502 



CAVITY. 



inferior boundary of the epigastric region, and 

 projecting partly into that region and partly 

 into the umbilical below, the transverse arch 

 of the colon runs with a slight curve concave 

 backwards and downwards. The position of 

 this important portion of the great intestine is 

 always lower in the abdomen of a subject thus 

 opened than it can possibly be during life. In 

 fact, when the abdominal wall is unimpaired 

 and the usual compression is maintained, the 

 stomach and colon must be in very close appo- 

 sition with each other, so that it must be diffi- 

 cult, if not impossible, to make pressure from 

 without on the one without affecting the other 

 nearly to the same degree. The arch of the 

 colon is loosely covered on its anterior surface 

 by two laminae of peritoneum, which descend 

 from the greater curvature of the stomach and 

 entering into the umbilical region are reflected 

 upwards after a descent as far as the lowest 

 part of that region, forming a curtain which 

 covers the convolutions of the small intestine 

 beneath the transverse arch of the colon. This 

 curtain is the great Omentum or Epiploon, 

 ( Omentum majits,) which, in the natural con- 

 dition of the parts during life, there is every 

 reason to believe is closely applied to the an- 

 terior surface of the small intestine ; much 

 variety, however, may be observed as to the 

 extent of its relation to this portion of the 

 intestinal canal, and it is difficult to account for 

 this variety. Thus we sometimes find the in- 

 testine uniformly covered by this membrane 

 more or less loaded with fat, descending as 

 low as the upper outlet of the pelvis ; this 

 may be regarded as the normal state in the 

 adult. But at other times we find the omentum 

 so crumpled up or contracted, that the small 

 intestine is completely exposed, and it is only 

 by pulling down the omentum from the arch 

 of the colon towards which it is folded up or 

 crumpled, that we can form an estimate of its 

 extent. Again, in other cases we observe that 

 it is only long enough to descend halfway or a 

 little lower over the surface of the small intes- 

 tine. It is said to have less extent in females 

 who have borne many children than in any 

 others; I cannot confirm this statement, inas- 

 much as I have not unfrequently seen it of its 

 full dimensions in such subjects. In the na- 

 tural state of the parts, then, the whole of the 

 central portion of the umbilical region is oc- 

 cupied by the omentum, forming a moveable 

 curtain over the anterior surface of the con- 

 volutions of the jejunum and ilium. 



The iliac region of the right side is occupied 

 by the coacum or caput cob, and in the lumbar 

 region of the same side the ascending colon is 

 visible, sometimes when distended projecting 

 considerably, at other times so contracted as to 

 appear sunk towards the posterior wall of this 

 region, and to allow of being overlapped and 

 concealed from view by some of the convo- 

 lutions of the small intestine. In the corres- 

 ponding regions of the left side the remaining 

 portions of the colon are seen, and they too 

 are very frequently, if not generally, closely 

 applied to the posterior wall : in the lumbar 

 region the descending colon is much more 



frequently in a contracted than in a distended 

 state, and in the iliac region, not occupying it 

 to the same extent as its fellow is occupied by 

 the coecum, we find the sigmoid flexure of the 

 colon winding its curved course over the psoas 

 muscle, and sinking into the pelvis to assume 

 the name of rectum. The lower convolutions 

 of the small intestine invariably fill up the 

 superior outlet of the pelvis, and are found to 

 a greater or less extent in that cavity, in pro- 

 portion as the bladder and rectum are empty 

 or the reverse. 



Such being the position of the parts as they 

 appear when the anatomist lays open the ab- 

 domen in a recent subject, we proceed now to 

 examine what parts are found in each com- 

 partment of this cavity, and the relation which 

 they bear to each other. We may observe, 

 in passing, that there cannot be much difference 

 in the position of the abdominal organs during 

 life, even in the varied attitudes of the body, 

 from that which we find them to possess in a 

 body recently dead. Making allowance for 

 the pressure which is maintained upon them 

 by the abdominal parietes, it is obvious that 

 the position of each organ during life will be 

 higher in the abdomen than that which it occu- 

 pies in the dead body; all the organs are more 

 firmly applied to one another and to the pos- 

 terior wall of the abdomen. 



It is not, however, unimportant to bear in 

 mind that such is the nature of the contents 

 of the hollow abdominal viscera, and such the 

 rapidity with which they become accumulated, 

 that changes of relation may be rapidly 

 effected. Thus the stomach, or any part of the 

 intestinal canal, may by a rapid accumulation 

 of air or any other matter within it, occupy 

 a much more extensive portion of the abdo- 

 men than it usually does in the natural state. 

 This is allowed by the extraordinary com- 

 pressibility of the other viscera, a com- 

 pressibility which is every day exemplified in 

 pregnancy, aud in cases of ovarian dropsy, 

 of ascites, &c. 



1. T/ie epigastric region. The right extre- 

 mity of this region or the right hypochondrium 

 is occupied almost entirely by the liver, which 

 is connected with the diaphragm and anterior 

 wall of the abdomen by the folds of perito- 

 neum which form what are called the ligaments 

 of the liver. When the left lobe of the liver 

 is raised up, we see the lesser or gastro-hepatic 

 omentum extended between the lesser curvature 

 of the stomach and the transverse fissure of 

 the liver. A defined margin terminates the 

 gastro-hepatic omentum on the right side, just 

 adjoining the neck of the gall-bladder: if the 

 finger be pushed underneath this margin from 

 right to left, it passes through an opening which 

 leads into the cavity of the omentum, and if 

 continued downwards behind the stomach will 

 separate the laminae of the great omentum. 

 This opening is commonly known under the 

 name of the Foramen of Winslow: the lesser 

 omentum bounds it in front, behind it lie the 

 supra-renal capsule, the venacavaascendens, and 

 the psoas muscle, covered by a lamina of perito- 

 neum which ascends towards the diaphragm, 



