Mesenteric Principles of

Gastrointestinal Surgery: Basic and

Applied Science Coffey, John Calvin,
Sehgal, Rishabh, Walsh, Dara
Mesenteric Principles Of
Gastrointestinal Surgery: Basic And
Applied Science Coffey
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MESENTERIC PRINCIPLES OF
GASTROINTESTINAL
SURGERY BASIC AND
APPLIED SCIENCE
MESENTERIC PRINCIPLES OF
GASTROINTESTINAL
SURGERY BASIC AND
APPLIED SCIENCE
CRC Press
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There is nothing new under the sun.
Ecclesiastes 1:4-11

I could be bounded in a nutshell, and count myself

a king of infinite space.
Hamlet, Act II, Scene 2

To Dee

and

Victor Warren Fazio

Master without peer
Contents

Preface ix
How to access three-dimensional models using QR codes xi
Acknowledgments xiii

PARt 1 1

1 History 3
J. Calvin Coffey and Nicola O’Riordan
2 Mesenteric and peritoneal anatomy 11
J. Calvin Coffey, Peter Dockery, Brendan J. Moran, and Bill Heald
3 Embryologic development of the mesentery, peritoneal reflection, and Toldt’s fascia 41
J. Calvin Coffey, Rishabh Sehgal, and Joep Knol
4 Histology of the mesentery 47
J. Calvin Coffey, Miranda Kiernan, and Leon G. Walsh
5 Toldt’s fascia 57
J. Calvin Coffey and Ravi Kiran
6 Mesenteric physiology 69
J. Calvin Coffey, Rishabh Sehgal, Awad M. Jarrar, and Mattias Soop
7 Pathology of the mesentery 85
J. Calvin Coffey, Jonathon Roddy, Miranda Kiernan, and Shaheel M. Sahebally
8 Radiographic appearance of the mesentery and peritoneum 109
J. Calvin Coffey and Martin Shelly
9 Operative nomenclature 119
J. Calvin Coffey, Bill Heald, and Brendan J. Moran
10 Teaching mesenteric principles 137
J. Calvin Coffey, Deirdre McGrath, and Colin Peirce
11 Gastroenterology 147
J. Calvin Coffey and Manus Moloney

PARt 2 151

12 Mesenteric-based colorectal surgery 153

J. Calvin Coffey and Ian Lavery
13 Appearance of the mesentery during laparoscopic/robotic colorectal surgery 157
J. Calvin Coffey and Manish Chand
14 Appearance of the mesentery during open colorectal surgery 177
J. Calvin Coffey and James O’Riordan
15 Instruments used during mesenteric-based colorectal surgery 199
J. Calvin Coffey and John P. Burke
16 General techniques in mesenteric-based colorectal surgery 211
J. Calvin Coffey and Jeremy Lipman

vii
viii Contents

17 Mesenteric component of sigmoid colectomy 233

J. Calvin Coffey and Mathew Kalady
18 Mesenteric component of rectal resection 251
J. Calvin Coffey and Jonathon Efron
19 Mesenteric component of right colectomy 277
J. Calvin Coffey and Steven D. Wexner
20 Mesenteric component of flexure mobilization 293
J. Calvin Coffey and Neil J. Smart
21 Mesenteric considerations in resection of the transverse colon 301
J. Calvin Coffey and Ian Lavery
22 Mesenteric considerations in small bowel resection 311
J. Calvin Coffey, Eoghan Condon, and David W. Waldron
23 Mesenteric considerations in ileal pouch anal anastomosis 317
J. Calvin Coffey and James W. Ogilvie Jr.
24 Mesenteric considerations in ostomy formation and reversal 323
J. Calvin Coffey, Colin Peirce, and Ann Brannigan
25 Mesenteric considerations in reoperative abdominal surgery 333
J. Calvin Coffey and Feza Remzi
26 Future directions 343
J. Calvin Coffey

Appendix A: Operative templates 347

Index 351
Preface
This work is intended to furnish the Student
and Practitioner with an accurate view of the
Anatomy of the Human Body, and more espe-
cially the application of this science to Practical
Surgery.
Henry Gray (1858)
MESENTERIC-BASED SURGERY DEFINED
Mesenteric-based surgery is where the surgeon exploits
mesenteric and associated structures in guiding an intesti-
nal resection. The associated structures are the peritoneal
refl ction and Toldt’s fascia. Rather than indiscriminately
dissecting through tissue, structures, and planes, the surgeon
selects certain structures and conducts a particular activity
related to that structure. For example, during sigmoid mobi-
lization for colectomy, the surgeon divides the peritoneal
refl ction at the right side of the base of the mesosigmoid
(via a peritonotomy), which exposes the underlying meso-
fascial plane. Th s plane is formed at the interface between
the mesosigmoid and the underlying Toldt’s fascia. The sur-
geon then separates the components of this plane to mobilize
the mesosigmoid.
Nonmesenteric-based surgery is one where the surgeon
does not adhere to a particular anatomic roadmap. The
mesentery is divided directly across and dissociated from
the posterior abdominal wall. During dissociation, the ret-
roperitoneum and contained structures are often not recog-
nized before being damaged.
Examples of mesenteric-based surgery now abound
and include complete mesocolic excision, total mesorectal
excision, and total mesocolic excision. Variations are also
emerging, including transanal total mesorectal excision
and modifi d complete mesocolic excision. As part of these
procedures, the surgeon accesses the mesofascial plane in a
targeted manner (through division of the peritoneal reflec-
tion), then mobilizes an intact mesentery without its disrup-
tion. Similarly, the retroperitoneum and covering fascia are
preserved. When the mesentery is sufficiently mobilized,
the vessels contained within are selected, skeletonized, and
divided, and the mesentery is similarly divided up to the
level of the intestine.
Several terms have been used in reference to nonmesen-
teric-based surgery. These include “conventional” surgery,
“non-CME surgery, and “non-TME surgery.” Unfortunately,
the terms “CME” and “TME” have not been scientifically
defined in the first instance, and so the related terms also
lack defi ition.
Mesenteric-based surgery has been practiced internation-
ally for over a century and thus is far from new. However, it
is certainly not universally practiced, and considerable varia-
tion has been demonstrated. The variation is explained by
the disparity that has persisted between anatomic and sur-
gical approaches to the intestine for the past century. While
mesenteric-based surgery is far from new, it is remarkable that
its anatomic basis has only recently been formally described.
This means that the principles can now be reproducibly
taught and conducted in an entirely standardized manner.
This book is composed of two parts. In the first part, the
mesentery, peritoneum, and associated fascia are charac-
terized. In the second part, the data explained in the first
are applied to all aspects of resectional colorectal surgery.
Surgical anatomy, activities, and operations are carefully
defined to enable all surgeons to reproducibly conduct
mesenteric-based surgery.
J. Calvin Coff y
ix
How to access three-dimensional models
using QR codes

Each figu e legend in this book will direct the reader to a
QR code. The QR code to be accessed is specifi d in the fi st
number in the following annotation: “QR 2/3.” Th s directs
the reader to QR code 2 and annotation 3.
The QR codes are listed below. Using the example above,
the reader should identify QR 2 below and scan the QR code
with a QR reader (i.e., in a smart phone, lap-top, or tablet).
The reader then will be brought to a three-dimensional
model relating to the figu e legend and figu e in question,
with a series of numbers overlaying the model. By clicking
on the number 3, the reader will be brought to a particular
viewpoint of the model.
QR codes and models can also be accessed directly at the
website “www.mpgs.ie.”

QR 1 - Overview of mesentery QR 2 - Mesentery, peritoneum

and intestine and intestine

QR 2d - Mesentery, peritoneum QR 3 - Sectioned view of right

and intestine and left mesocolon
as seen from above I

QR 3d - Sectioned view of right QR 4 - Sectioned view of right

and left mesocolon and left mesocolon
as seen from above II viewed from below up

QR 6 - Sectioned right and left

QR 5 - Sectioned view of the
mesocolon viewed
mesosigmoid as seen
from above down from below up

QR 7 - Colon and mesocolon QR 8 - Medial view of base of small

intestinal mesentery

xi
xii How to access three-dimensional models using QR codes

QR 9 - Splenic flexure in isolation QR 10 - Splenic region with

flexure removed

QR 11 - Hepatic flexure in isolation QR 12 - Hepatic region with

flexure removed

QR 13 - Mesorectum and fascia

Acknowledgments

We the authors gratefully acknowledge the insight and advice offered by the following individuals:
Ann Brannigan Awad M. Jarrar
Consultant Colorectal Surgeon Department of Cellular and Molecular Medicine
Mater Misericordiae Hospital Lerner Research Institute
University College Dublin Cleveland Clinic
Dublin, Ireland Cleveland, Ohio

John P. Burke
Mathew Kalady
Consultant Colorectal Surgeon
Department of Colorectal Surgery
Beaumont Hospital
Digestive Diseases Institute
Dublin, Ireland
Cleveland Clinic
Manish Chand Cleveland, Ohio
Consultant Colorectal Surgeon
Department of Surgery and Interventional Sciences Miranda Kiernan
University College London Department of Surgery
London, United Kingdom Graduate Entry Medical School
University of Limerick
Eoghan Condon
Limerick, Ireland
Consultant Surgeon
Department of Surgery
University Hospital Limerick Ravi Kiran
University of Limerick Department of Surgery
Limerick, Ireland Columbia University Medical Center
Mailman School of Public Health
Peter Dockery Center for Innovation and Outcomes Research
Department of Anatomy Division of Colorectal Surgery
School of Medicine New York Presbyterian Hospital-Columbia
National University of Ireland New York, New York
Galway, Ireland

Jonathon Efron Joep Knol

Ravitch Division of GI Surgery Consultant General and Colorectal Surgeon
Department of Surgery Jessa Hospital
The Mark M Ravitch Professor of Surgery and Urology Hasselt, Belgium
Johns Hopkins University
Baltimore, Maryland
Ian Lavery
Bill Heald Department of Colorectal Surgery
Pelican Cancer Foundation Digestive Diseases Institute
Basingstoke Hospital Cleveland Clinic
Basingstoke, United Kingdom Cleveland, Ohio

xiii
xiv Acknowledgments

Jeremy Lipman Jonathon Roddy

Associate Professor of Surgery Department of Surgery
Cleveland Clinic Lerner College of Medicine University of Limerick Hospitals Group
Case Western Reserve University University Hospital Limerick
Staff Colorectal Surgeon Limerick, Ireland
Cleveland Clinic Foundation
Cleveland, Ohio
Shaheel M. Sahebally
Deirdre McGrath Department of Surgery
4i Centre for Interventions in Inflammation, Infection and University of Limerick Hospitals Group
Immunity University Hospital Limerick
Graduate Entry Medical School Limerick, Ireland
University of Limerick
Limerick, Ireland
Martin Shelly
Manus Moloney
Department of Radiology
Department of Gastroentrology
University of Limerick Hospitals Group
University of Limerick Hospitals Group
University Hospital Limerick
University Hospital Limerick
Limerick, Ireland
Limerick, Ireland

Brendan J. Moran
Peritoneal Malignancy Institute Neil J. Smart
Basingstoke Hospital Department of Colorectal Surgery
Basingstoke, United Kingdom University of Exeter Medical School
Royal Devon & Exeter Hospital
James W. Ogilvie Jr. Exeter, United Kingdom
Department of Colorectal Surgery
Spectrum Health/Ferguson Clinic
Michigan State University Mattias Soop
Grand Rapids, Michigan Department of Colorectal Surgery
University of Manchester
D. Peter O’Leary Manchester, United Kingdom
Department of Surgery Salford Royal Hospital
University of Limerick Hospitals Group Salford, United Kingdom
University Hospital Limerick
Limerick, Ireland
David W. Waldron
James O’Riordan
Department of Surgery
Department of General and Colorectal Surgery
University of Limerick Hospitals Group
Tallaght Hospital
University Hospital Limerick
Dublin, Ireland
Limerick, Ireland
Nicola O’Riordan
Department of Surgery
University of Limerick Hospitals Group Leon G. Walsh
University Hospital Limerick University of Limerick Hospitals Group
Limerick, Ireland University Hospital Limerick
Limerick, Ireland
Colin Peirce
Department of Surgery
University Hospitals Limerick Steven D. Wexner
Limerick, Ireland Digestive Disease Center
Department of Colorectal Surgery
Feza Remzi Cleveland Clinic Florida
Professor of Surgery Weston, Florida
Director, Inflammatory Bowel Disease Center Florida Atlantic University College of Medicine
NYU Langone Medical Center Florida International University College of Medicine
New York, New York Miami, Florida
 PART 1

1 History 3
2 Mesenteric and peritoneal anatomy 11
3 Embryologic development of the mesentery, peritoneal reflection, and Toldt’s fascia 41
4 Histology of the mesentery 47
5 Toldt’s fascia 57
6 Mesenteric physiology 69
7 Pathology of the mesentery 85
8 Radiographic appearance of the mesentery and peritoneum 109
9 Operative nomenclature 119
10 Teaching mesenteric principles 137
11 Gastroenterology 147

