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Vague Abdominal Discomforts Loose Kidney

After the vague pains around joints so commonly called rheumatic, and
which occur so frequently that probably there is no one over forty who
is quite ready to confess that he has not had rheumatism, the most
important source of vague discomfort is the abdominal region. This
occurs particularly in people who are engaged in a sedentary
occupation which prevents much exercise, keeps them indoors, and gives
them abundant opportunity as a rule for introspection and dwelling
upon their sensations. There are few people who live the intellectual
life who have not suffered from some of this abdominal discomfort,
which they presumed must mean some definite lesion, or portend some
serious development, and yet, as a rule, they have lived for years
afterward without any of their fears proving true.

Physicians are not spared from this source of worry and discomfort.
They suffer from it even a little more than others. Their knowledge of
the possibilities of serious pathological developments within the
abdomen, especially after the age of forty, makes them a little more
concerned as to the significance of these vague discomforts.

At least half a dozen times a year, for the last ten years, I have
heard physicians say that they were sure that some organ or other
within was not performing its function properly, and that there was
probably some organic lesion. The thought has usually been in their
minds for months, sometimes for years, and they have come to be
thoroughly examined. Sometimes they rather expect to be told that they
should go to a surgeon. They are usually half concealing a question as
to how soon they should set about putting their affairs to rights and
how serious the outlook is. As a rule, I am able to dismiss them
without any further treatment than the injunction not to think so
persistently about certain obscure feelings which they are allowing to
occupy their consciousness. Sometimes I know they take the
advice--even oftener, perhaps, I know they do not. Once it has got
hold of us, it is hard to get away from morbid introspection, and I
sometimes hear of them consulting others. All of these patients are
improved for a time after their consultation by the reassurance that
so long as they have a good appetite--which is the case with all of
them--and their bowels are regular--which unfortunately is not the
case with most of them--and so long as they sleep well and have no
acute pain, there is little likelihood of any serious latent abdominal

Such reassurance cannot be given until the abdominal region is
carefully palpated, and especially the right side explored as
thoroughly as possible. Here lies the appendix, the head of the
colon, which is sometimes the seat of trouble not necessarily
originating in the appendix. Just above them one may find a loose
kidney, for the right kidney is more likely to be movable than the
left, because of the overhanging liver, and finally the gall-bladder,
and the bile passages, so likely to be the seat of serious trouble. If
none of these organs are tender on deep palpation, if the kidney does
not come down when the patient is examined in the standing position,
if there are no serious derangements of digestion, except such as can
be attributed to nervous indigestion, and if there is no dilatation of
the stomach, and no enlargement of the spleen, there is no reason why
one should do anything but try to get the patient's mind off himself.

There is always the danger of overlooking an abdominal cancer, in
these eases, though with the care in diagnosis I have suggested this
is minimal. The best therapeutic test that I know to determine this,
if there should be any doubt, is to put the patient on an increased
diet and watch the scales. If he is able to digest the added food
well, and without trouble, and if he proceeds promptly to gain in
weight, there is much less than one chance in a hundred that he is the
subject of latent cancer in the abdominal region. The old farmer's
maxim is: "A sick hog don't get fat." When human beings properly
respond to increased feeding, it is probable, not only that there is
nothing serious the matter with them, but that the symptoms of which
they complained before may very likely have been due to lack of
nutrition. The digestive organs not having enough to occupy them, were
tempted to digest themselves, or at least to have their function
disturbed by the short circuiting of nervous energy looking for
something to do.

I have seen a number of these cases that had been operated on for
vague discomfort--some whose appendices had been removed, some whose
kidneys had been fastened up because they were slightly movable, some
whose gall passages had been examined for adhesions that were supposed
to exist, or perhaps for a stone that it was thought might be found
there, and except where some actual organic lesion was found and
relieved, none of them was materially improved when seen several years
after operation. I have heard reports of cures of these cases by
surgeons who felt that the removal of an appendix presumed to show a
catarrhal process, or a hyperemia, or an adhesion at its tip, had
meant the cure of vague abdominal discomfort which had continued for
many years and made the patient profoundly miserable. But these
reports were founded on the patient's condition at the end of
convalescence after the operation, and not on the condition that
established itself some months, or perhaps a year, later. Operations
on the abdomen, except for very definite indications, have, in my
experience, always done more harm than good, and I have seen serious
conditions--hernia, displacement of organs and disturbance of the
peristalsis of the intestines--develop subsequent to them.

