HAEMORRHAGE FROM THE KIDNEY. 7 



when the hyperaemia is extreme, and there are no counter-indications 

 against blood-letting. 



CHAPTER II. 



HAEMORRHAGE FROM THE KIDNEY. 



ETIOLOGY. The causes of haemorrhage from the kidney are : 1. 

 Wounds, contusions, and other injuries of the organ. The presence of 

 calculi in the pelvis of the kidney is one of the most common sources 

 of such injury. Rayer tells about a patient with renal calculus who 

 had haematuria whenever he was compelled to ride. 2. Haemorrhage 

 from the kidney may proceed from intense hypersemia, and rupture of 

 the overloaded renal capillaries, and especially from that form of 

 hyperaemia which accompanies the first stage of inflammation of the 

 kidney, and which ensues after the employment of irritating diuretics, 

 as well as in that form of the affection which follows scarlatina, small- 

 pox, typniis, malarial fevers, and other infectious diseases. The hyper- 

 aemia which exists about the seat of a parasite, or a neoplastic growth, 

 especially cancer, often gives rise to haematuria. Finally, the exces- 

 sive obstructive engorgement of the kidney, produced by disease of 

 the heart and lungs, often results in an escape of blood from the renal 

 capillaries. 3. In rare instances renal haemorrhage depends upon u 

 hcemorrhagic diathesis, that unknown disorder of the olood-vessels 

 from which scorbutus and purpura haemorrhagica proceed. 4. In the 

 Isle of France, Brazil, and some other tropical regions, haemorrhage 

 from the kidney is endemic, there being no known cause for the disease. 



A peculiar form of renal haemorrhage, haemorrhagic infarction, arises 

 under conditions similar to those in which haemorrhagic infarction takes 

 place in the spleen. This can be traced in most cases to embolism. 



Genuine renal apoplexy is usually the result of severe injury, but 

 in children may also proceed from severe hyperaemia (Hokitansky). 



ANATOMICAL APPEARANCES. In haemorrhage from the kidney, the 

 blood may be effused into the normal interstices of the tissues without 

 detriment to the latter. In this way ecchymoses arise, in which there 

 are spots of varying size stained of a deep red, and from which blood 

 flows freely when they are cut into. They are situated sometime* 

 under the albuginea, or within the tissues of the kidneys themselves. 



In variola and diseases of that class, besides ecchymoses in the 

 renal tissue, the mucous membrane lining the pelvis of the kidney is 

 usually of an even, dark-red color, decidedly thickened (haemorrhagic 

 infiltration), and rough on the surface. 



When recent, haemorrh agio infarction has the appearance of a dark- 

 red deposit of a cuneiform shape, the point of the wedge being directed 

 toward the hilus of the kidney. When of longer standing, the deposit 

 51 



