Reflections suggested by a series of cases of renal calculus / by Rickman J. Godlee.

Rickman Godlee

Date:: [1887]

Credit: Reflections suggested by a series of cases of renal calculus / by Rickman J. Godlee. 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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nephrectomy, while exposing herself only to the problematical risk of the onset of albuminoid changes, or the infection of the system by tubercle, if the renal mischief were really tuberculous. Cases such as the three last detailed should encourage us not to be in too great a hurry in urging a patient to submit to the removal of the kidney, for it must be remembered that though the organ may be a source of discomfort and of possible danger, it still does a certain amount of work. It is exceedingly difficult, again, to estimate the exact condition of that of the opposite side, and I have shown elsewhere1 that disturbance occurring in or in the neighbourhood of a much-diseased kidney may cause great functional derangement, amounting even to complete stoppage of secretion in that of the other side, al- though the latter may be much less diseased, in fact, compara- tively speaking, healthy. It must also be borne in mind that the patient cannot properly estimate the possible risks of the operation, and that we have yet to learn a good deal about the history of patients who are left with only one kidney. While, however, it is well to keep the dangers of the opera- tion fairly in view, it should be borne in mind that, in a good number of cases, nephrectomy may be undertaken wTith com- parative freedom from anxiety. Putting out of account the possibility of the other kidney being disordered, the principal dangers appear to be from shock and loss of blood; and of these the former is the most serious. The amount of shock again would seem to depend upon the extent of the adhesion to surrounding parts, and thus the removal of an inflamed kidney of small size is, as a rule, a much less formidable undertaking than that of a large one, and hence the great advantage of draining such a kidney and allowing it to shrink before taking it away. The removal of a kidney tumour, if it be free from the surrounding parts, produces very little disturbance ; but if it be adherent, the shock will probably be severe; in fact, considering the extreme likelihood of recurrence under such circumstances, I believe it is best at once to desist from the operation if the growth have extended at all beyond the cap- sule. Koughly speaking, the danger of a nephrectomy may be measured by the time occupied by the operation : if this ap-

Reflections suggested by a series of cases of renal calculus / by Rickman J. Godlee.

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