|6 DISEASES OF THE KIDNEY. 



long axis, so as to bring a large part of its convex surface in contact 

 with the abdominal wall. Hsematuria and albuminuria are absent 

 about as frequently as they occur. As already stated, part of the 

 bleeding proceeds from the vessels of the growths which push into the 

 urinary passages, while another part is the result of excessive hyper- 

 jemia of the surrounding tissues. Owing to the large quantity of 

 blood thus discharged, the haematuria often forms one of the most 

 prominent symptoms of this disease. The complexion of the patient 

 assumes the dirty hue so common in cancer, and he dies of exhaustion 

 which progresses all the more rapidly when the haemorrhages are 

 frequent and profuse ; unless, indeed, death ensue in consequence of 

 some intercurrent disorder, or from the invasion of other vital organs 

 by secondary cancer. Treatment is ineffectual, and must be limited to 

 husbanding the patient's strength, repression of the haemorrhages, and 

 removal of coagula from the bladder, according to surgical rules. 



CHAPTER X. 



TUBERCULOSIS OP THE KIDNEY. 



ROKITANSKY recognizes two forms of renal tubercle. The first 

 form is symptomatic of a tuberculosis involving several or even the 

 majority of the organs. In acute miliary tuberculosis, gray nodules, sim- 

 ilar to those found studding the lungs, pleura, peritonaeum, etc., are also 

 found in the albuginea and parenchyma of the kidney. In extensive 

 chronic tuberculosis, tolerably large, yellow, cheesy deposits of tubercle 

 are sometimes met with in the kidneys, but they rarely contain collec- 

 tions of softened tubercular matter or tubercular cavities. The first 

 of these forms has but little effect upon the action of the organ. It is 

 unrecognizable during life, and is of more moment in a pathological 

 than in a clinical point of view. 



The second form of renal tubercle is generally complicated with 

 tuberculosis of the testicle, prostate, seminal vesicles, and urinary pas- 

 sages. It is not constantly preceded by pulmonary tubercle ; but this 

 disease almost always sets in at a more advanced period of renal dis 

 order. In this second form the deposit is very copious, and the indi- 

 vidual nodules soon coalesce into large tubercular masses. The organ 

 becomes enlarged, assumes an irregular, knobby shape, and within it 

 we find large cheesy collections, some of which are filled with tubercu- 

 lous pus. This form of renal tuberculosis, too, would likewise frequently 

 escape observation, were not the diagnosis almost always aided by the 

 complications above mentioned. The longer a chronic disease of the 

 urinarv passages has coexisted with the admixture of pus, and now and 



