An Address on Some Points in the Surgery of the Kidneys
Authors: H. Morris
Journal: BMJ (1885)

IN accepting the honour which the officers of thle Medical Society have done me, by asking me to open a discussion on the surgery of the kidneys, I felt it was fortunate for me that the President of the Society was a surgeon whose sympathetic interest and attention I shotild be sure to have, not only because of our personal friendship,''bVt, more, because he himself was one of the very first in this counitry to take a practical share in the exploration and removal of the kidn ey.I may at once assume that surgical treatment-that is, certain de- finite surgical operations, such as nephrotomy, nephrolithotomy, and nephrectomy-is, to-day, well recognised as being not only justifiable, but successful, in combatting several of the afections of th;e kidney.This is now granted on all hands; but there still remains much to learn (A) with respect to the symptoms which should guide us to these proceedings; (B) as to which of these operations is best adapted for particular cases; and (c) as to how we can most safely and certainly find out the working power of the second kidney, or even if' there be a' second kidney at all.I sh'all to-night say a few words on each of these points, and thereby, I trust, open up a sufficiently wide, but at the samd time definite, range for an instructive and i-nteresting discussion.A. And, first, let me take the subject of renal calculus, to illustrate oiir need of further and more accurate knowledge of the symptoms of renal diseases.,Formerly, and whilst surgical operations, on the kidney re- ceived the censure and reproaches of surgical aunhorities,.certain sym- ptoms came to be associated with certain, diseases, which were often enough not verified by post mortem examination-; and, of couqe, were never checked off by the disclosures of the operatiig tablei But, of late years, we have hal a way of testing the accuracy of our diagnoses by the results of our exploratory incisions on the living.Now, before a surgical exploration of the kidney, with a view to nephrolithotomy, is undertaken, two things .axerequired; first, that there shall have existed for some time before, and still exist, certain sym- ptoms which are looked upon as characteristic of renal calculus; and, secondly, that these symptoms shall have shown themselves irremedi- able by medicinal treatment.And if I were to agk "what are the symptoms so characteristic of renal calculus as to justify surgical exploration ?"I should be told that they are these.1. Pain in the region of one 1kiduey, extending at times, probably, to the groin and testicle.If this pain be more or less parox- ysmal in character, aggravated by movement, and occasionally exciting vomiting and sweating-in other words, if renal colic occur-the evi- dence is regarded as all the stronger.2. Blood and pus in the urine, not necessarily in more than slight quantity at-any time, and it may be not always, or almost always, present.3. The.absence of any ascertainable condition of the bladder or prostate which can explain these symptoms.4. Frequency of micturition, though by' no means unfrequently absent, is confirmatory of the other symptoms if it be present.Without doubt, these symptoms are strongly,suggestive of calculus, and very often correctly so.But the time has arrived when it should be pointed out that experience seems to show that they are not pQsitively characteristiQ.