Other abscesses in the neighbourhood of the kidney can usually be de tected by their causing enlargement behind in the renal region. Accord to Si William Jenner, this is rarely the case with a simple swelling of the kidney.
accumulation may be, perhaps, mistaken for a renal tumour; but a mass sufficiently large to give rise to hesitation must be very rare in the child. Faecal lumps lie very superficially, and can be indented with the finger. Besides, they can be cleared away by a copious injection.
Ovarian tumours are sometimes found in little girls. These dip clown into the pelvis, and the fingers cannot be passed beneath their lower bor der. Moreover, they are rarely covered by coils of intestine. These are all pressed away towards the lateral regions of the groin.
Having ascertained the existence of a renal tumour, it is sometimes. very difficult to decide upon its nature. If the tumour be double, or be accompanied by signs of severe nephritic colic, it is probably due to a hydronephrosis. So, also, if the swelling is noticed to be diminished in size after a copious flow of urine, it may be attributed to the same condi tion. Usually the doubt can be only removed by an exploratory puncture of the swelling. If fluid be withdrawn containing urea, there can be no further hesitation as to the nature of the tumour.
The distinction between hyclronephrosis and ascites is described in the chapter treating of the latter disease (see page 703).
Treatment.—In cases of sarcoma of the kidney we can do nothino. but attend to the general nutrition of the patient. In the case of bygone phrosis :—If occasional reductions in the size of the tumour have been noticed to follow a copious discharge of urine, friction and shampooing of the abdomen, such as proved successful in a case reported by Dr. W. Roberts, may be made use of. In other cases occasional tapping may greatly relieve the patient. Dr. Day reports a case in which nephrectomy was successfully performed by Mr. Knowsley Thornton, and the child re covered. A cure may, however, be effected by a less serious operation. It appears from a case recorded by Dr. Tuckwell, and Mr. H. P. Symonds, of Oxford, that persistent drainage of the sac may sometimes lead to its. shrinking and contraction. In the case referred to—a boy eleven years of age—an incision was made into the sac in the lumbar region, and a large drainage-tube was introduced through the opening. Antiseptic dressings were employed, and at the end of thirteen weeks from the operation the tube was finally removed. The child recovered perfectly, and six months afterwards no sign of the tumour could be discovered on examination of the belly. Operative interference in these cases should not be undertaken unless a healthy state of the urine indicates that the opposite kidney is free from disease.