History
J. CALVIN COFFEY AND NICOLA O’RIORDAN
Introduction
Carl Toldt
Sir Frederick Treves
Limited support for Toldt’s observations
Radiology
Renaissance in focus on the mesentery
Two roads diverged in a wood, and I—
I took the one less travelled by,
And that has made all the difference.
Robert Frost
INTRODUCTION
For centuries, the mesentery and associated peritoneal
lining have been regarded as structurally complex. In 1885,
Sir Frederick Treves provided the fi st comprehensive
description of both, emphasizing that while some mesenteric
regions persisted in adulthood, others regressed and were
lost [1]. For example, the small intestinal mesentery, trans-
verse, and sigmoid mesocolon were consistently identifiable
in adults, while the right and left mesocolon were identifi-
able in a minority only. Treves’ descriptions were welcome
at the time, given the apparent complexity of the topic, and
were subsequently indoctrinated in virtually all anatomic,
embryologic, clinical, and related literature [1–3]. To the
present, the fi st chapter of most reference texts on intestinal
surgery focuses on anatomy and physiology and is based on
Treves’ descriptions. A review of later chapters dealing with
techniques in intestinal removal identifies a remarkable dis-
parity. The right and left mesocolon are invariably present
in the adult and must be resected like any other mesenteric
region. Put simply, intestinal surgery has always relied on
the persistence of all regions of the mesentery.
Numerous factors contributed to the divergence of
anatomic and surgical approaches to the mesentery and
peritoneum. Since the time of Treves’ anatomic-based
research, surgeons focused increasingly on cellular aspects
of disease. With increasing awareness of the molecular basis
1
3 Laparoscopic and robotic surgery: The craft of
3 colorectal surgery 7
4 Anatomic continuity: A simpler principle 8
6 Future directions 8
6 Summary 8
7 References 8
of surgical disease, the emphasis of research shifted away
from the anatomic-based craft component. More recently,
laparoscopic and robotic surgery have increased focus on
the “craft” component of surgery. In keeping with this,
the fi ld of surgical anatomy has increased in relative sig-
nificance and led to the demonstration of continuity of the
mesenteric organ from the small intestinal mesentery to the
mesorectum [4,5]. The following chapter will demonstrate
these shifting trends and clarify the manner in which recent
demonstrations allow a reconciliation of anatomic and sur-
gical approaches to this important organ. This chapter fin-
ishes by demonstrating the opportunities that now occur
across a broad array of clinical and non-clinical sciences.
CARL TOLDT (1840–1920)
Carl Florian Toldt was born on May 3, 1840, in Bruneck,
Austria. After spending much of his childhood repair-
ing clocks, he received his doctorate in 1864 at St. Joseph’s
University in Vienna and was appointed Professor of
Anatomy at the University of Vienna in 1875 (Figure 1.1). He
became Professor of Anatomy at the German university in
Prague. He subsequently returned to Vienna in 1884 to work
with his colleague, Langer, and together they established
the Anatomy Institute of Vienna. Carl Toldt’s best-known
anatomic work was Anatomischer Atlas für Studierende
und Aerzte (An Atlas of Human Anatomy for Students and
Physicians) (Figure 1.2), which was translated into English.
Despite the superb quality of this work, and its anatomic
accuracy, it has been little referenced overall. Toldt died
from pneumonia in Vienna in November 1920 [6–9].
Toldt’s descriptions were based on dissection of fresh
cadavers that had not been exposed to corrosive preservative
3
4 History

agents. He first observed that intestinal mesenteries did not

simply comprise two thin layers of closely apposed cells (i.e.,
the mesothelia) but rather contained vessels, nerves, and fat.
He called the resultant complex of structures the “lamina
mesenteria propria” (Figure 1.3). While Treves described
disappearance of the right and left mesocolon as humans
matured into adults, Toldt maintained they persisted and
attached (i.e., flattened against) to the abdominal wall.
Where they attached, Toldt identifi d a thin seam of con-
nective tissue (Toldt’s fascia) separating mesentery from
abdominal wall, just as two layers of rock might be sepa-
rated by a seam of rock (see Chapter 2). Toldt suggested that
wherever the mesentery attached to the abdominal wall, the
cellular layer lining both (i.e., the mesothelium) underwent
a “gradual disappearance” to “admit contact and fusion of
their connective tissue laminae.” Toldt also suggested that
the outer cellular layer of the intestine, the tunica serosa,
could undergo a similar process and merge with the cov-
ering mesothelium of adjacent mesentery. There is a strik-
ing similarity between current descriptions, and those of
Toldt, and it is remarkable that his work should have been
so infrequently referenced over the past two centuries [6–9].

SIR FREDERICK TREVES

Figure 1.1 Carl Toldt (1840–1920).
Figure 1.2 Cover illustration of Anatomischer Atlas Fur
Studierende und Aertze.
Frederick Treves was born in Dorset, England, in 1853
(Figure 1.4). He received his medical education at the
London School of Medicine and became assistant surgeon
at the London hospital in 1879. In 1883 he was appointed
as surgeon and head of the department of Anatomy. He
famously housed Joseph Merrick, “the Elephant Man,” in his
attic until Merrick died in 1890 [6,10]. Treves was awarded
the Jacksonian prize for dissertations on the pathology,
diagnosis, and treatment of obstruction of the intestine and
numerous Hunterian lectures on the anatomy of the intes-
tinal canal and the peritoneum. He served in the Boer war
in 1899. He was knighted by King Edward VII on whom he
performed an appendectomy in 1902. He was a noted travel
writer and took up final residence in Geneva (Switzerland)
due to poor health. He died of peritonitis in 1923 [6,10,11].
Treves described the human mesentery as fragmented.
Accordingly, the right and left mesocolic components of
the mesentery are, according to Treves, mostly absent in
the adult human. He described the small intestinal, trans-
verse, and sigmoid mesentery as persisting into adulthood
and attaching directly to the abdominal wall (Figure 1.5).
At the time, his descriptions provided a welcome rational-
ization of what was, and still is, regarded as a complex ana-
tomic topic (i.e., mesenteric and peritoneal anatomy in the
adult human). Although some aspects of his descriptions of
the mesentery and peritoneum are now regarded as inaccu-
rate, he was correct in describing a “mesenteric root” at the
origin of the superior mesenteric artery. He was also cor-
rect in describing the mesentery of the appendix as arising
from the undersurface of the mesentery in the right iliac
fossa. Treves’ stunning descriptions were made at a time
when significant advances were occurring in anatomic and
 Sir Frederick Treves 5

Tunica serosa intestini

Tunica Stratum longitudinale
muscularis Stratum circulare
Durchtritt eines Arterienzweiges durch die
Tunica muscularis

Tela subserosa

Tunica serosa mesenterii

Epithelium

Tunica mucosa

Tela submucosa

Lamina mesenterii
propria Fettgewebe
9/
1
Einstrahlung des Bindegewebes der Lamina
mesenterii propria in die Darmwand Venenzweig

Figure 1.3 The mesentery and adjacent intestine is demonstrated. Toldt drew submesothelial connective tissue as well
as a mesenteric connective tissue lattice. He demonstrated a contiguity between these and the connective tissue of the
outer layers of the intestine. (Taken from Carl Toldt’s Anatomischer Atlas Fur Studirende und Aertze.)

Right colonic Left colic

attachment attachment

Figure 1.5 Mesenteric attachments and peritoneal anatomy

Figure 1.4 Sir Frederick Treves (1853–1923).
in the adult human as per Sir Frederick Treves. The mesen-
tery of the small intestine, transverse, and sigmoid colon are
depicted by Treves as having linear attachments to the pos-
terior abdominal wall. The attachment of the right and left
colon is indicated (arrows). These correspond to the regions
where a right or left mesocolon, if present, would be located.
6 History
safe surgery, a factor that is likely to have aided in their
indoctrination in mainstream literature. Not surpris-
ingly, they were adopted comprehensively in most ana-
tomic, embryologic, and surgical texts and to the present
they form the basis of introductory chapters in reference
textbooks. It is remarkable that even today, case reports
continue to emerge describing the presence of a right or
left mesocolon (now known to be correct) as anomalous or
pathologic [1,5,6].
LIMITED SUPPORT FOR TOLDT’S
OBSERVATIONS
Toldt’s findings were supported by the observations of
Broesike (1891), Vecchi (1910), Vogt (1926), and Congdon
(1942) [12]. Gerota (1895) and Southam (1923) described
an “anterior renal fascia” (also referred to as the lat-
eroconal fascia or Gerota’s fascia) as being “fusional in
nature,” thereby touching on Toldt’s concept of adhe-
sion [13,14]. In a review of the topic in 1942, Congdon
noted that only a single reference anatomic text men-
tioned Toldt’s fascia, that is, Poirier and Charpy’s text
of anatomy [15]. Congdon also noted that at that time,
several anatomic texts including that of Waterston,
Last, Cunningham, and Grant omitted the fascia from
contained illustrations. Toldt’s observations received
little if any attention following Congdon’s corroboration
of them. It is not known why this occurred. Reference
in anatomic texts was, and to this day remains, scant.
Although surgical texts can be credited with a little more
emphasis, this has also remained limited [16]. The tide
may be turning however as the most recent edition of ref-
erence anatomic texts such as Gray’s Anatomy acknowl-
edge continuity of the mesentery, as well as the presence
of Toldt’s fascia between mesentery and the retroperito-
neum [4].
‘The mesocolon extends along the entire length
of the colon and is continuous with the small
bowel mesentery proximally and the meso-
rectum distally … Toldt’s fascia lies immediately
posterior to the mesocolon, where it is adherent
to the retroperitoneum of the posterior abdom-
inal wall’ (Culligan et al. 2014).
In the main, Treves’ arguments supporting discon-
tinuity were adopted in general and specialty literature
[5,6]. Mesenteric discontinuity meant that the right and
left mesocolon were, in general, considered absent in the
majority of adult humans. If they were present, then they
were regarded as abnormal or pathologic. In an attempt to
reconcile Treves’ descriptions with theories on the embry-
ologic development of the mesentery, two theories were
developed. These were attempts at explaining mesenteric
regression or obliteration and were called the sliding and
regression theories [17–19].
RADIOLOGY
One of the best ways of appraising living anatomy in its undis-
turbed format is through radiologic imaging. Radiologists
continue to try reconciling the radiologic appearance of
the mesentery and associated peritoneum, with Treves’
descriptions. Not surprisingly, many articles on the topic of
mesenteric and peritoneal radiology open with a statement
asserting the complexity of the fi ld in general [20,21].
As mentioned earlier, and in keeping with other disci-
plines, radiologic appraisals of mesenteric anatomy adhere
to the descriptions of Treves. Earlier radiologic techniques
relied on the injection or consumption of radiopaque con-
trast to outline the intestinal lumen. These provided lim-
ited information on structures outside the intestine, which,
for the most part, had to be inferred. The groundbreaking
development of computerized axial tomography (CT) and
magnetic resonance imaging (MRI) meant that structures
outside the intestinal tract could now be visualized. With
this development, radiologists attempted to reconcile CT
and MRI appearances of the mesentery, with classic ana-
tomic teaching, and difficulty was again encountered.
To address this problem, Oliphant (1982) suggested that
the mesentery was continuous with the retroperitoneum
(Figure 1.6), leading to the concept of the “subperitoneal
space of Oliphant” (Figure 1.6) [22]. In 1986, Dodd indi-
cated that the then current theories of mesenteric anat-
omy could not be correlated with the shapes observed on
CT imaging. He suggested that in order to reconcile both
fi lds (i.e., radiologic and anatomic), the mesentery was
best considered as being entirely extra-retroperitoneal
lt
ghl
gsl
hdl
pcl
dcl
tm
srl
sim
im
Figure 1.6 Schematic illustration demonstrating
Oliphant’s interpretation of the subperitoneal space.
 Laparoscopic and robotic surgery: The craft of colorectal surgery 7
[23]. The theory of Oliphant gained acceptance, while that
of Dodd went largely unnoticed until recently (see the
“Anatomic continuity: a simpler principle” section).
More recently still, Charnsangavej et al. exploited
vascular markings in order to identify mesenteric regions
on abdominal CT [20,21,24]. This approach is practical and
readily adopted, which likely explains its widespread use.
However, the sentiment expressed by Dodd (that the CT
appearance of the mesentery is difficult to correlate with
prevailing anatomic concepts) still holds.
RENAISSANCE IN FOCUS
ON THE MESENTERY
Interest in the mesentery increased with the realization
that when the mesentery associated with the rectum (i.e., the
mesorectum) was fully excised for rectal cancer, the inci-
dence of recurrent cancer decreased signifi antly. The con-
cept was termed “total mesorectal excision.” Although total
mesorectal excision had been conducted worldwide and
for decades, the anatomic basis for its success was a recent
discovery. In 1982, Heald et al. showed that a plane occurs
between the mesorectum and the pelvis and that dissection
in this plane, “the holy plane,” enabled a total mesorectal
excision (Figure 1.7) [25,26]. Th s was a highly signifi ant
anatomic description as it provided surgeons with a fail-
safe anatomic roadmap, which, if adhered to, led to better
outcomes for patients with rectal cancer. Initial uptake of
the anatomic principle was begrudgingly slow, but it has
now gained worldwide acceptance. Surprisingly, Heald and
coworkers did not extrapolate the same anatomic basis to
the remainder of the colon and mesocolon.
Figure 1.7 Professor R.J. (Bill) Heald, OBE, MChir,
FRCS(Ed)(Eng).
LAPAROSCOPIC AND ROBOTIC SURGERY:
THE CRAFT OF COLORECTAL SURGERY
During the 1990s, the development of laparoscopic and
minimally invasive surgery (and subsequently robotic tech-
niques) revolutionized intestinal surgery by providing high
magnifi ation (greater than 20-fold) and high-resolution
anatomic imagery. Just as the principles of laparoscopic
and robotic intestinal surgery emerged, terminologies such
as “mesocolon” and “Toldt’s fascia” were increasingly uti-
lized. For laparoscopic and robotic colorectal surgery to be
safe and repeatedly successful, the surgeon must adhere to a
universally reproducible anatomic roadmap. Unfortunately,
the anatomic basis for laparoscopic and robotic intestinal
surgery was also sketchily developed [5,27]. Th s asser-
tion may be considered as unexpected, given surgeons for
decades practiced technically superb resections in the open
context. It is not surprising, however, when one considers
that descriptions of open, laparoscopic and robotic surgi-
cal techniques are hallmarked by limited reference to the
mesentery, the associated peritoneum and fascia.
A brief illustration of this point is important at this junc-
ture. The mesofascial plane is a key plane throughout colorec-
tal surgery. Access to it is universally gained by division of
the overlying peritoneal reflection. Peritonotomy (i.e., divi-
sion) of the reflection and separation of plane components
are core colorectal activities and are universally required
for colorectal resection. Despite being centrally important,
their anatomic basis has only recently been described.
Focus on the anatomic and surgical importance of the
mesentery increased further when Werner Hohenberger
described superb results for patients undergoing a “com-
plete mesocolic excision” for colon cancer (Figure 1.8) [28].
Figure 1.8 Professor Werner Hohenberger, MD, PhD.
8 History
In his 2009 article, he demonstrated that by applying
anatomic principles, one could achieve an R0 resection
(i.e., clearance of all microscopic disease) in 97% of cases.
Around the same time, West et al. demonstrated the eff cts
of anatomic dissection on colon cancer outcomes. Their
findings suggested that by adopting a strictly anatomic
approach, one could enhance patients’ survival following
surgery for stage three colon cancer [29,30]. These findings
went a considerable distance in demonstrating the associa-
tion between anatomic surgery and better cancer-specific
outcomes.
Remarkably, however, a unifying anatomic principle
that could reconcile anatomic with established surgi-
cal approaches to the colon, rectum, and small bowel
remained elusive.
ANATOMIC CONTINUITY: A SIMPLER
PRINCIPLE
In 2012, a study was performed involving collaboration
between the Department of Surgery in University Hospital
Limerick, Ireland, and the Department of Colorectal Surgery
at the Digestive Diseases Institute at The Cleveland Clinic, in
which the anatomic structure of the small and large intestinal
mesentery was formally clarifi d (Chapter 2) [31]. Crucially,
the authors demonstrated that the small intestinal and colonic
mesenteries are different regions of the same anatomic struc-
ture and that the mesentery itself spans the intestinal tract
from the duodenum to the junction between the rectum and
anus (Figure 1.9). Th s was a considerable departure from
Transverse
Transverse mesocolon
colon
Left mesocolon
Right
mesocolon
Right Sigmoid colon
colon
Rectum
Mesosigmoid
Anorectal
Mesorectum junction
Figure 1.9 (See also QR 1 and 7.) The mesenteric organ.
The illustration is of a model of the mesentery generated
using a 3D printer. Pan-mesenteric continuity is demon-
strated (from the duodenum to the anorectal junction).
the classic depictions as it meant that the mesenteric organ is
a substantive and continuous structure, and not fragmented
or discontinuous as was generally described [32,33].
The newer appraisal was far simpler than the classic
description. Recognition of continuity led to similar obser-
vations on the peritoneal refl ction and Toldt’s fascia. It is
now accepted that Toldt’s fascia is continuous from the origin
of the mesenteric organ (at the superior mesenteric artery)
to its termination at pelvic fl or. Similarly, the peritoneum
is draped in a contiguous manner over intraperitoneal struc-
tures from the root region to the so-called anterior refl ction
in the pelvis [32,33].
FUTURE DIRECTIONS
Anatomic continuity and contiguity of mesentery, fascia,
peritoneal reflection, and gastrointestinal tract has major
implications at numerous levels and across multiple special-
ties (clinical and nonclinical). These form the basis and con-
tent of this book. For the surgeon, continuity and contiguity
mean that the same anatomic technical elements can be uni-
versally used to perform a safe intestinal resection [33]. For
the abdominal radiologist, they enable a clearer understand-
ing of the type and extent of intraperitoneal disease [33].
Perhaps most importantly, identification of continuity and
clarification of anatomy now permits the systematic (i.e., sci-
entific) study of the mesentery and associated structures [33].
SUMMARY
There are numerous incidents in the history of medicine
where an inaccurate understanding of structure was dog-
matically integrated in literature. William Osler wrote that
“the greater the ignorance the greater the dogma.” Recent
clarification of mesenteric structure has presented a far sim-
pler structure than heretofore thought. The following chap-
ters will describe the scientific opportunities that stem from
this clarification. In addition, it will explain the mesenteric
basis of clinical practice.
REFERENCES
1. Treves, F., Lectures on the anatomy of the intesti-
nal canal and peritoneum in man. Br Med J, 1885.
1(1264): 580–583.
2. McConnell, A.A. and T.H. Garratt, Abnormalities
of fixation of the ascending colon: The relation of
symptoms to anatomical findings. Br J Surg, 1923. 10:
532–557.
3. Netter, F.H., Atlas of Human Anatomy. Elsevier
Health Sciences, Philadelphia, PA, 2014, pp. 263–276.
4. Standring, S., Gray’s Anatomy: The Anatomical Basis
of Clinical Practice. Elsevier Health Sciences, London,
U.K., 2015, Chapter 62, pp. 1098–1111, 1124–1160.
5. Coffey, J.C., Surgical anatomy and anatomic
surgery—Clinical and scientific mutualism. Surgeon,
2013. 11(4): 177–182.

