Report of two successful nephrectomies / by George Ben Johnston.

  • Johnston, George Ben, 1853-1916
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Report of two successful nephrectomies / by George Ben Johnston. 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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    examination of the urine was made to determine the adequacy of the other kidney to carry on the function of both organs. This examination showed such a marked diminution in the amount of urea eliminated that I advised against immediate operation, deeming it best to obtain further information on this point. The patient then passed into the hands of Dr. Hoge, with whom I again saw the case in consultation. By this time the excretion of urea had more nearly approached the normal and operation was advised.^ The patient was admitted to the Old Dominion Hospital on November 14, 1898. Examination through relaxed abdomi- nal wall revealed the presence of a large, smooth, globular, freely-movable fluctuating tumor in the region of the right kidney, which was thought to be either a hydronephrotic kid- ney or a cyst of that organ. Operation.—November 15, 1898. Chloroform anesthesia. Langenbeck’s incision. As soon as the peritoneal cavity was opened the left kidney was searched for and found to be present. It was much hypertrophied. The intestines were then displaced to the left and padded away with gauze sheets. The posterior layer of peritoneum was incised and the cystic kidney liberated. The vessels and ureter were ligated sepa- rately with heavy, chromicized catgut. There was practically no bleeding. The slit in the peritoneum was closed with a running suture of fine catgut. The abdominal wound was closed with through-and-through sutures of silkworm catgut. An impervious dressing, consisting of gauze covered by a layer of muslin saturated in flexible collodion, was applied. No drainage. The patient was on the operating table only twenty-eight minutes. During this time sixteen ounces of normal salt solution were infused into the subclavicular re- gion. Reaction was prompt and recovery was without event. This patient left the hospital in two weeks from the day of operation. The kidney after removal presented a large cyst, with very thin walls, containing 600 cc. of clear fluid. [Plate I.] A very small amount of apparently healthy kidney tissue re- mained. Microscopic examination of the unaffected portion was made by Dr. Moses D. Hoge, by whom the case had been