The Kidneys. 245 



Landmarks for Ureter. The ureter may be 

 represented by a line drawn downwards and slightly in- 

 wards from a point opposite the tip of the tenth costal car- 

 tilage, about two inches from the median line, to a point 

 below, indicated by the junction of the line joining the 

 two iliac spines with a vertical one drawn upwards from 

 the spine of the pubes. This latter point, i.e., this point 

 of junction, is about where the ureter crosses the pelvic 

 brim. The landmark for where the ureter is crossed by 

 the spermatic vessels is a point in its course about one 

 inch below the level of the umbilicus, or, about four inches 

 internal to the highest point of the iliac crest. 



Renal Reflexes. The nerves of the kidney con- 

 tain vasomotor, sensory and secretory fibres. The sen- 

 sory nerves explain the local pain and soreness felt in the 

 renal region when a stone is situated in the pelvis of the 

 kidney. The shock and collapse sometimes present in 

 renal colic are no doubt dependent on the impression made 

 on the solar plexus through its sensory branches to the 

 kidney, and when the pain in renal calculus is felt in other 

 parts of the abdomen, it is probably due to reflex disturb- 

 ance of the branches of the solar plexus, as in the case of 

 the intestinal reflex neuroses, already referred to. When 

 pain is referred to the testicle, it is dependent on diffusion 

 of the sensory impressions along the ureteral plexus to its 

 termination at the testicle. This ureteral plexus sur- 

 rounds the ureter, and is formed by branches derived 

 from the renal, the spermatic, the mesenteric and the 

 hypogastric plexuses. When pain, in renal calculus, is 

 experienced in the lower parts of the abdomen and down 

 the thigh, it is no doubt a reflex action, the paths being 

 from the ureteral plexus through the spermatic, etc., to 

 the aortic plexus, thence through the rami communicantes 

 to the origins of the upper lumbar spinal nerves, the first 