I have in mind two typical cases. One was a physician whom I had seen
on a number of occasions, and who complained of vague discomfort,
mainly in the right side of the abdomen, though never acute, never
accompanied by fever, nor even by any disturbance of pulse when he was
not in an excitable mood. His bowels were not always regular, and he
had had some disturbance of circulation as the result of thrombosis of
veins on that side after an attack of typhoid fever. My opinion
was that his discomfort was entirely due to the disturbance of
circulation. There was probably some interference with the normal full
circulation to the large intestine, in its ascending portion, that
gave him a feeling of uneasiness, or of consciousness of its function.
Eventually he became convinced that he was suffering from a chronic
form of appendicitis. After considerable persuasion he convinced a
surgeon friend that his appendix should be removed, and the operation
was done. I saw his appendix afterwards. It was supposed to be
thickened, but considering the normal limits of size of the appendix,
I could not think that it was beyond them in any marked way. At most
there was but a slight catarrhal inflammation.

For a time after operation he was much improved. He felt confident
that all his trouble has disappeared, and he took some pains to
impress me with the supposed fact that in these vague cases of
discomfort there was always some underlying organic lesion that needed
surgical treatment. During convalescence he had gained in weight, and
was looking very well. When I met him a year and a half later he said
that some of his discomfort had returned. He had grown thinner and was
feeling discouraged. Six months later he was about to submit to
another operation, this time for the breaking up of adhesions in the
neighborhood of his gall-bladder. He had become convinced that this
must be the seat of the difficulty. After this operation he was sure,
beyond peradventure, that his trouble was gone never to return. Two
years later I found him preparing to have his right kidney sewed up. I
had known that his right kidney was slightly movable, but it did not
move sufficiently to cause any disturbance of kidney function, and
certainly not enough to justify serious surgical intervention.

After this operation I met him once casually and he assured me that
now everything was surely all right. I have since heard that he
submitted to an operation either for the breaking up of some adhesions
around his stomach or in order to tuck up that organ for ptosis. It
had not been quite decided whether an adhesion caused a slight
hour-glass constriction of the stomach, with some dilatation of the
splenic end of the fundus, or whether there had been some actual
sagging. I am sure that after this operation, as after preceding ones,
with the strong suggestion that he ought to be better and an increase
of weight during convalescence, he lost his vague abdominal discomfort
for a time, though I have no doubt that it either has or will return.
When he gets something to so occupy his mind that he does not dwell
too much on his discomfort, he will not increase it to the extent that
makes it intolerable. Then he will remember that most people have some
discomfort, and he will learn to distract his mind, rather than allow
it to dwell on the thought of his particular ailment until it becomes

It has taken twelve years or more to develop this case to the point
where it is as instructive as it now is, and it is a typical example
of what may happen even to a physician. There are other cases in my
notes that are quite as instructive, two of them occurring in
thoroughly educated men, clergymen who were of good intellectual
capacity, but who became too much occupied with themselves. One of
these had more operations done on him than my friend the physician. He
first had his appendix removed, and was better for a time. Then his
kidney was fastened up, and improvement once more took place. After
this he lost in weight considerably and suffered so much from
headaches that a friendly surgeon suggested that there must be
adhesions between his dura and his brain. Accordingly a trephining was
done, and these adhesions, real or supposed, were broken up. For a
time he seemed to be better. Then he had some urinary trouble. A long
prepuce, though one that was never tight or adherent, and only
required a little attention to cleanliness to keep it from giving
bother, was removed. Some disturbance of his appetite led him to limit
his eating for a time, and then he suffered from constipation. This
was diagnosed by a specialist in rectal troubles as due to abnormally
developed valves in his rectum, and these were cut. He still
complained very much of abdominal discomfort at times. This was
diagnosed as ptosis of his organs, and an operation was done to tuck
these up. After this he developed a large ventral hernia, which had to
be relieved by a subsequent operation.

