Transcriber’s Note:
The cover image was created by the transcriber and is placed in the public domain.
| Vol. CX. | MARCH, 1916. | No. 3 |
Renal tuberculosis occupies a pre-eminent place in the listof those diseases whose initial symptoms are apparently soinsignificant and whose onset is so insidious that the truestate of affairs is either entirely overlooked or else recognizedonly after it is too late to accomplish the most good.
[Footnote A: To the courtesy and generosity of Dr. Edward L. Keyes, Jr., withwhom I am now associated, I owe the privilege of employing the abovecases, which have been selected from his wonderful storehouse of instructivecase histories.]
A large number of the cases that come under our observation,exhibit symptoms which are referable solely to thebladder in the guise of a mild cystitis, the patients perhapscomplaining only of a slightly increased frequency of micturitionby day, not even being disturbed once at night toempty his bladder. Here the temptation on the part of manyphysicians at once arises to treat such cases lightly—doubtless98to dismiss the patient with assurances that his conditionis one of a mild inflammation of the bladder which, in allprobability, will soon right itself after an irrigation or two,plus a few tablets of urotropin.
On the other hand, the onset may be so stormy or symptomsso terrifying, that we at once think of all the horribleconditions to which the genito-urinary tract is heir. Butonce our suspicion is aroused as to the possibility of tuberculosisof the kidney, the question of an exact diagnosis, thequestion of which kidney is involved, and the condition ofthe other kidney (on which naturally depend the course topursue) are matters not always easy to decide.
To this end, cystoscopy, ureteral catheterism, renal functiontests and the X-ray, lend themselves as invaluable aids.But we must remember that even with so much assistance athand, the pitfalls are many and it is with the hope of pointingout a few of the former as well as emphasizing the morecertain means of diagnosis, that I feel justified in this presentation.
Case I,—E. P. was first seen in September, 1907. Hethen complained of an ulcer on the penis and frequent andpainful urination. One brother had died of pulmonary tuberculosis.The ulcer had appeared a year previously, beginningwith a redness of the meatus, which persisted, withsuperficial ulceration. No history of exposure. In April,1907, the dysuria began, and at the time he first consultedDr. Keyes, he was urinating every two hours, day and night.He had also experienced a chill three weeks before this time.