6. Sehgal, R. and J.C. Coffey, Historical development of
mesenteric anatomy provides a universally applicable
anatomic paradigm for complete/total mesocolic
excision. Gastroenterol Rep, 2014. 2(4): 245–250.
7. Toldt, C., Bau und wachstumsveranterungen
der gekrose des menschlischen darmkanales.
Denkschrdmathnaturwissensch, 1879. 41: 1–56.
8. Toldt, C., An Atlas of Human Anatomy: For Students
and Physicians, Vol. 6: Primary Source Edition.
BiblioBazaar, 2013.
9. Toldt, C. and A.D. Rosa, An Atlas of Human Anatomy
for Students and Physicians. Macmillan, New York,
1926.
10. Cohen, M.M., Jr., Further diagnostic thoughts about the
Elephant Man. Am J Med Genet, 1988. 29(4): 777–782.
11. Treves, F., Discussion on the subsequent course and
later history of cases of appendicitis after operation.
Med Chir Trans, 1905. 88: 429–610.
12. Congdon, E.D., R. Blumberg, and W. Henry, Fasciae
of fusion and elements of the fused enteric mesenter-
ies in the human adult. Am J Anat, 1942. 70: 251–279.
13. Chesbrough, R.M. et al., Gerota versus Zuckerkandl:
The renal fascia revisited. Radiology, 1989. 173(3):
845–846.
14. Amin, M., A.T. Blandford, and H.C. Polk, Jr., Renal
fascia of Gerota. Urology, 1976. 7(1): 1–3.
15. Poirier, P. and A. Charpy, Traité D’Anatomie Humaine
Publié Sous la Direction de P Poirier et a Charpy.
BiblioBazaar, Charleston, SC, 2010.
16. Goligher, J., Surgery of the Anus Rectum and Colon.
All India Traveller Book Seller, 1992.
17. Moore, K.L., T.V.N. Persaud, and M.G. Torchia, The
Developing Human: Clinically Oriented Embryology.
Elsevier Health Sciences, Philadelphia, PA, 2015,
pp. 210–239.
18. Sadler, T.W., Langman’s Medical Embryology. Wolters
Kluwer Health, Philadelphia, PA, 2011, pp. 208–232.
19. Schoenwolf, G.C. et al., Larsen’s Human Embryology.
Elsevier Health Sciences, Philadelphia, PA, 2014,
pp. 341–374.
20. Charnsangavej, C. et al., CT of the mesocolon.
Part 1. Anatomic considerations. Radiographics,
1993. 13(5): 1035–1045.
21. Charnsangavej, C. et al., CT of the mesocolon.
Part 2. Pathologic considerations. Radiographics,
1993. 13(6): 1309–1322.
References 9
22. Oliphant, M. and A.S. Berne, Computed tomography
of the subperitoneal space: Demonstration of direct
spread of intraabdominal disease. J Comput Assist
Tomogr, 1982. 6(6): 1127–1137.
23. Dodds, W.J. et al., The retroperitoneal spaces revis-
ited. Am J Roentgenol, 1986. 147(6): 1155–1161.
24. Coffey, J.C. et al., An appraisal of the computed
axial tomographic appearance of the human mes-
entery based on mesenteric contiguity from the
duodenojejunal flexure to the mesorectal level.
Eur Radiol, 2016. 26(3): 714–721.
25. Heald, R.J., The “Holy Plane” of rectal surgery.
J R Soc Med, 1988. 81(9): 503–508.
26. Heald, R.J., E.M. Husband, and R.D. Ryall, The
mesorectum in rectal cancer surgery—The clue
to pelvic recurrence? Br J Surg, 1982. 69(10):
613–616.
27. Coffey, J.C. et al., Terminology and nomencla-
ture in colonic surgery: Universal application of
a rule-based approach derived from updates on
mesenteric anatomy. Tech Coloproctol, 2014. 18(9):
789–794.
28. Hohenberger, W. et al., Standardized surgery for
colonic cancer: Complete mesocolic excision and
central ligation—Technical notes and outcome.
Colorectal Dis, 2009. 11(4): 354–364; discussion
364–365.
29. West, N.P. et al., Pathology grading of colon cancer
surgical resection and its association with survival:
A retrospective observational study. Lancet Oncol,
2008. 9(9): 857–865.
30. Coffey, J.C. and P. Dockery, Colorectal cancer:
Surgery for colorectal cancer—Standardization
required. Nat Rev Gastroenterol Hepatol, 2016.
13(5): 256–257.
31. Culligan, K. et al., The mesocolon: A prospective
observational study. Colorectal Dis, 2012. 14(4):
421–428; discussion 428–430.
32. Coffey, J.C. et al., Mesenteric-based surgery exploits
gastrointestinal, peritoneal, mesenteric and fas-
cial continuity from duodenojejunal flexure to the
anorectal junction—A review. Dig Surg, 2015. 32(4):
291–300.
33. Coffey, J.C. and D.P. O’Leary, The mesentery:
Structure, function, and role in disease. Lancet
Gastroenterol Hepatol. 1(3): 238–247.
 2
Mesenteric and peritoneal anatomy

J. CALVIN COFFEY, PETER DOCKERY, BRENDAN J. MORAN, AND BILL HEALD

Aim 11 White line of Toldt 22

Introduction 11 Mesosigmoid 25
Mesenteric anatomy 14 Mesosigmoid: Transverse axis 25
Mesenteric root region 14 Mesosigmoidal angles 25
Mesentery in the right iliac fossa 14 Congenital adhesions 26
Small intestinal mesentery 14 Mesorectum 28
Right mesocolon 16 The peritoneal reflection 28
Adipovascular and avascular mesenteric regions 16 Flexural anatomy 34
Hepatic flexure 17 Duodenojejunal and ileocecal flexures 34
Transverse mesocolon 20 Hepatic flexure 34
Relationship between transverse mesocolon and Splenic flexure 38
greater omentum 20 Colosigmoid and rectosigmoid flexures 38
Middle colic adipovascular pedicle 20 Mesenteric conformation in general 38
Splenic flexure 20 Future directions 38
Left mesocolon 20 Summary 38
Inferior mesenteric adipovascular pedicle 22 References 38

There is pleasure in recognising old things from
a new viewpoint.
Richard Feynman
AIM
The aim of this chapter is to summarize mesenteric and
peritoneal structure in light of recent advancements in
our understanding of both. A second aim is to indicate the
relevance of both to current clinical practice.
INTRODUCTION
The magnification aff rded by endoscopic techniques
coupled with the resolution of modern displays has revolu-
tionized our appraisal of living anatomy. Nevertheless, ref-
erence anatomic and embryologic texts continue to present
classic anatomic descriptions. In keeping with this, classic
descriptions of mesenteric and peritoneal anatomy continue
to dominate reference texts. Sir Frederick Treves compre-
hensively described the human mesentery and peritoneum
in a study spanning 100 cadavers in 1889 (Figure 2.1) [1].
His descriptions were first presented in a series of classic lec-
tures and thereafter integrated in most reference anatomic,
embryologic, surgical, and radiologic texts [1–11]. Treves laid
down his understanding of mesenteric and peritoneal anat-
omy at a time when anatomic descriptions were providing a
formal basis for safe and anatomic surgery (Figure 2.1) [1,9].
Treves correctly described the small intestinal mesentery
as having a “mesenteric root” at the origin of the superior
mesenteric artery. According to his descriptions, the small
intestinal mesentery then fans out from the duodenum to
terminal ileum. At the gastrointestinal margin, the mes-
entery elongates considerably. This contrasts considerably
with the length of the “attachment” to the posterior abdom-
inal wall. As per Treves, the mesenteric attachment extends
across the posterior abdominal wall from duodenojejunal
flexure to ileocecal level. As it does so, it obliquely traverses
the aorta and inferior vena cava (Figure 2.2a and b) [1,12].
Treves described the right and left mesocolon as being
absent in the majority of cases. If an anomalous right or left
mesocolon was present, then this would be seen to attach
in regions corresponding closely to the attachment of the
right or left colon (Figures 2.1 and 2.2a,b). For example, the
attachment of the right mesocolon corresponds to that of

11
12 Mesenteric and peritoneal anatomy

Mesenteric attachments: classic teaching

Attachment
of transverse
mesocolon

Attachment
of right colon
Attachment
of left colon
(i.e., left
mesocolon)

Attachment of
mesosigmoid
Attachment
of small
intestinal
mesentery

Figure 2.1 Schematic demonstrating the attachments of the mesentery as depicted by Treves. The small intestinal
mesentery attaches along a diagonal line crossing the posterior abdominal wall from the fourth part of the duodenum
to the ileocecal junction.

