Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen.

  • Pedersen, Victor Cox, 1867-1958.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tubules. Another form, however, has the tubercles scattered along the depth of the tubules so that on gross examination they are not or at most very little in evidence. They may, nevertheless, cause bleed- ing by local hyperemia or ulceration into the tubules. These cases are difficult to diagnosticate after nephrectomy, excepting with full pathological analysis. The urine in tuberculosis of the kidney is of the desquamative type due to the chronicity and usually superficial character of the lesions, hence beside the blood the urine shows abundance of epithelium from the pelvis and the ureter with, sooner or later, pus containing altered epithelial cells as well as white blood cells. The one great diagnostic point is the discovery of the tubercle bacillus in the urine. The morphology must be proved by inoculation into the peritoneal cavity of guineapigs for death in a few weeks, usually from four to eight, or into the thigh for deposits of the disease in the lymphatic glands of the groin, which usually occurs in about fourteen days, so that a much earlier decision may, in this way, be reached. As in the preceding causes of renal hematuria, the earlier the diagnosis is made the better, as at this stage there is very great value in the use of bacillus emulsion in ascending doses, beginning at o.oooi gramme twice a week and increasing an equal fraction at each dose, until at the end of a year the patient is receiving large doses. No dose or rate of repetition must be followed which results in a reaction, as such overdose may not only hinder the progress, but, if marked, increase the suscepti- bility rather than the resistance of the patient. All known methods of hygienic treatment should be in- cluded in this management. The significance of renal hemorrhage to the pa- tient’s life is illustrated by a case which I recently saw in consultation. The woman had been allowed to pass blood in her urine for nearly six weeks in noticeable and even large quantities before consent- ing to consult a surgeon. By this time she was very