286 PROFESSOR CHRISTOPHER ADDISON. 



in more than a quarter of the cases the transverse colon passed 

 below, or in greater part below, the umbilicus in the middle 

 line. 



In considering the question of prolapse of the transverse colon, 

 it is necessary to observe what the accompanying position of 

 the transverse meso-colon is. Five of the cases of a low position 

 of the transverse colon had the attachment of the transverse 

 meso-colon as high or even higher than usual. In them, 

 therefore, the low position of the bowel was associated with an 

 elongated, not a prolapsed mesentery. 



The average level of the attachment of the transverse meso- 

 colon in the middle line was 3 cm. below E.F., and at its 

 commencement on the right side, 6-45 cm. below E.F. Some- 

 times its attachment at the right may be low down, while that 

 in the middle line is as high as usual, but the low attachment at 

 the right may be sufficient to allow of prolapse of a great part of 

 the transverse colon. 



We may, however, with sufficient accuracy define prolapse of 

 the transverse colon or of its mesentery, as when the upper 

 border of the bowel or the attachment of its mesentery in the 

 middle line is more than 5 cm. below E.F. There were thus 14 

 cases of prolapse of the transverse colon more or less considerable, 

 and 8 cases of prolapse of the transverse meso-colon more or less 

 considerable. Seven cases (Nos. 2, 15, 22, 24, 27, 36, and 39) were 

 common to the two groups. In case 7 also the meso-colon at its 

 commencement was as low as the level of the iliac crest, and was 

 of considerable length. In case 24 the meso-colon did not start 

 until within 3 cm. of the middle line, and was situated below 

 the level of the iliac crest. In case 30 there was a very long 

 meso-colon attached 5 cm. below E.F. in the middle line, and a 

 little lower than usual at the right, and in this case the trans- 

 verse colon ran across below the level of CD. 



If the diagrams of the cases presenting both prolapse of the 

 transverse colon and of its mesentery be compared with the 

 similar outlines of the liver (Plate LII., Part II.) and stomach 

 (Plates XLIII. and XLIV., Part I.), it will be seen that a low 

 position of the liver was especially remarkable, and in many 

 cases also the stomach was low down in the middle line. More 

 than this can hardly be said. 



