Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

285/440 (page 267)

and elasticity. True it is that it is normal for the abdominal walls which have been physiologically stretched during pregnancy, to make as good a recovery as the womb; but in cases where the lying-in has gone wrong, where labours and abortions have succeeded each other rapidly, they become flabby, shrivelled, and thin, and pendulous belly, which is here so injurious, is apt to follow, with or without divari- cation of the recti muscles. If now the intra-thoracic pres- sure is increased {i.e. if the diaphragm is forced down), as in lifting, in diflficult defEecation, or severe efforts of any sort, the efficient means of fixing the abdominal contents furnished by well-braced abdominal muscles fails, and the descent of the kidney is opposed by diminished resistance. But the subjects of pendulous belly are just the persons who are also predisj)osed to severe bearing down efforts, inasmuch as they are usually much constipated. Finally, however, where pendulous belly is present, the action of the intra-abdominal pressure, which normally presses with equal force on all the viscera, is reversed, inasmuch as the bowels which occupy the loose sac formed by the abdominal walls exercise trac- tion on the superjacent parts, including the kidneys, when the patient stands upright. The''' fatter and heavier the ab- dominal walls, the greater the pendulous belly and the greater therefore this traction. This is the obvious explana- tion of the occasional great difficulty of breathing in persons with pendulous belly, the traction of the viscera impeding the normal expiratory movement of the diaphragm. But by the frequently recurring distension of the abdomen, whether physiological or pathological, the peritoneum also is relaxed, and in pendulous belly the anterior peritoneal layer of the capsule of the kidney, and with it the kidney, is subjected to direct traction. The injurious effect of the above-named causes is confirmed by clinical observation. The vast majority of women affec- ted with moveable kidney have borne many children, and, as shown by the appended table of my own observations, it is striking how frequently their deliveries had followed each other closely. Among the forty-two cases observed by mo 1 [It is, however, a fact tliat hernia and allied conditions are commoner in thin, flabby individuals than in Eat ones.—Tcanslatoe.]