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Haynes, J. S., The relation of the heart and lungs to the anterior chest wall as determined by
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188 ORGANS OF RESPIRATION AND VOICE.

Hasse, C. , Der Bau der Lunge des Menschen, bedingt durch die Beivegung der Brusticdnde bei
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Heymann, Rudolph, Beitrag zur Kenntnis des Epithets und der Drusen des menschlichen
Kehlkopfes im ycsunden und kranken Zustande, Archiv f . path. Anat. , Bd. cxviii.

Howes, Or. B. , Rabbit with an intra-narial epiglottis, with a suggestion concerning the
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Humphry, L., Accessory lobe to the left lung, Jour. Anat. and Phys., vol. xix., 1885.

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Spiers, GK, Ueber den Blutstrom in der Schleimhaut des Kehlkopfes, u. s. w., Arch. f. Anat. u.
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THE URINARY ORGANS.



BY E. A. SCHAFER AND J. SYMINGTON.



THE urinary organs consist of the kidneys, the glands by which the urine is
secreted, and the ureters, bladders and urethra, serving for its reception and
evacuation.

THE KIDNEYS.

The kidneys, two in number, are deeply situated in the loins, lying one on each
side of the vertebral column, at the back part of the abdominal cavity, and behind




Fig. 204. OUTLINE VIEW OF THE KIDNEYS FROM BEHIND, CONSTRUCTED FROM A SERIUS OF HORIZONTAL

SECTIONS THROUGH THE TRUNK OF AN ADULT MALE. (J. S. )

R.K., L.K., right and left kidneys; E.S., outer border of erector spinse muscle ; Q.L., outer border
of quadratus lumbovum muscle ; i.e., iliac crest ; i>. i>., dotted line to show lower limit of costal pleura.

the peritoneum. The upper and greater part of each kidney is situated in the
hypochondriac and epigastric regions, but the lower end usually extends into the



190



THE URINARY ORGANS.



adjacent portions of the lumbar and umbilical regions. They are on a level with
the last dorsal and the upper two or three lumbar vertebrae (fig. 204), the right
kidney being usually a little lower than the left, probably in consequence of the
vicinity of the great right lobe of the liver. They are maintained in this position
by their vessels, by a quantity of surrounding loose areolar tissue, which usually




Fig. 205. THE URINARY ORGANS OF THE FEMALE FROM BEHIND (Henle).

R, right kidney ; TJ, commencement of the ureter ; A, aorta, Ar, right renal artery, Vc, vena cava ;
\ T r, right renal vein ; Vu, urinary bladder ; Ua, commencement of urethra, g

contains much fat (capsula adiposa), and by the tonicity of the muscles of the
abdominal wall.

The kidneys measure about four inches (100 mm.) in length, two-and-a-half
inches (GO mm.) in breadth, and one-and-a-quarter or one-and-a-half in thickness.
The left is usually longer and narrower and a little heavier than the right. The
weight of the kidney is usually stated to be about four-and-a-half ounces in the male,
and somewhat less in the female. Vierordt gives 277 g. as the weight of the two
kidneys together in the male. The specific gravity is about 1'050.



THE KIDNEYS.



191



Form and relations. The surface of the kidney is smooth and of a deep red
colour. It is bean-shaped, and possesses two surfaces, an anterior looking forwards
and outwards, and a posterior backwards and inwards ; two borders,lm~0z</er, which
is convex, and an inner, concave ; and two somewhat enlarged convex extremities,
upper and lower. Its long axis is directed from above downwards and slightly
outwards. The posterior surfaces of the two kidneys lie against the abdominal
wall and are nearly identical in their relations, but the connections of their
anterior or visceral surfaces differ on the two sides. The posterior surface,
embedded in areolar and adipose tissue and uncovered by peritoneum, rests upon the
last rib and sometimes, more particularly on the left side, also upon the eleventh
rib ; the diaphragm ; the anterior layer of the lumbar aponeurosis covering the
quadratus lumborum, and the psoas, these two muscles intervening between the
kidney and the transverse processes of the first and second lumbar vertebrae. The
pleura descends behind ths upper part of the kidney, separated, however, from
it by the diaphragm. Below the twelfth rib the last dorsal, ilio-inguinal and





Fig. 206. DIAGRAM TO ILLUSTRATE THE RELATIONS OF THE KIDNEYS, AS SF.EN FEOM BEFORE. (J. S. )

