TYPICAL CASES OF RENAL CARCINOMA.
Case 1. Renal Carcinoma, Hemorrhage, Retinal Ancemia.—G. W., mt. 44, under Mr. McCarthy. Twelve months previous to coming under my observation the patient, being in perfect urinary health, was lifting a moderate-sized weight when he felt something snap in his left side. He passed a large quantity of liquid blood.. The hem orrhage was arrested by a week's medicine and rest in bed. It re curred upon his going back to work, and large worm-shaped clots came away with the urine. Since this recurrence, the character of the attacks has always been the same. The hemorrhage is profuse— in some instances alarmingly so, but rest in bed checks it. On re sliming his occupation the blood returns with great violence. No pain and no frequency of micturitiou were noticed. The clay I exam ined him with the cystoscope the hemorrhage had completely ceased.
Cystoscopy.—February 7th, 1889. Bladder healthy throughout. Left ureteral orifice is marked by a red blush, the lips are pouting; right ureteral .opening healthy; prostate small; no renal tumor; diagnosis, probably left renal carcinoma. This occurred in'the early days of electric cystoscopy, and as my incomplete diagnosis did not satisfy one of my colleagues, I had the patient watched. He became "blind" for four days in Seabrook Ward, Hemel Hempstead Infirm ary, from excessive loss of blood, and finally drifted into the In firmary in St. George's in the East, under Dr. Harris, where he died.
Dr. Elwin Harris, to whom I applied for a record of the autopsy, very kindly wrote me a letter about the patient (dated October 13th, 1891), in which he says : " George W. was a case of profuse lnema turia, which I erroneously diagnosed as malignant disease of bladder. I well recollect my surprise at finding the bladder quite free from dis ease at the post-mortem. I signed the certificate 'Carcinoma of kid ney.' " Case 2. Renal Carcinoma, Repeated Retention.—B., mt. 52. About a year previous to this patient coming under my observation he passed a clot of blood "like a fly." For fourteen days he was free
and then another clot appeared. About this time he remarked that he was losing his elasticity of spirits, that he tired easily and was glad to sit down and rest. A month after the appearance of the clot, a short railway journey having been taken, he was seized with reten tion. A catheter was passed and much difficulty was experienced in clearing the bladder of many large black clots. He remained free from all symptoms for two and a half months, when he had a similar attack of retention. Again there was an entire absence of symptoms until one day he noticed a constant desire to micturate, which he complied with. Every ten or fifteen minutes he passed without diffi culty a little clear water. Accompanying this was the greatest sense of discomfort and miserable restlessness. He did not know whether to sit down or stand up. This mild urethral spasm con tinued for an hour or two. He then drank a quantity of hot tea and immediately obtained relief both from the pain and from the con stant desire to urinate. Shortly afterward he passed a long piece of tissue which was pronounced to be a worm but which really turned out to be a ureteral clot. He never suffered from these uneasy symp toms again. He has noticed that he has been losing flesh and grow ing anmnic. A few months ago a right-sided varicocele appeared.
When he consulted me there was a well-marked hard movable right renal growth. He had no frequency of micturition and no pain. He was merely annoyed by recurrent attacks of profuse hem orrhage and obstinate constipation. There was no history of cancer in the family, but the patient had had syphilis twenty years previ ously and had been invalided home from India for phthisis. I ad vised nephrectomy, and I heard a few weeks. after that the patient had taken another opinion and that the right kidney had been suc cessfully removed and found to be carcinomatous.