Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

328/440 (page 310)

witli its calices. Through these changes in position, the upper portion of the ureter, wliich normally lies on the inner side, comes to point more forwards and outwards, and comes to be placed between the anterior internal wall of the dis- tended renal sac and tlie poritoneura which invests it. Encjlisch similarly gives his opinion against the assumption of a primary abnormal course of the ureter as a cause of hydi'onephrosis. When, however, Simon, starting from this explanation, goes on to assert that the ureter, occluded by a stone, or com- pressed by a parametric cicatrix, or hindered in its evacuation of urine by the distension of the bladder, collapses above the impediment, this hypothesis is actually impossible, for the result of urinaiy obstruction is to produce distension above the point of compression. Thus, the conclusions drawn from this explanation appear unjustifiable. The oi'igin of hydro- nephroses of this kind is therefore inexplicable, either from the artificial explanations of Gruveilhier and Simon, or from the general hypothesis of the congenital character of the morbid insertion and valvular occlusion of the ureter. Moveable kidney, however, appears from the above con- siderations calculated to produce urinary obstruction and consequently hydronephrosis, by frequently repeated dis- placement and twisting and kinking of the ureter. This view is confirmed by the fact that the majority of hydrone- phroses of obscure origin are seen in women of considerable age, and on the rjght side. (2) Proofs derived from Anatomical conditions. When dealing with the post-mortem appearance in move- able kidney (see above), we mentioned some cases in which an abnormal position of the hilum (which sometimes pointed upwards and sometimes forwards), and of the ureter (which sometimes ran upwards in a curve above the pelvis of the kidney) were actually shown. Although hydronephrosis was not simultaneously present in all these cases, we cannot con- clude from this circumstance, as Mosler has done, that it cannot be caused by these abnormalities, but only that it