Haematinuria / by J Warburton Begbie.

Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Haematinuria / by J Warburton Begbie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    notable cases of albuminuria in connexion with vascular brouchocele and exophthalmos, dropsy has not been present. In prosecuting my inquiry on this subject, a very interesting cir- cumstance became manifest, namely, that the albuminuria was in certain cases limited to the period of digestion—present imme- diately after a meal, and absent when the person fasted. I had in one case been not a little puzzled by noticing the strange variety presented by the urine within very short periods—the albumen present in considerable quantity one day, and absent the next—pre- sent in the urine of the forenoon, and not to be detected in that passed before dinner. By obtaining repeatedly specimens of the urine in this case, and in one or two others, I was able to satisfy myself that in this disease the albuminuria is apt to possess the remarkable character of only occurring during or immediately after the digestion of the food. This appears to me to be a most interesting feature, and it is also in various ways a very important one. The existence of albumen might readily escape detection if the physician relied on the results of one examination, as he is not unapt to do ; and even when taking more than usual care, it is quite possible that in several specimens of urine furnished by the same patient for examination it might be found that no albumen existed. Conceive a patient so affected con- sulting a medical man before breakfast or luncheon ; his urine, carefully examined, found to be non-albuminous ; but, from some cause or other—and we know how fickle some patients are—calling for another physician shortly after a meal, when a large precipitate of albumen occurred on applying heat as well as on the addition of a little nitric acid. Remarkable as this character of the albuminuria which occurs in cases of vascular bronchocele and exophthalmos is there is another feature pertaining to it which is even more striking! The albumen is present in much larger quantity after breakfast than after either luncheon or dinner. In one case of this kind, which I was able to observe at intervals for a considerable time, the urine presented the following characters :—It was passed in average amount, was of healthy colour, reaction, and density. On no occa- sion was the density observed to fall below 1015, and it never rose above 1025 ; the average density was that of health, 1020. Very occasionally this urine deposited lithates, and from time to time contained a slight excess of earthy phosphates. Sugar was never present. Albumen existed in this urine daily for upwards of a twelvemonth, but only at certain times of the day, and these times were readily found to be shortly after meals. After breakfast, however, the amount of the albumen was invariably greater than atter luncheon, dinner, or an evening meal. Being greatly inte- rested m these peculiar phenomena presented by tlie urine in the case ot a gentleman whom I had recommended to spend the spring months in the south of England, I requested him to take an oppoi? tumty of consultmg Dr George Johnson of London, whose opinion