CYSTIC RENAL DISEASE.
It has been remarked in discussing the symptomless hmnaturias that some cases of chronic renal disease bleed smartly and pain lessly. There is no doubt, however, that occasionally hemorrhage from this source is accompanied by pain; and in some of these I have found definite cystic conditions of the kidneys.
Case. —I was called on July 6th, 1894, to see a man, aged 31, by a physician who desired me to perform some operation for his relief. The patient was blanched by profuse hematuria; had scar evidences of having suffered from severe secondary syphilis; his urine was loaded with casts and albumin, and showed a specific gravity of 1.009. Both kidneys were tender on deep pressure. His history was as follows : A year previously he had had a sharp attack of hiematuria accompanied by pain in the right side. On July 1st, 1894, he was suddenly seized with great pain in the region of both kidneys, and in twenty-four hours bright blood appeared in the urine.
The amount of blood varied from a mere trace to an almost pure con dition. He urinated ten times in twenty-four hours and passed 60 to 107 ounces daily. On July 5th, the urine being then clear, the physician introduced a Pravaz syringe into the left kidney and a syringeful of pure blood was withdraw. About fifteen minutes after ward the patient passed fourteen ounces of blood per urethram, ac companied by severe pain in the left side. The luematuria continued, diarrhoea appeared, and a rigor took place a week after the explora tion. I declined to interfere by operation, and the patient died on the tenth day after. On post-mortem both the kidneys were found to be enormous and transformed into a conglomerate mass of multi locular cysts, probably of congenital origin.