On the origin and progress of renal surgery : with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter.

  • Morris, Henry, Sir, 1844-1926.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: On the origin and progress of renal surgery : with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    different reasons upon the same organ : and I have then seen my sutures embedded in a mass of tough fibrous tissue, and have had to pull or cut them out from the renal parenchyma before I could detach the kidney. Here they had for months harmlessly remained Avithout showing the least tendency to become the nuclei of calculi, as some surgeons anticipated would be the case. M. Tuffier of Paris, whose admirable experimental work, published in 1889, on this and other branches of renal and ureteral surgery is well known, is of opinion that the paren- chyma where the sutures constrict it, becomes sclerosed and atrophied. This condition did not appear to have been caused in the kidneys of the cases just referred to ; but even if it had been, the amount of the kidney tissue so affected would be small, and could easily be spared without danger to the individual. Moreover, it would be less extensive than the superficial sclerosis which follows the plan which M. Tuffier himself advocates. Tuffier, believing that the proper capsule of the kidney —smooth, thin, little resisting, avascular, and fibrous as it is— prevents the kidney itself from forming firm adhesions with the tissues and organs around it, recommends its partial decor- tication, and the suturing of the tunica propria to the edges of the parietal wound. This done, he thinks the parenchyma does not fail to attach itself firmly to the neighbouring tissues by the whole of the exposed area. The figures show two different ways by which he accomplishes this. Various modifications of Turner's method have been practised by different surgeons, but the principle of them all is to obtain direct adhesion between the bared parenchyma and the deep tissues of the abdominal wall; whether the capsule is de- tached in small squares, or in one large piece, or in many triangular slips, or is merely scarified. A fourth method has more recently been suggested by M. Vulliet* of Geneva, and was first tried by his friend Poullet of Lyons. It consists in making use of a long slender slip of the tendon of the erector spinas of the patient, as the means of fixation of the kidney. After exposing and freeing the * Vulliet: D'une nouvelle operation de nephropexie (Revue Mvdicale de la Suisse Romande, 20 Juin, 1895, pp. 326 et seq.).