178 PROFESSOR CHRISTOPHER ADDISON. 



along with the stomach, had been pushed upwards by distended 

 intestines. 



The lowest portion of the duodenum is the least firmly 

 supported of any part of that viscus, and might most easily 

 bulge downwards without any general displacement of the 

 duodenum as a whole. As regards the iliac crest : In 5 cases 

 the duodenum was at the level of the highest part of the crest ; 

 in 11 cases it was below, and in 24 cases above that part. The 

 general position of the duodenum in regard to the iliac crest, 

 with an average of "72 cm. above the highest point, is somewhat 

 lower than the impression which, it seems to me, is generally 

 given by the text-books. 



The Duodenum in the Middle Line. — The duodenum in the 

 middle line is somewhat readily distended, although less so 

 than the part situated above the iliac crest, and its position is 

 subject to the various displacing forces which have already 

 been mentioned in connection with other parts of the 

 duodenum. Its position in regard to the umhilicus may be 

 summarised : The lower border averaged 2'3 cm. above the 

 umbilicus. In 20 of the cases the variation was between 

 1 cm. and 3'5 cm. above, inclusive. In 9 other cases it was 

 from 4 cm. to 5 cm. above, inclusive. Two cases were higher 

 than this, viz. : cases 4 and 5 (those with the high stomach). 

 In 2 cases it was on the same level as the umbilicus, whilst 

 in 7 cases it was below the umbilicus, only 2 of them, cases 

 13 (2-25 cm.) and 39 (4 cm.), being more than 1 cm. below. 

 The displacement of the parts in these two cases has been 

 already fully considered. 



The Duodeno-Jejunal Flexure. 



The duodenum is held up beneath the inferior surface of the 

 pancreas by the fibrous tissue surrounding the mesenteric 

 vessels and coming down from the diaphragm on to, and over, 

 the duodeno-jejunal flexure, representing Treitz' Suspensory 

 Muscle. Lockwood (14), in his work on hernia, takes the 

 upper border of the duodeno-jejunal flexure as representing the 

 upper border of the mesentery. Firmly attached beneath the 



