1030 THE DIGESTIVE SYSTEM. | | 
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In the foetus and child, as well as in the adult with the infantile type of czectum, the appendix 
springs from the true apex, not from the inner and posterior aspect. 
Foreign bodies, although reputed to find their way very easily into the appendix, are rarely 
found there after death. On the other hand, concretions or caleuli, formed of mucus, faeces, and 
various salts, are often present (Berry). 
Structure (lig. 697).—The serous coat is complete, and forms a perfect: investment 
for the process. The muscular coat, unlike that of the rest of the large intestine, has a 
continuous and stout laver of longitudinal fibres, which passes at the root of the process into 
the three teenie coli (Fig. 698). The layer of circular fibres is well developed. The 
submucosa is almost entirely occupied by large masses of lymphoid tissue surrounded by 
sinus-like lymph spaces. Owing to the large size of these lymphoid nodules, the areolar 
tissue of the submucosa is compressed against the inner surface of the muscular coat, and 
forms a well-marked fibrous ring, which sends processes at intervals between the lymphoid 
masses towards the mucous membrane. ‘The inner portion of this fibrous ring seems to 
have been generally mistaken for the muscularis mucosee, which latter, as seen in Fig. 
697, lies internal to the chief masses of lymphoid tissue, and not outside it, as figured 
by Testut. These lymphoid nodules, which correspond to solitary glands, have, owing to 
LYMPHOID NODULES 
SA KR pz MESENTERY 
: ROS if 
ee iff 
SSS, ( LONGITUDINAL 
N 
cs Wes MUSCULAR 
AW FIBRES 
\\\ 
: \\ \z\ CIRCULAR 
A \ A) 
t 
/E PERITONEUM 
_SUBMUCOUS 
Fic. 697.—STRUCTURE OF THE VERMIFORM APPENDIX. 
A. From a child two years old. B. From a male, age 56. 
It will be observed that the submucosa is almost entirely occupied by lymphoid nodules and patches. The 
muscularis mucose is very faint, and lies quite close to the bases of Lieberkiihn’s glands. The longi- 
tudinal layer of muscular fibres forms a continuous sheet. 
their great number, been almost completely crushed out of the mucosa (in which they 
chiefly lie in the intestine) into the submucosa. 
The mucous coat corresponds to that of the large intestine in its general characters, 
but the Lieberktihn’s glands are fewer, and irregular in their direction ; the muscularis 
mucose is thin and ill-defined ; it lies just internal to the lymphoid nodules of the sub- 
mucosa, and immediately outside the base of Lieberkiihn’s glands. Some few lymphoid 
nodules lie in the mucous coat also. 
Blood-vessels of the Cecum and Vermiform Appendix (Fig. 696)—These parts are 
supplied with blood by the ileo-cecal artery. This gives off, near the upper angle formed by 
the junction of the ileum with the small intestine—(@) an anterior cecal artery, which passes 
down on the front of the ileo-ceecal junction to the cecum, and breaks up into numerous branches 
for the supply of that part ; (b) a posterior cecal artery, similarly disposed on the back ; and (ec) 
the artery of the appendix. The last-named branch passes down behind the ileum (Fig. 696), then 
enters the mesentery of the appendix, and running along this near its free border, sends off several 
branches across the little mesentery to the appendix, before finally ending in it. The course 
of the artery behind the ileum is said to render it subject to pressure from feecal masses in that 
gut, and thus to predispose to an interference with the supply of the appendix, and morbid 
changes in the process. It has also been said that the appendix receives a small branch from the 
left ovarian artery in the female—a statement which I have been unable to verify. 
The veins correspond to the arteries. The lymphatics pass with the vessels to join a few 
small glands which are found in the mesentery of the appendix at its base, the efferent vessels 
from which join the mesocohe glands behind the ascending colon. 
Czcal Folds and Fossze.—The peritoneum forms in the neighbourhood of the 
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