When this condition has developed and operative measures, even of a comparatively trivial kind, have to be undertaken, as for instance emptying of the atonic bladder with the catheter, the surgeon will do well, when not compelled by any great or sudden urgency, to take all precautions specially directed toward averting such septic re sults. It was in reference to what the late Sir Andrew Clarke re ferred to as catheter fever that the attention of the profession was first pointedly drawn to this particular aspect of the subject. Ca theter fever, as a rule, implies the existence of a surgical kidney, though it may not have reached that stage pathologically so as to be at once apparent to the unaided eye. Antiseptic precautions, com bined with the sterilization of the urine by the use of quinine, bo racic acid, salol, and the like, have largely diminished the frequency of instances of this kind. Where the state of the bladder or of the urine requires it, the gentlest form of catheterism with antiseptic ir rigation will often also be required for the purpose of preventing the kidneys being injuriously influenced by the presence of morbid excre tions below them which furnish a ready medium for the cultivation of bacteria. As a rule, the moderate use of stimulants, as in all sep tic disorders, combined with nutritious and easily digested food, will be required.
In reporting a case of unilateral surgical kidney, occurring in a patient upon whom nephrectomy was practised, which was followed by complete recovery of the man, Dr. Weir draws the following conclu sions : "I would consider it hereafter justifiable, if the patient's gen eral condition would warrant it, in a case of acute septic invasion of the kidneys to make on one or both sides an exploratory incision not only in the hope of relieving the acute interstitial invasion, but also perhaps of encountering a larger and well-defined focus of pus, which pathological condition cannot always, it is understood, be readily dis criminated from the more dangerous lesion of the veritable surgical kidney. Should the symptoms point, as in the case narrated, to one kidney only, or should a double exploratory incision show the same result, a nephrectomy may with some hope now be resorted to." I have already stated that, in inflammatory affections involving the kidney where progress is not in the direction of recovery so far as the local symptoms are concerned, a lumbar exploratory incision is to be commended. It has frequently led to- the discovery of an abscess
either within or outside the capsule of the kidney, while in that con dition of tension which exists during the process attending the devel opment of a surgical kidney good might reasonably be expected from the adoption of a well-recognized principle. A timely incision in Dr. Weir's case might possibly even have averted the necessity for a suc cessful nephrectomy. It seems probable that the albuminuria which so frequently follows the nephritis observed in connection with scarlet fever is largely clue, in the first instance, to the mechanical tension under which during this complication the urine is excreted. If we had the means of relieving this physical condition during the process of a nephritis I do not think we should hear so much of albuminuria as a sequel of this eruptive fever. Nor do I consider it as unlikely that this principle of tension-relieving by partial division or puncture of a fibrous capsule will be found on cautious trial capable of further extension. I allude to some of those inflammatory changes in the secreting texture of the kidney which take place in connection with certain affections somewhat vaguely referred to under the name of chronic nephritis. I have met with more than one instance where an albuminuria of some standing disappeared after an unsuccessful explo ration of a kidney for stone. How much of this was due to the direct relieving of one kidney by the removal of tension and to the restora tion of the excretory balance thus effected, is a matter affording in teresting speculation.
In a paper on nephritis Dr. Keyes' has drawn the following deduc tions in relation to the circumstances under which surgical kidney is produced : " (1) To use reasonable care in exploring a -healthy bladder or passing any instrument into it; (2) To use greater care if there be traumatism from stone, tumor, stricture, especially if the powers of the individual be weakened by age or disease.; (3) To ex ercise every known precaution in exploring and manipulating in strumentally cases of dilated bladder in a fibrotic stage with en larged ureters and damaged kidneys." These no doubt represent varying degrees of susceptibility.