Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

341/440 (page 323)

the knowledge of the numerous symptoms caused by it. The fact that they are so very often overlooked or wrongly interpreted depends not only on want of acquaintance with their subjective and objective symptomSj and on the usual supposition that the patients are hysterical or hypochondriacal, but also on real diflB.culties standing in the way of their recognition. When indeed one succeeds in seizing a solid body situated in the abdominal cavity in such a way that one can move it more or less backwards and forwards between the lumbar and umbilical regions, in finding the pulsation of the renal artery and the hilum, there is no difficulty in making a diagnosis. But if a kidney possesses only moderate mobility or is situated within a patient with strong and fat abdominal walls, the physical symptoms afford but an uncertain conclusion, and the subjective symptoms are genei-ally of such a nature as to be capable of other equally justifiable interpretations. Finally, if one even succeeds in feeling a solid round body in the abdomen without recognising the shape of the kidney, there are a large number of other pathological conditions (tumours and so forth) which can easily be mistaken for it on account of the similarity of their subjective and objective symptoms. On examining the statistics of moveable kidney, we find in 'fact that the same may be said of them as Simon (170) asserted for hydronephrosis: That they consist of a long series of errors of diagnosis followed by an equal number of inappropriate interferences. Now since moveable kidney has no pathognomonic symptoms, it is quite necessary to ascertain the differential signs between it and many pathological conditions which give similar manifestations. Even then it will often be impossible to make a correct diagnosis except by exclusion. An enumeration of all possible sources of mistake would amount to a treatise on the diagnosis of abdominal tumours. Only the most important and frequent will therefore be given here. Partial contractions of the Eecti, Transversi and Obliqui Abdominis muscles frequently give the impression of a smooth oval tumour, which after a certain time disappears on pressure by the palpating hand, just like a moveable kidney. If these patients are put under chloroform, it is true that the influence