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.

    19/30 (page 17)
    fore made an incision into the pelvis, but still got no pus. On inserting my finger I found that the calices were much enlarged, and I divided several septa, pushing my finger into the kidney in all directions, but gaining no further information as to the cause of mischief. The parts outside the kidney were quite normal. I inserted a drainage tube and closed the wound. The patient was very feeble for a couple of days, and the temperature remained high. After July 9th the course of convalescence was one of steady improvement, with occasional rises of temperature and attacks of pain, the urine being sometimes alkaline and containing albumen, and sometimes acid and free from albumen. Later on, it was discovered that these attacks yielded promptly to purgation, and Dr. Coker suggested that free purgation might have obviated the necessity for the second operation. This is just possible, although I hardly think it likely. It did not occur to any of us to treat the case in this way at the time of serious danger, and the bowels were then being frequently moved without difficulty. It should further be considered that although I discovered nothing but a much dilated kidney at my second operation, I must certainly have altered the relations of its calices to each other by my manipulations, and that in this way I may have broken down some obstruction to the exit of urine. I am inclined to think that this patient had suffered from pressure of the tumour on her ureters, especially the left, for many months before operation, that the kidney was distended occasionally, and that when she got up after lying on her back for a fortnight, the left kidney was tilted over, and induced a valvular obstruction which was closed by the pressure of the fluid within the kidney, and could not properly relieve itself till the kidney was opened. At the second operation I probably relieved some valve-like obstruction such as is described by Danger in the ‘ Annals of Surgery ’ for June.* For the past two months both the wounds have been quite healed; the patient can get about, and has been in very good health, with the exception of one attack of pain, accompanied by a rise of temperature, which continued for about four days, and on one occasion was as high as 104 F. A free purge was * The operative conservative treatment of sacculated kidney. ‘ Annals of Surgerv,’ June, 1806. (8080) , B