432 CLINICAL APPLIED ANATOMY. 



and so contrasts with swellings of the gall bladder or spleen 

 which are more superficially placed. A word of warning, how- 

 ever, is necessary with regard to massive splenic tumours, for 

 these too tend to fill the loin and can be felt through the lumbar 

 muscles if of sufficient size. 



The kidneys normally move slightly in respiration, following 

 the movement of the diaphragm. Renal enlargements also show 

 the respiratory excursion unless fixed by adhesion. Owing to the 

 fact that the kidneys are not so closely related to the dome of 

 the diaphragm as the liver and the spleen are, the respiratory 

 excursion of the latter viscera and of the fundus of the gall 

 bladder, is more marked. 



As a renal tumour increases it may obstruct the passage of 

 blood along the left spermatic vein in the male by stretching the 

 vessel in front of it. A gradually increasing varicocele may be 

 produced in this way. The right spermatic vein does not open 

 into the renal vein like the left, but joins the inferior vena cava 

 at a lower level, consequently it is not liable to be compressed by 

 an enlargement of the right kidney. 



DISEASES OF THE BLADDER. 



Cystitis. Inflammation of the mucous membrane of the bladder 

 is most commonly the outcome of infection. Micro-organisms 

 usually reach the bladder in one of three ways : First, ascend- 

 ing along the urethra, the distance being comparatively long in 

 the male and short in the female though the same anatomical 

 fact may serve to explain the reason of the more complete and 

 prolonged retention of organisms within the bladder in the male 

 as compared with the female ; secondly, descending from a focus 

 within the kidney, as, for instance, in the secondary infection of 

 the bladder from a tuberculous pyelitis ; and, thirdly, although 

 rarely, through the blood stream. 



The rugose condition of the mucous membrane makes it 

 difficult to dislodge the bacteria even by repeated and thorough 

 washings out. 



