ABDOMINAL VISCERA IN MAN. 189 



wood's measurements in adults up to forty years of age. He 

 gives the upper border of the mesentery as from 3 to 4 inches 

 above a base line, drawn across the highest parts of the iliac 

 crests. He considers that when the distance is less than 

 3 inches (say 7 cm.), the mesentery may be termed prolapsed. 

 He associates prolapse of the mesentery especially with pro- 

 lapse of the splenic flexure of the colon. 



It has been already pointed out that prolapse of the duodeno- 

 jejunal flexure is associated especially with a large or lowly 

 situated liver combined with a distended and low stomach, and 

 these causes seem more direct than those — whether laxity of the 

 peritoneal bands, or of the abdominal muscles, or pressure from 

 above — which would more particularly favour prolapse of the 

 splenic flexure of the colon. 



In cases 2, 7, 15, 22, 27, and 36 the mesentery would be 

 called prolapsed according to Lockwood's definition. It was 

 in all these cases associated with a large or low liver and with 

 a distended stomach. Of these cases in Nos. 22, 36, 2, and 7 

 the splenic flexure of the colon was also prolapsed. It was 

 not prolapsed in cases 15 and 27, although in both cases the 

 transverse colon was very low down, and in the former case 

 the stomach and liver were very much displaced down- 

 wards. 



Prolapse of the Splenic Flexure of the Colon. — The chief agent 

 in maintaining the position of the splenic flexure of the colon 

 is the costo-colic ligament, and in the preceding cases of pro- 

 lapse it had evidently given way before the stomach and liver, 

 except in case 22, in which the fold was apparently, primarily, 

 very small, and existed as a small band stretching transversely 

 from the prolapsed colon to the abdominal wall. 



In this connection it may be well to present the other cases 

 in which the splenic flexure of the colon was low or prolapsed ; 

 viz., cases 16, 24, 18, and 32. 



In case 16 it was clearly pushed down by the stomach and 

 liver, which extended far over to the left, and the same applies 

 to case 24, in which the colon was further held down by dis- 

 tended small intestines. In case 16 the mesentery reached its 

 normal level. In case 24 the upper border of the mesentery, 

 although situated in the plane of E.F., was little more than 



