At first the mother had noticed no other symptoms, but after the haemorrhage had continued for several mouths, the patient had begun to complain of pain in the left side and back, at first only occasionally, but latterly several times in the day. The child cried bitterly, and attempted to relieve her distress by bending her body backwards across her mother's knee, with her head and legs hanging down.
On admission, the girl was in good condition and had a florid com plexion. Her weight was twenty-two pounds ten ounces. Her liver and spleen were of normal size, and the heart and lungs were healthy. The abdomen was unusually compressible. The aorta and iliac arteries could be felt pulsating on deep pressure, and both kidneys could be felt. They were not tender when touched, and seemed in every way normal. She passed water more frequently than was natural, but there was no pain in micturition. Her skin was not harsh, acted fairly well, and there was no sign of oedema. The urine was dark with blood, of specific gravity 1.024, threw dosyn a copious precipitate on boiling; and showed an abundance of blood-corpuscles under the microscope. After a few clays stellate crystals of uric acid were also discovered in the sediment.
The child was kept in bed, and was given a mixture carbo nate of potash. The amount of blood in the water gradually decreased, and in five days had disappeared. The urine then became perfectly normal, and ceased to contain albumen or blood-corpuscles. There were never any signs of casts, of purulent matter, or of mucus. No pain was noticed during her residence in the hospital, and she was soon discharged. About a month afterwards she was readmitted with the same but they quickly disappeared as before with rest and alkalies. Her tem perature was always normal.
This case is a good illustration of the symptoms produced in children by renal concretions in the kidney. It would be difficult to attribute the htematuria, to any other cause. The significant fact that the bleeding oc curred for the most part after exercise, and that until the amount of blood became excessive, the water was clear in the morning when the child first rose from her bed, were strong arguments in favour of urinary concre tions. The patient, besides, was hi good condition. and of a healthy ap
pearance, and although her kidneys could be felt on palpation, no increase in their size could be detected. Lastly, crystals of uric acid were found in the sediment.
Examination of the urine in these cases often gives a negative result. Calculus may exist in the kidney without giving rise to symptoms of any kind. Between the attacks of haanaturia the water may contain neither blood nor albumen, and unless sand or crystals of uric acid be actually passing, it may redden litmus paper but faintly.
Sometimes the irritation produced by the presence of the calculus in the pelvis of the kidney may set up pyelitis. The stone then usually be comes enlarged by deposition of phosphatic salts upon its surface.
A child was admitted into the East London Children's Hospital, suffer ing from tubercular meningitis. After death, which took place in two days' time, besides the morbid appearances usual in such cases, the left kidney was found to be extensively diseased. The organ was much enlarged and contained about two ounces of creamy pus. In the interior it was hollowed into cavities, and its proper substance was almost replaced by caseous matter. A calculus of the size of a cherry-stone was impacted in the upper part of the ureter. Above this, the ureter and pelvis of the kidney were much dilated. In this case, no doubt, the stone had first, by the irritation it produced, set up pyelitis, and had then become impacted in the ureter, preventing the escape of the purulent matter.
When the concretion passes from the kidney into the ureter, and down wards into the bladder, there is always pain ; but the child suffers far less than an adult would do under similar circumstances. Sometimes an attack of abdominal pain in a child, attributed, as all such pain is apt to be, to abdominal derangement and colic, is followed by symptoms of stone in the bladder. It is in all cases where pain, more than or dinarily severe, appears to be suffered, to examine the state of the child's water, and inquire of the nurse whether sand or gravel has been seen at the bottom of the chamber-pan.