Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

337/440 (page 319)

$31^ front of the kidney, unless this is very low down; and althougli purgatives may evacuate tlie air wlaicli masks tlie- true percussion souud from tlie intestine, they cannot do so from tlie stomach. A special value has been laid on the percussion signs in kidney diseases, caused by the relations, of the kidney to the colon. Whereas in the case of tumours^ of the kidney the colon almost invariably lies on their inner side, and the percussion sound on their outer side is dull (a&. would naturally be supposed in the case of extraperitoneal tumours), moveable kidney has had the percussion signs of an intraperitoneal tumour assigned to it {Simon, Alilfeld), aud- it has been believed always to lie on the inner side of the colon, and always to be bounded on the outer side by tympanitic resonance. This relation however is only found where the kidney has a long mesentery, and where in addition' the flexure of the colon is very long or the kidney has migrated between the folds of the mesocolon. But when the mesocolon is taut and short, even if the kidney is moveable the colon is usually pressed inwards, and the percussion note- on the outer side of the kidney remains dull, as in the case of a subperitoneal tumour. A moveable kidney therefore- behaves with regard to percussion, at one time as an intra- peritoneal and at another as an extraperitoneal tumour. Here also it is generally believed that the absence of the kidney from its usual position in the lumbar and postei'ior abdominal region furnishes important percussion signs. According to Bollet, Trousseau and others, the note over the side corresponding to the displaced kidney is clearer and fuller than on the other side. The majority of the textbooks and handbooks on- percussion say the same. Piorry (159), the founder of renal percussion, claims to have percussed out even the slightest changes of size in the kidney. , According to Guttmann (160) the diagnosis of a moveable kidney (whenever at least a proof is needed), rests on the circumstance that percussion shows the absence of the kidney from the normal place, by the diminished dulness. If a kidney is displaced the lumbar region of that side is more resonant than the other side. Numerous investigations however have convinced me of$

Selected monographs.

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