While Israel is of the opinion that on deep inspiration even a normal kidney may be partly felt by this method of examination, Glenard considers all cases in which the kidney can be perceived by palpation as abnormal. This writer distinguishes four degrees of movable kidney:

First degree of nephroptosis: The lower part of the kidney can be palpated during deep inspiration; during expiration the kidney slips back to its place and it is impossible to arrest it.

Second degree: The greater part of the kidney can be palpated and it can be also arrested, but its superior margin cannot be felt.

Third degree: The superior margin of the kidney can be reached on deep inspiration.

Fourth degree: The whole kidney is accessible to palpation even during expiration (the movable or wandering kidney of the older writers).

Symptoms due to movable kidney, as such, are the following:

1. A feeling of traction and weight in the abdomen.

2. Quite violent palpitation in the epigastrium (pulsation of the abdominal aorta).

3. The disturbances are usually more pronounced when the patient stands or walks, and disappear in the recumbent position.

4. Frequent urination, occasionally attended with slight burning.

5. Pains in the sacral region after slight exertion.

6. In women the discomfort is usually increased at the time of menstruation, and considerable improvement manifests itself during pregnancy.

These six symptoms need not always be present; they may all be absent, or occur separately.

The right kidney is often found movable, occasionally both kidneys are, seldom the left kidney, and still more rarely the spleen. The liver may also partly or wholly descend, and thus a more or less considerable surface of this organ will be accessible to palpation.

Cases of floating liverl can be divided with regard to their symptoms into the following live groups:

I. Cases unaccompanied by symptoms, in which the floating: liver gives rise to no disturbances.

2. Dyspeptic cases, with indefinite digestive disturbances in conjunction with a feeling of weakness and certain other nervous symptoms.

1 Max Einhorn " Fasting: Liver and its Clinical Significance Medical Record. September 16th 1899

3. Cases of hepatalgia, in which almost constantly pains are present on the right side of the abdomen (hepatic region), which often radiate toward the back and shoulder blades. These pains frequently subside in the recumbent posture. In many instances sensations of a drawing and tearing character are present.

4. Cases of hepatic colic, in which colicky attacks occur similar to gall-stone colics. In these no icterus is commonly present, although it may appear in rare instances.

5. Asthmatic cases, in which a feeling of fulness and constriction in the upper abdominal region, associated with slight dyspnoea, is especially prominent.

In females a prolapse of the uterus is not infrequently found. Apparent tumors of the abdomen1 are occasionally encountered in patients with enteroptosis.

Diagnosis

The diagnosis of enteroptosis is quite easy. It is only necessary to think of this condition, and it is not likely to escape detection. The subjective symptoms above detailed, in conjunction with the result of a thorough examination of the abdomen by the usual physical methods, will reveal the presence of enteroptosis. Another auxiliary in diagnosis of this condition is the so-called Glenard's "belt test." The physician, standing behind the patient, encircles the lower part of the abdomen of the latter with both his hands, at the same time supporting and partly lifting it. The patient is now asked if this procedure gives him relief. If so, it speaks in favor of the presence of enteroptosis.

1 Max Einhorn: "On Apparent Tumors of the Abdomen." Medical Record. November 24th, 1900.

Prognosis

The prognosis of enteroptosis is good. When appropriate treatment is instituted, an amelioration in the condition of the patient quickly takes place. Whether a full restitutio ad integrum can occur is not yet definitely settled. With regard to this point it is interesting to note that, as early as 1883, Henderson1 reported a perfect cure in a patient with movable kidney, within the short period of two and a half months. His remarks are very appropriate even now: "Nowadays, when the surgeon boldly invades the great cavities of the body - clearing out tubercular vomicae, freeing an impacted gall duct, stitching a displaced kidney to the lumbar muscles, and in other ways threatening the position of the physician in his own domain - it behooves the latter,.in friendly rivalry, as well as for the general good, to show that his art does not end with the diagnosis of abnormal conditions, but also extends to their successful removal." From my own experience I would say that a perfect cure of enteroptosis is possible. I know of positive cures - that is to say, the stomach has returned to its normal position, and a movable kidney has disappeared - in more than a dozen cases of my own.

As a good instance of such a cure, I describe the following case, which was very recently under my observation:

Miss Mary G------, 20 years old, was troubled with her digestive organs as far back as she could remember. She had always suffered from severe constipation. Her appetite was poor; she frequently had slight pains some time after meals. She often felt somewhat faint some time after rising, and was hardly able to walk any considerable distance on account of the great fatigue and backaches which overcame her. On examination I found that the chest organs were intact. The stomach extended four fingers' widths below the navel, while the lesser curvature could be found two fingers above the navel. Both kidneys were movable, the right in the fourth and the left in the second degree. After being treated for about two months with ample feeding, intragastric faradization, and an abdominal bandage, she steadily improved. I will also add that during this time she took a great deal of outdoor exercise (bicycling, rowing, walking, golfing, etc.). In this short period she gained fifteen pounds in weight, felt well in every respect, was strong, could eat everything, and her bowels moved quite regularly.

Another examination of the abdomen showed that the stomach now extended only down to one finger above the navel, while neither of the kidneys could be palpated.

1 P. Henderson: "A Case of Movable Kidney Permanently Cured." The Glasgow Medical Journal, vol. xx., 1883, p. 329.

Treatment

In treating enteroptosis all measures will be of value which serve to strengthen the entire organism, and especially the abdominal muscles, and remove existing disturbances of the stomach or bowel. Besides, we must try to exert a beneficial influence on the position of the abdominal organs by mechanically reducing the volume of the abdominal cavity and thus lifting the stomach up. The means for strengthening the organism are well known and consist in suitable nutrition, gymnastics and out-of-door exercise, cold ablutions, and rubbings. For the purpose of strengthening the abdominal organs in enteroptosis we may make use of (1) Dietetic treatment; (2) electricity; (3) hydrotherapeutics; (4) massage; (5) gymnastics.