450 THE HEMORRHAGIC DIATHESES 



might show perfectly normal conditions, while in the immediate vicinity of the 

 excised portion changes might have taken place which gave rise to the hemor- 

 rhage ! 



Pasteau has described a typical case of so-called essential hematuria in 

 floating kidney. Here the hemorrhages were connected with severe attacks of 

 renal colic, and were permanently relieved by nephropexy. 



In opposition to many other authors, Castan believes in an actual essen- 

 tial hematuria, as a proof of which he mentions the following typical case: 

 A woman, during the menopause, and for a period of several months, had 

 very profuse hematuria without the slightest symptom of nephritis being evi- 

 dent. Complete and permanent cure was effected by means of baths, massage, 

 etc. In Castan's opinion, a disturbance of menstruation may cause the reten- 

 tion in the body of certain toxins which, without causing demonstrable disease 

 of the renal parenchyma, may give rise to hematuria. To this category the 

 hematuria of the pregnant also belongs : " La f emme est en etat de toxhemie 

 permanente." 



Guyon declares that among the causes of severe threatening renal hemor- 

 rhages congestive conditions occupy the front rank. The kidneys, however, 

 macroscopically and microscopically, may present no changes to explain the 

 congestion. He admits, of course, that renal hemorrhages may be due to 

 inflammation, neoplasms, stone, etc. Guyon mentions cases of profuse con- 

 gestive renal hemorrhages in which neither at the operation nor at the autopsy 

 could pathological changes be detected in the kidney. Especially noteworthy 

 are three observations in which, during pregnancy and lactation, severe conges- 

 tive conditions led to profuse renal hemorrhages. 



Briefly, the cases are as follows : 



1. A woman, aged thirty-five, previously healthy, in the eighth month of 

 pregnancy voided for fourteen days urine of a coffee-brown color. In the 

 eighth month of her third pregnancy hematuria recurred and lasted for three 

 weeks. During this pregnancy there were no signs of nephritis. Three 

 months after this last labor, sudden, severe, continuous hematuria appeared, 

 and debilitated the patient greatly. There was a discharge of coagula, with 

 severe pain in the right renal region. Up to this time the patient had been 

 nursing her child. Upon advice she ceased nursing the child, and the hemor- 

 rhages immediately stopped. Eight kidney somewhat enlarged; irregular 

 shape. Diagnosis : Neoplasm of the right kidney. Upon lumbar incision and 

 section, kidney found to be perfectly normal. Suture; recovery. Hemor- 

 rhage has not recurred. 



2. Hematuria in the course of the fourth and fifth pregnancies; otherwise 

 perfectly normal conditions. 



3. Severe hematuria at the end of pregnancy; sudden stoppage after ter- 

 mination of labor. 



The same author mentions two other cases of hematuria during preg- 

 nancy. A total of twelve cases of this kind is found in literature. Guyon 

 does not believe that these pregnancy hematurias are to be looked upon as true 

 essential hematurias. Besides mechanical causes, infiammatory changes which 

 lead to congestion evidently play a great role. 



