Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

342/440 (page 324)

of tension of the abdominal walls is eliminated, but the- differential diagnosis cannot always be made, because a moveable kidney also usually retreats into its place during narcosis. A conclusion is however arrived at by frequent examination, and especially by carefully conducted strong percussion over the supposed tumour. It may be very hard to decide whether the tumour is a tumour of the liver, a liver deformed hy tight lacing, hypertrophy of the liver, a liver developed in lappets^ (Zipfelbildung^) ; or a moveable Icidney without complications, or adherent to the lower border of the liver j because the same signs on percussion and palpation hold good under both conditions, and the symptoms in both cases may consist of gastric disturbances, jaundice, and vague pains in the lower abdomen. It has already been mentioned that the physical signs deduced from the absence of the kidney from its normal situation are not decisive. I have observed a patient (see below) who frequently suffers from jaundice, and in whom a diagnosis of moveable- kidney adherent to the lower border of the liver would be impossible but for the fact that the moveable kidney could be felt before the formation of adhesions. Lastly, a conclusion may frequently be arrived at by the presence of some setiological ' element, or by the course and consequences of treatment. In this way it took me several months of observation in the case of three patients to diagnose a moveable kidney and exclude an affection of the liver; in two cases a tumour finally declared itself as a hypertrophic cirrhosis of the liver of obscure origin. Trousseau (171) relates a case of moveable kidney in which ten physicians had made the diagnosis of a tumour of the liver, an instance to which I could add many others. AVlien le Bay (172), referring to the difi'erential diagnosis between affections of the liver and moveable kidney, remarks that a sulcus must intervene between the moveable kidney and the liver, it must be remembered that palpation just at the border of the arch of the ribs is much hampered, and that a similar 1 There is no English word equivalent to Zipfclbildung. The lappets are generally more or less isolated and moveable over the right lobe. Many af them repi-esent conditions found in the lower animals.—Teanslator.