity of urine obtained from the bladder, though too limited to enable us to ascertain its specific gravity, nevertheless, by the agency both of heat and nitric acid, afforded an albuminous precipitate almost equal in volume to the quantity of fluid employed.'

In many of the succeeding cases, it will be observed, that the urine was submitted to chemical examination after the death of the patients. Now, though I am aware that on this account objections may be urged against the validity of such cases, on the ground of the serum of the blood exuding through the tissues of the bladder after death,

CASE VII.-Mrs. W. for three years before her death had laboured under symptoms of diseased stomach. Upon dissection, the pyloric extremity of the stomach was found in a well-marked state of what is usually denominated scirrhus of the stomach. All the other abdominal organs were healthy. Unfortunately, however, the kidneys were not minutely examined, so that we are unable to bring forward any positive evidence as to their natural or healthy state. We have, however, thought this case worth inserting along with the preceding one of scirrhus of the stomach, more especially as the urine which was obtained from the bladder was highly albuminous.

CASE VIII.-J. A., 73 years of age, had been the subject of retention of urine for the last ten or twelve days of his life, seemingly dependent upon a paralysed state of the bladder. The urine was secreted in considerable abundance, and was of a dark greenish colour; specific gravity 1022. This urine contained a large quantity of albumen. Upon dissection the left kidney was very small and atrophied, containing a considerable sized calculus within its pelvis. The parenchymatous tissue of this kidney was almost entirely converted into serous cysts. A smaller calculus, of a peculiar flat button shape, was contained in one of those cysts at the upper part of this kidney. The right kidney was in a state of hypertrophy, but otherwise healthy. The urinary bladder was large, and immensely hypertrophied in all its coats; its inner or mucous coat was rough and granular, several small calculi were found in the urethral portion of the prostate gland, which gland itself was much increased in size.

Some writers upon the granular kidney, in establishing the existence of albumen in the renal secretion, as one of the pathognomic symptoms most to be relied on for pointing out the disease, deny, that, whilst the renal tissue remains unaltered, any organic lesion of the liver is capable of producing the phenomenon in question. It will be seen, by referring to a few cases which follow, that albumen was detected in the urine of individuals, in whom the tissue of the liver was, upon dissection, found to deviate from its normal condition, and to have assumed that peculiar appearance known by the term cirrhosis. Little value may, perhaps, however, be attached to such cases, seeing that it has been doubted by able authority whether this seeming change of structure be really an accidental deposit. I have, notwithstanding, thought them worth recording.

CASE IX.-A Prussian sailor fell by accident into the hold of his vessel. Immediately afterwards he was brought to the Casualty Hospital (Leith), when it was found that he had sustained a severe fracture of the cranium. He died in a few hours after admission, with symptoms of compression of the brain. Upon dissection, a large coagulum was found between the inner table of the scull and dura mater. The corresponding or left cerebral hemisphere was much compressed, and partially lacerated. The liver was large, and contained many large patches affected with cirrhosis. The spleen was soft, and the kidneys perfectly healthy. The urine was pale and colourless; specific gravity, 1016. When exposed to heat or nitric acid an abundant precipitate of albumen was the result. This man was uncommonly powerful, 30 years of age, and in the full enjoyment of health both previous to and at the time of the accident.

CASE X.-J. Robertson, aged 30 years, a stout muscular porter, of intemperate habits, was seized with all the ordinary symptoms of delirium tremens, from which he died.

Upon dissection, the traces of general cerebral congestion were apparent, without, however, any of the prominent effects of inflammatory action. Considerable serous effusion was found between the arachnoid membrane and pia mater, as also at the base of the cranium. The two serous surfaces of

and consequently mingling with the urine therein contained, nevertheless, as from experiment I know this to be by no means a phenomenon of universal occurrence, I think it but right to record these cases in conjunction with others.

the pericardium were universally adherent, by old cellular tissue. The left ventricle of heart was hypertrophied, without much dilatation. A ring of Osseous deposit was found surrounding the mitral valve.

The liver was about its natural size, but much affected with cirrhosis. The kidneys were perfectly healthy. The urine was of a dark straw-colour; specific gravity, 1018. Heat and nitric acid gave an albuminous precipitate, equal in volume to perhaps a fourth of the fluid employed.

Dr. Blackall gives an instance of albuminous urine co-existing with diseased liver, which we shall here abridge.

CASE XI.-A. B. aged 45, sallow and bloated skin; pulse 100, hard; dyspnea; loss of voice, and stricture about the hypochondria; abdomen swelled; frequent dark bilious discharges; œdema of legs; urine of the appearance and colour of rennet whey, copious at night, precipitating at 160; convulsions shortly came on, with fixed but not dilated pupils. Blood drawn was watery, and much cupped. Not more than two hours before her death, the pulse remained still quick and hard.

Dissection.-Lung every where free from adhesion; about four ounces of bloody serum on each side of the chest ; a small quantity of pale fluid in the pericardium; very little water in the abdomen. The liver hard, with a thick curled edge, its membrane being rather white, and greatly thickened, and its surface irregular with tubercles. A considerable portion of its substance was divided into hard brown tubercular masses; the other viscera of the abdomen sound. "I speak," says he, "particularly of the kidneys." It is clearly evident from this language, that his attention was in an especial manner directed to the kidneys, so that it is scarcely possible to conceive that, had their tissue been materially affected, the change would have eluded his observation.

