For the less complicated wounds involving the kidney, both gun shot and incised, it does not appear that there is much risk arising out of the extravasation of urine into the cellular tissue around the organ, so far as is gathered from such experience as the American war afforded. Little else than good drainage, the removal of foreign debris, and some simple dressing, in the absence of complications, is required.
Passing to those varieties of kidney lesion which are more fre quently met with in civil practice, it will be noted that they usually happen without any breach of surface or even evidence of local con, tusion. The history of some of these cases and the circumstances attending them are often at first clouded by the insensibility of alcohol, and death is known to have occurred from a lesion which was never diagnosed, for the reason that nothing obvious was present to raise such suspicion.
Contused wounds of the kidney are for the most part occasioned by the application of considerable violence in the direction of the loins, as in falls from a height, crushes and squeezes as by carriage wheels, and the like. It sometimes happens that very severe lacerations of the kidney may be inflicted without any sufficient indication of the lesion being apparent for some time afterward, and the attention of the surgeon is not directed to what has actually occurred, until some of the secondary effects of extravasation of urine, inflammation, or hemorrhage appear upon the scene. Mr. Henry Morris, to whom
we are so largely indebted for developing the surgery of the kidney, records' a case of this kind " where the patient was unable to give any explanation of the onset of his illness and denied any recollection of having had an injury, but it is probable that while intoxicated he met with an injury to his side." After a somewhat vague illness of five weeks' duration Mr. Morris saw the patient in consultation, and diagnosing kidney trouble made an exploratory incision in the left ilio-costal region. A very large amount of blood clot was discovered in the retroperitoneal space, when it was ascertained that the source of the hemorrhage was a deep rent on the anterior surface of the kidney. As it was probable that fresh bleeding would occur, the kidney was removed, and the patient made a good recovery.
Pathologically speaking, kidney lesions present every variety in degree, from very small abrasions of the cortical substance accom panied by slight and transient hdematuria to the tearing of the organ almost completely across. One or two illustrations, as indicating points in diagnosis and treatment, may be given.