On the diagnosis of unilateral pyelitis and pyo-nephrosis in women / by Arthur Lewers.

  • Lewers, Arthur Hamilton Nicholson, -1934.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: On the diagnosis of unilateral pyelitis and pyo-nephrosis in women / by Arthur Lewers. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    before she came to the hospital she had been quite unable to hold her urine. She had never passed blood with her urine. On one occasion, in April, 1886, the patient had a pain across the small of the back and in the stomach. The pain was severe and shooting ; it came on suddenly and went away suddenly; it did not cause nausea or vomiting, nor did it pass down towards the legs. On admission, the patient was anaemic, but fairly well nourished ; the temperature normal. There was no ten- derness in the abdomen, nor anything abnormal to be felt there. Vulva and skin adjacent to it red and sore-looking. Hymen perfect but lax. On vaginal examination, pressure on the anterior vaginal wall caused pain, much more than the same pressure on the posterior vaginal wall. The uterus and its appendages were normal. The sound passed into blad- der a distance of three inches or rather less, the measure- ment being taken from the external orifice of the urethra. The passage of the sound caused pain. About a drachm of urine was obtained by passing a catheter; reaction am- photeric ; it contained pus in abundance, and some shreds or flakes ; no casts; only pus-cells and bladder epithelium were seen under the microscope. The other organs were healthy. The case was thought to be one of cystitis only for some time, and the bladder was washed out daily with liquor carbonis detergens (one drachm to a pint) and afterwards with boracic acid lotion, without however, any improvement taking place.—May 31st: The temperature had hitherto been normal; but from this date onwards the patient suf- fered from attacks of high fever running an irregular course ; the temperature on several occasions being as high as 104°. —July 8th : Examined under ether to-day. No tumour to be felt in the region of either kidney.—August 21st : The patient has lost 13 lb. in weight since June 14th.—31st: There have been general pains during the attacks of fever, but no pain specially referred to the region of the kidneys. For the last three weeks increased resistance has been felt in the region of the left kidney ; palpation causing some pain, and exciting the abdominal muscles to contract. When the patient lay on her face, dulness over the left kidney in the back was found to reach two fingers’ breadth lower than over the right kidney. Under ether a lump was easily felt in the situation of the left kidney. The obser- vations on the character of the urine flowing from the right
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