CHRONIC BRIGHT'S DISEASE. —The occasional brightness of the blood in acute Bright's disease is of course well recognized, but I do not think that the profession at large has yet realized that a very abundant and intermittent, often brightish hemorrhage may occur in chronic contracting granular kidney. This occasional brightness is a source of fallacy. I have met with various examples, and have thought, until quite recently, that the subject had been overlooked," but my attention has lately been drawn to papers on the same subject by Dr. West and Mr. Bowlby" which were published before my note. Dr. West gives three valuable cases, and mentions the following which came under Dr. Sharkey's care at St. Thomas' Hospital: " The tient, a young girl, passed so much blood with the urine that the bladder was sounded, and the surgeon, failing to find a stone, gested dilatation of the urethra and digital exploration of the der. To this Dr. Sharkey did not, for good reasons, consent, and the patient died. No stone was discovered at the autopsy but mark edly granular kidneys." " The symptomless cases I have met with form about twelve per cent. of the obscure limnaturias which I have examined with the toscope. I believe, as these cases progress, frequency of micturi Lion and renal pain supervene, and they fall into the group of limma turia with symptoms (q.v.) Not unfrequently the hemorrhage has ensued upon a slight strain or fall on the buttocks, and much difficulty has subsequently arisen in stating positively whether the slight symptoms of renal disease found in the urine were the outcome of the injury or preceded it. I
believe in many of these cases a degeneration pre-exists, and the kid ney tissue, being friable, splits more easily than would healthy renal substance and heals proportionately more slowly.
The cases are recognized by the condition of the urine, a low spe cific gravity, the presence of albumin and casts; to which may be added cardiac and retinal changes in advanced stages. These cases heal with prolonged rest and milk diet. I have recently met with a case of hematuria in which the blood was proved on post-mortem to emanate from congenital cystic kidney; clinically, however, it could not be diagnosed from the contracting granular kidney except by the severe pain in the renal region.
Schede of Hamburg records the following interesting case of un controllable renal hemorrhage : A man, aged 50, passed bloody urine for the first time after a cold drink. He had frequently before noticed a sensation of cold in the left lumbar region. If he remained quietly in bed the bleeding ceased, but it returned directly he got up. Styptics did not relieve the condition, and the blood was proved by catheterism of the ureters to issue from the left ureter. Left uephrectomy was performed; the kidney substance was found to be very friable, and microscopical examination of it revealed what was invisible to the eye, viz., an anaemic condition interspersed with small petechia, and decayed cylinders covered with red blood-cells.