AURAL DISORDERS.—The suppuration of middle-ear disease is lessened and the odor removed by the use of hydrogen dioxide. Impacted cerumen may be dis integrated by instilling a few drops of the solution into the ear. Violent effer vescence ensues, the cerumen is disin tegrated, and removal by warm water and syringe rendered easy.
Used with success in 22 cases of sup puration of the middle ear. In ortena and rhinitis it is used in 10-per-cent. strength. F. W. Frankhauser (Times and Register, Aug. 15, '91).
HYDRONEPHROSIS.—Gr.
water, and rEcppO:;, a kidney.
Definition.—A collection of urine in the pelvis and calyces of the kidney due to obstruction.
Varieties.—In addition to the usual or more or less typical form, two subvarie ties are distinguishable: (a) the inter mittent and (b) hydronephrosis para plegics. In the latter type paraplegia develops as a complication, and beyond the mention of this fact it scarcely de serves a separate clinical description.
Symptoms.—The clinical symptoms are somewhat dependent upon the cause and stage of development of the hydro nephrosis. When, as generally happens, the condition is unilateral, it often es capes notice, since the symptoms are slight or even wanting, until a tumor is discoverable. The ureter on the opposite side may become obstructed, followed by ummic manifestations, the latter occur rence first inviting attention to the con dition. In the bilateral form, the uriemic symptoms are apt to supervene easily. The flow of the urinary fluid may be noticeably diminished, though subject to variations. The patient may complain of frequent and acute pains that shoot about the affected loin-space and down ward toward the thigh. Abnormal sen sations of weight and a dragging dis comfort, at times amounting to a dull, aching pain, are quite common. The
latter symptom, particularly in large hydronephrotic tumors, may be continu ous and distressing; less frequently the cyst is painless. The tumor may cause obstinate constipation from pressure of the colon; or it may, if moderate in size, provoke diarrhoea, from the pressure irritation. Resulting from the same cause are flatulency and irregular bowel action. Among gastric symptoms. ano rexia is the most common, while nausea and vomiting are sometimes associated. thematuria may be present, but is rare and usually occurs with attacks of pain. Slight albuminuria may be present. The urine is of low specific gravity; the urea is diminished, and the phosphates are greatly reduced in most instances. Renal casts are absent, as a rule, unless chronic nephritis co-exists as a complication.
In all except the earliest stages there is easily detectable a swelling in the 1 region of the affected kidney. It in creases in size in a slow and gradual man lier, and there is great dilatation of the pelvis of the kidney. Visible bulging usually occurs in the hypochondriac and lumbar regions.
On palpation, a rounded, firm, more or less elastic and sometimes fluctuating tumor is detected. The enlargement may be slightly tender. I would advise energetically that when the tumor is of moderate size it is most readily felt when the abdominal position is employed, ex amining bimanually. Percussion elicits dullness over the mass, except in cases in which, the colon overlies it, when the note is tympanitic: a characteristic sign of renal tumors. Moderate enlargements generally do not descend during inspira tion, though exceptions to this rule rarely occur.