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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![ilium is usually found ; and pressure made by the hands, placed one in front and one behind, will sometimes discover a tumour, or elicit a feeling of elastic resistance or indistinct fluctuation. The tumour thus perceptible is rounded, with smooth edges, and moves little, if at all, with the respira- tory act. The girth of the lumbar region becomes from swelling unsym- metrical, and the affected side measures one to two inches more than the opposite region. Tliis is best appreciated by measurement with the tape, for the swelling may be general and not localized. There may also be broadening of the buttock, effacement of the normal hollow in the loin, increased girth of the upper portion of the thigh, effacement of tlie dimple over tlie trochanter, and spinal deviation towards tlie diseased side. The tumour discovered by palpation must be distinguished on the left side from feces in the descending and sigmoid portions of the colon ; and on the right from liver tumour. Evacuation of the contents of the great intestine by laxatives and enemas, and the normal situation of the colon percussion-tympany, will remove one source of doubt; and the motion of the liver during respii-atory acts will get rid of tlie other. The tumefaction is accompanied by a subjective tenderness and sense of tension, wliich will probably be increased as suppuration occurs in the inflamed tissue. It may also cause dysjincEa from pressure upwards against the diaphragm. Finally, in those cases of perinephritis which do not result in resolution, fluctuation becomes evident. This is preceded, perhaps, by i-igors, local oedema, redness, and excpiisite pain on pressure over the advancing [lus. When the abscess is opened, either spontaneously or by operation, the febrile temperature falls, the digestive organs perform their functions pro- perly, and the patient is relieved of pain. Cure soon follows, unless com- plications or extensive burrowing of pus have occurred. In chronic perine- phric abscess the symptoms may be very obscure. The clinical characteristics of perinephric abscess and its proper treat- ment will be illustrated by the following history :— Case I. Perinephric Abscess, subsequent to Internal Urethrotomy, treated by Incision; Rapid Recovery A gentleman who had suffered during a number of years w’ith an irritable stricture of large calibre, was subjected, in February, 1882, to internal urethrotomy. After the opera- tion, w'hich was done by a distinguished professor of surgery, a large bougie w'as passed (36 French). Subsequently he had in the course of a few' days three chills; but was soon able, though weak, to go out of the house. The urethra was systematically dilated with large instruments during this period. Two or three w'eeks after the division of the stricture he consulted me, because of intense pain in the right lumbar region and right testicle, for which he had kept his bed during several days. There was great ]>ain on motion, which sometimes persisted even when the man kept still; but nothing abnormal. exce[)t tenderness on pressure, could be detected in the loin. I looked upon the case as one of myalgia, or of](https://iiif.wellcomecollection.org/image/b22379289_0009.jp2/full/800%2C/0/default.jpg)
