1062 
pouch may be sudden, or funnel shaped. The cecum continues to 
enlarge, making the disproportion between it and the appendix more 
and more conspicuous. At or about the time of birth a secondary 
differentiation occurs. The large intestine has up to this time possessed 
a uniform, longitudinal muscle coat like that of the small intestine. At 
this period the longitudinal muscle splits into three longitudinal bundles, 
between which the intestine projects as hernia-like protrusions. The 
transverse constrictions (plicae semilunares caeci et coli) between the 
several haustra represent the position of the larger vessels of the caecum 
and colon. The longitudinal muscle is not separated into bands over 
the appendix, the three longitudinal bands of the cawcum converging 
toward the root of the appendix. 
Complete congenital absence of the appendix is rare; other conditions 
simulating this condition are intussusception of the appendix (1), in- 
clusion of the appendix between peritoneal folds or in scar tissue, and 
obliterating appendicitis. 
Kelly and Hurdon® state that appendices have been described which are very 
short (Huntington, 5 millimeters; Bryant, 6 millimeters, ete.). They consider 
that most writers describing apparent examples of complete absence of the 
appendix are in error and have overlooked an obliterated appendix adherent to 
the cecum. They state that authentic cases have been reported by Huntington 
(two cases), by Zuckerkandl, and by Bryant. The subject is reviewed by Schridde 
(5), who searched the literature of the last hundred years and found only six 
cases which he considered definitely established, and four others which he regarded as 
doubtful. ~The cases cited are: (1) Puchelt; no trace of appendix. (2) I. Gerlach; 
appendix 3 millimeters long. (3) Merling; two doubtful cases. (4) Hunter; no 
trace of appendix on a cecum appearing in an inguinal hernia, (5) Autenrieth; 
hernia containing a cecum with no appendix. (6) Meckel; absence of appendix 
in a woman whose intestines were otherwise normal. (7) Faweett and Blach- 
ford; absence of appendix once in 350 cadavers. 
Schridde’s specimen was obtained from a female infant dead of tuber- 
culosis. There were neither peritoneal adhesions, nor lesions of the 
peritoneum, nor other congenital defects. The appendix was absent. 
The caecum was longer than normal, egg-shaped, free from mensentery, 
completely enveloped in peritoneum, and projected laterally from the 
lower end of the colon. The cacum showed six haustra on the lateral 
aspect. The three longitudinal muscle bundles did not unite, but formed 
a triangle at the lower end of the cecum. After studying the appendix 
in man, monkeys, and lower animals, Schridde concluded that the normal 
cecum should show four lateral haustra, and he believed that the two 
extra haustra present in his case represented the appendix. 
From his review of the literature he concludes that there are hitherto 
no conclusive examples of a total absence of the appendix, as this can not 
definitely be established without counting the haustra of the cecum. 
It seems from Schridde’s description that he was not dealing with 
2 Loc. cit., p. 136. 
a a 
