Vol. 60, 1909 - University of North Carolina at Chapel Hill

XLII THE CHARLOTTE MEDICAL JOURNAL.
readily ])alpated. A hole is now made in external obli(iue is closely united by two or
the perirenal fascia over the posterior part three mattress sutures and subsequently by
of the kidney, and the renal fat will at once a continuous catgut suture,
protrude. This hole can now be enlarged Apart from the case with which one can
vertically over the posterior surface of the fix the kidney in its j)roper position by this
kidney, and the fat being pushed outwards operation, there is another great advantage
or reniox'ed the posterior surface of the kid- in this incision. liveryone is familiar in
ney isexposed. The renal fat is then partly cases of movable kidney with the ditEcuUy
removed and partly pulled forwards with of being certain that all the symptoms are
the perirenal fascia and the kidney is grad- entirely due to that mobility. With the orually
shelled out and can be readily brought dinary lumbar incision one cannot as a rule
out of the wound. The posterior part of the make any investigation of the condition of
wound is then thoroughly cleared from fat these other parts but with the incision detill
the diaphragm, the psoas, and the quad- scribed it is quite easy to do so. By makratus
lumborum muscles are fully exposed, ing an incision into the peritoneal cavity
The faty capsule and the posterior part of after having exposed the kidney, one can
the renal capsule are thoroughly turned ascertain the condition of the various parts,
aside (it is well to take away a good deal of And not only can these conditions be diagthe
fat in case it should get in between the nosed, but some of them can also be remekidney
and the muscles and prevent firm died without making a further incision. For
adhesion). The kidney is then turned for- example, it is, of course, quite easy to stitch
wards and incisions are made through the the liver up to the edge of the ribs so as to
capsule on the posterior surface, as follows: obtain adhesion between that organ and the
A vertical incision running upwards near diaphragm. And also, the colon can be
the inner side of the posterior surface and fixed up to the under surface of the liver at
curving outwards at the upper part towards the same time. And then the various conthe
upper and inner part of the posterior ditions in connection with the gall-bladder
surface, and then a transverse incision run- are quite accessible by extending the incisning
across the kidney at the lower end of ion.
this vertical incision. The capsule can be jj
I
stripped off as far as the convex border of Johann
the kidney. From each end of the lower
Hofl's Malt with Iron
Digested.
Easily .
J
transverse incision a small vertical incision
is made through the capsule, and then this "' pharmacological action.
i
portion can be pulled down so as to hang Powers of three different kinds are condownwards
from the lower pole of the kid-
^eyed to the body by Iron. First. Are
ney. The fatty capsule and loose fascia
t^°s^ derived from its presence in all the
being prevented from getting
tissues.
in between Second. Those of appetite, digesthe
kidney and the posterior muscles t>0",
the
strength, derived from its action or
kidney can now be turned back and placed
nutrition. Thi>d. Those which arise from
exactly in ''^s the position which is desired;
formation of heemoglobin, without which
it
can be put up as far as one wishes, and "either the blood nor life itself
also would be
at the proper distance from the spine. By possible.
;|
means of strong catgut or
'^^^
silk stitches the
importance of Iron is obvious; but it ,•
vertical piece of capsule is now stitched ^^^^ ^^ S^^'^" '" ^ digestible form.
~
^
down to the muscles behind, taking care not _ .":
..
^^ . „, . T
Pruritus Remedies tbal
to stitch it too Work.
tightly, because the natural
tendency of the kidney is for the outer bor- Pruritus of the skin, anus or vulva, espeder
not to be so closely in contact with the cially when attended by scaling of the skin
the posterior wall of the abdomen as the of the hands or feet, may be invariably set
inner border is. The piece of capsule which down as due to autotoxemia from fecal abis
hanging down from the lower pole is then sorption. This condition is admirably met
stitched to the muscles below the kidney, by the following combination:
and in this way the raw surface of the kid- Juglandin gr. 1-6 to stimulate secretion, f
ney is kept in contact with the surface of relieves costiveness, and favors the loosenthe
muscles behind and acquires firm adhe- ing of fecal matter adherent to the coats
sion to them. The capsule at the lower of the bowels; physostigmine gr. 2-250, to
part is strengthened by stitching down the stimulate peristalsis and the ejection of
detached portion of the renal capsule so as fecal matter; berberine gr. 1-6, to induce |;
to form a sort of ledge on which the kidnev contraction of the relaxed and dilated ti
rests. The kidney having been fixed, the bowel. This dose should be given from L
peritoneum is then allowed to fall back into three to seven timet a day (with the morn- T
position and a few stitches will generally ing salithia flush ) and continued as long as j
bring the deeper muscles together while the the necessity exists. fl