Definition:—A condition in which the urine when passed contains blood.
Etiology:—The condition follows extreme congestion and acute inflammation. It occurs during the course of nephritis and pyelitis and from the presence of an embolus or a calculus. Tubercular degeneration or malignant disease of the kidneys is a common cause. It occurs from the presence of parasites, from the taking of large doses of irritating remedies which must be excreted through the kidneys, and from severe injuries, as a blow over the kidneys or an injury from falling, or severe protracted muscular exercise, or from violent muscular strain, or from a gunshot or other penetrating wound of the kidney.
It may occur also from injuries to the bladder, from the presence of stones, tumor, ulceration, or the rupture of varicose veins: also from disease of the bladder, notably from acute and chronic cystitis. The condition occurs more frequently in males than in females, and is most common between the ages of twenty-five and forty years.
The disease results also from acute infectious disorders, and seems to be more common in hot climates than in temperate localities. It occurs in chronic gout, in leukemia and scurvy. It appears at times in the form of malarial hematuria, or with purpura, or in hemolithiasis.
Symptomatology:—In acute cases, with the appearance of the hemorrhage, there is a flash of heat over the body; there is a sensation of heaviness or weight in the loins, some faintess, and perhaps slight nausea, with an almost constant desire to urinate. The urine will contain blood from the first; it may be uniformly diffused or it may be in the form of clots, the urine itself being but slightly discolored, or both conditions may be present. When caused by a fall or by other local injury, the patient will become very weak and there will be severe pain down the course of the ureters and in the genital organs.
In cases that are more chronic in character the urine is uniformly discolored, and in cases where but little blood is lost, the urine may be of a smoky hue and have but little if any sediment.
Diagnosis:—Occasionally the presence of blood will be determined only by the proper reagent; in other cases there may be so large a quantity as to nearly fill the bladder with a single clot.
It becomes necessary at times to catheterize the ureters to determine whether one or both kidneys are affected. When hemorrhage is undoubtedly from these organs, the urine is uniformly discolored and the clots assume the form of casts of the ureters. When from the bladder, the first of the urine which passes may be quite clear, to be followed by clots which temporarily block the urethra, and are expelled by urine which is more thoroughly mixed with blood.
Treatment:—If possible, the cause of the hemorrhage must be at once determined, but no time should be lost if the condition of the patient is at all serious. The patient should lie quietly in bed, and should have hot applications applied to the feet. If the stomach will receive it well, he should have thirty drops of the compound tincture of the oils of erigeron and cinnamon, made by dissolving one dram each of these oils in fourteen drams of alcohol. This should be administered in a tablespoonful of water and repeated in a half an hour if necessary. An hour later the patient should have ten grains of gallic acid in cinnamon water, and this should be repeated every two hours as long as a hemostatic is heeded. Other agents which are available under different circumstances, and should be selected with reference to the conditions present, are ergot, thuja, hydrastis canadensis; as an auxiliary, collinsonia, hamamelis, in full doses, and in extreme cases the acetate of lead, which may be used for a short time only. The underlying condition must be treated with reference to its complete cure. This will be found extremely difficult in some of the obscure cases, or where tuberculosis is present. Other remedies of much service are aromatic sulphuric acid, capsella and geranium maculatum. At other times, when the pulse is full, bounding and strong, veratrum viride in two or three minim doses may be given every hour for a few hours.