, ABDOMINAL VISCERA IN MAN. 173 



a glanee at Plates XXIII., XXIV., and Table III. (Appendix) 

 shows that on account of the variability of both these points, 

 this average is very frequently of little value. The third part 

 of the duodenum lies in a groove on the inferior aspect of the 

 pancreas, but the groove is not often so well marked or so deep 

 as that lodging the second part. Further remarks on this 

 part of the duodenum are postponed to the next section ; and, 

 until that section is reached, there is nothing to add to the 

 current description of the fourth part of the duodenum. 



III. Variations in the Position of the Duodenum. 



The changes in the position of the pylorus and the conditions 

 leading thereto have been already described. 



Alteration in Level. — In regard to the hirjliest 2^oint of the 

 duodenum, this being as a rule the spot where the first part 

 begins to bend down to the second part, the general alterations 

 in level may first be summarised. 



There were 4 cases in which this point was on the level of 

 E.F. ; in 31 cases it was above that plane, and in 5 cases below 

 it. The average was 1"8 cm. above. There were 25 cases, or 

 62-5 per cent., in which the level was from E.F. up to 3 cm. 

 above, inclusive. There were 5 cases situated more than 3 cm., 

 but not more than 4 cm., above E.F. Higher than this there 

 were 5 cases, Xos. 25 and 40, at 4-5 cm.. No. 37 at 5-75 cm.. 

 No. 5 at 6 cm., and No. 31 at 6*5 cm. 



Group 1. — The position of the first part of the duodenum 

 varies in general with the position and direction of the pylorus, 

 though not always, as cases 21, 32, 34, and 38 show (compare 

 Plates XLIII. and XLIV. with XXIII. and XXIV.). In these 

 4 cases the stomach was distended and low down, but the liver 

 was as high as, or even higher than usual, and the first part of 

 the duodenum was at its normal level. In case 34 the upper 

 border of the liver was higher than usual, although the lower 

 border — the liver being a very large one — extended somewhat 

 lower down than the average. 



Group 2. — The cases of high level of the duodenum, namely, 

 those more than 4 cm. above E.F. — cases 25, 40, 37, 5, and 31 — 

 were those in which the stomach occupied a high level, being 



