SYMPTOMS OF RENAL NEOPLASM.
The symptoms of a renal neoplasm are by no means well defined or constant. An increased bulk in the organ is probably the leading feature in conjunction with what I would speak of as the natural history of its development and the circumstances attending it. Irri tation of the bladder, hmmaturia, personal appearance, pain in the part, oedema of one or both legs, engorgement of the abdominal cutaneous veins, all have their significance; these indications of a structural lesion must be weighed in conjunction with the application of those diagnostic tests to which reference has already been made.
Lastly comes the question as to how these neoplasms are to be treated—to what extent is it legitimate to remove them, by the extir pation of the kidney through either a lumbar or abdominal incision? This can only be answered by carefully weighing in a given case the questions : Can the disease be entirely removed at no very great and immediate risk to life, so as to give the patient a fair chance of future immunity? or, Are the symptoms of such intensity, so far, for instance, as pain, bleeding, or urinary retention are concerned, as to justify the surgeon, in the absence of all other modes of relief, in making any at tempts of an operative nature that may seem to be within reach? To both of these questions there are cases of an exceptional nature where the answer must be, in the interest of suffering humanity, in the affirmative. The outlook in the growths of early life, there can be
no doubt, is most unfavorable. As Mr. Paul observes, "that all these congenital tumors are malignant is clearly established by a most valuable paper drawn up by Mr. Sutton," in which he shows that out of thirty-five operations for the removal of renal sarcoma in children under six years of age fifteen recovered, but all died within a year from recurrence of the growth. Thus, however interesting it is to us as pathologists to study cases such as these, it is a somewhat dis heartening reflection that up to the present they remain hopeless from the clinical point of view." A reference to the methods of per forming nephrectomy and operations for the exploration of the kidney will be found in a preceding section.
It has been stated that some of these neoplasms may be checked in their course toward destruction by various agencies; of these, iodide of potassium and Chian turpentine appear to have given some slight evidence of their efficacy in this direction.
It is too soon as yet to say anything definite in regard to the use of the erysipelas toxines in the treatment of malignant neo plasms of the kidneys or other organs. Their therapeutic value, if they possess any, can be demonstrated only by actual experience in a long series of cases.