A, riykt kidney ; S, area for right suprarenal capsule, non-peritoneal ; L, area for liver, peritoneal ;
D, area for second part of duodenum, non-peritoneal ; C, area for ascending colon and hepatic flexure
of colon, non-peritoneal ; J.I., area for convolutions of jejuno-ileum, peritoneal. B, left kidney ;
S, area for left suprarenal capsule, non-peritoneal ; St, area for stomach, peritoneal ; Sp, area for
spleen, peritoneal ; C, area for splenic flexure and descending colon, non-peritoneal ; J.I., area for
convolutions of jejuno-ileum, peritoneal ; P, area for pancreas, non-peritoneal.

ilio-hypogastric nerves pass outwards behind it. The anterior surface of the right
kidney is covered on its upper and outer part by peritoneum which intervenes
between it and the large renal impression on the liver. Near its inner border the
second part of the duodenum descends in contact with it, while more externally it is
crossed by the commencement of the transverse colon ; both those portions of the
intestine are destitute of peritoneum posteriorly. The lower end of the right
kidney is again covered by peritoneum. The anterior surface of the left kidney is
crossed transversely, just above the level of the hilum, by the pancreas and the
splenic vessels. Above this there is usually a small area covered by the stomach,
the lesser sac of the peritoneum intervening. Below the pancreas it is separated
from some coils of the small intestine by the peritoneum. The upper end of the
right kidney is capped by the right suprarenal capsule and the liver, and that of the
left kidney by its capsule and the spleen. The lower ends of the kidneys are
generally smaller than the upper. They reach on an average to within about 2 inches
of the iliac crest. The outer border of the right kidney is covered in about its
upper two-thirds by the liver, and the left kidney in its upper half or more by the
spleen. The ascending colon on the right side and the splenic flexure and descending



192 THE URINARY ORGANS.

colon on the left are found at the lower and outer parts of the right and left
kidneys respectively. The inner border presents about its middle third a vertical
fissure termed the hilum, which is bounded by anterior and posterior lips. The
direction of the hilum varies considerably in different subjects and even on the two
sides in the same individual, but as a rule it looks more forwards than towards
the middle line, and not unfrequently the posterior lip reaches as far forwards
as the anterior one.

D. J. Cunningham has shown that the kidneys when hardened in situ present
facets corresponding to the viscera with which they are in contact, and the posterior
surfaces also have slight depressions opposite the last rib, and the transverse
processes of the upper two lumbar vertebrae.

Varieties. The kidneys sometimes vary from their normal form, being either longer and
narrower, or shorter and more rounded. The characteristic fcetal lobulation may persist in
the adult. Occasionally one kidney is very small, while the other is proportionately enlarged.
Upward displacement is very uncommon, but they are often found lower than normal, lying
more or less entirely in the iliac fossa, or with their lower ends projecting into the true
pelvis. Numerous cases are recorded of absence of one kidney, most frequently the left.
The single kidney is usually enlarged, but not invariably. The occurrence of an additional
kidney is extremely rare, the supernumerary organ is placed either in front or on one side of
the vertebral column or in the pelvic cavity.

Instances are now and then met with in which the two kidneys are joined by their lower
ends across the front of the great blood-vessels and vertebral column. The conjunct organ
has usually the form of a horse-shoe. Sometimes two united kidneys are situated on one or
other side of the vertebral column in the lumbar region, or, but much more rarely, in the
cavity of the pelvis.

The kidney may be mnrable owing to the laxity of its aroolar and adipose capsule, or in
rare cases. floating, when it has a more or less distinct mesonephron, and the peritoneum moves
with the organ. These conditions occur much more frequently in connection with the right
than the left kidney.

Structure. The kidney is surrounded by a proper fibrous coat, which forms a
thin, smooth, but firm investment, closely covering the organ. It consists of dense
areolar tissue, with numerous fine elastic fibres, and can easily be detached from the
substance of the gland, to which it adheres by minute processes of connective
tissue and vessels. Underneath the capsule in the human kidney is an incomplete
layer of plain muscular fibres.

On splitting open the kidney by a longitudinal section, from its outer to its
inner border, the fissure named the hilum (fig. 207, h, h) is found to extend some
distance into the interior of the organ, forming a cavity called the sinus of the
kidney (s). This is enclosed on all sides except at the hilum by the solid substance
of the organ ; and is lined by an inward prolongation of the fibrous coat. The
solid part consists of cortical and medullary substance ; the latter being arranged in
separate conical masses named pyramids of Malpighi with their broad bases
(b, V) directed towards the surface, and their points towards the sinus, where they
form prominent papillae. The pyramids are embedded in the cortical substance,
which separates them from each other, and encloses them everywhere except at the
papillae, which emerge from it and project into the sinus.

