The patient was a fifty-nine year-old man. Abaut two years ago, he had a sudden attack of haematuria, but after several days was completely cured by medical treatment. One month later, the attack of haematuria was repeated and this time with complete retention of urine, which was however smoothly drawn off by catheterisation. From that time onward, these fits were repeated, and on several of these occasions he complained of severe pains in the left upper abdomen, or in the bladder region. About two months before his case came before us, namely, at the end of April, 1937, the last attack occurred and was treated as usual, but could not staunch the flow of blood. In adition to this, it was apparent that his anaemia continued to increase. As to his past history, he had, at eighteen years of age, suffered from typhoid. fever. Apart from this he had enjoyed excellent health. He was a well-developed man and well-preserved for his age. The conjunctiva palpebrae et bulbi were anaemic on account of the heavy haemorrhage. His abdomen was apparently normal. Both kidneys were easily palpable, and moved freely with his respiration, and there were no painful parts in the kidney and ureter region. Besides this, there were no other abnormal parts to be seen. Syphilitic reactions were negative (Browning, Murata, M.K.R. II). Blood pressure was 165-85. Pirquets reaction was faintly positive in twenty-four hours. Urine: - Colour, dark red; appearance, two plus cloudy; reaction, acidic; pus cells, three plus; red blood cells, also three plus; micro-organismus, negative. A mixed phenolsulphonephthalein test showed an output of 70% in one hour. He discharged 1095cc of urine during a period of 4 hours from 1000cc of water which he had drunk. The specific weight of his urine before he had drunk the water was 1013, and its minimum specific weight after he had drunk was 1002. Cystoscopy and pyelography, performed on May 26th, 1937, showed a completely normal bladder. The right ureteral orifice was also completely normal, but from the left orifice periodic excretion of bloody urine like red wine was noted. There were no obstacles to the passage of the catheter to either ureter. Urine from the right kidney was normal, but urine from the left side contained many red blood cells and pus cells, as was seen from spontaneous urine. The partial-kidney-function-test of indigocarmin was almost entierly satisfactory as to both kidneys.
Pyelogramm of air in both kidneys showed no shadow of calculus. Pyelogramm of iodnatrium: Right side was normal. The shadow of the left side revealed a remarkable change; namely, (1) enlargement of the calyx to twice the size of the right one, (2) the margin of the shadow of the calyx was not plain, but it showed a zigzag con figuration, (3) the density of the shadow was not equal, its appearance seemed reticulate, (4) two round defects of shadow at the upper edge were noted, (5) the shadow of the ureter was normal, (6) generally, the density of shadow on the left side was thinner than on the right. An operation was performed on June 8th lumbar anaesthesia of scurocaine. Incision was made by Bergmann-Israels method. There were no adherations anywhere, so that the kidney was easily picked out. Pathological examination: length 12cm, breath 7cm, thickness 4cm, weight 225g The surface of the kidney was almost plain, but at the upper part of the kidney, two round tumours protruded somewhat. The kidney was rather tender, and felt wavy. On the cutting surface, there were many beautiful coralline papilloma which covered all the mucous membrane of the calyx. At the upper part of the calyx there was a clot of blood about the size of a small hens egg. The parenchym of the kidney itself was thin (about 0.5-1.0cm in breadth) on account of the pressure of the tumour. It seemed as if a sack enveloped the papilloma. Microscopical examination showed a typical papilloma specimen. In the region of the kidney parenchym, many atrophic tubuli and glomeruli
mixed with healthy ones were noted. Nineteen days after the operation, the patient was uneventfully cured. About one year after the operation, I got a letter from him, enjoying a healthy life.