190 PROFESSOR CHRISTOPHER ADDISON. 



3 inches above the iliac crest. In both of these cases the 

 transverse colon was prolapsed. 



In case 18 the splenic Hexure of the colon was markedly 

 prolapsed, but the stomach and liver were higher than usual, 

 forced up by distended small intestines, which, on the other 

 hand, beneath a long transverse meso-colon, bulged forwards 

 and displaced the transverse and splenic colons downwards. 

 The upper border of the mesentery was up to its usual level. 

 A long attenuated band stretched upwards from the summit 

 of the splenic flexure of the colon to the lower end of the 

 spleen, where it passed on to the abdominal wall. The spleen 

 was lifted up with the stomach. 



In case .'-32 there was a complete descending meso-colon ; the 

 great omentum stretched from the splenic loop of the trans- 

 verse colon on to the abdominal wall and continued upwards 

 as bands, evidently dragged upon, to the inner surface of the 

 costal cartilages at the left border of the distended stomach. 

 In this case the attachment of the mesentery passed down the 

 middle line nearly as low as CD. before passing to the right, 

 and the upper border of the duodeno-jejunal flexure was just 



3 inches above the iliac crest. 



There were, therefore, 8 cases presenting prolapse of the 

 splenic flexure of the colon, in 4 of which the mesentery also 

 was prolapsed, and in 2 others it was lower down than usual. 

 There were 6 cases presenting prolapse of the mesentery, in 



4 of which the splenic flexure of the colon was also pro- 

 lapsed. 



The cases seem to me not so much to show any special 

 direct relationship between prolapse of the splenic flexure of 

 the colon and of the mesentery, but to indicate that the latter 

 is chiefly related to the position of the liver and stomach, and 

 the former, whilst in a measure dependent on the same causes, 

 has associated with them the condition as regards strength of the 

 costo-colic hgament. 



The age of the patients presenting prolapse of the mesentery 

 or of the splenic flexure of the colon, or both, was over forty years 

 in all cases, except in cases 7 and 18, which were thirty-six and 

 thirty-nine years of age respectively, and in case 27, thirteen 

 years. In this last case there was a large intra-thoracic growth. 



