Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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to other causes^ namely, its frequently intermitting appearance attnicting even clinical attention. These intermissions are of course observed under other circumstances, as for instance, in cancer of the bladder in the region of the trigone, or in the case of the repeated passage of stones from the kidney, but other symptoms characteristic of these disorders render it almost impossible to mistake them for hydronephrosis in a moveable kidney. It should not be expected that, after the disappearance of the tumour, remains of kidney tissue in the hydronephrotic sac will be palpable through the abdominal walls ; the sac is far too thin for accurate palpation and when, empty sinks back against the vertebral column. Even after complete evacuation of unilocular ovarian tumours, the most searching bimanual palpation sometimes fails to make out their walls, as I have repeatedly ascertained. Besides this, hydronephroses of moveable kidney have nothing at all special about them ; indeed, as their origin implies, when they become larger they completely resemble the hydronephroses of fixed kidneys. Both grow in the direction of least resistance, the fixed variety downwards, the moveable upwards, so that it is only when they are of a certain moderate size, i.e. repletion, that their relations to neighbouring organs, especially the colon, are different. The assertions of Simon (177) that in the case of the hydrone- phrotic sacs of moveable kidneys, the ascending or descending colon remains in its normal situation ; and of Ahlfeld (178) — that hydronephrosis in a moveable kidney developes in front of the intestines like an ovarian tumour, cannot therefore be regarded as correct. Again, the hydronephroses of moveable kidneys gradually grow into the lumbar region, so that when of a certain size they cannot be distinguished from the hydronephroses of fixed kidneys. I will not here dwell further upon the remaining diagnostic points, especially upon the value of exploratory tapping and the differential diagnosis between hydronephroses and other tumours.