1120 



SURGICAL AND TOPOGRAPHICAL A.XATOMY 



higher than is usually supposed to be the case, the upper two-thirds of the right 

 and all the left kidney being behind the ribs. To mark them in from the front 

 the following points should be noted: The upper extremity should reach as high 

 up as the seventh costal cartilage, close to the costo-chondral junction. The 

 lower end, about four and a half inches below this point, should be above a 

 line drawn horizontally through the umbilicus, though it is to be remembered 

 that the right often encroaches upon this line. Relatively to the vertebriP, the 

 kidneys lie along the sides of the last thoracic and the tirst three lumVjar. A 

 vertical line carried up to the costal arch from the centre of Poupart's ligament has 

 one-third of the kidney to its outer side, and two-thirds to its inner side, i.e. 

 between this line and the median line of the body. The distance between the two 

 kidneys and between each viscus and the middle line is thus given by Thane and 

 Godlee: The position of the superior pole is indicated by a spot about two 'inches 

 from the middle line, the hilum is placed at the same distance, and the inferior 

 pole about two and a half to three inches from the middle line. The shortest dis- 

 tance between the two kidneys, 'at the upper part of their mesial borders,' meas- 

 ures about two and a half inches. 



Fig. 689. — Transverse Section of the Abdomen through the Kidneys and 

 Pancreas, at the level of the first Lumbar Vertebra. (Biaune. ) 



Inferior cava 



Bound ligament 

 Rectus I 



EIGHTH RIB I ' 



TRANSVERSE COLON 

 / SEVENTH RIB 



' / ASCENDING COLON 



SIGMOID FLEXURE 



DESCENDING COLON 

 External oblique 



EIGHTH RIB 

 Obliquus externuB 



NINTH RIB 



PLEURA 

 TENTH RIB 



Splenic vein 



Descending aorta 

 BODY OF FIRST LUMBAR VERTEBRA 



LIVER 

 Diaphragm 



ELEVENTH RIB 

 TWELFTH RIB 



On the posterior surface of the body the kidney's boundaries are indicated by 

 the following: — (1) A line parallel with, and one inch from, the spine, between the 

 lower edge of the tip of the spinous process of the eleventh thoracic and the 

 lower edge of the spinous process of the third lumbar vertebra; (2) and (3) lines 

 drawn from the top and bottom of this line outAvards, at right angles to it, for 

 two inches and three-(i[uarters; (4) a line parallel to the first, and connecting (2) 

 and (3). Within this parallelogram the kidney lies (Morris). 



The spleen (figs. 588 and 589). — This lies very obliquely from above down- 

 Avards, and from within outAvards, in the left hypochondrium: thus its long axis 

 corresponds closely with the line of the tenth rib. It is placed opposite the 

 ninth, tenth, and eleventh ribs externally, being separated from these by the dia- 

 ])hragm; and internally it is connected with the great end of the stomach. BeloAv, 

 it overlaps slightly the outer border of the left kidney (figs. 690, 709, 710, and 

 711). Its highest point is on a level Avith the spine of the ninth thoracic, and its 

 lowest Avith that of the eleventh thoracic vertebra. Its inner end is distant about 

 an inch and a half from the median plane of the body, and its outer about reaches 

 the mid-axillary line (Godlee). In the natural condition it cannot be felt; but if 

 enlarged, its notched anterior margin extends doAvnwards towards the umbilicus, 

 and is both characteristic and readily felt. 



