Iviii PROCEEDINGS OF THE 



round which the gullet bends, as it enters the abdomen. In the other 

 case (b) the left half of the diaphragm is represented posteriorly by 

 the sterno-vertebral band only, but anteriorly it has costal attach- 

 ments (to the 7th, 8th, and 9th cartilages), and has a sharp edge 

 which constricts the upper surface of the liver. 



There is in each case a wide communication between the left pleural 

 sac and the peritoneal cavity. 



The disposition of the viscera is very similar in the two cases. The 

 abdominal cavity contains the right half of the liver, the descending 

 colon, and sigmoid flexure. The caecum and vermiform appendix are 

 displaced, lying just below in one case (a), and in the aperture leading 

 into the thorax in the other case (b). 



In the thorax in both cases the heart and pericardium are pushed 

 over to the right side, and the left lung is small and flattened against 

 the mediastinum, near the apex of the space. In both examples the left 

 pleural sac is completely filled with abdominal viscera, stomach, spleen, 

 duodenum, the loop of the colon, and the coils of the small intestines. 

 The colon ascends between the stomach and the coils of the small 

 intestine, and crossing the duodenum, binds it down to the posterior 

 thoracic wall. The stomach is wholly contained in the thorax ; and the 

 oesophagus, to join it, takes a sudden bend round the left crus (stereo- 

 vertebral band) of the diaphragm. The position of the spleen is 

 extraordinary ; by the flexion of the stomach, the cardiac end pushed 

 upwards carries the spleen along with it. It occupies in each 

 case a secondary hernial sac, which projects into the right pleural 

 sac, behind the pericardium and oesophagus, and in front of the 

 aorta. 



Having recently had the opportunity of examining a considerable 

 number of foetuses of various ages, one can state with some precision 

 how frequent this condition is. These are the only cases of a com- 

 plete hernia found in 268 foetuses between 3 and 9 months (155 male, 

 113 female), of which 134 are full-time (81 male, 53 female). This 

 condition thus occurs in 0*74 per cent, of cases at all ages, and in 1-5 

 per cent, of cases at full time. 



(12) Professor A. M. Paterson described a rase of Left Inferior 

 Vena Cava (fig. 4). 



The vena cava inferior begins on the left side of the bifurca- 

 tion of the aorta, opposite the fourth lumbar vertebra. It passes 

 upwards in this relation to the aorta as far as the upper border of the 

 third lumbar vertebra, where it passes obliquely across the artery, and 

 continues its further course on its right side. It is formed by the 

 union of the two common iUac veins, of which the right receives the 

 middle sacral vein. The vena cava receives also right and left lumbar 

 veins, the left spermatic and left inferior phrenic veins, and two renal 

 veins on each side. The right spermatic vein joins the lower right 

 renal vein. A vein of considerable size crosses the spine behind 

 the aorta, and connects together the right and left renal veins; it 



