Renal insufficiency with combinations of angiotensin converting enzyme inhibitors and diuretics.

The latter half ofthe nineteenth centuryproduced aremarkable expansion of surgical practice. Althoughmost of these newtechniques and concepts weresoundlybased, others, such as the movable orfloating kidney,were later ridiculed anddiscredited.In Glasgow Royal Infirmary during the 48 years from1880, when movable kidney wasfirst mentioned intheannual reports of thehospital, to 1928472 patients (89%female) werediagnosed assuffering from thecondition.Nearly half of them(216) underwent operation and theoperative mortality was low. In thefirst decade ofthiscentury an average of 18 cases a year wereadmitted tothe wards of the infirmary. From 1915 to 1920the numberof casesdropped, as did the proportion undergoingoperation, but in the 1920s the numbers increased again.In common with other ineffective treatmentsforimaginary diseases, operations for the movable kidneysimply faded away in Britain in the 1930s. University Department of Surgery, Western Infirmary, Glasgow GIl6NT DOUGLAS L McWHINNIE, FRCS,surgical registrarDAVID N H HAMILTON, PHD, FRCS, consultant surgeon Correspondence to: Mr David N H Hamilton, Wellcome Unit for Historyof Medicine, University ofOxford, 47Banbury Road, Oxford OX2 6PE.Introduction Inthe second half of the nineteenth century there was a notableexpansion ofsurgical practice. Newtechniques appearedrapidly after the introduction andimplementation of antisepsisand anaesthesia. Although most of this new surgical practice wassoundly based, this confidence also produced diagnoses and evenoperations that were later ridiculed and discredited. One suchdisorder was the "movable" or"floating" kidney.This condition had been noted in earlier times,l but it becameincreasingly popular as adiagnosis in the latenineteenthcentury, when it wasapplied tothose patients with abdominalsymptoms and akidney that onpalpation wasalleged tobeabnormally mobile.Early attempts to treatthis disorder with nephrectomy led toanappallingmortality.2 In 1881,however, Dr Ernest Hahn ofLeipzig described a less radical operation in which the renalcapsule and parenchyma weresutured tothe adjacent muscleand fascia thusimmobilising the kidney (fig 1).3 This fixationprocedure of nephrorrhaphy (also termed"nephropexy,"especially in French publications) wasincreasingly performedboth inhospitals and in private practice until the 1930s, whenthe concept of the movable kidney wasdiscredited.We undertook aquantitative study of the rise and fall ofsurgery for movable kidney. The annual reports of the GlasgowRoyal Infirmary contained avaluable clinical section thatsummarised in some detail the causes of admission to that hospi-tal, theoperations performed, and their mortality. Moreover,these records are continuous and areconsistently reported, thusproviding theopportunity tostudy the management of movablekidney in that hospital.