New growths in the abdomen may also be confounded with movable kid ney. Here the character of the suffer ing, the cachexia, and often intestinal obstruction, together with the shape and density of these growths, are in sharp contrast to the history, symp toms, and mobility of the kidney. Re peated examinations, and, if necessary, anesthesia, will enable one to establish the diagnosis in doubtful eases. G. B. Johnston (Annals of Surg., Feb., '95).
In the diagnosis of movable kidney one should find a wore or less movable tumor somewhere in the abdomen, which has the size, shape. and consistency of a kidney. An attempt is to be made to feel the hilus, and, if possible, the pulsa tion of the renal artery. This examina tion is best made by relaxing the ab dominal walls by flexing the thighs and raising the upper portion of the body, standing on the right side of the patient if the right kidney is being examined. The left hand is put in the right lumbar region pressing upward, while the right hand carefully palpates the abdomen and only gradually goes down deeper. If in this way a tumor is found which seems to be the kidney, the patient should be put into the knee-elbow posi tion and one should try to percuss both kidneys in order to ascertain the ab sence of one of them. Gustav Fritterer (Amer. Gyna..e. and Obstet. Jour., Feb., '99).
In the case of intestinal tumors, steno sis of the gut sometimes settles the diag nosis. Tumors of the omentum occupy ing the right hypochondrium are rare, growths of the pylorus usually cause greater gastric disturbance and are situ ated higher and nearer the median line, and impacted aces disappear after a purge.
Etiology. — The condition is much more common in women; it is most fre quent during the child-bearing period and particularly in women who have borne several children. This is thought to be because of the lax condition of the peritoneum, of the abdominal wall, and the absorption of the circumrenal fat thus induced, for movable kidney may follow emaciation due to any wasting dis ease. The right kidney is affected four times as often as the left; this is attrib uted to the proximity of the liver, which, in its movement downward with the dia phragm, may force the kidney before it. Traumatism has been mentioned as a cause, but this is not in accord with the infrequency of the condition among males. Probably in most cases renal mo
bility is to be attributed to a combina tion of several causes.
Arab women wear no corset, girdle, nor any form of dress likely to influence dis placement of the kidney; yet the pro portion in which this organ was found on examination to be freely movable amounted to no less than 42 per cent. of the eases examined. This is a higher percentage than is found in corset-wear ing European women. M. Trekaki (Edin burgh :Med. Jour., Dec., 1900).
The essential cause of movable kidney lies in a particular body-form. The chief characteristics of this body-form are a marked contraction of the lower end of the middle zone of the body, with a diminution in the capacity of this por tion of the body-cavity. This diminu tion in the capacity of the middle zone depresses the kidney so that the con stricted outlet of the zone comes above the centre of the organ, and all acts— such as coughing, straining, lifting, flexions of the body, etc.—winch tend to adduct the lower ribs press on the upper pole of the kidney and crowd it still further downward. It is the long continued repetition, in a suitable body form, of these influences, which col lectively may be called internal trau mata, that gradually produces a mov able kidney. A distinctly movable kid ney is never the immediate result of a single injury or external trauma. M. L. Harris (Jour. Amer. Med. Assoc., June 1, 1901).
Treatment.—In a very few cases the application of a suitable abdominal sup port is all that is necessary; if it proves unavailing, operation should be consid ered.
Ordinary support of the kidney by means of a belt properly adjusted while the patient is on the back is all that is required in the majority of these eases. The amount of pressure necessary to hold a kidney in place is very slight. Frequent resort to surgical interference in these cases deprecated. Me Naughton (Brooklyn Med. Jour., Feb., '9S).
The abdominal bandage is a very valu able resource if one expects from it no more than a relief of the symptoms which result from the abnormal mobility of the kidneys (and other prolapsed ab dominal organs); If, however, it is ex pected that this measure will at the seine time remove all the existing dis turbances (gastric and intestinal affec tions), one will meet everywhere with disappointment.