Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

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$middle line and the navel, as a smooth, oval, solid sensitive body. Now and then we succeed in feeling the shape of the kidney, but rarely (as happened in Frericlis' clinique) in feeling the pulsation of the renal artery. The right kidney is easier to feel than the left, because the left is surrounded by softer and more yielding parts than the riglit, and can therefore more easily slip away. The extreme mobility of the kidney is remarkable, for a slight touch or the contrac- tion of the abdominal walls is sometimes alone sufficient to make it change its position, and in the horizontal posture it easily slips back into its normal place. The mobility of the kidney is often so great that one has actually to surprise it in order to catch it for palpation. Once back in its normal position it is sometimes hard to render it apparent again. Some patients can press it into the flanks and bring it forward again by peculiar sidelong movements of the trunk. This however does not always succeed, and so, after making a diagnosis one is often subsequently at a loss. This habit that the kidney has of retreating into its normal position and staying there is so characteristic that in two cases in which a moveable kidney was certainly present and a long incision had been made in the linea alba with the view of removing it, it could not be brought forward into the wound in the abdo- men without shaking and changing the position of the whole body {%ee Ke^opler (165) and Laucnstein (166)). On a third occasion even the shaking was in vain, and King (167) (whose case it was) was obliged to abandon the operation. Palpation must be practised with the patient in different postures and always Umanually (168). The knee-elbow position which was formerly recommended is least suitable for this purpose, because in this position the kidney tends to fall towards the diaphragm, that is, into its normal position ; the most convenient is the horizontal posture with the upper part of the body moderately raised and the legs moderately bent, a position which is usual in gynaecological examinations on account of the diminution in the intra-abdominal pressure which It causes. It appears useful to place the patient on the left side to feel the right kidney, to press the right hand firmly against the lumbar region and to press the kidney 21$

Selected monographs.

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