Anatomy of the Abdominal Viscera. 161 



the infra-sternal notch, as well with regard to the more variable parts 

 of the costal arch and the umbilicus, were fully worked out, and are set 

 forth in the paper. 



Further, in regard to deeper parts and the various visceral dis- 

 placements : 



1. In connection with the stomach (a) It is found that a low position 

 of the stomach, even combined with distension, is not sufficient to 

 cause material downward displacement of the pylorus, but that that 

 part, firmly bound with the first part of the duodenum to the liver 

 requires downward displacement or enlargement of the liver particu- 

 larly of its omental tuberosity for it to be substantially moved 

 downwards. 



(6) Lateral displacements of the pylorus also are found more related 

 to the condition of the liver than to that of the stomach ; and the 

 evidence does not point to any considerable displacement of the pylorus 

 to the right in the filling of the stomach. Similarly, displacements of 

 the duodenum and the head of the pancreas to the left are associated 

 with a low position of the lower border of the liver. 



(c) Concerning the " stomach-bed " described by Birmingham, the 

 parts behind the stomach vary with the condition of the stomach in 

 this manner : When the stomach is distended or situated low down, it 

 flattens out the pancreas, increasing the vertical extent of its gastric 

 surface and diminishing the prominence of its anterior border and the 

 depth, antero-posteriorly, of its inferior surface; and the pancreas is 

 further pushed down over the face of the left kidney, leaving an 

 increased gastric surface of that organ exposed above its upper border. 

 The reverse of all these processes takes place when the stomach is 

 pushed upwards by distended intestines below. 



(d) The stomach does not displace the left kidney downwards ; in 

 fact the position of the left kidney is not found to vary directly with 

 that of any other organ in its neighbourhood, but is chiefly dependent 

 for its maintenance upon the strength of its enveloping connective 

 tissue. 



It may here be mentioned, that the level of the left supra-renal body 

 in relation to the left kidney is determined very much by the level of 

 the pancreas with regard to the kidney. When the pancreas is pushed 

 down over the kidney the supra-renal body follows it, but is not 

 depressed to so great an extent ; and the reverse takes place when the 

 pancreas is pushed upwards. 



2. The duodenum and the head of the pancreas have a considerable 

 range of level compared with the vertebral column as great as, or 

 greater than, that of the right kidney. These alterations in level of 

 the duodenum and the head of the pancreas are found to be chiefly 

 related to the position and size of the liver which, on the other hand, 

 does not appear to be potent to displace the right kidney downwards. 



