Abdominal Drainplug

Doctors who know how to treat the patient suffering from a virtually complete failure of kidney function find it far more difficult to treat kidney problems that are more numerous and less serious.

Complete breakdown calls for the familiar artificial kidney.* Partial failure calls for repeated "peritoneal irrigations" to wash out the body's natural metabolic poisons--and the process requires an abdominal incision for each irrigation.

For the less critical kidney patients, Harvard Physician John P. Merrill and his colleagues at Boston's Peter Bent Brigham Hospital have devised a bold and ingenious technique: a miniature plastic "manhole"' permanently implanted in the abdominal wall.

Leading to a plastic conduit, the manhole serves the patient in much the same way that a fuel oil intake in the sidewalk serves a suburban home. The conduit, 1 in. to 3 in. long, is inserted through a slit in the belly muscle. It is threaded to take a screw-plug that seals the whole apparatus when it is not in use. For irrigation, this plug is unscrewed and replaced by one with a hole drilled through on the bias. Through this hole a tube is inserted to carry the irrigation fluid. By rotating the plug with its angled orifice, fluid can be directed to or drained from different parts of the abdominal cavity.

Dr. Merrill could not say how much longer his patients had lived because of the treatment. But the fact that one was treated at home by her husband led him to hope that the technique can be made safe for widespread use. At the same meeting of the American Society for Artificial Internal Organs where Dr. Merrill made his report. Seattle's Dr. Belding Scribner carried the do-it-yourself idea a long step farther. Though the irrigation has to be repeated over several hours with a total of about 20 qt. of fluid. Dr. Scribner described a machine with a reservoir and an automatic cycling system with which, he suggested, a patient might be able to treat himself at home.

* Its use involves cutting into blood vessels in the arms or legs to insert tubes. Permanent implantation of the tubes for repeated treatment is still experimental (TIME, May 12).

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