Abdominal surgery . ructure. The accompanying drawing (Fig. 71), which is more true to nature than any I have^ seen, shows clearly the truth of Mr. Lloyds contention. The pelvis passing downwardsand inwards from the hilum,gradually contracts to form theureter. The ureter is said tobegin at the lower border of thekidney, and passes downwardsand inwards behind the peri-toneum to its insertion into thebase of the bladder. Fromabove downwards, it is in rela-tion with the psoas muscle andthe genito-crural nerve; at thebrim of the pelvis, it crosses theexternal iliac vessels on theright side, and th
Abdominal surgery . ructure. The accompanying drawing (Fig. 71), which is more true to nature than any I have^ seen, shows clearly the truth of Mr. Lloyds contention. The pelvis passing downwardsand inwards from the hilum,gradually contracts to form theureter. The ureter is said tobegin at the lower border of thekidney, and passes downwardsand inwards behind the peri-toneum to its insertion into thebase of the bladder. Fromabove downwards, it is in rela-tion with the psoas muscle andthe genito-crural nerve; at thebrim of the pelvis, it crosses theexternal iliac vessels on theright side, and the common iliacvessels on the left; thence itpasses in the fold forming theposterior false ligament of thebladder to its insertion. Allthrough its course the ureteris very loosely attached to thecellular tissue in which it lies. The kidney is kept in position by its thick packing of fatty cellular tissue, known as the tunica adiposa. This tissue varies in amount in different individuals; but it is always of consider-. FlG. 71. (Heitzmann). Pelvis and, Calyces of the Kidney prepared out of the Renal Substance. I. Minor 4. Ureter. Major Calyces. 504 OPERATIONS ON THE KIDNEY. able thickness. In this elastic bed, the kidney enjoys someliberty of movement; when it is opened up, and the kidney isexposed, regular movements are seen to follow the respiratoryacts. When the fat is partly absorbed, or its density is dimin-ished, anatomical displacements may be produced. In operations upon the kidney, the lowest limits of the pleuraand its relations to the twelfth rib are of importance. Dum-riecher of Vienna, in an operation upon an enlarged kidney, bymisadventure opened the pleura. Holl of Vienna and Lange ofNew York have made studies on this point, which show that thelast rib is frequently so short as to be overlooked, and that thepleura descends as low as if the twelfth rib were of normal length.(Fig. 72.) The lower edge of the pleura passes horizontally
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