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ALBUMINOUS URINE.
256
nevertheless, unwilling to attach to it so much importance as I should to purulent expectoration. To the Editor of THE LANCET. Again, as regards our pathological deducSIR :-Illustrations of new or important tions : admitting coagulable urine to prove tacts in pathology cannot fail to prove of the existence of organic lesion of the kidney, general interest, and the opinions ofof M. Desir it appears, from the 100 cases related by on"Albuminous Urine as a Sign Disease," Dr. Bright, that some obscurity exists as as detailed in your Number for Sept. 24th, ap- to the actual condition of that organ, for we " pear to me well deserving attention, for the find kidney, hard, soft, large, small, &c.," and it is at present a doubtful point as to subject is one of considerable interest. One of our highest authorities (Dr. Bright) views whether these conditions are mere modificacoagulable urine, in reference to the condi- tions of one and the same change. The subtion of the kidney, with the same anxiety as ject is, however, as I before observed, of he does purulent expectoration in reference deep moment, and I hope that it will be to the lung, and considers the one equally followed up with the interest which it deindicative of organic mischief as the other. serves. Yours, &c. W. T. ILIFF. On this head I confess, at present, I ought not to venture an opinion ; but should I do Newington, Oct. 14, 1836. ALBUMINOUS URINE.
so, it would be to follow M. "
Desir, and say,
When the urine is albuminous, there will always be found an organic or functional lesion of the urinary apparatus." Having had several cases of organic and functional disturbance of the urinary apparatus lately under my care, I have been led to pay some attention to the subject. In one case, where the urine was invariably albuminous, the kidneys were found to be enormously enlarged, and, as my friend Mr. King has observed, " the entire mass seemed to be made up of simple spherical cysts,
-
ALBUMINOUS URINE.
To the Editor of THE LANCET. SIR:—Since the publication of Dr. Bright’s work on Albuminous Urine as a Symptom of Renal Disease, the members of the medical profession have appeared to be doubtful regarding the extent to which the sentiments promulgated by that physician should be accredited. My attention has been called to this subject in consequence of a report which appeared in a recent number of your varying in size between the dimensions of a interesting and independent journal, of a walnut, and those of a sand-grain, &c." The discussion which occurred at the last meetright kidney weighed 2 lb. 12 oz., avoirdu- ing of the members of the Westminster poise, and is preserved in the museum of Medical Society, on albuminous urine. I Guy’s Hospital. In this case there was, feel disposed to agree with Messrs. Greenthroughout, no pain at all ; but in another wood and Johnson, who were the principal case, where the suffering of the young lady speakers on that occasion, in thinking that was considerable, from disturbance of the albuminous urine is frequently symptomatic whole of the urinary apparatus, the urine of functional disturbance of the system, and contained albumen at one time ; no traces should not be considered as depending on of it have existed latterly, and although this organic disease of the kidney, unless when case was considered by the first authorities of long continuance, and in conjunction to be one of organic disease, yet, as her re- with other well-marked symptoms. The covery has almost taken place, I am dis- opinions, however, of those gentlemen can posed to trust that only functional disturb- only be considered as conjectural, remainance has existed, and that the coagulable ing unsupported as they are by any wellurine may be attributed to that circum- known and authenticated facts. That the stance only. opinion of Dr. Bright relative to albuminous That circumstances do occur, where albu- urine being an infallible criterion of renal men is only occusionally detected, is borne disease is untenable, may, I imagine, be out by the fact stated by Dr. Bright in No. satisfactorily determined by referring to the 2 of "Guy’s Hospital Reports," for he albuminous urine secreted by children alludes to this circumstance as having been labouring under common catarrhal affecnoticed both by himself and Dr. Addison ; tions,-a circumstance which, so far as I am also by the remarks in M. Desir’s °Thesis," acquainted, is unaffirmed by any hitherto—" In a healthy person the urine may acci- published statement of this fact. Albumidentally be albuminons for twenty-four hours nous urine is most frequently met with together, towards the termination of an ex- during the first two or three days of catarrhal citement of the urinary passages;" and no or inflammatory affection in children, othercase occurred in the 100 cases related by wise most healthy, an occurrence owing to Dr. Bright as having had albuminous urine some temporary functional disturbance, and where some disease did not exist in other this appears to be confirmatory of the sentiorgans save the kidney. Therefore, although ments promulgated by Dr. Wells, (Trans. of I am disposed to look with considerable a Society foi- the Improvement of Med. and caution on this condition of urine, I am, Surg. Knowledge, vol. iii.-p. 167, et seq.)
