Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

355/440 (page 337)

occupations cannot wear tliein unless the lower end of tlie middle piece,, the so-called busk (Blancliette) is well padded, or, as I have tried, arranged to fold up. But in most cases these long stays act extremely well. The favourable effect of this artificial abdominal wall consists not only in rendering the abdominal contents immoveable, but at the same time in the temporary removal of one of the fundamental causes of moveable kidney, pendulous belly, for the radical treatment of which we possess no method.^ The abdominal muscles, which are generally loose in cases of moveable kidney and pendulous belly, must however be also directly strengthened. To this end the use of cold in the form of cold compresses and douches, or sensible hydropathic treatment or sea bathing, or lastly electrical treatment of the abdominal muscles by the induced current, are to be recommended. Methodical shampooing of the abdomen again appears benefi- cial in many ways in the treatment of moveable kidney ; in the first place it strengthens the abdominal muscles, in the second place it is capable of removing constipation with its peculiarly evil consequences, by exciting the peristaltic movements of the intestines, and in certain cases by direct mechanical de- pression of the faeces (184). By the combined use of the above methods remarkably good results are often obtained. A stay of several weeks at ' The above considerations on the very important subject of stays lead us back to the question of the intra-abdominal pressure. Moveable kidney seems to be a member of the Hernial Group (including Hernia, Pendulous Belly, and Descent of the Pelvic Organs, including, probably backward dis- placements of the womb even where descent is not well-marked, Prolapsus Am, &c.), one of the characteristics of which is the relative increase of the intra-abdominal pressure (relative that is to the resistance afEorded by the supports). We need not again discuss the question of increased buoyancy ot tlie kidney by increase of the intra-abdominal pressure, which seems net to be the main question. But increase of pressure by stays will increase the intra-abdominal pressure, and will almost certainly tend to increase the descent of a hernia, of the pelvic organs, or of the rectum, all of which mu.st be considered together. It is quite Ukely that the stays will tend to hx the viscera, but they are at best only palliative appliances, and it must not be forgotten that by increasing the intra-abdominal pressure they come under the class of palliatives which increase the original morbid state — IfiANSLAXOK. 22