Dr Barclay-Smith, Extreme Visceral Dislocation. 19 



considerable amount of abnormal enlargement. The pylorus was 

 situated well on the left side of the vertebral column, and the 

 proximal part of the duodenum was disposed almost vertically with 

 a slight inclination leftwards, by which it attained its usual 

 relations to the displaced gall bladder. 



Such in brief were the main features of the case which has 

 provided material for the following reflexions and speculations. 



The renal displacement probably points to the history of the 

 case. A ballooning of the first part of the large gut would exert 

 a direct pressure on the kidney from below ; the caecum therefore 

 was conceivably the first part to be affected, and the distension 

 then gradually and progressively involved the successive segments 

 of the gut. 



The enormous displacement and severe distortion which the 

 liver had undergone would at first sight seem incredible if the 

 weight, bulk, and resistance of this organ are taken into account. 

 But the plasticity of the solid viscera, and the extent to which 

 they can be moulded by the hollow viscera are points which have 

 been specially emphasised as the result of investigation by the 

 method of hardening the viscera in situ, and have been brilliantly 

 elucidated by His and Cunningham. The hepatic displacement 

 and distortion may therefore be regarded as an exaggerated con- 

 dition of the normal influence of the hepatic bend of the colon on 

 the liver; room was not to be denied to the distending tube, and 

 the liver retreated along the direct line of pressure. 



Perhaps the greatest interest is attached to the position 

 occupied by the stomach, a viscus which had also become ab- 

 normally enlarged, and which in the ordinary course of events 

 would have overlapped its boundaries rightwards. The colon 

 and stomach both being hollow viscera, the battle for increased 

 accommodation would be fought apparently at equal odds. The 

 result, however, whereby the stomach succumbed to the colic 

 aggression and retreated towards its own side, only finding 

 additional space by encroaching downwards, may be explained 

 by assuming that the gastric distension was periodic, a condition 

 of dilatation alternating with that of collapse, while the colon 

 presumably was in a state of more or less constant dilatation, and 

 gradually thrust its neighbour aside by more prolonged if not by 

 more forcible pressure. 



The colic distension exhibited by this case was obviously 

 gaseous, the gut not being loaded with faecal material, and as 

 such must be regarded as a simple exaggeration of a condition 

 which is almost universally met with in the dissecting and post 

 mortem rooms. This condition is a more or less well marked 

 dilatation of the proximal part of the large gut as compared with 

 the distal. The caecum, the ascending colon, and frequently the 



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