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1063 
agenesis of the appendix, but with a case in which the usual arrest of 
development did not occur in the appendicular portion of the embryonic 
cecum. 
We have been able to find only one other example in more recent litera- 
ture. Ferguson (3) mentions, without comment, the fact that in his 
series of 200 dissections, congenital absence of the appendix was noted 
once. 
Ellsworth Eliot (2) reported a case operated on for recurring attacks 
of pain over the ileo-cecal region. A fibrous cord, free from smooth 
muscle and surrounded by fat, was the only trace of appendix found. 
Dr. Stafford, of the Civil Hospital, informs me that he and Major E. C. 
Carter had a similar case not very long ago. 
The specimen here described came from an adult, male Filipino dead 
of cholera. There was no abdominal scar, nor were there other deform- 
ities; the peritoneum was free from adhesions; only the lower end of 
the cecum was free, the mesenteric attachment extending nearly to its 
tip and almost up to the point of union of the three longitudinal muscle 
bands. ‘There was no trace of an appendix. The longitudinal bands in 
the specimen united at a point on the posterior, inferior surface of the 
cecum to the mesial side of the axis of the cecum. At this point there 
was a small, papular elevation about 6 millimeters across and about 2 
millimeters high which was the only rudiment of appendix to be found. 
It is to be noted that below the ileo-ceecal junction there was one large 
cecal pouch on the right, or lateral aspect, which was partially subdivided 
into four shallow haustra, and one smaller haustrum on the left, or 
mesial aspect of the cecum. On the lower end of the ileum opposite 
its mesenteric attachment there was a free fold’of mesentery containing 
a little fat, corresponding to the embryonic meso-appendix, or ileo-colic 
fold. This was removed in preparing the specimen and only its attach- 
ment to the ileum is visible in the illustration. On opening the hardened 
specimen, a few circular folds of mucosa were seen surrounding a shallow 
depression corresponding to the orifice of the appendix. Sections show 
that the mucosa has dipped down to occupy this depression. The dip 
in the mucosa can be followed in serial sections as a gland-like tube, 
which runs diagonally through the mucosa of the cecum, bends sharply 
on itself, passes through the submucosa, and ends abruptly after penetrat- 
ing rather less than half way through the circular muscle of the cecum. 
At the point of origin, where its dimensions are greatest, the invagina- 
tion measures 6 millimeters by 3 millimeters, the size decreasing to its 
tip. In structure it consists of a tube of mucous membrane presenting 
many simple glands, having the structure of the crypts of Lieberkiihn, 
and rich in mucous cells. Between the glands are many lymphoid fol- 
licles. Surrounding the mucosa is loose, connective tissue quite abund- 
antly supplied with vessels. Van Gieson stains show that the rudiment 
has no muscle coat. ‘The muscle fibers of the cecum are separated partly 
