362 SURGICAL APPLIED ANATOMY, [Chap. xvn. 



most accessible to pressure at the outer edge of the 

 erector spin?e, just below the last rib. The right 

 kidney lies nearly three-quarters of an inch lower 

 down than does the left ; but even the lower end of 

 the right gland only just reaches to the level of the 

 umbilicus. The upper end of the left kidney is on a level 

 with the eleventh dorsal spine behind, the right being a 

 little lower (Figs. 30 and 31). The inferior extremity 

 of the left gland is about one and five-eights inches from 

 the iliac crest, that of the right about one and a 

 quarter inches. The kidney lies a little lower in the 

 female than in the male. In many instances in the 

 female its lower end reaches the iliac crest, and may 

 even go below it. Such positions are much less 

 common in the male. A vertical line carried upwards 

 from the middle of Poupart's ligament has one-third 

 of the kidney to its outer side and two-thirds to its 

 inner side. The hilum lies about two inches from the 

 middle line, and is opposite to the gap between the 

 first and second lumbar spines. The kidney has been 

 reached by the finger when the entire hand has been 

 introduced into the rectum, but the procedure has 

 failed to prove of much use in diagnosis. 



The anterior surface is but slightly covered by 

 peritonenin, being only in contact with that membrane 

 in such parts as are not in relation with the cellular 

 tissue at the back of the colon and at the back of the 

 duodenum or pancreas. The external border is more 

 closely in connection with the peritoneum, while the 

 posterior surface is quite devoid of that membrane 

 (Figs. 34 and 35). Crossing the posterior surface of 

 the kidney obliquely from above downwards and out- 

 wards are branches of the last dorsal nerve and of the 

 first lumbar artery, together with the ilio-hypogastric 

 and ilio- inguinal nerves. Rupture of the kidney is 

 more often recovered from than is a like lesion of 

 any other of the more commonly injured abdominal 



