On Albuminuria During Paralytic Insanity
270 Art. XI.?
Dr yon Rabenau, of Vienenburg, Germany, recently published some observations lie has made on this subject, and, contrary to the opinion of others who have investigated the question, arrives at the conclusion that albuminuria is far more frequent amongst paralytic patients than amongst other lunatics. He examined 40 different cases of paralysis, and found albumen in the urine of 26 of them. On the other hand, he examined the urine of 85 other lunatics, and found albumen only 31 times. At the same time he points out that the paralytic patients were examined without any choice or selection, while with the other patients the investigation was never made unless albumen was suspected in the urine from other reasons. The observations were continued for two years, and Dr von Rabenau examined some 15 specimens of urine every day. He found, as a further detail, that albuminuria was most frequent amongst those paralytic patients who could no longer pass urine voluntarily ; from these he obtained the daily specimens by means of the catheter. It was suggested to him that catarrh of the bladder might often cause the presence of albumen in the urine; and he therefore remarks that he never examined alkaline urine, or such as was of very high specific gravity. In the urine of patients suffering from epilepsy Dr von Rabenau never found albumen, but he owns that the number of his cases may not have been sufficient for him to form a correct judgment. The conclusion finally drawn from his 26 cases of albuminuria, among 40 paralytic patients, is that this disease must necessarily result from cerebral causes, and must in many cases be entirely independent of any other illness from which the patient may suffer. This is the point on which Dr Richter (and also Dr S. Rabow, of Lausanne, according to a publication on the urine of the insane, from his pen) differs from Dr von Rabenau. We cannot do better than give a short summary of the 26 cases in question, to enable our readers to judge for themselves. The first twelve of these are hardly conclusive with regard to the question at issue, as the albumen in the urine may have been caused by other illnesses; the remaining ones, however, go far to prove Dr von Rabenau’s views. (Wherever the temperatures are not given, they remained between 3(5*0 and 38*0 C.) Case 1.?The urine of the patient contained a small quantity of albumen when he first entered the asylum, but this disappeared rapidly. He had several paralytic strokes, the temperature decreasing to 33*0. Later on the patient had pneumonia. No further traces of albumen appeared. Years ago the patient had suffered from nephritis.
Cases 2 and 3 showed small quantities of albumen ; the patients suffered from inflammation of the bladder. Case 4.?Albumen appeared in the urine during an attack of pneumonia.
Case 5.?September 13, 1874. Epileptic attacks for 12 hours ; no albumen. September 16. Traces of albumen ; temperature 40’1; slight cramps from time to time. September 2. Traces of albumen; no fever. September 26. No albumen. Case 6.?Never any albumen until September 22, 1874. On this date traces of albumen. The patient has had a feeling of intense numbness for the last three days ; temperature 40*1 ; lungs free. September 23. No fever ; no albumen. October 5. Patient feels numbed; traces of albumen; temperature 38. October 16. Normal state.
. Case 7.?Never any albumen until October 2, 1873. Showed irregular symptoms of fever, and felt very poorly the last fewdays ; temperature 39*9 until October 28 ; from that day until November 8 no fever. From October 9 until November 8 a constant small quantity of albumen in the urine. Kecovered so much after November 8 that he could leave the asylum after a short time. This patient doubtless suffered from some disease of the lungs (lobular pneumonia ?), but the albumen remained for a long time afterwards, and only began to disappear when the cerebral complaint got better.
Cases 8 to 12.?Albumen appeared only during the last days or weeks of their lives. All these patients suffered from some severe bodily illness.
Cases 13 and 14.?During their last days the temperature sank to very low readings. The urine contained a large quantity of albumen. No somatic disease could be discovered either during life or after death.
Case 15.?When the patient entered the asylum he was in a state of deep melancholia, and for the first few months he got gradually worse, both in mind and body. Then he began to recover, and remained very much better up to the end of 1874. While the melancholia lasted much albumen was present in the urine, and the quantity decreased as the patient got better. Later on only traces were apparent on two different occasions. At the end of 1874 he had a relapse, the melancholia returned, but 110 albumen appeared. The observations were unfortunately interrupted.
Cases 16 to 18.?During the last weeks of 1874 these patients declined much in health, without any apparent reason. Neither fever nor other bodily diseases could be detected. The urine, which had up to that time been always clear, now showed traces of albumen. The patients were still alive at the end of 1874. Case 19.?Showed no albumen up to February 2, 1873. The urine was last examined on January 29 ; attack of apoplexy on February 2 ; no albumen on February 4 ; traces of albumen on February 6. After this no albumen until January 3, 1874; another attack of apoplexy; much albumen; no fever. January 4. No albumen until March 23,1874. March 23. Paralytic stroke, and death immediately afterwards ; much albumen ; no fever. Case 20.?Never any albumen up to October 6, 1873. Has declined much in health lately. Traces of albumen on October 6. October 7. Attack of apoplexy; temperature normal. Octobers. Traces of albumen in urine. October 10. Large quantity of albumen; temperature 34*8 ; death.
Case 21.?No albumen up to May 5, 1873. Three days ago an attack of apoplexy. May 5. Traces of albumen in the urine.
Case 22.?No albumen up to November 1, 1873. On this day twitchings in the left arm, and strong feeling of numbness; traces of albumen; no fever. November 3. Sensation better ; no twitchings. No albumen up to April 29, 1874. From that date great decline in health, accompanied by a constant presence of more or less albumen in the urine. Death soon afterwards.
Case 23.?No albumen up to December 6, 1873. On that day feeling of numbness, could not stand, took no food, and passed his excrements involuntarily; temperature 39*2 ; lungs healthy; much albumen in urine. December 7. Temperature 37*5; much albumen; still very numbed. December 8. Feels better ; no albumen up to April 25, 18”4. April 25, 1874. Similar attack as before, but without fever; but little albumen in urine. April 27. Same condition. April 29. Traces of albumen ; very excited; 7*0 grammes of chloral given to him per day. May 1-12. Feels better; no albumen; from this time often albumen in urine, without any apparent connection with the cerebral disease.
Case 24.?During April and May 1874, quantities of albumen without any apparent reason ; after that no albumen up to June 23. Paralytic stroke; three hours after its beginning, traces of albumen. June 24. No albumen.
Case 25.?Never any albumen up to May 2, 1874. After that date up to May 8 traces of albumen. May 9. Paralytic stroke; quantity of albumen; no fever. May 10. Large quantity of albumen; no fever; lungs healthy. May 12. No albumen ; excited and noisy. May 22. Traces of albumen without apparent cause. Case 26.?No albumen up to December 27, 1873. On that, date the patient feels very numbed ; temperature 38*4 ; he hardly takes any heed of his surroundings: phlegmon in the left arm; much albumen in urine. December 28. Temperature 37*3; formation of pus; incision; much albumen. December 29. The wound looks well; no fever and but little albumen. Up to January 15 the patient felt better; n? albumen; then traces for two days. Death a little time afterwards. The post mortem examination showed that both kidneys had changed to large conglomerations of cysts.
In Cases 13 to 25, a direct connection of the albuminuria with the cerebral disease can hardly be denied. In Case 23 the temperature of 39*2 is no doubt important. Case 26 is a singular one. Dr von Kabenau owns that it should have been added to the first twelve, where the albuminuria was complicated with severe bodily diseases. But he points out that it is also admissible to look upon the phlegmon as a trophical disturbance, particularly as the mental state of the patient at the same time got worse so considerably.
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