Physician to Out-patients at the Bristol Hospital for Sick Children and Women, and Pathologist to the Bristol Royal Infirmary. Two papers have recently appeared in the pages of the BRITISH MEDICAL JOURNAL upon the presence of traces of albumen in the urine in the "apparently healthy." The subject is an important one, and though the following notes of cases of intermittent albuminuria are incomplete, they may be of interest. The term " apparently healthy" could not perhaps be applied with

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... to the general condition of the children who were the subjects of this albuminuria, but they were not distinctly ill. In popular language they would be described as weakly or delicate. The aspect was that of listlessness, associated on some days with a swelling of the eyelids, which was absent on others. Although some children who present swelling of the eyelids may be found to have occasional traces of albumen in the urine in others repeated examination of the urine may fail to discover it, but I have seen one case of intermittent swelling of the eyelids in which albumen was always present in the urine, and yet the child did not seem to suffer worse health than those whose urine was always free. The three following cases are examples of swelling, of the eyelids associated with the occasional presence of albumen in the urine. CASE I.-A boy, aged 42, attended the out-patient department of the Bristol Hospital for Sick Children on April 13tb, x898, with very marked swelling of the eyelids. The upper eyelids, moreover, were markedly discoloured, being yellowish-brown, like a disappearing bruise. Below the left lower eyelid there was a purplish tinting. The mother stated that eighteen months before the eyelids hadbeen similarly " puffed up." The recent swelling had been present for six weeks, but had varied in amount, sometimes disappearing altogether. There was no cedema of the legs. Urine passed in the out-patient room did not contain the faintest trace of albumen. On April x8th two specimens of urine were examinedone passed the same morning, the other in the middle of the previous day. There was a trace of albumen in the morning urine, but none in the other specimen. The urines were tested twice carefully with the same result. On April 2sth three specimens were tested, from the morning evening, and middle day. No albumen was found in the first and third, but a trace was present in the second. The eyelids were less swollen. On October i8th, I8qg, when I saw the boy again, he anpeared to be in perfect health. No swelling of the eyelids haa occurred since July, I898. Two specimens of urine were afterwards obtained, and neither contained any albumen. CASE II.-A boy, agedIO, who was brought to the hospital on January 3oth,I899, was rather thin and lethargic-looking, but intelligent. Nothing could be found wrong in the physical signs of the heart, lungs, or abdomen. On February6th the mother mentioned that the boy's eyelids often became swollen. They were not swollen at the time; there was, on the contrary, a somewhat sunken hollow appearance about the eyes. Urine passedin the out-atient room contained no albumen. On February 20th hreespecimens of urine were tested: that of the morning and evening contained not the least trace of albumen, but that of midday gave a very marked ring with cold nittic acid. On March 6th and 28th three specimens were again tested, but theywere all free from albumen. However, on October 12th, I899, the boy was visited at his parents' home. He was still lethargic in appearance and disposition. Two specimens of urine were obtained' both of which contained albumen. The morning urine gave a very falnt ring with nitric acid, but in the evening specimen the ring was very marked. CASE III.-A girL, aged Io, attended the hospital on August 3rd, x898, marked swelling of the eyelids and face was present. Nine months before, when she had seen me for the same affection, I had tested three specimens of her urine but found no albumen. On August 6th the swelling of the eyelids and face had disappeared. Of two specimens of urine examined, one, that of the previous evening, contained no trace of albumen, but themoroing specimen gave a verv marked ring with nitric acid, and on boiling, a deposit which was sufficiently abundant an hour later to occupy a third of the height of the urine in the tube. Apparently I did not examine the urine again, but the girl was seen recently. During the nine months that had elapsed since her visit to the hospital, swelling of the eyelids had occurred from time to time. Three specimens of urine were examined. There was no trace of albumen in the morning or in the evening urine, but that of the middle day gave a very marked ring with nitric acid.I It should be stated that In none of the above cases could a history of scarlet fever be obtained.2 As I have previously mentioned, cases closely resembling the above are not uncommonly seen, in which there is occasional swelling of the eyelids associated with lethargy, but repeated examination of the urine may fail to show any albumen in the urine. The following two cases are examples: CASEI.-A boy aged1o was brought to the hospital on August 8th, I898. He was stated "to ne languid and easily got tired " and that his eyelids were puffy at times. There was some swelling of the eyelids on the day of his first visit. The urine passed in the out-patient room contained no albumen. On August 22nd two specimens of urine were tested, but no albumen was found in either. On September igth two specimens were tested; no albumen in either. On October 3rd one specimen showed no albumen. The boy was seen again on October 12th, 1899, when the eyelids were still said to swell occasionally, and the boy's aspect was not that of good health. Three specimens of urine were tested; all were free from albumen. CASE II-A girl aged 7 attended the hospital on October xith, I899. She was brought up for general weakness, and was said to suffer from headache. For two years there had been occasional swelling of the eyelids, especially in the morning. The swelling was said sometimes to be vevy marked, and when it passed away left a discoloration like that of a bruise, especially in the right eye. During subsequent visits five specimens of urine were tested; two passed in the morDing, two in the evening, and one in the middle day. All were free from albumen. In the following case albumen was apparently always present, yet the general condition of the child did not seem to be worse than that of most of the preceding. Case of Occasional Swelling of the Eyelids in which Albumen was always Present.-A girl, aged 3, was brought to the hospital on September 3rd, I896, with a history of having had occasional swelling of the eyelids for over a year. There was no history of scarlet fever. At the time of the first visit the eyelids were markedly swollen, but on the second visit the swelling had disappeared. The urine, however, was found to contain albumen and the child was admitted. The urine was frequently tested and albumen was always found to be present, but the amount was "variable." Three years later the child was again seen. She was then thin and delicate-looking, with a somewhat sunken appearance about the eyes. The eyelids, however, were said to still swell occasionally, but the right eyelid more than the left. The right hand and right foot were also said to swell at times. The swelling was said to come on after some unusual exertion, such as " dancing round a barrel organ " or after excitement such as a quarrel with her brother. Four specimens of urine were examined; all contained albumen.