The disturbances of the stomach and intestinal canal must be treated accord ing to the principles prevailing at the present time.
Besides a serviceable, well-fitting ab dominal bandage (a cushion for the kidney can almost always be omitted), the medical treatment consists in pro moting the nutrition and strengthening the organism. The former is done by a liberal diet (forced feeding), so that an increase in weight takes place. The lat ter is accomplished by gymnastics, by general massage, and electricity. In a few cases, after a considerable increase in flesh has occurred, there is not only a disappearance of all the subjective symp toms, but also the return of a previously movable kidney in the second or even third degree to its normal position, so that the organ can no longer he palpated.
Personal experiences point decidedly in favor of medical treatment. While, in general, operative treatment in cases of floating kidney is opposed, still in rare instances nephrorrhaphy may be justifiable especially when a connection between the symptoms (both the direct as well as the gastrointestinal dis turbances) and a movable kidney ap pears to be proved in a high degree, and the above-described dietetic-mechanical methods of treatment have completely failed. Every surgeon, before advising operative intervention in movable kid ney, should completely exhaust the sug gestions and remedies of the physician. Einhorn (Med. Record, Aug. 13, '93).
When in movable kidney in children the affection is latent or well borne, rest and an abdominal belt may suffice to re lieve the symptoms. A flannel bandage wound several times around the body and supporting the abdomen is the best means of immobilization that can be devised. Dyspepsia and constipation should receive careful treatment. In the event of persistent unbearable pains, peritonitis and hydronephrosis from twisting of the ureter, an operation should be performed, fixing the kidney to the posterior abdominal wall. Jules Comby (Brit. Med. Jour., Oct. 15, '93).
In floating kidney the Weir-Mitchell treatment of rest and forced feeding has been followed by great benefit; and a few cases are on record of apparent cure of the disease without treatment, simply because an improvement in nutrition took place. The only good that we may
hope to accomplish with a pad and band age is by crowding up the whole of the abdominal contents. For this purpose a round cushion should be made of chamois-leather, and covered with a movable cotton cover, to be frequently changed. This cushion should be filled with curled hair for the sake of elas ticity and lightness; and, indeed, an air cushion of rubber might do as well, and it should be thick enough to give the woman. when it is applied, a distinct roundness or plumpness of the abdomen. It should be put on while the patient is lying on his back, and held in place firmly by means of a broad flannel or woven elastic bandage, so as to keep it evenly pushed into the abdomen. When the patient stands erect all the abdom inal contents will be supported, and the patient will experience great comfort immediately.
In those cases in which the above methods of treatment are impracticable or unsuccessful, nephrorrhaphy, which, as a rule, gives very satisfactory results, must be resorted to. A. Lapthorn Smith (Canadian Jour. of Med. and Surg., Nov., '99).
From 90 to 95 per cent. of symp tomatic movable kidneys can be relieved symptomatically by the judicious use of the corset. Those cases in which the kidney is at the pelvic brim, as a rule, give the least trouble. Fixation only transfers the weight from the vascular pedicle to a cicatrix. This treatment does not achieve all that is desired. Mechanical means are superior to opera tive procedure. Belts and pads have their advantages. The prevailing style of corset is a good one and should be as long in front as can be worn. A corset 2 inches smaller than the size usually worn should be selected. The lacing should be from below upward, pushing the kidney well up beneath the ribs be fore fastening the upper hooks. The corset should be fastened on before the patient rises in the morning. Great at tention should be paid to the general health of the patient. A. Ernest Gal lant (Phila. Med. Jour., Apr. 27, 1901).