Volume 1

Surgical diseases of the kidney and ureter including injuries, malformations and misplacements.

  • Morris, Henry, 1844-
Date:
[pref. 1901]
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Surgical diseases of the kidney and ureter including injuries, malformations and misplacements. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    very fine and loose cellular tissue fibres, which pass from the proper fibrous capsule of the kidney to the perinephric fascia, and wliich are rather stronger and Ijetter marked at the extremities of the organ. It is itself but loosely connected with the proper fibrous capsule of the gland ; but sometimes, after inflammatory changes have taken place in it, the adhesion between them is very intimate and even inseparable. It is perhaps to this packing of areolar fatty tissue, more than to any other single feature of its anatomy, that the kidney owes its fixity of position in the recess of the loin. But m spite of this, and of the restraint aft'orded by the perinephric fascia, the vertebro-costal ligament and the pei'itoneum which covers its anterior surface, the kidney has, in certain persons, an undoubted tendency to shift from its bed and become displaced. The amount of fat in the tunica adiposa is vai-iable. In fat persons it is often very considerable, and may mislead one at the bed-side examination as to the size of the kidney itself. Again, when fat persons lose flesh rapidly the fatty elements of the tunica adiposa are quickly absorbed, the capsule becomes loose, and its connections both with the kidney and the surrounding perinephric fascia are relaxed. The perinephric fascia—The kidney, covered by its proper fibrous capsule, to be again mentioned later on, and embedded in its adipose capsule which has just been described, is contamed within a sheath of thin fascia, which has of late been specially studied by Anderson, Zuckerkandl, Gerota, Glantenay* and Gosset, and others. This perinephric fascia consists of two layers, an anterior and a posterior, which meet above and on the outer side, but not on the inner side or below. To this fascia is attached a very important rSle in the fixation of the organ (Plate I., Figs. 2 and 3). The anterior layer is thinner than the posterior, and follows the course of the peritoneum which covers it. It passes over the anterior surface of the kidney and suprarenal capsule, and the structures at the hilum, and is continuous across the middle line with the correspondmg layer of the perinephric sheath of the opposite kidney. On the left side it is, according to * Glantenay and Gosset, Le Fascia Peri-regnal, Annales des Maladies, des Organes Genito-urinaires, 1898, p. 118 et seq.