Case of hadmaturia, at first paroxysmal and later more constant. Fibrous clots were frequently present, and the first portion of the urine was often more deeply colored thou the later portion. An operation showed that the condition was caused by numerous small varicose veins in the prostatic portion of the urethra. Krauss (Wiener klin. Woch., July 9, '96).
Characteristics of idiopathic hwma Luria: It is hereditary, familial, and congenital. It may be persistent for many years, but vary in extent. All cases are liable to paroxysmal exacerba tions, which are usually accompanied by slight pyrexia, malaise, headache, vomit in•, and slight pains in the back or limbs. The duration of these exacerba tions is usually several days, but seldom exceeds a week or at most a fortnight. and after the first few days the blood gradually lessens in amount. Idiopathic hrematuria is not associated with oedema nor• with aseites, nor with the cardio vaseula r changes following ordinary nephritis. The hremo•rhage is not due to the presence of uric acid nor of ox alates. The specific gravity of the urine is not unduly low. It varies from 1.015 to 1.030. The quantity of urine passe 1 is not above or below normal. The re action is acid or neutral. None of the subjects of idiopathic haematuria were haemophilic. L. CI. Guthrie (Med. Press, May 7, 1902).
The causes of bleeding from the blad der are traumatism (calculi); diseases of the bladder, acute or chronic; varicosi ties of the veins (vesical hamorrhoids); ulcerations of the mucous membrane, diphtheritic or tuberculous; tumors, es pecially cancer of a villous and fungous nature; parasites, such as Distona hcematobium, or Bilharzia, and Filaria sangvinis; it may also occur in htemor rhagic diathesis, in haemophilia; and also in infectious fevers, variola, etc.
Bleeding from the pelves or the ure ters is generally caused by calculi or 'by tuberculous disease, also by acute infec tious diseases of hmmorrhagic character; by parasites (distoma and filaria).
Case of a 13-year-old girl who had suf fered for two years from a painless haematuria, which became progressively more severe. The cystoscopic examina tion showed that the blood came from the left ureter. The corresponding kid ney was extirpated, and upon macro scopical examination seemed to be hefilthy. Upon microscopical examina tion, however, the kidney was found affected with chronic nephritis. Hof
bauer (Centralb. f. innere Med., No. 30, 1900).
Bleeding from the kidneys is fre quently due to irritating poisons, such as cantharides, turpentine, etc.; very large doses of quinine and salicylic acid are said to have produced renal licema turia.. Different diseases of the renal blood-vessels may cause bleeding; for instance: embolism of the renal artery, thrombosis of the veins, aneurism; trau matism.
Case of Inematuria in which, medical treatment failing, surgical interference was resorted to, and the kidney fixed about two months after the time of her first visit. The hfematuria continued as before; the kidney was then removed, and the patient made a complete recov ery. On examination, its substance was apparently quite normal, but the mucous membrane of the pelvis was red, thick ened. and pulpy, and covered with minute papilliform elevations and rugre, which gave its interior a curiously roughened appearance. On microscopical examination myxangiomatous changes were found in the submucons tissue of the pelvis, and it was thought that the htematuria had been caused by them.
Myles (Med. Press and Circular, Aug. 23, '99).
Recorded cases of "essential" renal hsematuria classified as regards etiology: Hmmophilia; vasomotor disturbances; mechanical causes; kidneys which are the seat of nephritis; and cases which cannot be classified because imperfectly recorded, the kidney having been rarely submitted to microscopical examination. Floderus (Cent. f. Chin, Aug. 26, '99).
Painless hrematuria occurring in young adults is very often due to an engorge ment of the papillary elements of the Mal pighian pyramid and to a plexiform mesh of dilated vessels covering the papilla itself. The vascular change is due prob ably to a localized patch of interstitial nephritis, impeding the circulation in the boundary layer of the pyramid. The site of the disease is only apparent on open ing the renal pelvis, when a vivid red papilla assuming the aspect of a tiny villous growth may be seen standing out in strong contrast to the pale papillae around. The writer asserts that the re moval of this vascular papilla with a sharp scoop is sufficient to arrest a renal bleeding which no drug can control. Two personal cases successfully treated by this method. Fenwick (Brit. Med. Jour., Feb. 3, 1900).