Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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with tlie riglit liaucl against tlie left hand resting on the abdomen. In tho case of the left kidney vice versa. By these manipulations it is surprisingly easy in favourable cases to feel the lower end even of the normally placed kidney, and when it is moveable to move it to and fro between the hands. At the same time an impression is gained by practice whether one or other luinbar region is more easily indented than usual or than the other. This condition, constantly to be observed in moveable kidney and important for diagnosis, depends upon the fact that when the kidney is absent from its normal position, the soft parts situated in the flank, the muscles and intestines, are more ■easily pressed under the arch of the ribs; but is not, as has been erroneously supposed, explained by imagining that the kidney which is normally situated beneath the arch of the ribs betrays its absence directly by this diminished resist- ance. Palpation itself is generally painful. Sometimes violent jpressure makes a patient vomit. Trousseau (i6g) made use •of the tenderness caused by pressure on the kidney for dia- gnosis, comparing it with the tenderness produced by pressure over the other kidney. Auscidtation has not hitherto been utilised for diagnosis in the case of moveable kidney. It is not however to be doubted in this case also a whistling murmur will be audible when twists and narrowing of the vessels occur.^ IX. Diagnosis. The recognition of a moveable kidney depends on the physical signs, especially those derived from palpation, and 1 The auscultation of abdominal tumours is in so unsatisfactory a state tliat little can be said about it. A murmur is said to be occasionally beard in ovarian tumours, but what these tumours are, or what arc the circum- :stances under which murmurs occur in them is not stated. It would be a picturesque circumstance for a murmur to develop in an ovarian tumour durino- twisting of the pedicle ; but where is such a case recorded P Tlie uterine murmur in some fibrous tumours is well known. The wisest course in tlie present chaotic state of knowledge is to follow the advice of the American :ambassador, and Never prophesy unless you know.—Thanslatoe.