112 DR H. D. KOLLESTON. 



on a prominent papilla without any ampiillary cavity, corre- 

 sponds to this specimen. 



This specimen was removed from the body of an emaciated 

 woman, who died of hepatic cirrhosis. For the excellent draw- 

 ings which illustrate this specimen, we are much indebted to 

 P. L. Mummery, Esq., F.E.C.S., at present House-Surgeon to 

 St George's Hospital. 



A similar specimen of a double duodenal pouch has been 

 observed by Nattan-Larrier.^ 



It is conceivable that the evolution of this double pouch 

 was as follows: — That the pouch was originally an ordinary 

 single duodenal pouch, and remained so until, as the result 

 of visceroptosis, the duodenum tended to prolapse and fall 

 towards the pelvis. The bile duct would then hold the 

 duodenum up, and in so doing, would become taut, and lift 

 up the mucous membrane, covering it in the floor of the pouch. 

 We do not venture to state dogmatically that this is the true 

 explanation ; it is quite possible that the diverticula were 

 separate from the time of their formation. Meckel's diverti- 

 culum, which, though not strictly homologous to, has analogies 

 with a duodenal pouch, may be knobby or hammer-shaped, from 

 secondary pouches, as in cases figured by L. Hudson.^ 



II. Duodenal Pouch in the neighbourhood of the Opening 

 OF Santorini's Duct of the Pancreas. 



Cases 2 and 3 showed pouches possibly of this nature, though 

 Santorini's duct was not dissected out in either. 



In case 2 there was a pouch i inch in dia,meter and | incli 

 deep embedded in the head of the pancreas ; it was | inch above 

 the biliary papilla. 



In case 3 there was a smaller pouch, -|- inch deep and l inch 

 in diameter, situated ^ inch above the biliary papilla, but other- 

 wise exactly in the same position as the pouch in case 2. 



There was no sign of ulceration ; microscopic sections, cut in 



1 Bull. Sor. Annt. Paris, 1898, p. 4. 



a Hudson, Trans. Path. Sor., vol. xl. p. 98 



