RENAL TUBERCULOSIS.
Some observations will now be offered in reference to the surgical aspect of tubercular or scrofulous kidney in addition to what is in eluded under the sections devoted to nephritic suppurations and pyo nephrosis. The deposition of tubercles in the kidney, its pelvis, or its ureter is a frequent cause of the latter conditions, and cannot as a rule be dissociated from them. Hence some general remarks on the subject of urinary tuberculosis will be necessary.
Tubercular disease of the genito-urinary organs has much in com mon with what is observed when it attacks other parts of the body. In the first place it is distinctly hereditary, and we usually find that a patient's predecessors suffered from some form of tubercular dis ease. The family history, therefore, is an important investigation, and should be carefully gone into when there are grounds for believ ing that the disorder may be of this nature.
Secondly, the disease corresponds in its occurrence with that period of life when the development and use of the sexual organs are commencing and continuing to be active; it is essentially a disease of adolescence and of vigorous though not necessarily robust manhood. It is comparatively rare in women. When tubercle attacks females the most frequent seat is the lungs, and why their sexual apparatus enjoys this comparative immunity is not at first sight so apparent. It may be, and certainly is to some extent, due to the fact that females are less exposed than males to what I may term the excitants, or per haps more correctly the localizers, of this disorder. In tubercular subjects, protracted gonorrhoea and its complications, more frequently than all other causes put together, determine the deposit in some region of the urinary tract, from which it slowly spreads to other parts of the system. A chronic orchitis is a constant precursor of
urinary phthisis. Women, though they suffer from gonorrhoea, do not do so in the same way or to the same degree, nor are their com plications of the disorder so protracted or severe. Further, they are more readily cured. Tubercle may invade the urinary organs either from the kidneys downward, or from the testes upward; these are the more usual modes of accession. In the female, a labial abscess is often the initial lesion, as an inflammatory deposit in the testis may be in the male.
It will not be necessary for clinical purposes to occupy much time with a description of the mode in which tubercle invades the normal tissues, its varieties, or its chemistry; this part of the subject will be treated of at length in one of the later volumes of this series. In the form of gray miliary granulations, or as yellow caseous masses of various sizes, tubercle may be met with indiscriminately in any part of the genito-urinary apparatus; it is found in the kidney, the ureter, the bladder, the prostate, the vesicula seminalis, the testis, the epi didymis, and the urethra; wherever implanted there is no knowing where it will spread to. It will be seen that the tendency to diffusion is an important feature in relation to points connected with diagnosis and treatment.
Urinary tuberculosis, when the deposit is in relation with the mu cous tract from the kidney downward, is almost sure to be associated with one or other of three symptoms, though as a rule they are all pres ent in varying degree. These prominent symptoms are hmmaturia, frequent micturition, and excess of or change in the urinary mucus.