Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

50/440 (page 34)

$imagine tliat the demonstration of albumen in normal urine is beset with difficulties. It is likewise to be supposed that differences may occur even in the normal condition, and that the discovery of albumen sometimes succeeds and at other times fails. Not only does the pressure in the glomerular vessels vary under physiological conditions^ a fact which admits of no doubt, the result being that the fluid which transudes from them contains sometimes more and sometimes less albumen, but in addition, that portion of the urinary secretion which depends upon true glandular action, being under the influence of physiological conditions, is sometimes abundant and sometimes scanty. This latter fact is equally certain, and corresponds with our knowledge of all other glands. The more productive the activity of the glandular epithelium, the poorer will the urine be in albumen, other conditions being equal, and the more difficult the demon- stration, and the reverse. And thus it comes to pass that in consequence of the varying action of the two sources of the urine under physiological conditions, different combinations can be imagined, as a result of which the discovery of albumen may be easy, or difficult, or impossible, that is to say, that albuminuria may or may not be demonstrated, according as both sources either co-operate or act in opposition with refer- ence to the quantity of albumen in the urine. Increase of the pressure under which filtration takes place in the glomerular vessels, and of the secretion in the epithelium, will cause albuminuria to be absent {i.e. obvious excretion of albumen), diminution of both those factors will produce its appearance, increase of the one and diminution of the other will produce a result dependent upon the influence which preponderates, as will be shown in special cases in subsequent pages (p. 39 et seq.). If to all these considerations we add the individual differences with regard to filtration and secretion, which are properly allowed to play so common a part in the dissimilar reaction of different individuals under physiological and patho- logical conditions, we shall have scarcely any difficulty m understanding the fluctuations to which physiological albuminuria is subject. All this discussion, all the matters of fact and the con- clusions deduced therefrom, are therefore incorporated in$

Selected monographs.

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