160 Dr. C. Addison. On the Topographical 



(e) It almost invariably crosses some part of the head of the pan- 

 creas, usually about its upper third, and in the left lateral line it 

 represents, in the average, the anterior border of the pancreas, this 

 part being, in 70 per cent, of the cases, at or within 2 cm. of the plane. 



(/) In the left lateral line it represents, in the absence of a distended 

 stomach, the anterior border of the pancreas, the greater curvature of 

 the stomach, the attachment of the transverse meso-colon, and the 

 upper border of the transverse colon. 



(g) Further to the left beneath the ribs it represents the upper part 

 of the basal surface of the spleen. 



Second, concerning the lower transverse abdominal line, quarterway from 

 the pubes to the supra-sternal notch : 



It occupies a very regular position with regard to the ilium, repre- 

 senting practically Cunningham's intertubercular plane. It is normally 

 situated 2 inches above the anterior superior iliac spines, and is found, 

 in regard to these points and the highest parts of the iliac crest, to be 

 somewhat less variable than the umbilicus. In regard to vertebrae, it is 

 situated over the upper part of the fifth lumbar vertebra. 



In regard to deeper parts : (a) It represents the place where the psoas 

 muscles diverge from the lumbo-sacral promontory, and passes a little 

 above the inner attachment of the meso-sigmoid. 



(b) In the right lateral line it represents the upper border of the 

 ileo-colic junction the inner border of the ascending colon at this 

 point being situated immediately external to the lateral line. 



(c) In the left lateral line it passes a little above the commencement 

 of the meso-sigmoid the inner border of the descending colon at this 

 point being situated immediately external to the lateral line. 



Third, taking a plane across the abdomen midway between the trans- 

 verse lines : For practical purposes it represents in each lateral line 

 the lower pole of the kidney, passing a little above that of the right 

 and a little below that of the left ; in the right lateral line it indicates 

 the turning inwards of the peritoneum to form the commencement of 

 the transverse meso-colon ; and in the middle line the crossing of the 

 mesentery. 



Fourth, taking a plane midway between the lower transverse 

 abdominal line and one through the anterior superior iliac spines, it 

 represents in the right lateral line the root of the appendix, and a little 

 internal to this, at the pelvic brim, the lower attachment of the 

 mesentery and the innermost point of the caecum. 



This aspect of the paper, however, need not be further enlarged 

 upon. An indication has been given of the position of some of the 

 more important points of various parts around which others may be 

 easily filled in. Suffice it to say, that, as with regard to the surface 

 lines, so the levels and variations of the different viscera with regard 

 to the more stable surface points, such as the parts of the ilium and 



