Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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downwards or backwards as the patient stands or lies, can hardly exercise such a pressure on the bowel as to produce obstruction while the abdominal walls are lax. In spite of the opportunity of observing very many cases of moveable kidney, he never once found hypertrophied stomach, which is usually found in cases of stenosis of the pylorus. Finally, he proved the complete competence of the pylorus by directly distending the stomach with air, in cases of moveable kidney in which another method had seemed to prove its incom- petence, and, therefore, the truth of JBartels' hypothesis. On the whole Oser considers the causal connection between displacement of the kidney and distention of the stomach as not proven, and only allows the possibility of this connec- tion in cases in which the displaced kidney is so firmly fixed in its new position that it is able to compress the duodenum. The principal objection, however, to Bartels' assumption is its inadmissibility on anatomical grounds. The right kidney even when in its normal ^position lies with only its uioper half parallel to the descending portion of the duodenum, as Fig. 1 shows, and, when moveable, lies with its upper end below the inferior horizontal part of the duodenum, so that the two organs are actually not in contact. Besides, the specific gravity of the kidney, which alone can be considered as con- tributing to real compression (the intra-abdominal pressure being probably somewhat the same as that of water), is far too low to exercise such compression, so that a force is still needed to press the kidney against the gut, and this force is wanting. Moreover, since chronic catarrh of the stomach is found even when the moveable kidney is on the left side, in women who do not lace, and in men who have moveable kidney, it is evident that another explanation of general application must be sought for the connection between gastric disturb- ances and moveable kidney. Such an explanation seems to me to be easily found in the fact that the posterior parietal layer of the peritoneum covers at once the anterior layer of the capsule and vessels of the kidney and passes over the duodenum, so that if the kidney becomes displaced forwards, inwards and downwards, a tendency to dragging and kinking of the limbs of the duodenum both on the right and left side