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- Herausgeber: Science & Technology Publishing
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
Nashville Journal of Medicine and Surgery Vol. CX. March, 1916. No. 3 is a significant historical medical periodical that offers a fascinating glimpse into the medical practices, research, and discussions of the early 20th century. Published in Nashville, Tennessee, this volume is part of a long-running series that served as a vital resource for physicians, surgeons, and medical professionals in the region and beyond. The March 1916 issue features a diverse collection of articles, case studies, editorials, and reviews that reflect the medical knowledge and challenges of the era. Within its pages, readers will find detailed reports on surgical techniques, advancements in medical treatments, and the management of various diseases prevalent at the time. The journal also includes correspondence from practicing physicians, offering firsthand accounts of clinical experiences and observations. Topics such as infectious diseases, public health concerns, and the impact of contemporary medical innovations are explored, providing valuable insights into the evolution of healthcare. In addition to scientific articles, the journal contains book reviews, meeting notes from medical societies, and updates on medical education and legislation. The writing style is formal and scholarly, aimed at a professional audience, yet it remains accessible to those interested in the history of medicine. This volume not only documents the state of medical science in 1916 but also serves as a testament to the dedication and curiosity of the medical community during a transformative period in history. Nashville Journal of Medicine and Surgery Vol. CX. March, 1916. No. 3 is an essential resource for historians, medical professionals, and anyone interested in the development of medical science, offering a window into the challenges, achievements, and daily realities of healthcare over a century ago.
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Transcriber’s Note:
The cover image was created by the transcriber and is placed in the public domain.
NASHVILLE JOURNAL—OF— MEDICINE AND SURGERY
Original Communications
CASES OF RENAL TUBERCULOSIS ILLUSTRATING MODERN METHODS OF DIAGNOSIS.[A]
Renal tuberculosis occupies a pre-eminent place in the list of those diseases whose initial symptoms are apparently so insignificant and whose onset is so insidious that the true state of affairs is either entirely overlooked or else recognized only after it is too late to accomplish the most good.
[Footnote A: To the courtesy and generosity of Dr. Edward L. Keyes, Jr., with whom I am now associated, I owe the privilege of employing the above cases, which have been selected from his wonderful storehouse of instructive case histories.]
A large number of the cases that come under our observation, exhibit symptoms which are referable solely to the bladder in the guise of a mild cystitis, the patients perhaps complaining only of a slightly increased frequency of micturition by day, not even being disturbed once at night to empty his bladder. Here the temptation on the part of many physicians at once arises to treat such cases lightly—doubtless to dismiss the patient with assurances that his condition is one of a mild inflammation of the bladder which, in all probability, will soon right itself after an irrigation or two, plus a few tablets of urotropin.
On the other hand, the onset may be so stormy or symptoms so terrifying, that we at once think of all the horrible conditions to which the genito-urinary tract is heir. But once our suspicion is aroused as to the possibility of tuberculosis of the kidney, the question of an exact diagnosis, the question of which kidney is involved, and the condition of the other kidney (on which naturally depend the course to pursue) are matters not always easy to decide.
To this end, cystoscopy, ureteral catheterism, renal function tests and the X-ray, lend themselves as invaluable aids. But we must remember that even with so much assistance at hand, the pitfalls are many and it is with the hope of pointing out a few of the former as well as emphasizing the more certain means of diagnosis, that I feel justified in this presentation.
Case I,—E. P. was first seen in September, 1907. He then complained of an ulcer on the penis and frequent and painful urination. One brother had died of pulmonary tuberculosis. The ulcer had appeared a year previously, beginning with a redness of the meatus, which persisted, with superficial ulceration. No history of exposure. In April, 1907, the dysuria began, and at the time he first consulted Dr. Keyes, he was urinating every two hours, day and night. He had also experienced a chill three weeks before this time.
The patient had never noticed any blood in his urine. His weight had dropped from 170 to 149. Physical examination showed his kidneys to be insensitive, and his prostate and seminal vesicles were negative.
