444 THE HEMORRHAGIC DIATHESES 



for hours or weeks. With these the patient had insignificant pain in the 

 right renal region. He consulted a physician only when a hemorrhage lasted 

 longer than eight days. Upon the 2d of Novemher, 1895, pain occurred in 

 the right renal region, and upon the 9th of November he voided bloody urine. 

 Examination showed nothing abnormal; no pathologic constituents except 

 blood were found in the urine. In spite of numerous remedies the hemorrhage 

 continued, and the anemia constantly became more marked. Upon the 28th 

 of December all drugs were stopped, and hydrotherapy was begun. The 

 patient had a bath each day lasting ten minutes, followed by affusions to the 

 renal region. The bath was begun at a temperature of 95° P., the water being 

 gradually cooled to 75.2° F. The afEusions were at a temperature of 82.4° F. 

 to 60.8° F. Gradually the hemorrhages became slighter, and the urine finally 

 cleared. Upon the 15th of January the patient left the clinic cured. 



A fourth case is published by S. Grosglik : " Ueber Blutungen aus anatom- 

 isch unveranderten Nieren " (Sammlung hlin. Vortrdge, ISTr. 203). An army 

 officer, aged thirty-six, of a bleeder family on both paternal and maternal sides. 

 The patient was of healthy appearance, but suffered frequently from marked 

 epistaxis and hemorrhage from the rectum. In September and December, 

 1896, he had severe hematuria for which clinically no cause could be assigned. 

 As the patient's history was unknown at that time, the diagnosis wavered be- 

 tween a beginning tumor and tuberculosis of the kidney. After an observa- 

 tion of six months, as no further point of support could be determined for 

 either diagnosis, and after the patient had related his family historyj Gros- 

 glik made the diagnosis : " Idiopathic renal hematuria upon a hemophilic 

 basis." 



In other cases of " nephralgie hematurique " in which the hematuria could 

 not be assigned to a hereditary hemophilic constitution, it has been assumed 

 that the cases were due to vasomotor or traumatic renal hemorrhage (i. e., 

 due to corporeal over-exertion). Accordingly, varieties of hemophilic vaso- 

 motor and traumatic renal hemorrhage might be described in which the possi- 

 bility of other causes for hemorrhages than an anatomical substratum could 

 not be excluded. 



In regard to the diagnosis, if there is no enlargement of the kidney, and 

 if the composition of the urine and the accompanying symptoms do not favor 

 an organic affection, the following facts are of importance: The proof of a 

 hereditary hemophilic predisposition, a preceding exertion, or disturbances of 

 the nervous system (hysteria, neurasthenia, etc.) by which the vasomotor 

 center for the kidney might be implicated. If the history reveals anything 

 positive, the diagnosis of essential hematuria becomes likely. It only becomes 

 certain, however, when, after prolonged observation, no distinct signs of ana- 

 tomical change have appeared. 



The treatment of hemophilic renal hemorrhage, according to Grosglik, 

 should be expectant. If the course of the affection is severe internal remedies 

 are powerless, and if the hemorrhage threatens to prove fatal the bleeding 

 kidney must be removed as soon as possible. In so-called vasomotor renal 

 hemorrhages the diagnosis should be immediately confirmed by surgical inter- 

 ference, which should not only embrace the exposure and palpation of the 



