Ihe Kidneys. 247 



dau). Greig Smith states that long flexible spines, 

 with sloping lower ribs and flat slender waists, is the con- 

 formation that most favors renal mobility. To examine a 

 patient for movable kidney, Hare advises : "With the pa- 

 tient lying down, the physician should place the fingers of 

 the left hand on the postero-lumbar region under the last 

 ribs, gently pushing forward that part. The ends of the 

 fingers of the right hand should then be placed in front 

 just below the costal cartilages. On the beginning of a 

 deep expiration, the kidney, if movable, will be felt be- 

 tween the two hands." Among the symptoms of movable 

 kidney, Dietl's crises are not infrequent. These are char- 

 acterized by attacks of severe abdominal pain, nausea and 

 collapse, which arise from a kinking or twisting of the 

 renal vessels and the accompanying plexus of nerves, thus 

 disturbing the solar plexus. Edebohls states that in 80% 

 of cases of movable kidney, chronic appendicitis is present, 

 due, he thinks, to the compression by the kidney of the re- 

 turn circulation through the superior mesenteric vein. 



In perinephritic inflammation, there are often present 

 certain special symptoms, such as lameness of the affected 

 side, flexion of the thigh, etc., from the involvement of the 

 psoas muscle on which the kidney lies. Should pus form, 

 it rarely penetrates the peritoneum, but tends to burrow 

 towards the surface of the body, or upwards towards the 

 thorax, possibly perforating the diaphragm or lung; or 

 downwards towards the pelvis ; or it may enter the psoas 

 muscle and appear below, as a psoas abscess. 



Operative Work on the Kidney. Punctur- 

 ing the kidney may be done in cases of hydronephrosis, 

 hydatids, etc., and is best performed with an aspirating 

 needle inserted, according to Morris, when on the left 

 side, just in front of the last intercostal space, and, when 

 on the right side, midway between the last rib and the 



