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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    fort the man disappeared from view and treatment, as do most syphilitics whenever their general con- dition is bettered. In due course the hemorrhages returned more or less incessantly, and in the care of a colleague after another diagnosis with ure- teral catheterization, hypernephroma was deter- mined and operated on. At this time the kidney showed enlargement, while at my investigation no focal kidney conditions were subjectively or objec- tively present. It is likely that if I had made a complete analysis of the case, as I should now do in a similar patient, I should have recognized the tumor in a far earlier and more operable condition than it was a year later. This incident carries its own lesson. Renal lithiasis as a cause of hemorrhage should also be diagnosticated in its earliest possible degree —in the aseptic rather than the septic stage, as in the latter operative intervention is much less valuable. Unlike neoplasm, lithiasis may occur at any age, even in childhood, and is not uncommon in adolescence and midlife. Careful history usually records excess of crystals or the passage of gravel and calculi in the urine. The bleeding as a rule is not profuse, painless if without clots, painful if with clots, and excruciating if accompanying the passage of a stone down the ureter. Anything causing a stone to move in its bed in kidney or ureter will either excite or increase the blood, while rest in bed is usually followed by prompt and pronounced disappearance of at least macroscopic blood. When infection is added to the lithiasis, pain of more or less constant or remittent type ap- pears, together with enlargement and tenderness of the kidney previously free from these signs. The urine is of the “attrition” type, due to the rubbing of the stone about in its bed and resulting in ex- foliation of epithelium, increase and thickening of the mucus, the presence of pus in varying quanti- ties, microscopic in the aseptic and macroscopic in the infected cases, and finally crystals due to those