The external or cortical substance (a) is situated immediately within the fibrous
capsule, and forms the superficial part of the organ throughout its whole extent to
the depth of about 4 mm., and moreover sends prolongations inwards (septula
renum or columnce Bertini) between the pyramids as far as the sinus and bases of
the papillae. It is of a nearly uniform light crimson-brown appearance, and is soft
and easily lacerated in directions vertical to the surface. The medullary portion of
the kidney is more dense than the cortical, and is distinctly striated, owing to its
consisting of small diverging uriniferous tubes, and to its blood-vessels being
arranged in a similar manner. There are generally more than twelve pyramids, but



THE KIDNEYS.



193



their number is inconstant, varying from eight to eighteen. Towards the papillae
the pyramids are of a lighter colour than the cortical substance, but at their base
they are usually purplish and darker.

Excretory apparatus. On squeezing a fresh kidney which has been split
open, a little urine will be seen to drain from the papillae by fine orifices on their
surface. The secretion is carried away and conveyed into the bladder by the ureter.
This long tube on being traced up to the kidney is seen to be somewhat enlarged,
and then to expand as it enters the hilum, into a large funnel-shaped dilatation
named the pelvis (fig. 208, P). This, within the sinus, divides usually into three,
but sometimes only two primary tubular divisions, and these at length end in a
larger number of short, truncated but comparatively wide branches named calices or
infundibula, which receive the papillae into their wide mouths and are attached





Fig. 207. PLAN OP A LONGITUDINAL SECTION THROUGH THE PELVIS AND SUBSTANCE OF THE RIGHT
KIDNEY. ONE-HALF THE NATURAL SIZE.

a, the cortical substance ; b, 6, broad part of two of the pyramids of Malpighl ; c, c, the divisions
of the pelvis named calices, or infundibula, laid open ; c' . one of these unopened ; d, d, summit of the
pyramids or papillae projecting into calices ; e, e, section of the narrow part of two pyramids near the
calices ; p, pelvis or enlarged portion of the ureter within the kidney ; u, the ureter ; s, the sinus ; h,
the hilum.

Fig. 208. CAST OF THE INTERIOR OF THE UPPER END OF THE URETER. (Henle.)
P, pelvis ; U, ureter.

around the bases of those prominences from which, of course, they catch the
issuing urine.

A single calix often surrounds two, sometimes even three papillae, which are in
that case united together ; hence, the calices are in general not so numerous as the
papillae. The spaces between the calices are occupied by a considerable amount of
fat, imbedded in which are seen the main branches of the renal vessels.

Like the rest of the ureter, the pelvis and greater part of the calices consist of
three coats, viz., a strong external fibrous and elastic tunic, which becomes
continuous around the bases of the papillae with that part of the proper coat of the
kidney which is continued into the sinus ; secondly, a thin internal mucous coat,
which, or at least its epithelium, is reflected over the summit of each papilla ; and
thirdly, between these two, a double layer of muscular fibres, longitudinal and
circular. The longitudinal fibres are lost near the extremity of the calix, but the
circular fibres, according to Henle, form a continuous circular muscle round the
papilla where the wall of the calix is attached to it.

VOL, III., PT. 4.



194



THE URINARY ORGANS.



The pyramidal masses found in the adult kidney indicate the original separa-
tion of this gland into lobules in the earlier stages of its growth. Each of these

Fig. 209. DIAGRAM OF A SECTION THROUGH PART

OP THE KIDNEY PARALLEL TO THE MEDULLARY

TUBULES. (Testut. )

a, papillary zone ; 6, boundary zone ; c, cortical
zone. 1, apex of papilla ; 2, capsule ; 3, clear
striae of boundary zone, formed by tubules of
medulla ; 4, dark stria; of boundary zone formed
by vasa recta ; 5, vascular arches ; 6, medullary
rays ; 7, labyrinth ; 8, interlobular vessels ; 9,
Malpighian corpuscles ; 1 0, subcapsular layer.

primitive lobules is in fact a pyramid
surrounded by a proper investment of
cortical substance, and is analogous to
one of the lobules of the divided kidneys
seen in many mammals. As the human
kidney continues to be developed, the
adjacent surfaces of the lobules coalesce
and the gland becomes a single mass ;
the contiguous parts of the originally
separate cortical investments, being-
blended together, form the partitions
between the pyramids already described.
Moreover, upon the surface of the
kidney even in the adult, after the
removal of the fibrous capsule, faintly
marked furrows may be traced on the
cortical substance, opposite the intervals
in the interior between the several Malpighian pyramids ; and not unfrequently
instances occur in which a deeper separation of the original lobules by grooves,
remains apparent in the adult kidney.





