CHAPTER XXVI. 



THE SUPRARENAL CAPSULES AND 

 THE PANCREAS. 



ANATOMY. LANDMARKS. 



RELATIONS. DISEASE. 



OPERATIONS. 



The Suprarenal Capsules. These structures, 

 two in number, lie against the diaphragm, oppo- 

 site the eleventh ribs, and are about two and a 

 half inches apart. The right one is pyramidal in form, 

 with its apex directed upwards and inwards, while the 

 left, crescentic in shape, is placed towards the inner aspect 

 of the left kidney and extends nearly to the hilum. 



Relations. The upper portion of the anterior sur- 

 face of the right capsule lies behind the posterior surface of 

 the liver, while the lower part is crossed, on its inner as- 

 pect, by the duodenum. Internally, it touches the vena 

 cava. The left suprarenal capsule is situated behind the 

 stomach and a small portion of the left end of the pan- 

 creas. Externally, it is in contact with the spleen, while 

 internally, it reaches nearly to the aorta. 



The Landmarks for these bodies may be arrived at 

 by remembering the outline of the kidneys, above which 

 they lie, extending for a distance of about one and a quar- 

 ter inches and continuing the upward and inward direc- 

 tion of these organs. 



Disease. The suprarenal capsules are the organs 

 principally affected in Addison's disease, and some of the 

 theories as to the causation of this disease, are, that it de- 

 pends on suprarenal inadequacy of excretion (MacMunn), 

 or of secretion (Langlois), or that it depends on inter- 

 ference with the nervous supply (Greenhow). This ner- 



