Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

326/440 (page 308)

(that tlie dropsical kidney arises from mechanical causes, one o£ the ureters being compressed and preventing the escape of the urine, which is retained in the kidney and gradually distends it), and expressly remarks that cases are met with, and indeed, are the majority, in which the ureters are quite patent. But the conditions of the malady arc still unknown. Gruveilhier propounded the following explanation for these cases, which has also been accepted by Englisch (129) : li an organic sac or tube has once been expanded and its tissues overdistended so as to lose some of their elasticity, the distention of the walls^ remains, and the collection becomes permanent. In the foetus an obstruction of this kind may be produced by the adhesion of the contiguous epithelial layers. According to Bosehstein the cause of hydronephrosis in the absence of any discoverable impediment, is in many cases ohsmre. Vircliow (130) observes that those cases are the strangest of all in which extreme hydronephrosis is present, in spite of patency of the ureter. Virchotv has frequently examined such cases, and has each time found a valvular obstruction ■caused by a folding of the wall due to an oblique origin of the ureter out of the pelvis of the kidney. Simon (131) has also observed this sort of hydronephrosis, which according to him most frequently gives occasion to operative proceedings, and to which, although practically the most important, but little attention has hitherto been paid. In two cases examined by him the completely pervious ureter arose not only at an acute angle from the pelvis of the kidney, but its upper part even lay in the wall of the pelyis for a length of seven to ten centimetres, yet not in the proper wall of the renal pelvis, but between this and its peritoneal investment. The valvular closure at the renal orifice of the ureter (ostium pelvicum) was so complete, in spite of the perviousness of the ureter, that, even when the sac was filled with water at a considerable pressure, not a drop escaped from the ureter. Cohnheim (132) alludes to the abnormal insertion of the 1 Wunde, a misprint for Wandc—Teanslatoe.