Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

292/440 (page 274)

sional occurrence of isolated ruptures of the capsule of the kidney by a blow or its contrecoupwill not be doubted. I myself have seen two patients in whom careful investigation proved the sudden appearance of an abdominal tumour, in one case after carrying a heavy weight with the trunk bent sidewaySj and in the other case after a fall, in both cases without any predisposing anatomical cause. In a similar fashion other authors have seen moveable kidneys actually develop in the course of labour after severe bearing down ; but in these cases it is questionable whether a moveable kiduey already produced had not been pushed up during pregnancy by the growth of the uterus, and merely reappeared after delivery. This complaint, however, is more frequently induced by repeated injury, especially by the shock of cough in bronchitis, pleurisy, whooping-cough, and particularly when favoured by other factors, such as the rapid emaciation of phthisis. Even Riolan and Fortal drew attention to the importance of this influence, and they have been confirmed by the obser- vations of Le Bay, Defontaine, Olivier, Eeppler, and Bayer. I myself cannot doubt, when I consider that the kidney lies above the lowest part of the pleura, that every pleurisy with effusion must necessarily depress the kidney, so that under these circumstances, violent concussion of the diaphragm may very easily produce mobility of the kidney. But repeated exertions, such as prolonged and severe labour, lifting great weights, carrying heavy children, violent straining at stool, may act in the same way as fits of cough- ing in loosening the attachments of the kidney and thus contributing to its mobility.^ Literature contains many vouchers for their occurrence. Thus a patient under my care, in whom no predisposing anatomical cause of moveable kidney could be ascertained, had been used to carry heavy burdens on the hips, with tho trunk bent sideways.^ 1 [The steady squeeze, presumably equal in all directions, produced by any of the above methods is surely a very different thing from shocks, such as that of coughing, blows, or falls. This has been remarked m a previous note—Teanslatoe.] , . l f l ■ = [This unsymmetrical position may have been a very important lactor in the case.—TiiAnsiiATOB. J