CASE XII.—James Lamb, aged 48, by occupation a carpenter, was squeezed between two logs of wood in a ship-building yard, and immediately brought to the Leigh Dispensary, where he soon afterwards died. Upon dissection, the four superior ribs of both sides were found fractured. The right lobe of the liver was lacerated and torn. Its substance presented the appearance usually known under the name of cirrhosis. The kidneys were quite healthy. The bladder contained so little urine as to prevent our ascertaining its proper specific gravity; but which, nevertheless, yielded a copious precipitate both by heat and nitric acid. This man had enjoyed good health previously.

CASE XIII.-V. Ward, aged 41, died labouring under the symptoms of phthisis and diabetes insipidus. Upon dissection, the lungs were found tuberculous. The liver had seemingly undergone fatty degeneration. The kidneys, and other organs, were healthy. The urine was of a pale colour; its specific gravity, however, was not ascertained; heat and nitric acid both yielded a copious albuminous precipitate.

CASE XIV.-W. Saunders, aged 60, died of chronic ulceration of the epiglottis and larynx. Upon dissection, the liver was found partially affected with cirrhosis. The kidneys, as well as other organs, were, to all appearance, healthy. The bladder contained a small quantity of urine, which did not admit of its specific gravity being taken, but which yielded a copious precipitate by heat, which was not redissolved by the addition of acid. The following are cases of various descriptions.

CASE XV.-William Hollingworth, aged 45, of very temperate habits, had long laboured under symptoms of diseased heart and blood-vessels, from which he at length sunk. Upon dissection, the left ventricle of the heart was greatly dilated, with proportional hypertrophy. The right auricle was greatly dilated, without hypertrophy. The inner membrane of the ascending aorta was covered with osseous laminæ.

The urine was of a dark straw colour; specific gravity, 1022; heat and nitric acid both yielded an albuminous precipitate.

1 Blackall on Dropsies, p. 145.

CASE XVI.-James Stirling, aged 23, a young man previously in the enjoyment of good health, was seized suddenly at Hull with indisposition, for which blood was taken from the arm. On his return home he was labouring under severe inflammation of the vein which had been opened. Latterly, symptoms of purulent effusion within the pleural cavity took place, under which he sank.

Upon dissection, the veins of the arm were found filled with purulent matter. Several pints of the same fluid were contained in the right pleural cavity. The kidneys and other viscera were healthy. About a pint of urine was passed in the twenty-four hours, of a straw colour; specific gravity, 1012; heat and nitric acid in this instance formed almost a solid coagulum.

CASE XVII.-Jane Patterson, aged 3 years, had been affected with wellmarked pertussis for about two months. By imprudent exposure to cold, an attack of cynanche trachealis supervened, and terminated fatally.

Upon dissection, the lungs were found to be the seat of interlobular emphysema. The larynx was highly vascular throughout, having its mucous surface covered here and there with soft lymph. Heart, liver, kidneys, and other organs were perfectly healthy in this case. The urine was pale and colourless; its specific gravity was not ascertained; heat and nitric acid, however, gave a large precipitate of albumen.

CASE XVIII.-J. M., aged 5 years, had a mild attack of scarlatina, from which he was convalescing favourably. About three weeks after the appearance of the eruption, his parents observed him slightly swelled in the lower extremities. At this period he was suddenly seized with dyspnœa, and severe lumbar pain, stretching itself down the thighs; the breathing was hurried and laborious, with loud mucous rattle over the whole chest; the urinary secretion was almost suppressed, and the small quantity passed was of a high colour, and deposited an abundant precipitate of a brick colour; pulse 170, strong and full. He was immediately bled, and leeches were applied to the loins. The urine was examined, and its specific gravity found to be 1015, at the same time that it contained an abundant proportion of albumen.

Upon dissection, both lungs were found in a state of active congestion; all the other viscera were healthy, with the exception of the kidneys, which were congested.'

As our limits will not permit a full detail of each individual case in which albuminous urine was detected, we must close this part of our subject by little more than a simple mention of those cases of disease in which this phenomenon was found.

1st. It was observed in the case of a young girl affected with pertussis. This girl is now in the enjoyment of excellent health.

2dly. It was observed in a case of diabetes insipidus, since dead, without a post mortem examination being obtained.

3dly. It was observed in a case of icterus, occurring in a previous healthy man, whose urine was of the low specific gravity of 1008. This man is

since quite well.

4thly. It was observed in a case of chronic bronchitis, with diseased heart, where there was no reason to apprehend kidney disease.

5thly. It was observed in the case of a man for many years affected with syphilis, having lost his nose and soft palate by ulceration. This man had taken large quantities of mercury.

6thly. It was observed in a man labouring under severe gastric fever, owing to over-indulgence in eating and drinking.

The appearance which the kidneys presented in this case was simply, as might have been a priori expected from the symptoms, that of active congestion, without the slightest vestige of any of the prominent appearances which, according to Dr. Bright, characterise the first stage of the affection described by him.