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

The reason for this is that the blood and
lymph supply of kidney' and perirenal tissue
being continuous infectious material escaping
through the urine finds a place of least
resistance in the bruised and contused perirenal
tissue. This class of cases is very
interesting, becanse the injury may be overlooked
and urinalysis is negative.
Symplomatology.
When the suppuration is secondary to the
disease in the kidney, there are first the
symptoms of that disease; later, there are
those of the suppuration itself, and these
may be divided, first, into those common to
suppuration anywhere, and, second, those
due to the anatomical location of the process.
The suppurative process may here,
as elsewhere in the body, begin violently
and pursue a severe course with the rapid
development of a large abscess and septic
symptoms. It may begin mildly and pursue
a slow course, requiring several weeks
to produce fluctuation. Pulse, temperature
and blood count indicate suppuration.
Special Symptoms.
The anatomical relations of the kidney
to the diaphragm will account for painful
inspiration, resembling the pain of pleurisy,
will explain painful cough and the development
of pleurisy with or without elTusion.
.The fact that the last dorsal, ilioinguinal
ORIGINAL COMMUNICATIONS. 151
by occupation; family and previous personal
history negative; non-alcoholic. Six
weeks before I saw him, while hanging a
set of harness on a peg, the box on which
he was standing turned over, causing him
to fall across the edge of it, striking his left
loin. He continued to work for ten or
twelve days, when he had a slight chill,
associated with pains in the region of the
left kidney. From this time he began to
lose appetite, flesh and strength, and he
thought that he had fever at times. Four
weeks after he received his injury he discontinued
his work, but was not confined
to bed. He had lost thirty pounds in weight,
at which time I saw him. Examination
shows a strong man, reduced by emaciation,
with a stoop and a limp, and complaining
of slight pain in the region of the
left kidney, in which region there is to be
seen a slight fullness. Heart and lungs
normal. Bimanual examination reveals a
deep-seated swelling in the region of left
kidney, tender, and uninfluenced by respiration;
no constipation or vomiting, no reflected
pain.
Treatment.
Incision and drainage with prompt recovery.
The second case is far more interesting,
and at the time very obscure. This patient
was twenty-four years old, strong and ac-
,
,
•
land the iliohypogastric nerves pass down
behind the kidney explains the pain in the
tive, slightly given to alcohol, with no history
of gonorrhoea. He had just begun to
hip, flank, groin, scrotum, testicle and recover from a severe attack of acute pro-
thigh. The rigid spine is explained by the ductive nephritis which had its possible
;kidney resti:;^ on the ([uadratus lumborum cause in alcohol, fatigue and exposure to
muscle; the flexed thigh by the relation of cold and wet, at which time he also receiv-
the kidney to the psoas maguus muscle. A ed a slight injury to the left flank. About
'left abscess can cause painful accumula- ten days after convalescence from his
tion of gas and faeces in ascending and nephritis had begun, when there was no
transverse colon. Constipation may be very fever, and all oedema of feet and face had
tobstinate, even alarming.
disappeared, and the patient was out of bed,
Diagnosis
he was suddenly seized with a severe pain
in the left flank, accompanied by a chill
i May be very easy or very di flic alt. I will
and vomiting; there was intense desire to
not go into detail, but will ([note Ransohoff
urinate associated with agonizing pains in
,in describing the local features.: He says;
the head of the penis. I saw this patient
"Ir\ intaneous oedema makes the diagnosis
introduced and about twenty ounces of
Tnatmint.
urine was withdrawn. This urine wasfilled
with pus. I'Vom this time on, for about
Ill' ision and drainage for the primary forty-eight hours, the catheter was required
i-'-i is sufficient. l'"or the secondary cases, every four or five hours on account of great
he condition of the kidney demands its pain in the bladder, associated with an in-
'ijroi)er treatment.
The I first case I have to report is as foltolerable
desire to pass water. The temperature
during this time was about 102,
lows; Male, 36 years old, harness-maker and patient was very sick. Catheterization