. Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women. epresentation of ThreeDegrees of Displacement of the Kidney. Firstdegree (palpable), only the lower pole is perceptibleto the touch; second degree (movable), the upper polejust emerges from under the costal margin; third degree(floating), the entire kidney can be palpated. Notehow the vascular pedicle suspends the kidney to acertain degree so that in the second and third stagethe kidney swings over toward the mid-line of the body. EXAMINATION AND DIAGNOSIS OF MOVABLE 497 the liiluiii. The
. Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women. epresentation of ThreeDegrees of Displacement of the Kidney. Firstdegree (palpable), only the lower pole is perceptibleto the touch; second degree (movable), the upper polejust emerges from under the costal margin; third degree(floating), the entire kidney can be palpated. Notehow the vascular pedicle suspends the kidney to acertain degree so that in the second and third stagethe kidney swings over toward the mid-line of the body. EXAMINATION AND DIAGNOSIS OF MOVABLE 497 the liiluiii. The sli])])iiii; l)a(k of llio kidney with eacli expiration is also veryeliaracleristic ( Fios. 2 \ I jind 24r»). It will be renienil)(>re(l that in \]\o chapter on general physical examina-tion the fact was mentioned that lynipany is nsnal over a movable kidney onpercnssion. An exception to this genci-al rnle is nlToivIed by tlie tloating kid-neys which come directly in contact witli the anterior abdominal wall. Gnyonintrodneed a modification of this method of palpation which is of value in. Fig. 244.—Bimanual Palpation of Right Kidney; Patient in Dorsal Posture, LeftHand Pressing Just Below the Costal Margin; Right Hand as Shown. With adeep inspiration, the upper hand is allowed to follow the abdomen upward and thenpresses down sharply with expiration, thus catching the kidney. many cases, a ballottement of slight taps with the anterior hand. In the caseof the kidney there is a transference of these taps to the posterior hand. Thisis rare with the liver or gall bladder. Nevertheless, there are not infrequentcases where both liver and kidney constitute a mass, and in such cases onenaturally gets the Ijallotteinent through liver to kidney. (2) Israelis Method.—A very useful method of examining has beenpopularized by Prof. Israel, of Berlin, one which sometimes succeeds whenthe dorsal posture fails. The i:)atient is put in the Sims lateral posture whenexamining for the right
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