)iio;isui-('s  limy  lii'  ronliniiod  I'nr  .1  liiiic,  bill  if  suppression  eonliiiu<-s 
(he  (]uesliun  nrises  wliellier  ;iiiy  ;itleiiipl  In  relieve  Ihe  bloekinj4  o|  tlie 
renal  liilies  by  providiiijj^  an  oullel  nieebanieally  by  incision  of  one  ol 
the  kidneys  should  Ik-  made.  Should  such  a  nu'asure  have  beim 
alteinpted  in  Case  ya,  for  example,  m  vvliieh  the  ”(meral  eoiidition  was 
u'ood  almost  to  the  end.-’  t '|)  to  Ihe  present  (his  procedure,  hrsi 
sii^fj^'esled  by  Weriu'r,*'  appears  to  Inu’c  been  adopted  m  snp|)ression 
of  urine  in  blaekvvali'r  fever  only  on  (v\'o  oi'easions.  In  Ihe  lirst 
case,t  nil  liu-  third  day  of  suppression  lu'phrolomy  was  |)erformed, 
the  How  of  urine  eoiita  iiiiiij^'  abimdaiiee  ol  aibnmm  beinp; 
re-established,  but  snb.se(|nently  aimria  reappeared  and  death 
occurred.  In  the  second  c:aset  nephrotomy  was  perlormed  alter  live 
days'  suppression  of  urine;  the  operation  resulted  m  (he  re  establish 
meni  of  a  profuse  si'erelion  of  urine,  but  de.ilh  occurred  snbsecjnently 
I'rom  proori'ssively  inereasiiij^'  weakness.  It  is  clear,  on  reference  to 
b2  (p.  131)),  Ibat  if  Ihe  bloekint.;-  of  Ihe  renal  passayi's  is 
snflicienlly  extensive  no  mere  incision  ol  llu'  kidney  would  be  ol  mnch 
use,  but  if  the  bloekiii}.;;  is  chielly  eonlined  to  Ihe  duels  ol  Hi'i’tini, 
as  ])robably  oeeiirs  in  most  east's  and  was  observed  in  ( 'ases  7a  and  1  1 
(biffs.  33  ..|()  and  53  5(1),  then  nephrotomy,  if  Ihe  patient's  slren^dh  is 
maintained,  oilers  a  means  ol  re  establishm;.;  (he  How  ol  urine,  It 
does  not,  however,  follow  that  this  will  necessarily  lead  to  recovery, 
for  Lhonf;h  cases  are  on  record  in  which  after  several  days' 
snppressitm  in  blackwater  fever  re  establishmeni  of  the  How  of 
urine  has  occurred  spontaneously,  yet,  nevertheless,  death 
occurred  from  other  coiuphcal ions  ;  two  such  cases  are  recorded  by 
I'.  I’lehn.  Ihe  ellect  ol  incision  is  ol  course  hunted,  as  rcf^'anls  (he 
oullel  which  it  provides  for  the  escape  of  urine,  to  only  a  small 
Iraction  of  the  kidney  incised,  but  it  ma.y  be  pointed  out  that  a  fraction 
of  one  kidney  not  exceeding  one  half  to  one  (|uarler  ol  the  total 
kidney  uia.ss  is  siifhcimit  to  carry  on  Ihe  work  ordinaril)’  |)erfornied 
by  the  two  kidneys, tj  Ihe  best  lime  lor  carryiiij.^'  out  ne|)hrolomy  is 
|)robably  belore  the  suppression,  d('lermined  by  catiu'lerisation,  bus 
lasted  more  than  twenty  lour  to  lorly-eif.^hl1f  hours,  it  beiiifr,  of  course, 
assumed  that  Ihe  j^eiu'ral  condition  of  Ihe  patient  is  siiflieienl  ly  j^mod 
to  permit  of  opera!  ion. 
,1.  t  ‘^‘-'('"‘U'r.wassL'i lii.'l)criiiiui it  ilie  Ni'iiliroliiiiiic  iiKliza'i I  .-  Dciil  med 
VV  (iclicnsclii'.,  U)Oi,  Ni).  ,)2. 
I  /.iciimmi,  MoiioKUipliiv  iilici  Miilaiiii,  Mciisf'.s  I  IiiiuIIhicIi  ,U-i  'ri<)p(!iil<iaiil(li<-ilcii, 
lilt.  1 1 1,  S.  sHyc.  '  ’ 
.  ,  .I-  \\'<'OK'i,  ill, a  liio  Ninni  Ik'Iiii  .Srlnvai/wai-Kti  lic'lici, 
Anh.  I.  ScIhIis-  u.  !  i'()]»cnliy}4.,  ifjoy,  l»(l  ii,  S,  5. 
S  lb  M.  I’caic'c,  llic  inlliifiicc  ot  icdiiclioii  ol  liiiliicy  Milisliuici.-  iipini  inli(ii!ciiiiiis 
inetabolisin,  jcnmi.  ol  Ihxp.  Me<licjnf,  Vol.  10,  p. 
(-p.  W’criicr,  !o(‘ cil,,  p.  i~. 
