407 



terial assistance to the surgeon engaged upon an appendicectomy and 

 should enable him to find that organ easily and readily. 



Relations of peritoneum to caecum. 

 Probably no point about the anatomy of the caecum has given 

 rise to so much discussion as this comparatively simple question. 

 Authors have differed upon many points but upon none has that 

 difference of opinion been more diversified than on this particular 

 question. 



The classical authors and modern text-books regard the caecum 

 as an extra-peritoneal organ, but these descriptions are so obviously 

 erroneous that it would be folly to reproduce them. 



Bardeleben (8) was among the first to doubt the classical de- 

 scription of the caecal peritoneum, inasmuch as he stated that "the 

 caecum is usually completely enveloped by peritoneum". 



Rieux (9), writing in 1853, granted the possibility of a caecum 

 completely surrounded by peritoneum, but thought the classical con- 

 ception the rule, and such an instance the exception. 



Engel (10), in 1857, was even more out of date in his views 

 than Rieux, for he states that the peritoneum invests the caecum in- 

 completely and hence the latter cannot undergo any very considerable 

 displacements. 



Luschka (11), some years later, repeated Bardeleben's idea 

 and stated that "as a general rule the caecum is completely invested 

 by peritoneum". In this view he was supported by Langer (12), a 

 year later. 



Treves (1) is even more decided than any of the foregoing 

 authors and distinctly states that "he has never found the posterior 

 surface of the caecum uncovered by peritoneum", and further, "that 

 he has never found it attached by areolar tissue to the iliac fascia". 

 In this view Struthers joins. At a meeting of the Edin- 

 burgh Medico-Chirurgical Society held on 3rd May 1893, Struthers 

 said (13), "that the caecum always had peritoneum all round. He 

 had long been in the habit of pointing out the error of describing 

 the caecum as usually destitute of peritoneal covering behind, an 

 error still to be found in some Standard books on Anatomy, such as 

 Quain's Anatomy". 



Treves' error is easily accounted for, as I hold his definition of 

 the caecum to be a misconception ; while Struthers modified his 

 statement a little later on in the same year, for writing in the Edin- 

 burgh Medical Journal for October 1893, he said, "that cases of ex- 



