Selected monographs : comprising Albuminuria in health and disease ... Some considerations on the nature and pathology of typhus and typhoid fever ... Moveable kidney in women.

Date:
1884
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Licence: Public Domain Mark

Credit: Selected monographs : comprising Albuminuria in health and disease ... Some considerations on the nature and pathology of typhus and typhoid fever ... Moveable kidney in women. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    284/440 (page 266)
    2GG wliicli occur during clofaBcatioiij are sufficient to dislocate the kidney downwards. We ought not therefore to he surprised at finding among those suffering from movcahle kidney a large number who have recovered from acute febrile diseases, such as enteric fever and ague, or who are still suffering from chronic and rapidly emaciating affections such as phthisis, &c. Thus out of nine of BietVs cases, severe ague and enteric fever had preceded the moveable kidneys in four. A conspicuous part in the production of moveable kidney is also played, especially in women, by affections of the aiclominal walls, which are exposed normally in pregnancy and pathologically in the numerous cases of tumours of the genital organs, to serious alterations in compactness, firmness important, and that it is not always positive, has been definitely proved hy Matthews Duncan and Schatz; but beyond this very little is practically known. And at the outset difficulties meet us. In the first place it seems certain that hernia, descent of the uterus, and descent of the abdominal organs are conditions due to closely allied if not identical causes (this will be dis- cussed again later on, p. 357). In this class of cases the intra-abdominal pressure would seem to be increased. But increased intra-abdominal pressure is equivalent to diminished specific gravity or increased buoyancy of the intra-abdominal organs, which (in the case of the kidneys for instance) would mean diminished tendency to descend. With regard to the effort of straining as being an exciting cause of descent cf the kidneys this explanation seems more than doubtful; for if the kidney is squeezed downwards by the diaphragm with a certain force, it is squeezed upwards by the abdominal muscles with an equally great force, besides the increased buoyancy produced by increase of the intra-abdominal pressme which would tend rather to lift than to depress it. The effect of jerks and falls and perhaps vomiting is a question of impetus and belongs to a different category; their effect in dislocating the kidney, especially when the abdominal muscles are not braced, is easily explained. The only possible mode of reconciling facts with regard to the conditions of the intra-abdominal pressure in our q)resent state of ignorance would be to regard the kidney (and other abdominal viscera) as generally having a tendency to descend, even when their buoyancy was at its greatest, and to regard the apparent increase in the intra-abdominal pressure in lieraia, descent of the uterus, &c., rather as the result of diminished resistance to a generally positive pressure, witli which the weight of the viscera would co-operate. Against this view would have to be put the occasional high position of fioating pelvic tumours and of the pregn.ant uterus. It is not, however, proved that the intra-abdominal pressure is the same in all parts of the abdominal cavity even at the same time.—Thanslator.]