The Clinical History of Intermittent and Latent Albuminuria
Authors: G. Johnson
Journal: BMJ (1889)

IN a leading article on "Albuminuria in Life Assurance," which appeared in the JOURNAT on January 5th, the following state- ment is made:-"Dr.George Johnson believes that albuminuria always indicates a condition of renal stress which sooner or later leads to organic disease unless this tendency be combated by very careful regimen.Ilis long experience undoubtedly gives weight to his views, but it may Jftirly be doubted wvhether, having failed for so many years to recognise the class of cases nowv referred to, he is the best authority as to their subsequent progress."The cases referred to are cases of chronic but presumably curable albumin- uria.The italics are mine.If the writer, whom, for brevity's sake, I shall in the course of this paper designate by the algebraic sign X, had made himself as thoroughly acquainted with all that I have published on the class of cases in question as he appears to be with the writings of Dr. Saundby, to whom he twice refers in the course of his article, he would not have made the statement which I have quoted in italics, and the inaccuracy of which I shall have no difficulty in demonstrating.It is probable that many readers of the JOURNAL are not better informed than X with regard to the history of this very important and interesting subject; I therefore propose, as briefly as is consistent with clearness, to set forth certain facts which may tend to elucidate the matter.Dr. Moxon, in his paper" On Chronic Intermittent Albuminuria" in the Guy's Hospital Reports, 1878, is credited by X and some other writers with having directed attention to a class of cases hitherto unrecognised.Now I should be most unwilling to de- prive a physician, who is no longer amongst us to speak for him- self, of any credit that may be his due, but, having carefully read the paper in question, I cannot refrain from expressing my sur- prise that any physician who has had a large experience of cases of albuminuria should look upon that paper as an important con- tribution to clinical medicine.The cases, seven in number, are most imperfectly recorded, generally without dates, so that in most instances the duration of the albuminuria cannot be ascertained.Case v appears to have been the most chronic, its dura- tion having been two years.Cases vi and VII afford the most remarkable illustration of in- exactitude on the part of the author.Mr. at 20 had albu- minuria always in the evening from September, 1877, " up to the time at whichl I write "-the date of writing is not given.The history of this case concludes with the following remarkable prediction: "I have no doubt that in a few months he will recover from this state of weakness."Whether this young man did recover, or whether he has since died or is living in an advanced stage of Bright's disease, we have no means of knowing.Case vii was seen only once, with " urine considerably albuminous."The urine was not afterwards sent for examination;but Dr. Moxon says: "I mention the case because, eighteen months before, the lad was under my care for subacute pleurisy of the left side, lasting some months.I examined the urine re- peatedly whilst he was under that trial, but it was never albu- minous."Apparently it is assumed that because the urine was free from albumen eighteen months before it would cease to be albuminous at some subsequent period, and these two last imper-