Any device, therefore, which will enable us to shorten the time of the operation is a most welcome addition. I have derived the greatest assistance from the use of the Kidney Operating Table" devised by Dr. J. H. Cunningham, of Boston, in the performance of all lumbar renal operations. It is, I think, far the best means at our disposal for the purpose, and I take pleasure in commending it to your favorable notice. I have asked Dr. Cunningham to demonstrate it here this afternoon, and I will not anticipate what he will have to say about it himself. BIBLIOGRAPHY. The following 22 cases are taken from the tables of Schenck and of Tenney, to which references have already been given in the body of the article: Albarran. Communication upon the renal function. (International Congress, Madrid, 1903.) Bevan. (Annals of Surgery, 1903, Vol. 37, p. 575.) Cabot. (Annals of Surgery, Oct., 1903.) Israel. (Chir. Klin. der Nierenkr. Berlin, 1901.) Albarran. (Renal Retention.-Assoc. Francaise d'Urologie, V. 1, 1896.) DISCUSSION. Dr. BENJAMIN TENNEY, of Boston, said that he had had an opportunity of seeing two types of anuria in the same patient on whom he operated. Some of these attacks before the operation lasted for eighteen hours. Fifteen months after the ureteral calculus was removed, the patient slipped and fell in a sitting position. This was followed by considerable pain on the operated side, and one month later he was called to see the patient who had been working on her feet for several consecutive hours. On examination a tender swelling the size of a child's head and movable was felt on the left side. Within an hour after lying down with hips elevated the swelling entirely disappeared, and the patient's bladder had been filled and emptied twice. The earlier attacks were due to the presence of the calculus, and the last to a kink in the ureter, caused by the slipping down of a large kidney. A second operation may be necessary to keep the kidney up in place. Dr. Tenney agreed with Dr. Watson that anuria was frequently connected with a mechanical obstruction. In all the cases which he has looked up in connection with the article to which Dr. Watson referred, there was evidence of such obstruction. In the twenty-one cases of anuria which appeared in the combined tables of Dr. Schenck and Dr. Tenney, there was an operative mortality of 52%. Morris speaks of forty-nine cases operated upon with a mortality of 49%, and compares this with the mortality of 80% in cases not operated. The speaker believes that draining the pelvis of the kidney through the loin, added so little to the risk of an already grave condition, that it was the only treatment to be considered where the anuria had lasted more than thirty-six hours. Dr. PAUL THORNDIKE, of Boston: In the first part of his paper Dr. Watson called our attention to the well known fact that if the renal outlet is partially occluded for a longer or shorter interval there results a hydronephrosis, while if the obstruction is complete and sudden the renal function practically ceases with equal suddenness and the organ begins to degenerate. If there be an infection as well, the destructive process is so much the more rapid. Now if the renal function is so interfered with that the unobstructed kidney ceases to functionate (from reflex causes) we get a more or less complete anuria, and if operation upon the obstructed kidney fails to re-establish the renal secretion it is conceivable that a second operation upon the other (unobstructed) kidney might be indicated. This has never come within the range of my experience and I should like to ask Dr. Watson what degree of suppression of urine would indicate the necessity for such an operation and how long he would wait after the first operation before cutting down upon the second kidney? I wish to add my word of commendation for Dr. Cunningham's table. It has several times enabled me to explore kidneys and remove stones from them without the delivery of the organ on to the loin, and that is something which I have rarely been able to accomplish before. |