350 



DISEASES OF THE URINARY APPARATUS. 



h. The constitutional diseases, and especially hemophilia, leuk- 

 emia, pernicious anemia, etc. 



I. Filaria of the blood (Lange) producing vascular lesions in the 

 kidney. 



The most salient characters of hematuria are the red or red- 

 brown coloration of the urine,. the red precipitate which is formed 

 in it and the microscopical evidence of the red corpuscles ; the co- 

 existence of these three symptoms is necessary in order to make 

 the diagnosis of hematuria. We have already seen how hematuria 

 can be distinguished from hemoglobinuria ; we must add that the 

 presence in the urine of a few red corpuscles, which are insufficient 

 to give this liquid the red tint, ought not to be qualified as hema- 

 turia in ordinary description. 



A very delicate question which is often most difficult to solve is: 

 Where does the blood come from? Does it emanate from the 

 kidneys, the bladder, or the urethra? We have a thoroughly 

 established series of symptoms serving as a starting-point for the 

 differential diagnosis, but, as shown by Ilering, the practical value 

 of these symptoms is open to doubt. In general, we must take 

 into account the following facts : 



The cylinders of coagulated blood are characteristic of renal 

 hemorrhage, for they can only be formed in the renal canaliculi» 

 When the hemorrhage comes from the kidneys, the urine and the 

 blood are intimately mixed, the color of the liquid varies from a 

 brownish red to a brown-black, the quantity of red corpuscles is 

 small, and the fibrinous clots are colored red (the first two charac- 

 ters are quite often wanting). The symptoms of nephritis, the 

 presence in the urine of the epithelium of the kidney or of albu- 

 minous cylinders (casts), etc., permit us to decide as to the renal 

 origin of the hemorrhage. 



In vesical hemorrhages the blood is eliminated in the shape of 

 more or less voluminous clots ; the animals have frequent desire of 

 passing urine (pollakiuria). The color of the blood is clear; the 

 red corpuscles are well preserved, the fibrinous clots are colored 

 red. The abundance of the vesical epithelium is a valuable symp- 

 tom for the establishment of a diagnosis. 



In urethral hemorrhage the blood runs off, drop by drop, during 

 the intervals of micturition. 



We must not confound hematuria with the hemorrhages of men- 

 struation, metrorrhagia, and with the abnormal colorations of the 



