50(5 



CAVITY. 



in it, whether originating in the wall or in the 

 coecum. 



There is no part of the intestinal canal in 

 which accumulations are more likely to take 

 place than in the coecum ; and it is now pretty 

 well ascertained by the researches of various 

 observers that inflammation is often pro- 

 pagated from the ccecum distended with har- 

 dened faeces to the cellular tissue and muscles 

 of the iliac fossa, thus exciting abscess, which 

 may open either externally through the abdo- 

 minal parietes or internally into the ccecum.* 

 By careful manual examination of the anterior 

 abdominal wall corresponding to this fossa, 

 we are in general able to detect even a slight 

 distension of the ccecum, and percussion em- 

 ployed here will often afford considerable 

 assistance in forming a diagnosis. The ver- 

 miform appendix of the ccecum frequently 

 hangs down into the pelvic cavity connected to 

 the ceecum by a fold of serous membrane; 

 at other times it lies in the iliac fossa, being 

 folded up under cover of a projecting portion 

 of the ccecum, sometimes as a natural result, 

 and at others as an effect of morbid adhe- 

 sions. 



The left iliac fossa contains the sigmoid 

 flexure of the colon, which from its cylindrical 

 form, as well as from the circumstance of 

 its being in general much contracted, does not 

 occupy that region to the same extent as the 

 right side is filled by the ccecum. The sig- 

 moid flexure is here connected by a mesocolon 

 similar to that of the descending colon, and 

 its relations to the other parts contained in the 

 iliac fossa are pretty much the same as those 

 of the ccecum on the right side. In the centre 

 of the hypogastric region we observe that the 

 posterior wall is formed by the last lumbar 

 vertebra and the promontory of the sacrum, 

 and this region is open below, whereby it com- 

 municates with the pelvis through the superior 

 outlet. Hence along the posterior wall we find 

 the rectum with its mesorectum, the middle sacral 

 artery, and the hypogastric plexus of nerves ; 

 and some of the pelvic viscera under particular 

 conditions pass forwards into this region, and 

 even admit of being examined during life 

 through the anterior wall. Thus the bladder 

 under distension comes forward, and, as the 

 distension increases, ascends, so as often to 

 occupy the whole of this region to the ex- 

 clusion of its natural contents; so also the 

 uterus. The vas deferens in the male and the 

 round ligaments of the uterus in the female, 

 and in both the obliterated umbilical arteries, 

 the urachus and the spermatic vessels, are also 

 among the parts belonging to the hypogastric 

 region. 



The preceding account of the abdominal 

 cavity as it is found upon dissection, has re- 

 ference chiefly to the adult male subject; but 

 there are certain differences in the relations and 

 positions of parts, dependent on sex and age, 

 to which it is highly important to pay due 



* See Dance in Rep. Gen. d'Anat. et de Phys. 

 t. iv. p. 74; Meniere, Arch. Gen. de Med. t. xvii.; 

 and Ferrall, Ed. Med. and Surg. Journal. No. 108. 



attention. In the adult female, the chief dif- 

 ference arises out of the great size of the pelvis 

 and the consequent increase in the magnitude 

 of the lower part of the abdomen, the trans- 

 verse measurement of which will be found to 

 exceed that of the epigastric region, more 

 especially where that region has been arti- 

 ficially compressed and consequently dimi- 

 nished in its capacity, by the custom of wear- 

 ing tight stays. During pregnancy, which, 

 as being a natural change, may be not inap- 

 propriately noticed here, the female abdomen 

 experiences a very considerable alteration in 

 its form, capacity, direction, the relations of its 

 organs, and the order of its circulation. 



" In the first month," says Blandin, " it 

 seems to contract, and its walls to fall in upon 

 themselves; but afterwards opposite changes 

 take place. By reason of the resistance offered 

 by the pelvis, when the uterus begins to in- 

 crease, and especially when it has acquired a 

 certain size, it makes, as it were, a protrusion 

 upwards, and is carried into the supra-pelvic 

 part of the abdominal cavity, which it dilates, 

 especially in front, in consequence of which 

 the obliquity of the axis of that cavity for- 

 wards is diminished. The dilated uterus is 

 placed entirely in front, behind the anterior 

 abdominal wall, and presses the small intestine 

 and omentum towards the spine: the omen- 

 turn, however, is sometimes, though rarely, 

 found in front of the uterus. The diaphragm 

 is also pushed upwards and raised as high as 

 the level of the sixth dorsal vertebra : all the 

 peritoneal folds of the uterus are obliterated ; 

 the peritoneum no longer descends into the 

 pelvic excavation, the bladder and the rectum 

 are strongly compressed, and are in some de- 

 gree impeded in performing their functions; 

 the uterus itself is inclined to one side, in con- 

 sequence of the projection of the vertebral 

 column, and generally to the right side, which, 

 according to Chaussier, is attributable to the 

 greater shortness of the round ligament of the 

 right side. Notwithstanding all this enlarge- 

 ment of the abdominal cavity, the viscera are 

 compressed more strongly than usual, and can 

 become protruded with greater facility, when 

 the distended and attenuated walls have lost 

 much of their power of resistance. The nor- 

 mal irritation of which the uterus is the seat, 

 causes a greater afflux of blood into the whole 

 inferior part of the vascular system, and into 

 its own vessels in particular."* 



During the development and growth of the 

 walls of the abdominal cavity some interesting 

 changes are observed to take place in its shape, 

 capacity, and in the positions of the contained 

 viscera. The most remarkable characteristic of 

 the abdomen at the earliest period is its very 

 great capacity when compared with the other 

 cavities; this arises from the great development of 

 its contained organs. This great size, however, 

 is manifest entirely in the umbilical region, for 

 neither the epigastric nor the hypogastric can 

 be said to exceed their proportional magnitude 

 in the adult. On the contrary, both these 



* Blandin, Anat. Topog. p. 431. 



