HEMOPHILIA 447 



nitrogen. The reaction was always acid. With the exception of the first 

 day upon which the urine still contained some blood, and upon the succeeding 

 day when a small amount of albumin was present, abnormal constituents wore 

 never noted. The examination for nitrogen was conducted according to the 

 well-known process of Kjeldahl, and several times urea was estimated accord- 

 ing to Pfliiger's modification of Liebig's method. It was shown from the 

 table, published in Senator's report of his case, that immediately after the 

 operation the remaining left kidney performed all the work of both kidneys, 

 perhaps at first functionating even a little more, for a daily excretion of 

 nitrogen of over 16 grams (such as was seen in this case) is the normal for 

 an adult person with a plentiful supply of food, and for a young girl in such 

 a condition (lessened amount of food after the operation) is a decided and 

 abnormal increase. 



Floderus in Lennander's Clinic observed a case of renal hematuria with 

 macroscopically unchanged kidneys. He examined microscopically the kid- 

 ney extirpated by Lennander, and demonstrated a disseminated sclerotic 

 glomerulitis with advancing sclerosis in the adjacent connective tissue, also 

 fatty degeneration and atrophy of the epithelium. In consequence of this 

 finding Floderus studied minutely the previously published cases of so-called 

 essential renal hemorrhage. He divides these cases into the five following 

 groups : 



1. Eenal hemorrhage in hemophilia. 



2. Eenal hemorrhage due to vasomotor disturbance. 



3. Hematuria from mechanical causes. 



4. Hemorrhage from kidneys which are the seat of nephritic processes. 



5. Imperfectly described cases of essential renal hemorrhage. 



After these literary deductions Floderus enters upon a discussion of most 

 of the cases published, minute reports of which are entirely lacking. For 

 this reason the last group must include the majority of the cases assigned to 

 the four other groups. His criticism of the cases described in literature per- 

 mits the assumption that in scarcely a single instance was the bleeding kidney 

 shown to be intact histologically. 



In a woman aged forty-five, who for two years and six months suffered 

 from a left-sided renal hematuria, de Keersmaecker performed nephrectomy. 

 The kidney revealed interstitial and parenchymatous inflammatory nephritis 

 (with hemorrhage). 



Eovsing has written a long article regarding unilateral hematuria of ques- 

 tionable origin and its treatment by nephrectomy. 



Before making the diagnosis, "hemorrhage from normal kidneys" we 

 must determine by all methods at our command: 1. That the hemorrhage 

 actually originates from the kidney; 2. That all pathologico-anatomical 

 changes which may be assumed to be the cause of renal hemorrhage are abso- 

 lutely excluded. The cases published may be divided into two groups: 1. 

 The cases treated exclusively by medication; 2. The cases in which the kidney 

 was directly palpated by operation, was incised, or was removed. Only the 

 last-named cases, of which Eovsing collected reports of 13, are of particular 

 importance. In all of these observations the authors unanimously state that 