I had followed the case carefully during many years, seeing him at
times, and I was always opposed to the idea of operation and fully
confident that none of the operations were really needed. He could not
be persuaded that what his case needed most was occupation of mind
with something besides his condition. Whenever I could persuade him of
this I had seen him gain in weight, get into much better spirits and
be almost able to take up his work again. Then he would become
discouraged, and before long I would hear of another operation that
was planned, or was about to be performed. During the course of one of
his many progressive losses in weight as a consequence of depression
of mind, he developed tuberculosis. He resisted this very well, but
eventually died rather suddenly of an empyema. A careful autopsy
showed nothing but the traces of former operations, and no reason why
they should have been done.

Another case: A friend, also a clergyman, had three operations done,
one of them circumcision, the second an appendectomy and the third on
a supposed floating kidney. None were indicated, so far as I could
see, by any definite symptoms, or justified by his condition. He had
vague abdominal discomfort, and this continued to bother him in spite
of treatment by various specialists, and his mind became so much
occupied with it that he was ready to submit to anything in order to
be rid of his burden of discomfort. At no time was it an ache, nor did
he ever speak of it as a pain. He had some tendency to dilatation of
the stomach and at times, when much occupied with indoor work and
neglecting muscular exercise, there was probably some delay of
digestion. His appetite was good whenever he would let it be; his
bowels were regular whenever he was eating sufficient to stimulate
them to normal function; he slept well, except when unnerved by
something, but the presence of this abdominal discomfort disturbed
most of his waking hours. He could stand it so far as it had gone, but
he was sure that it would become so much worse in the future that it
would be unbearable. He dreaded that cancer or some other awful
development would come after a time.

As a matter of fact, the main portion of the discomfort in these cases
is the dread of what may happen. It is a dread, just as misophobia or
claustrophobia or acrophobia or any of the other dreads that we
discuss in the chapter on that subject. The constant occupation with
this dread apparently inhibits to some degree the flow of nerve
impulses to the abdominal organs, and digestion, already disturbed, is
still more impaired. Indeed, the whole of the discomfort seems
to be a consciousness of stomach and intestinal function rather than
anything more serious. The stomach will take two or three pounds or
even more of mingled liquids and solids at a meal and pass them on to
the intestines without forcing itself into the field of our
consciousness. Anyone who is aware what a thin-walled membranous bag
the human stomach is--what it most nearly resembles is perhaps the
familiar bladder of the cow--may well be surprised that, though it is
supplied with many sensitive nerves, it gives so little sign of the
load that is often placed in it. It may, however, be brought rather
poignantly into the sphere of consciousness by concentration of
attention on it.

The intestines function usually with the same lack of reflex. They
proceed to pass on this quantity of food, store up two or three days'
rations, digest what is nutritious and eliminate what must be
rejected, without rising into consciousness. If either stomach or
intestines once begin to attract attention, then it will be difficult,
unless care is exercised to distract the mind from them, to replace
and keep them back in the sphere of the unconscious once more.
Peristaltic movements are constantly taking place in the digestive
tract. Various things may interfere with peristalsis, and the
disturbance of it will almost surely cause some sensation. It may not
be serious, and digestive processes may continue, yet there may be
discomfort. If there is delay in the passage of food, gas accumulates
in the stomach, presses up against the diaphragm and interferes with
the heart action. This will give rise to many bothersome sensations,
some of which are felt in the heart region itself; others much lower
down on the left side, where it is rather hard to recognize just what
the real seat of them may be. A good deal of the abdominal discomfort
of which people complain, is due to such functional disturbances,
emphasized by the fact that digestive action has come into the sphere
of consciousness and now attention is being concentrated on it, to the
detriment of digestion itself, as well as to the increase of the
annoyance which the discomfort may occasion.

Operations for abdominal discomfort are quite contra-indicated, unless
there are very definite localizing symptoms of some pathological
lesion that can surely be relieved by operative intervention. To
operate on general principles is sure to emphasize the patient's
concentration of attention on his abdominal discomfort, if it does not
relieve it, and in most of these cases it utterly fails. The strong
suggestion of an operation will relieve for the time being, just as
operations for epilepsy seemed to relieve when that procedure was
first introduced, though now, unless there are definite localizing
signs, there is no question of such an operation.