Mesentery and attachments: classic vs. current

Mesenteric attachments:
classic teaching

Mesentery:
classic teaching Transverse
mesocolon

Right
mesocolon

Left
mesocolon
Vestigial
left mesocolon

Mesosigmoid
Mesosigmoidal
attachment

(a) (b)

Figure 2.2 (a) Schematic summarizing Treves’ descriptions of the attachment of the mesentery and mesocolon (red region).
As per Treves, when an anomalous right mesocolon is present, it attaches along a vertical trajectory from the right iliac fossa
to the hepatic flexure. The transverse mesocolon attaches along a horizontal line that traverses the upper part of the abdo-
men. When an anomalous left mesocolon is present, it attaches along a vertically oriented region, while the mesosigmoid
attaches along a v-shaped line. The attachment of the mesorectum was not defined by Treves. (b) 2.5D snapshot from a
3D digital sculpture of the mesocolon (yellow) as depicted by Treves. The small bowel and associated mesentery have been
conceptually removed for clarity. The right and left mesocolon are vestigial or near absent, while the transverse and sigmoid
regions are substantial. The mesorectum is absent. Overall, the mesentery is fragmented and discontinuous. (Continued)
 Introduction 13

Mesenteric attachments:
current teaching

Mesentery:
current teaching Left
mesocolon

Left
Right mesocolic mesocolic
attachment Mesosigmoid
and small bowel
mesenteric
attachment

Mesorectum

Mesosigmoidal
(c) attachment (d)

Figure 2.2 (Continued ) (c) Schematic summarizing the attachment of the mesocolon (yellow region) as described by
Toldt. The right mesocolon is always present and attaches over a broad region on the right side of the posterior abdomi-
nal wall. The left mesocolon is always present and attaches over a similarly broad region on the left side of the abdomen.
The mesosigmoid is a distal continuation of the left mesocolon. (d) (See also QR 1/1.) 2.5D snapshot from a 3D digital
sculpture of the mesocolon (yellow) as it is currently understood. The distal small bowel and associated mesentery have
been retained in the illustration. The right and left mesocolon are substantial and continuous with adjacent regions of mes-
entery. The right mesocolon is continuous with the small intestinal mesentery medially and with the transverse mesocolon
at the hepatic flexure. On the left, the left mesocolon, mesosigmoid, and mesorectum are similarly continuous. Overall,
the mesentery is continuous from root region to the mesorectum.

the right colon, extending along a vertical orientation from
the right iliac fossa to the subhepatic region. The attachment
of the left mesocolon corresponds to that of the left colon,
extending from the subsplenic region to the left iliac fossa
(Figures 2.1 and 2.2a, b) [1]. To the present, many reference
texts continue to describe these regions as the attachments
of the right and left olon or mesocolon [3–5,13,14].
Treves’ description of the transverse and sigmoid meso-
colon was similar to that of the small intestinal mesentery.
He described the transverse mesocolon as being “attached”
along a horizontal trajectory to the upper part of the posterior
abdominal wall (Figure 2.2a and b). He described the meso-
sigmoid as attaching to the posterior abdominal wall in the left
iliac fossa. The attachment followed an inverted V shape, with
the apex of the “V” providing an important landmark overly-
ing the left ureter (where this crosses the bifurcation of the
common iliac artery) (Figure 2.2a and b) [2,4,6,14,15].
The mesosigmoid, transverse mesocolon, and small
intestinal mesentery were described as mobile, while the
right and left mesocolon were described as absent (or vesti-
gial) [4,6,8,9,13,14]. According to this, the mesenteric organ
is fragmented (present in some regions, absent in others).
If this description were correct, then one would expect to
identify start and end points for each mesenteric region.
These were never described, a point that is explained by
their absence in the first place [10].
A question arises as to how Treves’ generated his fi dings.
His descriptions can be explained if one were to conceptu-
ally slice through the posterior region of the abdomen in a
coronal plane, that is, (1) posterior to the right and left colon
and (2) at the level where the small intestinal mesentery
attaches to the posterior abdominal wall (Figures 2.1 and
2.2b). Doing this would generate the impression of a series of
mesenteric insertions for the small intestine, transverse, and
sigmoid mesocolon [10,16,17]. In addition, it would fail to
identify the right and left mesocolon as well as the attached
region of the mesosigmoid and mesorectum.
In 2012, our group refuted the findings of Treves
demonstrating mesenteric continuity from small intes-
tinal mesentery to mesorectal level (Figure 2.2c and d)
[10]. This led to a general overhaul of our understand-
ing of mesenteric anatomy [2]. We found that the small
intestinal mesentery attaches to the posterior abdomi-
nal wall and extends laterally as the right mesocolon
(Figures 2.2c, d, 2.3, 2.4). Along the line of attachment,
a peritoneal reflection extends from the small intestinal
mesentery to the posterior abdominal wall and bridges
the gap between the two. The line along which the small
intestinal mesentery attaches to the posterior abdomi-
nal wall (and continues laterally as the right mesocolon)
extends diagonally from the duodenojejunal junction to
the ileocecal level.
14 Mesenteric and peritoneal anatomy
Peritoneum, mesentery, Mesentery,
fascia, and intestine fascia, and intestine
(a) (b)
Legend
Mesentery Fascia
Figure 2.3 (a) (See also QR 2/1.) 2.5D snapshot from a 3D digital sculpture of the mesentery, associated peritoneal reflec-
tion, and large bowel. Just as the mesentery is contiguous so too is the peritoneal covering and associated large bowel.
(b) Same model as in (a) but with peritoneum removed. (c) Same model as in (b) but with peritoneum and fascia removed.
(d) Same model as in (c) but peritoneum, fascia, and colon removed.
MESENTERIC ANATOMY
Mesenteric root region
The following is a description of mesenteric anatomy as it
is currently understood. Before commencing, it is impor-
tant to define the terms “attachment” and “suspension.”
“Attachment” refers to the flattening of the mesentery
against the posterior abdominal wall so the mesentery
becomes apposed to the retroperitoneum. As will be seen
from the following, the mesentery does not “insert” into
the posterior abdominal wall in any location. “Suspension”
refers to the suspension of the mesentery to the posterior
abdominal wall at vascular points of suspension.
The mesentery fans out from the “root region” where
the superior mesenteric artery suspends it to the posterior
abdominal wall. This was correctly described by Treves [1].
From this point, the mesentery expands, like a Chinese fan.
In some regions, it is mobile while in others it is attached
to (i.e., flattened against) the posterior abdominal wall. The
continuous mesentery spans the intestine from duodenoje-
junal to anorectal junction.
Mesentery in the right iliac fossa
In the right iliac fossa, the mesentery tapers toward an apex
at the ileocecal junction. Th s region of mesentery can be
Mesentery and intestine Mesentery
(c) (d)
Colon Peritoneum
arbitrarily called “the ileocecal mesenteric confluence,”
a term that is descriptively useful (see section “Flexural
anatomy”). A fatty appendage (the mesoappendix) extends
from the under surface of the ileocecal mesenteric confluence
(Figure 2.5a through c). Retromesenteric origin of the meso-
appendix explains how the appendix often occupies a retroce-
cal location (the clinical relevance of this will be expanded
on in Chapter 7) (Figure 2.5a through c). Treves correctly
described the mesoappendix as originating from the under-
surface of the mesentery in the ileocecal region [1,12].
The ileocecal mesenteric confluence is a substantive tissue
mass separated from the retroperitoneum by Toldt’s fascia.
When the abdomen is first entered, the confluence is obscured
from direct view by a peritoneal reflection. This is an extension
of the peritoneal reflection at the base of the small intestinal
mesentery. Regions of the peritoneal reflection are of surgical
and pathobiologic importance, as mobilization of the mesen-
tery requires their division to permit access to surgical planes.
In addition, they act as a mechanical barrier to the spread of
submesenteric disease (see Chapters 6 and 7) [18].
Small intestinal mesentery
Though the base of the small intestinal mesentery (i.e.,
where it continues as the right mesocolon) is short, the intes-
tinal margin of the small intestinal mesentery is approxi-
mately 4 ft in length [10,18]. As a result, the mesentery
 Mesenteric anatomy 15

Small intestinal mesentery and right mesocolon

Small intestional
mesentery

Right
mesocolon

(a) (b)

Small intestinal
Right mesentery
mesocolon

(c)

Ascending colon

Transverse
Right colon
mesocolon

Small
intestional
mesentery

(d) Transverse mesocolon

Figure 2.4 (a) (See also QR 3/1.) 2.5D snapshot of a 3D digital sculpture of the small bowel mesentery and right
mesocolon. The model has been sectioned and the point of view is looking from above downward. The small intestinal
mesentery is continuous with the right mesocolon. (b) (See also QR 4/1.) The model used in (a) has been sectioned
through at the same level, but the point of view now is from below upward. The small intestinal mesentery is continuous
with the right mesocolon. (c) Cadaveric demonstration of continuity between the small bowel mesentery and right
mesocolon. (d) Intraoperative image depicting mesenteric and mesocolic continuity.
16 Mesenteric and peritoneal anatomy

Mesoappendix

Mesoappendix

Small intestinal
mesentery Mesoappendix

Origin of
(a) mesoappendix (b)

Right
mesocolon

Mesoappendix

Small intestinal
(c) mesentery

Figure 2.5 (a) 2.5D snapshot of a 3D digital sculpture of the mesentery at the ileocecal region. The mesoappendix
arises from the undersurface of the mesentery. Given this origin, it is not surprising that the appendix frequently takes
up a retrocecal position. (b) Digital model of mesentery indicating how the mesoappendix arises as an appendage,
from the undersurface of the ileocecal mesenteric confluence. (c) Intraoperative image demonstrating the origin of the
mesoappendix from the ileocecal region of mesentery.

elongates considerably from its base (Figure 2.6). In the
undisturbed abdomen, it is packed in a concertina-like man-
ner and readily adopts this position once returned intraperi-
toneally [10,18]. The disparity in length between the base of
the mesentery and the mesenteric border of the intestinal
tract means that the small intestinal mesentery cannot be
unfolded and flattened out in its entirety (Figure 2.6).
Right mesocolon
In contrast to the small intestinal mesentery, the right
mesocolon has a smaller surface area and volume. It extends
from the base of the small intestinal mesentery to the mes-
enteric border of the right (ascending) colon. The right
mesocolon is a substantive mesenteric region (Figure 2.4)
that is attached to (i.e., flattened against) the posterior
abdominal wall but kept anatomically separate by Toldt’s
fascia (Figures 2.7a,d and 2.8a) [2,10,16]. Although this ana-
tomic arrangement is exploited in safe colorectal surgery,
these concepts have been adopted in one reference text, i.e.
Gray’s Anatomy [2].
Adipovascular and avascular
mesenteric regions
In the region of the ileocolic vessels, increased mesenteric
adiposity creates a near constant adipovascular pedicle
(Figure 2.8b). Similar mesenteric thickening occurs
throughout the mesocolon in association with major ves-
sels such as the right, middle, and left colic vessels and
 Mesenteric anatomy 17

Small intestinal mesentery

Gastrointestinal
mesenteric margin
Region of attachment
(a)

Mesenteric folding
at intestinal margin

Right
mesocolon

Orientation of
the peritoneal reflection

(b)

Figure 2.6 (a) 2.5D snapshot of a 3D digital sculpture of the small bowel and associated mesentery. At the base of the small
bowel mesentery (i.e., where it continues as the right mesocolon) it is short in diagonal extent (dotted line). At the intestinal
margin it elongates extensively in tandem with the small bowel. Together with the associated bowel it is compactly plicated into
a finite intraperitoneal space. (b) (See also QR 1/1.) 2.5D snapshot of a 3D digital sculpture demonstrating continuity between
the small intestinal mesentery and right mesocolon. The small bowel mesentery elongates extensively at its intestinal margin.

also at the inferior mesenteric/superior rectal artery.
Adiposity increases around the marginal artery and thus
along the full longitudinal extent of the intestinal mar-
gin of the mesentery. Between adipovascular pedicles, the
mesentery thins out considerably and in some instances
adipose tissue is absent (except in obese patients). These
are the largely avascular interpedicular regions. They
are of surgical importance as they are regions in which
mesentery can be safely divided with minimal blood loss
(Figure 2.8b) [18–21].
At the intestinal margin of the mesocolon (but not the
small intestinal mesentery), mesenteric fat is similar to that
of appendices epiploicae (Figure 2.9a and b). The latter arise
from the serosa of the colon and are sufficiently turgid as to
permit grasping and retraction using robotic or laparoscopic
instrumentation. In contrast, mesenteric fat is soft, friable,
and easily bleeds (when denuded of overlying peritoneum)
and as a result it is not suitable for direct grasping during
laparoscopic or robotic surgery (if the surgeon wishes to
avoid troublesome bleeding). Importantly, epiploical fat can
be readily diffe entiated from mesenteric fat as it has a lobu-
lar appearance. In contrast, the surface of the mesentery is
smooth and gently contoured.
Hepatic flexure
At the hepatic flexure, the right mesocolon narrows, sep-
arates from the abdominal wall at its intestinal margin,
and continues as the hepatic component of the transverse
mesocolon (Figures 2.7b and 2.10). Thus, the mesenteric
18 Mesenteric and peritoneal anatomy

Mesentery: regional anatomy

Right mesocolon Transverse mesocolon Left mesocolon

(a) (b) (c)

Small bowel
mesentery

Right
mesocolon

(d)

Figure 2.7 (a–c) (See also QR 1/2 and 3.) 2.5D snapshot of a 3D digital sculpture in which adjacent mesocolic regions are
highlighted in yellow. The mesentery is an adipose structure that lacks distinct boundaries between contiguous zones. As
a result, the optimal means of demonstrating zones is through color coding. In each snapshot, nonhighlighted mesentery
is colored gray and the small intestinal mesentery has been removed to highlight the mesocolon. (d) Cadaveric example of
the right mesocolon after it has been fully mobilized intact, from the retroperitoneum.

