Acute mastoiditis associated with hematuria.

In dealing with hematuria we must consider its various causes. Not only does the kidney pathology, per so , produce hematuria, but systemic conditions as hemophilia, purpura hemorrhagica, leukemia, Hodgkin's disease, scurvy and such irritant drugs as cantharids, turpentin and prolonged use of urotropin. By means of the history and clinical findings we are able to eliminate the above as the etiology. Otogenic infections caused by the streptococcus hemolyticus may produce many complications, i. e. , sinus thrombosis, endocarditis, nephritis, et cetera. In the three aforementioned cases, hematuria resulted. It is problematical whether the hematuria resulted from the mastoiditis or whether it was focal or embolic in origin; on the other hand, it may have been the result of a direct attack by the toxins on the kidneys. If I may digress I should like to reiterate the interesting features of the cases on discussion. I . Hemorrhagic type of mastoids. 2. The streptococcus hemolyticus was isolated from the mastoid wounds. 3. The presence of the eosinophil in the blood picture; and last, but not the least, 4. Hematuria. From our statistics we learned that approximately 50 to 60 per cent of all operative mastoids were due to some form of streptococcus bemolyticus. Many observers have called our attention to the fact that certain streptococcic hemolytic strains are prone to produce complications. From a previous research, we learned that all positive cultures obtained in sinus thrombosis were found to be due to the streptococcus hemolyticus. It is therefore possible that certain streptococcic hemolytic strains found in mastoiditis and sinus thrombosis bears a close relationship to the scarlatinal organism. If the latter be true, many complications can be explained. In these three particular cases hematuria resulted. The presence of the eosinophil is of utmost significance. It is a well established fact that the eosinophil belongs to the leukohemato‐poietic system. The rǒle that the eosinophil plays is not entirely understood. It is normally present in the blood, disappears during acute in fection, reappears when the infection subsides and is constantly present in allergic phenomena. The allergic disturbances may be exogenous or endogenous. In the hemorrhagic mastoid caused by the streptococcus hemolyticus, we have endogenous lytic elements produced by the organisms affecting the red blood system and result in a hemolysis. In the course of the mastoid destruction lytic elements are produced and liberated in the mastoid area. There fore, the presence of the eosinophil in the above enumerated cases was a forewarning of lytic phenomena. The hematuria here may be just another lytic element added. Since there was an elapse of time from the onset of infection to the time of operation, the streptococci no doubt spread its toxins to other organs, and in these particular cases the urinary tract was involved. There is no doubt that the hematuria was the result of the infection, as it completely disappeared following operation. This finding was substantiated by repeated postoperative urinary examinations. In speaking of the influence of focal infection, we are dealing largely with theoretical considerations and not with definite, demonstrable facts. It is only by analyzing and deducting that we arrive