HEMORRHAGE FROM THE KIDNEY. 9 



urine is very large, it is of a dark or brownish red, and, after standing, 

 forms a cake of blood at the bottom of the vessel. Not unfrequently, 

 a partial coagulation of the blood takes place in the bladder, and the 

 coagula thus formed can only be got rid of after great suffering on the 

 part of the patient. Sometimes the blood coagulates while in the 

 ureters. ' In such instances, the symptoms of renal colic, hereafter to be 

 described, may arise, and long, worm-like coagula (casts of the ureters) 

 may be voided. 



The course of renal haemorrhage necessarily depends upon the na- 

 ture of the disease which causes the haemorrhage. When induced by 

 renal calculus, bleeding occurs regularly after every violent exertion. 

 Haemorrhage arising from the presence of a tumor, especially cancer, 

 is usually very profuse and persistent. The bleeding which accompa- 

 nies inflammation of the kidney and the infectious diseases, or which 

 results from venous obstruction or scorbutus, is not often very severe, 

 [n the endemic haematuria of the tropics there are periodical profuse 

 flows of Wood from the kidneys. 



In haemorrhagic infarction, if there be haematuria at all, it is always 

 slight. It is usually ushered in by a chill, and is attended by pain in 

 the region of the kidney, and by violent sympathetic vomiting. The 

 occurrence of such a train of symptoms a chill, lumbar pain, vomiting, 

 and haematuria in a case of heart-disease, would warrant the diagnosis 

 of a renal infarction, which otherwise generally escapes detection. 

 Renal apoplexy is marked by similar symptoms, which, however, are 

 of much greater intensity. 



The results of renal haemorrhage cannot be described in detail until 

 after a more thorough discussion of the diseases whereon they depend. 

 The haematuria arising from cancer, from renal calculus, and from the 

 tropical disease, acts chiefly by producing exhaustion from loss of blood. 



TREATMENT. The main point in the management of a case of renal 

 haemorrhage is the treatment of any hyperaemia, inflammation, or other 

 constitutional disease from which it proceeds. In most instances, when 

 the main disease is susceptible of efficient treatment, the haemorrhage 

 does not require any especial attention. Sometimes, however, the 

 danger of exhaustion arising from repeated attacks of profuse and per- 

 sistent haemorrhage, such as occur in cancer and renal calculus, may 

 require relief. Cold, in the form of a bladder of ice laid over the re- 

 gion of the kidney, cold sitz-baths, or cold injections, should then be 

 resorted to. Internal administration of styptics has been recommended, 

 and the whole list has been given seriatim in many cases, each failing 

 in its turn. Articles containing tannin, especially tannic acid itself, 

 which is eliminated through the kidneys in the form of gallic acid, and 

 thus is enabled to act directly upon the bleeding point, deserve the 