component of the hepatic flexure is a confluence between
right and transverse mesocolon [18,20].
The mesenteric component of each flexure is best
described in terms of radial and longitudinal axes. The
radial axis of the hepatic flexure extends radially from the
middle colic vascular pedicle to the intestinal margin of
the mesentery. As it does so, the mesentery changes from
attached (to the posterior abdominal wall) to nonattached
and thus mobile (Figure 2.12a). The longitudinal axis
extends longitudinally from the right mesocolon to the
transverse mesocolon. At the right mesocolic pole of the
longitudinal axis, the mesentery is fully attached across its
breadth. At the transverse mesocolic pole of the longitudi-
nal axis, the mesentery is attached centrally but mobile at
the intestinal margin. Thus, the mesenteric component of
the hepatic flexure undergoes considerable conformational
changes. These have implications for surgical mobilization
and resection of the hepatic flexure.
 Mesenteric anatomy 19

Right mesocolon
Small intestional
mesentery

Peritoneal
reflection

White line
of Toldt

Legend

Mesentery

Fascia

Colon

Peritoneum
(a)

Right colic
adipovascular
pedicle

Ileocolic
adipovascular
pedicle

Avascular
interpedicular
(b) regions of mesentery

Figure 2.8 (a) (See also QR 3/1.) 2.5D snapshot of a 3D digital sculpture showing continuity between the small intestinal
mesentery and the right mesocolon (viewed from above). In addition, the fascia that occurs between the right mesocolon
and retroperitoneum (Toldt’s fascia) is apparent. The fascia extends beneath the colon to form the colofascial plane and
stops at the right peritoneal reflection, where it gives rise to the white line of Toldt (circle). The fascia also extends medi-
ally until it stops at the small bowel mesenteric peritoneal reflection. (b) Overview of the right mesocolon demonstrating
adipovascular pedicles and avascular interpedicular areas. Adipose tissue is minimal in the interpedicular regions leading
to their near translucent appearance.
20 Mesenteric and peritoneal anatomy

Appendices epiploicae and mesenteric adiposity

Appendices
Appendices epiploicae
epiploicae
Mesenteric
fat

(a) (b) Mesentery

Figure 2.9 (a) 2.5D snapshot of a 3D digital sculpture demonstrating appendices epiploicae along the surface of the
ascending colon. (b) Intraoperative photograph of appendices draped along the surface of the right colon. They are vari-
able in shape and similar in color to nearby right mesocolon. They can be differentiated from nearby mesentery due to
their lobular appearance.

Transverse mesocolon Middle colic adipovascular pedicle

The transverse mesocolon is best thought of as the struc-
ture generated where the mesenteric components of the
hepatic and splenic flexure converge with the middle colic
vascular pedicle (Figures 2.7b, 2.11, and 2.12). Its radial
axis extends from the origin of the middle colic artery
(i.e., at the superior mesenteric artery) to the intestinal
margin of the mesentery. It changes from attached to
mobile along this axis. Its longitudinal axis extends from
the mesenteric component of the hepatic to the splenic
flexure (Figure 2.12).
As with the small intestinal and sigmoid mesentery, the
transverse mesocolon elongates dramatically at the intesti-
nal margin. In this region, and due to elongation, it folds
back on to itself and adopts a conformation that varies con-
siderably. Although the transverse mesocolon does not have
a formal insertion as depicted in classic anatomic appraisals,
it does converge on the middle colic artery (see Chapter 3)
(Figure 2.12) [18].
Relationship between transverse mesocolon
and greater omentum
The transverse mesocolon and colon overlie the small
intestinal mesentery, and the greater omentum overlies
the upper surface of the transverse mesocolon. Extensive
adhesions occur between the under surface of the greater
omentum and the upper surface of the transverse meso-
colon. As a result, the lesser sac is frequently obliterated
where the transverse mesocolon and greater omentum are
attached. This arrangement has surgical implications but is
also likely to have pathobiologic significance in limiting the
direct spread of intra-abdominal disease [2].
As occurs in the right and left mesocolon, mesenteric fat is
increased around the middle colic artery (the middle colic
adipovascular pedicle) (Figure 2.12). On either side of this
pedicle, the mesentery thins to the point of being translu-
cent in individuals whose body mass index is low (i.e., the
avascular interpedicular regions) [10,18].
Splenic flexure
At the splenic flexure, the transverse mesocolon contin-
ues distally as the left mesocolon (Figure 2.7c). As with
the hepatic flexure, the splenic flexure is best considered
in terms of radial and longitudinal axes. The radial axis
extends radially from the middle colic vascular pedicle to
the intestinal margin. As it does so, the mesentery changes
from attached to the posterior abdominal wall, to nonat-
tached and thus mobile (Figure 2.12b). The longitudinal
axis extends longitudinally from the transverse to the left
mesocolon. At the transverse pole of the longitudinal axis,
the mesentery is attached at middle colic pedicle and mobile
at the intestinal margin. At the left mesocolic pole of the
longitudinal axis, the mesentery is fully attached across its
breadth. Thus, the mesenteric component of the splenic flex-
ure undergoes considerable conformational changes. These
have implications for surgical mobilization and resection of
the splenic flexure [18].
Left mesocolon
The left mesocolon is continuous with the transverse
mesocolon at the splenic flexure. As one follows it dis-
tally, it rapidly expands in the axial plane (from the
 Mesenteric anatomy 21

Mesentery and mesenteric root region

Hepatic flexure

Hepatic
flexure

Legend
Mesentery

(a) (b) Mesenteric root Fascia

Colon
Mesenteric root
Peritoneum

Hepatic Transverse
flexure mesocolon

Hepatic
flexure

Transverse mesocolon Mesenteric root

(c) (d)

Figure 2.10 2.5D snapshots of a 3D digital sculpture showing how the right mesocolon narrows toward the hepatic
flexure. (a) Anterior view. (b) (See also QR 1/4.) Posterior view from above. (c) Posterior view looking from medial to lateral.
(d) Posterior view looking lateral to medial.

flexure). The full extent of the left mesocolon (i.e., from
nonintestinal to intestinal margin) is attached (i.e., flat-
tened against) to the posterior abdominal wall (Figures 2.7
and 2.13a through c). Toldt’s fascia is interposed between
it and the retroperitoneum (Figure 2.13a through c) and
also between the colon and the retroperitoneum (Figure
2.13b). Unlike the transverse mesocolon, the left meso-
colon does not undergo elongation at the intestinal mar-
gin. Distally, the left mesocolon continues as the attached
component of the mesosigmoid [10,18].
22 Mesenteric and peritoneal anatomy

3D printed mesentery and regional anatomy of transverse mesocolon

(a) (b)

(c) (d)

Figure 2.11 (a–d) (See also QR 1/2.) 2.5D snapshot of a 3D printed model of the mesocolon and colon demonstrating
contiguity throughout its length from ileocecal junction to mesorectal level. The transverse mesocolon is colored green to
demonstrate its appearance from different viewpoints.

Inferior mesenteric adipovascular pedicle White line of Toldt

An accumulation of fat around the inferior mesenteric
artery generates the inferior mesenteric adipovascular pedi-
cle. In thin individuals, the left mesocolon cephalad to this
pedicle is near translucent, while the mesocolon distal to the
pedicle is generally thickened due mainly to the presence of
sigmoidal vessels, the left colic, and the superior rectal arter-
ies (Figure 2.14).
The right and left colon, located at the intestinal margins of
the right and left mesocolon, are generally apposed to the
retroperitoneum (Figure 2.15a and b). As with the mesoco-
lon, they are maintained separate from it, by Toldt’s fascia.
The fascia extends under the mesocolon and colon and is
limited by the peritoneal reflection where the white line of
Toldt occurs (Figure 2.15a and b). The white line can be
 Mesenteric anatomy 23

Transverse mesocolon

Mesenteric
component of Middle colic
hepatic flexure adipovascular
pedicle

(a)

Mesenteric
component of
splenic flexure

Translucent
peritoneum,
i.e., region of
translucent zone

(b)

Figure 2.12 (a) (See also QR 1/6-8.) 2.5D snapshot of a 3D digital model in which the mesenteric components of the
(a) hepatic and (b) splenic flexures converge on the middle colic adipovascular pedicle.
24 Mesenteric and peritoneal anatomy

Left mesocolon

Legend
Mesentery

Fascia

Colon

Peritoneum

Left mesocolon

White line
Toldt’s fascia of Toldt

Retroperitoneum

(a)

Descending colon
Peritoneal
reflection

Toldt’s fascia
(b)

Descending
colon

Peritoneal
reflection

Toldt’s fascia Decending

mesocolon

(c)

Figure 2.13 (a) (See also QR 4/2.) 2.5D snapshot of a 3D digital model demonstrating the left mesocolon. (b) Cadaveric image
demonstrating Toldt’s fascia posterior to the colon. This relationship becomes apparent after division of the overlying perito-
neal reflection. (c) Once the colon has been separated from Toldt’s fascia, the mesocolon and underlying fascia are exposed.
 Mesenteric anatomy 25

Mesocolic continuity
Transverse
mesocolon Left mesocolon

Mesosigmoid

Inferior mesenteric
vascular pedicle

Figure 2.14 Cadaveric images of continuous transverse, left mesocolon, and mesosigmoid. Vascular pedicles and avascular
interpedicular areas are apparent. A small window was inadvertently created in the transverse mesocolon.

observed whenever an interface occurs between perito-
neal mesothelium and Toldt’s fascia. For example, it can
be observed beneath the right and left mesocolon. Thus, it
is inaccurate to suggest that it is confined to the right and
left peritoneal reflections. As will be seen in the chapters on
right and left mesocolectomy, the white line represents an
anatomic landmark that may help the surgeon in deciding
where to commence peritonotomy (i.e., peritoneal inci-
sion) (Figures 2.15 and 2.16) [18].
Mesosigmoid
The mesosigmoid is continuous distally with the meso-
rectum and proximally with the left mesocolon. It is best
considered in terms of longitudinal and transverse axes.
The longitudinal axis extends from the left mesocolon to
the mesorectum and spans the attached region of the meso-
sigmoid. The transverse axis extends from the midline
laterally.
Mesosigmoid: Transverse axis
the posterior abdominal wall. In between these junctions,
the sigmoid elongates and leaves the posterior abdomi-
nal wall, taking the mesosigmoid with it. This means that
the transverse axis is attached medially and mobile later-
ally (Figure 2.16a and b) [10,16,20,21]. Where the mobile
component detaches from the posterior abdominal wall a
peritoneal reflection bridges the gap between the two. The
line along which the mesosigmoid detaches has a diagonal
orientation along the left iliac fossa. The associated perito-
neal reflection has a similar orientation and extends from
the junction between the descending and sigmoid colon to
that between the sigmoid colon and rectum (Figure 2.16a
and b) [9,10].
The mobile component of the mesosigmoid fans out in
a manner similar to that of the transverse mesocolon and
small bowel mesentery. In keeping with this property, the
intestinal margin of the mobile component is considerably
longer than the base region at which it is attached [9,10].
This diffe ential in length is exaggerated in some individuals
and predisposes to volvulus formation, where the sigmoid
twists on its mesentery (see Chapter 7).

The transverse axis varies in breadth depending on the Mesosigmoidal angles

level examined. At the junction between the descending
and sigmoid colon, the transverse axis extends from the
midline to the junction laterally and is fully apposed to the
posterior abdominal wall. At the rectosigmoid junction,
the transverse axis is narrow and again fully attached to
At the junction between the descending and the sigmoid
colon, a mesenteric angle occurs, the proximal mesosig-
moidal angle (Figure 2.17). At the junction between the
sigmoid and rectum, a similar mesenteric angle occurs, the
26 Mesenteric and peritoneal anatomy

Left mesocolon, peritoneal reflection, white line of Toldt

White line
of Toldt

White line
of Toldt

Toldt’s fascia
(a)

Legend
Mesentery

Fascia

Colon

Peritoneum

Peritoneal
reflection

White line
of Toldt

Left mesocolon
(b) Toldt’s fascia

Figure 2.15 (a) (See also QR 6/5.) 2.5D snapshot of a 3D digital model demonstrating the left mesocolon (viewed from
above) and descending colon, sectioned in such a manner as to permit identification of the mesocolon. (b) (See also
QR 6/6.) 2.5D snapshot showing a section through the left mesocolon, viewed from below up. Toldt’s fascia is shown as it
extends from beneath the mesocolon, to beneath the colon, and thereafter to reach the left peritoneal reflection.

distal mesosigmoidal angle. These angles are of surgical and
endoscopic significance (Figure 2.17).
Congenital adhesions
Frequently, the lateral aspect of the mesosigmoid is adher-
ent to the parietal peritoneum of the left iliac fossa across
focal congenital adhesions. While in some individuals
these adhesions are absent, in others they are plentiful
and form a band resembling the peritoneal reflection. It is
this band that surgical trainees (and indeed sometimes
highly experienced colorectal surgeons) can mistake as the
starting point for lateral to medial mobilization of the
mesosigmoid.
 Mesenteric anatomy 27

Mesosigmoid

Sigmoid colon

Attached
mesosigmoid

Mobile
mesosigmoid

Toldt’s fascia
Legend
Mesentery

(a) Fascia

Colon

Mobile Peritoneum
mesosigmoid

Peritoneal
reflection

White line
of Toldt

Peritoneal
reflection
Attached
mesosigmoid
(b)

Figure 2.16 (a) (See also QR 5/1.) 2.5D snapshot of a 3D digital model demonstrating the mesosigmoid viewed from above
down and demonstrating attached and mobile regions. Toldt’s fascia is observed beneath the attached mesosigmoid,
between it and the retroperitoneum. The fascia continues laterally as far as the peritoneal reflection where the attached
region of mesosigmoid continues laterally as the mobile region. (b) (See also QR 6/1.) Same model as in (a) sectioned and
viewed from below up to illustrate the same mesofascial relationships beneath the attached mesosigmoid. The fascia con-
tinues laterally until limited by the lateral peritoneal reflection.
28 Mesenteric and peritoneal anatomy

Sigmoid and associated angles

Distal
mesosigmoid
angle Proximal
mesosigmoid
angle

Figure 2.17 Panel of 2.5 D images presenting sigmoid and rectum from multiple viewpoints. These enable demonstration of
the proximal and distal mesosigmoidal angles. The proximal mesosigmoidal angle occurs at the junction of the descending
and sigmoid colon. The distal mesosigmoidal angle occurs at the junction between the sigmoid and the rectum.

