242 Anatomy Applied to Medicine and Surgery. 



side to the vena cava. This close relationship of the kid- 

 ney with the vein should be borne in mind in nephrectomy 

 or removal of the right kidney. The artery arises from the 

 aorta on a level with the first lumbar vertebra, and before 

 entering the hilum, which is opposite the spine of the same 

 vertebra, breaks up into three or four terminal branches. 

 Occasionally, one or more extra branches are given off 

 that enter the renal substance at points other than the 

 hilum, and these might cause trouble during the operation 

 of nephrectomy. The capsule of the kidney is supplied 

 by the terminal twigs of the renal, by the suprarenal, the 

 phrenic, and the lumbar arteries, anastomosing with one 

 another, hence a limited amount of circulation may still be 

 carried on in the kidney when the renal itself has been oc- 

 cluded. The nerves surround the renal artery and form 

 the renal plexus, and, although a few filaments from the 

 pneumogastric are prolonged to this plexus, yet it is main- 

 ly formed by the sympathetic, i.e., by extensions from the 

 solar, the aortic, the spermatic plexuses, and from the 

 smallest splanchnic nerve. 



The Ureters are about twelve inches long and begin 

 above at the hilum of the kidney, being continuous with the 

 renal, pelvis. They are about one-sixth of an inch in dia- 

 meter when distended, and are composed of a fibrous, a 

 muscular and a mucous coat, and, in their passage towards 

 the pelvis, lie immediately beneath the peritoneum to 

 which the fibrous coat is intimately adherent, so that 

 when the peritoneum is stripped from the posterior ab- 

 dominal wall it carries with it the ureter. This may be 

 seen in extravasations behind the peritoneum in which 

 the ureter is raised with this membrane so that it lies in 

 the anterior wall of the cavity. At their commencement 

 the two ureters are about three inches apart, but, as they 

 descend, they converge slightly, so that at the brim of the 



