The treatment of traumatic lesions of the kidney : with tables of 155 cases / by William Williams Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of traumatic lesions of the kidney : with tables of 155 cases / by William Williams Keen. 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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    My own tables cover none of those of Maas, but begin, practically, where he left off. The date of his paper, 1878, may be said to mark fairly well the time when modern antiseptic sur- gery was generally practised, and also when the modern surgery of the kidney (which really began with Simon's book, in 1874) was fully established. I have grouped my cases into five tables. (1) Gunshot wounds of the kidney; (2) Wounds of the kidney other than gunshot; and, (3) Subcutaneous rupture of the kidney, with appended tables of rupture of the ureter and of traumatic hydronephrosis. (i) Gunshot Wounds of the Kidney.—Traumatic lesions have, as a rule, two advantages over the lesions of disease. First, they are apt to be unilateral, so that the other kidney is not injured, though, of course, bilateral injuries do take place {e.g., Table III/ 28, 57, and ioi),and, secondly, the uninjured kidney is apt to be healthy or fairly healthy. Thus, any surgical interference is apt to be 'unilateral, and the presumption at least is in favor of the opposite kidney being in such condition that it can supple- ment the work of the wounded one, whether that be temporarily disabled or nephrectomy itself has to be performed. The exist- ence of only one kidney is. considered under the cases of rupture. Gunshot wounds have two disadvantages, however. First, that the treatment of the kidney alone in many cases cannot be solely considered, because there are very frequently concomitant injuries of other organs. Thus, in my own case (I, 4) there were two wounds of the stomach, one of the liver, the intestine was per- forated, and a mesenteric artery was cut. These not uncommon associated injuries both complicate the recovery from the renal wound, prolong any operation, it may be, very seriously, and so obscure the conclusions as to the treatment of the kidney alone. In addition to this, especially if the part wounded is in the loin, some of the clothing, or in case a rib or vertebra be fractured, some of the bone, may easily be carried into the wound. Two such cases are quoted by Morris.' In one case, after seven months, the piece of clothing was passed by the urethra after causing the most prolonged and severe suffering. 1 In later references, I, II, III, etc., will refer to Table I, Table II, etc., and the numbers to the number of the case in that Table. ' Surgical Diseases of the Kidney, p. 159.