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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![neplinilgia ; and prescribed quinia, morphia, and belladonna, and applied a blister over the painful area. Considerable amelioration of pain occurred in a few days, and I tliought lie was getting well; but this was a very temporary improvement. I then examined the urine, whicli contained no pus, by the liquor potass® test, and showed no bloody discoloration. It contained, however, a large amount of albumen. The pain continued in varying intensity, and was accompanied witli great tenderness on both sides of the spine and over the sacrum. Me complained of anomalous feelings in tlie right lower extremity, wliich was described as being like a “ limb aslee[)” ratlier tlian painful. jNiotion, however, was good, tliougli perfoi-med slowly and with care. No heart or lung lesion was discovered by physical exploration. There was no ap])arent fever, no cliills, no special digestive disorder; and tlie urine was voided freely and in a large stream. No liistory of gravel having ever been passed could be obtained. A few days later I thought I detected a slight fulness near tlie lumbar spines, in the region of the kidney, but no duetuation could be distinctly obtained. At this time the urine showed a slight trace, of albumen, liad specific gravity of 1012, and contained no sugar. I considered the pain which existed to be occasioned by pressui’e on the lumbar [ilexus by some kidney affection, |irobably due to the chronic stricture. The pain in the scrotum was less than formerly, but the paresis of sensation in the thigh remained. On March 24th the swelling in the loin was more marked, and the local tenderness great. A large bougie could readily be passed through the, urethra. The introduction of a sound failed to discover any calculi or calculous material in the bladder. The morning and evening temperature was re|)orted by the nurse as below 100° ; tbere were no chills, and the jmlse was 80 to 90. Dr. John Ashhurst, at my request, saw the patient with me in consultation, and thought there w;?s (edema over the swollen surface. We made the diagnosis of abscess in the cellular tissue around the kidney, which Dr. Ashhurst thought to be still below the muscular masses of the hack. Poultices and the application of tincture of iodine were resorted to as the local treatment. Six days later I thought it would be proper to evacuate the pus, as fluc- tuation seemed rnoi’e distinct. At this time the i)ain liad become less severe, and there was no longer any albuminuria. Asking Di-. Ashburst to see the case a second time, I found that he concurred in the belief that o|)eration was advisable. I accordingly made a vertical incision, one and a (piarter inches long, through the skin and lumbar fascia. Introducing my forefinger, 1 bored down through the softened muscles, between two lumbar transverse processes, until at nearly the full length of my finger I evacuated two or three fluidrachms of pus; a drainage tube was intro- duced, and the wound |)oultieed. Carbolized injections tlirough the tube were subseipiently used every day. On the third day after this procedure, a note was made to the effect that there was little or no pain on pressure in the lumbar region, and that the jiain and numbness in the right buttock and extremity liad disappeared since the operation. The convalescence was rapid and uninterrupted. On the tenth day be was sitting up and walking about his room a little. About this time he began cautiously using a large bougie again. The last note, made about one month hiter, sivys he is strong and well, and walks a good detd. He still had !i slightly tender spot over the sacrum near the middle line, and the stricture was irritable after smoking.](https://iiif.wellcomecollection.org/image/b22379289_0010.jp2/full/800%2C/0/default.jpg)