Mesorectum (Figure 2.3). For descriptive purposes, the peritoneal reflec-

The mesorectum is the distal continuation of the mesosigmoid
(Figure 2.18a and b). It encases the upper rectum posteriorly
and laterally. Distal to the anterior refl ction the mesorectum
continues around the anterior rectum to encase this also.
Toldt’s fascia occurs between the mesorectum and surround-
ing structures. Th s relationship holds circumferentially at all
levels and is of considerable clinical relevance (Figure 2.18a
and b). Anteriorly, the fascia is markedly attenuated between
the rectum and prostate (in the case of males) and between
the rectum and the vagina in females (Figure 2.18). Anteriorly,
the complex of mesorectum and fascia is often referred to as
Denonvillier’s fascia. Deep in the pelvis, where the mesorec-
tum tapers toward the anorectal junction, the fascia coalesces
to become more distinct. Several terms are used interchange-
ably for the fascia in this region. They include Waldeyer’s fas-
cia, the retrorectal or presacral fascia (Figure 2.18c and d). In
most individuals, the fascia occupies the interface between the
distal (tapering) mesorectum and surrounding bony pelvis.
However, in some individuals, the fascia is markedly attenu-
ated in this region and an anatomic space arises [10,16,20,21].
THE PERITONEAL REFLECTION
An understanding of the anatomy of the mesentery is essen-
tial in comprehending the associated peritoneal reflection
tion will be subdivided into regions, based on the associated
region of mesentery, and these will be named accordingly.
Although this system greatly aids in the conceptualization
of the reflection, it is not meant to indicate that there are
separate anatomic structures [17,20,21]. Rather, they are dif-
ferent regions of a single, continuous structure.
As mentioned earlier, a peritoneal refl ction occurs where
the small intestinal mesentery attaches to the posterior abdom-
inal wall (the small intestinal peritoneal reflection) (Figure 2.19a
through c). The peritoneal refl ction in this location continues
on the inferolateral aspect of the ileocecal mesenteric conflu-
ence (arbitrarily called the “ileocecal peritoneal refl ction”),
thus obscuring this confluence from direct visualization
(Figure 2.20a and b). The refl ction then continues on to the
lateral aspect of the right colon as the right peritoneal reflection
(Figure 2.21a and b). As with the ileocecal mesenteric conflu-
ence, the right peritoneal refl ction obscures the plane formed
between the right colon and Toldt’s fascia. The right peritoneal
refl ction is often identifiable by the occurrence of a thin white
trace, that is, the white line of Toldt [3,11,16,18].
At the hepatic flexu e, the refl ction continues around the
cephalad aspect of the flexu e, as the hepatocolic refl ction
(Figure 2.22a through c). When this refl ction is surgically
divided via peritonotomy, the interface between the colon
and underlying fascia can be visualized. More medially, the
greater omentum coalesces with the hepatocolic refl ction
 The peritoneal reflection 29

Mesosigmoid, mesorectum and Toldt’s fascia

Mesosigmoid
Mesorectum

Mesosigmoid Legend
Mesentery

Mesorectum Fascia

Colon

Peritoneum
(a) (b)

Sigmoid
colon

Mesorectal
fascia

Denonvillier’s
fascia

Waldeyer’s
fascia
(c) (d)

Figure 2.18 (a) (See also QR 7/1.) 2.5D snapshot of a 3D digital model demonstrating continuity between the mesosig-
moid and mesorectum from a posterior and left-sided viewpoint. (b) (See also QR 7/2.) 2.5D snapshot of a 3D digital
model demonstrating continuity between the mesosigmoid and mesorectum from a posterior and right-sided view-
point. (c) 2.5D snapshot of a 3D digital model demonstrating continuity between the mesosigmoid and mesorectum
with Toldt’s fascia included. (d) 2.5D snapshot of a 3D digital model demonstrating continuity between the mesosig-
moid and mesorectum and fascia included.

making the anatomic arrangement in this location difficult
to defi e. A further refl ction is always evident beneath the
greater omentum bridging the space between this and the
transverse mesocolon [10,11,16,20,21]. Th s has been arbi-
trarily called the omento-colic refl ction.
The cephalad aspect of the splenic flexure is also
obscured from view by the splenocolic reflection. Just as
occurred for the hepatic flexure, coalescence of the greater
omentum with the splenocolic reflection makes it difficult
to diffe entiate anatomic structures at this location
30 Mesenteric and peritoneal anatomy

Small bowel peritoneal reflection

Small bowel
mesentery
Legend
Mesentery

Fascia

Colon Small bowel

peritoneal reflection
Peritoneum (a)

Small bowel
peritoneal reflection

(b) (c)

Figure 2.19 (a) Cadaveric view of the peritoneal reflection at the base of the mesentery and continuing around the ileoce-
cal junction. (b) (See also QR 4/1.) 2.5D snapshot from 3D digital model that has been sectioned through the mesentery
and right mesocolon. This enables demonstration of the peritoneal reflection at the base of the small intestinal mesentery.
The view is from below up. (c) (See also QR 3/1.) Same model as in (b) but with view from above down. The small intestinal
mesentery is continuous with the right mesocolon and at the base of the former, the peritoneal reflection is apparent.
Another random document with
no related content on Scribd:
that the only papers of Oudney’s placed in his hands, were “an
itinerary from Mourzuk to Bornou,” and “An excursion to the
westward of Mourzuk.” The latter is printed at the end of the
“Introductory Chapter;” but of the former, only a few mineralogical
notes are given. There is not a doubt, however, but that a vast mass
of materials illustrative of the districts visited, were collected by Dr.
Oudney, although it is now impossible to say what has become of
them. Mr. Barrow asserts that he was labouring under a pectoral
complaint when he left England; and that the disorder was increased
by this journey to Ghaat, and he would thereby insinuate that, during
the greater part of the time he lived in Africa, he was rendered unfit,
by bodily weakness, for keeping regular journals. Now, none of his
most intimate friends had the least suspicion that he was troubled
with any disease of the breast. His chest, instead of being
contracted, was broad and ample; and, in ascending the hills of his
native land, and the equally difficult common stairs of Edinburgh, the
lightness of his figure, and the activity of his habits, always enabled
him to outrun the longest-winded, and the supplest-jointed of his
companions; and certainly nothing mentioned in the letters which we
have published would lead to the inference that he did not enjoy the
most perfect health till after he had been a considerable length of
time in Bornou. It is likewise quite clear that he was not of a
character to neglect any duty which the situation in which he was
placed imposed upon him; and so we repeat, that a great deal of
valuable information must have been collected by him, although it is
to be feared it is now irrecoverably lost. It is to be regretted,
moreover, that his premature death rendered the term of his service
too short to warrant government to make some provision for his
sisters, now orphans, and one of them in a bad state of health.
 MEMOIR
OF

CAPTAIN HUGH CLAPPERTON,

THE

AFRICAN TRAVELLER.
 MEMOIR
OF

CAPTAIN HUGH CLAPPERTON,

THE

AFRICAN TRAVELLER.

Section I.—INTRODUCTORY REMARKS.

The life of Captain Hugh Clapperton, who died in his second attempt
to explore the interior of Africa, was short, but very eventful. Not only
did he possess a frame and constitution, both of body and mind, well
fitted for a career of active exertion and romantic enterprise; but from
the day of his birth to that of his death, it was his lot to endure, with
almost no interruption, a painful succession of hardships and
privations, or to be engaged in scenes and pursuits of a nature so
perilous as to put existence itself in constant and imminent jeopardy.
And had any record of these things been kept, either by himself or by
any one else, who might chance to know even a tithe of the manifold
dangers to which he was exposed, and the bold, and sometimes
rash enterprises in which he was engaged, a narrative might thence
have been composed, all true to the letter, and yet as full of
wonderful and diversified incident, as well as of fearless and daring
action, as ever flowed from the pen of the most creative genius in
fictitious history—all modified by the child-like simplicity and
generous nobleness of heart, combined with unbending integrity,
unshrinking courage, and indomitable fortitude, in the character of
him, whose fortunes in life they formed, and whose achievements in
the discharge of duty they exhibited. But no such record was kept,
except, while he lived, in our hero’s own retentive memory; and
therefore, now that he is dead, some of the most marvellous
passages of his life must remain in the deep oblivion in which they
have been buried. We are assured by the friends with whom he lived
in the closest intimacy, that when, like Othello, he was questioned
respecting the story of his life from year to year; the battles, sieges,
fortunes, that he had past; he would, with a fine flow of good humour,
and an interesting detail of particulars, run it through even from his
boyish days, down to the time when he was desired to tell it; and
then, like the enamoured Moor, it was his hint to speak of most
disastrous chances,

Of moving accidents by flood or field;

Of hair-breadth ’scapes in the imminent deadly breach;
Of being taken by the insolent foe,
And sold to slavery; of his redemption thence,
With all his travel’s history.

But these narratives of his adventures were given by Clapperton

for the sole end of entertaining his friends when they met for the
mere purpose of social intercourse and convivial enjoyment; and,
therefore, those friends can now give but a very indistinct account of
what “by parcels they had something heard,” without any intention of
detailing it again, unless in the same way and for the same purpose
it had been told to themselves. Hence the early and professional life
of our traveller can never be well known, except that part of it which
he has embodied in the published journals of his expeditions to
Africa. And not only are the incidents of his life during the time he
was a sailor imperfectly known, but even of those parts of it
respecting which we have obtained some vague information, we
have different versions of the same story considerably at variance
with one another; so that, amid their discrepancy, it is difficult to
select the facts and circumstances relative to the life of our hero
which are genuine and free from defect on the one side, and
exaggeration on the other. No memoir of his life has yet appeared at
all worthy of him. We have seen in one periodical an atrocious libel
upon his memory, the emanation evidently of a mean and malignant
spirit. Any newspaper notices of him which have been printed are
meagre in the extreme; and the “Short Sketch” which is prefixed to
the “Journal of his Second Expedition,” and purporting to be the work
of his uncle, a colonel of marines, although the best account of him
which has yet appeared, contains exceedingly little that is really
interesting. Such being the lack of materials, we regret much that we
shall not be able to produce a “Memoir” adequate to the subject; but
we can assure our readers that we have used all diligence to obtain
the most accurate and ample information which can now be had, and
shall therefore proceed to submit it to their candid consideration.

Sect. II.—HIS PARENTAGE AND EARLY MISFORTUNES.

In one of the short notices which have been published of the

traveller’s life, it is stated that the “family of Clapperton is ancient,
and not without celebrity in the north of Scotland. The name,” it is
added, “has been distinguished both in the church and in the field;
and in proof of this we are told that a Bishop Clapperton is buried in
the island called Inchcolm, in the Firth of Forth; while another
individual of the same name is mentioned in the history of Sweden
as having been a field-marshall in the army of that country. We
cannot tell whether the prelate or the soldier is to be regarded as
belonging to the family whence the African traveller was descended;
but it unquestionably was highly respectable, both in point of
antiquity and of its station in society. His grandfather, Robert
Clapperton, was a doctor of medicine, whose professional studies
were pursued by him first at the University of Edinburgh, and
afterwards among the hospitals in Paris. On his return to his own
country he married Miss Elizabeth Campbell, a near relation of
Campbell of Glenlyon, and settled at the town of Lochmaben, in
Dumfries-shire, as a medical practitioner. He is said to have been a
good classical scholar, and much attached to the study of antiquity;
and while he excelled in the tracing of genealogies, in the collecting
of coins and songs, with the view of illustrating border history, he
was highly esteemed as a skilful physician. He had two sons, the
younger of whom chose the army as his profession, and is now a
lieutenant-colonel of marines; but George, the elder of the two,
adopted that of his father; and having previously obtained an
adequate professional education, he settled as a surgeon in the town
of Annan, Dumfries-shire. He was long the only medical practitioner
of repute in that place; and the numerous operations and cures
which he performed proved the means both of increasing his
practice and extending his fame. While still young, he married a
daughter of Johnstone of Thornythwaite, by whom he had fourteen
children, Hugh, who afterwards became the African traveller, being
the tenth. The mother of this numerous family, who is described as
beautiful, amiable and accomplished, died in the thirty-ninth year of
her age, leaving behind her seven sons and a daughter, Hugh being
the youngest of these surviving sons, and consequently a mere
infant. And to enhance the greatness of the bereavement which he
had sustained in the loss of his mother, his father speedily
afterwards married a second wife, whom his friends regarded as a
woman of inferior station to that which he and his family occupied. At
the time when this second marriage took place, most of the sons had
left their father’s house, to engage elsewhere in the active pursuits of
life, and the girl had been taken away by her mother’s relations; but
the subject of this memoir and some of his younger brothers, were
left at home to encounter the stern control of a stepmother—a
species of government at best far from being desirable, but in the
case of the young Clappertons, rendered peculiarly arbitrary and
despotic, from the concurrence of a variety of incidental
circumstances. In the first place, their stepmother, conscious that
she was deemed by the friends of the family an unsuitable match for
their father, must have been haunted incessantly by a feeling, not at
all likely to soothe and sweeten her temper, or fitted to dispose her to
regard the children of the former marriage with any considerable
degree of complacency; by a feeling not likely to lead her to watch
over such of them as were subject to her management with any very
vigilant attention, to make her extremely solicitous about their
comfort or improvement, or to visit them with a treatment any way
marked by kind and tender affection. In the second place, she soon
had children of her own, and these, by degrees, increased, till they
amounted to the number of seven; and it will readily be allowed, that
her own offspring were naturally fitted more strongly to engage her
affections and to engross her solicitude, than those children with
whom she had only an adventitious relationship. And in the third
place, it would appear that Dr. Clapperton himself, the father of the
African traveller, was not by any means so attentive to the interests
of his immense family as he ought to have been; for his brother, the
colonel, says of him, “He might have made a fortune, but
unfortunately he was, like his father, careless of money;” and we
believe the fact cannot be denied; nor, moreover, can it be disguised
that the condition into which he fell in his latter days was owing,
partly at least, to a culpable neglect of his professional duties.[3]
When, therefore, it is considered that as his father advanced in
years, his circumstances in life so much declined, as at last to
reduce him into a state of abject indigence,—while at the same time
his family was constantly increasing in number, and that it was the
melancholy lot of our traveller to lose his mother in his infancy, and
so scarcely ever to have had the happiness to experience the
soothing and heart-impressive influence of maternal tenderness and
maternal care, but, on the contrary, to be placed at that tender age
under the care and control of a stepmother,—it will be abundantly
obvious that his life commenced under the most unpropitious
auspices that can well be imagined.

