Fleusburg and Sjoquist have recently proved that albuminuria regularly oc curs in the first days of life, and that the urine also contains an extraordinary quantity of uric-acid crystals; probably the albuminuria is then owed to the irritation of the kidneys caused by these crystals. Ebstein and Nicolaier have experimentally shown that, the kidneys are forced to excrete a surplus of uric acid which cannot be dissolved, but goes to the bottom in the form of crystals, the urine commonly contains albumin and sometimes even blood.
Gull found a certain form of physio logical albuminuria in adolescents about the age of puberty, especially in weak and pale individuals. Other authors, among whom is Quoin, have noticed that this condition is frequently associated with masturbation.
Slight traces of albumin met with ex tremely commonly, especially between the ages of 18 and 25 years. The urine found to be albuminous in 45.5 per cent. of 129 hospital patients between these ages. Levison (St. Barth. Hosp. Rep., xxxv, 169, '99).
Physiological Albuminuria and Life insurance.—The question of physiolog ical albuminuria in adults has been much discussed during the past few years and has particularly engaged the interest of the medical men employed in insurance work.
Statistics of life-insurance, etc., show ing that physiological albuminuria is met with in America in 2 per cent.; in England in 3 per cent. Privations, scanty food and clothing, unsanitary surroundings, cold bathing, severe phys ical exercise, and mental strain fre quently give rise to albuminuria. Shep herd (New Eng. Med. Monthly, '89).
Albuminuria, natural or artificial, never occurs except as the result of pathological changes in the kidney, and is consequently never normal or physio logical, and is never to be regarded with out distrust. Millard (N. Y. Med. Jour. May 9, '91).
Instance where a special examinatior of a ease was referred to author by the medical officers of a prominent life-insur ance company evith a mere trace of albu. min in the urine. He sought and fourk other evidence of a renal involvement and advised strongly against the risk; another company accepted the risk fof $10,000, and, before the second annua premium, the patient died. Purdy (N. Y Med. Jour., Feb. 2S, '91).
There is at present a tendency to un derrate the importance of albuminuria in life-assurance. While the possibilit3
of ephemeral and unimportant attacks is adolescents is undoubted. the presence of a]butninuria in persons of over forty years is very significant. F. de Haviland Hall (Brit. Med. Jour., Feb. 20, '93).
The presence of albumin in persons over middle age of exceeding importance, especially the variety of albuminuria in which, with a low specific gravity, the quantity of albumin present is only to be perceived with the greatest care. This form is indicative of gout of the kidney: a form in which the disease might ad vance to such an extent as to threaten the life of the patient, though the merest trace of albumin might he present in the urine. If properly treated with a non nitrogenous diet and warmth to the sur face. these eases might go on for years. Lauder Brunton (British Med. Jour., Feb. '93).
It is necessary, especially in women, to take steps to ascertain that the albumin in the urine is not of extravesical origin. One frequent cause of the presence of albumin in the urine of females is hemorrhagic endometritis. Routh (Brit. Med. Jour., Feb. 20, '93).
Necessity of having the patient urin ate in the presence of the examiner, in order to prevent the substitution of other urine. Mackenzie (London Lan cet, June 16, '94).
Quite young subjects who have albu minuria should be considered as below the average. Douglas Powell (London Lancet, June 16, '94).
Albuminuria is not always patholog ical; and, if albumin be not found at the second or third examination, the case should be recommended for accept ance. Symes Thompson (London Lam eet, June 16, '94).
In cyclical albuminuria the prognosis is generally admitted to be good, al though it is commonly assumed that the kidneys in such cases are specially vul nerable. If this be so, it is remarkable that the occurrence of fevers, even scar let fever, does not produce a notable increase in the amount of albumin. The contrary may, in fact. occur, as in one of Keller's eases, in which the amount of albumin was actually diminished during an attack of scarlet fever, the favorable influence of rest in the recumbent atti tude more than counterbalancing the un favorable influence of the febrile attack. Editorial (Practitioner, June. '97).