Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

283/440 (page 265)

their position are tumours of the suprarenal bodies and pancreaSj examples of wliich are fui'nished by Bayer and Bonnet. A similar effect is produced on the mobility of the kidney by tumours of its own substance, such as sarcomas, carci- nomas, and hydronephroses. In this case the mobility is produced by the great stretching and relaxation which the capsule—the most important attachment of the kidney— sometimes suffers through the increase in weight and size produced by these tumours. This is seen typically in cases of caries of the last thoracic and first lumbar vertebrae, and in psoas abscesses (Hender- son, Ebstein, Calligworth), in which the kidney is deprived of its firm base of support. One of the most important and frequent causes of mobility is absorption of fat from the capsula adiposa and relaxation of the peritoneum. The absence of the fat round the kidney can of course only produce mobility in cases in which it was- previously present in considerable quantity and then became rapidly absorbed. If, however, the fat is only slowly re- moved, an accommodation takes place, and the kidney main- tains its position just as it does in very young subjects who- have never had any fat in the capsules of their kidneys. In the other case, however, after a rapid absorption of the fat, the capsule looks like a relaxed wide-meshed envelope, easily capable of being bodily dragged down from the posterior wall of the abdomen, and within which it is easy for the kid- ney to descend. We see here just the same conditions as we do in the skin, which can be lifted up from the muscles in folds whose size is greater the more rapidly and thoroughly the panniculus adiposus has been absorbed. It generally happens, however, that at the same time as the fat round the kidney is being absorbed, that in the peri- toneal structures and the abdominal walls is also becoming absorbed, so that the means by which the kidney is indirectly secured are also deprived of their strength, and under these circumstances^ slight bearing down efforts, such as those 1 [Here for the first time in this treatise we meet with the very important but very obscure question of the Intra-abdominal pressure. That there is such a force, that it varies, that it has laws o£ its own, that its effects are-