CASE.-A dock laborer, aged 42, was in the summer of 1865 ad mitted into the Liverpool Northern Hospital under my care, for an injury to his back, caused by falling down the hold of a steamship on to the edge of a case of goods. The patient was much collapsed, and there was a contusion in the right lumbar region, without any breach of surface. On partially recovering from his collapse, in the course of a few hours, he passed urine deeply discolored by blood and small clots. On the day following the injury the urine contained some long worm-like which had been moulded within the ureter. These were not present after the third day. In addition, by the microscope, blood-casts of the uriniferous tubes were occasionally seen. The patient's condition gradually improved, though the urine showed traces of blood for nearly three weeks.
In injuries involving a lesion of an internal organ we recognize in the collapse that follows a provision for favoring the process of clot ting by which the vessels are sealed and excretion is suspended. The latter is important, for if the laceration were sufficient to permit of urine escaping into the tissues about the kidney, damage would be done, such as is seen when this secretion is elsewhere extravasated.
For some time afterward the injured kidney must be little else than a percolator of water, minus the urinary salts, the excretion of the latter being provided for by a compensating action on the part of the opposite organ. It is to the immediate plugging of the renal blood vessels, coupled with the fact that, if time is allowed, the uninjured organ is capable of doing double duty, that so many recoveries take place after rupture of the kidney. Hence we prefer to meet the col lapse attending this injury by warmth, in the shape of hot blankets and sinapisms, which by determining blood to the skin favors repair.
The bleeding from a lacerated kidney usually subsides spontaneously, .but when considerable its arrest may be aided by gallic acid, matico, or ergot.
Dr. H. G. Rawdon reports a case 2 which I had the advantage of seeing with him, and which, in connection with the treatment of ex tensive ruptures of the kidney, was, at the time of its occurrence, unique.