MALIGNANT DISEASE OF THE KIDNEY.
I have already expressed my belief that the onset symptom in the majority of cases of malignant disease of the kidney is hematuria, also that renal pain is not at first experienced. The consideration of this disease, therefore, fell into the group of symptomless But I am not supported in this statement by the literature of the subject, which represents the pain as being of quite a marked character at the outset,* and, moreover, I am aware of several cases in which pain either preceded the hemorrhage when the growth was very rapid, or a calculus pre-existed. In two cases the pain was obviously induced by the practitioner lighting up acute suppurative nephritis by his examination. It is, therefore, necessary briefly to allude to maligant disease of the kidneys under this group also.
Case. —Malignant Disease of Kidney with Pain in affected Loin, due pi.obably to Tension on the Capsule of the Organ."—M. X., rot. 50, consulted M. Reliquet in December, 1884, for urinary trouble. His history was as follows. For many years he had suffered from neph ritic colic accompanied by lmmaturia, and oided uric-acid gravel. After passing in 1881 a larger piece of calculus than usual, he re mained well until October, 1884, when he again had an attack of nephritic colic. Toward the 20th of October of this year, • fever, rigors, headache, anorexia, and frequent inicturition appeared. The urine had a strong odor, was muco-purulent, but abundant. No renal tumor could be felt at this time on the left side, where pain was complained of, but in the early part of December a tumor the size of a large apple was discovered in this region. It was painful on pressure, slightly movable, and was considered to be a hydro nephrosis by the medical attendant.
The patient now consulted M. Reliquet, who found a left renal tumor the size of an infant's head, without bosses or soft points. The urine was scanty, murky with purulent deposit, ammoniacal, and very fetid. There was extreme irritability of the bladder, a few drops of urine only could be voided at a time, with much suffering experienced both before and after the act. The patient demanded to be released from the excessive and recurrent pain of nephritic colic and strangury.
M. Roliquet, believing that he would not live much longer in such extreme suffering, performed lumbar nephrotomy by means of the thermo-cautery. When the renal tumor was laid bare, it was punctured with the thermo-cautery, and on withdrawing the point a jet of blood shot out from the opening with such great force that it passed over the operator's shoulder. The finger was inserted
into the kidney, and it was then found that the tumor was extremely soft and friable, so much so that when an attempt was made to enu cleate the kidney it broke down under the fingers in all directions. The operator, after tearing away as much as possible of the renal mass, arrested the profuse hemorrhage by means of sponges packed into the wound.
The patient was immediately relieved of all pain in urinating, the vesical irritability subsided, the nephritic colic ceased, and the urine augmented in quantity. Neither nausea nor vomiting reap peared, the patient was able to take food with great comfort, and indeed pronounced himself "cured." In spite, however, of this re markable result of the operation, the growth progressed, and the patient died two months afterward.
CASE.—Acute Malignant Growth of Kidney.—Clot Retention, Cathe terism and Washing.—Acute Suppurative Nephritis.—Great Renal Pain. —J. S., oet. 60. Two months before death the patient thought he had caught cold in his kidneys because he suddenly passed bright blood. He was placed upon iron and ergot, but no improvement followed, and he began to pass many worm-like clots. There was no renal colic, nor tenderness on deep pressure in either renal region. The prostate was enlarged antero-posteriorly and laterally. Under the •se of hazeline and with the enforcement of rest the blood began to diminish, and in a week's time it had ceased. The patient then be gan to suffer from pain in the left loin, and was unable to make water. A No. 12 English silver catheter was passed, and thirty ounces of dark-colored urine and clots were evacuated. Retention continued and almost pure blood was evacuated. The bladder was washed out with hazeline and a solution of boracic acid. The pain in the kid ney now became very severe, the retention ceased, the temperature began to rise, then to oscillate, and the patient died three weeks after the vesical treatment was commenced. On post-mortem ex amination a large kidney with scattered deposits of soft carcinoma was found, the unimplicated renal tissue being in a state of acute nephritis. The fellow gland was also affected with inflammation.
I believe that in this case urethral fever or slight cystitis (follow ing on clot retention, and the passage of a catheter and the manipu lation necessary to evacuate the clots) induced the pain and the fatal result; for fever appeared directly upon the interference and the pa tient's condition changed at once and for the worse.