916 ^ MANUAL OF ANATOMY 



special attention should be paid to the caecum, including its varieties, and the 

 vermiform appendix. The ascending, transverse, descending, and iliac colon 

 should next be studied in the order named. The position and connections 

 of the spleen are next to be studied, and for this purpose the stomach is to 

 be well drawn out from the left hypochondrium. It is to be remembered that 

 occasionally accessory spleens are met with in the gastro-splenic omentum, 

 or in the great omentum. The dissector is next to turn his attention to the 

 position, connections, ligaments, and component parts of the liver, in so far 

 as they can at present be made out. The gall-bladder is to be included in 

 this examination. 



A study of the foregoing structures will have prepared the dissector for 

 the examination of the peritoneum. The description given of this mem- 

 brane and its various folds should be read, and it should be compared with, 

 and verified from, the dissection. In a great number of bodies, however, 

 verification is rendered impossible by the existence of adhesions, but 

 the dissector should do his best. The continuity between the parietal and 

 visceral peritoneum is to be shown in two ways, namely, in the vertical 

 direction, and in the transverse direction. The continuity can be demon- 

 strated in the vertical direction without much difficulty, and the best 

 starting-point is the portal fissure of the liver. The peritoneum is to 

 be traced in the transverse direction at two levels, namely, above the 

 transverse colon, or at the level of the foramen of Winslow, and below the 

 transverse colon, or at the level of the umbilicus. The former is difficult of 

 accomplishment, but the dissector should try his best. The latter will not 

 cause much trouble. The various folds formed by the peritoneum, namely, 

 omenta, mesenteries, and ligaments, are next to be studied in the following 

 order : (i) the great omentum ; (2) the small omentum ; (3) the gastro-splenic 

 omentum ; (4) the mesentery proper ; (5) the appendicular mesentery or 

 meso-appendix ; (6) the transverse meso-colon ; (7) the pelvic meso-colon 

 (wliich, however, belongs to the pelvis) ; (8) the peritoneal ligaments 

 of thi; liver ; (9) the peritoneal ligament of the stomach, namely, the gastro- 

 phrenic ligament ; (10) the peritoneal ligaments of the spleen, namely, the 

 lieno-phrenic and lieno-renal ligaments ; and (11) the peritoneal ligament of 

 the splenic flexure of the colon, namely, the phreno-cohc or costo-colic liga- 

 ment (sustentaculum lienis). In connection with the ascending colon, a 

 peritoneal fold, known as the sustentaculum hepatis, may be met with. 



The cavity of the peritoneum is next to be studied, attention being given first 

 to the great cavity, and then to the small cavity. The boundaries of the 

 small cavity are to be studied, which will be facilitated by making an incision 

 through the descending layers of the great omentum about an inch below the 

 great curvature of the stomach. The hand should then be introduced through 

 the incision into the small cavity, and, unless there are adhesions, the dis- 

 sector will be able to insinuate it downwards between the descending and 

 ascen ling layers of the great omentum until it is arrested where that omentum 

 describes its bend. In this way the bag or sac of the omentum (great) is 

 demonstrated He should also pass his hand upwards behind the stomach 

 and gastro-hepatic omentum, and he will feel Spigel's lobe of the liver at the 

 upper end of the small cavity. Thereafter the foramen of Winslow should 

 be mastered. It will be found behind the right or free border of the gastro- 

 hepatic omentum. In order to familiarize himself with this opening, the 

 dissector should again pass his hand into the small cavity through the incision 

 already made below the stomach, keeping the thumb outside in the general 

 cavity. If the hand (except the thumb) is now carried upwards behind the 

 stomach and gastro-hepatic omentum, the index finger can easily be pushed 

 through the foramen of Winslow (unless it is blocked by inflammatory pro- 

 diicts) into the great cavity, where it can be made to meet the thumb. Again 

 the index finger of one hand should be passed through the foramen into tl>. 

 small cavity, and the thumb of the same hand should be brought down upon 

 the right or irc-e border of the gastro-hepatic omentum. This having been 

 done, the dissector will have two layers of peritoneum between the index 

 finger and thumb, one of which belongs to the small cavity, and the other 



