Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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deterioration of the general health were observed, so that thoughts were naturally entertained of a malignant growth. But even then it was impossible to interpret the signs except on the hypothesis that a moveable kidney had become can- cerous, especially as the mobility of the tumour remained very considerable. The appearances did not change till June, when pain persisted even during the horizontal position, jaundice appeared, and emaciation advanced so rapidly that it became possible on deep bimanual palpation to feel plainly the lower end of the right kidney in its normal situation. Although the tumour was neither fixed, nor situated at the outer border of the Rectus, nor pear-shaped, nothing but cancer of the gall-bladder could now be diagnosed. The autopsy, held in the Elizabeth Hospital, Berlin (where the patient attended at last), confirmed this dia- gnosis. The instances in which, vice versa, a moveable kidney is taken for an aifection of the liver (as has already been men- tioned), are still more frequent. It should also be remem- bered that both affections may occur together. In the case of Aherle mentioned above, gall-stones coexisted with move- able kidney; moreover I have seen a similar case myself (see below). If well-marked gall-stone colic, yielding to large doses of morphia, and the passage of gall-stones had not been ascertained, the jaundice which occurred in this case would very likely have been referred to the moveable kidney. The presence of pain occurring even during quiet decubitus ought to prevent us from mistaking cancers of the stomach or ^pancreas for moveable kidney, even apart from the relative immobility of these tumours. Such a mistake however is more likely to be made in cancers of the ascending and descending colon, which frequently cause nothing for a long time but digestive disturbances (Stenosis), and present to the examining hand a moveable tumour lying beneath the abdominal walls in the region of one or other flexure (I examined such a tumour in the Jewish Hospital of Berlin, which had been wrongly considered to be a moveable kidney). Then again the differential diagnosis is decided by the circumstance that the percussion note over a small cancerous growth in the colon lying immediately