The Kidneys

The upper limit of the kidney is indicated by a line drawn transversely at the level of the eleventh dorsal spine, the lower limit by one at the level of the third lumbar spine. About a third of the kidney lies above the lower margin of the twelfth rib, the left kidney about 1/2 inch higher than the right. The most external point of the outer border lies 4 inches from the mid-line and the hilum lies 1 1/2 inches from the mid-line between the tips of the transverse processes of the first and second lumbar vertebrae.

The Diaphragm And Liver

Posteriorly the right arch of the diaphragm and the right lobe of the liver extend upwards to the level of the angle of the scapula (eighth rib), while the left arch lies 1 inch lower; the central tendon is on a level with the eighth dorsal spine. The right lobe of the liver is covered posteriorly by the eighth to the twelfth ribs.

The Spleen is situated in the left hypochondrium behind the cardiac end of the stomach, and is overlapped by the ninth, tenth, and eleventh ribs, the long axis corresponding to that of the tenth rib.

The anterior angle is at the level of the ninth interspace in the mid-axillary line. The vertebral angle lies 1 1/2 inches external to the tenth dorsal spine. The inferior angle lies opposite the eleventh interspace on a level with the first lumbar spine : with these points the whole organ can be mapped out.

The Upper Extremity.

The Shoulder

The shaft of the clavicle is subcutaneous throughout. The tip of the acromion lies a little external to and in front of the outer end of the clavicle; and its outer border can be followed round along the spine of the scapula, the root of which is on a level with the third dorsal vertebra. The inferior angle and internal border of the scapula are easily felt. The tip of the coracoid process can be felt at the anterior border of the deltoid 1 inch below the point joining the middle and outer thirds of the clavicle. Internal to the coracoid process is a triangular depression between pectoralis major and deltoid; in this depression can be felt the axillary artery.

The rounded contour of the shoulder is formed by the upper end of the humerus covered by the deltoid; both tuberosities can be felt; the head of the humerus can be felt through the axilla.

The Axilla

The anterior fold of the axilla is formed by the lower border of pectoralis major and the posterior fold by latis-simus dorsi and teres major; between the two folds is the prominence of coraco-brachialis, behind which can be felt the third part of the axillary artery. High up in the axilla a few lymphatic glands can be felt.

The Upper Arm

The anterior and posterior borders of the deltoid can be traced in their whole extent; just under the posterior border, about half-way down, the circumflex artery and nerve and the musculo-spiral nerve enter the arm. The internal supracondyloid triangle, limited by the internal intermuscular septum posteriorly, and whose floor is formed by the inner part of brachialis anticus, contains many important structures ; from without inwards, the brachial artery, the median nerve, the lower part of the basilic vein, the internal cutaneous nerve, and two or three lymphatic glands.

The external intermuscular septum extends upwards from the external condyle to the insertion of the deltoid, and is pierced a third of the way down by the musculo-spiral nerve.

The posterior compartment of the upper arm is occupied by the triceps, the tendon of which can be felt at its insertion into the olecranon.

The brachial artery, overlapped above by coraco-brachialis and below by biceps, can be felt throughout the whole length of the internal bicipital furrow. The course of the vessel is mapped out by a line drawn from the inner border of the coraco-brachialis, at the level of the posterior fold of the axilla, to a point (opposite the neck of the radius) 1/2 inch below the middle of the bend of the elbow.

The cephalic vein ascends internal to the outer edge of triceps to the interval between the deltoid and pectoralis major.

The line of the median nerve is the same as that of the brachial artery. The course of the ulnar nerve is mapped out by a line extending from the posterior fold of the axilla behind coraco-brachialis to the back of the internal condyle of the humerus.

The course of the musculo-spiral nerve is mapped out by a line drawn from the point where it pierces the intermuscular septum (the junction of the upper and middle thirds of a line extending from the insertion of the deltoid to the external condyle) to the front of the external condyle; and obliquely upwards to the point where the posterior fold of the axilla joins the upper arm.