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A CASE OF MOVEABLE THIRD KIDNEY.
215 London slums
"could then proceed at a more rapid rate. So valuable is land in the metropolis that no doubt in time by a process of evolution all property of the nature we are discussing will be pulled down to make way for warehouses and offices which pay better, but we cannot wait for this. In the proposed Holborn to the Strand Improvement the cost of land for housing will amount to .E260 for each person while within 1t miles it would be .69. The liability to have to pay the whole cost of the land in sixty years is absurd. THE ADVANCE
OF THE
MEDICAL OFFICER
OF
HEALTH.
its own ureter and blood-supply, and distant about from 3 to 4 in. from the right kidney, which was felt in the right loin and apparently of normal size. The hand passed: up into the left loin also grasped the left kidney which was-. somewhat smaller than the right. In this case the symptoms were no doubt due to the mobility of the kidney and probably to slight pressure on, or kinking of, the ureter. As regards anatomical literature I have consulted Professor Hughes and find that very little has been said about. supernumerary kidneys. In the tenth edition of Quain’s Anatomy, having referred to the common malformationto the absence of one kidney, viz., horseshoe kidney-and the writer says : " The occurrence of an additional kidney isextremely rare; the supernumerary kidney is placed either in front or on one side of the vertebral column or in the pelvic cavity." In most standard works there are only statements. to a similar effect. Debierre (I I Trait6 d’Anatomie") relates. a case recorded by Gavard where three kidneys were situated’. against the lumbar spine, the ureter of the central kidneyopening into the ureter of the right kidney. This he regards. as a case of complete division of the right kidney. There are. also cases recorded by Adami, Day, and Halasy of completedouble ureter attached to one kidney and several cases of’
having
From what I have said I think you will see that the medical officer of health is becoming every day more and more highly specialised and more able to cope with the prevention of disease and of insanitary conditions. Elected by the local authorities and partly paid by the London County Council and controlled by the Local Government Board, could the mode of appointment be improved ?7 Do not the trammels of local influence, not to say the routine of their office, dwarf some of their powers for good ?7 Sir Benjamin Hall’s Act which created vestries has been in operation only about forty years, but during that time the death-rate in London has fallen one-half. England has always been the pioneer of hygiene, but if she has something to teach she has single (lateral) kidney by Birmingham, Dwight, Menzies, also something to learn. Ignorance, says a recent writer, Mackey and Koch, and Tweedy. The following are the pervades the minds of a large section of the public as to the facts of the case which came under my observation. elementary laws of ventilation as shown in the stifling air of I A woman, aged twenty-two years, had been under the care churches, theatres, law courts, schools, and even bedrooms ; of Mr. Coalbank of Teddington for some time suffering from the smoke-polluted atmosphere of our large towns continues indefinite abdominal pain, indigestion, and a general with little effort to alter it. We are indifferent to the hysterical condition. The only special feature in the dangers arising from the consumption of tuberculous meat symptoms was that when the pain was severe there was. and milk, yet a Royal Commission has lately reported diminution in the quantity of urine passed. On examining that any person who takes tuberculous matter into the body the abdomen Mr. Coalbank detected a swelling below theas food incurs the risk of acquiring tuberculous disease ; and umbilicus which was tender and corresponded to the chief will as animals suffer from tuberculosis so seat of the pain. Early in January, 1898, I saw the patient as long again long there exist a fertile source of that disease among human with him and examined her under chloroform. An irregular, beings. The Commissioners recommend the abolition of private flattened, tender swelling was readily felt behind the right. slaughter-houses and the establishment of public abattoirs, rectus muscle at the brim of the pelvis. The swellingand certainly we must have an improved inspection of our was somewhat but by no means freely moveable and had a. meat, whether killed in London or elsewhere. The inspector nodular character. It could not be felt from the pelvis and at Deptford told the Royal Commission that he often examined evidently had no connexion with the pelvic organs. As to 1000 carcasses a day; what could such inspection be worth ?7 the exact nature of the swelling we could not arrive at a, The case of milk is even worse. Meat at least is always definite opinion. The idea of a moveable kidney which preeaten cooked and so the dreaded bacillus is generally killed, sented itself among other suggestions was discarded onbut milk is often taken raw, though it could be heated and account of the situation of the tumour and the fact that it. cooled in a way that would impair its taste but little. Some could not be pushed into the loin. As, however, it was. experiments of Professor Delépine show that out of 93 evidently the chief source of the patient’s troublespecimens of milk taken at random in Manchester 17 were it seemed desirable to explore and ascertain the exact. tuberculous. It does not follow that every child who drank nature of the swelling and see whether anything reof this milk would get consumption, though the danger to mediable could be done. This I did on Jan. 18th, one with a sore mouth would be very great, but there can be 1898. On opening the abdomen in the middle line it. little doubt that a large part of the increasing tuberculosis was found that the tumour was situated behind the of childhood is due to tuberculous milk. The need, there- peritoneum resting on the right side of the lower lumbarfore, of skilled supervision of the milk-supply is very great. vertebras and the brim of the pelvis. The peritoneum having’ Again, tuberculosis does not exhaust the dangers of milk, been divided over the swelling and some fat around it havingfor typhoid fever and other diseases are unquestionably been cleared away it was exposed and presented the appearIt was now thoroughlyance of normal kidney substance. spread by this means. And now, though I have not exhausted my subject I have, protruded through the opening in the peritoneum and preI fear, exhausted your patience. I think I have shown you sented the shape and size of a normal kidney except that the need of overhauling our health administration. It wants it was distinctly lobulated. The hand was then passed!