Radiation Service in the Modern Hospital

Abstract

removed. I have twice removed kidneys when the kidney showed an actual excess of function apparently on the diseased side. The kidneys were grossly tuberculous and there was no question of the propriety of removing them. Dr. A. J. Crowell, Charlotte, N. C. : I wish to emphasize the point made by Dr. Lowsley. Guinea-pig inoculation with us has been unsatisfactory and the potato culture has been quite satisfactory. If one will use the potato culture, one will come to depend on it more and more and less and less on the guinea-pig inoculation.Dr. Paul O. Ferrier, Pasadena, Calif. : In southern Cali¬ fornia guinea-pig inoculation is used very largely. It is per¬ fectly astonishing how many of our patients have prolonged clinical cures. That does not mean that surgery should not be used, but I have seen a patient with a sinus that had per¬ sisted for eight months and that patient was cured by Dr. Wang.Dr. P. E. McCown, Indianapolis : I wish Dr. Wang would tell us how he uses tuberculin. We know these patients are constantly being inoculated by tuberculin from their lesions. Is the use of tuberculin confined to the afebrile group?Dr. Gilbert J. Thomas, Minneapolis : Concerning reflux, at the present time we are very careful to see that reflux does not occur in the patients whom we examine. Most of our patients with early renal tuberculosis show few abnormalities on cystoscopic examination. Their bladders and ureteral ori¬ fices may look absolutely normal. In spite of the fact that many times the bladders appear normal and no pathologic changes can be seen around the ureteral orifices, wc have attempted to produce reflux by overdistending the bladder with a solution of méthylène blue (methylthionine chloride-U. S. P.) when the ureteral catheters are in place in the ureters. It is our opinion that if reflux is present, it should occur when the ureteral catheters are within the ureter. If it does occur, méthylène blue is obtained through the ureteral catheters. Reflux has been present in only 1.5 per cent of the early cases of renal tuberculosis. When it is present, we consider the speci¬ men from this side contaminated. Pyelography has on many occasions given us the only evidence that the patient has renal tuberculosis. We do not use the pyelogram when large, destructive lesions are present and pyonephrosis is evident. Among the slides that I showed was that of a large, destruc¬ tive lesion of tuberculosis which was produced during four months. This patient should not have had a pyelogram, but in this instance the pyelogram was made to demonstrate the amount of destruction occurring in this kidney. We find the pyelogram indispensable in the diagnosis of bilateral lesions. The last slides that I attempted to show were to demonstrate the tiny lesions that may occur with beginning destruction from tuberculosis. We are reviewing our pyelograms care¬ fully, because we are coming to believe that when tubercle bacilli are found in the urine, in the majority of instances we can find very tiny filling defects. Many times we have...