Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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which we find in cases of moveable kidney, allows the pelvis of the kidney and upper part of the ureter to gradually separate itself from the posterior abdominal wall also, and follow the kidney in its movements. In this way an obstacle to the escape of the urine arising from the abnormal course oE the ureter is more easily overcome by the pressure of the retained urine than when the ureter remains kinked and not moveable. To this must also be added that the pain caused by the retention soon obliges a patient to lie flat down, and that in this position the kidney returns to its normal position and the kinked or twisted iireter at once rights and untwists itself. If however, under the influence of severe or prolonged bodily labour, especially in the erect posture, or in con- sequence of extreme descent and rotation of the kidney, the obsti'uction to the escape of urine becomes more frequently repeated, and increases in intensity, the continual change between tense repletion and complete evacuation of the pelvis of the kidney must result by degi-ees in its diminished elasticity and increased distension, and finally in the condition described by Gohnheim as the consequence of so-called kink- ing and improper insertion (and, I would add, torsion) of the ureter—that is, in hydronephrosis. According to his clear description, when, for instance, the ureter is inserted into the kidney opposite the upper part of the pelvis, in the erect posture the urine cannot overflow into (? out of) the pelvis of the kidney until the pelvis of the kidney is full to that point. The pelvis of the kidney is enclosed by a yielding and expansible wall, which gradually dilates under the pressure of the urine collecting within it, until the sac reaches such a size as to be capable, on its part, when full, of completely compressing the ureter, which lies immediately in contact with it. But only in the erect position ! For as soon as the owner of this kidney lies down, as for instance during sleep, the urine flows away continuously, and without any obstacle, out of the sac into the bladder. In the case of kinks, on the other hand, the change is produced by the segment of the ureter situated above the kink, rising some- what as the distension becomes greater, in such a way that the point of bending comes rather to resemble the point