Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

310/440 (page 292)

Uhsiein accepts this view, and considers the clinical sym- ptoms as produced hy the productioji of a more or less con- siderable peritoneal effusion. According to Gilewsld the incarceration of the kidney is produced by the wedging of the kidney between the last rib and vertebral columuj and by its being held there by the morbid contractions of the abdominal muscles. In a case observed by him this mode of incarceration is said to have been favoured by a curvature of the spine. The kidney thus incarcerated pressed the ureter against the vertebral column, produced pyelitis, acute hydronephrosis, and the symptoms above described. OerumSowitz accept this explanation only in part. To me, neither the character of the acute attacks described (pointing to the incarceration of the kidney), nor the clinical symptoms themselves (referred to the supervention of cir- cumscribed peritonitis, or, according to GileiusJci, to acute hydronephrosis) appear to be correctly explained. It is a priori unlikely that the kidney should become incar- cerated in the cellular tissue which is everywhere so yielding, and especially in the neighbourhood of parts so soft as the intestines. But granting that it could become wedged for a moment between the vertebral column and ribs ; the force to hold it fast in this position would fail, for one cannot possibly assume with (r^Zeit's/ci a contraction of the abdominal muscles lasting for days. A wedging of the kidney between the vertebral column and the anterior surface of the arch of the rib in the healthy skeleton is, however, impossible, because its longest diameter is less than the distance between the parts mentioned. On the supposition of an incarceration it would be most remarkable that the train of symptoms under discussion should, so far as at present observed, in- variably end in recovery without any active treatment, and it is not apparent how an incarcerated kidney could free itself from its incarceration without external interference. Finally, the incarceration of a kidney would certainly be a far more frequent occurrence than it actually is, considering that drag- ging of the cellular tissue and peritoneum takes place m every case of moveable kidney.