916 flexure, and we should not expect that an enlarged or downwardly displactd liver would operate, in the absence of special laxity of the peritoneal 'bands or of the abdominal muscles, in so direct a manner on the splenic flexure of the colon. In six cases of this series the mesentery was prolapsed according to Mr. Lockwood's definition. In all of them there was a large or low liver with a distended stomach.In four of them the splenic flexure of the colon was prolapsed, whilst in the remaining two it was not. On the other hand, there were eight cases presenting prolapse of the splenic flexure of the colon, in four of which the mesentery was prolapsed, and in two others it was only just above the line of prolapse. In all of these cases the low position of the liver and stomach was noted, and in the remaining two ca.es the splenic flexure was prolapsed without the other conditions. In those cases in which the mesentery was prolapsed without the splenic flexure of the colon the costo-colic ligament was found strong and held up the colon in spite of the low liver and stomach. In those cases in which the splenic flexure of the colon was prolapsed, without the prolapsed mesentery and the accompanying conditions, the costo-colic ligament was very thin or badly marked. We may say, thB'l'efore, that whilst, as Mr. Lockwood remarks, prolapse of the splenic flexure of the colon and of the mesentery are commonly associated, the latter is chiefly related to the position of the liver and stomach ; the former, in addition to these circumstances, possesses as a separate determining factor the strength of the costo-colic ligament.The ages of the patients presenting one or both of these conditions were over 40 years in all but three instances and in two of these the ages were 36 and 39 years respectively. In the other case, that of a lad, aged 13 years, the whole of the viscera in the upper part of the abdomen were displaced downwards by an enormous intra-thoracic growth.The root of the mesentery crossed the middle line low down in eight cases, ranging from 10 to 14 centimetres below E, F, and allowed the intestines in the left abdominal quarter a freer range of movement. In all but two of them there was a low transverse colon ; in all but three of them the stomach was low down ; but only in three of them, however, was the root of the mesentery anything prolapsed at its upper end. In all but two cases the patients were more than 45 years of age. In one of the cases there was a left inguinal hernia consisting only of a portion of the sigmoid flexure of the colon.The attachment of the lower end of the mesentery in these cases was 8'5 centimetres directly above Poupart's ligament. This agrees very well with Mr. Lockwood's figures when it is remembered that in these measurements Poupart's ligament is considered as stretching in a straight line from the anterior superior iliac spine to the spine of the pubes. Mr. Lockwood speaks of the lower end of the mesentery as prolapsed or dragged down when it is less than two and a half inches,...
