[Reprinted from the Transactions of the American Association of Obstetricians and 
Gynecologists, September, 1891.] 
ANOTHER METHOD FOR PALPATION OF THE 
KIDNEY. 
By ROBERT T. MORRIS, M.D., 
NEW YORK. 
Israel finds a kidney by placing the patient upon her back 
with flexed legs, and then while one hand makes pressure over 
the lumbar region on the side of the kidney to be examined, 
the tips of the outstretched fingers of his other hand are 
placed just below the costal cartilages, on a line which runs 
from the middle of Poupart's ligament parallel with the mid- 
dle line of the abdomen. Then, with each exhalation of the 
patient's breath the physician's fingers are pressed deeper and 
deeper down toward the kidney, and the impression left upon 
the finger tips at each step of progress is carefully stored in 
mind. Guyon palpates in very much the same way, but intro- 
duces a new feature, which consists in making quick, hard 
pressure with the lumbar fingers, and thereby causing a spas- 
modic contraction of the quadratus lumborum muscle, which 
forces the kidney up against the abdominal hand. 
With the patient in a supine position we have an obstacle 
to good palpation of the kidney, in the presence of interposed 
omentum and intestine or stomach; and the weight of a loose 
kidney will sometimes be sufficient to keep it in normal posi- 
tion during the time of examination, so that the abnormal 
condition is not recognized. 
In placing patients in various positions for the purpose of 
examining loose or diseased kidneys, I have found one position 
that regularly gives much satisfaction to the examiner. It 
may be that others are in the habit of gaining the advantage 
that this posture gives, but I do not find reference to it in 2 
ROBERT T. MORRIS, 
the literature of the kidney. If the right kidney is to be pal- 
pated, the patient lies upon her left side with the legs flexed, 
so that the abdominal muscles are relaxed and the intestines 
and omentum glide toward the table. If the kidney is loose, 
or if it is much enlarged, it then slides out upon the abdominal 
contents in such a way that it becomes the highest solid body 
found beneath the abdominal wall at a certain point. The 
intestines and omentum are out of the way and the kidney 
has moved between folds of peritoneum (or has swung upon 
a mesonephron) into a position to be easily examined. 
The certain point at which the kidney is found is somewhere 
in the concavity that forms along the margin of the right quad- 
ratus lumborum muscle, when the abdominal viscera sink to 
the left side toward the table. Different patients require some- 
what different positions of the limbs and different angles with 
the top of the examining table, in order that the point of 
greatest degree of relaxation of the abdominal walls be ob- 
tained. A very fleshy patient, for instance, may have to be 
rolled almost into a prone position, because the weight of the 
viscera must be partly borne by the table before the tension of 
the abdominal wall is relieved. 
For examining the left kidney the patient lies upon the 
right side, and the same condition of relaxation of the ab- 
dominal wall is again obtained. If a loose kidney does not 
at once slide out of normal position when the patient is 
properly placed, a blow upon the lumbar region with the hand 
will dislodge it, and we then obtain a more resonant percussion 
note over the site that the kidney formerly occupied. With 
some patients, in the position described, I have been enabled 
to hold the entire kidney in one hand almost as easily as if it 
were a potato in a bag. 
For examining a perfectly normal kidney, I still prefer to 
palpate according to the method of Israel or of Guyon in the 
majority of cases. 
It is surprising-to me at least-to find how many loose 
kidneys there are in the country, and it seems safe to predict 
that the kidney will be the next organ to be taken up by 
fashion in surgical practice. A great many patients who are 
being treated for disease of the pelvic organs, and for nervous PALPATION OF THE KIDNEY. 
3 
dyspepsia, and for all sorts of abdominal distress, are really 
suffering from the effects of slipping kidneys, and the true 
cause of disturbance is not recognized because the kidney has 
not, as yet, become a popular organ with surgeons, and because 
methods of palpation of the kidney are a good deal of a 
bother.