168 PROFESSOR CHRISTOPHER ADDISON. 



small inferior surface — whilst D shows this flat pancreas to 

 have been low clown on the left kidney, leaving a large gastric 

 surface of the kidney exposed above it. In case 37, on the 

 contrary, the conditions are reversed ; a high stomach, a pancreas, 

 with a large inferior and a small gastric surface — pushed up, that 

 is, from below — and the kidney with no gastric surface at all. 



The Pancreas in the 3fiddle Line. — One other matter in 

 connection with the stomach remains to be mentioned ; namely, 

 the condition of and relation to the stomach of the upper 

 border of the pancreas in the middle line, which averaged 

 •5 cm. above the lesser curvature. The extreme distance of the 

 upper border of the pancreas above the lesser curvature in the 

 middle line was in case 36, 7 cm. ; and, of the rest, Nos. 34 and 

 2 were the greatest with 375 and 3-5 cm. respectively. In 25 

 cases the pancreas was above the lesser curvature. In 4 cases 

 the levels corresponded. In the remaining 11 cases the 

 pancreas was below the lesser curvature : in case 29, 4 cm. ; in 

 case 37, 3-5 cm. ; in 2 cases 2-5 cm., and in 3 cases 2 cm.; the 

 distance in the remaining cases being less than 2 cm. 



Sometimes when the pancreas projects above the lesser 

 curvature it presents a well-marked omental tuberosity at or 

 near the middle line ; in others it merely thins out on to the 

 vertebral column. Prof. Symington (5), speaking of this 

 omental tuberosity, says : " As a rule, I believe it will be found 

 much more distinct when the stomach is distended than when 

 it is empty." In these cases it was most distinct when the 

 stomach was low down and distended. It was most distinct, 

 either as a ridge or as a tubercle, in cases 36, 34, 27, 15, 10, and 

 30, and in case 7 to the left of the middle line. In all of these 

 cases — except in Nos. 27 and 30, in which the stomach was 

 well filled — the stomach was described as distended, and in all 

 of the cases, except No. 10, the stomach was low down. 

 AVhen, however, the stomach was fairly high in the abdomen, 

 although distended, the omental tuberosity was noted as either 

 very small or practically absent ; namely, in cases 28, 29, 9, 32, 

 and 11; so that, apparently, a large omental tuberosity of the 

 pancreas occurs when the stomach is luw doion and distended, 

 as distinguished from the cases in which, whilst distended, the 

 stomach maintains its normal level. 



