Licence: In copyright
Credit: Medical gynecology / by Howard A. Kelly. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
23/680 (page 7)
![in warm water, after which the abdomen is palpated. It is my custom, and I think it is the best phm, first to feel the npper abdomen, running the hand across it and making pressure at several points, to make sure there are no undue prominences, or areas of tenderness, resistance, or fluctuation. I then examine the right hypochondrium, and if no resistance is felt, use botli hands, pressing deeply into the right flank and feeling for the kidney. If this is not discovered at once, I tell the patient to breathe deeply, and this may bring it down between the fingers. Sometimes with the Fio. 3.—Thb Gynf,coi,ogicai, Examining Table. The top is covered with leather, well padded, on this is placed a blanket covered with a linen sheet. A drainage cusliion is serviceable in protecting the table from contamination from discharges. In my office I sometimes use a much smaller cushion than that shown in the figure. The drawers serve for the storage of clean linen, towels, dressings, pessaries, etc. fingers pressing in deeply from behind and from tlic front simultaneously, a wedge within is felt, as the patient takes a deep breath, descending from under the ribs, entering the angle and pressing the fingers gently apart; with the act of expiration, the wedge retires back under the ribs again. In this way, the lower pole of tlic kidney can often ho felt. Witli a deep inspiration it descends until it is felt as far as the roual notcli, tlie second degi'ee of disphiceuient; or again, it slips down entirely below the fingers, which now lie al)ove the up]icr pole, Avlien tlie descent is one of the third degree. If tlic kidney cannot be felt in this way, it can sometimes be found by raising the head and shoulders and letting the patient lie on the left side, when the intestines drop away from the side under exann'natiou. On sitting up and leaning forward, or on standing up and leaning forward, a loose kid-](https://iiif.wellcomecollection.org/image/b21511512_0023.jp2/full/800%2C/0/default.jpg)
