The clinical history and exact localization of perinephric abscesses / by John B. Roberts.
- John Bingham Roberts
- Date:
- 1883
Licence: Public Domain Mark
Credit: The clinical history and exact localization of perinephric abscesses / by John B. Roberts. 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 clanger of thoracic involvement is insisted upon by Bowditcli. In nine cases of perinephric abscess, auscultatory signs of pulmonary implica- tion were discovered by him in seven. Although some of these presented no marked cliest symptoms, he regarded these physical signs an important argument for operation in the loin, because they showed that the inflam- mation was travelling upward and beyond tlie original site. Diagnosis—In the very early stages of perinephric abscess tlie diagno- sis is often impracticable. Especially is this so when the symptoms are not very pronounced, and when there have been no previous renal symp- toms to direct attention to the vicinity of the kidney. The symptoms already described make the diagnosis easy, as a rule, when the inflamma- tory process has advanced beyond the initial stage. Lumbago simulates the pain of perinephric abscess, but it is unaccompanied by fever, and causes the patient to walk with a rigidity of spine that is diflerent from the lameness due to the partially flexed hip of perinephritis. I must ad- mit, however, that there may be little or no fever in the latter disease, and that the jiain may cause a mere stiffness of the spine without any spasm of the psoas being present. Moreover, the impairment of the hip motions may in some cases of perinephritis occur late, or may, indeed, be altogether absent. Aching kidney^ and nephralgia, or neuralgia of the kidney, are terms indefinitely descriptive of pain in the renal region from unknown patho- logical cau.ses. Aching kidney gives, accordingtoDuncan,aheavy wearing pain, felt especially in the hypochondrium and frequently associated with pain down the limb and with irritability of the bladder. He believes that there exists swelling of the kidney or perinephric tissue, or both, which can be felt by palpation. The location of the pain in the anteidor region, the fact, at least in women, that it is increased during menstruation, and the non-sequence of more pronounced symptoms are supposed to distin- guish this condition from true perinephritis. Nephralgia may be recognized by the paroxysmal character of the pain and the known neuralgic dia- thesis of the individual, especially if the absence of injury or of genito- urinary irritation is conspicuous. Organic affections of the kidney may of course be the cause of peri- nephric abscess by secondary involvement of the cellular tissue around the organ. The diagnosis of renal lesions, without ])erinei)hric abscess, is made by the symptoms peculiar to each. Cancer of the kidney is usually accompanied by hematuria, ra[)id decline in health, and perhaps later by the physical signs of a distinct growth and the involvement of surround- ing viscera. The tumour may be nodular. Renal cysts are not accompanied by local increase of surface tempera- ture, nor by cedeina in the lumbar region. These symptoms are distinc- 1 J. Mathews Duncan, Medical Times and Gazette, Nov. 16, 1878, p. 503.](https://iiif.wellcomecollection.org/image/b22379289_0014.jp2/full/800%2C/0/default.jpg)