Toxic Factors.--Tea.--A very interesting phase of abdominal
discomfort seems to be associated with the taking of nerve stimulants.
I have frequently found that patients who complained of vague
abdominal uneasiness, sometimes rising particularly at night to the
height of colicky feelings but always on the left side, were indulging
to excess in tea or coffee. In one case, a woman was taking, she
thought, about a dozen cups of tea a day. Just how much more than this
she actually was taking I do not know, for it is almost incredible the
amount of tea that middle-aged women who are alone may take. I once
found by actual count made for me, that a woman was taking almost a
score of cups of tea in each twenty-four hours.

Just as soon as there is a reduction in the amount of tea taken in
these cases, relief is afforded the patient. This relief will not,
however, be absolutely satisfactory because the craving for the tea
stimulation makes the patients irritable, and it takes but very little
to cause them to complain that they still have their old discomfort.
In the course of three or four days they realize that the root of the
trouble has been reached. If the discomfort has continued for a good
while, a sort of habit seems to be formed, and the attention of the
mind gives a sense of uneasiness, if not discomfort, in the left
abdominal region. Usually it is in the upper left quadrant and seems
to be stomachic in origin. The discomfort is apparently due to the
presence of air, or gas, which is not properly expelled because of
some lack of co-ordination of muscles, and then the warmth of a room
or of the bed at night, or the presence of some slightly irritant
substance makes the discomfort more noticeable. In the patient's
over-stimulated condition, there is inability to withstand it
patiently. In none of these cases is there a fever, though in all
there is some disturbance of the pulse as if the heart's action were
interfered with and the organ resented it.

Coffee.--In some cases the same vague abdominal discomfort occurs as
a consequence of taking too much coffee. This is seen in men more than
in women. The tea topers are nearly all women, though my attention was
first called to this vague discomfort, that made life miserable for a
tea tester, who spent most of his day tasting tea, though drinking
very little of it. With regard to coffee, individual idiosyncrasy is
an extremely important matter. Some men seem to be able to take five,
six or even more cups of coffee in the day without inconvenience; some
cannot take even a small cup of coffee after six o'clock at night
without being kept awake for several hours; others cannot take a large
cup of coffee in the morning without having considerable discomfort,
which is usually attributed to indigestion. I have known large, strong
men, who were much better for not taking any coffee, or at the most a
tablespoonful of it in a cup of milk in the morning to satisfy the

Loose Kidney.--Movable kidney is responsible for many of these cases
of abdominal discomfort. Where it exists to a marked degree it may be
relieved by operation. It occurs much more frequently in women than in
men because, for physiological reasons, the kidneys are normally more
movable in women and this is particularly true of the right kidney,
which would otherwise perhaps be injured by pressure between the
pregnant uterus and the liver. It is probable that many of the cases
of the kidney of pregnancy are really due to an abnormal fixity of the
kidney to a particular place, so that the growing uterus interferes by
pressure with its circulation and its function. Slight movability of
the kidney, then, should not be considered pathological.

I have seen a number of these cases. They seem to occur particularly
in women who have lost weight. The fat around the kidney is somewhat
absorbed during the course of loss in weight, and this leaves this
organ more movable and also less protected and consequently more
liable to irritation. One sees it rather frequently in many unmarried
women who have some strenuous occupation. Many of these young women
come back from their vacation at the end of the summer having gained
fifteen or twenty pounds in weight. If there has been any kidney
sensitiveness or movability before, both have usually
disappeared. The kidney is well held in place because there is much
more fat within the abdomen, all the organs are better cushioned, yet
without any interference with their function.

During the course of the year these patients, school-teachers,
stenographers, and daily workers of various kinds, lose in weight.
When they have lost ten pounds the kidney begins to be sensitive again
and somewhat movable. By the time they have lost fifteen to twenty
pounds there is serious complaint in the right upper quadrant of their
abdomen extending at times over toward the navel, and the kidney
becomes quite movable. At this time the treatment must consist in
holding the kidney as firmly in place as possible, for dragging
downward will be followed by reflex symptoms in the stomach and
intestines. Disinclination to food, loss of appetite, and even the
occurrence of some nausea, as well as some constipation, are easily
traced to kidney reflexes. During the night there is no trouble,
because while the patient is lying down the kidney falls into its
proper position. On arising in the morning the kidney drops down out
of place. If a corset is put on at this time the kidney may be forced
still further out of place, giving rise, after a couple of hours, to
considerable discomfort. New shoes can be borne at first, but after a
time the pressure they produce shuts off circulation and causes
intolerable discomfort. To a less degree this happens to the kidney if
thus compressed and this explains the course of symptoms in many

