767 



practical value, than the uncertain intra-abdominal relations of the 

 appendix previously mentioned. 



6) Relations of Appendix to abdominal Walls. These 

 relations are at best uncertain and not of great practical value. Take 

 for example the well-known and familiar "Mc Burney's Point". It 

 must ever be uncertain as the line is drawn from such a variable 

 spot as the umbilicus. Further, it does not agree with the less known 

 method of Clado (1), who localises the base of the appendix upon 

 the anterior abdominal wall by drawing two lines, one parallel with 

 the outer edge of the right rectus muscle and another between the 

 two anterior superior iliac spines. The point of intersection gives the 

 base of the appendix. Clado's method places that particular spot in 

 the hypogastrium, Mc Burney's in the right ihac fossa. These methods 

 are not then infallible. 



7) Relations of Appendix to Peritoneum. This involves 

 a study of the mesentery of the appendix and with it I do not pro- 

 pose to deal as the meso-appendix falls more naturally to be con- 

 sidered with the other caecal folds and resulting fossae, and may 

 therefore be more fittingly discussed in a future paper. Suffice it to 

 say here, that I am very strongly of opinion, that the appendix is 

 always entirely invested by peritoneum and that it always has a 

 mesentery, any possible exception is probably pathological and in any 

 case is extremely rare. 



8) Obliteration of the Appendix. That obliteration of 

 the lumen of the appendix occurs is, I think, more than fully proved. 

 The generality of authors are agreed that the lumen of the appendix 

 is frequently non-patent either in part or throughout, and that, in the 

 latter case, the appendix becomes transformed into a fibrous cord. 

 To this opinion Clado (1) and Kelynack (4) are exceptions. Clado, 

 while not altogether doubting the possibility of obliterations, says that 

 he has never seen it. Kelynack also doubts whether the condition 

 is of such frequent occurrence as Fitz (16) and others would have 

 us believe. He gives the following figures from 98 cases: 



74 cases: appendix pervious throughout 



21 „ „ „ in part 



2 „ complete obliteration. 



The arithmetical error in this table is Kelynack's not mine nor 

 can I account for it. With the exception of these two authors, most 

 writers agree, and I am fully convinced of the truth of the statement, 

 that after, or about middle age obliteration of the appendix is the 

 rule, not the exception. 



