Abdominal surgery . ^ as much as possible into the anterior surface may be explored while the kidney is lyingon the psoas, againstwhich firm surface itis pressed. To explorethe posterior surface, thekidney is pulled forwardand compressed againsteither a broad spatula orthe fingers of the oppositehand. Langes proposal,to examine the pelvis bytilting forward the wholeorgan, is well worthy ofattention. (Fig. 43.) Itis certainly easier toexamine the kidney be-tween the fingers whenit is well pulled forwardsout of its bed, than whenit is lying far back in itsnormal situation. Every partic
Abdominal surgery . ^ as much as possible into the anterior surface may be explored while the kidney is lyingon the psoas, againstwhich firm surface itis pressed. To explorethe posterior surface, thekidney is pulled forwardand compressed againsteither a broad spatula orthe fingers of the oppositehand. Langes proposal,to examine the pelvis bytilting forward the wholeorgan, is well worthy ofattention. (Fig. 43.) Itis certainly easier toexamine the kidney be-tween the fingers whenit is well pulled forwardsout of its bed, than whenit is lying far back in itsnormal situation. Every particle of renal tissue is rubbed and squeezed between thefingers, and any hard spot is noted. If the stone is small, and if itis overlapped by renal tissue, which may be increased in densityfrom prolonged irritation, it may be impalpable. In one case ofMorriss, after the kidney had been removed and placed on a. Fig. 43- (Lange.) Pelvis and ureter exposed from behind afterremoval of peri-nephricfat. A, Kidney ; B, Pelvis of Kidney ; E, F, QuadratusLumborum. 472 NEPHRO-LITHOTQMY. table, it was found impossible to detect a stone which wasembedded in a calyx by palpation with the finger. Of this factthere can be no doubt: a most painstaking examination withthe finger may fail to detect a stone where it is present. Should a hard or elevated area be made out, the exploringneedle is pushed into it, and the stone felt for. Should no stone be felt, a systematic examination withexploring needle is now carried out. This needle is a fine sharpsteel probe, mounted on a wooden handle. It is so fine that itmakes a very small wound; and, being only two and a halfinches in length, it cannot, if pushed through the cortex, woundthe large renal vessels. The exploratory punctures are made ina thoroughly systematic manner from one end to the other ofthe posterior border. While this is being done with the needlein
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