26 LANDMARKS MEDICAL AND SURGICAL. 



Make a man lean forwards, with his arms folded across 

 the chest ; this will make prominent the spines of the ver- 

 tebrae. The lower border of the trapezius will guide you to 

 the spine of the twelfth dorsal vertebra. 



50. The place where the kidney is most accessible to 

 pressure is below the last rib, on the outer edge of the erector 

 spinae. 



51. The highest part of the ilium is about the level of the 

 fourth lumbar spine. The best incision for opening the 

 descending colon is in a slightly sloping line beginning at the 

 outer edge of the erector spinae, midway between the crest of 

 the ilium and the last rib, and continued across the flank for 

 three inches or more, according to the amount of subcutaneous 

 fat. 



52. In the pit of the neck we can feel the trapezius and 

 the ligamentum nuchae. By pressing deeply we detect the 

 forked and prominent spine of the second cervical .vertebra. 



53. The spines of the third, fourth, and fifth cervical 

 vertebrae recede from the surface to permit free extension of 

 the neck, and cannot often be felt. But the spines of the 

 sixth and seventh (v. prominens) stand out well. 



54. Notice that most of the spines of the dorsal vertebrae, 

 owing to their obliquity, do not tally v/ith the heads of their 

 corresponding ribs. Thus, the spine of the second dorsal 

 corresponds with the head of the third rib ; the spine of the 

 third dorsal with the head of the fourth rib, and so on till we 

 come to the eleventh and twelfth dorsal vertebrae, which do 

 tally with their corresponding ribs. All this, however, is best 

 seen in the skeleton. 



55. The spines of the vertebrae may be useful as land- 

 marks indicative of the levels of important organs. I have 

 therefore arranged them in a tabular form, thus : 



TABULAR PLAN OF PARTS OPPOSITE THE SPINES OF THE 

 VERTEBRAE. 



5th. Cricoid cartilage. (Esophagus begins. 



7th. Apex of lung : higher in the female than in the male. 



