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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    each inspiration, and ascends with each expiration; therefore, we must have some standard to determine whether or not a given kidney is ab- normally movable. A kidney may be displaced but not movable. It ^may be fixed in its abnonnal position by adhesions. Doubtless in some cases it is congenitally located in an abnormal position, and gives rise to no symptoms, having in this case only its normal mobility. I would sugge.st as a criterion to determine whether or not a kidney is abnormally movable, the fact that it fails to ascend during expiration. When kidneys are very movable and much displaced their position is but slightly influenced by respiration. For some years, in my practice, I searched in yain for movable kidneys. During that time I followed the method of examining the patient when she was lying on her back. I understand now why I failed to find the movable kidneys. It was because that in this position they slipped up above the margin of the ribs. In my entire experience I have felt not more than half a dozen kiclncys with the patient lying on her back. These wore cases of extreme displacement of long standing. It occurred to me that by examining the patient standing the diag- nosis could more easily be made, and experience has shown that this was one thing lacking in my previous investigations. The exam- ination should ha conducted as follows: The ])atient’s clothing should be loosened, all bands about the waist unfastened, and the skirts supported by a nurse or assistant, so that the patient will not be embarrassed with the fear that her clothing will fall off. She should then stand before a table or desk of convenient height, about thirty inches, with the examiner seated upon her right The patient then bends forward from the hips, and supports some of her weight by rest- ing her hands upon the table. She is directed to respire regularly, care being taken to relax herself thoroughly during expiration. The examiner’s left hand is placed against the lumbar region posteriorly, and his rirrht hand in a corresponding position in front of the kidney. By a conjoint manipulation the region between the two hands can be carefully palpated., and if present the kidney is easily recognized. .The points to be looked for are the shape and siz* of the kidney, and the fact that it can be readily displaced upwards beneath the margin of the ribs, and that it will return to its former location so soon as the examiner's hands no longer support it. When the kidney is com- pressed, as a general rule the patients complain of tenderness or pain of a peculiar character, and often make the statement that the pain causes them to feel faint or somewhat nauseated. The kidney must be differentiated from pelvic tumors, from tumors