* simplifying. There are too many authorities. It is not a up into each loin and a kidney found normally situated on case for more decentralisation but for more centralisation, each side, as has been already stated (this fact was for a general, uniform, coherent system. The Government, verified a second time before the abdomen was. indeed, might well initiate some fresh legislation. We have closed). The condition was thus clearly one of super-a Prime Minister’s authority for saying, "It is not the renumerary kidney and the patient’s trouble was essènof of it is the improvement arranging political machinery ; tially due to slight mobility of this organ. I made: the daily life of the struggling millions and the diminution no attempt to fix the kidney by stitches as that wouldof the sorrows which so many are called upon to bear have been very difficult and I hoped that the tearing and: which is the task, the blessed task, that Parliaments are disturbance necessary to expose it would lead to suct3 adhesions as would sufficiently fix it in its place. The kidney called into existence to perform." was therefore returned to its former position, the peritoneum, was brought together over it, and the abdominal wall was. closed in the usual manner with deep and superficial stitches. 1899, Mr. Coalbank writes to me that theA CASE OF KIDNEY. On Jan. 4th, lost her usual plaintive frame of mind and i&. patient "has BY W. WATSON CHEYNE, F.R.C.S. ENG., F.R.S., well and happy; she has had no medical attendance since SURGEON TO KING’S COLLEGE HOSPITAL ; PROFESSOR OF SURGERY, her return from the seaside after the operation."
MOVEABLE THIRD KING’S
COLLEGE.
IN the following case an independent third kidney was found on abdominal section and the extreme rarity of such a condition induces me to place it on record. Here a welldeveloped kidney was found on the right side of the lower part of the spinal column just at the brim of the pelvis,
Harley-street,
W.
BUDLEIGH SALTERTON COTTAGE
HOSPITAL.-The-
annual meeting of this institution was held on Jan. 12th. Thefinancial statement showed a balance in hand of .E72. Of’-" the motion of Dr. R. Walker it was decided to admit paying patients at a cost of not less than 12s. 6d. weekly.
"could then proceed at a more rapid rate. So valuable is land in the metropolis that no doubt in time by a process of evolution all property of the nature we are discussing will be pulled down to make way for warehouses and offices which pay better, but we cannot wait for this. In the proposed Holborn to the Strand Improvement the cost of land for housing will amount to .E260 for each person while within 1t miles it would be .69. The liability to have to pay the whole cost of the land in sixty years is absurd. THE ADVANCE
OF THE
MEDICAL OFFICER
OF
HEALTH.
its own ureter and blood-supply, and distant about from 3 to 4 in. from the right kidney, which was felt in the right loin and apparently of normal size. The hand passed: up into the left loin also grasped the left kidney which was-. somewhat smaller than the right. In this case the symptoms were no doubt due to the mobility of the kidney and probably to slight pressure on, or kinking of, the ureter. As regards anatomical literature I have consulted Professor Hughes and find that very little has been said about. supernumerary kidneys. In the tenth edition of Quain’s Anatomy, having referred to the common malformationto the absence of one kidney, viz., horseshoe kidney-and the writer says : " The occurrence of an additional kidney isextremely rare; the supernumerary kidney is placed either in front or on one side of the vertebral column or in the pelvic cavity." In most standard works there are only statements. to a similar effect. Debierre (I I Trait6 d’Anatomie") relates. a case recorded by Gavard where three kidneys were situated’. against the lumbar spine, the ureter of the central kidneyopening into the ureter of the right kidney. This he regards. as a case of complete division of the right kidney. There are. also cases recorded by Adami, Day, and Halasy of completedouble ureter attached to one kidney and several cases of’
having
From what I have said I think you will see that the medical officer of health is becoming every day more and more highly specialised and more able to cope with the prevention of disease and of insanitary conditions. Elected by the local authorities and partly paid by the London County Council and controlled by the Local Government Board, could the mode of appointment be improved ?7 Do not the trammels of local influence, not to say the routine of their office, dwarf some of their powers for good ?7 Sir Benjamin Hall’s Act which created vestries has been in operation only about forty years, but during that time the death-rate in London has fallen one-half. England has always been the pioneer of hygiene, but if she has something to teach she has single (lateral) kidney by Birmingham, Dwight, Menzies, also something to learn. Ignorance, says a recent writer, Mackey and Koch, and Tweedy. The following are the pervades the minds of a large section of the public as to the facts of the case which came under my observation. elementary laws of ventilation as