766 



when it is remembered that the importance of the exact situation of 

 the appendix as regards its insertion into, or its origin from, the 

 caecum has been fully recognised by physicians and surgeons alike. 

 To understand and to appreciate, the nature of the relation of 

 the appendix to caecum, one must be familiar with the types of caeca 

 mentioned by the writer in a previous paper (15) and originally descri- 

 bed by Treves (9). It was owing to a familiarity with Treves' de- 

 scription of these types that the author was enabled to work out the 

 relations of appendix to caecum and thereby put the matter on a 

 firmer basis. 



There are four types of caeca, type three being most constantly 

 met with, in 91 "/o according to Treves and in 94 "/o according to my 

 own statistics. This, the third form of caecum, is described by Treves 

 as follows: 



"In the caecum of the third type, that part of the caput coli 

 that lies to the right side of the anterior band grows quite out of 

 proportion to the part placed to the left side of the band as the parts 

 appear when viewed in situ. Moreover the anterior wall of the caecum 

 becomes more developed than the posterior wall. As a result the 

 true apex of the caecum is turned more and more to the left, until 

 at last, it is placed in close proximity to the ileo-caecal junction and 

 can be only recognised by noting the point of origin of the appendix. 

 The highly developed part to the right of the anterior band becomes 

 so dependent and prominent that it forms a new or false apex to the 

 caecum and it is indeed, to this projection that the anatomical term 

 'apex' is usually applied. Moreover, from the undue development of 

 the anterior wall the root of the apendix (the true apex) is carried 

 towards the posterior aspect of the caput and by these changes the 

 caecum of the third type is produced." 



Such is Treves' description of this — the most constant form of 

 caecum. From it, it will be noticed that the appendix springs from 

 the true apex of the caecum on the postero-internal aspect of the gut 

 and in close proximity to the ileo-caecal junction. This relation of 

 appendix to caecum is, I found, an almost constant one, and it may 

 therefore be said that in over 90% of cases the appendix will be 

 found arising from the postero-internal aspect of the caecum at a 

 point 1,7 cm below the lower border of the ileum just where that 

 viscus enters the large gut. This fact, as the author has pointed out 

 elsewhere (14), is of immense value to the surgeon. The relations of 

 appendix to caecum are then much more constant, and of far more 



