. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . organs frombeing needlessly excised, and was applicable to both kidneys ofthe same person when both were movable and required fixing. But Hahns method had this drawback, that it was notalways or permanently efficacious; whereas, of course, nephrec-tomy, though only capable of being employed for one kidneycould not be followed by a return of symptoms. The principle o
. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . organs frombeing needlessly excised, and was applicable to both kidneys ofthe same person when both were movable and required fixing. But Hahns method had this drawback, that it was notalways or permanently efficacious; whereas, of course, nephrec-tomy, though only capable of being employed for one kidneycould not be followed by a return of symptoms. The principle of Hahns operation was perfect; what waswanted was the improvement of the technique. I never felt 8 HUNTERIAN LECTURES. confidence in this mode of fixation, and preferred to attachthe kidney itself to the cut edges of the transversalis fasciaand the aponeurosis of the transversalis muscle by meansof three sutures dipped deeply into the posterior surface ofthe organ and running for from three-quarters of an inch toan inch in its substance. I have used various materials forsutures—stout catsfut, kangaroo tendon, and silk, but nowalways employ fine silk. The accompanying figure willexplain my method of inserting the Fig. 1.—Authors method of fixing kidney. Left kidney shown. The results obtained have in most of the cases beenperfectly satisfactory, and I see from time to time patientsupon whom I operated nine or ten years ago with theirkidneys as firmly fixed as can be desired, and who have beenquite free of their former symptoms ever since the , I have had the opportunity of witnessing in theliving bodies of some three or four of my patients the soundand complete holdfast which this method affords. It hasa few times happened to me from six to twelve months orlonger after fixing a hydronephrotic as well as after fixing thehealthy kidney, to have to do a second operation for quite ORIGIN AND PROGRESS OF RENAL SURGERY. 9 different reasons upon the same
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