shown in the stifling air of I A woman, aged twenty-two years, had been under the care churches, theatres, law courts, schools, and even bedrooms ; of Mr. Coalbank of Teddington for some time suffering from the smoke-polluted atmosphere of our large towns continues indefinite abdominal pain, indigestion, and a general with little effort to alter it. We are indifferent to the hysterical condition. The only special feature in the dangers arising from the consumption of tuberculous meat symptoms was that when the pain was severe there was. and milk, yet a Royal Commission has lately reported diminution in the quantity of urine passed. On examining that any person who takes tuberculous matter into the body the abdomen Mr. Coalbank detected a swelling below theas food incurs the risk of acquiring tuberculous disease ; and umbilicus which was tender and corresponded to the chief will as animals suffer from tuberculosis so seat of the pain. Early in January, 1898, I saw the patient as long again long there exist a fertile source of that disease among human with him and examined her under chloroform. An irregular, beings. The Commissioners recommend the abolition of private flattened, tender swelling was readily felt behind the right. slaughter-houses and the establishment of public abattoirs, rectus muscle at the brim of the pelvis. The swellingand certainly we must have an improved inspection of our was somewhat but by no means freely moveable and had a. meat, whether killed in London or elsewhere. The inspector nodular character. It could not be felt from the pelvis and at Deptford told the Royal Commission that he often examined evidently had no connexion with the pelvic organs. As to 1000 carcasses a day; what could such inspection be worth ?7 the exact nature of the swelling we could not arrive at a, The case of milk is even worse. Meat at least is always definite opinion. The idea of a moveable kidney which preeaten cooked and so the dreaded bacillus is generally killed, sented itself among other suggestions was discarded onbut milk is often taken raw, though it could be heated and account of the situation of the tumour and the fact that it. cooled in a way that would impair its taste but little. Some could not be pushed into the loin. As, however, it was. experiments of Professor Delépine show that out of 93 evidently the chief source of the patient’s troublespecimens of milk taken at random in Manchester 17 were it seemed desirable to explore and ascertain the exact. tuberculous. It does not follow that every child who drank nature of the swelling and see whether anything reof this milk would get consumption, though the danger to mediable could be done. This I did on Jan. 18th, one with a sore mouth would be very great, but there can be 1898. On opening the abdomen in the middle line it. little doubt that a large part of the increasing tuberculosis was found that the tumour was situated behind the of childhood is due to tuberculous milk. The need, there- peritoneum resting on the right side of the lower lumbarfore, of skilled supervision of the milk-supply is very great. vertebras and the brim of the pelvis. The peritoneum having’ Again, tuberculosis does not exhaust the dangers of milk, been divided over the swelling and some fat around it havingfor typhoid fever and other diseases are unquestionably been cleared away it was exposed and presented the appearIt was now thoroughlyance of normal kidney substance. spread by this means. And now, though I have not exhausted my subject I have, protruded through the opening in the peritoneum and preI fear, exhausted your patience. I think I have shown you sented the shape and size of a normal kidney except that the need of overhauling our health administration. It wants it was distinctly lobulated. The hand was then passed!* simplifying. There are too many authorities. It is not a up into each loin and a kidney found normally situated on case for more decentralisation but for more centralisation, each side, as has been already stated (this fact was for a general, uniform, coherent system. The Government, verified a second time before the abdomen was. indeed, might well initiate some fresh legislation. We have closed). The condition was thus clearly one of super-a Prime Minister’s authority for saying, "It is not the renumerary kidney and the patient’s trouble was essènof of it is the improvement arranging political machinery ; tially due to slight mobility of this organ. I made: the daily life of the struggling millions and the diminution no attempt to fix the kidney by stitches as that wouldof the sorrows which so many are called upon to bear have been very difficult and I hoped that the tearing and: which is the task, the blessed task, that Parliaments are disturbance necessary to expose it would lead to suct3 adhesions as would sufficiently fix it in its place. The kidney called into existence to perform." was therefore returned to its former position, the peritoneum, was brought together over it, and the abdominal wall was. closed in the usual manner with deep and superficial stitches. 1899, Mr. Coalbank writes to me that theA CASE OF KIDNEY. On Jan. 4th, lost her usual plaintive frame of mind and i&. patient "has BY W. WATSON CHEYNE, F.R.C.S. ENG., F.R.S., well and happy; she has had no medical attendance since SURGEON TO KING’S COLLEGE HOSPITAL ; PROFESSOR OF SURGERY, her return from the seaside after the operation."
MOVEABLE THIRD KING’S
COLLEGE.
IN the following case an independent third kidney was found on abdominal section and the extreme rarity of such a condition induces me to place it on record. Here a welldeveloped kidney was found on the right side of the lower part of the spinal column just at the brim of the pelvis,
Harley-street,
W.
BUDLEIGH SALTERTON COTTAGE
HOSPITAL.-The-
annual meeting of this institution was held on Jan. 12th. Thefinancial statement showed a balance in hand of .E72. Of’-" the motion of Dr. R. Walker it was decided to admit paying patients at a cost of not less than 12s. 6d. weekly.