Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

338/440 (page 320)

the nntrustworfchinoss oE fcliis sign. Evou strong percussion hardly detects any difference between the two sides in move- able kidney. When one considers that one percusses a thick layer composed of the muscles o.f tlie back, the ribs, and the qnadratus lumbornm muscle, it is not to be expected that the dulness will be changed into resonance by the absence ■of the kidney. If the kidney is displaced on the right sidle, which is generally the side in point, its place is at once taken by the posterior surface of the liver, which of course in no way changes the original dulness. Thus neither Weil (i6i), who examined a patient whose kidney had been removed by Gzerny, nor I under similar circumstances found any differ- ence in resonance. Moreover Keppler (162) justly denies, on ithe ground of careful examination, the so-called physiological Ikidney dulness. Pansch (163) again has pointed out, from minute topo- ■graphico-anatomical investigations, the errors of the clinical observers like Gerhardt, according to whose account of the kidney dulness the kidney normally reached as far as the ■crest of the ilium, whereas it does not reach so far by three to five centimetres. Pansch moreover correctly observes that even an area of dulness reaching to the crest of the ilium is not necessai-ily identical with the proper kidney dul- ness, since the capsula adiposa lying below the kidney is often as thick as the kidney itself which causes the •dulness. After all We shall therefore be obliged to agree with Slcoda's (164) statement already mentioned : The size of the kidney has very little to do with the state of the reso- nance in the lumbar region. This may be quite dull when the kidneys are very small, and tympanitic although the kidneys are very large. We must therefore when possible press the plessimeter down until we get complete dulness and the resistance of a solid organ. By repeating this process at several spots we can judge where the kidney shows a striking onlargcment.' As a matter of fact even in the case of moveable kidney the most unmistakeable signs are furnished by palpation. Palpation.—A moveable kidney is generally to be per- ceived beneath the free edge of the ribs, rather towards the