360 THE GENITO-URINARY SYSTEM 



half or two-thirds is in contact with three muscles ; from the 

 medial to the lateral side these are the psoas major, the 

 quadratus lumborum, and the transversus (Fig. 97). Between 

 the kidney and the latter two muscles, the subcostal nerve 

 (T. 12) and the ilio-hypogastric and ilio-inguinal nerves (L. i) 

 pass obliquely downwards and laterally, round the abdominal 

 wall. Tumours of the kidney may compress these nerves and 

 give rise to painful symptoms which are referred to the areas 

 of their peripheral distribution, i.e. the lower part of the 

 abdominal wall and the proximal parts of the thigh and the 

 buttock (Fig. 74). 



Movable Kidney. This condition must be distinguished 

 from Floating Kidney, which is an extremely rare anomaly. 

 In the latter case, the kidney is invaginated into the peritoneal 

 cavity, and is attached to the posterior abdominal wall by 

 peritoneal ligaments, whereas, in movable kidney, the viscus 

 retains its normal relationship to the peritoneum, i.e. it remains 

 entirely retro-peritoneal. 



The two kidneys are enclosed in a large fascial capsule, which 

 also contains the aorta, the inferior vena cava, the renal vessels 

 and the commencements of the two ureters (Gerota's Space). 

 It is said that the capsule may extend downwards beyond the 

 lower pole of the kidney, and that this condition constitutes 

 an important predisposing cause of movable kidney. 



The symptoms produced by this condition are usually very 

 vague and difficult to define, and it is probable that they are 

 caused, for the most part, by the weight of the viscus dragging 

 on the peritoneum, on the renal vessels, and on the sympathetic 

 nerves, which lie on their coats. 



Palpation of the Kidney. In highly neurotic individuals, 

 the abdominal walls may be so lax that palpation of the 

 anterior surfaces of the kidneys can be carried out with 

 surprising ease. In such cases, the vertebral column and the 

 abdominal aorta can also be felt without any difficulty. 



In order to palpate the kidney, one hand should be placed 

 on the dorsal aspect of the trunk below the twelfth rib so as 



