Accordingly the left kidney was exposed and its upper third found to be a cheesy mass, obviously an old tubercular process. The patient was then turned over and an exploratory incision revealed a low-lying right kidney which was hypertrophied to twice its size, but otherwise apparently normal. The patient was now turned back and his left kidney removed. Both wounds healed by primary union, the patient making an uneventful recovery.
In later reviewing the case Dr. Keyes states that he would have been warned of tuberculosis on the left side had he but seen some pus in the urine from that side, for, as he further says, “casts on one side and deficient function with pus and without marked enlargement of the kidney upon the other side, is very suggestive of unilateral tuberculosis.” The case is of further interest on account of the greatly hypertrophied right kidney. Aside from demonstrating the capability of one organ to take over the work of its impaired mate, it should emphasize the necessity of keeping in mind such possibilities in making a diagnosis.
Selected Articles
PUERPERAL INSANITY.
ELIOTT BISHOP, M.D.,
Brooklyn, N. Y.
The request from the secretary of this society is a command when he asks me to read a paper, otherwise I should be more profuse in my apology for the modest effort I present to you tonight. For me to present to the gentlemen of achievement before me any of my rare dashes into the field of major procedures in gynecology or obstetrics would be farcical and I was casting about for something of interest for us all to think about together tonight when two post partum patients in the Low Maternity one afternoon developed mental disturbances.
As we must all admire the German attitude of continually interrogating, so we must, when something unusual occurs, say “Why” and “When?” and then become Yankees again and say “What are we going to do about it?” Every few years we must take stock of just such questions and it is perhaps a reasonable duty for some of the younger and less active members of this society like myself to make the inventory.
Definition.
Is it an entity? In Peterson’s “Obstetrics,” Lewis, of Chicago, tells us that the opinion is gaining ground that it is a coincidence and without etiological relation to maternity and that to childbearing can we probably assign only an exciting etiologic relation in the production of an outbreak of insanity. The study of so-called puerperal insanity then resolves itself into the study of the different types of mental disorder as they may occur and reveal themselves in a pregnant, parturient or puerperal woman. (Pp. 825–830.)