Movable kidney / by Charles P. Noble.

  • Noble, Charles P. (Charles Percy), 1863-1935.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: Movable kidney / by Charles P. Noble. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of urine passed in the twenty-four hours, are at times due to a twisted ureter. Dysmenorrhea is frequently associated^ with a movable kidney. The sensation of dragging or weight in the lower abdomen is, I am convinced, frequently attributed to pelvic disease, when it is due to a displaced kidney. Diagnosis.—^The existence of a displaced kidney may be sus- pected when a thin woman complains of general nervous symptoms, palpitation of the heart, indigestion, bloating, neuralgic areas, a sen- sation of dragging in the lower abodmen when standing, the inability to sleep when lying upon one or the other side, and finally, when pain is complained of in the renal region. The diagnosis, however, can be established only by a physical exploration, and the discovery of the kidney in its abnonnal location, together witli the fact of its undue mobility. In order to establish a diagnosis of a displaced and movable kidney, its proper location must first be agreed upon, and also the de- gree of its mobility. The position of the kidneys is variously stated by automatical text books. Thus Gray states that the lower border of the kidney is near the crest of the ileum, the right being lower than the left. McClellan states that the lower border of the right kidney reaches to the third lumbar vertebrae, that of the left not so low. It must not be for- gotten that the results of the investigations upon the dead and the living may vary; at all events, I am not disposed to accept these state- ments as to the usual location of the kidneys. In three-fourths of the cases examined by myself the kidney could not be palpated; in other \yords, neither kidney extends below the margin of the ribs. We must not forget, however, that the angle between the last rib and the spinal column is an acute one, well filled in by thick muscles, and that the kidney might extend slightly below the border of the rib at its junction with the vertebrae, without being apparent upon a clinical examination. From my standpoint, however, as in three-fourths of the cases examined the kidney could not be felt, it must be accepted that its normal, or in other words its usual position, is above the lower border of the ribs. As the distance between the lower border of the ribs and the ileum varies extremely in different patients, an allowance should be made for this fact in determining whetlier or not a kidney is abnor- mally low. I have no doubt that it is normal for the kidney to exten(| below the border of the ribs in some of these cases. The kidney is normally a movable organ, which descends with
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