Acute pyelonephritis due to bacillus coli / by H.D. Rolleston.

  • Humphry Rolleston
Date:
[1910?]
Catalogue details

Licence: In copyright

Credit: Acute pyelonephritis due to bacillus coli / by H.D. Rolleston. Source: Wellcome Collection.

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    infection has been advocated by many writers (Barnard^ Dudgeon, Bond, and Box), and is probably the most frequent path of infection. (2) Descending infection or infection due to the excretion of organisms from the blood into the tubules of the kidney. From experimental observations it is probable that the kidney tissue must be damaged before micro-organisms can pass through it (Sherrington), but this may be done by their toxins and by minute emboli, or may be the result of some existing disease of the kidney, such as a calculus, new growth, or nephroptosis. In some cases the isolation of organisms from the blood has been obtained, and thus favours the view that haematogenous infection may occur. Albarran (1889) and Macaigne (1896) early recognised hgemic infection of the kidney with B. coli, and described an ordinary parenchy¬ matous nephritis and multiple miliary abscesses due to this cause. It is assumed that the organisms usually gain entrance into the blood stream through some damaged area of the mucous membrane of the bowel. Thus, it may follow gastro¬ enteritis, diarrhoea, or constipation. It has also been suggested that cracks about the anus may be the point of entrance for B. coli into the blood stream (Ritchie, Thomson). (3) Trans-parietal infection or the passage of micro¬ organisms from the colon to the kidney, probably by means of the lymphatics. In order that this may occur the mucous membrane of the colon must be damaged so as to allow bacteria to penetrate freely into the wall of the bowel and so reach the lymphatics and pericolic tissues. There is reason to believe that B. coli may pass from the colon to the urinary bladder ; and it is also logical to assume that the bacteria may pass from the colon to the pelvis of the adjacent kidney. In one case which I often saw the history of a previous case of appendicitis one year before might have suggested that infection passed direct from an abnormally situated vermiform appendix to the pelvis of the right kidney ; but in this case there were several relapses, and the left kidney was nearly always subsequently attacked, so it was more probable that the infection was not trans-parietal. If the signs of infection are confined to one kidney a local trans-parietal infection would appear to be a reasonable explanation. If an inflamed appendix
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