Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

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    junction of the first and second lumbar vertebrae. The proper place to feel for it, therefore, would be in the linea alba about two or three inches above the umbilicus. Is it perceptible to the touch?—only under very deep pressure, and very favourable circumstances, such as an emaciated and empty abdomen. It is worth remembering that it may be felt under such conditions. The pancreas of normal size, in thin per- sons, has been mistaken for disease—disease of the trans- verse arch of the colon, or aneurysm of the abdominal aorta. 99. Kidney.—The kidney lies at the back of the abdomen on the quadratus lumborum and psoas muscles, opposite the two lower dorsal and two upper lumbar spines. The right, owing to the size of the liver, is a trifle—say, three-quarters of an inch—lower than the left. The pelvis of the kidney is about the level of the spine of the first lumbar vertebra : the upper border is about the level of the space between the eleventh and twelfth dorsal spines ; the lower border comes as low as the third lumbar spine. During a deep inspiration both kidneys are depressed by the diaphragm nearly half an inch. Can we feel the normal kidney ? The only place where it is accessible to pressure is just below the last rib, on the outer edge of the ' erector spinae.' I say accessible to pres- sure, for I have never succeeded in satisfying myself that I have distinctly felt its rounded lower border in the living subject, nor even in the dead, with the advantage of flaccid abdominal walls and the opportunity of making hard pressure with both hands, placed simultaneously, one in front of the abdomen, the other on the back. For these reasons, although we can easily ascertain its degree of tenderness, we cannot actually feel it unless it be considerably enlarged. We must be on our guard not to mistake for the kidney an enlarged liver or spleen, or an accumulation of faeces in the lumbar part of the colon. 100. Large intestine. — Let us now trace the large intestine and see where it is accessible to pressure. The ' caecum/ or 1 caput coli,' with the appendix vermiformis and the ileo-caecal valve lie in the right iliac fossa. The ascending