Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

336/440 (page 318)

VIII. Objective Signs of Moveable Kidney. Moveable kidney is capable of attracting attention both by its absence from its normal position and by its appearance in an abnormal situation. It Avill therefore be necessary to examine tlie question what physical signs, both in tlie anterior and posterior lumbar region are due to it. Inspection.—In thin subjects with a moderate amount of pendulous belly, the moveable kidney may occasionally be found against the anterior abdominal wall in the erect posture. Its outline can in some cases be also made out when the patient lies.flat on the back or on the side opposite to that of the moveable kidney. Sometimes the kidney can be seen to map itself out by a sulcus parallel to itself which moves down- wards on deep inspiration along the anterior abdominal wall. The condition of flattening or depi-ession of the corre- sponding lumbar region, especially plain in the knee-elbow position, described by the majority of writers (158) as constant, is an untrustworthy and exceptional sign. Its small value is best seen by the fact that in a patient whose right kidney had been removed, and whose great emaciation also furnished the most favourable conditions for its pi-oduction, I was nnable to see this flattening. Keppleo' also failed to find this depression. The fact that in certain positions, especially when the legs are adducted, the so-called lateral lumbar sulcus corresponding to the lateral border of the sacrospinalis muscle normally comes out pretty plainly in thin subjects, has in my opinion given rise to many mistakes of this kind. Percussion.—The resonance over a moveable kidney in the abdomen is generally dully tympanitic. It is only when the kidney has a long mesentery, and relaxation of the subperi- toneal cellular tissue allows the ureter to detach itself far from the posterior wall of the abdomen, that the resonance is absolutely dull (and then of course only on superficial percussion), because in this case no intestines separate the kidney from tho abdominal wall. On the left side the resonance is also but seldom quite dull, because the voluminous stomach and intestine filled with air always lie in