RARE CASES OF STONE IN THE KIDNEY. — It is considered that hematuria is the most important clinical symptom of renal calculus ; and though I am inclined to dissent from this view and to place pain as the most characteristic feature of renal stone, yet I feel sure that in rare cases in children and young adults luematuria may be the only symptom in the early stages of this affection. The character which apparently stamps it is the marked effect of exercise in increas ing or producing the bleeding. It may be that in children the pain of renal calculus is often misunderstood and that which is complained of is vaguely termed "stomach ache," and it is accepted as such by the mother and the physician. I have seen children passing blood and crystals of uric acid who were said to suffer no pain, but examination elicited the fact that they occasionally complained of easiness and cramp in the stomach. They have subsequently passed calculi. Criticism might condemn the introduction of this group among the symptomless hematurias, and it would be just, were it not for the fact that in the adult hematuria also occasionally occurs in renal stone without other symptoms being present. In time,
however, other symptoms supervene.
Case 1.—A little girl was observed to pass clotted blood and urine on the floor at the age of two. For three years the heematuria inter mitted and was quite painless. Sometimes the urine was very bright, and at other times smoky. When she came undermy observation she was a pasty-faced child five years of age with a tender right kid ney. The urine was clear but deposited a thick layer of crystals of phosphate of lime. There was no frequency of urination. I advised course of lime juice and water and luckily she passed a small, smooth stone at the end of a fortnight, the expulsion being preceded by in tense pain in the belly. The child has since been well.