b. Blood.—A small quantity, even a microscopic trace, means a corresponding amount of serum albumin. It is likely that some at least of those cases, diagnosed to have albumin in the urine from ex ertion, may have had latent renal calculus or some other cause for the appearance of a microscopic quantity of blood which would show, on testing, a trace of albumin. It is, I believe, especially in the latent periods of villous papilloma or other forms of vesical growth that serum albumin and small quantities of blood appear. This often happens before the attack of lidematuria which first draws attention to the urinary tract. I have known several patients, from whom I have subsequently removed villous papillontata, to present themselves with a history that, in the earlier stages of the papilloma, a diagnosis of Bright's disease had been made.
The highest accentuation of this condition is found in the symptom known as " fibrinuria of Ultzmann," in which the urine gelatinizes after being passed. It is only seen in rare cases of villous papilloma, and it is due to the straining of the serum through the slender vessels of the fragile growth.
c. Serum Leakage.—The albuminuria of spasm or strangury is on a par with the preceding, although the character of the surface from which the albuinin leaks is different. Usually the surface epithelium has been shed in various parts of the bladder, under the influence of a chronic inflammation, and the spasm set up by some form of obstruction, such as enlarged prostate, stone, or stricture, strains through the weakened wall a variable amount of serum. I believe that many patients are denied the benefit of operation by the discovery of more albumin in the urine than can be accounted for by the pus present. In the case of one patient on whom several attempts
had been made to remove an enlarged median lobe by the perineal route, the surgeon became alarmed by the appearance of a quantity of albumin in the urine and refrained from operation. The patient came ultimately under my care. Not only were the kidneys intact, but he bore a very profuse hemorrhage from suprapubic prostatec tomy, without any depression, and completely regained his health and bladder power, the albumin disappearing directly the vesical straining induced by the prostatic obstacle had been relieved. Serum leakage is also found in tubercular ulceration of the bladder, where there is spasm of the detrusor muscle. Perhaps this false albu minuria occurs more often in vesical calculus than is usually believed. In one instance I refused for some time to operate for stone on ac count of the decided amount of albumin in the urine, and yet the patient bore a suprapubic lithotomy for the removal of a three-ounce calculus without difficulty, and the water cleared subsequently.
d. Chyle.—The admixture of chyle also with the urine in chyluria causes the secretion to be albuminous. See section on Chyluria.
e. Seminal and Vesicular False Albuminuria.—It is stated that al bumin is found in young males who are passing seminal or prostatic fluid. In these the microscope will reveal the characteristic appear ances of the fluid, and if this can be established it is a significant fact, for albumin is often found in boys attending large public schools where the tendency to onanism is great.
To avoid the mistake of diagnosing accidental as renal albuminu ria it is but necessary to filter the urine, examine more carefully with the microscope, and take the percentage of urea.