Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

284/440 (page 266)

2CG wliicli occur during defascation, arc suflBcIent to dislocate the kidney downwards. Wo ought not therefore to be sui'pi-ised at finding among those suffering from moveable kidney a lai^ge number who bave recovered from acute febrile diseases, sucli as enteric fever and ague, or who are still suffering from chronic and rapidly emaciating affections such as phthisis, &c. Thus out of nine of Diefl's cases, severe ague and enteric fever had preceded the moveable kidneys in four. A conspicuous part in the production of moveable kidney is also jDlayed, especially in women, by affections of the abdominal walls, which are exposed normally in pregnancy and pathologically in the numerous cases of tumours of the genital organs, to serious alterations in compactness, firmness ; impoiiant, and that it is not always positive, has heen definitely proved hy Matthews Duncan and Schatz; but beyond this very little is practically known. And at the outset difficulties meet us. In the first place it seems certain that hernia, descent of the uterus, and descent of the abdominal organs are conditions due to closely allied if not identical causes (this will he dis- cussed again later on, p. 357). In this class of cases the intra-abdominal pressure would seem to be increased. But increased intra-abdominal pressure is equivalent to diminished specific gravity or increased buoyancy of the intra-abdominal organs, which (in the case of the kidneys for instance) would mean diminished tendency to descend. With regard to the efEort of straining as being an exciting cause of descent ■of the kidneys this explanation seems more than doubtful; for if the kidney is squeezed downwards by the diaphragm with a certain force, it is squeezed upwards by the abdominal muscles with an equally great force, besides the increased buoyancy produced by increase of the intra-abdominal pressure which would tend rather to lift than to depress it. The effect of jerks and falls and perhaps vomiting is a question of impetus and belongs to a different category ; their effect in dislocating the kidney, especially when the abdominal muscles are not braced, is easily explained. The only possible mode of reconciling facts with regard to the conditions of the intra-abdominal pressure in our present state of ignorance would bo to regard the kidney (and other abdominal viscera) as generally having a tendency to descend, even when their buoyancy was at its greatest, and to regard the apparent Increase in the intra-abdominal pressure in hernia, descent of the uterus, &c., rather as the result of diminished resistance to a generally positive pressure, with which the weight of the viscera would co-operate. Against this view would have to be irat the occasional high position of floating pelvic tumours and of the pregnant uterus. It is not, however, proved that the intra-abdominal pressure Is the same in all parts of the abdominal cavity even at the same time.—Tbanslatoe.]