PERITONEUM 
of the falciform ligament of the liver, they may 
both be slipped along on the free surface of the 
anterior parietal portion of the peritoneum in a 
direction at first upwards, then slanting, then 
backwards, until they are each of them arrested 
in a corner, or cul-de-sac. They have passed 
along first on the peritoneal lining of the an- 
terior abdominal muscles, and afterwards on 
that of the diaphragm. They are now arrested 
from being slipped along any further in the 
same direction by the peritoneum leaping 
across, or extending across, from the lower sur- 
face of the diaphragm to the upper surface of 
the liver. In order to pass them along any 
further on the peritoneal surface they must be 
carried off laterally or slipped downwards over 
the upper surface of the liver. We will pursue 
the latter course. The corners, or cul-de-sacs, 
in which we suppose the fingers to rest, are 
those formed by the falciform ligament, the 
liver, the diaphragm, and the coronary liga- 
ment all meeting together: the latter is the 
name given to that portion of the peritoneum 
which extends across between the diaphragm 
and the liver. 
First, then, let the finger which is placed 
on the left side of the falciform ligament be 
slipped down over the upper surface of the 
left lobe of the liver, round its anterior edge, 
and backwards along its inferior surface ; it 
will be arrested by a membraniform sheet ex- 
tending across from the fissures of the liver to 
the lesser curve of the stomach, called the lesser 
or gastro-hepatic omentum. There for the 
present we leave it, and now let the other 
finger be in like manner passed down over the 
upper surface-of the right lobe of the liver, 
around its anterior surface, and backwards along 
its under surface, either over the gall-bladder 
or to the right of it: behind the neck of the 
gall-bladder, by giving it a direction inclining 
towards the left, it may be slipped behind the 
same sheet as arrested the other finger; that is 
to say, it may be brought to rest upon the pos- 
terior surface of the lesser omentum, upon 
whose anterior surface we left the other finger. 
This position it gains by being slipped- along 
on the narrow isthmus of liver called lobulus 
caudatus situated behind the portal fissure, 
in doing which it passes through a kind of fo- 
ramen, called the foramen of Winslow, whereof 
the lobulus caudatus is the superior boundary. 
The inferior boundary of this so-called foramen 
is formed hy the duodenum ; the posterior by 
the vena cava; and the anterior by the vena 
pres the gall-duct, and the hepatic artery. 
hese are the organs and vessels which sur- 
round the foramen of Winslow: they are, how- 
ever, all covered by peritoneum in such a 
manner that the finger passed round the fora- 
men, which is about one inch in diameter and 
of a somewhat semicircular form, glides around 
on a continuous circle of peritoneum. 
The free surface of the lower aspect of the 
right lobe of the liver has been seen to extend, 
through the foramen of Winslow, along the 
lobulus caudatus ; the continuity of surface of 
course extends to the lobulus Spigelii, from 
whence it may be traced towards the left and 
937 
forwards to the posterior aspect of the lesser 
omentum, and backwards to the posterior 
abdominal parietes. 
The finger being placed on that part of the 
peritoneum which covers the right kidney, it 
may be made to glide along the free surface 
up to the posterior boundary of the foramen 
of Winslow, and into the foramen itself, which 
demonstrates the peritoneal continuity in this 
direction. In much the same way the finger 
may be slid along on the duodenum until it is 
thereby conducted into the foramen. 
With regard to the continuity of the perito- 
neal surface of the anterior boundary of the 
foramen of Winslow, if the finger be placed 
on the anterior surface of the lesser omentum 
and slid along on it towards the right, it comes 
to a free edge thickened by the vessels and 
duct mentioned above; doubling around this 
edge it may be made to glide into the foramen ; 
thus demonstrating that the anterior and poste- 
rior surfaces of the lesser omentum are con- 
tinuous with one another around the vessels 
and duct that thicken its free border and form 
the anterior boundary of the foramen of Win- 
slow. 
Now since, as we remarked above, a free 
peritoneal surface always indicates a layer of 
peritoneum, the lesser omentum having two 
free surfaces consists of two layers ; and its two 
surfaces being continuous around the vessels 
mentioned, its two layers are continuous in like 
manner. It, therefore, is a portion of perito- 
neum doubled or folded upon itself, enclosing 
vessels and a duct in the extremity of the fold ; 
just as we saw was the case with the falciform 
ligament enclosing, in the extremity of its fold, 
the obliterated umbilical vein. 
When a double peritoneal sheet passes across 
from one bowel to another, or from the parietes 
to a bowel, it is described as attached along the 
lines where it first lights upon or comes in con- 
tact with such parts. Speaking in such a way, 
the lesser omentum is attached to the liver and 
stomach by the whole extent of its borders, 
except that small portion between the duode- 
num and porta which is free: and in fact this 
border is said to be free only because that which 
it encloses is small; if the gall-duct were an 
inch in diameter, the right border of the lesser 
omentum would be said to be attached to the 
gall-duct. Disregarding at present the last 
observation ; the line of attachment, then, of the 
lesser omentum is continuous all around except 
at its free border. Let us trace this line of 
attachment from the porta of the liver to the 
pyloric end of the stomach in the circuitous 
direction in which alone it can be done. From 
the porta, then, we trace this line along the 
posterior half of the antero-posterior fissure of 
the liver, inclining a little to the left of this fis- 
sure so as to reach the cardiac end of the sto- 
mach, and thence along the lesser curvature of 
the stomach to the pylorus. 
The gastric attachment of the) lesser omen- 
tum is placed transversely, whilst its he- 
patic attachment runs antero-posteriorly, with 
only a moderate inclination from side to side, 
so that this omentum has a kind of twist. 
