Proceedings of the Boston Society for Medical Observation

A. M. SUMNER
1879 Boston Medical and Surgical Journal  
Doe read the following account of a case of primary cancer of the kidney, and the report of the autopsy was made by Dr. Cutler : Miss G., forty-five years of age, single, dress-maker, always had had good health, except an attack of intermittent fever twenty-one years ago, until January, 1876, when she first consulted Dr. Doe for distress at the epigastrium and constipation. She was at that time quite anaemic, and complained of a general feeling of lassitude, but still continued at her work.
more » ... r tonic treatment she became quite strong again, but constantly complained of a tired feeling in the right lumbar region, with a dull pain extending from just above the crest of the ilium to the pubes, if she overworked. In December following, the distress at the epigastrium returned, attended by anorexia, pyrosis, constipation, headache, and a slight yellowish tinge of the conjunctivas. The urine had at no time shown any trace of albumen. On February 19, 1877, she first noticed that her urine was bloody; it remained so most of the time for ten days, though at intervals it would be clear for a few hours. When the haemorrhage was very free, it was attended by vomiting, but no acute pain. Three weeks later she had a second attack, coming on suddenly and lasting a week. At this time she suffered from a dull, aching pain in the right lumbar region, which would partially subside on lying down. During the interval between the haemorrhages she continued at her work, but looked very pale and worn. On the morning of April 1st, before rising, she was seized with a severe attack of pain in the right lumbar region extending to the spine, and also into the groin. She said it set-ned as if somethiug had turned over in that region, internally. For a few days previously she bad suffered from sharp, cutting pains there. On examination, a tumor was detected in the right lumbar region, extending anteriorly to within an inch of the umbilicus, and from the border of the ribs to the crest of the ilium, and posteriorly nearly to the spine. The tumor was quite movable, easily defined both anteriorly and posteriorly, of an irregular surface, and but very slightly sensitive on pressure. From this time the haemorrhages would recur about once in three weeks, and were always preceded by increased pain in the lumbar region, which would be relieved as soon as the bleeding began. At times the pain would be very acute, like reual colic, just before the haemorrhage, and on one occasion she found a blood clot of the ureter, an inch and a half in length, the pain ceasing immediately after its passage.
doi:10.1056/nejm187909181011205 fatcat:qzzbxih7ifb4nih4bcexzf6vgq