Antall József szerk.: Orvostörténeti közlemények 60-61. (Budapest, 1971)
KISEBB KÖZLEMÉNYEK — ELŐADÁSOK - Kótay Pál: Százéves a vesesebészet (angol nyelven)
Simon has got a positive reply to his first question. Consequently, if the other organ is healthy, the removal of one of the kidneys is not fatal. Nevertheless, some problems were still unsolved. One of these was the following: until then, most operations of the abdominal cavity have ended in death, due to the accompanying peritonitis. In this connection, Simon recalled the experiences of some of his predecessors (Spencer Wells, Baker, Brown ). Nevertheless, how different it is —and how more complicated —to enucleate a kidney from the mass surrounding it than to remove a smooth-walled ovarian cyst. Therefore, he embarked on anatomical studies so as to determine whether it would be possible to rearch the kidney without injuring the peritoneum. Isn't there any other way, except the bdominal cavity which in most cases results in fatal complications? Before him nobody has ever engaged in such studies—at least, according to his knowledge. Based on very detailed anatomical investigations, he succeeded to establish that the organ is located on the peritoneal cavity and that only its anterior surface is connected with the peritoneum. This, however, may be detached with due care. At this point, only the domination of the haemorrhage appeared to be unsolved. His further experiments performed on dogs have clarified where and when is the danger of haemorrhage the greatest. The anatomical conformation of the dog's back muscle is, on the whole, similar to that of man. If during his experiments the line of intersection avoided the massive back muscles (sacrolumbar muscles), only two, relatively unimportant arteries could be found: the intercostal and the lumbar ones, the ligation of which offered no problems. The haemorrhage became severe only when the kidney was freed and lifted from its environment and if during this operation the arteries pertaining to the pedicle of the kidney were injured. The experience shows that this may be easily avoided, if during the freeing of the organ—particularly in the pedunculated area—we avoid the use of sharp instruments, and try to advance as gently, cautiously and bluntly as possible. The bleeding of the renal arteries may be prevented, if —following the preparation of the pedicle—a small piece of renal parenchyma is left over at the end of the arteries, which is meant to impede the sliding down of the silk thread used as a ligature. By the end of July, 1869 he felt that he and his team have finally acquired both the theoretical, as well as the practical informations required. Once again he revealed the situation to his patient. He explained to her that despite the most careful preparations, certain perils can't be entirely avoided. In her unfortunate position the woman said that nothing will deter her from trying again and that she isn't fearing death. On August 2, 1869, in addition to his pupils, he invited to the clinic all the physicians of Heidelberg. He made a short speech about his intentions and described his long and consciencious preparations. In the last minute he became conscious of the fact that his action is practically unique and that he is standing all alone, facing a terrible trial. He reckoned with the possible unfavourable reaction of the scientific community, all the more so as in the past he himself
