Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm.

  • Malcolm, John David.
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm. 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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    near its centre. There were many minute calculi in the left kidney, which was otherwise healthy. At two points the left ureter was visibly distended, apparently by two stones. But on the slightest pressure the obstructions crumbled away. They were collections of minute calculi which had got jammed in the ureter so as to block its lumen. Case No. 20.* In this case an unusually adherent dermoid ovarian tumour was removed on June 11th, 1896, and the patient’s condition gave absolutely no trouble or anxiety for a fortnight. On the sixteenth day she was allowed to get up and lie on the sofa, and she then complained that her belt hurt her. She con- tinued to complain of pain, and two days later there was a rise of temperature. The patient was confined to bed again, and I discovered a decided tenderness in the left kidney, which was enlarged. I then obtained a history that for 18 months the urine had from time to time been thick when passed. The specimen which I had examined before operation became very slightly hazy on boiling. The urine passed during the first fortnight of con- valescence was abundant, acid, and clear, but 1 did not examine it for albumen. On July 3rd, the twenty-second day after the operation, some urine was passed containing about half its bulk of pus. After this the patient’s condition improved somewhat; but the right kidney also was now slightly enlarged and tender. The urine again became clear, and contained only a trace of albumen. There was no trouble from the bowels. The lower abdomen was soft and flaccid, and no hardness or tenderness -was detected in the pelvis by bimanual examination. The left kidney remained very tender. On July 6th, the twenty-sixth day after the operation, the patient’s condition was again worse, the left kidney was very hard and could not be touched without causing severe pain, the temperature rose to 105°, the pulse, which had kept steady, about 84 to the minute, rose above 100. The patient became drowsy and indifferent, and I expressed the opinion that she would die if an opening were not made into the left kidney. The patient’s friends wished Dr. Douglas Powell to see her, and he kindly met me and Dr. Coker, of Uxbridge Road, on July 7th, when it was agreed that the kidney should be opened. This was done immediately. The kidney was very large, not less than 9 inches long, and broad in proportion. On tapping it with a trocar and cannula, I drew off some red fluid, but no pus. I there-