344 The Kidneys 



found in young children, and occasionally in adults ; they indicate the 

 development of the gland in lobules, which remain through life dis- 

 tinct from each other, separated by fibrous tissue. Sometimes the 

 kidneys are united by their lower ends across the aorta and vena 

 cava, forming a horse-shoe kidney. 



The relative position of some of the chief abdominal viscera may IDC 

 remembered by such a system as this : The stomach lies across the 

 middle line and is prolonged into the right hypochondriac region, being 

 continued on by the horse-shoe curve of the duodenum ; the head of the 

 pancreas fills in this duodenal curve, its body extending to the left, be- 

 hind the stomach ; its tail lies on the front of the upper part of the left 

 kidney, and touches the concave surface of the spleen, into which the 

 convex end of the stomach is fitting. As the tail of the pancreas passes 

 in front of the top of the kidney to reach the spleen, the kidney must 

 lie to the inner side of the spleen, and behind the stomach. 



The peritoneum touches the front of the kidney, but does not give 

 it an investment. A movable kidney is one which, on account of the 

 looseness of its connection, can shift its position behind the peritoneum. 

 A floating kidney has a complete serous investment, and swings about 

 in the general peritoneal cavity at the end of a meso-nephron, tethered 

 only by its blood-vessels. Its movements vary with the position of the 

 subject, and also with respiration, and are often accompanied with un- 

 pleasant sensations and even pain. Tight-lacing, and the disturbance 

 of the abdominal walls and viscera associated with pregnancy, render 

 floating kidneys more common in women than men. 



The removal of the kidney without wounding the peritoneum is, as 

 far as concerns the anatomy of the parts, so like Amussat's operation 

 (p. 331) that it is unnecessary here to describe it. The incision is made 

 nearer to the last rib than in colotomy, but, as the pleura sometimes 

 descends below the level of the twelfth rib, the knife must be used very 

 carefully. When the kidney is loosened from its bed the vessels and 

 ureter are ligated and divided, and the gland is taken out. 



If the diseased kidney seemed to be too large to come readily 

 through the space between the last rib and the iliac crest, it would be 

 better to remove it through the corresponding linea semilunaris. In 

 that case the peritoneal cavity would be opened and the intestines 

 drawn aside, the peritoneum being traversed posteriorly on the outer 

 side of the colon, so as not to risk interference with the vessels passing 

 to and from the colon. 



The fibrous capsule is a tough, thin layer which sends numberless 

 filamentous processes throughout the interior of the gland; their peri- 

 pheral attachment is noticed when the capsule is being stripped 

 off. 



The hiliun leads into a cavity called the sinus of the kidney, into 

 which the dilated end pelvis of the ureter opens. The pelvis of the 

 ureter gives off three short primary divisions inj'umlibulti and 