256
respecting ulbuminous urine being connect- 19th of January, 1833, I was suddenly sum-
ed with too great action in some part of the moned to ber assistance. I found herwittiin system. I am, Sir, your obedientservant, labour, a foetuswasquickly expelled, membranes unbroken, and its placenta WILLIAM TEEVAN, M.R.C.S.L. its attached them; -m secoutt foetus followed. 2, Bryanston-square, Oct. 31., I836. under thetosame circumstances, and when I opened their membranes, the v proved ?. be INSTANCES OF
attached to them; a second foetusfollowed,
dead and shrivelled, but not at all putrid or offensive. Here it will be perceived that
BLIGHTED FŒTUSES.
were rotained in the uterus 95 To the Editor of THE LANCET. ; the sfoetuses after vi etality appeurs to have ceused. attention of the profession day having been directed to blighted twins, by I would iliustrate ;.thi8--this subject further, observe, now I em pon the some recent letters in your valuable and but willofonly twins, that cf:;l5alof 1571 cases which widely-circulating journal, I hasten to send subject have happened in my own practice, 17 have you the following cases .,t,,;iii cases. Of these, six were first On 6M’26th of .Feb. last, I was callcd to Jane F—, a single woman, who was re- cases of pregnancy, and four of them nocurred in 1833, the number of births in that ported to be in year having been 106.I remain. Sir, your Ifoundthesrila,p obedient servant, as urgent, she natural, and, the pains were GEORGE YEATESHUNTER. HWTER GEORGE YEATES ,. waa, seen delivered of a female living child of an average size. On Placing my hand Margate, Nov. 7th, 1836. upon the trF3ilo>raabdomen, my invariable habit after LISFRANC ON ANEURYSMS. delivery, 1 found that the uterus contained a second fcetus,which,as the pains oor.tinued strong, and the presentation was ’ ’ To the Editor of THE LANCET. SIR:—Having read very attenflvely the proper, very quickly followed the first-bron, but with to membranes unbroken. Opening exceedingly interesting case of aneurysm of these I discovered a dead female, smaller ’the- arteria innominata, &c., lately operated than the first, having, as I considered, died ’apott by Mr. Fearn, of Derby, as well as inabout the seventh month of utero-gestation,the remarks which appeared upon that oase shrivelled, and of a leadon colour, but with- in your ournal of Oct. 29, I was ied to reier out the slightest traceofputrefaction; the to a book which I had read not long since, funis was much longer, harder, and smaller viz., " Lisfrancon Anemysms."
SIR :—The
-
’
-
been
labour. Upon examination
,
- ..’ _.
-
in circumference than usual. The placenta
,
After
deecribing othermedesof operating
casily followed; it was uniform; and large, in aneurysms, he mentions that of Brasdor, the unbilical cords arising from separate which he divides, first, into " those cases
bases, and at some distance from cach other. in which no arterial branch arises between This patient, who Ni-,qs-pre,-,aa3l.t-fQr the first the ligature and the sac ;" secondly, "when time, had been attended for some internal one or more branches do take their origiii comf:laint .before-1 saw her professionally ; between the ligature and the -sai." In - she had coneealed her situation, and ,her giving the results of the different operations, mother wa,; much surprised and mortified he states, that live cases healed by the firstmentioned method have occurred, three of when I made it known. Iremember attending another case- in 1819, which were sucessful, the other two not so butat this distance of time, I must be con- The arterypraetised upon was the common tent to copy ii from my midwifery case-book : cartid. The operators were Wardrop, —"April 16, 1819, Mrs. Win. D. Behind the Lambert-, Bush, and Montgomery. In the Roman Catholic Chapel, past 7, P.M. Twin cases treated by the second method, which
females, .Brat pregnancy, one appeared to were ten in- number, nine are described as have been dead about four months, and came having been unsuccessful, one as suecessful. away with the plaeenta." I trust -the’fol-. The aneurysms were of the arteria innomilowing case will be found interesting, and nata, the external iliac, the subelavian, and the femeral arteries, the operators being worthy of publication:— About Oct. 15, 1832, Mrs. John F—, Mott, Key, Evans, Wardrop, James, White, whom I had attended jn several labours, A. Cooper, Dupuytren, and Deschamps. received a viol nt mental shock, while work- ’ After the accurate descriptions of the difing in the fields, in consecuence of being ferences bétween the operations of Hunter, told, without preparation, of the sudden and Brasdor, hiid- WaTdrt4p, which appeared in -
unexpected death of hernext-doorneighbour.
youlast week’s Journal, no further remarks she fainted, but I did not then see are required from’ me. The above stateher.- She believed herselfto be pregnant, ments show what has been frequeutly rehavmg quickened more than a fortnight be- -peated, ’namely,that the Preach know fore. From this time the bosom, and abdo- nothing of what is doing by the medical
I believe
to feel men, gadually subsided, she ceased her notion
the child,
and began to fancy that
of pregnancy
was
erroneous;but on the
.profession in England. tlient servant,
London, Nov. 1, 1836.
