File:The principles and practice of surgery (1916) (14761072291).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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spread isalong the bladder and ureters to the kidney.The rapidity of onset and its severitysuggests a blood infection, but Walker hasshown experimentally that bacteria arelymphatics from the urethra to the kidney,to arise in patients with impaired kidneys and on the first passage ofinstruments ; hence the special danger of instrumentation in prostaticcases. (See p. J.39.) Clinically the affection varies widely, and there may be : (a) A single rigor with pyrexia up to 105° or thereabouts. (b) Intermittent fever with repeated rigors lasting sonic days. (<-•) Intermittent fever and rigors with signs of renal infection, thirst,anorexia, weakness, diminished secretion of urine, which may be purulent;suppression oi urine may occur and the patient die in a few days. (d) The infection may be more generalized and pyemic abscesses develop.Prevention is the besl treatment here, by special can-, in the sterilizing of trumentsand the urethra, the latter being anaesthetized, while the patient
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Fig. 210; Stricture of the urethra, in front of which a false passage (containing a fine bougie) leads into the bladder. rapidly transmitted by theCatheter fever is more prone 620 A TEXTBOOK OF SURGERY is kept warm in bed after the examination, especially where the renal function is lowered r where no previous examination has been made. Treatment of Catheter Fever. The patient is kept warm in bed andgiven plenty of warm, demulcent lluid, as milk, weak tea, lemonade, andurotropin. Further operations are delayed till acute symptoms pass off, unlessabsolutely needed to drain the bladder, when this should be done by theperineum for stricture (external urethrotomy) ; in other cases suprapubicdrainage will be best. Where suppression of urine threatens, the blood-pressure is raised by saline infusion per rectum or intravenously ; digitalinhypodermically may be beneficial. As a last resource rapid exposure of thekidneys and stripping the capsule may be tried. Prognosis in Cases of Str

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