A contribution to the natural history of scarlatina derived from observations on the London epidemic of 1887-1888, being a dissertation for the degree of doctor of medicine in the University of Oxford / by D. Astley Gresswell.

  • Gresswell, Astley.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the natural history of scarlatina derived from observations on the London epidemic of 1887-1888, being a dissertation for the degree of doctor of medicine in the University of Oxford / by D. Astley Gresswell. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    the fact that the urine had not been passed at 8 p.m. It was at 8 p.m., i.e. 'at the close of a day of comparative activity' that albumen was most frequently found ; and at 8 a.m. only somewhat less frequently. Diet, and time of taking food, had practically no influence; and there was no observable relation between the ap- pearance of albumen and specific gravity or colour of the urine. Indeed, erect posture and exercise were the chief factors concerned. The urine had a specific gravity of 1036 to 1036; it was always acid, generally clear ; it did not contain sugar, peptones or haemo- globin, nor did it deposit any casts, uric acid or oxalates. In 1886 and 1887 Dr. C. Ralfe drew special attention to an intermittent form of albuminuria independent of renal lesion, the urine contain- ing albumen, excess of urea and of urobilin, intermittently ; and he supposed that it was essentially of the same nature as paroxysmal haemoglobinuria, both being attributed by him to excessive haemo- lytic action in the liver. M. Teissier, also, spoke of ten persons, in whom albuminuria was directly excited by violent exercise and excessive emotional excitement; and he ascribed it to over-action of the liver; the urine contained bright metal-like particles and oily matters. Dr. Merley, who has recently confirmed these ob- servations, thinks that the primary fault is insufficiency of general metabolism, and that the affection is allied to gout. In 1887 Dr. A. W. Stirling reported the occurrence of 'postural albuminuria' in 77 out of 369 boys on a Thames training ship ; the albuminuria came on at 9 a.m., about three hours after rising: and so assured was he of its direct relation to the erect posture, and to it alone, that he adopted for it the above designation. The albumen appeared within a short time of getting up, independently of time of day when the boy got up, independently also of food and all other conditions save the erect posture ; it continued to appear for one or two hours; and then it generally diminished, so that, if the boy got up in the morning, it was absent by bedtime, though in some instances it persisted throughout the day ; and it disappeared on lying down at any time. It might increase after a meal, but only to a trivial extent: whether relatively or absolutely is not stated. Exercise by walking had no effect, neither had the mani- pulation of a heavy weight for twenty minutes while recumbent in bed. He ascribed the albuminuria in these cases to hyperaemia of the kidney ; 'jumping out of bed causing a sudden rush of blood to,