HEMATURIA OR HAEMATURIA. stands in relation to this phase of the disorder as hmmoptysis does to pulmonary phthisis ; it is frequently an early symptom, though the amount of blood lost in this way is generally small. The profuse bleeding of urinary tuberculosis is usually asso ciated with its later stages of ulceration. I have seen a considerable amount of blood lost from those excavating ulcers of the bladder which are common in the course of this disorder. Then there is fre quency of micturition, which as a rule, when the kidneys only are in volved, is not explainable by anything that the surgeon can detect; and lastly there is a considerable excess in the urinary mucus. These are symptoms which, when they continue and are otherwise unac counted for, are very significant. When the disease has made more advance, either in the kidney, bladder, or prostate, the urine becomes charged with pus and other signs of disintegrating tissue. It is curious to notice how, even under these circumstances, the urine retains an acid reaction; it is not until it undergoes decomposition, by the re tention within it of pus and unhealthy lymph, that it becomes offen sive and ammoniacal. A person who is infected primarily with urin
ary tuberculosis not unfrequently develops symptoms of a subacute form of peritonitis, which shows that the disease has invaded by contiguity more or less of the peritoneum. In this way I have on several occasions seen the disease brought to a termination with a swollen, tender, and tympanitic abdomen.
Tubercle of the kidney in its earliest form is not unfrequently found to be a cause of incontinence and urinary irritability in children. Many children, especially males, who were suspected of stone, have proved to have tubercular kidneys. In an instance that came under observation, the prepuce of a child had been removed with the hope that this might relieve the urinary irritability; excessive renal tuber culosis, with an almost entire atrophy of one kidney, was shown after death to have been present. The following case illustrates some features to which reference has been made :