Stone in t/ie Kidney 349 



the pelvis. Ovarian disease begins below, and hydro-nephrosis works 

 downwards. 



A large sarcomatous, cystic, or suppurating kidney may extend 

 across the middle line as well as fill the flank. 



(For renal artery, v, p. 354 ; for renal vein, v. p. 349.) 



The nerves of the kidney come from the sympathetic system of the 

 thorax (sphanchnic) and of the abdomen (solar plexus). Filaments 

 are also derived from the upper lumbar ganglia, and so the plexus 

 becomes associated with the upper lumbar nerves. Offshoots from 

 this network pass to the spermatic plexus. 



The lymphatics enter the lumbar glands. 



In renal calculus pains radiate widely on account of the extensive 

 communications of the nerves of the kidney. Thus, they strike along 

 the ureter to the bladder, causing frequent micturition ; and, descending 

 in the spermatic offshoot of the renal plexus to the testis, they may 

 so disturb its vaso-motor nerves as to set up orchitis. And, on account 

 of the association between the renal plexus and the upper lumbar 

 nerves through the higher lumbar ganglia, pains dart along the ilio- 

 hypogastric and ilio-inguinal nerves (of the first lumbar nerve), and 

 along the genito-crural (of the second) to the cremaster, so that 

 retraction of the testis is to be looked for in renal calculus. Neuralgia 

 may also extend along other branches of the lumbar nerves into the 

 thigh ; and irritation through the neighbouring solar plexus may cause 

 nausea and vomiting. The renal capillaries are bruised by the stone, and 

 the urine becomes bloody. At the end of the ureter the stone may be 

 for a while impacted, and by its presence it may cause obstruction of 

 the ureter and disorganisation of the kidney. It may sometimes be felt 

 fixed there, close to the bladder, by digital examination through the 

 rectum. The pains which have been caused by the stone scraping 

 along the ureter suddenly cease on its escape into the bladder. 



In the case of disease of the second and third lumbar vertebrae, 

 with inflammatory pressure upon the posterior root of the second 

 lumbar nerve of one side, there would be dull pain in the back, 

 which would be increased by exercise, and possibly some tenderness 

 in the renal region, especially if abscess were forming. There would 

 be pain referred to the testis, and, on account of the irritation of the 

 genito-crural nerve, retraction of the testis. There might, moreover, 

 be increased frequency of micturition. Thus it is quite possible that 

 lumbar caries may be mistaken for renal calculus. 



Ureter. From the hiluin the ureter emerges, sloping downwards 

 and inwards ; it is behind the renal artery, the vein being in front of 

 both. Though the anterior surface of the kidney is the more convex, 

 and the upper end the larger, still the best way of telling the right kidney 

 from the left is by the position of the ureter, which is posterior to the 

 vessels and slopes downwards and inwards. -It is about fifteen inches 

 long, and, descending gently inwards, it rests upon the psoas and 



