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

  • Rickman Godlee
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

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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    occasionally reached 101 *3°, and the pulse rose to 104 and 108. She was evidently losing ground, and apparently had not long to live. Accordingly, on August 23, I exposed the kidney by a transverse incision in the loin, four inches in length, and then made a vertical cut into its substance large enough to admit the finger, by which the opening was then considerably enlarged. The haemorrhage was not very great, the kidney substance being thin and fibrous. Large irregular masses of stone, weighing in all 7J drachms, the larger of which are shown in Fig. 4, were then extracted by the finger, necrosis-forceps, and a litbotomy scoop, the kidney substance being freely torn down for the purpose. The wound was then cleansed with chloride of zinc solution (40 grs. to 1 oz.) and iodoform ; a large drainage tube was inserted into the kidney, and the gaping wound was dressed with iodoform wool. The operation occupied an hour. The stone was chiefly phosphatic. The immediate result of the operation was to produce considerable shock, but the temperature did not rise, and in the course of a few days fell to about 99°. The pulse, however, rose to 130, and was very weak. Sickness set in and lasted for five or six days. The wound at first was sloughy, but soon granulated ; the Fig. 4. discharge was moderate in quantity and of an offensive odour, which was more or less subdued by various antiseptic materials—iodoform, sanitas, quinine, &c. Some urine no doubt escaped from the wound. That which was passed in the natural way was scanty, but as some of it escaped into the bed it was difficult to estimate the quantity ; as, however, it reached on one occasion 40 oz. in the twenty-four hours, it was presumably not very deficient, and it was interesting to note that the pus, and with it the albumen, practically disappeared entirely and at once. I may summarise this part of the case by saying that the patient slowly con- valesced, the wound closing, except the sinus which held the tube, and that she lost all her former pain, but complained much of the soreness of the wound. The temperature was sometimes normal, but sometimes rose to 100°. The pulse gradually sank to about 92. The urine continued practically normal. In this state she was sent down to Eastbourne on November 15, where she rapidly put on flesh, and returned after a month in very fair general health, but suffering much discomfort from the wound. If the tube were left out, an ac- cumulation of stinking pus took place in the kidney, with accompanying pain and fulness in the loin, and whilst it was in position it caused her a good deal of
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