Annals of surgery . had many dead bodiesat my disposal, and have taken the opportunity of investi-gating this question. The danger to the pleura in operating upon the kidneyappears to me to depend upon the length of the last rib. InFig. I I have represented by a dotted line the commonestposition of the reflection of the pleural membrane in theneighborhood of the last two ribs. If this line is to be of anyvalue, from a surgical point of view, it must be shown to bear 1 Dr. Melsome is apparently not aware of the work already done in this importantmatter by Dr. Holl, of Vienna, and Dr. Lange, of
Annals of surgery . had many dead bodiesat my disposal, and have taken the opportunity of investi-gating this question. The danger to the pleura in operating upon the kidneyappears to me to depend upon the length of the last rib. InFig. I I have represented by a dotted line the commonestposition of the reflection of the pleural membrane in theneighborhood of the last two ribs. If this line is to be of anyvalue, from a surgical point of view, it must be shown to bear 1 Dr. Melsome is apparently not aware of the work already done in this importantmatter by Dr. Holl, of Vienna, and Dr. Lange, of New York, Annals of Sur-gery, Vol. II, October, 1885, P- 286.—[Editors.] 27 417 4i8 IV. S. MELSOME. a fixed relation to some substantial landmark. The pointwhere the erector spinas cuts the twelfth rib is an excellentlandmark. It can be easily felt Avhen a person is lying down,or when he is in a stooping position, trying to touch the toeswithout bending his knees. Now the twelfth rib is sometimes absent; much more. Fig. I.—P, dotted line represents the mean level of the pleura, and theblack lines its variations ; E, erector spinse muscle ; K, kidney ;O, oblique incision into the angle between the muscle and thetwelfth rib; pleura not wounded. commonly it is short and fails to reach the outer border ofthe erector spinse muscle, but the commonest condition of allis a twelfth rib extending beyond the outer border of themuscle, and when this is so, an incision may be made upwardonto the lower margin of any part of the rib which projectsbeyond the outer edge of the muscle without wounding thepleura. LOWER LIMITATIONS OF THE PLEURAL CAVITIES. 419 In Fig. I I have represented by black lines the variationsabove and below the mean level of reflection that I have metwith in fifty-seven examples. In not one of these did thepleural membrane extend below the lower border of the ribat the point I have mentioned,—, where the outer borderof the muscle cuts the twelfth rib; and in no
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