Fig. 210. DIAGRAM OF THE COURSE OF THK TUBULES IN A UNI-PYRAMIDAL KIDNEY, SUCH AS THAT

OF THE RABBIT. (Toldt. )

a, Malpighian bodies ; b, first convoluted tubule ; c, d, looped tubule of Henle ; e, second convoluted
tubule ; /, collecting tube ; g, ducts of Bellini.



THE KIDNEYS.



195



Tubnli uriniferi. On examining the summit of one of the papillae carefully,
especially with the aid of a lens, a number of small orifices may be seen varying in
diameter from 0'06 to (rl2 mm. They are frequently collected irflarge numbers
at the bottom of a slight depression or foveola found near the summit of the papilla,
but most commonly the surface is pitted over with about a score of small depressions
of this sort. On tracing these minute openings into the substance of the pyramids,




Fig. 211. DIAGRAM OP THE COURSE OF TWO CRINIFEROUS TUBULES. (Klein.)

A, cortex ; B, boundary, zone C, papillary zone of the medulla ; a, a', superficial and deep layers of
cortex, free from glomeruli. For the explanation of the numerals, see the text (p. 197).

they are discovered to be the mouths of small tubes or ducts, the uriniferous tu~bes
before mentioned, which thus open upon the surface of the several papillse into the
interior of the calices.

As these tubules pass up into the pyramidal substance, they bifurcate again and
again at very acute angles, their successive branches running close together in
straight and slightly diverging lines, and they continue thus to divide and subdivide
until they reach the sides and bases of the pyramids, whence they pass, greatly
augmented in number, into the cortical substance. In the cortical part the straight
tubules belonging to a Malpighian pyramid are continued for some way, in several

o 2



136



THE URINARY ORGANS.



groups or bundles, the tubules in the centre of which approach nearer the surface
Lhan those at the sides. These bundles are known as the medullary rays (fig. 209, 6)




Fig. 212. THREE MALPIGHIAN CORPUSCLES AND URINIFEROUS TUBULES OF A YOUNG MAMMAL SHOWING

THREE STAGES OF FORMATION OF THE LOOPED TUBULES, AND THE ADHERENCE OF THE BEGINNING
OF THE SECOND CONVOLUTED TUBES TO THE MALPIQHIAN CORPUSCLES. (Golgi.)

of the cortex, and the cortical substance between and around them is termed, on
account of the intricate arrangement of its tubules, the labyrinth of the c&rtex (7).
The part of the pyramid which is nearest the cortical substance contains a
number of pencil-like bundles of small blood-vessels, which originating from arterial



THE KIDNEYS. tVl

and venous arches at the junction of cortex and medulla, dip into the pyramid, and
thus commence the separation of its tubules into the bundles whicb-are continued
into the cortex as the medullary rays. The portion of the pyramid which is thus
broken up is termed the boundary zone (fig. 209, &).

Course of the tubules. Each tube commences in the labyrinth of the cortical
substance by a spherical dilatation enclosing the vascular Malpighian tufts to be
afterwards described.

Emerging from this dilatation (fig. 211, 1), which is known as the capsule (2), the
tubule is at first convoluted and wide (first convoluted tubule, 2, 3), but on approaching
the medullary ray it becomes nearly straight with a slight tendency to a spiral
(spiral tubule of Schachowa, 4). At the junction of cortex and medulla the spiral
tube rapidly narrows and passes straight down through the boundary zone towards
the apex of the pyramid (5). After a shorter or longer course, however, it loops
upwards again (6) becoming enlarged in the boundary zone (7), but somewhat smaller
again above this (8, 9) where it passes again up the medullary ray. The part of
the uriniferous tube which thus dips down towards the papilla and turns upwards
again is known as the looped tubule of Henle. On emerging from the medullary ray
the tubule is characterized by great irregularity of outline (irregular tubule, 10)






Fig. 213. DIAGRAM SHOWING SEVERAL PHASES OF DEVELOPMENT OF THE URINIFEROUS TUBULE.

(Golgi.)

before again becoming convoluted (second convoluted tubule, 11). Finally this last
is connected with one of the collecting tubules of the medullary ray by a small
functional tubule (12), and the collecting tubes (13, 14, 15) uniting with one another,
as already noticed, become gradually larger as they pass to open as excretory tubes at



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