Sect. III.—HIS BIRTH, EDUCATION, AND YOUTHFUL ADVENTURES.

He was born in the year 1788, and was, as we have seen, soon
after placed under the charge of a stepmother, by whom it is said he
was not only neglected, but treated with harshness and cruelty; and
hence throughout his life stepmothers were regarded by him with a
feeling of unconquerable horror.[4] The accounts which he
occasionally gave his companions of the sufferings of his youth,
arising from the causes which have been specified, were appalling.
In reference to them, an enemy, who, however, seems to have been
in possession of accurate information on the subject, says, that while
a schoolboy, “the climate of Lapland and that of Timbuctoo
alternated several times in the course of a day—a species of
seasoning, or rather case-hardening, that must go far to render him
invulnerable on the sultry banks of the Joliba.” And one of the most
intimate of his friends thus speaks of them in a letter now before us:
“How can the hardships and privations of his early life be touched
upon without hurting the feelings of relatives? These had much
better be buried in oblivion, although they tended to form the man
hardy and self-denying.” When he was a boy, he was nearly
drowned in the Annan; and on that occasion he used to say, that he
felt as if a calm and pleasing sleep was stealing over his senses, and
thought that gay and beautifully painted streamers were attached to
his legs and arms, and that thereby he was buoyed out into the sea;
but he always declared that he experienced no pain until efforts were
making to restore him to a state of animation. At this time he was an
expert swimmer, having been previously taught that useful art by his
brothers; but he had exhausted his strength by continuing too long in
the water. When the alarm of his danger was given by some one to
his father, he hastened to the spot, plunged in, and found his son in
a sitting posture in very deep water.
Among the injuries of his early life, that of a neglected education
was none of the least. He was taught the ordinary acquirements of
reading, writing, and arithmetic, which are generally imparted to the
lowest classes of the Scottish youth; but he was never initiated into a
knowledge of the classic authors of Greece and Rome. Under Mr.
Bryce Downie, however, a celebrated teacher of geometry in the
town of Annan, he acquired a practical knowledge of mathematics,
including navigation and trigonometry, and afterwards, by means of
his own application, he acquired many other branches of useful and
ornamental knowledge, and excelled especially in drawing.[5]
He very early discovered a strong propensity for this latter
accomplishment, so that, with the aid of a few instructions from his
father, who excelled in the knowledge of geography, he could sketch
a map of Europe, while still a child in frocks, with chalk on the floor.
His love of foreign travel and romantic adventure, were likewise very
soon manifested in the delight which he took in listening to his father,
while he pointed out the likely situation of the “North West passage”
to him and his brothers on the globe; in the enthusiasm which he
displayed, when told by his father that he might be the destined
discoverer of that long sought for route from Europe to Eastern Asia;
and also in the avidity with which he devoured books of voyages and
travels of all descriptions whenever they fell in his way.
The circumstance of his entering upon a seafaring life is variously
reported. By one account we are assured that his situation at home
being so unpleasant, he became so thoroughly disgusted with his
father’s house, that he left it clandestinely, and went on board the
first vessel in the harbour of Annan that was willing to receive him.
By his anonymous and unfriendly biographer, it is said that he was
promoted to the rank of an apprentice to a coasting sloop of
Maryport, commanded by Captain John Smith, and that soon
afterwards he was again promoted to the rank of cook’s mate on
board his majesty’s tender in the harbour of Liverpool. His uncle’s
account, in the sketch of his life prefixed to the Journal of his Second
African Expedition, is, that on leaving Mr. Downie, at the age of
thirteen, he was, by his own desire, bound an apprentice to the
owner of a vessel of considerable burden trading between Liverpool
and North America: that after making several voyages in that vessel,
he either left her or was impressed into his Majesty’s service, and
put on board the tender lying at Liverpool. It is clear, from all these
accounts, that Captain Clapperton commenced his naval career as a
common sailor boy—a situation which implies hard duty and rough
usage; yet, as is testified by the following well authenticated
anecdote, this, with all he had previously endured, was unable to
break his spirit, or to subdue the dignified feelings of a noble nature.
As soon as he had joined the trading vessel in which he first sailed,
he was told that one piece of duty which he had to perform on board
was to brush his captain’s boots and shoes. This he positively
refused to do, adding, that he was most willing to take his full share
of the hardest work which belonged to the loading, the unloading, or
the working of the ship; but to the menial drudgery of cleaning boots
and shoes he certainly would not submit. After he had for a short
time served on board several trading vessels, he was impressed into
his Majesty’s service at Liverpool; and in 1806 he was sent to
Gibraltar in a navy transport.[6] The idea, however, of having been
placed on board a man-of-war by force, and retained there as a
prisoner, was so galling to his nature—to a spirit panting and
struggling to be free—that he formed the resolution (one most
difficult to be put in practice) of deserting whenever the opportunity
of doing so should occur: and such was the reckless daring of his
disposition, that, watching the time when he was least observed by
his messmates before the mast, he actually threw himself headlong
overboard, and swam towards a Gibraltar privateer—a vessel of that
class which, during the late war, were usually called rock scorpions
by our sailors. He was taken on board the privateer, and so for a
short time he was the associate of an abandoned and a lawless set
of robbers. But he was soon disgusted with their regardless, savage
and brutal manners, and so embraced the first opportunity of leaving
them, and of going again into the merchant service. While, however,
he was on board the Rock Scorpion, she had sustained an
engagement, in which our hero was severely wounded by a grape-
shot—an accident by which his body was seamed and scarred in a
frightful manner, and which, had it happened to his face or his limbs,
must have rendered him deformed or lame for life.

Sect. IV.—THE MANNER IN WHICH HE WAS PROMOTED TO THE RANK OF

A MIDSHIPMAN IN THE ROYAL NAVY.

After he had left the privateer he was soon discovered, and

brought back to the Renommée frigate as a deserter. It is mentioned
in the “Sketch,” which says nothing of the rock scorpion adventure,
that when Clapperton first joined the Renommée frigate, which was
commanded by Sir Thomas Livingstone, having heard that his uncle,
a captain of marines on board his Majesty’s ship Saturn, which had
arrived at Gibraltar for the purpose of watering and refitting, he sent
him a letter describing his situation on board the Renommée; that his
uncle having previously been a messmate of her captain, Sir
Thomas Livingstone, interfered with him in behalf of his nephew, and
through his interest got him promoted to the rank of a midshipman.[7]
All we can say to this statement is, that Clapperton himself, whose
heart was most grateful, never spoke of a letter he had written to his
uncle, nor that he was in any way indebted to that gentleman for his
promotion in the navy. He seems never to have seen his uncle till he
met him in London after he had engaged to go with Dr. Oudney to
Africa. In a letter to a friend, dated London, 1st September 1821, he
says, “my uncle has been to see me several times, and was truly
kind. He is a perfect gentleman, without any nonsense.” Now, the
correspondent to whom he thus writes, declares that Clapperton
never mentioned to him that he had ever written to his uncle,
soliciting his interest in his favour, or that he was in any respect
indebted to him, in the first instance, for his promotion in the navy.
But while he said nothing to his friend of his uncle in connexion with
this matter, he frequently gave him a most circumstantial and graphic
description of the manner in which this promotion took place. And as
it is in keeping with the rest of the romantic and eventful life of our
hero, and, above all, as it is his own account, we hasten to lay it
before our readers.
When he was apprehended as a deserter, and brought back to his
old birth on board the Renommée, his captain, Sir Thomas
Livingstone, having previously observed that he possessed a
strength of body, a robustness of constitution, and a fearless
daringness of spirit, which might be turned to good account in the
naval service, which, at that time required to be sustained and
strengthened by attaching to it men of such mental and bodily
qualities as these, asked the deserter, if he should pardon his
delinquency, and raise him to the rank of a midshipman, would he
give him his solemn pledge, that he would no more desert, but do his
duty faithfully? Clapperton, with the bold and dauntless air and
bearing of the captive British prince, who “had been the admiration,
the terror of the Romans,” when led in triumph through the streets of
the mighty capital, still “walked the warrior, majestic in his chains,”
replied that he was not yet prepared to give a final and decisive
answer to such a question, and therefore asked time to consider on
what he should determine. “Are you not aware, Sir,” rejoined the
captain, “that I can order you to be flogged as a deserter?” “That I
know you can do, and I expect no less,” was our hero’s reply, “but
still I am unprepared at present to decide on your proposal.” The
result, however, of this extraordinary conversation was, that the
captain ordered him into solitary confinement, with an admonition to
lose no time in coming to a speedy determination as to the course
which he should adopt. In this situation his reflections took a wise
and a prudent turn, and led him quickly to resolve to give his
generous captain the assurance of fidelity which he required of him;
and, on doing so, he was promoted to the rank of a midshipman on
board the Renommée frigate, where he had first served as an
impressed sailor boy, and on the deck of which he had stood in the
capacity of an apprehended deserter. Afterwards, on his own
request, he was allowed to go on shore during a specified period of
time, on his parole of honour. It is very true the account of his
promotion through his uncle’s interference in his behalf accords
better with the ordinary course of things in such proceedings than
that stated above. But we think, that if Clapperton had been aware
that he was indebted to his uncle on this occasion he would not have
concealed the fact from his friends; and likewise we think, that the
disparity of his condition as a common sailor, and that of his uncle as
a captain of marines, would have been sufficient to deter him from
making himself known to his uncle, or asking any thing from him. For
though his feelings of honour sometimes rested on mistaken
principles, they were always very sensitive; and so we are decidedly
of opinion, that in the circumstances of this case he would have felt
equally unwilling to expose his own servile condition to his uncle,
and to compromise his uncle’s dignity by making the captain of
marines appear the near kinsman of the common sailor. We happen
to know a case in point which illustrates this view of the matter.
During the late war, one of the sons of a gentleman in Argyleshire,
absconded from his father’s house, and for a while it was unknown
where he had gone, till he was discovered by one of his brothers, a
captain in the army, as a common sailor on board a man-of-war. The
captain instigated by fraternal affection, was anxious to procure an
interview with his brother, and so sent him a note, informing him
where he was, and expressing his earnest desire that he would
endeavour to meet him on shore. The answer to this kind and
brotherly invitation was an expression of wounded pride. “If,” said the
sailor, “Captain M. has any business to transact with Donald M. let
him come on board H. M. S——— and transact it there.” And we
think Clapperton would have been apt to feel and act nearly in the
same manner in the circumstances in which he and his uncle were
relatively situated on board the Renommée frigate, and the ship
Saturn; though at the same time, it is not unlikely that Sir Thomas
Livingstone having discovered his deserter’s connexion with his old
messmate, was disposed not only to remit his punishment, but
likewise to give him the chance of retrieving his honour and of
benefiting his country. Neither do we think it is the least unlikely that
Sir Thomas and Captain Clapperton may have had mutual
communications respecting our hero, but we can see no reason for
believing that he was in any way made privy to them, but many to
make us believe the contrary. Now raised to the rank of a
midshipman, he performed some hard service on the coast of Spain,
in which he was wounded on the head—a wound which, though it
seemed apparently slight, afterwards gave him much annoyance. He
remained on board the Renommée, and under the command of Sir
Thomas Livingstone, to whom he was so deeply indebted, till the
year 1808, when the frigate was brought to England and paid off.[8]

Sect. V.—HIS SERVICE IN THE EAST INDIES.

