Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

282/440 (page 264)

$logical spocimon, siicli for instance as compression, torsion of vessels, and pressure on nerves. We have already seen that the kidney, lying as it does in the capsula adiposa, against the quadratus lumborum muscle, and for the most part within the bony enclosure of the thorax, is maintained in its position directly by physical pressure, as for instance by the intra-abdominal pressure, as well as by its anatomical attachments. ^As soon, therefore, as one of these factors fails, the kidney may become moveable. Anatomical Causes. Many authors {Bayer, Mollet) have mentioned the pressure exercised by neighbouring organs when enlarged (especially tumours of the liver and spleen) as important causes of moveable kidney ; but this is erroneous. It is true that moveable kidneys have been found in patients with ague or splenic leuktemia or hypertrophy or tumours of the liver, but the well-established fact that they are not constantly found in these diseases proves that the mobility of the kidney can- not be laid to their charge. Since, moreover, tumours of the liver and spleen grow downwards over the anterior surface of the kidney and not in the direction of the long axis of the kidney, such tumours would tend to maintain the kidneys in their position rather than to depress them. The only tumours which could displace the kidneys by virtue of ^ [The logic of this sentence as it stands seems douttful; the author probably means that all the factors are necessary and no more than are neces- sary to maintain the position of the kidney. But this again is not proved. It seems more probable, from the analogy of other organs, that one or more factors are essential and generally sufficient, the others coming into play only in case of failure of the iirst. Thus in a railway train the screw- couplings are generally sufficient, but th6 chain-couplings are added in case of their failure. Or take the case of the uterus, whose descent is not pre- vented by the perineum unless its ordinary means of attachment fail; the perineum generally does not deserve to be described as one of the means of preventing descent of the uterus. This may be seen any day in women whose perineums are completely gone, the uterus nevertheless remainmg high up in the pelvis. The question belongs to a large and important department.—Ta anslatoe .]$

Selected monographs.

Licence and re-use

Contents