Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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must be produced, especially as tliese limbs, but particularly the flexure between the duodenum and jejunum, are fixed l>y somewhat firm connective tissue to the vertebral column, and are comparatively unyielding (see Fig. 1). Of course this kinking should not be represented as permanent, as the kidney changes its place with various movements of the body, and in the recumbent position generally returns to its normal position, thus instantly relieving the dragging pro- duced through the peritoneum. When, however, this drag- ging and the consequent obstruction to the calibre of the gut are frequently repeated as the erect position is assumed, and when other influences, such as pendulous belly, which acts in a similar manner, supervene, distention of the stomach and chronic catarrh of the stomach will not fail to appear. With respect again to the jaundice which occurs in move- able kidney, direct compression of the common bile duct by the right kidney has been cited as the cause of the jaundice by Litteoi (log), who observed in Frerichs' clinique (in the case of a woman, thirty-seven years of age, suffering from frequent attacks of pain in the right hypochondrium induced by a moveable kidney on the right side) a jaundice recurring twice within two weeks and only lasting a few days. Litten, who was unable to find a similar observation on record, put aside the idea of gastro-duodenal catarrh and of gall-stones as a cause for the jaundice, and assumes a temporary com- pression of the common bile duct. Stiller (no) had already alluded to the possibility of this connection^ when he replied to the assumption by Bartels of compression of the duodenum by the moveable kidney, that, if the des'cending portion of the duodenum were really com- pressed by the kidney, this same pressure must produce jaundice by pre'ssing on the diverticulum Vateri (the common gall and pancreatic duct) in this situation. This objection, however^ according to Stiller is enfeebled by the anatomical consideration that the right kidney in becoming moveable must sink down along the right or outer surface of the duo- denum, and the compression can hardly be so complete as to close the orifice of the common bile duct which lies on the opposite or left surface. Besides (says Stiller) the subject is at present too novel for us necessarily to accept the