Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

316/440 (page 298)

complete obstruction of the vein witli subsequent thrombosis, or kmldng, or only considerable narrowiug by twisting. If the patient immediately assumes a quiet horizontal posture, we havo at once the most favourable conditions for the organisation of a thrombus, or the untwisting of a twist, or the straightening of a kink in the vein. Finally, my hypothesis explains certain processes, the causes of which have been hitherto obscure. Among these I count the atrophy of the moveable kidney comparatively often found post-mortem, which has been observed by Jjitten and Buchiualcl after ligature of the renal vein in animals, especially when a delay or imperfection in the reestablishment of the collateral circulation has suspended the function of the whole or of certain parts of the kidney. Similarlyit is probable that the colloid degeneration of the epithelium, observed by these authors, and due to the same causes, stands in intimate relation to the discovery of colloid material in the cyst of a hydronephrosis, in which, also through pressure, the function of the kidney has been considerably impaired. But it is certain that the perinephritic and paranephritic abscesses of moveable kidneys mentioned by Biolan himself, and finally the so-called putrefaction or formation of abscesses in the kidney itself, are best explained by thrombosis of the renal vein. A thrombus in a larger or smaller branch of the renal vein remains of course harmless provided it is not infectious and the kidney is healthy. But if these conditions necessary for the harmlessness of a thrombus are absent, especially if there is pyelitis, or if the collateral circulation leading to recovery does not become properly established, abscesses in or near the kidney, or even peritonitis and pyamia easily supervene. We cannot be surprised that obstruction of the renal vein, producing osdema of the kidney, &c., will cause dragging on the peritoneal investment of the capsule, and secondarily pro- duce pain like that of peritonitis, as in twisted ovarian pedicle. In the next place slight adhesions between the kidney and neighbouring organs may form; but the essential part of the process is produced neither by incarceration of the kidney nor by circumscribed peritonitis. Moreover, these adhesions are often produced by the same chronic process as affects