Diagnosis of renal calculus in women / by Howard A. Kelly.

  • Kelly, Howard A. (Howard Atwood), 1858-1943.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Diagnosis of renal calculus in women / by Howard A. Kelly. 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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    of silver nitrate, and, finally, solutions of mercuric chlorid, beginning with a strength of i : 100,000, and gradually reduced to i : 5000. This was kept up throughout the winter of 1894-95. On two occasions upon emptying the pelvis of the kidney by strong suction, applied at the end of a catheter by means of an air-tight syringe connected with it by a short piece of thick, rubber tubing, I found in the bottom of the conical glass receiver several minute, black specks not over a half-milli- meter in diameter. On putting these under a microscope, they turned out to be little masses of uric acid, holding firmly together, and only crushed with some difficulty by the point of a needle. At no time had any similar pieces been found in the urine passed in the usual way. On the basis of this find, associated with the fact that it was impossible to clear up the urine coming from the pelvis of the kidney, I concluded that the patient had a stone in the pelvis. I operated March 30th, removing a small, black, rough, uric-acid calculus, 11x16 mm., shown in Fig. 2, natural size. The kidney was brought out through a lumbar incision, the renal pelvis opened posteriorly, and the stone was found lying in the lower part of the pelvis over the ureteral open- ing. After its removal, the pelvis was closed by suture with catgut. Before closing, the ureter was palpated and found normal down to the pelvic brim. The abdominal incision was closed down to a small opening in the loin left for a gauze-drain. The patient recovered rapidly, and the urine cleared up completely. When she left my care early in June there was absolutely no pus in it, and, on catheterizing the kidney for a final examination through the bladder and ureter it was proved that clear urine was secreted in the normal manner, and