A Few Notes on a Few Cases of Renal Tuberculosis

PAUL THORNDIKE
1907 Boston Medical and Surgical Journal  
in the profession is to temporize, and under the soothing narcotic belief and self-commendation of being conservative and safe, to treat the patients with palliative measures so long as they are not in immediate danger or are not actually suffering. In the presence of danger and of pain or at the final insistence of the patients themselves, they are at length brought to the surgeon at a time at which their malady has long since passed the stage at-which surgical intervention could have saved or
more » ... could have saved or greatly benefited or cured them. Renal tuberculosis is another example of the eases which surgery cannot be expected to benefit in any important degree when it is in its later phases; it can be looked to to cure at least 20% of those who are brought at or near its inception, and will prolong life and spare suffering of a still larger proportion under those circumstances. Moreover, up to the present time it is the only treatment which can accomplish anything worth mentioning in the way of cure, and though its results are not brilliant, we may say that they are at least twenty times better than can be hoped for from any other course known to us. I have purposely spoken with reference only to the essential features which concern the application of nephrotomy and nephrectomy in cases of renal tuberculosis, and of the latter operations, only in so far as its curative power is concerned, thinking that to enter into any other parts of this most, interesting subject would lead me too far afield. Just one other point 1 should like to touch upon; it is with reference to what nephrectomy may do to benefit patients in the cases in which we do not look for cure because of the fact that both kidneys are already involved. Nephrectomy is not positively contra-indicated in all of these, and in some of the eases in which I have done the operation myself under these circumstances, and in some in which 1 have had the opportunity to see something of the results of the operation when done by others, I have found great temporary benefits result from it. The indications for taking out one kidney when the other is slightly affected are when the seriously damaged kidney is the seat of extensive suppuration, is causing a great deal of pain and high temperature and when, for any reason, it is better to run the greater danger to life from the performance of a nephrectomy than to have a fistula to care for after doing a nephrotomy. _._
doi:10.1056/nejm190702281560903 fatcat:6agjbpjt3nalbap3xzcmqup4ma