172 PKOFESSOK CHRISTOPHER ADDISON, 



treme examples of this condition, although in no case was the 

 pancreas sufficiently voluminous to encircle this second part 

 of the duodenum, as in the case described by Symington (12). 

 The second part of the duodenum is not in immediate contact 

 with the inferior vena cava, save perhaps at the outer border 

 of the vessel, the relationship being determined by the extent 

 of the head of the pancreas to the right, behind the duodenum. 

 Usually at the bend between the first and second parts, the 

 duodenum overlies the lower angle of the right supra-renal 

 capsule. 



The relation of the second part of the duodenum to the right 

 kidney agreed, in the average, with the general descriptions, and 

 does not call for comment. An important point in connection 

 with the relative levels of these parts will be reserved for the 

 next section. 



In a sagittal plane through the highest point of the first 

 part of the duodenum, the lower border of the liver overlapped 

 the duodenum for 3*5 cm. ; completely covering, as a rule, the 

 lumen of this part of the bowel. 



Gail-Bladder. — The tip of the gall-bladder was situated 

 375 cm. below E.F., and the central point of the summit of 

 the gall-bladder was situated just outside the right lateral 

 line — (6-5 cm. from the middle line). Its projection on the 

 front, therefore, would be in the right lateral line directly in 

 front of and nearly half-way down the second part of the 

 duodenum. The lower part of the gall-bladder, however, was 

 usually lifted off from the front of the duodenum by the trans- 

 verse colon, which passed across the second part of the duo- 

 denum in the right lateral line with its upper border 2-25 cm. 

 below E.F. The portion of the gall-bladder that, in the average, 

 directly overlay the duodenum was in the plane of E.F. about 

 the right lateral line. 



Iliac Crest. — The nearness of the lowest point of the duo- 

 denum to the highest point of the iliac crest has been pointed 

 out. When that bone can conveniently be felt, it constitutes 

 a useful guide to the lowest point of the duodenum. 



Third Part. — The position of the lower border of the duo- 

 denum in the middle line as 1 inch above the umbilicus would 

 seem a useful guide from the obviousness of the umbilicus, but 