When Clapperton left the Renommée frigate, and his generous

captain, Sir Thomas Livingstone, to whom he was indebted for his
first step of promotion in the Royal Navy, he is said to have joined his
Majesty’s ship Venerable, (or, as others say, the San Domingo,)
which then lay in the Downs under the command of Captain King.
But as this was a situation too monotonous and inactive for his
enterprising spirit, he volunteered to go with Captain Briggs, to the
East Indies, in the Clorinde frigate. Though, however, his services
were accepted, he could not obtain his discharge in time to make his
voyage to India in the Clorinde; and so he was deprived of the
pleasure of getting acquainted, in the course of it, with those with
whom he was ultimately to be associated as his messmates. But as
tranships and convoys were frequently sailing from England to the
east, he was ordered by the Admiral to have a passage on board
one of them, and to join Captain Briggs on his arrival in India.
In the course of this outward voyage, he was ordered, during the
raging of a tremendous storm, to go, in an open barge, to the relief of
a vessel in distress. The barge was accordingly manned, but the
mighty rolling of the billows chaffed and vexed with the furious raging
of the tempest, was such, that Clapperton and many others on board
the ship in which he sailed, were of opinion, that it was next to
impossible an open boat could live during the blowing of so heavy a
gale. In this emergency, Clapperton said, that it was not for him to
dispute the orders of his superior officer, but that he was thoroughly
convinced that in doing his duty he must sacrifice his life. Then, in
serious mood and sailor-like fashion, he made his will, bequeathing
any little property he had among his messmates—his kit to one, his
quadrant to another, and his glass and watch to a third—adding, that
in all probability they should never meet again, and requesting them
to keep these articles, trifling as they were, in token of his affection
for them. Then he jumped into the barge, which, in spite of all that
the most skillful seamanship could accomplish, had scarcely left the
side of the ship, when she was upset, and the greater part of her
crew engulfed in the awfully agitated waters. Clapperton, however,
and a few other individuals, still clung to the sides of the floating
wreck; and though their perilous situation was distinctly seen from
the ship, no assistance could be afforded to them, so long as the
tempest continued to rage with so much violence. In the mean time,
Clapperton, while he was careful to preserve his own life, did his
utmost, and more than perhaps any other man would have ventured
to do in like circumstances, to save the lives of his companions in
distress. As they, one by one, lost their hold of the barge, and
dropped off into the sea, he swam after them, picked them up, and
replaced them in their former situation. He was especially anxious to
save the life of a warrant officer, the boatswain of the ship, we
believe. This man he several times rescued when he was on the
point of sinking, and restored him to the barge. By these efforts,
Clapperton’s strength, great as it was, soon became nearly
exhausted, and while with difficulty he was bringing the boatswain
back to take a fresh hold of the boat, and while at the same time he
was crying, “Oh, what will become of my wife and children,”
Clapperton coolly observed, that he had better pay some attention to
his own safety at present, otherwise he must, however reluctantly,
leave him to his fate. This man was drowned, as well as every one
else who had left the ship in the barge, except Clapperton and the
bowman, whom our hero cheered by saying, “Thank heaven neither
you nor I is the Jonah,” intimating, by this marine proverb, that it was
not for the punishment of their bad conduct that the tempest had
been sent; and at the same time advised him to bob, that is, to lay
himself flat, when he saw a wave approaching, so that he might not
be washed off the barge.
Long prior to this signal occurrence, in which our hero showed so
much of the boldness of determined courage, united with the gentle
feelings of compassion, he had become a general favourite both with
the officers and men. His stately form, his noble bearing, his kind,
frank, and manly demeanour, had endeared him to all on board the
ship in which he served. But a man is often the last to know the
sentiments entertained of him by others to whom he is known; and
indeed, seldom knows them at all, unless when they happen to be
revealed to him by accidental circumstances. And hence, as
Clapperton was hoisted on board the ship, in an exhausted state,
after being rescued from the perilous situation in which he had so
long struggled for his life, he had his feelings strongly excited, on
hearing the wives of the Scottish soldiers on board exclaiming,
“Thank heaven, it is na our ain kintryman, the bonny muckle
midshipman that’s drownded after a’!”
It may reasonably be supposed, that the gallantry and humanity
which Clapperton had so conspicuously displayed on this trying
occasion, would tend to deepen the esteem in which he was held by
all on board, and especially that it would be the means of securing
for him the admiration, the affection, and the friendship of many
kindred spirits connected with the navy—a service so long and so
eminently distinguished for firmness of purpose and nobleness of
disposition. Accordingly, when Clapperton arrived in India, and when
his gallantry was made known, he received the greatest attention
from Captain Briggs,[9] during the whole of the time he continued
under his command; and among other friendships which he formed
with officers of his own standing, was one of peculiar intimacy and
tenderness, with Mr. Mackenzie, the youngest son of the late Lord
Seaforth. It happened that this amiable and noble youth became, in
that distant region, the victim of a dangerous disease; and during the
whole of his illness, Clapperton, his newly acquired friend, unless
when the avocations of professional duty called him hence, never left
him; but continued to amuse and nurse him with the affectionate
assiduity of a loving brother, till he was so far recovered as to be
able to resume his public duty. After Mackenzie was in some degree
restored to health, he continued to be depressed in spirits, and in
that state became careless of his person and of every thing else,
thinking, like most hypochondriacs, that death was fast approaching
to deliver him from all his sufferings. When under the influence of
these feelings—afflicted indeed both in mind and body—he was by
no means a desirable companion, and in truth was shunned by most
of the young officers on board the Clorinde. But Clapperton, whose
benevolent heart would not permit him to witness a fellow-creature,
and still less a countryman and a friend an object of unfeeling
neglect, redoubled his attentions to the forlorn youth. He read with
him daily such books of instruction and amusement as either of them
had in their possession, or could procure the perusal of from the
other officers. He endeavoured to inspire him with the sentiments
befitting his rank as the lineal descendant of a noble family, and with
a sense of the duties incumbent upon him as an officer of the British
navy. He talked to him of Scotland, and relations, and home. He
entertained him with amusing anecdotes, of which he possessed an
inexhaustible fund, and by relating to him the numerous vicissitudes
and strange adventures of his own early life. And such was the
happy effect produced upon the health and spirits of his young
friend, that he was able to resume his duty on board the Clorinde,
and to enjoy and return the cordial friendship which he experienced
from Clapperton.
Though we believe, that the officers of the British navy are,
perhaps, more distinguished for simplicity of feeling and openness of
heart, than the men belonging to any other profession whatsoever;
yet, it would appear, that some of the officers of the Clorinde had
given entertainment in their breasts to the green-eyed monster,
Envy. And hence, when they observed the close intimacy which
subsisted between Clapperton and Mackenzie, and the kind
attention which, during his illness, the latter experienced from the
former, they said among themselves, but loud enough to be heard by
Clapperton, “The canny Scotsman knows what he is about, by
attaching himself so closely to a sprig of nobility; he courts his favour
that he may use him as his instrument for obtaining promotion.” The
effect of these injurious whisperings upon the mind of our hero was,
in the first instance, to cause him to make a great sacrifice of feeling
to the injury both of himself and his friend. He withdrew all attention
from Mackenzie, and ceased, not only to keep company with him,
but even to speak to him when they met. Mackenzie, in utter
ignorance as to the cause of the change which had so suddenly
taken place in the conduct of Clapperton towards him, after having
puzzled and perplexed his mind in conjecturing in what way he had
given such deadly offence to his friend, as to make him behave in
the manner he was doing, at last mustered courage, fairly to ask
him, why he had of late treated him with so much coldness and
distance? On this, Clapperton, with his feelings strongly excited,
stated to his friend what had been said among their shipmates, of
the interested motives which had been attributed to him, as the
cause of what they had represented as pretended friendship on his
part. “But,” he added, “my dear Mackenzie, I have been wrong to
punish both myself and you, in listening to these most false and
injurious speeches. And henceforth let the best of them beware how
they use them in future; for the first man whom I detect doing so,
must do it at the risk of his life.” As this hint was pretty publicly
intimated on the part of Clapperton, his friendship for Mackenzie
suffered no interruption afterwards, so long as they served together
in the same ship. But the disease which he had caught returned
upon him again, and after causing him to linger for some time as an
invalid, he was sent to his friends, with little hope of his recovery; nor
indeed had he been long at home, till he died. While, however, he lay
upon his death-bed, he spoke with all the enthusiasm of sincere and
warm friendship, of the kind attentions he had received from
Clapperton when ill and far from home; and entreated his relations,
and especially his mother, to discharge the debt of gratitude which
he owed him, by treating him as a son, in requital of his having, so
long as he had it in his power, treated him as his brother.
 We have not been able to obtain any satisfactory information
respecting the nature of the naval service in which Clapperton was
employed in India, nor of the exploits of seamanship and prowess
which he performed while he was on that station, except in one
instance, which is well worthy of being recorded to his honour. When
we stormed Port Louis, in the Isle of France, he was the first man
who advanced into the breach; and it was he who pulled down the
colours of France, and planted those of Britain in their place. And we
know that his conduct was in all respects worthy of the rank which he
had obtained in a manner so unique, and such as entitled him to
expect his turn of promotion in due course. He continued in India
from the early part of 1810 till the latter end of 1813, when he
returned to England. He had not been long at home, when he was
draughted, along with a select number of midshipmen, for the
purpose of being sent to Portsmouth, to be instructed by Angelo, the
famous fencing-master, in the cutlass exercise, with the view of
introducing that mode of defence and attack into the navy. These
young men, when perfected in the art, were distributed through the
fleet, as teachers of the young officers and men. Clapperton, being
an apt pupil, soon excelled in this exercise, and when his
companions were distributed through the fleet as drill-masters, he
was sent to the Asia, the flag ship of Admiral Sir Alexander
Cochrane, then lying at Spithead.

Sect. VI.—HIS SERVICE ON THE LAKES OF CANADA.

While he taught Angelo’s sword-exercise on board the Asia, he

volunteered his services for the lakes of Canada, in the expedition
which was sent to that novel scene of naval enterprise towards the
beginning of the year 1814. In the voyage from England to
Bermuda[10] he continued to act as a drill-master on board the Asia;
and though, as yet, he had obtained no higher rank than that of
midshipman, such was the respect in which he was held, and the
deference paid to him, that in most respects he was treated as if he
had been a lieutenant. He was now a tall and handsome young man,
with great breadth of chest and expansion of shoulders, and
possessing withal a mild temper and the kindest dispositions. Along
with his other duties he drilled the young officers and men on deck,
whenever the weather permitted, and when amusement was the
order of the day, he was the life and soul of the crew; he was an
excellent table companion, he could tell humourous tales, and his
conversation was extremely amusing; he painted scenes for the
ship’s theatricals, sketched views, drew caricatures, and so he was
much beloved and respected by all, to whose amusement he so
largely contributed.
The following incident affords a striking proof of the almost
invincible hardiness of his constitution, for which he was indebted
partly to the bounty of nature, and partly to the privations and habits
of his early life. Having bidden adieu to the flag ship, on which he
had acted so conspicuous a part, and taken his passage to Halifax,
with the view of thence proceeding to the lakes, he was sent along
with others to perform some service on the horrid coast of Labrador,
and being there cast away while in a long boat, all the individuals
who were along with him at the time were so severely frost bitten
that some of them died, and the rest were lame for life, while he
escaped with only losing the power of the first joint of his left hand
thumb, which ever after continued crooked, and on that account
used to be called “Hooky,” both by himself and his friends.
He was sent, along with a party of five hundred men, from Halifax
to join Sir James Yeo, who, at that time, had the command upon the
Lakes. As this journey was performed in winter, when the river St.
Lawrence is frozen over, and of course when the water
communication is suspended, it was both tedious and toilsome. The
men marched on foot, first to Quebec, and then to the lakes, while
the baggage was dragged after them in sleighs. Soon after his arrival
on the lakes, he and a small party of men were appointed to defend
a blockhouse on the coast of Lake Ontario; but he had not been long
in this situation when the blockhouse, which had only one small gun
for its defence, was attacked by a superior American force, by which
it was speedily demolished; and when Clapperton and his men were
left no other alternative but to become prisoners of war, or to cross
the ice to York, the capital of Upper Canada, a distance of sixty or
seventy miles. Frightful as the attempt was, in their destitute and
forlorn circumstances, the journey was instantly resolved upon. But
the party had not advanced more than ten or twelve miles, when a
boy, one of the number, lay down on the ice unable to proceed
farther, on account of the cold, and his previous fatigue. The sailors
declared, each in his turn, that they were so benumbed with cold,
and so exhausted by wading through the newly fallen snow, that it
was with difficulty they could support themselves, and so could afford
no assistance to the poor unfortunate boy. On this trying occasion
the strong benevolence of Clapperton’s character was strikingly
manifested. His nature was too generous to suffer him for a moment
to endure the idea of leaving a fellow-creature inevitably to perish
under such appalling circumstances; for as it was snowing at the
time, it was quite evident that the boy would, if left, have been
quickly overwhelmed by the drift. Clapperton, therefore, took the boy
upon his own back, and carried him about eight or nine miles, when
he found that he had relaxed his hold, and on examining the cause,
he was perceived to be in a dying state, and very soon after expired.
The party then proceeded on their journey, and endured very great
sufferings before they could reach York. Their shoes and stockings
were completely worn off their feet; and the want of nourishment had
dreadfully emaciated their bodies, as they had no provisions during
the journey except a bag of meal. According to his uncle’s account, it
was, while he was making generous efforts to save the boy, who fell
a victim to the cold, that Clapperton lost the first joint of his thumb.
His uncle says, “he took the boy upon his back, holding him with his
left hand, and supported himself from slipping with a staff in his
right;” and adds, “that from the long inaction of his left hand in
carrying the boy upon his back, he lost, from the effects of the cold,
his thumb joint.”—This is certainly a very probable account of the
matter, and assigns a cause sufficiently adequate for effecting a
greater bodily injury than the loss of part of a thumb. But, as we have
great confidence in the information which we have received on the
subject, we are inclined to adhere to the account which we have
given above, namely, that Clapperton lost the joint of his thumb on
the coast of Labrador, when his companions in distress lost their
limbs and their lives. It is evident, moreover, that his uncle’s
information on many points was neither very extensive nor very