Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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entirely disappears, as all observations agree in stating, the threatening symptoms having reached their acme on the fourth to the sixth day. One of the first signs of recovery is the copious excretion of clear urine of low specific gravity. Dietl, who first directed attention to this hitherto unknown train of symptoms and gave it the name of renal incarceration, considers its essence to consist (as in the case of ruptures) in incarceration of the kidney in the surrounding connective tissue and peritoneum, with subsequent circumscribed peri- tonitis with effusion. He is followed by nearly every writer. Thus Bollet gives the following explanation : In order to understand the symptoms of renal incarceration we need only consider the physical processes which must take place when the kidney (under bodily exertion, violent straining, shock, or congestive swelling at the menstrual period, &c.) changes its place and is displaced from its normal position with more or less force. Apparently it must first make its way within the connective tissue surrounding it, and in which no vacant space exists. It is inevitable during this that parts of the surrounding connective tissue, and even the peritoneum passing over it, should be dragged and pressed, and the vascular arrangements disturbed in some manner. In con- sequence of the irritation and vascular disturbance in the surrounding connective tissue, produced by changes in the position of the kidney, the connective tissue becomes the seat of inflammatory swelling. The kidney is all the more likely to stick in the narrow meshes of the sub-peritoneal cellular tissue and to become really incarcerated there, as its retreat into the normal situation is in a moment cut off. The sym- ptoms caused by the incarceration of a moveable kidney tally with this representation of facts. If the incarceration of the kidney is not reduced early enough, either spontaneously (by the recumbent posture, observation of strict diet, and softening fomentations), or artificially by gentle or, if the diagnosis is quite certain, even powerful pressure on the kidney in the contrary direction, not only does the cellular tissue surrounding the kidney become inflamed, but the inflammation easily spreads to the peritoneum and a more or less violent circumscribed peritonitis supervenes, with inflam- mation of the capsule and parenchyma of the kidney.