Mechanical Treatment.--If the corset is adjusted before the patient
rises, and fits reasonably snugly, but not too tight, the contents of
the abdomen will all be kept in place, and the kidney will maintain
its normal position. When the corset is not sufficient to retain the
kidney in place, a simple pad, a towel or a napkin or, if there is
much sensitiveness, something more elaborate, especially adapted to
conditions, can be placed over the kidney, and when held firmly by the
corset will keep the kidney in its place. At first the kidney is
usually sensitive to this on account of having been pressed upon
during the preceding weeks or months. The patient must bear some
little inconvenience at first, must get accustomed to the new
conditions in which the kidney is kept in place, and must not expect
complete relief at once. Any improvement must be considered a step
forward, and further amelioration can be confidently promised. As in
all other cases of the use of apparatus or mechanical
aids--spectacles, false teeth or crutches--the patient must be content
to grow used to the new order of things, before expecting satisfying

This is the palliative treatment. The natural treatment of many of
these cases is to have the patient maintain such weight as will hold
the kidney in place, because of the fat within the abdomen, without
any necessity for external aids. This can be done more readily than is
often thought to be possible. These patients insist that they lose
their appetite when they settle down to work, but what they really
lose is the habit of eating a definite amount at stated intervals.
Very often it will be found that breakfast, which they took abundant
time to eat during vacation, is rushed. The luncheon suffers in the
same way and is small in quantity. They take only one good meal, and
one good meal is not sufficient to maintain normal weight.

Question of Operation.--When a kidney is so movable as to deserve
the adjective "floating," so that it moves considerably from its place
and, perhaps, even sags and may be felt in the subumbilical region, it
should be fastened up by surgical means. There is a choice
between two evils. The fastening of the kidney in the loin does not
restore the normal condition, but puts it in an artificial condition.
The kidney supports are of such a kind that it was evidently meant to
be slightly movable. When it is fastened firmly in the loin, it is
likely to feel every jar, and certain post-operative cases that I have
seen, in which firm adhesions had supposedly taken place, complained
considerably of the discomfort occasioned by this. In a certain number
of cases, even after the operation, the kidney is still somewhat
movable, because the adhesions yield and some of the old distress
returns. All this must be realized before there is any question of an
operation. There must be not merely a little discomfort, but enough of
actual ache and of reflex disturbance that can be traced directly to
the kidney to warrant the operation.

No floating kidney should be operated upon in a patient who has lost
much in weight and has developed a sensitiveness of the kidney since
the reduction of weight. Definite efforts should first be made to
bring about increase in weight, so as to see whether this will not
restore the previous condition of reasonable comfort. At times it is
said that the disturbance of the stomach, that is reflex to such a
floating kidney, prevents the patient from taking and assimilating
enough food to restore normal weight. This will be true if attention
has been called to the condition very seriously, and if the patient is
persuaded that this is the reason why there is no appetite and poor
digestion. Ordinary palliative measures, such as a binder, or a
specially made corset, will be sufficient to prevent the kidney from
producing reflex disturbance of the stomach, and will exert a strong
suggestion to this effect under the influence of which the patient
will usually gain in weight.

Intermittent Discomfort.--The discomfort that comes with a loose
kidney may be quite intermittent. I have known patients to be bothered
by it for months, and then quite free from it for several years, only
to have their discomfort renewed so that they become quite worried.
Some definite local or mechanical condition can generally be found for
these variations in feeling.

In thin people a jolting ride over a rough road or stepping off a car
will occasionally be the beginning of the trouble, and as this also is
likely to cause a stone in the kidney to give its first
manifestations, there may be serious suspicion of a more grave
pathological condition than is really present. If this discomfort
continues only the X-ray can absolutely decide the question.

Once the mechanical conditions which cause the discomfort are
understood by the patient, the actual ache becomes much more easy to
bear. Apprehension makes it almost intolerable. Attention exaggerates
it, and makes diversion of mind difficult. Understanding helps all the
conditions and lessens the pain, not actually but mentally, until
after a time very little attention is paid to it.

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