of practical writers, taking fully into the account these recently-ascertained facts of albuminuria in alleged health, that the presence of albumen in the urine in sufficient quantity to be detected by any of the ordinary tests is a decidedly serious symptom. [Footnote 15: _New York Medical Record_, xv. 297.] The influence of many well-recognized pathological states in bringing about venous stasis, and that delay of the blood in the renal--and more especially the Malpighian--vessels which seems the most essential factor in the secretion of albumen, is well known, and its recognition is of much importance in diagnosis and prognosis, since the unfavorable signification of albuminuria in certain cases is liable to be overrated, and a diagnosis of chronic renal disease made to depend upon symptoms which really belong to some other affection. How far alteration in the capillaries and epithelium is in each case concerned in the production of albuminuria it is often impossible to say, since any alteration in these elements which can be observed after death is almost certain to be complicated with lesions which can disturb the local circulation. Cardiac obstructive disease is very likely to be accompanied by albuminuria, and the state of the kidneys by which this condition is brought about is undoubtedly venous congestion. The urine in a case of this kind is usually scanty, of high specific gravity, high colored, often with a deposit of urates, while the albumen appears in small quantity. A few {40} hyaline casts are not infrequently seen, and do not materially increase the gravity of the prognosis so far as renal disease is concerned. The kidney which furnishes this urine is usually a little harder and a little denser than normal, but with a nearly normal microscopic structure, exhibiting but little more than capillaries well filled with blood, and in the interior of some of the tubes casts similar to those found in the urine during life. Doubt may occasionally arise as to the diagnosis between a congested kidney consequent upon valvular disease of the heart and an interstitial nephritis with hypertrophy of the heart. In the latter case, however, the urine, although containing albumen, is usually much more copious and of low specific gravity. Diminished power of the heart without valvular lesion may have as a consequence albuminuria which disappears if the heart recovers its vigor. In many of the cases in which albumen appears in the urine temporarily it is not easy to say whether an actual nephritis may not be present, though not sufficiently severe to give rise to other symptoms.