CASES OF HEMATURIA Typical cases of renal calculus showing how much the hematuria and symptoms depend upon the proximity of the stone to the mucous membrane : A Case of Renal Stone Imbedded in the Cortex of the Kidney under the Capsule and hence Situated at a Distance from the Mucous Membrane of the Pelvis. —J. A., aged 30 (Dr. Eastwood, of Darlington) perfectly well until seven years ago when he fell on to his back on the ice and ruptured his kidney (query?) and passed blood for fourteen days, but never since. From this date he has had a dull, heavy pain from the back of the kidney to the front. The pain never radiates, it is aggra vated by exercise and sometimes " sickens" him. He has no frequency of micturition. The stream is good, it never suddenly stops. He has never passed gravel. Urine normal in appearance; specific gravity 1.030; acid ; oxalate of lime crystals. A few pus cells. Diagnosis cortical oxalate calculus. Nephrolithotomy. A dark oxalate of lime calculus the size of a monkey-nut was removed from the convex sur face of the kidney by merely cutting through the capsule. Cure.
A Case in which Stones were so Deeply Imbedded in the Thickness of the Kidney Substance as to be Unfeelable through the Unbroken Cortex. —G-. B., aged 52 (Dr. Alec Mackenzie, of Romford). Pain in left kidney came on suddenly ten years ago; this was severe, but did not radiate. Since then the pain has been constant, but subject to ex acerbation. Any error of diet or exercise increased it. Status prcesens—He can cover the "pain area" with his thumb. He fre quently passes blood, generally of a coffee-color, but lie has neither frequency of micturition nor pain in the act. Urine 1.022, clear, de positing a few blood and pus cells. He always lies on the affected side. Nephrolithotomy incision—a collection of seven stones found encapsulated in centre of kidney tissue—cured.
Long Pointed Calculus Imbedded in Renal Cortex, but with its Point Projecting into lower Part of renal Pelvis.—T. L., 36 years of age (Mr. John Harris, of Dartmouth). Patient complained of left renal pain, from which lie had suffered for twenty years. He could cover its position with the last phalanx of his thumb. It could be elicited also
by percussion over the renal region, or by any succession of the body. It came on with any exertion, even with walking. The patient had never had colic nor any radiating pain beyond a left testicular pain if the renal suffering was acute. Sometimes he suffered from great frequency of micturitiou in the day, and occasionally had to rise five or six times at night, passing very little at a time. He had never noticed blood in his urine. Has often passed gravel. The urine was clear; specific gravity, 1.020; it contained no pus or blood, and only a few oxalate crystals were visible under the microscope; it contained a slight amount of albumin. By nephrolithotomy I removed a rough pointed stone, which measured 1+ inches in length and weighed drachms. It was imbedded in the lower end of the kidney and its nose projected out free into the pelvis.
Loose Stone in Pelvis _Producing backward Pressure Symptoms and Inflammation and Evoking Typical Attacks of Renal Colic.—W., aged 52 (a patient of the late Sir Andrew Clark.). Patient had suffered from violent recurrent right renal colic for five years. At first the attacks recurred only once in six months, but the interval of rest diminished, until finally, when he consented to an operation, they were taking place every week.
Each attack was accompanied by numbness in the back, down the inside of both thighs, and in the calves of the legs and testicles. He had passed blood several times, but always of a mahogany color. The patient had faithfully followed careful instructions as to diet, and had taken courses of piperazine without any effect. Before the oper ation the urine was acid, and contained one-sixth albumin; specific gravity, 1.010; the quantity was ample. He had never had fre quency of micturition. On nephrolithotomy a small, flat, oval uric acid stone was found free in the pelvis and removed. The pelvis was much dilated; but as there was a fair amount of cortex left, the kidney was drained. It healed sluggishly, and left an obstinate sinus, which remained for months.
Cases in which the inflammation was so far advanced as to pro duce extreme pyelitis are quoted in the article on pyuria.