,
I am,
Sir, your obeJ. p
nevertheless, unwilling to attach to it so much importance as I should to purulent expectoration. To the Editor of THE LANCET. Again, as regards our pathological deducSIR :-Illustrations of new or important tions : admitting coagulable urine to prove tacts in pathology cannot fail to prove of the existence of organic lesion of the kidney, general interest, and the opinions ofof M. Desir it appears, from the 100 cases related by on"Albuminous Urine as a Sign Disease," Dr. Bright, that some obscurity exists as as detailed in your Number for Sept. 24th, ap- to the actual condition of that organ, for we " pear to me well deserving attention, for the find kidney, hard, soft, large, small, &c.," and it is at present a doubtful point as to subject is one of considerable interest. One of our highest authorities (Dr. Bright) views whether these conditions are mere modificacoagulable urine, in reference to the condi- tions of one and the same change. The subtion of the kidney, with the same anxiety as ject is, however, as I before observed, of he does purulent expectoration in reference deep moment, and I hope that it will be to the lung, and considers the one equally followed up with the interest which it deindicative of organic mischief as the other. serves. Yours, &c. W. T. ILIFF. On this head I confess, at present, I ought not to venture an opinion ; but should I do Newington, Oct. 14, 1836. ALBUMINOUS URINE.
so, it would be to follow M. "
Desir, and say,
When the urine is albuminous, there will always be found an organic or functional lesion of the urinary apparatus." Having had several cases of organic and functional disturbance of the urinary apparatus lately under my care, I have been led to pay some attention to the subject. In one case, where the urine was invariably albuminous, the kidneys were found to be enormously enlarged, and, as my friend Mr. King has observed, " the entire mass seemed to be made up of simple spherical cysts,
-
ALBUMINOUS URINE.
To the Editor of THE LANCET. SIR:—Since the publication of Dr. Bright’s work on Albuminous Urine as a Symptom of Renal Disease, the members of the medical profession have appeared to be doubtful regarding the extent to which the sentiments promulgated by that physician should be accredited. My attention has been called to this subject in consequence of a report which appeared in a recent number of your varying in size between the dimensions of a interesting and independent journal, of a walnut, and those of a sand-grain, &c." The discussion which occurred at the last meetright kidney weighed 2 lb. 12 oz., avoirdu- ing of the members of the Westminster poise, and is preserved in the museum of Medical Society, on albuminous urine. I Guy’s Hospital. In this case there was, feel disposed to agree with Messrs. Greenthroughout, no pain at all ; but in another wood and Johnson, who were the principal case, where the suffering of the young lady speakers on that occasion, in thinking that was considerable, from disturbance of the albuminous urine is frequently symptomatic whole of the urinary apparatus, the urine of functional disturbance of the system, and contained albumen at one time ; no traces should not be considered as depending on of it have existed latterly, and although this organic disease of the kidney, unless when case was considered by the first authorities of long continuance, and in conjunction to be one of organic disease, yet, as her re- with other well-marked symptoms. The covery has almost taken place, I am dis- opinions, however, of those gentlemen can posed to trust that only functional disturb- only be considered as conjectural, remainance has existed, and that the coagulable ing unsupported as they are by any wellurine may be attributed to that circum- known and authenticated facts. That the stance only. opinion of Dr. Bright relative to albuminous That circumstances do occur, where albu- urine being an infallible criterion of renal men is only occusionally detected, is borne disease is untenable, may, I imagine, be out by the fact stated by Dr. Bright in No. satisfactorily determined by referring to the 2 of "Guy’s Hospital Reports," for he albuminous urine secreted by children alludes to this circumstance as having been labouring under common catarrhal affecnoticed both by himself and Dr. Addison ; tions,-a circumstance which, so far as I am also by the remarks in M. Desir’s °Thesis," acquainted, is unaffirmed by any hitherto—" In a healthy person the urine may acci- published statement of this fact. Albumidentally be albuminons for twenty-four hours nous urine is most frequently met with together, towards the termination of an ex- during the first two or three days of catarrhal citement of the urinary passages;" and no or inflammatory affection in children, othercase occurred in the 100 cases related by wise most healthy, an occurrence owing to Dr. Bright as having had albuminous urine some temporary functional disturbance, and where some disease did not exist in other this appears to be confirmatory of the sentiorgans save the kidney. Therefore, although ments promulgated by Dr. Wells, (Trans. of I am disposed to look with considerable a Society foi- the Improvement of Med. and caution on this condition of urine, I am, Surg. Knowledge, vol. iii.-p. 167, et seq.)
