Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

312/440 (page 294)

hydronephrotic atrophy, becomes anaamic and ceases to secrete. But in the case of moveable kidney we see from the com- mencement disturbances in the secretion of the urine, amounting even to hsematuria. In a woman, the subject of an uretero-vaginal fistula (112), moreover, I produced an unilateral hydronephrosis by the use of the probe, but this was not followed by the symptoms enumerated above. In unilateral hydronephrosis again produced unintentionally by sewing up the ureter in the course of the operation for vesico- vaginal fistula, I have seen symptoms develope which were essentially different from those tinder discussion. We must, therefore, look out for another explanation of the production and of the clinical symptoms accompanying so-called renal incarceration, and this I find in an intense local disturbance of circulation in the moveahle Icidney, caxised, hy twisting or JdnMng or acute angular insertion of the renal vessels, especially the vein, in consequence of the change of position and rotation of the Mdney. Although the authority of Gohnheim (113) (who thinks that renal obstructions due to local obstacles to the return of blood in the renal veins play hardly any part in pathology) is opposed to this supposition, its correctness seems to me to be supported by a series of important reasons. We have already discussed the relation of the renal vessels and ureter during descent and rotation of the kidney, a rela- tion which is of great importance for the ti-ain of symptoms before us. We have also already found the acute angular course and torsion of the renal vessels established by some autopsies. In order, however, to bring these relations more prominently into view I have got some preparations of kidneys made artificially moveable in the dead subject drawn, these preparations showing some kinds of twisting and kink- ing of the vessels (see Tigs. 4 and 5^). But my hypothesis is supported by expeinment and by observation of the clinical changes even more strongly than by these drawings. » I have totliank Br. GuUmann, Dii-ector of tlie State Hospital at Moabit for furnishing me with a subject, and Dr. Smiclt for help in preparing the dissections. Figures 4 to 8 are drawn after nature by Herr Ch-ohmann.— AUTHOE.