ABDOMINAL VISCERA IN MAN. 297 



viscera vary in particular cases, and in which the liver and 

 right kidney share, the liver is unable to materially displace the 

 right kidney downwards. 



The Colon. — The hepatic flexure of the colon must be con- 

 sidered amongst the forces which may assist in maintaining the 

 right kidney in its position, for in most cases it presses con- 

 siderably on the lower segment of the right kidney. 



Except in the cases of prolapse, the colon passes upwards on 

 the anterior aspect of the lower segment of the kidney, and in 

 these there is not much to be learnt from the figures as to the 

 amount of support it gave to the kidney. But in cases 7 and 

 15 it could have given the kidney very little support, and in 

 cases 24 and 36 none at all, as, especially in the former, it had 

 wholly retreated from the kidney ; which, as it happens in both 

 cases, was higher than usual. 



Band. — In case 24 the connective tissue passing from the 

 upper pole of the kidney to the diaphragm was carefully 

 dissected ; it contained a very strong fibrous band passing on to 

 the right crus as it passed forward. This band very clearly 

 gave additional strength to the connective tissue helping to keep 

 the kidney in its place. A similar condition was remarked in 

 several other cases, but in none was it so well marked as in case 

 24, in which, as we have seen, the kidney had lost its colic 

 support, and in which, moreover, the liver had descended very 

 low down. 



This case, perhaps, most forcibly of all, shows that, in the 

 absence of lax connective tissue, the kidney is very much 

 independent of the pressure of the liver above, or of the support 

 from the colon below. 



Other Points.— The kidney in case 38, and less so in case 11, 

 was spoken of as movable, but the cases present no special 

 feature. 



The highest point of the right supra-renal body averages 

 5-3 cm. above E.F., about half-way between the middle and 

 lateral lines. The lowest point is "2 above E.F. The innermost 

 point is situated 2-5 cm. from the middle line, and is overlapped 

 by the inferior vena cava for 14 cm. 



