Chap, xvii.] THE KIDNEY. 367 



about one inch over the erector spinee, and a part 

 of the quadratus lumborurn will probably have to be 

 divided. The periuepliritic tissue is opened up, and 

 the gland enucleated from the capsule of fat in which 

 it lies. In some instances the last rib has been 

 resected to obtain more space for the operation. 

 This can be done without risk to the pleura. In 

 one case the twelfth rib was rudimentary, and the 

 eleventh rib was removed under the impression that 

 it was the twelfth. The pleura was opened and death 

 ensued. 



When the kidney is free from its fatty capsule, 

 the vessels at the hilum are secured en masse by a 

 ligature. They constitute a surgical pedicle of the 

 kidney. At the hilum the vein lies in front, the artery 

 and its branches next, and the ureter behind and 

 towards the lower part. The artery is about the size 

 of the brachial, and usually divides into four, five, or 

 six branches before it reaches the kidney. This fact 

 must be borne in mind if the structures at the hilum 

 are separately secured. The vein also is represented 

 at the hilum by three or four branches. The renal 

 artery may be represented by two, three, four, or even 

 live branches. Some may enter the upper end of the 

 kidney or its anterior surface. In removing large 

 renal gi'owths an abdominal incision is advised, the 

 cut being made either along the corresponding semi- 

 lunar line, and on a level with the diseased mass, 

 and in the linea alba. The abdominal operation of 

 course involves an opening into the peritoneal cavity, 

 but it has the advantages of greater ease and rapidity 

 in performance. 



The ureters are strong tubes about fifteen inches 

 long, with thick muscular walls, and are placed 

 entirely behind the peritoneum. The average width 

 is that of a goose-quill. The ureter rests from above 

 downwards upon (1) the psoas muscle and the genito- 