The urine was acid, showed a fair amount of pus and albumin, but no casts. No. T. B. bacilli found.
A month later the patient was seen again. In the interim he had suffered an attack of fever (T. 105), and also an intense pain in the right testicle and right side, lasting four days. The urine suddenly showed a great increase in pus after which relief followed. All this time the prostate remained unchanged, but the right kidney was now tender on palpation.
During the next couple of months the patient showed a quite perceptible general improvement on anti-tubercular treatment, but had at times passed some blood in his urine.
However, in January, 1908, he began to have pain all over the abdomen. Cystoscopy having been unsuccessfully attempted two months previously, separate urines from the right and left kidney were now obtained by means of the Luys’ urine separator and showed the following: From the right kidney, 14 cc. of urine, containing 2.4% urea, and a slight amount of pus; from the left kidney ¾ cc. of urine, a very little urea and a large amount of pus. A nephrectomy of the left kidney a few days later revealed a small tubercular pyonephrotic kidney, with an apparently normal ureter.
In April, 1910, this patient was heard from directly for the last time. By virtue of his social status he was forced to lead a life which was not in conformity with his personal welfare, doing hard manual labor most of the time. And while he has suffered various setbacks, he always managed to readily recuperate under enforced rest and anything like proper hygienic conditions. He had even gained considerable weight when, another setback occurring, due to over-exertion, he went to the Adirondacks, immediately contracted pneumonia, and died within a week of its beginning.
While the above case does not serve especially well to illustrate a pre-operative diagnosis of renal tuberculosis, inasmuch as there was no X-ray and no T. B. bacilli were ever found in his urine, it does bring out a certain fairly infrequent symptom which would be extremely—I might almost say—fatally, misleading in the diagnosis of surgical conditions of the genito-urinary tract but for other aids in diagnosis. I refer to the phenomenon of crossed renal pain. That this was renal involvement of a kind requiring surgical interference was well evidenced by the blood and pus in his urine, together with his history of pain at various times. But had we gone strictly by the pain, whose location was chiefly in his right testicle and right side, the patient would have been the victim of a nephrotomy, at least of his right kidney. However, the presence of 2.4% urea with a slight amount of pus (probably pus from the bladder as the Luys’ separator does not always preclude this possibility) from the right ureter as against a very slight amount of urea and a large amount of pus from the left ureter, dispelled all question of doubt as to which kidney should be explored.
Case II, E. B.—Male, gave the following history: A father and two brothers died of pulmonary tuberculosis. Others in the family had lived to ripe ages.
At the age of 31, the patient passed blood in his urine. Three years later he experienced right renal colics and slight irritability of the bladder. The colics continued every few weeks for seven years. Then, because of an attack of intense bladder symptoms, and profuse hematuria, Dr. Charles McBurney diagnosed the condition as renal calculus (this was in 1900—the pre-radiographic days), explored the kidney, and found nothing.
The operation relieved the renal colics. But the bladder still caused him untold agony, the patient urinating blood every two or three hours.
On January 16, 1908, eighteen years after the first symptoms of his disease, the patient consulted Dr. Keyes, having in the interval suffered three vain searches for stone and two cystoscopies, and having developed double tubercular epididymitis.
Physical examination revealed nothing except ridgy seminal vesicles. The urine was cloudy and contained a small amount of albumin, pus, red blood cells, a few hyaline casts and many T. B. bacilli.
The X-ray revealed an irregular shadow in the right kidney region, which the radiographer reported as “consistent with a diagnosis of renal tuberculosis.”
Cystoscopy was now tried again, but failed on account of the extreme pain attending it. Recourse was then had to the experimental polyuria test, which showed fairly good, though deficient renal function. The diagnosis of tuberculosis of the right kidney being now fairly certain, the kidney was removed in April, 1909. Though the pelvis was uninvolved, the parenchyma was riddled with abscesses, the latter confirming the diagnosis.
