Movable kidney : with a report of twelve cases treated by nephrorrhaphy / by George M. Edebohls.

  • Edebohls, George M. (George Michael), 1853-1908.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Movable kidney : with a report of twelve cases treated by nephrorrhaphy / by George M. Edebohls. 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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    gynecologist whose tacile sense is educated by daily practice. With the patient in the dorsal position, and the thighs flexed to relax the abdominal parietes, the examiner sits at her right side, oppo- site the loins,^and with his left hand passed under the small of her back, pressed deeply into the renal region to either crowd the kidney out of its place, or to keep it from slipping unrecog- nized into its normal position while the examination is being made. The fingers of the right hand palpating the front and side of the abdomen usually recognize the displaced organ with- out difficulty. When it is detected it should be caught between the fingers of both hands and gently pressed until it escapes alter- nately upward and downward from between the compressing fin- gers. The contour of the upper and lower poles and the entire characteristic kidney shape of the tumor are thus recognized without the possibility of mistake. The majority of movable kidneys when thus moderately pressed and handled are not sensi- tive to pressure ; in a minority of cases the patient complains of slight, quite bearable pain. Landau has found that pressure upon a movable kidney causes cardialgia. I have never elicited this symptom, but have often produced a slight nausea on com- pression of the displaced organ. Perhaps the difference in the sensations of the patient may be due to varying degrees of press- ure employed. The displaced kidney is almost uniformly of about normal size ; in but five or six instances have I found it enlarged. Should there be difficulty in palpating the kidney in the dorsal position, the left lateral decubitus (Sims’ position), as recom- mended by Lindner, may be tried. I have myself never resorted to it. When I have failed, with the patient in the dorsal position, to dislodge a suspected movable kidney from its normal situation by pressure of the left hand applied to the back, I have always succeeded by directing the patient to sit upon the edge of a chair with the body inclined forward and the hands resting upon the knees. In this position I have never experienced difficulty in reaching a diagnosis. By employing this position, or the left lateral decubitus, the necessity of repeated examinations in doubtful cases, in.sisted upon by many authors, can be avoided. Very rarely, indeed, should there be difficulty in distinguishing a movable kidney from other tumors of the abdomen, and refer- ence to this part of the subject would scarcely be necessary were it not that errors have been made by the ablest diagnosticians. Thus in the case of Dr. Angus Mac -, already alluded to as re- ported by Dr. Baker, the patient acquired a movable tumor in the right hypochondrium as a result of prolonged vomiting from sea-sickness. Several clinicians of the highest reputation exam- ined the tumor, and at least two of them pronounced it a mova- ble kidney. The patient finally consulted Lawson Tait, who. IQ