Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

296/440 (page 278)

kidney is exposed to greater pressure tlian the left. Otlier things being- equal, tho loft kidnoy would be much more easily displaced laterally in the left hypochondrium which is not occupied by firm abdominal glands, than the right, for the right kidney could only bo displaced by more intense pressure or traction from under the liver, which occupies the whole of the right hypochondrium. But the different behaviour of the right and the loft kidney seems to me to be best explained by the differences in their mode of attachment. 1. The upper end of the descendincj colon lies higher and is attached to the ribs further to the left and further down (seitlicher und tiefer) than the ascending colon. Whereas the ascending colon lies against the middle of the right kidney, the descending colon lies against the external convex border of the kidney. Hence it follows that the left kidney, although placed on the same horizontal level as the right, is fastened to the posterior abdominal wall both higher up and more firmly (hoher hinauf und starker) than the right.^ 2. The descending colon and the splenic flexure are tauter (straffer) and shorter in their attachment to the posterior abdominal wall than the ascending colon and hepatic flexure ; in other words, the mesocolon of the splenic flexure is shorter and tauter than that of the hepatic flexure. This indirect means of attachment is therefore stronger on the left than on the right. 3. The ascending colon does not form a right angle with the transverse colon as the descending colon does, but an obtuse angle, or even forms a dependent loop before passing into the- transverse colon. The reason for this peculiar behaviour of the ascending colon, which I have seen a few times in children, and many times in adults, and which Sappey has described as normal,, appears to me to be the upward movement of the fasces in ' [This sentence, which is somewhat obscure, seems to mean that the colon (which by means of its attachments to tho postbrior abdominal wall on the one side and to the kidney on the other, is one of the defences of the kidney against downward displacement) is itself attached to the posterior abdominal wall higher and more extensively on the left side than on the right.—