ST. JOSEPH, MO.

VOLUME XX

CONTRIBUTORS, 1901

8079/he Medical Herald.

LIBRARY, 1901.

ST JOSEPH,

OFFICIAL TRANSACTIONS, MEDICAL SOCIETY OF THE
MISSOURI VALLEY.

[CONTINUED FROM THE DECEMBER NUMBER.]

DOUBLE URETER – REPORT OF A NEPHRECTOMY DONE UPON
A YOUNG CHILD WITH THIS CONDITION PRESENT.

J. E. Summers, Jr., M. D., Omaha.

Double ureter is comparatively uncommon.

Out of 726 con

secutive autopsies made in the New York Infant Asylum four cases
of "supernumerary ureters" were observed. In another series of
autopsies of about one-half this number of cases made in two other
institutions only one case of any kind of kidney malformation was
seen, (Holt). Double ureter proper may be found on both sides
or on one side alone, more commonly the left side. When double
ureter exists there are two pelves, an upper and a lower, either of
which may be the larger and they do not connect. The ureters
either join before reaching the bladder or remain separate and enter
the bladder on the same side at two distinct points.
I have ex-
amined one post mortem specimen of double ureter on both sides.
Each ureter entered the bladder separately on its corresponding
side. In fused kidneys most frequently we find two pelves and two
ureters which enter the bladder in the usual manner; there may be
only one ureter and this enter the bladder in the mesial line. Fusel
kidneys, although usually placed in the middle line, may be situated
as a mass upon one side of the spinal column having two ureters en-
tering the bladder separately on the same side or on opposite sides.

In solitary or unsymmetrical kidney, an extremely rare condition, found once in about 3500 post mortem examinations, the rule is that there is a single ureter which enters the bladder upon the same side on which the kidney is found. In such instances there is no evidence of a rudimentary kidney on the other side and in about 10 per cent of these cases the suprarenal capsule is wanting. It was my fortune to see a post mortem examination at the New York Hospital twenty years ago upon the body of a well-nourished young woman dead of "idiopathic peritonitis". There was found

a large solitary kidney on the left side (one ureter), which was in a state of chronic parenchymatous nephritis. There was also a bicornuate uterus, and the left lung was divided into three lobes and the right lung into four lobes. In another case, the post mortem examination having been made by my preceptor (I missed the au

topsy), a large solitary kidney (one ureter) was removed from the body of a tall, thin man of about fifty years of age, dead of nephritis. A congenitally atrophic kidney on one side may have a ureter varying from an impervious cord to a practically normal tube entering the bladder in the usual way. It is important to observe that a solitary kidney may have two ureters whether there be a true

congenital absence or atrophy of the opposite kidney. (Henry Morris).

My own case of double ureter on the left side with probably the same anatomical arrangement upon the right side may be briefly stated. A fairly well nourished delicate female child, 24 years old, was referred to ine May 26, 1900, by Dr. W. O. Bridges. The father is an epileptic and on the mother's side an aunt had died from plumonary tuberculosis. The child suffered from irritability of the bladder, wetting the bed, napkins, etc. The urine, secured by catheterization, was acid, cloudy and precipitated a whitish purulent deposit. Tubercle bacilli were found in abundance. A tumor evidently the left kidney. was easily palpable.

My Harris segregator and instruments for catheterizing the ureters are only intended for adolescents or adults, hence there was no attempt toward determining the condition of each kidney, in fact, this was deemed unnecessary. Nephrectomy was advised and carried out in the Clarkson Hospital, May 29, 1900. An oblique incision was made and the diagnosis of the tuberculous kidney verified The right kidney was palpated through a buttonhole opening made in the right side. The kidney was somewhat enlarged or rather elongated and lobulated and at the time I thought it tubercular. We decided that the only hope for the child was the removal of the palpably and visibly diseased left kidney. This I did after being considerably puzzled at first before recognizing that I had two ureters with separate pelves to deal with--an upper, much enlarged, tubercular tube, a lower normal tube. The former was followed well down below the pelvic brim, the latter for a short distance only. They were removed together with the kidney. It is my opinion that these ureters entered the bladder alone--had they joined before entering the bladder it is probable the lower ureter would have shown some sign of infection.

Healing was per primam and the child left the hospital June 18. Tubercle bacilli (from the stump of the upper ureter probably) were to be found in the urine. days ago was reported in treatment consisted in the

Since then she has done well and a few a good general condition. The after giving of urotropin and methylene blue.

In connection with the subject of double ureter the writer wishes to draw attention to the fact of the possibility of error in using "segregators" to determine the presence and condition of