ABDOMINAL VISCERA IN MAN. 175 



movements in position in regard to the vertebral column. In 

 fact, between cases 5 and 7 of this series the movement of the 

 upper border of the first part of the duodenum about the disc 

 between the first and second lumbar vertebrae was 9 "5 cm., or 

 nearly 4 inches — viz., from 5 '5 cm. above in case 5 to 4 cm. 

 below in case 7, the upper border of the right kidney falling 

 in the same cases from 6 cm. above in case 5 to 1 cm. above 

 in case 7. The variations in relation to E.F. are shown on the 

 Plates (XXIII., XXIV.). In fig. 8 they are set out in detail 

 on two curves. In the upper one, A, the highest point of the 

 duodenum, the upper pole of the right kidney, and the upper 

 border of the pancreas in the middle line are represented in 

 relation to E.F. The upper border of the pancreas is perhaps 

 the most generally stable point, but it presents oscillations 

 from 2 cm. below E.F. to 7 cm. above. On curve B. the 

 highest point of the duodenum and the upper pole of the right 

 kidney are represented about the disc between the first and 

 second lumbar vertebrae, and the duodenum is clearly seen to 

 be quite as variable in its level in relation to the vertebral 

 column as the upper pole of the right kidney is, if not more so. 



We are not concerned in this place with the causes producing 

 alterations in the level of the right kidney, but it can be said 

 that as far as these cases go they do not enable one to say that 

 in any one case, when the relative levels of the duodenum and 

 the right kidney are unusual, that the difference is produced by 

 an alteration in the position of the kidney — or even chiefly so. 

 If the liver be enlarged, and lower than usual, it is most likely 

 the duodenum that is displaced downwards ; and if the liver 

 and stomach are high up, — pushed up by distended intestines, — it 

 is very possibly the duodenum that is pushed upwards. 



Lateral Variations. — The average of the distance of the 

 highest point of the duodenum from the middle line was 4 cm. 

 There were 25 cases, or 62-5 per cent., ranging from 3 to 5 cm. 

 from the middle line, inclusive. There were 8 cases more than 

 5 cm. to the right — viz., case 20, 5-5 cm., and cases 5, 21, 32, 35, 

 38, 4, and 10 varying from 6 up to 7 cm. In all these cases 

 there was a full or a distended stomach extending far over to 

 the right. 



The cases in which the highest point of the duodenum was 



VOL. XXXV. (N.S. vol. XV.) — JAN. 1901. M 



