446 THE HEMORRHAGIC DIATHESES 



in spite of a profusion of hyaline, granular and epithelial casts.^ 6. There 

 are cases of nephritis with paroxysmal, profuse hemorrhages. 7. Nephritic 

 hemorrhages may occur and run their course with or without colic; the hemor- 

 rhage is not the cause of the colic. Both phenomena are the results of renal 

 ' congestion. 8. A great number of pathologic conditions designated up to 

 now as nephralgie hematurique are to be referred to nephritic processes. 9. 

 Incision into the kidney in many cases influences the nephritic process and 

 its symptoms favorably. — In a lecture, " Hemorrhage from a Formal or Appar- 

 ently Normal Kidney," Naunyn in the main agrees with Israel that interstitial 

 nephritis is the most frequent cause of this form of renal hemorrhage. 



Pousson in two cases of apparently spontaneous renal heijiaturia extirpated 

 the affected kidney. The microscopic examination of the congested kidney 

 revealed inflammatory foci in the renal cortex without other abnormalities. 

 Poirier and Picque advise in such cases only the operation of nephrotomy, as 

 frequently the other kidney also presents signs of chronic nephritis. In con- 

 trast to this Eegnier believes that in such cases we are invariably dealing with 

 a beginning renal tuberculosis ( ?) ; he therefore strongly advises early 

 nephrectomy. 



Hofbauer (Mitth. a. d. Grenzgeb. d. Med. u. Chir., 1899, V, 3) describes 

 a case of essential unilateral hematuria in a girl aged thirteen: It was espe- 

 cially difficult to determine in this case the etiology of the hematuria which 

 had persisted for two years. It had appeared without an assignable cause, and, 

 in spite of this great duration, had produced no sequelae with the exception of 

 anemia and its consequences. The examination of the urine revealed no 

 pathological constituents except an admixture of blood. Upon cystoscopy the 

 urinary bladder was found normal ; the blood was seen to exude from the left 

 ureter while from the right ureter clear urine was being excreted. No signs 

 upon palpation. An exact clinical diagnosis was not made. On account of 

 marked loss of blood there was an exploratory incision only ; this did not fur- 

 nish the hoped-for, absolute certainty. On exposure, the kidney was found to 

 be normal in size, and palpation revealed no pathologic changes. 



When, to facilitate more exact inspection, the kidney was drawn forward, 

 a laceration of one of the larger vessels made extirpation necessary. The 

 hemorrhage ceased. Eecovery followed. Macroscopically, the kidney, the 

 renal pelvis, and the ureter were perfectly normal. Microscopical investiga- 

 tion of the extirpated organ revealed a chronic glomerular nephritis. In this 

 case the diuresis following the nephrectomy was very interesting. The amount 

 of urine a few days after the operation not only equalled the former amount 

 but decidedly exceeded it. 



In 1891 Senator, in his case of renal hemophilia (Berliner Min. Woch- 

 enschr., 1891, Nr. 1), tested the activity of the remaining left kidney. For 

 this purpose he examined the urine daily for four weeks from the second day 

 after nephrectomy, in regard to amount, specific gravity, and its contents of 



1 I should likf; to remark in this connection that upon the occasion of the Tenth 

 Congress of Internal Medicine in 1891, when I demonstrated the centrifuge in Wiesbaden 

 for the first time, I called attention to the fact that " casts occur quite frequently in 

 urine free from albumin, and can scarcely be looked upon as pathological." 



