302 ON DROPSY, CONNECTED WITH DISEASE OF THE KIDNEYS. digitalis, the acetate of potash and squill in combination. As an alterative in this stage, the hydrochlorate of ammonia may sometimes be employed with benefit. The last resource, as before mentioned, is the operation of paracentesis abdominis, and the indications for its necessity have already been described. PART III. DISEASES OF THE KIDNEY WITHOUT DROPSY. ALBUMINOUS, SANGUINOLENT, AND PURULENT URINE, CHAPTER I. TEMPORARY ALBUMINURIA.-INTERMITTENT HÆMATURIA. ENDEMIC HEMATURIA. Ir has been already shown that albuminous urine, with a peculiar and characteristic sediment, is significant of a special form of disease of the kidneys. But the urine may be albuminous, may be sanguinolent, may be purulent, and yet not symptomatic of morbus Brightii; for these states of the urine, apart from the tube-casts, are common to many disorders of the renal organs. In the one case a greater or lesser amount of general dropsy is always present; in the other, these morbid conditions of the urine are independent of any such symptom. I propose to illustrate by a few typical cases these albuminous, sanguinolent, or purulent states of the urine, unconnected with morbus Brightii. The diseases in which albumen appears temporarily in the urine have been already enumerated. It may be convenient to repeat them. In pneumonia, albumen in small quantities is found in the urine, apparently having some connection with the disappearance of the chlorides; for, as they diminish or disappear from the urine, albumen in small amount may usually be detected. As the chlorides reappear, the albumen is no longer present. In pleurisy, as well as in pericarditis and peritonitis, albumen has occasionally, but by no means constantly, been detected in the urine. So also in erysipelas it has occasionally been found. In typhus and typhoid fevers, in variola and in measles, albumen has frequently been found present. Its presence in the secondary febrile disturbance of scarlatina has already been noticed. In the reactionary stage of cholera, the urine first passed always contains albumen. The urine found in the bladder after death is, I believe, universally albuminous; this may be a post-mortem effect from passive transudation of serum. In phthisis the urine is occasionally albuminous, but it has already been shown that this arises from true degeneration of the renal structures and the development of one form of morbus Brightii. No satisfactory explanation of the cause of the urine becoming temporarily albuminous in the above-named diseases has hitherto been offered. It is a functional disturbance, depending, in all probability, on diffuse capillary blood stasis, by which the functions of all organs are more or less impeded or deranged, a condition common to all fevers and inflammations. M. Robin's statement, read before the Academy of Medicine in Paris in 1851, accounting for the presence of albumen in the urine by the theory that, in health, albumen is an excrementitious product in the blood, and that it is decomposed in the process of respiration, and the nitrogenized residue of this combustion, urea and uric acid, are excreted by the kidneys, has been already quoted (p. 22), and my objections to this theory stated; and I repeat that in erysipelas, typhus, and typhoid fevers, cholera, variola, and measles, albumen is occasionally present; but in these febrile diseases there is not that |