Erlanger and Hooker made their experiments on two young mcn, aged 29 and 2S respectively, the former being healthy and the latter having been subject to orthotie albuminuria for five years when the condition was first observed. Blood pressure, pulse pressure and circu lation were determined by precise instruments under varying conditions, They let the orthotic patient breathe against high air pressure in the deeubitus, in order to increase the venous pressure in the general cireu lation and found the urine free from albumin. The same findings resulted when in the horizontal position thc intra-abdominal pressure was raised by tension of the muscular abdominal wall. Erect position at. once produced albuminuria, but failed to appear if the body weight was eliminated by immersion of the erect body in water. American investi gators have detnonstrated the fact, that elimination of muscular exertion and tension does not prevent albuminuria. In a sitting posture violent movements with arms and legs did not lead to albuminuria, while the latter, when present, waS lessened by walking about.
The orthotic patient commenced to excrete albumin when erected to an angle of about 40°, but this did not occur when the patient was turned in the reverse direction. This experiment rendered it probable that albuminuria was caused by- insufficient regulation of the level of the total organic fluid, the lower extmmities being insufficiently supplied; and this pathogenesis became almost a certainty no albumin was secreted upon compressing the lower extremities by pneumatic stockings which drove the blood aml tissue fluids upward under a pressure of 50 in in. fig. The pressure measurements, taken in a large number of experhnents, showed that concurrently with the onset of albuminuria there were: increase of the minimal pulse pressure, decrease of the pulse pressure, increase in the pulse frequency, unchanged product of pulse frequency and pulse pressure combined.
Frank, too, thinks that the chief factor in orthotic albuminuria is an injury to the renal elements owing to deficient blood supply. He considers his view supported by the established fact that albuminuria is always associated with oliguria. Diuresis is even impaired, at least to a certain degree, under the influence of diuretics. Alburninuria disap pears in the erect individual under the influence of faradization at any part of the body. Frank believes, as a result of his highly interesting experiments, that the vascular disturbance of the kidney is a reflex process.
Erlanger and Hooker had previously pointed ottt that the position of the erect body had a certain influence upon albuminuria, the latter decreasing when patient bent forward over a table at right angle. Frank
amplified this statement by demonstrating that, aside from lying down or sitting, standing up with the body bent forward caused albuminuria to disappear. The position of the body is most emphasized by Jehle. According to him the position of the body associated with lordosis of the lumbar spiue causes albuminuria which disappears when the lordosis is corrected. Certain distinct conditions, however, nmst prevail: The fordosis must be arc-shaped and the lowest point of the curvature must be in the region of the first and second lumbar vertebrte. Lordosis in the region of the third and fourth vertebne does not produce the same effect (Figs. 2a and 2b).
According to Jehle, orthotic albuminuria is lortlotic alburninuria. He was able to demonstrate the characteristic shape of lordosis in all his patients with orthotic albuminuria. lie further demonstrated that albuminuria could be immediately produced when lying down by artificially inducing lordosis, while albumin (lid not disappear even in the decubitus in a lordotic child that had been placed in a plaster cast.
Furthermore, Jelde was able to produce albuminuria in healthy persons by the artificial induction of lordosis. A6 he expresses it: the kidney reacts to this position with a degree of accuracy equal to a physical experiment. So far as children are concerned, there need not even be a predisposition, since every healthy kidney will react as described.
This opinion is contrary to that of the other authors referred to who do not think that the position of the body is the exclusive causative factor, but rather the insufficiently- regulated level of the tissue fluids caused by a vasomotor reflex.
The fact that all children will not excrete albumin when brought into the lordotic posture is, according to Jehle, not the consequence of renal resistance, but the difficulty of producing effective lordosis.
Jehle states that the question why lordosis should produce albu minuria is most plausibly answered by assuming that it causes mechanical congestion, and for this reason it is necessary that the lordosis should be located at the level of the juncture of the renal veins and the inferior vena cava, which would produce venous stasis or some other circulatory disturbance of the renal circulation.
Sotne of Jehle's urinary: findings in orthotic albuminuria, such as the presence of casts (often in very- large numbers) and red blood cor puscles, are not confirmed in my own experience which has recently been enlarged by a fresh number of examinations. On the other hand, he has also found the characteristic presence of proteid bodies precipi table by acetic acid, and high concentration.