176 PROFESSOR CHRISTOPHER ADDISON. 



either on the middle line, or as little as 1 cm. to the right of 

 it, were Nos. 3, 15, 22, 24, and 13 ; and in all these cases, 

 except the first (in which, as already noticed, there was a 

 small empty stomach well over to the left), there was a large 

 or lowly placed liver extending far across the middle line to 

 the left. 



The conditions associated with lateral displacements of the 

 first part of the duodenum practically rim parallel with those 

 which have been already noticed as associated with lateral 

 displacements of the pylorus. 



Right Point — The average gr-eatest extent of the duodenum to 

 the right of the middle line was 7 cm., and, taking 1-5 cm. each 

 way from the average, there were 36 cases varying from 5'5 cm. 

 to 8-5 cm. to the right of the middle line inclusive. Cases 10 

 and 11 each extended 10*5 cm. to the right, and in both cases 

 the stomach was well over to the right and the liver was highly 

 situated. The ascending colon in one case was empty and in 

 the other distended. In cases 15 and 24 the outer border of 

 the duodenum came nearest to the middle line ; being only 

 2*5 cm. and 3*5 cm. away in the two cases, respectively ; the 

 duodenum being bodily pushed towards the left by the large 

 liver. 



The point nearest to E.F. at which the duodenum first 

 attained its extreme right (right point) averaged 2*5 cm. below 

 E.F. In 9 cases it corresponded with E.F. ; in 2 cases it was 

 above, and in 29 cases below that line. 



The Duodenum and the Ousted Arch. — Definite figures of the 

 relation of the duodenum to the costal arch can hardly be stated 

 as an average. The relation was noted in the following way 

 (see Table III., Appendix). If the duodenum at any part 

 extended beneath the costal arch, the part where it extended 

 most beneath the arch was taken, and the cartilage on the same 

 horizontal plane which formed the costal margin was noted. 

 For instance, if the duodenum extended 3 cm. beneath the ninth 

 costal cartilage, it would be written " +3 (9th) " ; if the point of 

 the duodenum nearest to the costal arch was 3 cm. away from, 

 say, the ninth costal cartilage, it would be written " — 3 (9th)." 

 The results were these : — The duodenum was on the margin of 



