Diseases of the kidney which require surgical operation : illustrated by three cases / by W. Morrant Baker.
- William Morrant Baker
- Date:
- 1881
Licence: Public Domain Mark
Credit: Diseases of the kidney which require surgical operation : illustrated by three cases / by W. Morrant Baker. 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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![The general health was somewhat impaired by the repeated attacks; but the patient was able to attend as an out-patient, under the care of Dr. Duckworth until the date of his readmission into the hospital. March 15, 1881. At this date, rather more than a fortnight after the patien t’s readmission, he had a severe attack of pain, and, the left renal region being occu- pied by a large, fluctuating and tense swelling, I decided on seizing the oppor- tunity and exploring the tumour by operation. The incisions made resembled those commonly adopted for lumbar colotomy the wound being enlarged subsequently by making an incision upwards at right angles to the first which lay parallel to the last rib. After exposure of the tumour, which proved to be a largely dilated kidney, it was punctured ; and about a pint and a half of pale slightly turbid fluid escaped. [Sp. gr. 1005, neutral in reaction, and containing pus-cells and a trace of albumen.] The opening was then enlarged, and the dilated kidney was explored as thoroughly as possible by the finger and, afterwards, a metal sound. The lower boundaries, which seemed to extend into the pelvis, could not be satisfactorily reached. No calculus was discovered. The edges of the wound in the kidney-cyst were now stitched, as to part of their extent, to the edges of the wound in the abdominal wall, and an India- rubber tracheotomy tube was afterwards inserted to ensure good drainage. The wound was dressed lightly with carbolized oil. Carbolic spray was used during the early stages of the operation, but was dis- continued as soon as all danger of wounding the peritoneum was over. The subsequent history of this case is only one of almost uninterrupted progress towards recovery—that is, so far as the operation and its immediate results are concerned. The patient has completely regained his health and is free from pain. He still wears a drainage tube, through which a considerable quantity of urinary fluid is daily discharged. Quite recently Mr. JBuckland, one of the , surgical dressers, has arranged a simple apparatus, by means of which the fluid is discharged into a bottle which the patient, when walking about, carries slung to his waist. Mr. Buckland has kindly furnished me with the following account of the urinary fluid passed through the renal fistula, and of the urine passed per urethram : Fluid discharged by the renal fistula: average amount (daily) 21 ounces, sp. gr. 1005. Albumen : — July 22, July 29, i. August 1, i. Urea:—July 22, O' 2 per cent. July 29, 0'1 „ August 1, 0*1 „ Acid, slightly ; blood, a trace ; sugar, none. Urine discharged per urethram, average amount daily, 28 ounces, sp. gr. 1015. Albumen, none. Urea .'—July 22, l'O per cent. July 29, 1*4 „ August 1, 2'0 „ Acid,slightly; sugar, none ; blood, none. Case III.—A case of Renal Lithotomy.— A poorly-nourished, rather feeble woman, aged forty-three, was admitted into St. Bartholomew’s Hospital under the](https://iiif.wellcomecollection.org/image/b2245925x_0009.jp2/full/800%2C/0/default.jpg)
