Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

311/440 (page 293)

Taking the analogy of a strangulated^ hernia the symptoms consequent on incarceration of the kidney have been explained in this bearing also by the supposition of a circumscribed peritonitis. This idea has been strengthened by the resem- blance of the clinical symptoms to those of circumscribed peritonitis due to other causes, such as perimetritis and peri- typhilitis, by the supervention of great distention, which was taken for effusion, and finally by the fact now and then observed that during and after an attack the mobility of the kidney is restricted. The invariably favourable course, however, of this supposed peritonitis with effusion, as well as the circumstance that the elfusion, which is sometimes enormous, disappears in from six to eight days, cannot fail to throw doubt on the correct- ness of this explanation. Besides, the peculiar outline of impaired resonance which is found diffused around the move- able kidney, does not admit of easy explanation on the assump- tion of circumscribed peritonitis. The opinion of Gilewslci that acute hydronephrosis produced by incarceration of the kidney constitutes the essence of the process under discussion, appeai-s again unlikely, inasmuch as the weight of a normal kidney is far too small to be able to overcome by its pressure the pressure under which the urine is secreted into the ureter ; besides an acute hydrone- phrosis is not competent to distend the pelvis of the kidney to the size found in those cases, and, moreover, it does not, as we know from numerous experiments, produce the sym- ptoms we have named. A dog whose ureter has been tied, secretes, as Gohnhewi (iii) says (when the operation is not followed by inflammation, the general health remains unim- paired and the same food is taken), the same quantity of urine and that of the same specific gi-avity as before. And this not only in the first days and weeks after the operation, but also later, when the occluded kidney is attacked by * [Great difficulty has been felt in deciding between strangulation and incarceration as the equivalent oE Einkloramung ; but the latter word has been chosen, as tallying best with the facts, as a word used synony- mously with Einklemmung frequently in the text, especially in connection with the name of Dietl, the author of the term. But, in the present passage, the reference is obviously to the general class of Strangulated Hernia.— TxiANSLATOH.]