Some cases of abdominal cysts following injury / by Rickman John Godlee.

  • Godlee, Rickman John, Sir, 1849-1925.
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: Some cases of abdominal cysts following injury / by Rickman John 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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    difficult; it was very difficult to find the organ at all, as it was embedded in dense fibrous tissue, very high up, and, of course, small. However, the nephrectomy was accomplished, but I fear that the upper end of the ureter was left behind and is the cause of the non-closure of the sinus, which still discharges alittlepus. The temperature remained high, 101°—103°, for nearly a week and then fell to normal, the ligatures coming away en masse on November 25, a month after the operation. The child has made an excellent recovery and is now fat and strong, but, as was said, a minute sinus still remains. It is difficult to collect all the urine of a child of this age. It may be said, however, that there was no marked diminution in amount after the operation. It varied from 10 or 12 up to 20 or 30 oz., the sp. gr. and the percentage of urea varying in proportion from 1030 to 1008 and from 2 to 1*2 respectively. Other cases of this sort have been recorded. I submit that it is the best treatment to adopt when the patient is distinctly loosing ground and there is evidence that the other kidney is healthy. In fact in this instance, after the first opening, no other cause seemed open to me as it appeared likely that if the pyrexial attacks continued the child would ultimately fall a victim to them. Undoubtedly cases may arise where a permanent fistula communicating with the ureter does no harm beyond the inconvenience it causes, and then the patient must weight this inconveuience against the dangers of a nephrectomy. Whether it might have been better to have delayed inter- ference longer on the chance of the kidney becoming atrophied is another question. Possibly an answer may be suggested by the two cases which are to follow. The first of these almost certainly received some injury to the kidney, but I am quite unable to say what the natures of that injury was and how far it accounted for the symptoms. J. R., set. 23, a valet, was admitted under the care of my colleague Mr. Beck, on July 13, 1885 (No. in hospital register 1420), having been knocked down on that day and run over by a heavy waggon as he lay on his back, the wheel passing over his abdomen from the right hip to the left hypochondrium. He was suffering from shock on admission and vomited the contents of the stomach, flecked over with streaks of bright arterial blood. There was considerable pain all over the abdomen. A drop of blood was found at the end of the catheter when the water was drawn off; on this and the follow- ing two days, as he was unable to pass his water, it was drawn