326 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



THE KIDNEY. 



Right. 



Under surface of liver. 

 Duodenum. Commence- 

 ment of transverse colon. 

 Ascending colon. 



In front. 



Left. 



Fundus of stomach. 



Descending- col n. 



Pancreas. 



Externally. 

 (On left side) Spleen. 



Behind. 



Lower part of arch of diaphragm. 

 Quadrat us luinborurn. Psoas. 



The kidneys are deeply placed, and cannot be felt 

 and distinctly identified when normal. They are 

 most accessible to pressure at the outer edge of the 

 erector spinse, just below the last rib. The right 

 kidney lies about three-quarters of an inch lower 

 down than does the left ; but even the lower end of 

 the right gland barely reaches to the level of the 

 umbilicus. The upper end of the left kidney is on a 

 level with the eleventh dorsal spine behind, the right 

 being a little lower (Figs. 30 and 31). The inferior 

 extremity of the left gland is about two inches from 

 the iliac crest, that of the right about one and a 

 quarter inches. The hilus lies about two inches from 

 the middle line, and is opposite to the first lumbar 

 spine. The kidney has been reached by the finger 

 when the entire hand has been introduced into the 

 rectum, but the procedure has failed to prove of much 

 use in diagnosis. 



The anterior surface is but slightly covered by 

 peritoneum, being only in contact with that membrane 

 in such parts as are not in relation with the cellular 

 tissue at the back of the colon and at the back of 

 the duodenum or pancreas. The external border 

 is more closely in connection with the peritoneum, 

 while the posterior surface is quite devoid of that 



