CHAPTER XXIV; 

 THE KIDNEYS AND URETERS. 



ANATOMY. RENAL REFLEXES. 



RELATIONS. CLINICAL EXAMINATION. 



LANDMARKS. OPERATIVE WORK. 



The kidneys are situated at the back of the abdominal 

 cavity behind the peritoneum, and are about four inches 

 long, two and a half inches wide and one and a half inches 

 thick, the left being a little narrower and heavier than the 

 right. Each organ presents two surfaces, two borders 

 and two extremities, and is surrounded and suspended by 

 a quantity of loose areolar tissue formed by a thickening 

 of the subperitoneal layer and termed the "capsula adi- 

 posa." In addition to this tissue the renal vessels and the 

 tonicity of the abdominal muscles assist in retaining the 

 kidney in its normal position. The influence of the ab- 

 dominal muscles in supporting the kidneys is shown by 

 the effects of the pressure exerted on the surfaces of each 

 kidney by the contiguous structures, since Cunningham 

 has demonstrated that the kidney, when hardened in situ, 

 presents a point of maximum convexity, which, in the case 

 of the left kidney, is a blunt summit, and in that of the 

 right, is a transverse ridge. On the inclined planes above 

 and below these convexities lie the different organs that 

 are in contact with the kidneys, and these organs, thus 

 moulding the kidney, assist in maintaining it in its posi- 

 tion in the abdomen and are themselves supported by the 

 abdominal muscles. Each kidney is situated at the inter- 



