TEATMENT OF THE VARIOUS CAUSES OF HEMATURIA - CARCINOMA OF THE KIDNEY.
tincture of chloride of iron will prove most efficacious. Ergot or chloride of calcium may be exhibited for some time on the expectation of increasing the coagulability of the blood. The disadvantage of these styptics is the difficulty of getting rid of the clots they cause, for it is only at the expense of much renal suffering that they will be forced along the ureter. On no account should the bladder be sounded or washed out if a decided tumor is discovered in the loin. It may not be harmful, but it has been fol lowed by serious, even fatal results.
statistics of nephrectomy for carcinoma are en couraging enough to permit us to hope that, with an early diagnosis, we may achieve a success in removing a renal carcinoma. Schede, of Hamburg, records a series of ten cases of nephrectomy for differ ent diseases without a death. Previous to this he had operated seven times with six recoveries, thus making a total of seventeen cases with one death. This, as the cases are not picked, shows how the mortality has decreased in the hands of a highly skilled general surgeon, for the statistics of Gross showed a mortality of 44.6 per cent., of Brodeur 44.4 per cent., of Czerny 44.4 per cent., of Morris
30.4 per cent., and of Tait 18 per cent. Of the ten cases last recorded by Schede three were for carcinoma. No case is at present, I believe, published in which the renal artery has been tied to check hemor rhage and new-growth, though there is 'no reason why this should not be attempted. The future of nephrectomy in renal carcinoma depends upon a diagnosis being made and acted upon very early in the course of the disease; for the general feebleness of the patient and the intimate connections, whether inflammatory or neoplastic, which the kidney acquires with surrounding structures, render the operation very hazardous in itself, while the generalization which rapidly takes place makes operative interference useless if it is not undertaken soon after the degeneration has commenced.
I regard anemia as an important contra-indication to operative interference.
As the tumor increases in size, it may press upon the vessels and strangle the blood-supply, or the renal pelvis and ureter may become .filled with clot which will render that canal permanently impervious. In either case, the hematuria ceases.