38 LANDMARKS MEDICAL AND SURGICAL. 



owing to the size of the liver, is a trifle say, three-quarters 

 of an inch lower than the left. The pelvis of the kidney is 

 on about the level of the spine of the first lumbar vertebra : 

 the upper border is on about the level of the space between 

 the eleventh and twelfth dorsal spines ; the lower border 

 comes as low as the third lumbar spine. During a deep 

 inspiration both kidneys are depressed by the diaphragm 

 nearly half an inch. 



Can we feel the normal kidney ? The only place where 

 it is accessible to pressure is just below the last rib, on the 

 outer edge of the ' erector spinae.' I say accessible to pres- 

 sure, for I have never succeeded in satisfying myself that 

 I have distinctly felt its rounded lower border in the living 

 subject, nor even in the dead, with the advantage of flaccid 

 abdominal walls and the opportunity of making hard pres- 

 sure with both hands, placed simultaneously, one in front of 

 the abdomen, the other on the back. For these reasons, 

 although we can easily ascertain its degree of tenderness, we 

 cannot actually feel it unless it be considerably enlarged. 



We must be on our guard not to mistake for the kidney 

 an enlarged liver or spleen, or an accumulation of faeces in 

 the lumbar part of the colon. 



#4. Xiarg-e intestine. Let us now trace the large intestine 

 and see where it is accessible to pressure. The ' caecum,' or 

 ' caput coli,' and the ileo-csecal valve lie in the right iliac 

 fossa. The ascending colon runs up the right lumbar region 

 over the right kidney. The transverse colon crosses the 

 abdomen two or three inches above the umbilicus. The 

 descending colon lies in the left lumbar region in front of 

 the left kidney. The sigapoid flexure occupies the left iliac 

 fossa. 



Throughout this tortuous course, except at the hepatic 

 and splenic flexures, the colon is accessible to pressure, and 

 we could, under favourable circumstances, detect hardened 

 faeces in it. In a case which occurred in St. Bartholomew's 

 Hospital, a collection of faeces in the transverse colon formed 

 a distinct tumour in the abdomen. All the symptoms 

 yielded to large and repeated injections of olive oil. In 