256
respecting ulbuminous urine being connect- 19th of January, 1833, I was suddenly sum-
ed with too great action in some part of the moned to ber assistance. I found herwittiin system. I am, Sir, your obedientservant, labour, a foetuswasquickly expelled, membranes unbroken, and its placenta WILLIAM TEEVAN, M.R.C.S.L. its attached them; -m secoutt foetus followed. 2, Bryanston-square, Oct. 31., I836. under thetosame circumstances, and when I opened their membranes, the v proved ?. be INSTANCES OF
attached to them; a second foetusfollowed,
dead and shrivelled, but not at all putrid or offensive. Here it will be perceived that
BLIGHTED FŒTUSES.
were rotained in the uterus 95 To the Editor of THE LANCET. ; the sfoetuses after vi etality appeurs to have ceused. attention of the profession day having been directed to blighted twins, by I would iliustrate ;.thi8--this subject further, observe, now I em pon the some recent letters in your valuable and but willofonly twins, that cf:;l5alof 1571 cases which widely-circulating journal, I hasten to send subject have happened in my own practice, 17 have you the following cases .,t,,;iii cases. Of these, six were first On 6M’26th of .Feb. last, I was callcd to Jane F—, a single woman, who was re- cases of pregnancy, and four of them nocurred in 1833, the number of births in that ported to be in year having been 106.I remain. Sir, your Ifoundthesrila,p obedient servant, as urgent, she natural, and, the pains were GEORGE YEATESHUNTER. HWTER GEORGE YEATES ,. waa, seen delivered of a female living child of an average size. On Placing my hand Margate, Nov. 7th, 1836. upon the trF3ilo>raabdomen, my invariable habit after LISFRANC ON ANEURYSMS. delivery, 1 found that the uterus contained a second fcetus,which,as the pains oor.tinued strong, and the presentation was ’ ’ To the Editor of THE LANCET. SIR:—Having read very attenflvely the proper, very quickly followed the first-bron, but with to membranes unbroken. Opening exceedingly interesting case of aneurysm of these I discovered a dead female, smaller ’the- arteria innominata, &c., lately operated than the first, having, as I considered, died ’apott by Mr. Fearn, of Derby, as well as inabout the seventh month of utero-gestation,the remarks which appeared upon that oase shrivelled, and of a leadon colour, but with- in your ournal of Oct. 29, I was ied to reier out the slightest traceofputrefaction; the to a book which I had read not long since, funis was much longer, harder, and smaller viz., " Lisfrancon Anemysms."
SIR :—The
-
’
-
been
labour. Upon examination
,
- ..’ _.
-
in circumference than usual. The placenta
,
After
deecribing othermedesof operating
casily followed; it was uniform; and large, in aneurysms, he mentions that of Brasdor, the unbilical cords arising from separate which he divides, first, into " those cases
bases, and at some distance from cach other. in which no arterial branch arises between This patient, who Ni-,qs-pre,-,aa3l.t-fQr the first the ligature and the sac ;" secondly, "when time, had been attended for some internal one or more branches do take their origiii comf:laint .before-1 saw her professionally ; between the ligature and the -sai." In - she had coneealed her situation, and ,her giving the results of the different operations, mother wa,; much surprised and mortified he states, that live cases healed by the firstmentioned method have occurred, three of when I made it known. Iremember attending another case- in 1819, which were sucessful, the other two not so butat this distance of time, I must be con- The arterypraetised upon was the common tent to copy ii from my midwifery case-book : cartid. The operators were Wardrop, —"April 16, 1819, Mrs. Win. D. Behind the Lambert-, Bush, and Montgomery. In the Roman Catholic Chapel, past 7, P.M. Twin cases treated by the second method, which
females, .Brat pregnancy, one appeared to were ten in- number, nine are described as have been dead about four months, and came having been unsuccessful, one as suecessful. away with the plaeenta." I trust -the’fol-. The aneurysms were of the arteria innomilowing case will be found interesting, and nata, the external iliac, the subelavian, and the femeral arteries, the operators being worthy of publication:— About Oct. 15, 1832, Mrs. John F—, Mott, Key, Evans, Wardrop, James, White, whom I had attended jn several labours, A. Cooper, Dupuytren, and Deschamps. received a viol nt mental shock, while work- ’ After the accurate descriptions of the difing in the fields, in consecuence of being ferences bétween the operations of Hunter, told, without preparation, of the sudden and Brasdor, hiid- WaTdrt4p, which appeared in -
unexpected death of hernext-doorneighbour.
youlast week’s Journal, no further remarks she fainted, but I did not then see are required from’ me. The above stateher.- She believed herselfto be pregnant, ments show what has been frequeutly rehavmg quickened more than a fortnight be- -peated, ’namely,that the Preach know fore. From this time the bosom, and abdo- nothing of what is doing by the medical
I believe
to feel men, gadually subsided, she ceased her notion
the child,
and began to fancy that
of pregnancy
was
erroneous;but on the
.profession in England. tlient servant,
London, Nov. 1, 1836.
,
I am,
Sir, your obeJ. p