The detection of albumen in the sputum is said to rank as a valuable aid to the diagnosis of pulmonary tuberculosis, especially as it is easy of application, and gives, according to the researches of Roger and Levy-Valensi, followed by those of Oddo and Gachet and then the present writer, valuable and reliable results. Roger obtained a positive reaction in 200 cases of tuberculosis and Oddo in twenty-nine, in six of which the bacteriological examination had been negative. These authors state that albumen is always present in tubercular sputa, and only cases of bronchitis associated with albuminuria or cardiac conditions give the same reaction. The elimination of such cases is easy, and the absence of albumen would lead to the rejection of a diagnosis of tuberculosis. The procedure is as follows: Dilute the sputum with about 50 per cent. of water; add a few drops of acetic acid to coagulate mucine; shake briskly in a test-tube (with the aid of broken glass if sputum is very thick); filter; test filtrate for albumen by the usual methods, preferably by heat. Roger at first employed a concentrated solution of ferrocyanide of potassium, but now prefers boiling. Cornu adds to the filtrate one tenth of its volume of a saturated solution of sea-salt or of sulphate of soda in order to render coagulation more evident, then boils the upper layer. Sputum containing blood must be rejected. Cornu obtained a positive reaction in twenty-four cases. Twenty were manifestly tubercular, the bacillus being present. Three were suspected to be tubercular on general grounds—loss of weight, anorexia, poor health— but the clinical examination had not permitted a definite diagnosis. A positive reaction was obtained on four different occasions in another patient who had given no clinical evidence of a tubercular infection. He had suffered from several attacks of bronchitis, regarded as simple, and some attacks of acute articular rheumatism, and presented a slight systolic murmur at the apex. At the time of examination of sputum he was complaining of rheumatic pain in his knee. The question then arose as to whether the albuminous sputum was dependent on the cardiac condition or related to a tubercular arthritis.
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