Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

Hermann Senator

Date:: 1905

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$cases invade the kidneys themselves. These parasites, for the most part, are those which occur in the tropics {^Distoma hcematohiwn and Filaria sanguinis—hcematuria intertropica—see p. 438); an ameba (^Sporydium polyphagum) discovered by Bonome^ in sheep affected with hematuria; and an acarus found by Myake and Scriba ^ in a case of renal hemorrhage, and designated by them Nephrophages sanguinarius. (See Hemoglobinuria, p. 61.) Hereditary renal hemophilia was observed by H. W. Attlee^ and even more extensively by L. G. Guthrie,'* who observed the condition altogether in 12 children of 2 sisters, who were themselves sufferers from periodic hematuria without any other demonstrable cause. Other signs of hemophilia were not present in these patients. There still remains a group of cases in which nothing can be found in the kidneys or outside of the kidneys to account for the hemorrhage and the accompanying continuous or paroxysmal pain; these have accordingly been called cases of essential renal hemorrhaged' ^ In a few of them careful examination revealed the presence of certain changes which are to be regarded as the cause of the hemorrhages; thus, for example, angiomatous proliferation was reported by E. H. Fen wick ^ in the papillse, and after the removal of the latter by papillec- tomy the hemorrhage ceased. [Cases of renal hematuria without demonstrable lesion at operation have been described also by M. L. Harris.'^ The editor has seen a case of painless hematuria in a man of about forty-five, the bleeding having lasted for ten months. Cystoscopic examination showed that it came from the right ureter. The examina- tion of the kidney at the operation res^ealed nothing pathologic in the pelvis or kidney proper. A section of the kidney showed normal structure. The hemorrhage ceased ten days after the operation, and at the time of writing, twenty weeks after the patient has left his bed, has not recurred, and the man is apparently well and is at work.—Ed.] In other cases more or less extensive inflammatory processes have been found in the kidneys, and the hemorrhages have therefore been ascribed to a hemorrhagic nephritis. But the inflammatory changes in some of these cases were very slight and the process had evidently subsided long before, so it is not probable that these changes had any causal connection with the hemorrhages. Such cases and a few others in which no changes, and certainly no nephritic processes, could be detected even with the aid of the microscope, suggest that these essential hemorrhages depend on a nervous disturbance, and are either angio- ^ Virchow's Archiv, 1895, cxxxix., p. 1. ^Berlin, klin. TFbc^.,1893,No. 16. ' St. Bartholomevfs Hosp. Jour., December, 1901. * Lancet, May 3, 1902, xviii. ^ As a great deal of literature has appeared on this subject within the last few years, the writer will refer the reader to the following: Grosglik, in Sammlung klin. Vortrdge, N. F., 1898, No. 203; Albarran, Ann. des maladies des organs genitaux-urinaires, 1898 and 1899; K. Robinson, Pathogenie et traitement des hematuries renales dites essen- tielles, Paris, 1899; Guyon, Assoc, fran^aise d'urologie, IV. Session, 1899, and the discus- sion ; J. Isi-ael, Chirurg. Klinik der Nierenkrankheiten, Berlin, 1901, p. 403; H. Senator, Deutsch. med. Wock, 1902, No. 8. « British Med. Jour., 1900, No. 3. ^ Fhilada. Med. Jour., 1898.$