Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

347/440 (page 329)

tumour was extreme, and a certain diagnosis could only be made from the circumstance that in spite of the superficial situation of the tumour and the possibility of grasping it completely^ the pulsations of the renal artery could not be felt. The stock signs given for the diagnosis of tumours of the kidney (175) are useless under the circumstances under dis- cussion. In making a diagnosis therefore it is recommended to proceed by first disregarding entirely the doubtful tumour itself, and looking to see if the other organs claiming attention £Lve to be found and are of normal shape. With a view to this, bimanual palpation of the kidneys should be attempted, the result of which is however seldom trustworthy. But before all things the diagnosis of the presence of the normal uterus and both normal ovaries should be attempted by the usual bimanual examination or Simon's rectal exploration with the entire hand, which is only of value in this case (176) ; 3.nd these facts can nearly always be ascertained. In making ■a differential diagnosis between tumours of the kidney and generative organs therefore, the presence of the normal ovaries and of the normal uterus will confirm the diagnosis of a moveable kidney ; the presence of only a single normal ovary, that of a tumour of the other ovary. Lastly, there is still a condition under which the wrong diagnosis of a moveable kidney is likely to be made, namely, that of so-called phantom tumour, whose symptoms consist of a permanent and extreme distention of the abdomen with unusually tense abdominal walls, and the tetiology oi which is still obscure. Women affected by this complaint generally feel themselves pregnant, say they feel the movements of the child, and so on. The thickness and firmness of the abdominal walls and their contraction on the slightest touch renders palpation useless without ansBsthesia, then indeed it is usually possible to recognise the nature of the apparent tumour and to exclude moveable kidney. It is still more frequent for moveable kidney to simulate so-called spurious pregnancy, which will however hardly be mistaken after a careful examination of the generative organs. Other possibili- ties of error, such as isolated collections of fafc in the omentum