Produced by Richard Tonsing and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive) NASHVILLE JOURNAL —OF— MEDICINE AND SURGERY CHARLES S. BRIGGS, A.M., M.D., Editor. W. T. BRIGGS, B.A., M.D., Associate Editor. ─────────────────────────────────────────────────────────────────────── VOL. CX. MARCH, 1916. No. 3 ─────────────────────────────────────────────────────────────────────── Original Communications CASES OF RENAL TUBERCULOSIS ILLUSTRATING MODERN METHODS OF DIAGNOSIS.[A] BY HOWARD S. JECK, PH.B., M.D., New York, N. Y. Renal tuberculosis occupies a pre-eminent place in the list of those diseases whose initial symptoms are apparently so insignificant and whose onset is so insidious that the true state of affairs is either entirely overlooked or else recognized only after it is too late to accomplish the most good. [Footnote A: To the courtesy and generosity of Dr. Edward L. Keyes, Jr., with whom I am now associated, I owe the privilege of employing the above cases, which have been selected from his wonderful storehouse of instructive case histories.] A large number of the cases that come under our observation, exhibit symptoms which are referable solely to the bladder in the guise of a mild cystitis, the patients perhaps complaining only of a slightly increased frequency of micturition by day, not even being disturbed once at night to empty his bladder. Here the temptation on the part of many physicians at once arises to treat such cases lightly—doubtless to dismiss the patient with assurances that his condition is one of a mild inflammation of the bladder which, in all probability, 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 symptoms so terrifying, that we at once think of all the horrible conditions to which the genito-urinary tract is heir. But once our suspicion is aroused as to the possibility of tuberculosis of the kidney, the question of an exact diagnosis, the question of which kidney is involved, and the condition of the other kidney (on which naturally depend the course to pursue) are matters not always easy to decide. To this end, cystoscopy, ureteral catheterism, renal function tests and the X-ray, lend themselves as invaluable aids. But we must remember that even with so much assistance at hand, the pitfalls are many and it is with the hope of pointing out a few of the former as well as emphasizing the more certain means of diagnosis, that I feel justified in this presentation.