SURGICAL KIDNEY.
Disseminated suppurative nephritis, or, as it is commonly called, surgical kidney, differs materially from the preceding. Here we have an illustration of the septic effects on this organ of disease originating in another part. This form of suppurative nephritis is frequently seen in connection with cystitis caused by the presence of tumor, stricture, or'enlarged prostate. It is, in conjunction with the dilatation of the ureter and of the pelvis of the kidney, the out come of obstructive disease lower down, and its presence seriously handicaps the efforts of the surgeon in removing what caused it.
From experiments made some years ago it seemed probable that if, for the purpose of remedying that painful condition known as extro version of the bladder, it was found possible to connect the ureters with the intestines and to divert the flow of the urine in this way, the emanations proceeding from the latter canal would be sure to destroy life by inducing a condition of surgical kidney. That the ammonia cal exhalations from the bladder are capable of bringing this about there can, I think, be no doubt.
This is a form of kidney disorder which often proceeds to a fatal issue comparatively slowly. Though usually occurring later on in life, the process by which a normal kidney is converted into a surgi cal one—a very inappropriate designation by the way—may be well studied in, and deducted from, such instances as the one recorded in a previous section where a ruptured kidney was treated by Dr. Raw don by nephrectomy. A cystitis from the descent of foetid and de , composing blood clots, in the first place, caused dilatation of the ureter and, secondly, the molecular suppuration and disintegration of the remaining organ. In its relation to obstructed urination and surgical, operations both of urgency and of expediency, it is of chief interest to the practitioner and moment to the patient.
The developmental process of a septic or surgical kidney is mani fested by symptoms of a general character which, though not urgent in themselves, are usually referred to as of a low typhoid nature. The
urinary invalid, perhaps suffering from the difficulties and complica tions attendant upon a large prostate where the use of a catheter is necessary, becomes feverish, his tongue is dry and so usually is his skin, the breath is offensive, there is headache and emaciation, and sleep, however gained, is unrefreshing. The blood, in fact, is charged with products which the kidneys are failing to eliminate.
Then we have, following, variations in temperature of a febrile character and frequently rigors. These are sometimes directly asso ciated with catheterism or the use of instruments, while in other in stances they are not. These rigors are often repeated and it has been stated, but I do not know with what degree of truth, that each re currence marks the development of a fresh focus of pus in the kid neys. Profuse sweating sometimes follows these manifestations, and thus the powers of the patient are gravely taxed. The appetite is capricious and thirst is usually complained of. These symptoms may spread themselves over many weeks.
The urine may vary in character; it is often purulent or ammonia cal. In the earlier stage, where the disorder is limited to a pyelitis, though there is pus in the urine, the latter generally presents a dis tinctly acid reaction. Both kidneys are usually involved, but in stances of unilateral surgical kidney are by no means uncommon. Death generally occurs from exhaustion, though in some instances there is complete suppression of urine, and the end comes painlessly from uraemia. The prognosis is most unfavorable.
The treatment of this condition is for the most part preventive, and the knowledge of what is likely to occur furnishes a sufficient rea son in itself for the early treatment of all forms, urethral and prostatic, of urinary obstruction. In evidence of this we have only to look at museum specimens, where illustrations will be found, without number, of what is likely to occur if strictures of any kind are disregarded.