The Atlanta Medical and Surgical Journal (Volume 10) (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1893. Excerpt: ... broken down and he incapacitated for the ordinary duties of life I would unhesitatingly advise surgical procedure. This, it is needless for me to add, should be done under the strictest aseptic and antiseptic precautions. Nephrorrhaphy or suturing the kidney to the structures around it should be done, the patient should be thoroughly purged and the surface rendered aseptic by washing it with green soap, then ether, then a bichloride solution of 1 to 1000. He should be placed with the face downward, inclined to the side and an incision made two and one-half to three inches from the vertebral spines and parallel to them; beginning one-half an inch to one inch below the twelfthrib and extending to near the iliac crest, cut down through the tissues to the capsule of the kidney. Some surgeons advise dividing this and stitching the edges to either side of the incision, while others advise passing the sutures into the kidney substance. This I would not do unless the capsule was too lax and allowed the kidney too much play; then I would not hesitate to pass my suture a slight depth into the kidney itself. It is well to scratch the capsule with your aseptic finger in order to excite plastic exudation. I would recommend for sutures silkworm gut or kangaroo tendon, as the catgut is absorbed too quickly. All bleeding vessels should be closed either by forcible pressure or ligation. Wash the wound thoroughly with hot sterilized water; pass a large size rubber drainage tube to the bottom of the wound. The wound should now be closed with silkworm gut sutures, which I use for all my surgical work. If there should be much oozing, I would place the drainage tube in position, pack the wound with iodoform gauze, place my sutures in position but not tighten them until the ooz...